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diff --git a/old/54599-0.txt b/old/54599-0.txt deleted file mode 100644 index 426df80..0000000 --- a/old/54599-0.txt +++ /dev/null @@ -1,13670 +0,0 @@ -Project Gutenberg's The Case for Birth Control, by Margaret H. Sanger - -This eBook is for the use of anyone anywhere in the United States and most -other parts of the world at no cost and with almost no restrictions -whatsoever. You may copy it, give it away or re-use it under the terms of -the Project Gutenberg License included with this eBook or online at -www.gutenberg.org. If you are not located in the United States, you'll have -to check the laws of the country where you are located before using this ebook. - -Title: The Case for Birth Control - A Supplementary Brief and Statement of Facts - -Author: Margaret H. Sanger - -Contributor: Johnah J. Goldstein - -Release Date: April 24, 2017 [EBook #54599] - -Language: English - -Character set encoding: UTF-8 - -*** START OF THIS PROJECT GUTENBERG EBOOK THE CASE FOR BIRTH CONTROL *** - - - - -Produced by Richard Tonsing and the Online Distributed -Proofreading Team at http://www.pgdp.net (This file was -produced from images generously made available by The -Internet Archive) - - - - - - - - - - The Case For Birth Control - A Supplementary Brief and Statement of Facts - - PREPARED BY - MARGARET H. SANGER - - To Aid the Court in its Consideration of the Statute designed to prevent - the dissemination of information for Preventing Conception - - PUBLISHED, MAY 1917 - -[Illustration] - - JONAH J. GOLDSTEIN - COUNSEL - - - - - Copyright by - MARGARET H. SANGER - 1917 - - - - - CONTENTS - - - CHAPTER I. INTRODUCTORY 4 - Introductions to Birth Control by Margaret H. Sanger, - Havelock Ellis, August Forel and G. F. Lydston. - - - CHAPTER II. THE ORIGIN AND PRACTICE OF BIRTH CONTROL IN VARIOUS 23 - COUNTRIES - Genesis of Movement, - England, - Holland, - France, - United States, - Other Countries. - - - CHAPTER III. POPULATION AND BIRTH RATE 43 - Birth Control, by Havelock Ellis, - Population Facts in United States, - Birth Rate of British Empire, - Birth Rate of Other Countries (With Tables). - - - CHAPTER IV. INFANT MORTALITY 93 - General Statistics, - Results of Children’s Bureau Survey at Johnstown, Pa., by Emma - Duke, - Manchester Report. - - - CHAPTER V. MATERNAL MORTALITY AND DISEASES AFFECTED BY PREGNANCY 155 - Children’s Bureau Report, by Grace L. Meigs, - Death Rates from Child Birth in Foreign Countries, - A Municipal Birth Control Clinic, - Tuberculosis, - Kidney Diseases, - Eclampsia, - Diabetes, - Pelvic Deformities, - Heart Disease, - Too Frequent Pregnancies, - Pernicious Vomiting. - - - CHAPTER VI. HARMFUL METHODS PRACTICED TO AVOID LARGE FAMILIES 185 - Coitus Interruptus, - Continence, - The Objects of Marriage, by Havelock Ellis, - Abortion. - - - CHAPTER VII. PROSTITUTION, FEEBLE-MINDEDNESS AND VENEREAL DISEASES 197 - The Social Evil, - Feeble-mindedness, - Syphilis, - Gonorrhea. - - - CHAPTER VIII. OTHER TRANSMISSIBLE DISEASES AND PAUPERISM 223 - Insanity, - Epilepsy, - Alcoholism, - Pauperism, - Child Labor. - - - CHAPTER IX. CONCLUSION: EMINENT OPINIONS 245 - The Progress of Holland, - Eminent Opinions - - - GLOSSARY 250 - - - - - FOREWORD - - -The purpose of the Appellant in presenting the various statistics and -medical and social facts incorporated in the supplementary brief, -entitled THE CASE FOR BIRTH CONTROL, is to give the Court a clear -conception of the meaning of birth control. The historical stages -through which this question has gone have been reviewed, its status in -foreign countries outlined. Finally, the effects upon the commonwealth -of the prohibition contained in the Section known as 1142 of the Penal -Law have been made clear. Said Section comprises in its prohibition the -very points of knowledge most necessary to human liberty, and has -resulted in extreme harm to the individual, to the family and to society -at large. - -The idea of the social and racial value of knowledge to prevent -conception is new in the United States, and therefore it has been -difficult to get first-hand facts and comprehensive statistics with a -local bearing. Consequently, the Appellant has been obliged to lay -emphasis upon data from foreign countries where the subject has been -exhaustively studied, both theoretically and practically. However, the -American case for birth control, as presented in this compilation, is -the most complete possible in view of the records available. - - MARGARET H. SANGER - - - - - CHAPTER I. - INTRODUCTORY - - -_The material in this general introduction to the question of the -prevention of conception comprises an article by Margaret H. Sanger and -extracts from the works of Havelock Ellis, August Forel and G. F. -Lydston, M.D. The last three are eminent authorities, whose opinions are -selected as being the clearest exposition of the social philosophy—Birth -Control._ - - - NOTE: All the notations of pages and tables refer to original - documents and not to the present volume. - - - CHAPTER I - _THE CASE FOR BIRTH CONTROL_ - - BY MARGARET H. SANGER - -(_The following is the case for birth control, as I found it during my -fourteen years’ experience as a trained nurse in New York City and -vicinity. It appeared as a special article in “Physical Culture,” April, -1917, and has been delivered by me as a lecture throughout the United -States. It is a brief summary of facts and conditions, as they exist in -this country._) - -For centuries woman has gone forth with man to till the fields, to feed -and clothe the nations. She has sacrificed her life to populate the -earth. She has overdone her labors. She now steps forth and demands that -women shall cease producing in ignorance. To do this she must have -knowledge to control birth. This is the first immediate step she must -take toward the goal of her freedom. - -Those who are opposed to this are simply those who do not know. Any one -who like myself has worked among the people and found on one hand an -ever-increasing population with its ever-increasing misery, poverty and -ignorance, and on the other hand a stationary or decreasing population -with its increasing wealth and higher standards of living, greater -freedom, joy and happiness, cannot doubt that birth control is the -livest issue of the day and one on which depends the future welfare of -the race. - -Before I attempt to refute the arguments against birth control, I should -like to tell you something of the conditions I met with as a trained -nurse and of the experience that convinced me of its necessity and led -me to jeopardize my liberty in order to place this information in the -hands of the women who need it. - -My first clear impression of life was that large families and poverty -went hand in hand. I was born and brought up in a glass factory town in -the western part of New York State. I was one of eleven children—so I -had some personal experience of the struggles and hardships a large -family endures. - -When I was seventeen years old my mother died from overwork and the -strain of too frequent child bearing. I was left to care for the younger -children and share the burdens of all. When I was old enough I entered a -hospital to take up the profession of nursing. - -In the hospital I found that seventy-five per cent. of the diseases of -men and women are the result of ignorance of their sex functions. I -found that every department of life was open to investigation and -discussion except that shaded valley of sex. The explorer, scientist, -inventor, may go forth in their various fields for investigation and -return to lay the fruits of their discoveries at the feet of society. -But woe to him who dares explore that forbidden realm of sex. No matter -how pure the motive, no matter what miseries he sought to remove, -slanders, persecutions and jail await him who dares bear the light of -knowledge into that cave of darkness. - -So great was the ignorance of the women and girls I met concerning their -own bodies that I decided to specialize in woman’s diseases and took up -gynecological and obstetrical nursing. - -A few years of this work brought me to a shocking discovery—that -knowledge of the methods of controlling birth was accessible to the -women of wealth while the working women were deliberately kept in -ignorance of this knowledge! - -I found that the women of the working class were as anxious to obtain -this knowledge as their sisters of wealth, but that they were told that -there are laws on the statute books against imparting it to them. And -the medical profession was most religious in obeying these laws when the -patient was a poor woman. - -I found that the women of the working class had emphatic views on the -crime of bringing children into the world to die of hunger. They would -rather risk their lives through abortion than give birth to little ones -they could not feed and care for. - -For the laws against imparting this knowledge force these women into the -hands of the filthiest midwives and the quack abortionists—unless they -bear unwanted children—with the consequence that the deaths from -abortions are almost wholly among the working-class women. - -No other country in the world has so large a number of abortions nor so -large a number of deaths of women resulting therefrom as the United -States of America. Our law makers close their virtuous eyes. A most -conservative estimate is that there are 250,000 abortions performed in -this country every year. - -How often have I stood at the bedside of a woman in childbirth and seen -the tears flow in gladness and heard the sigh of “Thank God!” when told -that her child was born dead! What can man know of the fear and dread of -unwanted pregnancy? What can man know of the agony of carrying beneath -one’s heart a little life which tells the mother every instant that it -cannot survive? Even were it born alive the chances are that it would -perish within a year. - -Do you know that three hundred thousand babies under one year of age die -in the United States every year from poverty and neglect, while six -hundred thousand parents remain in ignorance of how to prevent three -hundred thousand more babies from coming into the world the next year to -die of poverty and neglect? - -I found from records concerning women of the underworld that eighty-five -per cent. of them come from parents averaging nine living children. And -that fifty per cent. of these are mentally defective. - -We know, too, that among mentally defective parents the birth rate is -four times as great as that of the normal parent. Is this not cause for -alarm? Is it not time for our physicians, social workers and scientists -to face this array of facts and stop quibbling about woman’s morality? I -say this because it is these same people who raise objection to birth -control on the ground that it _may_ cause women to be immoral. - -Solicitude for woman’s morals has ever been the cloak Authority has worn -in its age-long conspiracy to keep woman in bondage. - -When I was in Spain a year ago, I found that the Spanish woman was far -behind her European sisters in readiness or even desire for modern -freedom. Upon investigation as to the cause of this I found that there -are over five thousand villages and towns in Spain with no means of -travel, transportation and communication save donkeys over bridle paths. -I was told that all attempts to build roads and railroads in Spain had -been met with the strongest opposition of the Clergy and the Government -on the ground that roads and railroads would make communication easier -and bring the women of the country into the cities _where they would -meet their downfall_. - -Do we who have roads and railroads think our women are less moral than -the Spanish women? Certainly not. But we in this country are, after all, -just emerging from the fight for a higher education of women which met -with the same objection only a few years ago. - -We know now that education has not done all the dreadful things to women -that its opponents predicted were certain to result. And so shall we -find that knowledge to control birth, which has been in the hands of the -women of wealth for the past twenty-five years, will not tend to lower -woman’s standard of morality. - -Statistics show us that the birth-rate of any given quarter is in ratio -with and to its wealth. And further figures prove that in large cities -the rich districts yield a birth-rate of a third of that of the poor -districts. In Paris for every 1,000 women between the ages of 15 and 50 -the poor districts yield 116 births and the rich districts 34 births. In -Berlin conditions are approximately the same. For every 1,000 women -between the ages of 15 and 50 the poor districts yield 157 births while -the rich yield 47. This applies also to all large cities the world over. - -It can be inferred from these figures that the women of wealth use means -to control birth which is condemned when taught to the poor. But the -menace to our civilization, the problem of the day, is not the -stationary birth-rate among the upper classes so much as the tremendous -increase among the poor and diseased population of this country.... - -Is woman’s health not to be considered? Is she to remain a producing -machine? Is she to have time to think, to study, to care for herself? -Man cannot travel to his goal alone. And until woman has knowledge to -control birth she cannot get the time to think and develop. Until she -has the time to think, neither the suffrage question nor the social -question nor the labor question will interest her, and she will remain -the drudge that she is and her husband the slave that he is just as long -as they continue to supply the market with cheap labor. - -Let me ask you: Has the State any more right to ravish a woman against -her will by keeping her in ignorance than a man has through brute force? -Has the State a better right to decide when she shall bear offspring? - -Picture a woman with five or six little ones living on the average -working man’s wage of ten dollars a week. The mother is broken in health -and spirit, a worn out shadow of the woman she once was. Where is the -man or woman who would reproach me for trying to put into this woman’s -hands knowledge that will save her from giving birth to any more babies -doomed to certain poverty and misery and perhaps to disease and death. - -Am I to be classed as immoral because I advocate small families for the -working class while Mr. Roosevelt can go up and down the length of the -land shouting and urging these women to have large families and is -neither arrested nor molested but considered by all society as highly -moral? - -But I ask you which is the more moral—to urge this class of women to -have only those children she desires and can care for, or to delude her -into breeding thoughtlessly. Which is America’s definition of morality? - -You will agree with me that a woman should be free. - -Yet no adult woman who is ignorant of the means to prevent conception -can call herself free. - -No woman can call herself free who cannot choose the time to be a mother -or not as she sees fit. This should be woman’s first demand. - -Our present laws force woman into one of two ways: Celibacy, with its -nervous results, or abortion. All modern physicians testify that both -these conditions are harmful; that celibacy is the cause of many nervous -complaints, while abortion is a disgrace to a civilized community. -Physicians claim that early marriage with knowledge to control birth -would do away with both. For this would enable two young people to live -and work together until such time as they could care for a family. I -found that young people desire early marriage, and would marry early -were it not for the dread of a large family to support. Why will not -society countenance and advance this idea? Because it is still afraid of -the untried and the unknown. - -I saw that fortunes were being spent in establishing baby nurseries, -where new babies are brought and cared for while the mothers toil in -sweatshops during the day. I saw that society with its well-intentioned -palliatives was in this respect like the quack, who cures a cancer by -burning off the top while the deadly disease continues to spread -underneath. I never felt this more strongly than I did three years ago, -after the death of the patient in my last nursing case. - -This patient was the wife of a struggling working man—the mother of -three children—who was suffering from the results of a self-attempted -abortion. I found her in a very serious condition, and for three weeks -both the attending physician and myself labored night and day to bring -her out of the Valley of the Shadow of Death. We finally succeeded in -restoring her to her family. - -I remember well the day I was leaving. The physician, too, was making -his last call. As the doctor put out his hand to say “Good-bye,” I saw -the patient had something to say to him, but was shy and timid about -saying it. I started to leave the room, but she called me back and said: - -“Please don’t go. How can both of you leave me without telling me what I -can do to avoid another illness such as I have just passed through?” - -I was interested to hear what the answer of the physician would be, and -I went back and sat down beside her in expectation of hearing a -sympathetic reply. To my amazement, he answered her with a joking sneer. -We came away. - -Three months later, I was aroused from my sleep one midnight. A -telephone call from the husband of the same woman requested me to come -immediately as she was dangerously ill. I arrived to find her beyond -relief. Another conception had forced her into the hands of a cheap -abortionist, and she died at four o’clock the same morning, leaving -behind her three small children and a frantic husband. - -I returned home as the sun was coming over the roofs of the Human -Bee-Hive, and I realized how futile my efforts and my work had been. I, -too, like the philanthropists and social workers, had been dealing with -the symptoms rather than the disease. I threw my nursing bag into the -corner and announced to my family that I would never take another case -until I had made it possible for working women in America to have -knowledge of birth control. - -I found, to my utter surprise, that there was very little scientific -information on the question available in America. Although nearly every -country in Europe had this knowledge, we were the only civilized people -in the world whose postal laws forbade it. - -The tyranny of the censorship of the post office is the greatest menace -to liberty in the United States to-day. The post office was never -intended to be a moral or ethical institution. It was intended to be -mechanically efficient; certainly not to pass upon the opinions in the -matter it conveys. If we concede this power to this institution, which -is only a public service, we might just as well give to the street car -companies and railroads the right to refuse to carry passengers whose -ideas they do not like. - -I will not take up the story of the publication of “The Woman Rebel.” -You know how I began to publish it, how it was confiscated and -suppressed by the post office authorities, how I was indicted and -arrested for bringing it out, and how the case was postponed time and -time again and finally dismissed by Judge Clayton in the Federal Court. - -These, and many more obstacles and difficulties were put in the path of -this philosophy and this work to suppress it if possible and discredit -it in any case. - -My work has been to arouse interest in the subject of birth control in -America, and in this, I feel that I have been successful. The work now -before us is to crystallize and to organize this interest into action, -not only for the repeal of the laws but for the establishment of free -clinics in every large center of population in the country where -scientific, individual information may be given every adult person who -comes to ask it. - -In Holland there are fifty-two clinics with nurses in charge, and the -medical profession has practically handed the work over to nurses. In -these clinics, which are mainly in the industrial and agricultural -districts, any woman who is married or old enough to be married, can -come for information and be instructed in the care and hygiene of her -body. - -These clinics have been established for thirty years in Holland, and the -result has been that the general death-rate of Holland has fallen to the -lowest of any country in Europe. Also, the infant mortality of Amsterdam -and The Hague is found to be the lowest of any city in the world. -Holland proves that the practice of birth control leads to race -improvement; her increase of population has accelerated as the -death-rate has fallen. - -In England, France, Scandinavia, and Germany, information regarding -birth control is also freely disseminated, but the establishment of -clinics in these countries is not so well organized as it is in Holland, -with the consequence that the upper and middle classes, as in this -country, have ready access to this knowledge, while the poor continue to -multiply because of their lack of it. This leads, especially in France, -to a high infant mortality, which, rather than a low birth-rate, is the -real cause of her decreasing population. - -We in America should learn a lesson from this, and I would urge -immediate group action to form clinics at once. We have in this country -a splendid foundation in our hospital system and settlement work. The -American trained nurse is the best equipped and most capable in the -world, which enables us, if we begin work at once, to accomplish as much -in ten years’ time as the European countries have done in thirty years. - -The clinic I established in the Brownsville district of Brooklyn -accomplished at least this: it showed the need and usefulness of such an -agency. - -The free clinic is the solution for our problem. It will enable women to -help themselves, and will have much to do with disposing of this -soul-crushing charity which is at best a mere temporary relief. - -Woman must be protected from incessant childbearing before she can -actively participate in the social life. She must triumph over Nature’s -and Man’s laws which have kept her in bondage. Just as man has triumphed -over Nature by the use of electricity, shipbuilding, bridges, etc., so -must woman triumph over the laws which have made her a childbearing -machine. - - - _RACE REGENERATION. HAVELOCK ELLIS. New Tracts for the Times. Cassell - & Co., Ltd., London, New York, Toronto and Melbourne. 1911._ - -HENRY HAVELOCK ELLIS: L.S.A. Hon. Member Medico-legal Society of New -York. Hon. Fellow of the Chicago Academy of Medicine; Foreign Associate -of the Societe Medico-Historique of Paris, etc.; General Editor of the -Contemporary Science Series (1889); born Croydon, Surrey, 2nd Feb., -1859; belonging on both sides to families connected with the sea; spent -much of childhood on sea, (Pacific, etc.); educated, private schools; -St. Thomas’s Hospital; engaged in teaching in various parts of New South -Wales, 1875–79. Returned to England and qualified as medical man, but -only practiced for a short time, having become absorbed in scientific -and literary work. Edited the Mermaid Series of Old Dramatists, 1887–89. -Publications: The New Spirit, 1890; The Criminal, 1890 (4th edition -revised and enlarged 1910); Man and Woman, a Study of Human Secondary -Sexual Characters, 1894 (5th edition revised and enlarged 1914); Sexual -Inversion, being Vol. II of Studies in the Psychology of Sex, 1897 (3rd -edition revised and enlarged 1915); Affirmations, 1897; The Evolution of -Modesty, etc., being vol. I of the studies in Psychology of Sex, 1899 -(3rd edition revised and enlarged, 1910); The 19th Century; A Dialogue -in Utopia, 1900; A Study of British Genius, 1904; Analysis of the Sexual -Impulse, 1903, (2nd edition revised and enlarged 1913); Sexual Selection -in Man, 1905; Erotic Symbolism, 1906; Sex in Relation to Society, being -vols. 3, 4, 5 and 6 of studies in psychology of sex; The Soul of Spain, -1908; The World of Dreams, 1911; The Task of Social Hygiene, 1912; -Impressions and Comments, 1914; Essays In War Time, 1916. - -When we survey the movement of social reform which has been carried on -during the past one hundred years, we thus see that it is proceeding in -four stages. 1—The effort to clear away the gross filth of our cities, -to improve the dwellings, to introduce sanitation, and to combat -disease. 2—The attempt to attack the problem more thoroughly by -regulating conditions of work, and introducing the elaborate system of -factory legislation. 3—The still more fundamental step of taking in hand -the children who have not yet reached the age of work, nationalizing -education, and ultimately pushing back the care and over-sight of -infants to the moment of birth. 4—Finally, most fundamental step of all, -the effort, which is still only beginning to provide the conditions of -healthy life even before birth. It must be remembered that this movement -in all its four stages is still in active progress among us. It is not -mere ancient history. On the contrary, it is a movement that is -constantly spreading and at every point becoming more thorough, more -harmoniously organized. Before long it will involve a national medical -service, which will impose on doctors as their primary duty, not the -care of disease, but the preservation of health. We have to realize at -the same time that this movement has been exclusively concerned, not -with the improvement of the quality of human life, but exclusively with -the betterment of the conditions under which life is lived. It tacitly -assumed that we have no control over human life and no responsibility -for its production. It accepted human life—however numerous it might be -in quantity, however defective in quality—as a God given fact, which it -would be impious to question. It heroically set itself to the endless -task of cleansing the channels down which this muddy torrent swept. It -never went to the source. Only take care of the soil, these workers at -social reform said in effect, and the seed is no matter. That, as we can -now see, was a silly enough position to take up. P. 26. - -Here we have been spending enormous enthusiasm, labor and money in -improving the conditions of life, with the notion in our heads that we -should thereby be improving life itself, and after 70 years we find no -convincing proof that the quality of our people is one whit better than -it was when for a large part they lived in filth, were ravaged by -disease, bred at random, soaked themselves in alcohol, and took no -thought for the morrow. Our boasted social reform has been a matter of -bricks and mortar—a piling up of hospitals, asylums, prisons and -workhouses—while our comparatively sober habits may be merely a sign of -the quietly valetudinarian way of life imposed on a race no longer -possessing the stamina to withstand excess. - -One of the most obvious tests of our degree of success in social reform -directed to the betterment of social conditions is to be found in the -amount of our pauperism, and the condition of our paupers. If the -amelioration of the conditions of life can effect even a fraction of -what has been expected of it, the results ought to be seen in the -diminution of our pauperism, and the improvement of the condition of our -paupers. Yet so far as numbers are concerned, the vast army of our -paupers has remained fairly constant during the whole period of social -reform, if indeed it has not increased. As to the ineffectiveness of our -methods the Royal Commissioners, especially perhaps in their Minority -Report, have shed much light. It was to be expected that these muddled -methods should be most marked in all that concerns the beginnings of -life, for that is precisely where our whole treatment of social reform -has been most at fault. Children under 16 form nearly one-third of the -paupers relieved. In the United Kingdom the Poor Law authorities have on -their books as outdoor paupers, 50,000 infants under four years of age. -As regards the annual number of births in the Poor Law institutions of -the United Kingdom, there are not even definite statistics available, -but it is estimated in the Minority Report that the number is probably -over 15,000, 30% of these being legitimate children, and 70% -illegitimate. There is no system in the treatment of mothers; and often -not the most elementary care in the treatment of the infants. It is -scarcely surprising that though the general infant mortality is -excessively high, the infant mortality of the workhouse babies is two or -three times as high as that among the general population. And the Royal -Commissioners pathetically ask, “To what is this retrogression due? It -cannot be due to lack of expenditure, or to lack of costly and elaborate -machinery.” No, it certainly is not. It is in large part due, as we are -now just beginning to recognize, to the concentration of our activities -on the mere conditions of life, to our neglect of the betterment of life -itself. We have failed to realize that the whitening of our sepulchres -will not limit the number of corpses placed in those sepulchres. It is -the renewal of the spirit within that is needed, not alone the -improvement of material conditions, but the regeneration of life. If we -wish to realize more in detail the slight extent to which our efforts to -better the conditions of life have raised the quality of life itself, we -have but to turn to the problem of the feebleminded, which during recent -years has attracted so much attention. It is necessary to remember that -this feeblemindedness is largely handed on by heredity. Exact -investigation has now shown that feeblemindedness is inherited to an -enormous extent. Some years ago, Dr. Ashby, speaking from a large -experience, estimated that at least 75% of feebleminded children are -born with an inherited tendency to mental defect. More precise -investigation has shown since that this estimate was under the mark. Dr. -Tredgold, who in England has most carefully studied the heredity of the -feebleminded, found that in over 82% there is a bad nervous inheritance. -Heredity is the chief cause of feeblemindedness, and Tredgold has never -seen a normal child born of two feebleminded parents. The very thorough -investigation of the heredity of the feebleminded which is now being -carried on at the institution for their care at Vineland, N. J., shows -even more decisive results. By making careful pedigrees of the families -to which the inmates at Vineland belong it is seen that in a large -proportion of cases feeblemindedness is handed on from generation to -generation, and is transmissible through three generations, though it -sometimes skips a generation. Not only is feeblemindedness inherited, -and in a much greater degree than has been hitherto suspected, but the -feebleminded tend to have a much larger number of children than normal -people. The average number of children of feebleminded people seems to -be usually about one-third more than in normal families, and is -sometimes very much greater. Page 26–36. - -And it is not only in themselves that the feebleminded are a burden on -the present generation and a menace to future generations. They are seen -to be often a more serious danger when we realize that in large measure -they form the reservoir from which the predatory classes are recruited. -This is for instance the case as regards the fallen. Feebleminded girls -of fairly high grade may often be said to be predestined to immorality -if left to themselves, not because they are vicious, but because they -are weak and have little power of resistance. They cannot properly weigh -their actions against the results of their actions, and even if they are -intelligent enough to do that, they are still too weak to regulate their -actions accordingly. Moreover, even when, as so often happens among the -high grade feebleminded, they are quite able and willing to work, after -they have lost their respectability by having a child, the opportunities -of work become more restricted and they drift into prostitution. -Criminality again is associated with feeblemindedness in the most -intimate way. Not only do criminals tend to belong to large families, -but the families that produce feebleminded offspring also produce -criminals. P. 40. - -Closely related to the great feebleminded class, and from time to time -falling into crime are the inmates of workhouses, tramps and the -unemployable. The so-called able-bodied inmates of our workhouses are -frequently found on medical examination to be more than 50% cases of -mental defectives, equally so whether they are men or women. P. 42. - -We have found that this movement for social reform, while it has been -inevitable and necessary, and is even yet by no means at an end, is not -fulfilling, and cannot fulfil the expectations of those who set it in -motion. It has even had the altogether undesigned and unexpected result -of increasing the burden it was intended to remove. Whatever the exact -action of natural selection may be, as soon as we begin to interfere -with it, and improve the conditions of life by caring for the unfit, -enabling them to survive and to propagate their like, as they will not -fail to do, insofar as they belong to the unfit stocks, then we are -certainly, without intending it, doing our best to lower the level of -life. We increase, or at best retain the unfit, while at the same time -we burden the fit with the task of providing for the unfit. In this way -we deteriorate the general quality of life in the next generation, -except insofar as our improvement of the environment may enable some to -remain fit, who under less favorable conditions would join the unfit. It -is now possible for us to realize how the way lies open to the next -great forward step in social reform. On the one hand the progressive -movement of improvement in the conditions of life, by proceeding -steadily back, as we have seen, to the conditions before birth, renders -the inevitable next step a deliberate controlled life itself. On the -other hand, the new social feeling which has been generated by the task -of improving the conditions of life, and of caring for those who are -unable to care for themselves, has made possible a new explanation of -responsibility to the race. We have realized practically and literally -that we are “our brother’s keepers.” We are beginning to realize that we -are the keepers of our children of the race that is to come after us. -Our sense of social responsibility is becoming a sense of racial -responsibility. It is that enlarged sense of responsibility which -renders possible what we call the regeneration of the race. We cannot -lay too much stress on this sense of responsibility for it is its growth -which alone renders possible any regeneration of the race. So far as -practical results are concerned, it is not enough for men of science to -investigate the facts and the principles of heredity and to attempt to -lay down the laws of eugenics, as the science which deals with the -improvement of the race is now called. It is not alone enough for -moralists to preach. The hope of the future lies in the slow development -of those habits, those social instincts arising inevitably out of the -actual facts of life, and deeper than science, deeper than morals. The -new sense of responsibility, not only for the human lives that now are, -but the new human lives that are to come, is a social instinct of this -fundamental nature. Therein lies its vitality and its promise. It is -only of recent years that it has been rendered possible. Until lately, -the methods of propagating the race continued to be the same as those of -savages thousands of years ago. Children “came” and their parents -disclaimed all responsibility for their coming; the children were sent -by God, and if they all turned out to be idiots, the responsibility was -God’s. That is all changed now. It is we who are more immediately the -creators of men. We generate the race; we alone can regenerate the race. -We have learned that in this, as in other matters, the Divine Force -works through us and that we are not entitled to cast the burden of our -evil actions on to any higher Power. The voluntary control of the number -of offspring which is now becoming the rule in all civilized countries -in every part of the world has been a matter of concern to some people, -who have realized that however desirable under the conditions, it may be -abused. But there are two points about it which they should do well -always to bear in mind. In the first place, it is the inevitable result -of the advance in civilization. Reckless abandonment to the impulse of -the moment, and careless indifference to the morrow, the selfish -gratification of individual desire at the expense of probable suffering -to lives that will come after, this may seem beautiful to some people, -but it is not civilization. All civilization involves an ever-increasing -forethought for others, even for others who are yet unborn. In the -second place, it is not only inevitable, but it furnishes us with the -one available lever for raising the level of our race. In classic days, -as in the East, it was possible to consider infanticide as a permissible -method for attaining this end. That is no longer possible to us. We must -go further back. We must control the beginnings of life. And that is a -better method, even a more civilized method, for it involves greater -forethought, and a finer sense of the value of life. To-day, all classes -in the community, save the lowest and most unfit, exercise some degree -of forethought and control in regulating the size of their families. -That it should be precisely the unfit who procreate in the most reckless -manner is a lamentable fact, but it is not a hopeless fact, and there is -no need for the desperate remedy of urging the fit to reduce themselves -in this matter to the level of the unfit. That would merely be a -backward movement of civilization. It is education, sobriety, and some -degree of well-being which lead to the control of the size of families, -and as it is social amelioration which brings this result about, it is a -result that we may view with equanimity. It used to be feared that a -falling birth rate was a national danger. We now know that this is not -the case, for not only does a falling birth rate lead to a falling death -rate, but in this matter no nation moves by itself. Civilization is -international, though one nation may be a little before or behind -another. Hitherto France has been ahead, but all other nations have -followed. In Germany, for instance, sometimes regarded as a rival of -England, the birth rate has fallen just as in England. Russia indeed is -an exception, but Russia is not only behind England, but behind Germany -in the march of civilization; its birth rate is high, its death rate is -high; a large proportion of its population live on the verge of famine. -We are not likely to take Russia as our guide in this matter; we have -gone through that stage long ago. But at the stage we have now reached -it is no longer a question of gaining control over the production of the -new generation, but of using that control, and of using it in such a way -that we may help to leave the world better than we found it. “What has -posterity done for me that I should do anything for posterity,” someone -is said to have asked? The answer is that to the human race that went -before him he owes everything, and that he can only repay the debt to -those who come after him. There is more than one way in which we can -repay our debt to the race, but there is no better way than by leaving -behind us those who are fit to carry on the tasks of life to higher ends -than we have ourselves perhaps been able to attain. Children have been -without value in the world because there have been too many of them; -they have been produced by a blind and helpless instinct, and have been -allowed to die by the hundred thousand. For more than half a century -after the era of social reform set in there was no decline at all in the -enormous infant mortality. It has only now begun, as the inevitable -accompaniment of the decline in the birth rate. Not the least service -done by the fall in the birth rate has been to teach us the worth of our -children. We possess the power, if we will, deliberately and consciously -to create a new race, to mold the world of the future. As we realize our -responsibility we see that our new power of control is not merely for -the end of limiting the quantity of human life, perhaps for a selfish -object, but for the high end of improving its quality. It is in our -power not only to generate life, but, if we will, to regenerate life. If -we realize that possibility, and if we understand how the course of -civilization has now brought it within our grasp, we have reached the -heart of our problem. Our greatest foe, apart from indifference, is -ignorance. Even science in this field is only beginning to feel its way, -while the mass have still to unlearn many prejudices of the past. P. -48–54. - -Galton, during the last years of his life, believed that we are -approaching a time when eugenic considerations will become a factor of -religion, and when our existing religious conceptions will be -reinterpreted in the light of a sense of social needs, so enlarged as to -include the needs of the race which is to come. Certainly for those who -have been taught to believe that man was in the first place created by -God, it should not be difficult to realize the divine nature of the task -of human creation which has since been placed in the hands of man, to -recognize it as a practical part of religion, and to cherish a sense of -its responsibility. P. 63. - - - _THE SEXUAL QUESTION. August Forel. A Scientific, Psychological, - Hygienic and Sociological Study. Translated by C. F. Marshall, - M.D., F.R.C.S. Late Assistant Surgeon to the Hospital for Diseases - of the Skin. London._ - -AUGUST FOREL: Doctor of Philosophy honoris causa; Doctor of Laws honoris -causa. Born September 1848 at Morges, Switzerland. Educated at -University of Zurich and Vienna. In 1873 assistant physician at the -district insane asylum at Munich; 1877, Privat-dozent at the University; -1879, Privat-dozent and then Professor at Zurich, and until 1898 -Director of the State Insane Asylum at Burgholzli near Zurich. Works: -Experience et remarques crit. sur les sensations des insectes (in 4 vol. -of Recueil Zoolog. suisse Genf. 1886–7) Giftapparat u. d. Analdrusen der -Ameisen, 1878; Les Fourmis de la Suisse, 1874; Errichtg. v. -Trinkerasylen, 1891; D. Hypnotismus; Gehirn und Seele; Hygiene der -Nerven und des Geistes; Die Sexuelle Frage; Verbrecher und Konstit. -Seelenabnormitat; Ges. Hirnanah. Abhandl; Sinnesleben d. Insekten; -Kulturstrebungen der Gegenwart. - -He discovered in 1885 the seat of the auditory nerves in the brain; -researches into the psychology of ants. - -We must not forget that among our brutal, yet human ancestors, the -struggle for life demanded the cruel and wanton exposure or slaughter of -all weak and decrepit individuals, and that epidemic diseases, plagues, -and pests ravaged the peoples without mercy. Of course our present -civilization has put up a barrier against all this. Yet for that very -reason, the blind and thoughtless propagation of degenerate, tainted and -enfeebled individuals is another atrocious danger to society. But then -the sexual appetite cannot be legislated out of existence, or killed by -repressive measures. We can but consider all legislation and all police -measures which are intended to regulate the sexual intercourse in the -human family as absolute failures, as inhuman, in fact as downright -detrimental to the race. Exacting laws have never improved the morals of -any race or nation, hypocrisy and secret evasion are the only results -obtained. It would be better by far if steps were taken to enlighten the -masses on the questions of sexual heredity and degeneration. Wisdom of -this kind does not corrupt. - -The law of heredity winds like a red thread through the family history -of every criminal, of every epileptic, eccentric and insane person. And -we should sit still and watch our civilization go into decay and fall to -pieces without raising the cry of warning and applying the remedy? - -The sexual appetite is very pronounced in tuberculous persons. They -marry and beget children in the most wanton fashion. The law cannot and -does not prevent them, and the carnal instinct is not to be killed. What -is to be done when law and religion forbid the application of preventive -measures and even prosecute the person that recommends them? Local -diseases and pathological conditions in the woman (at times in man also) -within wedlock, may render parturition and immediate danger to the life -of the mother or of the child, or of both together. Surely in such cases -it is the bounden duty of the physician to intervene and counsel -against, nay absolutely forbid impregnation. Well, how is it to be done? -Must husband and wife who love each other be separated? It would be -unnatural, in fact it is quite impossible. Or should they abandon sexual -intercourse altogether and live like brother and sister? Well, a few -exceptionally cold natures may have will power enough to carry into -effect such a pact. But in 99 out of 100 cases the interdict of the -sexual act sends the husband to satisfy his cravings elsewhere and -contract disease, or he falls in love with another woman and wrecks home -and family. Similar conditions may be brought about by other causes as -well. Take for instance, the poor working man, or mechanic, who has -already six or seven children, and whose wife is unusually fertile, -giving birth to children year after year. The wages of the father do not -suffice to properly support them all. The food that can be purchased -with the slender means is not at all adequate. Rent and other bills fall -behind and they get in debt. They are both young yet. What is to be -done? If they follow the natural law there will be an increase in the -family every year. Moreover, these ever-recurring labors weaken the -constitution of the mother and sap away her strength. Starvation? Sexual -continence in wedlock? It is curious indeed to hear rich men, well fed -clergymen, pious zealots and reformers, leaning back in comfortable -chairs discussing this burning question and bewailing the immorality of -the common people. Statistics prove that these very people who extol to -the poor all the blessings of a poor family never live up to their -teachings, either in theory or in practice. The majority of these -apostles of morality have no children at all or at the utmost two or -three. Why should that be so? What interesting reading it would make if -the sexual history of these persons were followed up and printed. - -Many hygienic reasons and the most elemental laws of humanity demand -that the wife who is fertile above the average should have a rest of at -least 18 months between each succeeding pregnancy. But this cannot be -achieved in the natural course of events except in very rare cases -without wrecking the marriage. If we crystallize this sexual social -question we arrive at the following conclusions: There are a great many -cases, especially of a pathological character, but none the less, also, -in normal and sound individuals, in which procreation within wedlock or -without either definitely or temporarily either for the mother or the -child, or for both, and for that reason should be interdicted. Very few -men and a very small proportion of women—no matter how firmly they may -be resolved—are capable of suppressing their sexual needs. Even if they -succeed the consequences are generally of a disastrous nature, loss of -marital love, secret illicit relations with others, and subsequent -infidelity, nervous disorders, impotence, etc. In all these cases we are -confronted with the following dilemma: 1—In the unmarried person: -onanism or prostitution, or both. Is that morality? Such people must -either forever forego love, marriage, and normal lawful sexual -intercourse, or face sterility in wedded life. 2—Within marriage: -onanism, prostitution and infidelity, or the adoption of rational -preventive measures. I leave it to the reader, and to the law maker to -pick out the correct alternative and to arrive at the one possible -decent and ethical solution of these conflicting questions. - -It seems almost incredible that in some countries medical men who are -not ashamed to throw young men into the arms of prostitution, blush when -mention is made of anti-conceptional measures. P. 427b. - -A year, at least, should elapse between parturition and the next -conception; this gives approximately two years between the confinements. -In this way the wife keeps in good health and can bear healthy children -at pleasure. It is certainly better to procreate seven children, than to -procreate 14, of which seven die, to say nothing of the mother, who -rapidly becomes exhausted by uninterrupted confinements. P. 430. - -It is quite certain that the sexual life of man can never raise above -its present state without being freed from the bonds of mysticism and -religious dogma, and based on a loyal and unequivocal human morality -which will recognize the normal wants of humanity, always having as its -principle object the welfare of posterity. P. 459. - -The true task of a political economy which has the true happiness of man -at heart should be to encourage the procreation of happy, useful, -healthy and hard-working individuals. To build an ever increasing number -of hospitals, asylums for lunatics, idiots and incurables, -reformatories, etc., to provide them with every comfort and manage them -scientifically, is undoubtedly a very fine thing, and speaks well of the -progress and development of human sympathy. But what is forgotten is -that by concerning ourselves almost exclusively with human ruins, the -results of our social abuses, we gradually weaken the force of the -healthy portion of the population. By attacking the roots of the evil -and limiting the procreation of the unfit we shall be performing a work -which is much more humanitarian, if less striking in effect. Formerly, -our economists and politicians hardly have considered this question, and -even now very few are interested in it because it brings no honors, nor -money, as we do not ourselves see the fruits of such efforts. In short, -we amuse ourselves with repairing the ruins, but are afraid to attack -what makes these ruins. P. 465–6. - -The anti-conceptional measures recommended have been often condemned, -sometimes as immoral, sometimes as contrary to aesthetics. To interfere -in this way with the action of nature is said to injure the poetry of -love and the moral feeling, and at the same time to disturb natural -selection. There are several replies to these objections. In the first -place, it is wrong to maintain that man cannot encroach on the life of -nature. If this were the case, the earth would now be a virgin forest, -and a great many plants and animals would not have been adapted to the -use of man. We have proved without deference, often with a brutal hand, -to the misfortune of art and poetry, that we are capable of successfully -meddling with the machinery of nature, even in what concerns our own -persons. - -The aesthetic argument appears, at first sight, more valid. It is -unnecessary, however, to discuss matters of taste. From all points of -view, the details of coitus leave much to be desired from the aesthetic -point of view, and such a slight addition as a protective does not -appear to make any serious difference. P. 497–8. - -She, (woman) ought to develop herself strongly and healthily by working -along with man in body and mind by procreating numerous children when -she is strong, robust and intelligent. But this does not nullify the -advantage that may accrue from limiting the number of conceptions when -the bodily and mental qualities are wanting in the procreators. P. 332. - -One of the most difficult and important future tasks of social science -toward humanity is to set free sexual relations from the tyranny of -religious dogmas by placing them in harmony with the true and purely -human laws of natural science. P. 357. - -In no animal do we find the abuses which man is permitted to practice -toward his wife and children. P. 368. - -The law should abandon its useless and even harmful chicanery concerning -the questions of sexual relations and love, and regulate more carefully -the duties of parents toward their children, and thus protect future -generations against the abuses of the present generation. P. 377. - -It is important to bear in mind that modern legislation on marriage -often favors the reproduction of criminals, lunatics and invalids, while -it hinders the production of healthy children by men who are -intelligent, honest and robust. When an abnormal, unhealthy man is -married his wife is obliged to submit to the conception of tainted -children. What we require is more personal liberty for healthy, -adaptable individuals and more restrictions for the abnormal, unhealthy -and dangerous. The civil law of the future will have to take these facts -into consideration if it wishes to keep level with scientific progress. -P. 393. - - - _THE DISEASES OF SOCIETY AND DEGENERACY. THE VICE AND CRIME PROBLEM. - G. F. Lydston, M.D., Professor of Genito-Urinary Surgery, State - University of Illinois. Prof. of Criminal Anthropology, Chicago, - Kent College of Law; Member of the American Medical Association, - etc., etc. The Riverton Press, Chicago, 1912._ - -The responsibility of rearing a large number of useful and upright -citizens is a little too great for the poor family drudge who -manipulates the wash board with one hand, holding a squealing baby with -the other, and simultaneously attempts to keep in control a dozen other -demonstrative and lusty children. She has a difficult task before her, -even where her environment is favorable to the rearing of children, but -where the children are brought into contact with evil associates as they -are very likely to be when parental control is so lax as it necessarily -is under such circumstances, they are not likely to become either -ornamental or useful factors in our social system. If more attention -were paid to quality of both parentage and children, and less fretting -done as to the possible disasters to the nation incidental to small -numbers of children, it would be better for the race. At the present -day, when practically no attention is paid to stirpiculture in the human -species, it seems absurd to worry about diminution in size of the -American family. Is the function of the wife altogether that of a -breeding machine? Has she no personal rights? Should she be sacrificed -to posterity? Is it always her duty to rear a large family? -Unhesitatingly I answer no to each question. The perpetuation of the -race depends upon matrimony, it is true. It is not however woman’s -function merely to increase numbers at the expense of her own life and -comfort. This is a fallacy and an injustice to womanhood, and should be -contradicted from the house-tops. The woman who is merely a beast of -burden, a breeder of children, is a failure in modern life. Quality of -progeny is not conserved along such lines, and quality, not quantity, -makes for the elevation of the human race. Woman should not be -sacrificed to posterity. Something is due her as a social integer. She -is entitled to life, liberty and the pursuit of happiness. She, as well -as man, comes within the provisions of the constitution. Better a single -child properly reared by a happy contented mother than a dozen ill-fed, -unkempt, dirty, vicious and half-baked hoodlums. “Multiply and replenish -the earth” was once sound doctrine, but it does not uniformly fit modern -conditions. The scriptural injunction should be qualified. The -multiplication should not extend beyond the parents capacity to -comfortably rear and educate their children, nor beyond the number -consistent with the preservation of the mother’s health and happiness. - - - - - CHAPTER II. - ORIGIN AND PRACTICE OF BIRTH CONTROL IN VARIOUS COUNTRIES - - -_In the countries covered by this chapter Birth Control has been -recognised as a legitimate science; leagues advocating the prevention of -conception have been formed; and the leading authorities have approved -the practice as being the foundation of a better social structure._ - - - _THE CONTROL OF BIRTHS. MARY ALDEN HOPKINS. Harper’s Weekly, April - 10th, 1915._ - -The European laws on this subject are in striking contrast to ours. They -treat contraception and abortion as two separate matters. The laws -against abortion are strict. The laws concerning contraception are -directed against distasteful advertising but not against private advice -or public propaganda. In England the applicant must state in writing -over his or her signature that he or she is married or about to be -married. In Holland formulas and methods may be supplied privately, but -must not be publicly advertised. In Germany there is no law on the -matter, but sentiment is strongly opposed to advertising. In Switzerland -it is forbidden to advertise or circularize. In Norway and Sweden -advertising is not expected. Italy and France have no law on the -subject. In Russia advertising in the newspapers is common. Everywhere -in Europe contraceptives are for sale at pharmacies. - -The Birth Control Movement is antagonistic to the general practice of -abortion. The Hungarian senate, a few years ago, declared that the -limitation of families by prevention of conception was absolutely -necessary in order to check the wide-spread evil of attempted abortion. - -Our present laws confuse the issue by classing—in a shockingly ignorant -fashion,—contraception, abortion, and pornography, in the same category. -The group is treated in the New York State Penal Code under the -astonishing title of “Indecent Articles.” The eye of the law -distinguishes no difference between the books of August Forel, a -scientist revered in laboratories all over the world, and the obscene -penny postcard sold by some slinking vendor. - - - _THE MALTHUSIAN LEAGUE OF ENGLAND. The Origin and History of Birth - Control in Great Britain. Reprinted from The Malthusian, April, - 1880._ - -Little improvement can be expected in morality until the production of -large families is regarded in the same light as drunkenness, or any -other physical excess.—John Stuart Mill, 1872. - -In obedience to the request of the Nestor of political economists of -Europe, the distinguished editor of the _Journal des Economistes_ of -Paris, M. Joseph Garnier, we give a short account of the reasons which -led to the foundation of the Malthusian League, the latest product of -the nineteenth century’s ideas in the direction of social progress. It -gives us unfeigned pleasure to be the means of making the most thorough -of all French writers on the doctrines of our English latter-day -economists acquainted with the position which the great population -question has recently assumed in this country. It is not, we believe, -too much to allege that the most advanced thinkers of this country are -at this moment well aware of the existence of the new-Malthusian remedy -for the evils of society. How this has come to pass we proceed at once -to show. - -It was not long after the publication of Mr. Malthus’ work that some -thoughtful men began to notice that in modern France the late marriage -customs of most European states were replaced to a certain extent by -prudence after marriage. Mr. Francis Place was one of the first to write -a work on population, in which he recommended the physical checks so -commonly made use of by the French parents for adoption in England. He -is said to have remonstrated with Mr. Malthus about an expression in the -first edition of his essay, in which he spoke of such checks under the -head of _Vice_, and the tradition is that Malthus left out the -expression in his subsequent edition: and, as he himself had two -children, Mr. Porter (of Nottingham) believes that Mr. Malthus was, like -Mr. Mill (the father of John Stuart Mill), himself a believer in the -_conjugal prudence_ practised by the better class of peasantry and -townspeople. Mr. Place is also said to have converted Mr. Robert Owen, -the socialist to his opinion, and it is believed that Mr. Owen owed the -success of his colony of New Lanark to a knowledge of this point, which -he communicated to his workmen. Mr. Robert Dale Owen, a son of Robert -Owen, emigrated in his youth to the United States of America, and became -before his death, in 1877, one of the foremost citizens of the western -republic. That gentleman, having doubtless heard the question discussed -by his father, Mr. Francis Place, and other friends in London, was -induced in 1830 to publish a now well-known treatise on the population -question, entitled _Moral Physiology_, a work written with the most -philanthropic design and couched in the most careful language consistent -with clearness and the attainment of its end, in which he gave a -description of the above-mentioned physical checks. This work was, -however, written subsequently to the publication of Mr. Richard -Carlile’s tract, entitled _Every Woman’s Book_, which was a most -outspoken work, written by one of those fearless thinkers who have done -so much to complete the reformation in England and secure freedom of -speech and of the press for this country. Had it not been for him and -his co-workers, England might at this day have been in as backward a -condition as modern Spain. Dr. Charles Knowlton, an able physician of -Boston, Massachusetts, U.S.A., was the next person who wrote upon this -question in his now famous little pamphlet, the _Fruits of Philosophy_, -wherein there was contained a good deal of popular information on -physiology, and a careful account of the checks spoken of by Mr. Dale -Owen and Mr. Carlile. This work was followed after a long interval by a -small pamphlet by Mr. Austin Holyoake, entitled _Large and Small -Families_, which, in company with the tracts by Carlile, Owen, and two -other works were sold for many years by booksellers of the ultra-liberal -party, latterly styled the _Secularists_. - -In 1876 the _Fruits of Philosophy_, after circulating without notice for -forty years, was suddenly attacked as an obscene publication under an -Act of Parliament called “Lord Campbell’s Act,” and a bookseller in -Bristol, of the name of Cook, was sentenced to two years’ imprisonment -for selling it. The London publisher of the work, Mr. C. Watts, was also -prosecuted for selling it, but, on submission, was let off with merely -the payment of costs, or about two hundred pounds fine. The work would -have been suppressed had not Mr. C. Bradlaugh, the head of the -Secularist party and editor of the _National Reformer_, the most -advanced liberal journal in England, in company with a young but already -most distinguished lady, Mrs. Annie Besant, come forward and sold it -openly. In order to try the case, Mr. Bradlaugh and Mrs. Besant entered -into partnership in a publishing establishment in Stonecutter Street, -Farringdon Street, London, and sold the _Fruits of Philosophy_ quite -openly, sending copies of it to the city authorities. Mr. Bradlaugh had -for many years been an avowed Malthusian, and the lady also was quite -convinced of the importance of the question. Both were determined that -no bigoted society should put the work under the ban of the law without -a fight for it. The case was first tried at Guildhall, and was sent on -to the Court of Queen’s Bench, before the Lord Chief Justice Cockburn. -The trial began on the 18th of June, 1877, and lasted three days. The -jury contained, among other persons of wealth and position, the name of -Arthur Walter, Esq., the son of the proprietor of the _Times_ journal. -After a most powerful defence, in which Mrs. Besant and Mr. Bradlaugh -delivered speeches which told most powerfully upon the judge and all -present in the Court, the jury delivered the following verdict: “We are -unanimously of the opinion that the book in question (the _Fruits of -Philosophy_) is calculated to deprave public morals; but at the same -time we entirely exonerate the defendants from any corrupt motives in -publishing it.” The judge—who had charged quite in favor of the -defendants—would have let them off with a nominal fine, but, influenced -by the information that they intended carrying on the sale of the work, -strangely sentenced them to a heavy imprisonment and fine. Fortunately, -the higher Court of Appeal decided that there had been an error in the -indictment, and thus the defendants were set free. The prosecution has -not been repeated since that date. - -The excitement caused by the trial led to the formation of a society -called The Malthusian League, which was set on foot as a means of -opposing both active and passive resistance to the attempts made to -stifle discussion on the population question. Mr. Bradlaugh had -commenced such a league many years previously, but the time was not ripe -for it. The first meeting of the League was held in the Minor Hall of -the Hall of Science, Old Street, on July 17th, 1877, for the election of -officers. That meeting elected Dr. C. R. Drysdale president, and Mrs. -Annie Besant honorary secretary, in company with Mr. Hember and Mr. R. -Shearer. The Council of the League consisted of Messrs. Bell, Brown, -Dray, Page, Mr. and Mrs. Parris, Mr. and Mrs. Rennick, Messrs. Rivers, -Seyler, G. Standing, Truelove, and Young. Mr. Swaagman was elected -treasurer to the League. - -Very soon after the formation of the League, another prosecution of Mr. -Edward Truelove, bookseller, of High Holborn, took place in the Queen’s -Bench on February 1st, 1878. The works he was prosecuted for were quite -of the same character as Knowlton’s _Fruits of Philosophy_, and were -entitled: _More Physiology_, a most philanthropic pamphlet by Mr. Robert -Dale Owen, Senator of the United States, and another pamphlet entitled -_Individual, Family and National Poverty_. Mr. Truelove was most -effectually defended by Mr. William Hunter, and the case fell through, -as one of the jury considered the book quite moral and philanthropic in -its tendencies. The secretary for the “Society for the Suppression of -Vice,” Mr. Collette by name, followed up the prosecution, and Mr. -Truelove was tried in the Central Criminal Court on May 9th, 1878, and -condemned to a fine of fifty pounds and an imprisonment of four months -duration, which he underwent. An immense meeting was held in St. James -Hall, on the evening of June 6, 1878, to protest against this -disgraceful treatment of an honest man like Mr. Truelove, at which the -president of the League took the chair, and enthusiastic addresses were -delivered by Mrs. Besant and Mr. Bradlaugh. - -The trial of Mrs. Besant and Mr. Bradlaugh lasted several days, and -aroused a greater interest in the subject than had been known since the -days of Malthus. The English Press was full of the subject; scientific -congresses gave it their attention; many noted political economists -wrote about it; over a hundred petitions were presented to Parliament -requesting the freedom of open discussion; meetings of thousands of -persons were held in all the large cities; and as result, a strong -Neo-Malthusian League was formed in London. - - * * * * * - -From the small beginning described in the above article the English work -has spread over all the rest of the world. The following is a list of -the leagues having membership in the Federation Universelle de la -Regeneration Humaine, in which the English organization has always -played a leading part: - - - FEDERATION UNIVERSELLE DE LA REGENERATION HUMAINE - (Federation of Neo-Malthusian Leagues). - - - _First President_: The late Dr. CHARLES R. DRYSDALE - - - _President_: Dr. ALICE DRYSDALE VICKERY - - - VICE-PRESIDENTS - - Señor ALDECOA, Director of Government Charities, Madrid. - Mr. G. ANDERSON, C.E. - Major-General E. BEGBIE, _C.B._, D.S.O., Brighton. - Dr. C. CALLAWAY, Cheltenham. - M. VICTOR ERNEST, Belgium. - M. G. GIROUD, Paris. - Herr MAX HAUSMEISTER, Stuttgart. - Mrs. HEATHERLEY. - Mr. S. VAN HOUTEN, Deputé of the First Chamber, The Hague. - Dr. ALETTA JACOBS, Amsterdam. - Mr. JOSEPH MCCABE. - Dr. MASCAUX, Courcelles, Belgium. - Mr. ARTHUR B. MOSS. - P. MURUGESA MUDALIAR, Madras. - Mr. VIVIAN PHELIPS. - Rt. Hon. J. M. ROBERTSON, M.P. - Dr. J. RUTGERS, Verhulststraat, 9 Den Haag, Holland. - Me. HOITSEMA RUTGERS, Verhulststraat, 9 Den Haag, Holland. - Frau MARIE STRITT, Dresden. - Dr. (Ph.) HELENE STOCKER, Berlin. - Professor KNUT WICKSELL, Lund, Sweden. - - - CONSTITUENT BODIES. - - ENGLAND (1877).—The Malthusian League. Periodical, _The Malthusian_. - - HOLLAND (1885).—De Nieuw-Malthusiaansche Bond. Secretary, Dr. J. - Rutgers, 9 Verhulststraat, Den Haag. Periodical, _Het Gellukkig - Huisgezin_. - - GERMANY (1889).—Sozial Harmonische Verein. Secretary, Herr M. - Hausmeister, Stuttgart. Periodical, _Die Sozial Harmonie_. - - FRANCE (1895).—_Génération Consciente._ 27 Rue de la Duée, Paris XX. - - SPAIN (1904).—Liga Española de Regeneración Humana. Secretary, Señor - Luis Bulffi, Calle Provenza 177, Pral, la, Barcelona. Periodical, - _Salud y Fuerza_. - - BELGIUM (1906).—Ligue Néo-Malthusienne. Secretary, Dr. Fernand - Mascaux, Echevin, Courcelles. Periodical: _Génération Consciente_, - 27 Rue de la Duée, Paris XX. - - SWITZERLAND (1908).—Group Malthusien. Secretary, Valentin Grandjean, - 106 Rue des Eaux Vives, Geneva. Periodical, _La Vie Intime_. - - BOHEMIA-AUSTRIA (1901).—_Zadruhy._ Secretary, Michael Kacha, 1164 - Zizhov, Prague. - - PORTUGAL.—_Paz e Liberdade_, Revista Anti-Militarista e - Neo-Malthusiana. E. Silva, junior, L. da Memória, 46 r/e, Lisbon. - - BRAZIL (1905).—Sección brasileña de propaganda. Secretaries: Manuel - Moscosa, Rua de’Bento Pires 29, San Pablo; Antonio Dominiguez, Rua - Vizcande de Moranguapez 25, Rio de Janeiro. - - CUBA (1907).—Sección de propaganda. Secretary, José Guardiola, - Empedrado 14, Havana. - - SWEDEN (1911).—Sallskapet for Humanitar Barnalstring. President: Mr. - Hinke Bergegren, Vanadisvagen 15, Stockholm, Va. - - FLEMISH BELGIUM (1912).—National Verbond ter Regeling van het - Kindertal. President, M. L. van Brussel, Rue de Canal, 70, - Louvain. - - ITALY (1913).—Lega Neomalthusiana Italiana. Secretary, Dr. Luigi - Berta, Via Lamarmora 22, Turin. Periodical, _L’Educazione - Sessuale_. - - AFRICA.—Ligue Néo-Malthusienne, Maison du Peuple, 10 Rampe Magenta, - Alger. - -The English organization, with headquarters in London, has for its -officers some of the most distinguished men and women in England: - - - FIRST PRESIDENT - - The late C. R. DRYSDALE, M.D., M.R.C.P., Lond., F.R.C.S., Eng. - - - PRESIDENT: Dr. ALICE DRYSDALE VICKERY. - - 47 Rotherwick Road, Hampstead Garden Suburb, N. W. - - - VICE-PRESIDENTS: - - Major-Gen. ELPHINSTONE BEGBIE, C.B., D.S.O. - ARNOLD BENNETT, Esq. - CHAS. CALLAWAY, Esq., M.A., D.Sc. - Lieut.-Col. J. FALLON, L.R.C.P., R.A.M.C. - E. S. P. HAYNES, Esq. - DENNIS HIRD, Esq., M.A., J.P. - Mrs. HEATHERLEY. - Captain KELSO, R.N. - JOSEPH MCCABE, Esq. - C. KILLICK MILLARD, Esq., M.D., D.Sc., M.O.H. - A. B. MOSS, Esq. - VIVIAN PHELIPS, Esq. - EDEN PHILLPOTTS, Esq. - Right Hon. J. M. ROBERTSON, M.P. - Lieut.-Colonel A. W. WARDEN, late Indian Army. - H. G. WELLS, Esq. - - - HON. TREASURER: - W. V. OSBORNE, Esq. - - - HON. SECRETARY: - BINNIE DUNLOP, Esq., M.B., Ch.B., Queen Anne’s Chambers, Westminster, - S.W. - (To whom all correspondence and subscriptions should be sent.) - - - - GENERAL SECRETARY: - Miss O. M. JOHNSON, B.A. - - - EDITORS OF “THE MALTHUSIAN”: - DR. C. V. DRYSDALE; MRS. B. DRYSDALE. - - - AUDITOR: - Mrs. E. AYRES PURDIE, A.L.A.A., Hampden House, Kingsway, W.C. - - - LITERARY SECRETARY: - Mr. GEORGE STANDRING, 7–9 Finsbury Street, London, E.C. - (From whom Books on the Population Question can be obtained.) - -The following are some extracts from the League’s rules: - - - II.—OBJECTS. - -That the objects of this Society be:— - -1. To spread among the people, by all practicable means, a knowledge of -the law of population, of its consequences, and of its bearing upon -human conduct and morals. - -2. To urge upon the medical profession in general, and upon hospitals -and public medical authorities in particular, the duty of giving -instruction in hygienic contraceptive methods to all married people who -desire to limit their families, or who are in any way unfit for -parenthood; and to take any other steps which may be considered -desirable for the provision of such instruction. - - - III.—PRINCIPLES. - -1. “That population (unless consciously and sufficiently controlled) has -a constant tendency to increase beyond the means of subsistence.” - -2. That the checks which counteract this tendency are resolvable into -positive or life-destroying, and prudential or birth-restricting. - -3. That the positive or life-destroying checks comprehend the premature -death of children and adults by disease, starvation, war, and -infanticide. - -4. That the prudential or birth-restricting check consists in the -limitation of offspring (1) by abstention from or postponement of -marriage, or (2) by prudence after marriage. - -5. That prolonged postponement of marriage—as advocated by Malthus—is -not only productive of much unhappiness, but is also a potent cause of -sexual vice and disease. Early marriage, on the contrary, tends to -ensure sexual purity, domestic comfort, social happiness and individual -health; but it is a grave social offence for men and women to bring into -the world more children than they can adequately house, feed, clothe, -and educate. - -6. That over-population is the most fruitful source of pauperism, -ignorance, crime, and disease. - -7. That it is of great importance that those afflicted with hereditary -disease, or who are otherwise plainly incapable of producing or rearing -physically, intellectually and morally satisfactory children, should not -become parents. - -8. That the full and open discussion of the Population Question in all -its necessary aspects is a matter of vital moment to Society. - -It has been the object of this organization during these years to carry -on the theoretical propaganda of Birth Control mainly among the -educators, consisting of clergymen, physicians, scientists, -sociologists, economists and others who in turn would form a strong, -reliable public opinion who would force the dissemination of practical -information among that element of society who are propagating the -diseased and unfit. - -It is only within the last few years that this League has begun to -distribute information to prevent conception. Thousands of copies of -this leaflet have been distributed in nearly every country throughout -the civilized world except _The United States of America_ where laws -prevent its circulation. - - - PRACTICAL METHODS OF FAMILY LIMITATION - -Notice.—The Council of the Malthusian League, while continuing to regard -this as a matter which is strictly within the province of the medical -profession, and which ought to be taken over by them, has compiled a -leaflet entitled “Hygienic Methods of Family Limitation,” for the -benefit of those desirous of limiting their families, but who are -ignorant of the means of doing so, and unable to get medical advice on -the subject. This leaflet can only be issued, however, to persons over -twenty-one years of age who are either married or about to be married, -and who declare their conscientious belief that family limitation is -justifiable on personal and national grounds. Anyone wishing to obtain a -copy of this leaflet must write his or her name and address clearly upon -both of the forms of declaration below, and send them to the Hon. -Secretary. The sealed leaflet will then be sent them. In order to -encourage family limitation among the poorest classes, _no charge will -be made either for the leaflet or postage_, but it is hoped that those -who can afford it will enclose stamps for postage or a small donation to -help the League in its work. - -_Under no circumstances whatever can the practical leaflet be supplied -without a properly filled up declaration_, nor can more than one copy be -supplied to the same person. Those wishing to help others, may have -additional copies of the declaration form to hand on. - -_The Malthusian League regrets that it is unable to comply with -applications for this leaflet from the United States._ - - - A BRIEF HISTORY OF THE MOVEMENT IN HOLLAND - -Interest in the subject did not confine itself to England, for in 1878 -at an International Medical Congress in Amsterdam the subject was -discussed with great enthusiasm. A paper prepared and read by Mr. S. Van -Houten (later Prime Minister) caused a wider interest in the matter and -a year later the Neo-Malthusian (or Birth Control) League of Holland was -organized. Charles R. Drysdale, then President of the English League, -attended the conference. - -As is usual in such causes, many of the better educated and intelligent -classes adopted the practice at once, as did the better educated -workers; but the movement had as yet no interest among the poorest and -most ignorant. The League set to work at once to double its efforts in -these quarters. Dr. Aletta Jacobs, the first woman physician in Holland, -became a member of the League, and established a clinic where she gave -information on the means of prevention of conception free to all poor -women who applied for it. - -All classes, especially the poor, welcomed the knowledge with open arms, -and requests came thick and fast for the League’s assistance to obtain -the necessary appliances free of charge. The consequence has been that -for the past twelve years the League has labored chiefly among the -people of the poorest districts. Dr. J. Rutgers and Madame Hoitsema -Rutgers, two ardent advocates of these principles, have devoted their -lives to this work. Dr. Rutgers says that where this knowledge is taught -there is a reciprocal action to be observed: “In families where children -are carefully procreated, they are reared carefully; and where they are -reared carefully, they are carefully procreated.” - -The Neo-Malthusian (or Birth Control) League of Holland has over 7,000 -men and women in its membership, and more than fifty nurses whom it -indorses. - -These nurses are trained and instructed by Dr. Rutgers in the proper -means and hygienic principles of the methods of Birth Control. They are -established in practice in the various towns and cities throughout -Holland. They advise women as to the best method to employ to prevent -conception. They work mainly in the agricultural and industrial -districts, or are located near them; and their teachings include not -only the method of prevention of conception, but instruction in general -and sexual hygiene, cleanliness, the uselessness of drugs, and the -non-necessity of abortions. (The Council of the Neo-Malthusian or Birth -Control League calls attention to the fact that it has for its sole -object the Prevention of Conception, and not the causing of abortion.) - -The clinic organized by Dr. Jacobs,—the first clinic in the world for -the organized dissemination of information on Birth Control,—proved so -efficient and beneficial to the standards of the community that others -were opened and established until there are now more than fifty in -operation. - -There is no doubt that the establishment of these clinics is one of the -most important parts of the work of a Birth Control League. The written -word and written directions are very good, but the fact remains that -even the best educated women have very limited knowledge of the -construction of their generative organs or their physiology. What, then, -can be expected of the less educated women, who have had less advantages -and opportunities? It is consequently most desirable that there be -practical teaching of the methods to be recommended, and women taught -the physiology of their sex organs by those equipped with the knowledge -and capable of teaching it. - -It stands to the credit of Holland that it is perhaps the only country -where the advocates of Birth Control have not been prosecuted or jailed; -because the laws regarding the liberty of the individual and the freedom -of the press uphold it, and protect its practise. - - - THE DUTCH NEO-MALTHUSIAN (BIRTH CONTROL) LEAGUE REPORT FOR 1914 - -Despite the outbreak of war, the progress of the League has been most -satisfactory. The membership increased from 5,057 at the beginning of -1914 to 5,521 at the end; and branches now exist in twenty-eight towns -in Holland. The list of officers and correspondents alone now occupies -four pages of the Report, and comprises nearly two hundred names. As -these are of persons in every part in the country, it will be realised -how great are the facilities for everyone to obtain practical -information. Besides the great amount of advice given by the trained -workers, 7,200 copies of the League’s booklet giving practical advice on -methods of family limitation (birth control) were supplied. It is -instructive to see, in the reports from the various branches open -statements that Mrs. X (full name given) helped 149 women and supplied -seven gross of preventives, the kinds being clearly specified. The -branch reports give particulars of nearly 1,300 women personally -instructed in preventive methods by trained workers, but the war -prevented the returns from being anything like complete. And this in a -country of only six million inhabitants.—_The Malthusian_, London, July -15, 1915. - - - RESULTS OF BIRTH CONTROL TEACHING IN HOLLAND - -There is no doubt that the Neo-Malthusian (Birth Control) League of -Holland stands as the foremost in the world in organization, and also as -a practical example of the results to be obtained from the teaching of -the prevention of conception. Aside from the spreading influence of -these ideas in Belgium, Italy, and Germany, Holland presents to the -world a statistical record which proves unmistakably what the advocates -of Birth Control have claimed for it. - -The infantile mortality of Amsterdam and The Hague is the lowest of any -cities in the world, while the general death rate and infantile -mortality of Holland has fallen to be the lowest of any country in -Europe. These statistics also refute the wild sayings of those who shout -against Birth Control and claim it means race suicide. On the contrary, -Holland proves that the practice of anti-conceptional methods leads to -race improvement, for the increase of population has accelerated as the -death rate has fallen. There has also been a rapid improvement in the -general physique and health of the Dutch people, while that of the high -birth rate countries, Russia and Germany, is said to be rapidly -deteriorating. - -The following figures will suffice to show some of the improvements -which have been going on in Holland since 1881, the time the League -became actively engaged in the work:— - - - VITAL STATISTICS OF CHIEF DUTCH TOWNS - -Taken from Annual Summary of Marriages, Births, and Deaths in England -and Wales, etc., for 1912.[1] - - - Amsterdam (Malthusian (Birth Control) League started 1881; Dr. Aletta - Jacobs gave advice to poor women, 1885.) - - 1881–85 1906–10 1912 - - Birth Rate 37.1 24.7 23.3 per 1,000 of population - - Death Rate 25.1 13.1 11.2 per 1,000 of population - - Infantile Mortality: per thousand living - (Deaths in first 203 90 64 births - year) - - - The Hague (now headquarters of the Neo-Malthusian (Birth Control) - League) - - 1881–85 1906–10 1912 - - Birth Rate 38.7 27.5 23.6 per 1,000 of population - - Death Rate 23.3 13.2 10.9 per 1,000 of population - - Infantile Mortality: per thousand living - (Deaths in first 214 99 66 births - year) - - - Rotterdam.[2] - - 1881–85 1906–10 1912 - - Birth Rate 37.4 32.0 29.0 per 1,000 of population - - Death Rate 24.2 13.4 11.3 per 1,000 of population - - Infantile Mortality per thousand living - (Deaths in first 209 105 79 births - year) - - - Fertility and Illegitimacy Rates. - - 1880–2 1890–2 1900–2 - - Legitimate birth per - Legitimate Fertility 306.4 296.5 252.7 1,000 Married Women - aged 15 to 45. - - Illegitimate births per - Illegitimate Fertility 16.1 16.3 11.3 1,000 Unmarried - Women, aged 15 to 45. - - - The Hague. - - 1880–2 1890–2 1900–2 - - Legitimate Fertility 346.5 303.9 255.0 - - Illegitimate Fertility 13.4 13.6 7.7 - - - Rotterdam. - - 1880–2 1890–2 1900–2 - - Legitimate Fertility 331.4 312.0 299.0 - - Illegitimate Fertility 17.4 16.5 13.1 - -Footnote 1: - - These figures are the lowest in the whole list of death rates and - infantile mortalities in the summary of births and deaths in cities in - this Report. - -Footnote 2: - - Lowest figure for the Continent. - -There has been a marked improvement in the labor conditions in Holland -during these last ten years especially, wages having increased and hours -of labor decreased, with the cost of living taking a comparatively very -small rise. - -There is no country in Europe where the educational advantages are so -great as in Holland. - -That the Birth Control propaganda has been a success in Holland any one -travelling through that delightful, clean and cheerful country can -testify. - -In that enlightened country, Holland, the teaching by the medical -profession of the most hygienic methods of birth limitation has enabled -the poor to have small families which they could raise to be physically -and morally better equipped than formerly, and what is most interesting -to observe is that, whether as a result of this or for some other -reason, the families among the well-to-do are not nearly as small as in -other countries.—_Dr. S. Adolphus Knopf, in The Survey for November, -1916._ - - - GERMANY - -Germany was the next to follow, in 1889, when Herr Max Hausmeister and -Herr Karl Lotter founded the Sozial Harmonische Verein, with its paper -_Die Sozial Harmonie_. Like the English League, this society has -confined its teachings to the theoretical and economic aspects of the -subject, in which it has especially distinguished itself. In Germany all -such doctrines are of course anathema, but the enormous decline in the -birth-rate in several towns testifies to the refusal of the German -people to be hectored into misery. All the signs point at present to an -extraordinary ferment of new ideas in Germany, and a large number of -other movements are more or less openly Neo-Malthusian.—From _The -Malthusian_ (London), January, 1909. - -The German Sozial Harmonische Verein, founded in 1889, by Herr Max -Hausmeister, has continued its quiet, but effective, work, and its -periodical, _Die Sozial Harmonie_, has contained many articles of great -economic value. A remarkable feature in Germany, however, has been the -rapid rise of the Mutterschutz Society, under the able presidency of Dr. -Helene Stocker, a society which aims at obtaining greater security and -freedom for married and unmarried mothers, and at securing better -conditions for the rearing of their offspring. Neo-Malthusianism (Birth -Control) is becoming an important feature of this work, and is also -dealt with in the _Zeitschrift fur Sexual-wissenschaft_, a scientific -journal devoted to sex matters. The birth-rate of Prussia has seen one -of the most rapid declines, from 36.2 in 1901 to 33.7 in 1906, and 33.0 -in 1907; while the death-rates for the same years have been 20.5, 17.9, -and 17.8, and the infantile mortalities 200, 177, and 168 respectively. -The birth-rate of Berlin in 1907 was 24.3, or below that of London, -26.8.—From _The Malthusian_ (London) for July 15th, 1909. - - - FRANCE - -France differs from all other countries in having realized the -individual advantages of the practice of birth control long before any -other country in Europe. It is said that the sale of the lands -(forfeited by the Emigrés or confiscated by the Commune after the -Revolution) to the people, together with the law of equal inheritance in -accordance with the principles of Liberty, Equality and Fraternity -adopted for their guidance formed the chief incentive to restriction of -the numbers of the family. - -The birth-rate declined in an irregular manner from 1870 to the present -time, especially among the wealthy classes, while the poor and ignorant -continued to be burdened with large families. This led M. Paul Robin in -1896 to form the French Ligue de la Regeneration Humaine, and to employ -his enormous energy and enthusiasm towards the formation of leagues in -other countries. Bohemia, Spain, Brazil, Belgium, Cuba, Africa and -Switzerland formed leagues in succession, most of them circulating -periodicals dealing with Neo-Malthusian (Birth Control) theory and -practice. At the same time M. Robin formed a Federation Universelle de -la Regeneration Humaine, in which the various leagues have been -associated and which has held two international meetings—the first at -Paris in 1900 and the second at Liege in 1905.—From _The Malthusian_ -(London) January, 1909. - -Fifteen years after the founding of M. Robin’s work, the propaganda in -France is very complete and intense. Theoretical or practical, it -appears under many forms. It acts through books, pamphlets, leaflets, -journals, lectures, pictures, and even songs. Tens of thousands of -theoretical volumes and pamphlets are disseminated, hundreds of -thousands of leaflets are distributed. The practical pamphlets find -their success in rapidly disappearing editions. In every part of the -land—in town, and even country—lectures are given, and numerous militant -workers diffuse the good tidings in multitudes of papers. The centers of -our propaganda are too numerous to be fully quoted. In the first rank -are the societies exclusively Neo-Malthusian (Birth Control), which, in -fact, each carry on in their own manner the work undertaken by -_Regeneration_. The most active, the most enterprising, and the most -combative of these organizations, _Génération Consciente_, multiplies -its efforts, extends its action, and prospers unceasingly. Again there -exists a different class of propagandists—the individual—who, without -periodical, place or society, works by disseminating not only the -pamphlets, leaflets, and books, but also the means of prevention.—From -_The Malthusian_ (London) of September 15, 1910. - -France has her population practically under control, and can increase or -diminish at will according to the prospects of good or bad times. (See -Page 37 for French Birth and Death Rate).—From _The Malthusian_ (London) -of April 15th, 1909. - -France has set the example of real civilization and other nations are -following her more or less rapidly according to their advancement in -culture. - -There has been a tendency to ascribe the low birth-rate in France to -infertility or degeneracy, although this is patently absurd to all those -who are acquainted with the French people. For the low birth-rate of -France is practically entirely due to prudential control of families -among married people who make no pretense to the avoidance of preventive -intercourse. - -Dealing with the conditions of the people in France there is little that -does not compare favorably with all other old countries. The average -duration of life is about fifty years, which is nearly the highest in -Europe. The infantile mortality is the worst feature,[3] but it has been -declining for some years. - -Footnote 3: - - Note: This is a problem of hygiene and infant welfare. If the same - care were given the babies of France as is being given the infants of - other advanced countries there is little doubt that the mortality rate - would decline proportionately.—M. H. S. - -There is no “too old at thirty-five” difficulty in France, elderly men -being employed where boys are (in other countries); there is no -unemployment worth speaking of; there is no land problem, and house -rents, instead of being forced up by excess of demand, are actually -lowered by excess of supply, so that the “unearned increment” is -frequently negative.—From _The Malthusian_ (London) for April 15th, -1909. - -Writing of France in 1879, a few years after the close of the disastrous -Franco-Prussian War, Johannes Swaagman said: - -“France, notwithstanding the heavy war indemnity of five milliards, and -perhaps an equal expenditure of her own war material, is now the only -country that has a surplus on its estimated budget, and can even dream -of reducing taxation. Besides this, large sums are being spent on -improvements, with a view of accelerating commerce and industry. - -“France has still many things to learn, notably as regards hygiene, but -we have no hesitation in asserting that as regards the solution of the -most distressing problems which humanity has to face and as regards -general happiness and culture she is far ahead of all other countries -and she has simply led the way in the direction in which all other -nations are bound to follow, and in which they are already -hastening.”—From _The Malthusian_ (London) of April 15th, 1909. - -Strong and vigorous movements exist in Switzerland, Belgium, Hungary, -Spain, Norway, Sweden, Denmark and Italy, while there are somewhat less -active ones in Russia, Japan, India, and even China. I will not take the -space to furnish the details of the movement in these countries because -they are mainly inspired in their activities from those well organized -Leagues already mentioned. - - - BIRTH AND DEATH RATE IN FRANCE - -The actual facts as regards the French birth-rate are constantly -misrepresented. Taking the actual population, this appears to have been -24.8 millions in 1783, 28.9 millions in 1806, and to have gone on more -or less steadily increasing to 39.26 millions in 1907. Exceptions to -this increase have taken place six times since 1881, there being a -deficit or excess of deaths over births of 38,446 in 1890, of 10,505 in -1891, of 20,041 in 1892, of 17,813 in 1895, of 25,988 in 1900, and of -19,920 in 1907. Despite these deficits the natural increase, or excess -of births over deaths, was 1,232,744 in the twenty-five years from 1881 -to 1905, while the total increase, including immigration, etc., was -1,690,000 during the same period. It is worthy of note also in view of -the suggestions that the deficit is about to become chronic, and that -France is therefore a “dying nation,” that in 1893 and 1894, after three -years of deficits, there were excesses of 7,000 and 39,000; in 1897 and -1898 of 93,700 and 108,000; and in 1901 of 72,000. There has been no -report since 1907, but Le Jour Officiel of Paris has given the figures -for the first six months of 1908, which show an _increase_ of 12,066, -partly due to a rise of 8,657 in the births and partly a decline of -8,416 in the deaths.—From _The Malthusian_ (London) of April 15th, 1909. - - - BIRTH RATE IN FRANCE - - Compiled from _The Malthusian_ (London), for April 15th, - 1909 - - Year Increase Decrease - 1890 38,446 - 1891 10,505 - 1892 20,041 - 1893 7,000 - 1894 39,000 - 1895 17,813 - 1896 No record available - 1897 93,700 - 1898 108,000 - Total for 8 years 247,700 86,800 - 86,800 - ——————— - Total increase 160,900 - ——————— - - Rate of increase per year (approximately) 20,100 - Increase in total population from 1783 to 1907 15,000,000 - - - UNITED STATES OF AMERICA - -It is interesting to know that the present agitation for the -dissemination of knowledge to prevent conception, as expressed in the -various leagues throughout the world to-day had its greatest impetus and -inspiration from two books written by Americans in the United States. - -The first of these was a pamphlet entitled “Moral Physiology,” written -by United States Senator Robert Dale Owen, son of Robert Owen, which was -published in New York City in 1830 and gave a description of the -physical checks made use of in France, where it was the custom to limit -the number of children to the means at the command of the family. This -book was much read and commented favorably upon in America. - -So favorably did this publication appeal to the thinking minds of the -time, that Dr. Charles Knowlton, an able Boston physician, on reading -Owen’s pamphlet, was so struck by its importance as a contribution to -the science of hygiene that he brought out a similar work in 1833, -entitled “The Fruits of Philosophy.” His book was addressed to young -married people and gave a popular description of the anatomy of the -organs of reproduction, especially in the female, and a somewhat more -detailed account of the physical checks to prevent conception than had -been given in Owen’s pamphlet. - -“The Fruits of Philosophy” circulated unchallenged for more than forty -years, and finally, in 1876, was attacked as an obscene publication -under the new act of Parliament called “Lord Campbell’s Act,” and a -bookseller of Bristol, England, was sentenced to two years’ imprisonment -for selling it. - -This work would have been suppressed altogether had not Charles -Bradlaugh and Mrs. Annie Besant, two ardent defenders of British -liberty, come forward and volunteered to sell it in order to test the -case in the English courts. The trial, as has been described herein -under the title of “Birth Control League of England,” attracted great -attention to this philosophy throughout the world. It is a sad -commentary upon the legislative bodies of this country that up to the -present every attempt by advocates of this principle to discuss this -subject and awaken our people to its needs has been met with prosecution -and jail sentences. - -During these last forty years the movement has made rapid progress in -all civilized countries except the United States. In this progressive -matter we find ourselves classed with Russia, Japan, India and China, -where national interest is concerned with quantity of human beings -rather than with quality. - -But during the last five years the subject has come forcibly to the -front, mainly through prosecutions. Again a message has gained a hearing -from the dock which it could never have won from the platform. - -The people of this country are now awakened to the need of knowledge to -prevent conception. Social workers, nurses, and members of the medical -profession find their work hampered and their activities nullified by -oppressive laws denying the individual the right of health, life and the -pursuit of happiness. - -The most advanced thinkers in America are with us in this movement, the -sentiment being largely in favor of the establishment of clinics, -similar to those in Holland, where the poor and overburdened mothers may -come for advice to be given by doctors, nurses or others competent to -instruct. - -Following are some of the names of men and women in the United States -who stand for the dissemination of such knowledge, have allied -themselves to this great humanitarian cause, and have come out in the -press for birth control as a national necessity: - - - WELL KNOWN WOMEN WHO ENDORSE BIRTH CONTROL - - Mrs. J. Borden Harriman - Mrs. Amos Pinchot - Mrs. Charles Tiffany - Mrs. Robert M. La Follete - Mrs. Herbert Croly - Mrs. Phillip Littell - Mrs. Raymond B. Stevens - Mrs. Simeon Ford - Mrs. Philip Lydig - Mrs. William I. Thomas - Mrs. Robert P. Bass - Mrs. Inez Haynes Irwin - Mrs. Paul Manship - Mrs. Frank Cothren - Mrs. George B. Hopkins - Mrs. J. Sargeant Cram - Mrs. William Leon Graves - Mrs. Gifford Pinchot - Mrs. J. G. Phelps Stokes - Mrs. Elsie Clews Parsons - Mrs. Amy Walker Field - Mrs. Mary Heaton Vorse - Mrs. Juliet Barrett Rublee - Mrs. Frances Hand - Mrs. Mabel Foster Spinney - Mrs. Belle I. Moskowitz - Miss Caroline Rutz-Rees - Miss Jessie Ashley - Miss Lillian D. Wald - Princess Troubetskoy - - - NOTED PHYSICIANS WHO ENDORSE BIRTH CONTROL - - Dr. Abram Jacobi, ex-president, American Medical Association, New York - City. - - Dr. Hermann M. Biggs, State Commissioner of Health, New York. - - Dr. John N. Hurty, secretary, State Board of Health, Indiana. - - Dr. Godfrey R. Pisek, professor of diseases of children, New York - Post-Graduate Medical School and Hospital, New York City. - - Dr. J. W. Trask, United States Public Health Service, Washington, D. - C. - - Dr. Ira S. Wile, editor, _American Medicine_, member Board of - Education, New York City. - - Dr. John A. Wyeth, professor of surgery and president of the New York - Polyclinic Medical School and Hospital, ex-president of the - American Medical Assn., and New York Academy of Medicine, New York - City. - - Dr. S. Adolphus Knopf, professor of medicine, department of - Phthisio-therapy, at New York Post-Graduate Medical School and - Hospital, New York City. - - Dr. Lydia Allen de Vilbiss, formerly of New York State Department of - Health, now in charge of the division of Child Hygiene of the - State Board of Health of Kansas. - - - NOTED WRITERS AND TEACHERS WHO ENDORSE BIRTH CONTROL - - Ernest Poole - Will Irwin - Walter Lippman - Paul Kellogg - Max Eastman - Winthrop D. Lane - John Reed - Prof. Warner Fite - Prof. William P. Montagu - Prof. Charles Zueblin - Prof. Durant Drake - Prof. Thomas Nixon Carver - Prof. Melvil Dewey - Prof. William H. Allen - Prof. Franklin H. Giddings - Prof. Irving Fisher - Hon. Homer Folks - Hon. William H. Wadhams - Dr. Henry Moskowitz - Hiram Myers - Dr. Scott Nearing - Eugene V. Debs - - - NOTED MINISTERS WHO ENDORSE BIRTH CONTROL - - Rev. Dr. Frank Crane, formerly pastor of the Union Congregational - Church, Worcester, Mass., now notable writer of editorial articles - for New York _Globe_, etc. - - Rev. Dr. Percy Stickney Grant, rector, Protestant Episcopal Church of - the Ascension, New York City. - - Rev. Dr. Frank Oliver Hall, minister, Church of the Divine Paternity, - New York City. - - Rev. Dr. John Haynes Holmes, minister, Unitarian Church of the - Messiah, New York City. - - Rev. Dr. Harvey Dee Brown, minister, Unitarian Church of the Messiah, - New York City. - - Rev. Dr. Stephen S. Wise, rabbi of the Free Synagogue, New York City. - - Rev. Dr. Sidney E. Goldstein, rabbi of the Free Synagogue, New York - City. - - Rev. Dr. Waldo Adams Amos, rector, Protestant Episcopal Church of St - Paul, Hoboken, N. J. - - - PROMINENT RESIDENTS OF CHICAGO, ILL., WHO ENDORSE BIRTH CONTROL - - Dr. Isaac A. Abt - Rev. Myron E. Adams - Rev. Edward S. Ames - Dr. Charles S. Bacon - Mrs. E. W. Bemis - Mrs. I. S. Blackwelder - Mrs. Tiffany Blake - Dr. Anna E. Blount - Ralph E. Blount - Mrs. Joseph T. Bowen - Mr. and Mrs. Horace Bridges - Mr. and Mrs. Edward B. Burling - Mrs. Benjamin Carpenter - Dr. and Mrs. Frank Cary - Mr. and Mrs. William L. Chenery - Dr. Frank S. Churchill - Mr. and Mrs. Samuel Dauchy - Dr. J. B. De Lee - Mr. and Mrs. William F. Dummer - Mrs. Joseph N. Eisendrath - Mrs. Kellogg Fairbank - Dr. John Favill - Prof. and Mrs. James A. Field - Mrs. Walter L. Fisher - Mr. and Mrs. Jerome Frank - Rev. and Mrs. Charley W. Gilkey - Dr. and Mrs. Maurice L. Goodkind - Dr. Ethan A. Gray - Mr. and Mrs. E. T. Gundlach - Mrs. Alfred Hamburger - Dr. and Mrs. Ralph Hamill - Dr. Alice Hamilton - Mr. and Mrs. Charles F. Harding - Dr. N. Sproat Heaney - Mrs. Charles Henrotin - Dr. Rudolph W. Holmes - Mrs. Leila K. Hutchins - Dr. Karl K. Koessler - Mr. and Mrs. Herman Landauer - Dr. W. George Lee - Prof. and Mrs. Frank R. Lillie - Prof. and Mrs. J. Weber Linn - Mrs. Edwin L. Lobdell - Max Loeb - Judge and Mrs. Julian W. Mack - Prof. and Mrs. George H. Mead - Dr. James H. Mitchell - Mr. and Mrs. William S. Monroe - Prof. and Mrs. Addison W. Moore - Mrs. James W. Morrisson - Mr. and Mrs. George Packard - Mr. and Mrs. Benjamin Page - Mrs. Elia W. Peattie - Allen B. Pond - Mr. and Mrs. James F. Porter - Mrs. Julius Rosenwald - Mrs. Dunlap Smith - Mrs. Henry Solomon - Dr. Alexander F. Stevenson - Prof. Graham Taylor - Mrs. Harriet W. Walker - Mr. and Mrs. Willoughby Walling - Mrs. George Watkins - Mr. and Mrs. Payson Wild - Mrs. Wilmarth - Dr. Rachelle Yarros - Victor S. Yarros - Mr. and Mrs. Sigmund Zeisler - -Physicians, scientists, economists, social workers and others interested -in the forward march of this country are simply marking time in progress -until it is decided whether or not the medical profession and its -assistants have the legal right to impart information to prevent -conception to those who need it. A favorable decision would permit men -and women to stem the incoming tide of feebleminded, unfit, degenerate -individuals who undermine our present social structure and place a -burden on generations yet unborn. - - - - - CHAPTER III - POPULATION AND BIRTH RATE - - -_In this chapter it is demonstrated that a high birth rate invariably -means a high death rate, particularly a high infant mortality. Where a -knowledge of methods to prevent conception results in a lowering of the -birth rate, proportionately more of those children born survive, and a -healthier, sturdier population is the result._ - - - BIRTH CONTROL - - BY HAVELOCK ELLIS - -It may be said that Nature has been seriously troubled with the problem -of reproduction even from the first creation of life. Our own doubts and -difficulties in that sphere are but a continuation of those experienced -on the earth long before Man’s ancestors descended from the forest -trees. Nature’s first insistent impulse was for reproduction, and so the -lowlier organisms increase at an enormous rate, though by far the -greater number of the creatures thus produced are doomed to early -destruction by other creatures which prey upon them. Then sex arose and -developed. And the object of sex may be said to act as a check on -reproduction, and not, as we have sometimes too hastily assumed, to -ensure reproduction, for that was already more than fully ensured by -other methods already in existence. The device of sex rendered -reproduction more difficult, but in decreasing the quantity of offspring -it at the same time improved their quality. As the sexual process -increased in complexity the individuals produced equally grew more -complex and better equipped to resist the dangers they were subjected -to. Fishes are spawned by the thousand, but only a few come to maturity. -The higher mammals produce but few offspring and surround them with -parental care until they are able to lead their own lives with a fair -chance of surviving. Thus the sexual process in its finally developed -form may be regarded as a mechanism for subordinating quantity to -quality, and so promoting the evolution of life to ever higher stages. - -This process, which is plain to see on the largest scale throughout -living nature, may be more minutely studied, as it acts within a -narrower range, in the human species. Here we statistically formulate it -in the terms of birth-rate and death-rate; by the mutual relationship of -the two courses of the birth-rate and the death-rate we are able to -estimate the evolutionary rank of a nation, and the degree in which it -has succeeded in subordinating the primitive standard of quantity to the -higher and later standard of quality. - -It is especially in Europe that we can investigate this relationship by -the help of statistics which in some cases extend for nearly a century -back. We can trace the various phases through which each nation passes, -the effects of prosperity, the influence of education and sanitary -improvement, the general complex development of civilisation, in each -case moving forward, though not regularly and steadily, to higher stages -by means of a falling birth-rate, which is to some extent compensated -for by a falling death-rate, the two rates nearly always running -parallel, so that a temporary rise in the birth-rate is usually -accompanied by a rise in the death-rate,—by a return, that is to say, to -the conditions which we find at the beginning of animal life,—and a -steady fall in the birth-rate is always accompanied by a fall in the -death-rate. - -The modern phase of this movement, soon after which our precise -knowledge begins, may be said to date from the industrial expansion, due -to the introduction of machinery, which Professor Marshall places in -England about the year 1760. That represents the beginning of an era in -which all civilised and semi-civilised countries are still living. For -the earlier centuries we lack precise data, but we are able to form -certain probable conclusions. The population of a country in those ages -seems to have grown very slowly and sometimes even to have retrograded. -At the end of the sixteenth century the population of England and Wales -is estimated at five millions and at the end of seventeenth at six -millions,—only 20% increase during the century—although during the -nineteenth century the population nearly quadrupled. This very gradual -increase of the population seems to have been by no means due to a very -low birth-rate, but to a very high death-rate. Throughout the Middle -Ages a succession of virulent plagues and pestilences devastated Europe. -Smallpox, which may be considered the latest of these, used to sweep off -large masses of the youthful population in the eighteenth century. The -result was a certain stability and a certain well-being in the -population as a whole, these conditions being, however, maintained in a -manner that was terribly wasteful and distressing. - -The industrial revolution introduced a new era which began to show its -features clearly in the early nineteenth century. On the one hand, a new -motive had arisen to favor a more rapid increase of population. Small -children could tend machinery and thereby earn wages to increase the -family takings. This led to an immediate result in increased population -and increased prosperity. But on the other hand, the rapid increase of -population always tended to outrun the rapid increase of prosperity, and -the more so since the rise of sanitary science began to drive back the -invasions of the grosser and more destructive infectious diseases which -had hitherto kept the population down. The result was that new forms of -disease, distress, and destitution arose; the old stability was lost, -and the new prosperity produced unrest in place of well-being. The -social consciousness was still too immature to deal collectively with -the difficulties and frictions which the industrial era introduced, and -the individualism which under former conditions had operated wholesomely -now acted perniciously to crush the souls and bodies of the workers, -whether men, women or children. - -As we know, the increase of knowledge and the growth of the social -consciousness have slowly acted wholesomely during the past century to -remedy the first evil results of the industrial revolution. The -artificial and abnormal increase of the population has been checked -because it is no longer permissible in most countries to stunt the minds -and bodies of small children by placing them in factories. An elaborate -system of factory legislation was devised, and is still ever drawing -fresh groups of workers within its protective meshes. Sanitary science -began to develop and to exert an enormous influence on the health of -nations. At the same time the supreme importance of popular education -was realised. The total result was that the nature of “prosperity” began -to be transformed, instead of being, as it had been at the beginning of -the industrial era, a direct appeal to the gratification of gross -appetites and reckless lusts, it became an indirect stimulus to higher -gratifications and more remote aspirations. Foresight became a -dominating motive even in the general population, and a man’s anxiety -for the welfare of his family was no longer forgotten in the pleasure of -the moment. The social state again became more stable, and more -“prosperity” was transformed into civilisation. This is the state of -things now in progress in all industrial countries, though it has -reached varying levels of development among different peoples. - -It is thus clear that the birth-rate combined with the death-rate -constitutes a delicate instrument for the measurement of civilisation, -and that the record of these combined curves registers the upward or -downward course of every nation. The curves, as we know, tend to be -parallel, and when they are not parallel we are in the presence of a -rare and abnormal state of things which is usually temporary or -transitional. - -It is instructive from this point of view to study the various nations -of Europe, for here we find a large number of small nations, each with -its own statistical system, confined within a small space and living -under fairly uniform conditions. Let us take the very latest official -figures (which are usually for 1913) and attempt to measure the -civilisation of European countries on this basis. Beginning with the -lowest birth-rate, and therefore in gradually descending rank of -superiority, we find that the European countries stand in the following -order: France, Belgium, Ireland, Sweden, the United Kingdom, -Switzerland, Norway, Scotland, Denmark, Holland, the German Empire, -Prussia, Finland, Spain, Austria, Italy, Hungary, Serbia, Bulgaria, -Roumania, Russia. If we take the death-rate similarly, beginning with -the lowest rate and gradually descending to the highest, we find the -following order: Holland, Denmark, Norway, Sweden, Switzerland, the -United Kingdom, Belgium, Scotland, Prussia, the German Empire, Finland, -Ireland, France, Italy, Austria, Serbia, Spain, Bulgaria, Hungary, -Roumania, Russia. - -Now we cannot accept the birth-rates and death-rates of the various -countries exactly at their face value. Temporary conditions, as well as -the special composition of a population, not to mention peculiarities of -registration, exert a disturbing effect. Roughly and on the whole, -however, the figures are acceptable. It is instructive to find how -closely the two rates agree. The agreement is, indeed, greater at the -bottom than at the top; the eight countries which constitute the lowest -group as regards birth-rate are the identical eight countries which -furnish the heaviest death-rates. That was to be expected; a very high -birth-rate seems fatally to involve a very high death-rate. But a very -low birth-rate (as we see especially in the case of France) is not -invariably associated with a very low death-rate though it is never -associated with a high death-rate. This seems to indicate that those -qualities in a highly civilised nation which restrain the production of -offspring do not always or at once produce the eugenic racial qualities -possessed by hardier peoples living under simpler conditions. But with -these reservations it is not difficult to combine the two lists in a -fairly concordant order of descending rank. Most readers will agree, -that taking the European populations in bulk, without regard to the -production of genius (for men of genius are always a very minute -fraction of a nation), the European populations which they are -accustomed to regard as standing at the head in the general diffusion of -character, intelligence, education, and well-being, are all included in -the first twelve or thirteen nations, which are the same in both lists -though they do not follow the same order. These peoples, as peoples—that -is, without regard to their size, their political importance, or their -production of genius—represent the highest level of democratic -civilisation in Europe. - -It is scarcely necessary to add that various countries outside Europe -equal or excel them; the death-rate of the United States, so far as -statistics show, is the same as that of Sweden, that of Ontario, still -better, is the same as Denmark, while the death-rate of the Australian -Commonwealth with a medium birth-rate, is lower than that of any -European country, and New Zealand holds the world’s championship in this -field with the lowest death-rate of all. On the other hand, some -extra-European countries compare less favorably with Europe: Japan, with -a rather high birth-rate, has the same high death-rate as Spain, and -Chili, with a still higher birth-rate, has a higher death-rate than -Russia. So it is that among human peoples we find the same laws -prevailing as among animals, and the higher nations of the world differ -from those which are less highly evolved precisely as the elephant -differs from the herring, though within a narrower range, that is to -say, by producing fewer offspring and taking better care of them. - -The whole of this evolutionary process, we have to remember, is a -natural process. It has been going on from the beginning of the living -world. But at a certain stage in the higher development of man without -ceasing to be natural, it becomes conscious and deliberate. It is then -that we have what may properly be termed _Birth Control_. That is to say -that a process which had before been working slowly through the ages, -attaining every new forward step with waste and pain, is henceforth -carried out voluntarily, in the light of the high human qualities of -reason and foresight and self-restraint. The rise of birth control may -be said to correspond with the rise of social and sanitary science in -the first half of the nineteenth century, and to be indeed an essential -part of that movement. It is firmly established in all the most -progressive and enlightened countries of Europe, notably in France and -in England; in Germany, where formerly the birth-rate was very high, -birth control has developed with extraordinary rapidity during the -present century. In Holland its principle and practice are freely taught -by physicians and nurses to the mothers of the people, with the result -that there is in Holland no longer any necessity for unwanted babies, -and this small country possesses the proud privilege of the lowest -death-rate in Europe. In the free and enlightened democratic communities -on the other side of the globe, in Australia and New Zealand, the same -principles and practice are generally accepted, with the same beneficent -results. On the other hand, in the more backward and ignorant countries -of Europe, birth control is still little known, and death and disease -flourish. This is the case in those eight countries which come at the -bottom of both our lists. - - * * * * * - -Even in the more progressive countries, however, birth control has not -been established without a struggle which has frequently ended in a -hypocritical compromise, its principles being publicly ignored or denied -and its practice privately accepted. For at the great and vitally -important point in human progress which birth control represents, we -really see the conflict of two moralities. The morality of the ancient -world is here confronted by the morality of the new world. The old -morality, knowing nothing of science and the process of Nature as worked -out in the evolution of life, based itself on the early chapters of -Genesis, in which the children of Noah are represented as entering an -empty earth which it is their business to populate diligently. So it -came about that for this morality, still innocent of eugenics, -recklessness was almost a virtue. Children were given by God, if they -died or were afflicted by congenital disease, it was the dispensation of -God, and, whatever imprudence the parents might commit, the pathetic -faith still ruled that “God will provide.” But in the new morality it is -realised that in these matters Divine action can only be made manifest -in human action, that is to say through the operation of our own -enlightened reason and resolved will. Prudence, foresight, -self-restraint—virtues which the old morality looked down on with -benevolent contempt—assume a position of the first importance. In the -eyes of the new morality the ideal woman is no longer the meek drudge -condemned to endless and often ineffectual child-bearing, but the free -and instructed woman, able to look before and after, trained in a sense -of responsibility alike to herself and to the race, and determined to -have no children but the best. - -Such were the two moralities which came into conflict during the -nineteenth century. They were irreconcilable and each firmly rooted, one -in ancient religion and tradition, the other in progressive science and -reason. Nothing was possible in such a clash of opposing ideas but a -feeble and confused compromise such as we still find prevailing in -various countries of old Europe. It was not a satisfactory solution, -however inevitable, and especially unsatisfactory by the consequent -obscurantism which placed difficulties in the way of spreading a -knowledge of the methods of birth control among the masses of the -population. For the result has been that while the more enlightened and -educated have exercised a control over the size of their families, the -poorer and more ignorant—who should have been offered every facility and -encouragement to follow in the same path—have been left, through a -conspiracy of secrecy, to carry on helplessly the bad customs of their -forefathers. This social neglect has had the result that the superior -family stocks have been hampered by the recklessness of the inferior -stocks. - -Such is the situation to-day when we find America entering this field. -Up till now America had meekly accepted at Old Europe’s hands the -traditional prescription of our Mediterranean book of Genesis, with its -fascinating old-world fragrance of Mount Ararat. On the surface, the -ancient morality had been complacently, almost unquestionably accepted -in America, even to the extent of permitting a vast extension of -abortion—a criminal practice which ever flourishes where birth-control -is neglected. But to-day we suddenly see a new movement in the United -States. In a flash, America awoke to the true significance of the issue. -With that direct vision of hers, that swift practicality of action, and -above all, that sense of the democratic nature of all social progress, -we see her resolutely beginning to face this great problem. In her own -vigorous native tongue we hear her demanding: “What in the thunder is -all the secrecy about anyhow?” And we cannot doubt that America’s own -answer to that demand will be of immense significance to the whole -world. - - - _BIRTH CONTROL. MARY ALDEN HOPKINS, in Harper’s Weekly, 1915._ - -No one knows what the birth rate of the United States is, or what it -ever has been. Every European country knows its birth rate and its death -rate, because every birth and every death is registered. Where the -number of births, the number of deaths and the number of the population -are all known, it is an easy matter to calculate the rates per thousand. -But in the international tables of vital statistics our country’s -figures are omitted. - -Our 1910 census announced that 23 states had “fairly complete” death -registration. They recorded about 90% of their deaths. But the birth -registration situation was shocking. The New England States, -Pennsylvania and Michigan were the only acceptable states. The figures -for the cities of Washington, D.C., and New York City passed muster -also. The 1910 census birth rate is not yet published, but the 1900 -census made shift to figure it out by means of the number of the -population’s increase and the death rate. This would be surer if the -death rate were not itself approximate. However, the calculated rates -were, birth rate, 35.1 per 1000 population; death rate, 17.4 per 1000; -excess of births over deaths 17.7 per 1000. Comparing these rates with -the rates of the European countries for the same decade, we find -ourselves near the head of the list for high birth rate, near the foot -of the list for low death rate, and increasing faster than any other -nation. These figures leave nothing to be desired from an emotional -viewpoint. But they leave much to be desired in the way of accuracy. In -addition to our lack of statistics we are confused by the effect of -immigration. - -The birth rate of every civilized country is falling. The following -comparison of national birth rates is based on the ten largest countries -of Europe. The less important ones show the same general -characteristics. Asiatic countries must be excluded as they have no -reliable vital statistics. The United States must be considered -separately because both our mortality records and our birth registration -are so defective that only approximate calculations can be made. The -maximum birth rate preceding the present decline occurred in France -1811–20; in Norway, Sweden, Finland, Austria and Prussia 1821–30; -Belgium 1831–40; Denmark 1851–60; Scotland and Spain 1861–70; England, -Wales, Ireland, Hungary, Switzerland, Germany, Bavaria, Saxony, and the -Netherlands 1871–80; Portugal, Italy, Serbia and Roumania, 1881–90. - -The figures of the following table are taken from the Report of the -Registrar General of Great Britain for 1910. Five year periods are used -in place of single years to eliminate variations of exceptional years. - -Seventy-third Annual Report of the Registrar-General of Births, Deaths -and Marriages in England and Wales, 1910, London. Pub. by His Majesty’s -Stationery Office. Printed by Darling and Sons, Ltd., Bacon St., E. -London. 1912. - - - Yearly Number of Births per 1000 - Inhabitants. - - 1881–5 1906–10 - Russia (European) 49.1 47.7[4] - Hungary 44.6 36.7 - German Empire 37.0 34.3[4] - Spain 36.4 33.6 - Austria 38.2 33.6 - Italy 38.0 32.6 - The Netherlands 34.8 29.6 - Belgium 30.7 27.7[4] - England and Wales 33.5 26.6 - France 24.7 19.7 - -Footnote 4: - - Figures for previous five years. - -The countries are arranged in order of their 1906–10 rates. - -By subtracting the figures in the second column from the first we obtain -the fall in the rates between 1881–5 and 1906–10. Russia, in 1910, had -the highest birth rate, and had suffered the slightest diminution, only -1.4 per thousand. Curiously Hungary, standing second in line, showed the -greatest fall, 7.9. England and Wales, far down the scale, had a drop of -6.9 per thousand. Italy, The Netherlands, France, and Austria kept a -fairly even pace with a fall of around 5. Belgium, Spain, and the German -Empire lost only about 3 per thousand. - -Much discussion has arisen concerning the cause of this decline. Two -distinct stages occur in the fecundity of animal life. In the species -below the human race it is checked by biological causes. In the human -race it is checked by social and economic causes. As the scale of life -rises, the number of offspring become fewer. The higher the animal, the -fewer the offspring. - -When we reach the human animal, we find in addition to pestilence, war, -and “acts of God,” various forms of voluntary check. Semi-civilized -countries manage the affair rather crudely; in India the Ganges is -hardly yet free from infant corpses, and in China girl babies show an -assisted mortality. More civilized countries limit the birth rate more -felicitously, reducing the number of marriages and advancing the age of -marriage, by imposing social, ethical, and financial obligations. This -decreases the number of possible children. These indirect checks held -back the increase of population so slightly, evenly and over so long a -period as to be hardly perceptible. In the seventies appeared a -phenomenon of spectacular novelty—the small family. Harmless methods of -contraception had been perfected, the knowledge disseminated, and the -means supplied. The birth rate, which had slowly declined through aeons, -from eggs by the millions to yearly babies, dropped with dizzying -rapidity. - -As the birth rates of the nations fall, so fall the death rates. Here -are the death rates for the same ten nations for the same years as the -previous birth rate table. - - - Yearly Number of Deaths per - 1,000 Inhabitants - - 1881–5 1906–10 - Russia (European) 35.4 30.9[5] - Hungary 33.1 25.0 - Spain 32.6 24.3 - Austria 30.1 22.3 - Italy 27.3 21.0 - German Empire 25.3 19.9[5] - France 22.2 19.2 - Belgium 20.6 17.0[5] - England and Wales 19.4 14.7 - The Netherlands 21.4 14.3 - -Footnote 5: - - Figures for previous five years. - -A comparison of the two tables shows immediately that the countries -having the highest birth rate have also the highest death rate. Russia, -which heads the list in births, heads the list in deaths. Hungary comes -second in both lists. Next come, in a slightly altered order, the four -countries, German Empire, Spain, Austria and Italy. An exception occurs -in France which has the unusual combination of a low birth rate and a -medium death rate. Belgium, and England and Wales occupy the same -position in both lists with low birth rates and low death rates. The -Netherlands is the notable country with its medium birth rate and its -low death rate. The Neo-Malthusians love to mention at this point that -this country has governmental encouragement in teaching contraception. - -The increase of a country is the difference between its birth rate and -its death rate. The population of a country depends, not upon its birth -rate, but upon its birth rate, minus its death rate. If the two are -identical, the population is stationary. This happened in France in the -1891–5 period. The number of births per thousand inhabitants was exactly -the number of deaths per thousand inhabitants. The rest of the world -tolled the knell for France. But France instead of declining into the -have-been nations showed that a controlled birth rate can be raised as -well as lowered. Slowly and apparently intentionally she raised her rate -during the succeeding years. - -Decline and rise of French Birth rate: 1881–5, 2.5; 1886–90, 1.1; -1891–5, 0.0; 1896–1900, 1.2; 1901–5, 1.6; 1906–10, .7. Nor has France -since those early nineties allowed her birth rate to fall below her -death rate. - -The populations of European nations are increasing, because the death -rates are falling faster than the birth rates. - -If we subtract the deaths per thousand inhabitants, given in the second -table, from the births per thousand inhabitants given in the first -table, we shall have the natural rate of increase. In every single case -the number of births is greater than the number of deaths—so every -country is increasing in population. - - - Natural Increase in Population - per 1,000 Inhabitants - - 1881–5 1906–10 - Russia (European) 13.7 16.8[6] - The Netherlands 13.4 15.3 - German Empire 11.7 14.4[6] - Hungary 11.5 11.7 - England and Wales 14.1 11.5 - Italy 10.7 11.4 - Austria 8.1 11.3 - Belgium 10.1 10.7[6] - Spain 3.8 9.3 - France 2.5 .7 - -Footnote 6: - - Figures for previous five years. - -From the second column we find that Russia is increasing most rapidly. -The Netherlands comes second in rate of increase—an honorable position -to which the regulationists point triumphantly when they assert that -control of the birth rate does not mean the ruin of the nation. The -German Empire comes next, with Hungary following. England stands fifth -in the rating of increase, and England takes the position with woeful -lamentations. Italy, Austria, Belgium, and Spain are near the foot of -the list, and France brings up the rear a long, long way behind. France -is the only one that is anywhere in sight of a stationary population. - -Excepting France and England, every one of these countries is increasing -at a faster rate than formerly, because though the birth rate has fallen -fast, the death rate has fallen faster. By comparing the second column -showing the increase in the 1906–10 period with the first column showing -the increase in the 1881–5 period, in the preceding table, we see how -much each country is gaining in her rate of increase. This increase may -or may not be considered desirable according to whether one wishes to -conserve the food supply or increase the army. To every one it presents -an interesting condition. It is unexpected to find with a falling birth -rate an increasingly increasing population,—always excepting France and -England. - - - FROM “THE EMPIRE AND THE BIRTH-RATE” - - BY C. V. DRYSDALE, _D.Sc._ - -When we are considering the growth of population it is not the _births_ -but the _survivals_ that count; and it is a remarkable fact, of which -illustrations will appear anon, that comparatively few of those who have -made strong remarks on the birth-rate question seem to have realised -this. The child that perishes before entering on a productive existence -is not an asset to the numbers or efficiency of the community, but a -drain upon it for which there is no compensating gain. - - - VARIATIONS OF POPULATION, BIRTH-RATE, &c., IN THE BRITISH EMPIRE - -We shall now study the principal parts of our Empire _seriatim_, and it -will suffice if we consider Great Britain and Ireland, Australasia, -Canada, South Africa, and India. - -_England and Wales._—Special attention should be given to this diagram -(Fig. 2), as, apart from England’s intrinsic Imperial importance, it -exhibits changes typical of those taking place in the majority of -civilised countries at the present time. Our Registrar-General’s Reports -give us figures starting from the year 1853, and it will be seen that -there was a fairly definite rise in the birth-rate till the year 1876, -after which there set in that rapid and steady decline which we hear so -much about to-day. - -As to the cause of this remarkable decline, it is now pretty generally -known that the chief factor is the voluntary reduction of the fertility -rate (the average number of children to a marriage). Further, the -decline has been largely a class one, affecting first the richer and -more cultured classes, rapidly extending through the various grades of -the middle classes until it has now reached the skilled artizans, but -not the poorest and most unskilled laborers. - -The evidence for these contentions is briefly (_a_) that just before the -year 1876 an actuarial enquiry made by Mr. Ansell on behalf of the -National Life Assurance Society revealed the fact that the average -number of children to a family in the upper and professional classes at -that time was somewhat over five, while the average for the whole -population was 4.63 according to the Registrar-General’s Report; (_b_) -that the birth-rate reckoned on the number of married women has since -fallen from 304.1 per thousand in 1876 to 196.2 in 1911; (_c_) that -families are now notoriously very small among the professional classes; -and (_d_) that the birth-rate in some of the poorest districts of our -large towns is still about as high as it was in 1876. We have not yet -got the detailed returns of families for the census of 1911 in England -and Wales; but for Scotland, where the variations in the birth-rate have -been very similar, Dr. J. C. Dunlop, in a paper read before the Royal -Statistical Society the other day, gave these details. The average -number of children to a family among the poorest unskilled laborers is -still about seven, while it is only 3.91 for medical practitioners, 4.33 -for the clergy, and 3.76 for army officers. - -[Illustration: FIG. 1.—POPULATION OF VARIOUS COUNTRIES.] - -_VARIATIONS IN BIRTH RATE &c., IN ENGLAND & WALES_ - -[Illustration: FIG. 2.—ENGLAND AND WALES.] - -[Illustration: FIG. 3.—IRELAND.] - -Turning at once, however, to the accompaniments of these changes in the -birth-rate, we find that the death-rate has also shown very decided -changes, although the temporary fluctuations prevent our locating them -with the same precision. For between fifteen and twenty years after 1853 -the general deathrate was approximately stationary, or perhaps slightly -rising; but since then there has been a rapid and steady fall from about -22 per thousand to a little over 13. The infantile mortality, after -various minor fluctuations, has fallen very rapidly since 1900. The net -result of these changes is that the rate of natural increase of -population (excess of birth-rate over death-rate) during the last five -years has averaged 11 per thousand, which is nearly the same as in the -first five years 1853–57, when it was 11.7 per thousand, although it -temporarily increased to 14.3 per thousand in the quinquennium 1874–78. -The cry of “depopulation” or of “race suicide” has little more -justification to-day when our birth-rate is only 24 and the average -family probably between three and four children than it had in 1855 with -a birth-rate of 34 and an average of 5 births per marriage. In an -article in the _Daily Telegraph_ of January 17 last, a writer pointed -out that mortality was very high among the large families of the -seventeenth and eighteenth centuries, and asked: “If to lose half, or -more than half, their children was common among well-to-do people, how -did poor folks fare?” - -The actual rise of the population, after allowing for migration, is, of -course, given by the census returns. Fig. 1 shows the variation of the -total population of the United Kingdom and of England and Wales, from -1850 onwards. - -Many of you will have heard alarmist statements from various quarters to -the effect that our population is rapidly becoming stationary owing to -the combined results of a declining birth-rate and an accelerated -emigration. In the _Fortnightly Review_ for February last an article on -“The Danger of Unrestricted Emigration,” by Mr. Archibald Hurd, -contained a characteristic statement of this kind:—“The population of -Ireland and Scotland is rapidly declining, and that of England and Wales -is now practically stagnant, the natural increase only slightly -exceeding the outflow due to emigration.” - -We will deal with Ireland in a moment; but as regards both England and -Wales and Scotland the statement appears entirely unwarranted. The -actual increase of population in England and Wales between the censuses -of 1901 and 1911 was 10.9 per cent., which is only a little below the -“natural” increase (in Wales it reached the unprecedentedly high -increase of 18.1 per cent.); while in Scotland the actual increase of -population was 6.4 per cent. over the decade. Probably these alarms were -due to consideration of emigration apart from immigration or from return -of our own emigrants.[7] The actual increase of population for the whole -of the United Kingdom was 9.1 per cent.; and this has only been exceeded -twice in the past six decades. - -Footnote 7: - - Further investigation appears to indicate that the official statistics - concerning emigration and immigration are very unreliable. The - Statistical Abstract for the United Kingdom for 1912 gives the total - emigration in the ten years 1901–10 as 4,724,233, and the total - immigration 2,409,490, leaving an outward balance of 2,314,723. In the - same period there were 11,628,493 births and 6,780,266 deaths, giving - a natural increase of 4,848,227; and since the actual increase by the - census returns was 3,757,944, the net loss by emigration could only - have been 1,091,283 or less than half of the officially recorded - number. Thus it appears that little over one-fifth of our natural - increase is lost by emigration. (Since writing this, I find the - Registrar-General admits the returns prior to 1908 were defective.) - -We need not consider Scotland further, as its variations resemble those -of England and Wales. - -[Illustration: FIG. 4.—AUSTRALIA.] - -[Illustration: FIG. 5.—NEW ZEALAND.] - -[Illustration: FIG. 6.—ONTARIO, CANADA.] - -[Illustration: FIG. 7.—TORONTO.] - -_Ireland._—Ireland’s statistics differ so much from those of most other -countries that they merit special consideration. In Fig. 3 are shown the -variations of its birth and death-rates. From these it appears that, for -many years past, Ireland has had very low but practically steady -birth-and death-rates. On further studying the matter, however, we find -that Ireland’s low birth-rate is not due to small families, but to a low -marriage rate (probably due to immigration of young people). The -fertility rate of its women has remained high and steady, 283 per -thousand in 1881, and 289 in 1901. The excess of births over deaths has -averaged 6 per thousand recently, although it was much higher forty-five -years ago. But the terrible poverty succeeding the famine produced the -great tide of emigration which has reduced the population from eight to -little over four millions. It should be observed, however, that it is -late in the day to deplore the depopulation of Ireland, _as it has now -practically ceased_. The fall of population was 11.8 per cent. between -the censuses of 1851 and 1861, but only 1.7 per cent. between those of -1901 and 1911; while in the closing years of the decade, the -Registrar-General’s returns gave the population as almost exactly -stationary. It is highly probable that the next census will show an -increase in the population of Ireland for the first time since 1846. - -We may now turn to the various parts of our Empire overseas, and it will -be sufficient if we consider the four principal divisions: Australasia, -Canada, Union of South Africa, and India. The order is chosen as dealing -with the populations of British origin first. - -_Australasia._—Australia and New Zealand both call for particular -attention in this connection, as family limitation appears to be very -general in them, and many authorities have spoken about it in strong -terms. Mr. Roosevelt, for example, wrote as follows in 1911: “The rate -of natural increase in New Zealand is actually lower than in Great -Britain, and has tended steadily to decrease; while Australia increases -so slowly that, even if the present rate were maintained, the population -would not double itself in the next century.” - -Again, the Bishop of London, last year appears to have told the -North-West Australian Diocesan Association “that the birth-rate in -Australia is going down even more rapidly than at home (United Kingdom), -and that he did not know how we are going to keep Australia even -British.” - -In addition to these grave warnings, fears have been continually -expressed concerning the danger of Australia from the Japanese or -Chinese. We are told also that from the industrial point of view -Australia is calling out for population; and a law giving a bonus of £5 -for each child was passed a twelve-month ago. It would appear, -therefore, that the birth-rate question is a very serious one in -Australasia, especially when we are aware that determined attempts at -checking the resources of family limitation have signally failed. - -Let us now examine the actual figures for the variation of the -birth-rate, etc., and compare them with the above statements. These are -given in Figs. 4 and 5. - -In both countries the birth-rate fifty years ago was remarkably high -(well over 40 per thousand), and it has since fallen very rapidly to 26 -or 27 per thousand. But in both of them the death-rate has fallen -somewhat, and they now have the lowest death-rates in the world, that of -New Zealand having been about 9.5 per thousand for many years past. So, -instead of increasing slowly, _their rate of natural increase by excess -of births over deaths is actually the highest in the world (with the -possible exception of Bulgaria)_. The natural increase of New Zealand -during the last five years has been more than 50 per cent. greater than -in Great Britain, instead of being less, as stated by Mr. Roosevelt; and -instead of the birth-rate going on falling, it has, on the contrary, -risen lately. The natural increase of Australia is 16 per thousand, -which would cause the population to double in forty-four years, or to -become five times as large in a century. The Australian birth-rate has -been well maintained during the past seven years, and the death-rate has -slightly declined; so the natural increase has slightly accelerated. - -The foregoing statements are, of course, quite independent of -immigration, and the following are the actual census figures for the -increase of population. - - - 1860 1870 1880 1890 1900 1910 - - Australia, 1,145,585 1,647,766 2,231,531 3,151,355 3,765,339 4,425,083 - population - - Per cent. - increase 43.8 35.5 41.2 19.5 17.5 - in decade - - New Zealand, 625,508 768,278 1,002,679 - population - - Per cent. - increase 22.6 30.5 - in decade - -It is worthy of note that in Australia, which is supposed to be needing -population so much, the actual increase in the last two decades has been -only slightly in excess of the natural increase. This means that the net -immigration must have been very small, or that nearly as many people -must have left Australia as entered it—a curious commentary on the -alleged need for them.[8] New Zealand, on the other hand, shows a -phenomenally large increase by the combination of natural increase and -immigration. - -Footnote 8: - - In the five years 1901–05 there was an actual net loss of over 16,000 - persons by excess of emigration. - -It will be well at this point to examine the justification for the -yellow peril theory as regards Australia. Japan has certainly moved in -the opposite direction to Australia in having increased its birth-rate -from 26 to 33 per thousand between 1891 and 1910. But its general and -infantile mortality have also increased. Thus its natural increase -to-day is only 12.5 per thousand as against the 16 or 17 per thousand of -Australia and New Zealand, while its actual rate of increase is far -short of theirs. Although the population of Japan is about ten times -that of the whole of Australasia, every year makes the proportionate -disparity of numbers less instead of greater; while as regards health, -physique and financial resources, the advantage, of course, lies heavily -with our people. That Australasia will be well advised to look to her -defences may be granted; but there seems no reason whatever to be -dissatisfied with the increase of her population. - -_Canada._—Little can be said about this part of our Empire, owing to -paucity of statistical information; but that little is most interesting -and significant. As regards the total population, the census returns -show a very rapid increase, that of 34 per cent. (from 5,371,315 in 1901 -to 7,204,838 in 1911) being without parallel in modern times. When we -come to consider the birth-rate, however, a remarkable phenomenon -appears. The only part of the Dominion for which vital statistics appear -to be available is the Province of Ontario. Fig. 6 shows that the -birth-rate of Ontario was only 22 or 23 per thousand in the eighties, -and actually dropped to 19 in 1895, since then it has recovered (owing -to an increased marriage-rate) to about 25 per thousand. Its lowest -birth-rate was equal to that of France to-day. But the death-rate had -also fallen—namely, to 10 per thousand, so that the natural increase was -9 per thousand, or not much behind that of most civilised countries. -This fact may be commended to the consideration of those who think that -the slow rate of increase of the French population is due to its low -birth-rate. - -The remarkable phenomenon now appears. The increase of the birth-rate in -Ontario to 25 per thousand has been accompanied, not by a corresponding -rise in the natural increase, but by an increase of the death-rate to 14 -per thousand! So the additional births appear to have populated the -graveyards rather than the country. It has been suggested to me by Dr. -Stevenson that the increase in the birth and death rates of Ontario may -be exaggerated, in that due allowance has not been made by the Canadian -authorities for the effect of immigration. But even making the fullest -allowance for this, there can be no doubt that both the birth and death -rates have risen, and by nearly the same amount. The city of Toronto -(Fig. 7) is a most striking example of the same phenomenon. - -There need be no great difficulty in understanding this result. We have -continually heard in the papers recently of poverty and unemployment in -most of the large towns of Canada. Although the resources of the country -are no doubt enormous, they can only be brought relatively slowly into -operation, owing to the shortness of the summer and the difficulties of -transport. The frequently quoted statement that her food exports show -signs of lessening indicates that the inability of food to keep pace -with an unrestricted population will prove true here as elsewhere. - -Canada offers excellent opportunities for sturdy efficient workers, and -will be able to support an immense population some day. But any attempt -to crowd it rapidly with children or inefficient town-bred immigrants -will only raise the death-rate, unemployment and labor unrest. The lives -of women settlers are generally exceedingly strenuous and trying; and -this, in combination with the long distances from medical or other help, -makes the bringing up of large families very precarious. - -_South Africa._—Beyond the fact that the population of the Union of -South Africa increased from 5,175,824 in 1904 to 5,973,394 in 1911 -(i.e., an increase of 15.4 per cent. in seven years) little information -appears to be available. The white population seems to have increased -from 1,116,806 to 1,276,242 (i.e., by 14.28 per cent.) in the interval, -while the native population increased from 3,491,056 to 4,019,006 (i.e., -by 15.12 per cent.). But since no figures as to birth-rates are -available nothing can be said beyond the fact that the actual increase -works out at about 20 per thousand per annum, which is fairly high. - -_India._—We now turn from colonies mainly occupied by our own race and -exhibiting our modern characteristics to a most marked degree, and come -to our great Eastern possession which has preserved the ancient -traditions of rapid reproduction. Writer after writer has launched into -panegyrics on “the glorious fertility of the East,” and the Bishop of -Ripon a few years ago issued this impressive warning: “Learn from the -East. If we could but bring ourselves to do so, perhaps at no very -distant period the Yellow Peril might turn out to be the White -Salvation.” - -That India is a country of high birth-rate is of course notorious. The -custom of almost universal child marriage, and the anxiety which -prevails among some (apparently not all) of the religious sects for a -large posterity would alone render this inherently probable. According -to the Statesman’s Year Book for 1913 the average birth-rate for India -in the three years 1908–10 was 37.7 per thousand. This, however, was -“officially but imperfectly recorded,” and the census report for 1901 -gave the probable birth-rate for India as 48.8 per thousand. This figure -is not at all an unlikely one, for the same rate has prevailed in Russia -and parts of Egypt; but such figures as have appeared in the 1911 census -report seem to confirm the lower estimate. Here are the figures for -three of the important provinces:— - - - Total for decade Percentage of Excess Actual - 1901–11 Population Births, – Increase - 1901 Deaths - - Births Deaths Births Deaths - - Bengal, Behar 29,351,442 25,373,322 39.10 33.80 3,978,120 4,552,293 - and Orissa - - Punjab 8,286,261 8,843,708 40.8 43.5 –557,447 355,383 - - Assam 1,883,545 1,564,022 35.70 29.65 319,523 489,892 - -It is possible that these figures are correct, even without any -restraint upon births, as the census report of 1901 mentioned that -premature and repeated maternity combined with chronic under-nutrition -appeared to lead to exhaustion and loss of fertility. In any case, -however, the birth-rate counts among the highest at the present day. - -But when we turn to the death-rate and the natural and actual increase -of population there seems little reason for congratulation. The -death-rate, given by the Statesman’s Year Book, for the three years -above quoted was no less than 34.3, leaving a natural increase of only -3.4 per thousand—the lowest in our Empire, and nearly as low as that of -France. The figures for Bengal, etc., above only show a natural increase -of 4.7 per thousand, half that of Ontario at its lowest birth-rate of 19 -per thousand; those for the Punjab reveal, despite the high birth-rate, -an actual diminution of population by excess of deaths over births. - -The emigration from India appears to be so infinitesimal in comparison -with its population that the actual increase represents the natural -increase almost exactly. In Fig. 1 is shown the variation of population -in the whole of India and in the British Provinces according to the -census returns. - - - 1872 1881 1891 1901 1911 - - Total 206,162,360 263,896,330 287,314,671 294.361.056 315.001.099 - population - - Per cent. - increase 23.1 13.1 2.4 7.0 - in decade - - British 195,840,000 199,200,000 221,380,000 231,600,999 244,279,888 - Provinces - - Per cent. - increase .08 1.6 11.0 4.5 5.5 - in decade - -Thus the rate of increase of population has been exceedingly slow except -as regards the totals for 1881 and 1891, and for the British Provinces -in 1891. But the Census Commissioners themselves state that the first -few enumerations rapidly increased in completeness, which probably -accounted for a good deal of the two former increases; while as regards -the British Provinces, there was an increase in area of no less than 25 -per cent. between 1881 and 1901, which heavily discounts the increase of -11 per cent. in population in 1891. The average increase in the British -Provinces comes out at only 4.3 per cent. per decade over the whole -period from 1861 to 1911; so when the increase of area is taken into -account it may be doubted whether there has been any great excess of -births over deaths at all. - -A more absolute contradiction to the theory that a “glorious fertility” -produces numbers and vigor it would be difficult to conceive. India is a -land of famine. We all know of the terrible holocausts of 1876–8 when -over five million perished, and that of 1899–1901, which was held -responsible for over a million deaths, besides numerous smaller ones. -But as Mr. W. S. Lilly has written in _India and its Problems_, “We may -truly say that in India, except in the irrigated tracts, famine is -chronic—endemic. It always has been.” Sir Frederick Treves in his -charming work, _The Other Side of the Lantern_, has expressed the same -opinion, and he says:—“These are some of the great hordes who provide in -their lean bodies victims for the yearly sacrifice to cholera, famine, -and plague.” The average death-rate of 34.3 per thousand, which is -probably underestimated, means, with a population of 315 millions, over -ten million deaths annually. Were the Indian death-rate 10 per thousand -as in Australasia, there would be only three million deaths. Hence, -unless medical authorities can give good reason for postulating an -inherent racial predisposition to premature death among the inhabitants -of India, this means that at least seven millions of lives are wasted -annually by starvation or the diseases to which it renders them an easy -prey. - -There can be no doubt in the mind of anyone who studies the figures, -that India is a chronically, seriously over-populated country, despite -the oft-quoted dictum of Sir William Hunter. That India might produce -food enough to feed her present population need not be contested. But -that any action on the part of the authorities will succeed in providing -for an increase of ten millions annually is inconceivable. The whole -Empire owes a tribute of gratitude and admiration to Sir A. Cotton whose -magnificent irrigation schemes have so greatly increased the -possibilities of agriculture. They have no doubt been the real cause of -the 7 per cent. increase of population in the last decade. This, -however, only means providing for two out of the seven millions to be -saved; and irrigation like everything else has its limits.[9] Nothing -will remove starvation, pestilence, misery and unrest from India, except -the adoption by her people of the parental prudence of western nations. - -Footnote 9: - - In the article on India in the “Encyclopaedia Britannica” it is stated - that the Irrigation Commission of 1901–03 emphatically asserted that - irrigation alone could not cure famine. - -The idea has been constantly put forward that the religious prejudices -of the Indian population make such a contingency impossible. Is it -certain, however, that this is so? The Census Report of 1901 suggested -that in Assam some restraints upon births had been in vogue. In 1911, -again, the Vice-President of the Calcutta Municipality, Babu Nilambara -Mukerji, M.A., called attention to the extreme poverty caused by -over-population, and strongly advocated such restraints. His address -seems to have been received with considerable favor, and I have been -asked to write articles for prominent native papers on the subject. - -The project of encouraging emigration from India has, of course, been -put forward. But the recent experiences in South Africa and elsewhere -hardly favor this proposition, and Mr. Archer in an interesting article -on “India and Emigration,” in the _Daily News_ of December 26, pointed -out that the real difficulty of over-population could not be appreciably -lessened in this way. - -_Ceylon._—In view of the foregoing, reference may be made to Ceylon -which has published its birth and death rates continuously since 1881, -though I do not know what reliance can be placed on them. Fig. 8 shows -that the birth-rate has rapidly risen from 27 to 41 per thousand, but -that the death-rate and infantile mortality have also greatly increased. - -_The Empire._—The top line in Fig. 1 shows the increase of the -population of the whole of our Empire according to the Statistical -Abstract just issued. The figures are as follows:— - - - Census 1891 1901 1911 - Population 345,356,000 385,572,000 417,268,000 - Per cent. increase in decade 11.6 8.3 - -Of course the increase from 1891 to 1901 was swelled by the addition of -the Union of South Africa, etc., but the addition in the second period -probably fairly represents the natural increase. The countries which go -to swell this increase are those in which small families are the rule, -and have rates of increase varying from 11 to 17 per thousand. It is -India with the highest birth-rate which pulls down the average. - -The population of the world is now probably about 1,800,000,000, and -increasing at the rate of 5 per cent. or 6 per cent. in a decade. So our -Empire includes about a quarter of the world’s population and is -increasing more rapidly than the remainder. - - - OTHER COUNTRIES - -No consideration of this subject would be complete if comparison were -not made with the more important nations outside our own Empire. If -Imperialist security depends upon numbers, it is relative, not absolute, -numbers which count, and our attitude towards the falling birth-rate -must depend upon what is happening among our rivals. - -_France._—The case of France appears to be the chief cause of the fears -concerning the declining birth-rate, and she is variously spoken of as -“dying,” “becoming depopulated,” “decadent,” etc. In Fig. 9, I have -collected the vital statistics for France over the whole period of her -declining birth-rate, i.e. from before the Revolution. They show the -following characteristics:— - -1. France is _not_ becoming depopulated. Her population has been slowly -but steadily rising ever since the Franco-German war, both actually and -by excess of births over deaths, although in some years the deaths have -exceeded the births. - -2. The excess of births over deaths in the last decade 1901–10, though -small, is double that of the previous decade, notwithstanding that the -birth-rate fell from 22.2 to 20.6. It averaged about 48,000 per annum. - -3. In 1781–84, before the decline of the birth-rate set in, the -birth-rate had the high value of 38.9 per thousand. But instead of this -giving a high natural increase of population, the death-rate was no less -than 37 per thousand, giving an excess of births over deaths of only 1.9 -per thousand—little more than that (1.2) of the last decade. - -4. The enormous fall of the birth-rate from 38.9 to 20.6 per thousand, -has been accompanied by a fall in the death-rate from 37 to 19.4 per -thousand. Thus a fall of 18.3 in the birth-rate has been accompanied by -a fall of 17.6 in the death-rate, and only a drop of .7 per thousand in -the rate of increase. - -[Illustration: FIG. 8.—CEYLON.] - -[Illustration: FIG. 9.—FRANCE.] - -[Illustration: FIG. 10.—GERMANY.] - -[Illustration: FIG. 11.—BERLIN.] - -5. The present low rate of natural increase in France is not necessarily -due to its low birth-rate, as Ontario in Canada, with a similar -birth-rate, had a death-rate of 10 per thousand, or a natural increase -of 9 per thousand—nearly as great as our own. The low increase of France -is therefore due to its high death-rate, not to its low birth-rate, and -an explanation or remedy should be found for the former before objection -is made to the latter. - -6. Possibly as a result of the present agitation in France in favor of -large families, the births in the first half of last year increased by -8,000 over those of the corresponding period of 1912. _Instead of -producing a greater increase of population, the deaths increased by -12,000, so that the survivals actually diminished._ - -It appears from the foregoing that while it is true that France is -increasing in population much more slowly than other countries, there is -no justification for believing that an increased birth-rate would -populate it more rapidly. Much more likely is it that the result would -be the same as that shown in Ontario and other countries—a higher -death-rate without any advantage as regards numbers. - -_Germany._—As France is held up as the awful example of a low -birth-rate, so is Germany regarded as the good example of a high one. It -is certainly fear of Germany that is responsible for so much of the -anxiety concerning our birth-rate. - -That the population of Germany is increasing very rapidly is quite true, -and it certainly has also a relatively high birth-rate. (Fig. 10). But -the birth-rate has fallen rapidly since 1876, and despite this the -natural increase of population has actually accelerated, because the -death-rate has fallen still more rapidly. As the German death-rate is -still considerably above the 9 or 10 per thousand line, there is plenty -of room for this process to continue. The curve of actual increase of -population in Fig. 1, shows that it has become exceedingly high of late -years, despite the great fall in the birth-rate. - -Those, however, who still think that Germany’s high birth-rate is a -source of advantage to her may be consoled to know it will not continue -long. The fall in the last few years has been phenomenal; and the -statement made in a German paper a few days ago that at the present rate -the German birth-rate will be down to that of France in ten years’ time -appears to be justified. The birth-rates of her large towns are already -close to this point (Berlin 20.4, Hamburg 21.8, Dresden 20.2, Munich -21.9, while that of London is still about 24) and the country districts -are sure to follow. But the example of Berlin is a most striking one as -to the fallacy of regarding high birth-rates as conducive to rapid -increase. Fig. 11 shows that the birth-rate of Berlin rose with great -rapidity from 32 per thousand in 1841 to over 45 in 1876, since when it -has fallen even more rapidly. But, neglecting sudden variations due to -war and epidemics, the death-rate has risen and fallen in such close -correspondence as to produce comparatively little change in the rate of -natural increase. The variation of the infantile mortality is very -similar. On all grounds, therefore, it seems difficult to see what -advantage Germany has derived from her high birth-rate, and the -disadvantages were so obvious that it is little wonder that the German -people have decided in favor of a low one. - -_Austria_ shows very similar variations to Germany. - -_Russia._—Russia has the largest population of any European nation, -120,588,000 in 1911. Its birth-rate for many years was the highest in -the world, very nearly 50 per thousand. But its death-rate and infantile -mortality have been the highest in Europe, so that its rate of increase -of population, though rapid, has been less than that of New Zealand or -Australia. Over two millions of unnecessary deaths have taken place -annually, and one infant in every four (or over a million annually) dies -in its first year. The war with Japan, a country of half its population -and a much lower birth-rate, strikingly illustrated the inefficacy of -mere numbers. In the _Standard_ of March 6, it was stated that although -the general recruiting standard in Russia is lower than in Austria, -France, Germany, or Great Britain, the rejections in many localities -reach the enormous figure of 70 per cent. - -_The Netherlands._—The foreign countries already dealt with are quite -sufficient to give us a fair idea of our position among the great powers -as regards the birth-rate question. No thoughtful person, however, can -fail to see that this has another aspect which has generally been quite -overlooked. It will therefore be of special interest to study the record -of a nation in which this has been kept in view for many years. Holland -is an intensely patriotic country, and its need for military efficiency -is beyond dispute. It is inconceivable that her statesmen could -contemplate a policy in any way detrimental to this. Yet it appears that -in 1881 an organisation having as its direct object the reduction of the -birth-rate, especially among the poor, was formed in Amsterdam, and that -it received the warm support of Dr. van Houten, Minister of the -Interior, and of Mynheer N. G. Pierson, the Finance Minister. It was -thus enabled to conduct an energetic propaganda in favor of small -families among the poorest classes, whose means or health did not permit -them to do justice to large families. In 1895 its work had become so -appreciated that it was approved by Royal Decree as one of the Societies -of Public Utility. To-day it is a large and flourishing association with -medical and other helpers in all the great centers. Thus in Holland the -diminution of the birth-rate has been favored and directed on -humanitarian and eugenic lines; and there has been a tendency for the -State to become more individualistic in character, rather than to adopt -that policy of State assistance which has been forced on most other -nations by the gravity of their social problems, and which, by pressing -on the educated classes, has led them seriously to restrict their -numbers. - -The results of their policy as regards the numbers and health of the -population can be seen from Fig. 12. The birth-rate has fallen steadily -and rapidly, especially in the last decade. The death-rate, however, has -fallen so much more rapidly, that it has now reached 12.3 per thousand -in 1912—the lowest figure in Europe; and the natural increase has -reached 15.7 per thousand, the highest figure in Western Europe. The -infantile mortality has also fallen more rapidly than in any other -country. Indeed, Amsterdam and The Hague, the principal centres of the -propaganda, had the lowest general and infantile mortality of all the -great cities of the world, according to our Registrar-General’s Annual -Summary for 1912. - -[Illustration: FIG. 12.—THE NETHERLANDS.] - -When we turn from the question of numbers to the physical and social -condition of the people, the results are even more gratifying. Those who -have traveled in Holland will, I think, admit that the country looks -prosperous, and the men, women and children robust and contented. Slums -such as we have in our great cities seem practically non-existent; nor -is there any sign of the stunting and anaemia so noticeable in our large -towns, and even in our countryside. Dr. Soren Hansen in the Eugenics -Congress of 1912 stated that the average stature of the Dutch people had -increased by four inches in the last fifty years. The army records given -in the official Year Book of the Netherlands are also most striking. The -number of young men drawn annually for conscription by lot has increased -from 27,559 in 1865 to 48,509 in 1911 (out of a population of -6,000,000); and of these the proportion over 5 ft. 7 in. in height has -increased from 24.5 per cent. to 47.5 per cent., while that of those -under 5 ft. 2½ in. has fallen from 25 per cent. to under 8 per cent. -This is doubtless due to the fact that in Holland the poorest and least -fit have been encouraged to be prudent, while in our country they have -been having the largest families—the fitter classes having smaller -families in consequence. Real wages which have fallen here and in -Germany have apparently gone up in Holland, and her agriculture has -rapidly improved. In every way that I have been able to test, her -prosperity and progress has been most satisfactory. Moreover, Holland -stands next to ourselves as a successful coloniser. Her possessions in -the East and West Indies occupy an area of 783,000 square miles with a -population of 38,000,000 (seven times her own population), 81,000 being -Europeans. Germany, with a home population ten times greater, has -colonies aggregating 1,029,000 square miles with a population of only -14,000,000 inhabitants, of whom but 25,000 are whites. - - - CONCLUSION - -In view of all these records I cannot think that any unbiassed person -will be able to avoid the conclusion that large numbers and national -efficiency are not to be secured by a high birth-rate, especially in the -lower strata of society. High birth-rates to-day invariably mean high -general and infantile death-rates, and, when accompanied by humanitarian -legislation, a serious process of reversed selection. - -The explanation of this apparent paradox lies in the fact, which never -seems to be properly understood, that the population of the world and of -nearly all countries is constantly being kept in check by insufficiency -of food. A French statistician, M. Hardy, has calculated (and his -figures, though challenged by great authorities, have now been accepted) -that if the total food production of the world were fairly distributed -among its inhabitants, the ration of proteids available for each would -only be two-thirds of that recognised as necessary for efficiency. Mr. -Seebohm Rowntree has shown that large numbers of families in our own -country—the richest in the world—have deficiencies of protein in their -diet by amounts up to 40 per cent., and over 2,500,000 adult male -workers have wages of 25s. a week or less, upon which with the present -cost of living and rent in towns it is impossible to bring up more than -three children properly. As a result, whenever families are large a -considerable proportion of the children die, and of those who survive -many grow up stunted and incapable of assimilating a good training. The -over-crowding caused by large families with an ever decreasing margin -for rent is also a potent cause of disease and of immorality—the latter -evil being further greatly intensified by the economic difficulties in -the way of marriage that are the chief bar to the prevention of those -terrible diseases for which the Royal Commission, presided over by our -Chairman, is investigating a remedy. - -That the rate of increase of population of a country depends in almost -every case upon its power of feeding its people by its own or imported -food, and not upon its birth-rate, is a matter which statesmen will have -to recognise; and those who are anxious for the increase of the -population of our country and Empire, should turn their attention to the -acceleration of food production instead of deploring the declining -birth-rate. No intelligent person will claim that the food producing -possibilities of the world are exhausted, but it does appear difficult -to increase them at more than a very slow rate (probably at present not -more than 6 per cent. or 7 per cent. in a decade); and the world’s -population cannot increase faster than the food does. Irrigation in -India has been followed by an increase in population far greater than -before, and encouragement of agriculture or of the industries which -bring food to this country is the only means by which our increase of -population can be accelerated. No shuffling of the incidence of -taxation, and no humanitarian schemes, will affect it—except -prejudicially by favoring the increase of the inefficient rather than -the efficient. Nor will emigration, the panacea of the orthodox -Imperialist, solve the problem. We do not want effective producers to -leave us, and these are the only people our colonies really desire. Our -town-bred weaklings are frequently less fitted to succeed in the -Colonies than at home, as the experience of Canada appears to testify. -It has been said that “no Empire can survive which is rotten at the -core”; and if we persist in the policy of encouraging the excessive -reproduction of the poor, of taxing the capable for their support, of -keeping about a third of our men and women unmarried, and of seeing many -of our best emigrate for want of decent prospects at home, we need not -be surprised if our Imperial efficiency diminishes. - -On the other hand, if we consider the example of Holland we may be -assured that a further fall in the birth-rate among the poorer classes -will be accompanied by an immediate and progressive improvement in their -conditions, by a checking of the output of physical and mental -defectives, and by a gain in the national efficiency, and probably also -in the rate of increase of our population. As the Bishop of Ripon said -at the Church Congress of 1910: “If the diminution of the birth-rate -could be shown to prevail among the unfit, we might view the phenomenon -without apprehension, and we might even welcome the fact as evidence of -the existence of noble and self-denying ideals.” There is no reason why -the death-rate in any part of our Empire should be higher than the 9 per -thousand of New Zealand, where poverty as we know it scarcely exists. -The birth-rate of Great Britain can therefore fall to 20 per thousand -before our normal natural increase of 11 per thousand is reduced. As -this paper is being concluded, the Registrar-General’s figures for 1913 -have come to hand, and show that the fall of the birth-rate in the last -three years has been accompanied by a recovery in the natural increase -to 10.8 per thousand. - - - DIAGRAMS OF INTERNATIONAL VITAL STATISTICS - - Prepared by Charles V. Drysdale, D.Sc., 1911 - -In the accompanying diagrams white strips imply birth-rates, shaded -strips death-rates, and black strips infantile mortality, or deaths of -children under one year. The amount of the white strip visible above the -shaded strip is, of course, the excess of birth over death-rate, or the -rate of natural increase of population. - -Fig. 1.—Shows the relation between birth and death-rates and infantile -mortality in various countries in 1901–05. - -Fig. 2.—Relation between birth-rate and _corrected_ death-rates in -various countries. (This shows that France is healthier than appears in -Fig. 1.) - -Fig. 3.—Shows relation between birth and death-rates from various causes -in five districts of London. - -Fig. 4.—Relation between the birth-rate and death-rate for various -arrondissements of Paris in 1906. (Note that the increase in the Elysée -quarter is as high as the average in the quarters of high birth-rate.) - -Figs. 5 and 6.—Variations of the total population of birth- and -death-rates in the United Kingdom and the German Empire. (Note that the -fall in the death-rate corresponds fairly closely to that in the -birth-rate.) - -Fig. 7.—The same for France. (Note that the population is still -increasing, although slowly.) - -Fig. 8.—Birth and death-rates for France since 1781. (Note that the rate -of increase of population in 1781 was no higher with a birth-rate of 39 -per 1,000 than in 1901–6 with a birth-rate of only 21 per 1,000. A fall -of 17.8 per 1,000 in the birth-rate has resulted in a fall of 17.5 per -1,000 in the death-rate.) - -Fig. 9.—Birth and death-rates and infantile mortality for England and -Wales. Also marriage rate, fertility of married women, illegitimacy, and -variation of diseases. (Note that the illegitimate birth-rate has fallen -to half since the fall of the birth-rate set in.) - -Fig. 10.—Birth and death-rates and infantile mortality in the -Netherlands. (Notice the rapid increase of population as the death-rate -falls, and the great fall of infantile mortality, probably due to the -practical work of the Dutch Neo-Malthusian Birth Control League among -the poor.) - -Figs. 11–13.—Protestant Countries. (Notice the correspondence between -the birth and the death-rates and infantile mortality in all.) - -Figs. 14–16.—Roman Catholic Countries. (Note that the fall of the -birth-rate has taken place almost equally with that in the Protestant -countries, and with the same result.) - -Figs. 17–20.—The only four countries in which the birth-rate is -approximately _stationary_. (Notice that the death-rate has not -fallen—except perhaps in Russia—and that the infantile mortality has not -fallen. Also that the highest birth-rate produces the highest death rate -and infantile mortality, and the lowest birth-rate the lowest -mortality.) - -Figs. 21–24.—The only four countries with _rising_ birth-rates. The -_death rate and infantile mortality have increased in every one_. - -Fig. 25.—Australia. The death-rate has fallen with the birth rate, and -is now only about 10 per 1,000. - -Fig. 26.—New Zealand. The only country in which the fall in the -birth-rate has not produced a fall in the death-rate, and which is not -therefore over populated. The infantile mortality is the lowest in the -world, and the death-rate less than 10 per 1,000, which gives us an -ideal which we can reach in all countries by lowering the birth-rate -sufficiently. - -Fig. 27.—The City of Toronto. The birth-rate has fallen and afterwards -risen. The death-rate has fallen with the birth-rate, and afterwards -risen, indicating that the improvements in sanitation have not been the -cause of the falling death rate in other countries. - -Fig. 28.—Berlin. The birth-rate rose rapidly from 1841 to 1876, and -afterwards fell even more rapidly. The death-rate, except for epidemics -and wars, rose and fell in almost precise correspondence with the -birth-rate. - -Fig. 29.—Berlin. The dotted area shows the fertility rate or births per -1,000 married women, and indicates the remarkably rapid fall since 1876. -The correspondence of the infantile mortality with the birth-rate shown -in Fig. 28 is very close. - -Figs. 30 and 31.—Europe and Western Europe. These show that the total -population of Europe is increasing faster the more the birth-rate falls, -while in Western Europe the birth and death-rates correspond almost -exactly. Calculations made from this show that about 25,000,000 fewer -births and deaths have occurred in Europe since 1876, due to the fall in -the birth-rate caused by the Knowlton Trial and the Neo-Malthusian -movement. It should be noted that in the great majority of cases the -decline of the birth-rate commenced in 1877, the year of the Knowlton -Trial. - - CHARLES V. DRYSDALE, D.Sc. - 1911. - - - _VARIOUS COUNTRIES - 1901–05._ - -[Illustration: FIG. 1.] - - - _VARIOUS COUNTRIES. - CRUDE & CORRECTED DEATH-RATES._ - -[Illustration: FIG. 2.] - - - _LONDON - 1905–1909._ - -[Illustration: FIG. 3.] - - - _PARIS - 1906._ - -[Illustration: FIG. 4.] - - - _UNITED KINGDOM. Growth of Population._ - -[Illustration: FIG. 5.] - - - _UNITED KINGDOM. Birth and Death Rates._ - -[Illustration: FIG. 5A] - - - _GERMAN EMPIRE. Growth of Population._ - -[Illustration: FIG. 6] - - - _GERMAN EMPIRE. Birth and Death Rates._ - -[Illustration: FIG. 6A.] - - - _FRANCE POPULATION._ - -[Illustration: FIG. 7] - - - _FRANCE._ - _BIRTH & DEATH RATES._ - -[Illustration: FIG. 7A.] - - - _VARIOUS DISEASES._ - -[Illustration: FIG. 7B.] - - - _FRANCE._ - _BIRTH & DEATH RATES._ - -[Illustration: FIG. 8.] - - - _ENGLAND & WALES._ - _BIRTHS & DEATHS._ - _MARRIAGE, FERTILITY, & ILLEGITIMACY._ - _VARIOUS DISEASES._ - -[Illustration: FIG. 9] - - - _THE NETHERLANDS._ - -[Illustration: FIG. 10.] - - - _NORWAY._ - -[Illustration: FIG. 11.] - - - _SWEDEN._ - -[Illustration: FIG. 12.] - - - _DENMARK._ - -[Illustration: FIG. 13.] - - - _BELGIUM._ - -[Illustration: FIG. 14.] - - - _ITALY._ - -[Illustration: FIG. 15.] - - - _SPAIN._ - -[Illustration: FIG. 16.] - - - COUNTRIES WITH NEARLY STATIONARY BIRTH-RATE - - - _RUSSIA._ - -[Illustration: FIG. 17] - - - _ROUMANIA._ - -[Illustration: FIG. 18] - - - _JAMAICA._ - -[Illustration: FIG. 19] - - - _IRELAND._ - -[Illustration: FIG. 20] - - - COUNTRIES WITH RISING BIRTH-RATES - -[Illustration: FIGS. 21-23] - - - BRITISH COLONIES - - - _CANADA (Ontario)._ - -[Illustration: FIG. 24] - - - _AUSTRALIA (Commonwealth)._ - -[Illustration: FIG. 25] - - - _NEW ZEALAND._ - -[Illustration: FIG. 26] - - - _THE CITY OF TORONTO._ - -[Illustration: FIG. 27] - - - _BERLIN._ - -[Illustration: FIG. 28] - - - _BERLIN._ - -[Illustration: FIG. 29] - - - _EUROPE._ - -[Illustration: FIG. 30] - - - _WESTERN EUROPE._ - -[Illustration: FIG. 31] - - - - - CHAPTER IV - INFANT MORTALITY - - -_In the preceding pages it was stated that a high birth-rate is always -accompanied by a high infant mortality. The material presented in this -chapter demonstrates the fact that ignorance of methods to prevent -conception forces the wives of ill-paid wage-workers to bear an excess -of unwanted children. Figures are adduced to show an appalling death -rate of infants under five years of age and the economic distress of the -survivors in families unwanted and too large._ - - - _MEDICAL GYNECOLOGY. Howard A. Kelly, A.B., M.D., LLD., Professor of - Gynecological Surgery in Johns Hopkins University, and - Gynecologist to the Johns Hopkins Hospital, etc. D. Appleton Co. - New York and London, 1912._ - -As long as a community can rest content in the belief that a large -infant mortality is the natural method of reducing the race of the -unfit, the doctrine of _laissez-faire_ can be accepted with -complaisance. If, however, it seems probable that the influence of -environment must be reckoned as a greater cause of infant mortality and -of physical unfitness than the influence of heredity, it may be wiser -for society, as it certainly will be easier, to preserve the lives and -health of the children born, than to stimulate an increase in a birth -rate now diminishing. As it is an open question whether the race as a -whole suffers mental and physical deterioration from a diminished rate -of production among the superior stocks, it is unquestionably a matter -of public policy, as well as of common humanity, that conditions of -living in communities should be made favorable to the preservation of -the life and health of all infants and children. P. 41. - - - _EUGENICS AND RACIAL POISONS. Prince A. Morrow, M.D. Pamphlet - published by the Society of Sanitary and Moral Prophylaxis, N. Y., - 1912._ - -Observation shows that the class known as degenerates is increasing much -more rapidly than the general population and that their average duration -of life has been lengthened. Diseases may be cured, but degeneracy, -which is usually due to some inherited defect in the physical, mental or -moral nature of the individual, is rarely amenable to curative -treatment. It is only through applied eugenics that the vast volume of -disease and degeneracy which flows through the channels of heredity can -be prevented. Obviously this can be accomplished only through education -and legislative restriction upon the procreation of the unfit. - -In the making of the child, the mother not only contributes one half of -the ancestral qualities which enter into its constitution, but furnishes -all the nutrition and energy which serve to support its life. From this -point of view the mother is the supreme parent of the child, she is the -source of its life and from her blood is drawn the material which -contributes to its growth and development. The welfare of the mother is -the welfare of the child. We have thus come to recognize the dominant -influence of the mother’s relation to the health, as well as the life of -the race. A high standard of physical motherhood is the most favorable -asset of a nation. Havelock Ellis, in his recent work, on the Psychology -of Sex, says, “Nations have begun to recognize the desirability of -education, but they have scarcely yet come to recognize that the -nationalization of health is even more important than the -nationalization of education. If it were necessary to choose between the -task of getting children educated and the task of getting them well born -and healthy, it would be better to abandon education. There have been -many great people who never dreamed of national systems of education; -there has been no great people without the art of producing healthy and -vigorous children.” - -Newman, the distinguished author of the work on “Infant Mortality” -declares that the problem of infant mortality is not one of sanitation -alone, or housing, or indeed of poverty as such, it is mainly a question -of motherhood. - -It is not probable that the scientific methods which have been -successfully applied to plants and the selective breeding of animals -will ever replace the haphazard methods of human reproduction. - -There is no fact better established than that a man can transmit only -that which he is. If his system is weakened by excess or tainted with -disease he can beget only physical weakness, or beings tainted with -disease. The syphilitic, the consumptive, the epileptic, the alcoholic, -should not produce his kind. - - - _NEO-MALTHUSIANISM AND RACE HYGIENE IN “PROBLEMS IN EUGENICS.” Vol. 2. - London, 1913. Dr. Alfred Ploetz, President of the Int. Soc. for - Race Hygiene._ - -Arthur Geissler concluded from a study of about 26,000 births of -unselected marriages among miners that the mortality of children was -least in the four first-born, and then increased to a very high rate. -Following are Geissler’s figures, (marriages with only one or two -children are omitted). - - - Deaths during first year - 1st born children 23% - 2nd born children 20% - 3rd born children 21% - 4th born children 23% - 5th born children 26% - 6th born children 29% - 7th born children 31% - 8th born children 33% - 9th born children 36% - 10th born children 41% - 11th born children 51% - 12th born children 60% - - - _INFANT MORTALITY. Results of a Field Study in Johnstown, Pa., based - on Births in one calendar year. By Emma Duke, Infant Mortality - Series, No. 3. Bureau Publication No. 9. U. S. Department of - Labor, Children’s Bureau._ - -The pamphlet embodies the result of a field study in Johnstown, Pa., -based on one calendar year. The inspection was made in 1913, of the 1911 -babies, so that even the last born baby included had reached its first -birthday—or rather had had a chance to reach its first birthday; many of -them were dead long before that day. Every mother of a 1911 baby was -visited. She was questioned about the health of that child and all her -other children. The report takes up the familiar factors—neighborhood -environment, sanitary conditions, sewage, housing, nativity, attendance -at birth, feeding, age of mother, and like matters. Full information is -given on these points. Then the report considers infant mortality from a -novel viewpoint—the relation of the death rate to the size of the -family. The Johnstown statistics include families varying in number from -one child to ten and over, and varying in health from none living to all -living. The result of the study of infant mortality in relation to the -size of the family is thus stated: “The statistics, based on the results -of all her reportable pregnancies, show a generally higher infant -mortality rate where the mother has had many pregnancies, but there is -not always an increase from one pregnancy to the next.” The following -table shows this tendency. It is based on the reproductive histories of -1,491 married mothers who had 5,617 births. Miscarriages are not -included. - - - Infant Mortality Rate for all Children borne - by Married Mothers: Table 36 - - Number of Pregnancies. Infant Mortality Rate. - 1 and 2 108.5 per 1,000 - 3 and 4 126.0 per 1,000 - 5 and 6 152.8 per 1,000 - 7 and 8 176.4 per 1,000 - 9 or more 191.9 per 1,000 - Average 149.9 per 1,000 - -In contemplating these figures we think immediately of wage-earning -mothers away from home, ignorant feeding, and lack of care. These are -powerful factors in raising the death rate. - -Of all the 1911 babies who died before they were a year old, 37% died in -the first month of life. So much pain and misery and then no baby after -all. All the skill in the world could not have saved those babies who -lived only long enough to die. - -The infant mortality rate for the babies whose fathers earn under $521 -is almost twice as great as for those born into families in the most -prosperous group. These figures strengthen the conclusion reached in the -study of the babies born in 1911, namely that the economic factor is of -far-reaching importance in determining the baby’s chance of life. - -One of the tables showing the influence of the economic factor, is -calculated on the basis of 1,434 live-born babies with fathers. 187 of -these babies succumbed during the first year, giving a general mortality -rate of 130.7 per 1,000. In these families a very few of the mothers -worked outside the homes. - - - Father’s earnings Live-births Deaths 1st year Infant mortality rate - Under $625 384 82 213.5 - $625 to $899 385 47 122.1 - $900 or more 186 18 96.8 - Ample 476 40 84.0 - -Expressed in words, this table asserts that when the family income is -under $625 a year, the children born alive die before the first birthday -at the rate of 213.5 to the 1,000. In striking contrast when the income -is $900 or more, they die only 96.8 to the 1,000. “Ample” was the -expression used when the investigator could not obtain exact information -as to the amount, but saw no evidence of actual poverty. The same ratio -held good when it was calculated for the native-born mothers alone and -when it was calculated for the foreign-born mothers alone. Even where -mothers are American-born women, staying at home to look after their -children, the amount of money to be spent on the child strongly -influences its chance of life and death. - -According to this table the superiority which children in indigent -households show over children in well-to-do households is preeminent -skill in dying. When father earns $12 a week the children die at the -rate of 213 per 1,000; but when father earns $18 a week, only 96 -children per 1,000 pass away the first year of their lives. The lower -the father’s wages, the higher the babies’ death rate. Many a death -certificate should read, “Died of poverty.” - -The following table is compiled from the 5,617 children borne by 1,491 -married mothers, in Johnstown, Pa. - - - Order of Birth Deaths per 1,000 - 1st and 2nd born children 138.3 - 3rd and 4th born children 143.2 - 5th and 6th born children 177.0 - 7th and 8th born children 181.5 - 9th and later born children 201.1 - -Apparently the size of the family has much to do with the child’s chance -of living, and apparently the earlier in the succession the child is -born, the better chance of life it possesses. Death warrants await the -coming of the youngest born. - - - Table 42.—Infant mortality rate for all - children of married mothers included in this - investigation, distributed according to the - father’s earnings. - - Father’s annual earnings Infant mortality rate - Under $521 197.3 - $521 to $624 193.1 - $625 to $779 163.1 - $780 to $899 168.4 - $900 to $1,199 142.3 - $1,200 to $1,200 and over 102.2 - - - - - U. S. DEPARTMENT OF LABOR CHILDREN’S BUREAU - - Julia C. Lathrop, Chief - - - INFANT MORTALITY - - RESULTS OF A FIELD STUDY IN JOHNSTOWN, PA., BASED ON - BIRTHS IN ONE CALENDAR YEAR - - BY EMMA DUKE - - 1915 - - - (_Certain tables omitted_) - - - - - INFANT MORTALITY: JOHNSTOWN, PA. - - - _INTRODUCTION_ - -The term infant mortality, used technically, applies to deaths of babies -under 1 year of age. An infant mortality rate is a statement of the -number of deaths of such infants in a given year per 1,000 births in the -same year. Some countries include stillbirths in making the -computations, but this method is not generally followed in this country -nor has it been followed in this report. - -Ordinary procedure is to compare the live births in a single calendar -year with the deaths of babies under 12 months of age occurring in that -same year, even though those who died may not have been born within the -calendar year of their death. The infant mortality rates in this report, -however, have not been computed on the usual basis, but for the purpose -of securing greater accuracy in measuring the incidence of death this -bureau has considered, in making the computation, only so many of the -babies born in the year 1911 as could be located by its agents, and has -compared with this number the number of deaths within this group of -babies who died within one year of birth, even though some of these -deaths may have occurred during the calendar year 1912. - -Infant mortality can be accurately measured in no other way than by -means of a system of completely registering all births as well as all -deaths. In 1911 the United States Bureau of Census regarded the -registration of deaths as being “fairly complete (at least 90 per cent. -of the total)” in 23 States, but the same degree of completeness in the -registration of births was found only in the New England States, -Pennsylvania, and Michigan, and in New York City and Washington, D.C. An -exact infant mortality rate for the United States as a whole cannot be -computed owing to this generally incomplete registration. In the 1911 -census report on mortality statistics, however, the infant mortality -rate is estimated at 124 per 1,000 live births. How this estimated rate -compared with the computed rates for other countries is shown in the -following summary: - - - DEATHS OF CHILDREN UNDER 1 YEAR OF AGE PER 1,000 LIVE BIRTHS, BY - QUINQUENNIAL PERIODS FROM 1901 TO 1910, AND ALSO FOR THE SINGLE - CALENDAR YEARS 1909 TO 1910.[10] - - ═══════════════════════╤═══════════╤═══════════╤═══════════╤═══════════ - COUNTRY. │ 1901 to │ 1906 to │ 1909 │ 1910 - │ 1905 │ 1910 │ │ - ───────────────────────┼───────────┼───────────┼───────────┼─────────── - Chile │ 306│ 315│ 315│ 313 - Russia (European) │ ([11]) │ │ │ - Austria │ 215│ │ │ - Hungary │ 212│ 204│ 212│ 194 - Prussia │ 190│ 168│ 164│ 157 - Jamaica │ 174│ 191│ 174│ 188 - Spain │ 173│ │ │ - Ceylon │ 171│ 189│ 202│ 176 - Italy │ 168│ │ 155│ - Japan │ 154│ │ 166│ - Servia │ 149│ │ │ - Belgium │ 148│ │ 137│ - Bulgaria │ 148│ │ │ - France │ 139│ │ 120│ - England and Wales │ 138│ 117│ 109│ 105 - The Netherlands │ 136│ 114│ 99│ 108 - Switzerland │ 134│ │ 115│ - Finland │ 131│ 117│ 111│ 118 - Scotland │ 120│ │ 108│ - Denmark │ 119│ │ 98│ - Province of Ontario │ 114│ 127│ 131│ 123 - Ireland │ 98│ 94│ 92│ 96 - Australian Commonwealth│ 97│ 78│ 72│ 75 - Sweden │ 91│ │ 72│ - Norway │ 81│ │ 72│ - New Zealand │ 75│ 70│ 62│ 68 - ───────────────────────┴───────────┴───────────┴───────────┴─────────── - -Footnote 10: - - From the Seventy-third Annual Report of the Registrar General of - Births, Deaths, and Marriages in England and Wales (1910). London, - 1912. - -Footnote 11: - - Available only for the period from 1896 to 1900, when it was 261. - -When it had been decided by the Children’s Bureau to make infant -mortality the subject of its first field study and to include all babies -born in a given calendar year, regardless of whether they lived or died -during their first year, advice and cooperation were enlisted of -mothers, physicians, nurses, and others experienced in the care of -children, and also of trained investigators and statisticians, in the -preparation of a schedule which was submitted to them for criticism. - -With its limited force and funds it was not possible for the Children’s -Bureau to extend its inquiries throughout the entire United States. It -was therefore decided to make intensive studies of babies born in a -single calendar year in each of a number of typical areas throughout the -country that offered contrasts in climate and in economic and social -conditions, the results to be eventually combined and correlated. It was -necessary to restrict the choice of the first area to a place of such -size as could be covered thoroughly within a reasonable time by the few -agents available for the work. - -Johnstown, Pa., was the first place selected. It is in a State where -birth registration prevails, and hence a record of practically all -babies could be secured; it is of such size that the work could be done -by a small force within a reasonable period, and it seemed to present -conditions that could with interest be contrasted with conditions -typical of other communities. Moreover, the State commissioner of health -and the State registrar of vital statistics were both working zealously -to enforce birth-registration laws; both were actively interested in -reducing infant mortality, and they welcomed a study of the subject in -their State. In Johnstown the mayor, the president of the board of -health, the health officer, and other local officials all showed the -same spirit of hearty cooperation and interest. - -Inasmuch as the study was confined to babies born in a single calendar -year and work was begun in January, 1913, the latest year in which the -babies could have been born and still have attained at least one full -year of life was 1911. - -Work was begun on January 15, 1913, with the transcription from the -original records at Harrisburg of the names and other essential facts -entered on the birth certificates of babies born in 1911, and, if the -baby had died during its first year of life, items on the death -certificate were also copied. - -In the meantime the people of Johnstown through the press, and through -the clergy in the foreign sections, had been informed of the purpose and -plan of the investigation. Without the friendly spirit thus aroused and -the interest manifested by the Civic Club and other organizations the -work could not have been brought to a successful issue. The -investigation was absolutely democratic; every mother of a baby born in -1911, rich or poor, native or foreign, was sought, and it is interesting -to note refusals were met with in but two cases. - -The original plan was to limit the investigation to those babies born in -the calendar year selected whose births had been registered, the purpose -being to secure facts concerning a definite group and not to measure the -completeness of birth registration. Shortly after beginning the work, -however, agents of this bureau were told that the Serbian women in -Johnstown seldom had either a midwife or a physician at childbirth; that -they called in a neighbor or depended upon their husbands for help at -such times, or that they managed alone for themselves, and that -therefore their babies usually escaped registration. The omission of -these babies meant the exclusion of a number of mothers in a group that -was too important racially to be omitted from an investigation embracing -all races and classes. Accordingly a list of babies christened in the -Serbian Church and born in the year 1911 was secured and an attempt made -to locate them. In addition an agent called at each house in the -principal Serbian quarter to inquire concerning births in 1911. A number -of unregistered babies of Serbian mothers were thus found and included -in the investigation. - -The agents were sometimes approached by mothers of babies born in 1911 -who resented being omitted from the investigation simply for the reason -that their babies’ births had not been registered. The agents were -therefore instructed to interview mothers thus accidentally encountered -and to include their babies in the investigation. But no additional -baptismal records were copied nor was a house-to-house canvass made of -the city; in fact, no further means were resorted to to locate -unregistered babies for the purpose of including them in the -investigation. - -There were 1,763 certificates copied at Harrisburg, and 1,383 of the -babies named in them were reached by the agents. In addition, 168 babies -for whom there were no birth certificates, but who were located in the -ways just noted, were included, making a total of 1,551 completed -schedules secured. - -Of the 380 not included in the investigation there were 149 who could -not be located at all; 220 others had moved out of reach—that is, into -another city or State; 6 of the mothers had died; 3 could not be found -at home after several calls, and 2 refused to be interviewed. - -From the following summary of data recorded on the certificates of the -380 unlocated babies just referred to it appears that the infant -mortality rate (134.3) among them is almost the same as that (134) shown -in Table 1 for babies included in the investigation. In reality, -however, it is perhaps a little higher, as some of these babies no doubt -died outside of Johnstown and their deaths were recorded elsewhere. - - - ════════════╤═══════╤═══════╤═════════════╤═════════════ - │ │ │ │SEX OF BABY. - ├───────┼───────┼─────────────┼─────┬─────── - │ │ │ │ │ - NATIONALITY │ Total │ Live │ │ │ - OF MOTHER. │births.│births.│Still-births.│Male.│Female. - │ │ │ │ │ - │ │ │ │ │ - ────────────┼───────┼───────┼─────────────┼─────┼─────── - Total │ 380│ 350│ 30│ 227│ 153 - ════════════╪═══════╪═══════╪═════════════╪═════╪═══════ - Native │ 134│ 118│ 16│ 76│ 58 - Foreign │ 246│ 232│ 14│ 151│ 95 - ────────────┼───────┼───────┼─────────────┼─────┼─────── - Slovak, │ │ │ │ │ - Polish, │ 43│ 41│ 2│ 27│ 16 - etc │ │ │ │ │ - Croatian and│ 13│ 11│ 2│ 10│ 3 - Servian │ │ │ │ │ - Magyar │ 1│ 1│ │ 1│ - German │ 8│ 8│ │ 6│ 2 - Italian │ 41│ 39│ 2│ 26│ 15 - Syrian and │ 7│ 6│ 1│ 3│ 4 - Greek │ │ │ │ │ - British │ 7│ 7│ │ 3│ 4 - Austrian │ │ │ │ │ - (not │ 123│ 116│ 7│ 73│ 50 - otherwise │ │ │ │ │ - specified)│ │ │ │ │ - Not reported│ 3│ 3│ │ 2│ 1 - ────────────┴───────┴───────┴─────────────┴─────┴─────── - - ════════════╤════════════════════════════╤═══════════ - │ ATTENDANT AT BIRTH. │ - ────────────┼──────────┬────────┬────────┼─────────── - │ │ │ │Certificate - NATIONALITY │ │ │ │ showing - OF MOTHER. │Physician.│Midwife.│Unknown.│ deaths - │ │ │ │ during - │ │ │ │first year. - ────────────┼──────────┼────────┼────────┼─────────── - Total │ 158│ 180│ 33│ 47 - ════════════╪══════════╪════════╪════════╪═══════════ - Native │ 122│ 5│ 7│ 12 - Foreign │ 36│ 184│ 26│ 35 - ────────────┼──────────┼────────┼────────┼─────────── - Slovak, │ │ │ │ - Polish, │ 4│ 37│ 2│ 3 - etc │ │ │ │ - Croatian and│ │ 7│ 6│ 5 - Servian │ │ │ │ - Magyar │ │ 1│ │ - German │ 2│ 5│ 1│ 2 - Italian │ 3│ 36│ 2│ 4 - Syrian and │ 3│ 4│ │ 1 - Greek │ │ │ │ - British │ 5│ 2│ │ - Austrian │ │ │ │ - (not │ 19│ 89│ 15│ 20 - otherwise │ │ │ │ - specified)│ │ │ │ - Not reported│ │ 3│ │ - ────────────┴──────────┴────────┴────────┴─────────── - - - RELATION OF INFANT MORTALITY TO ENVIRONMENT NEIGHBORHOOD INCIDENCE - -The rate of infant mortality is regarded as a most reliable test of the -sanitary condition of a district. (Sir Arthur Newsholme, Elements of -Vital Statistics, p. 120. London, 1899.) - -Johnstown is a hilly, somewhat Y-shaped area of about 5 square miles -which spreads itself out into long, narrow, irregularly shaped strips, -detached by rivers and runs and steep hills. In some places it is not -over a quarter of a mile wide, but its extreme length is about 4 miles. -The city is composed of 21 wards and is an aggregation of what were -formerly separate unrelated boroughs or towns. The names of these -different sections, together with the numerical designations of the -wards included in or comprising them, are shown in the following table. -This table gives for each section not only the total population -according to the Federal census of 1910, but also the number of -live-born babies included in the investigation and the number and -proportion of deaths among such babies during their first year. - - - TABLE 1.—DISTRIBUTION OF POPULATION, LIVE BIRTHS AND DEATHS DURING - FIRST YEAR, AND INFANT MORTALITY RATE ACCORDING TO SECTION OF - JOHNSTOWN, FOR ALL CHILDREN INCLUDED IN THIS INVESTIGATION. - - ════════════════════════════════╤═══════════╤═════════╤══════╤═════════ - │ │ │Deaths│ - │ │ │during│ - │ │ │first │ - │Population,│ Total │ year │ Infant - SECTION OF CITY AND WARD. │ 1910.[12] │live-born│ of │mortality - │ │ babies. │babies│ rate. - │ │ │ born │ - │ │ │ in │ - │ │ │ 1911 │ - ────────────────────────────────┼───────────┼─────────┼──────┼───────── - The whole city │ 55,482│ 1,463│ 196│ 134.6 - ════════════════════════════════╪═══════════╪═════════╪══════╪═════════ - Down-town section (wards 1, 2, │ 5,944│ 80│ 4│ 52.0 - 3, 4) │ │ │ │ - Kernville (wards 5, 6) │ 6,070│ 104│ 6│ 57.7 - Homerstown (ward 7) │ 4,476│ 109│ 17│ 156.0 - Roxbury (ward 8) │ 2,862│ 85│ 19│ 117.6 - Conemaugh Borough (wards 9, 10) │ 5,282│ 136│ 16│ 117.6 - Woodvale (ward 11) │ 3,945│ 107│ 20│ 271.0 - Prospect (ward 12) │ 1,893│ 55│ 11│ 200.9 - Peelorville (ward 13) │ 1,443│ 13│ 4│ ([13]) - Minersville (ward 14) │ 2,403│ 72│ 9│ 125.0 - Cambria City (wards 15, 16) │ 8,706│ 310│ 55│ 177.4 - Moxham (ward 17) │ 5,735│ 157│ 14│ 39.2 - Morrellville (wards 18, 19, 20) │ 5,757│ 194│ 15│ 32.5 - Coopersdale (ward 21) │ 968│ 36│ 8│ ([13]) - ────────────────────────────────┴───────────┴─────────┴──────┴───────── - -Footnote 12: - - Federal census of 1910. - -Footnote 13: - - Total live births less than 50; base therefore considered too small to - use in computing an infant mortality rate. - -To learn where the babies die is perhaps the first step in solving the -infant mortality problem. The modern health officer recognizes this and -generally has in his office a wall map upon which are indicated -sections, wards, city blocks, and sometimes even houses. As infant -deaths are reported, pins are stuck in the map in the proper places, a -density of pins on any part of the map indicating, of course, where -deaths are most numerous, although the percentage of infant deaths may -not be the highest. - -The highest infant mortality rate, 271, is found in the eleventh ward, -known as Woodvale, although this is neither the most populous ward nor -the one having the largest number of births. The infant mortality rate -here, however, is double the rate for the city as a whole and more than -five times as great as it is for the most favorable ward. - -This is where the poorest, most lowly persons of the community -live—families of men employed to do the unskilled work in the steel -mills and the mines. They are for the most part foreigners, 78 per cent. -of the mothers interviewed in this ward being foreign born. - -Through Woodvale runs the main line of the Pennsylvania Railroad. To the -north of the tracks rises a steep hill, toward the top of which is -Woodvale Avenue, the principal street north of the railroad. (See plate -A.) Sewer connection is possible for the houses along this avenue, as a -sewer main has recently been installed, but the people have not in all -cases gone to the expense of having the connection made, and in other -cases where they have done so sometimes only the sinks are connected -with the sewer and the yard privy is retained. - -On the streets above Woodvale Avenue dwellings are more scattered and -the appearance is more rural. A few of the families still have to depend -upon more or less distant springs for their water, although city water -is quite generally available throughout Woodvale. - -The streets near the bottom of the hill, as Plum Street, for example, -are so much below the level of the sewer mains that they can not be -properly drained into the sewer. Private drain pipes from houses are -buried a few feet below the surface and protrude from the sides of the -hills, dripping with house drainage which flows slowly into ditches and -forms slimy pools. (See Plates B and C.) - -None of the streets on the north side of the railroad track are paved; -sidewalks and gutters are lacking. In cold weather the streets are icy -and slippery and even dangerous on account of the grade. In warm weather -they are frequently slippery and slimy with mud. - -Maple Avenue is the principal street of that part of Woodvale lying to -the south of the railroad tracks, and it is the only properly paved and -graded street in Woodvale. The streets on this side of the tracks, -however, are not in as bad a condition as those to the north, nor are -the drainage and general sewerage conditions as offensive as north of -the tracks, but many of the streets are nevertheless muddy and filthy. -(See Plate D.) - -Prospect ranks next to Woodvale in infant mortality, having a rate of -200. This section, lying along a steep hill and above one of the big -plants of the steel company, has not a single properly graded, drained, -and paved street. The sewers are of the open-ditch type, and the natural -slope of the land toward the river is depended upon for carrying off the -surface water that does not seep into the soil. The closets are -generally in the yard and are either dry privies or they are situated -over cesspools. Some of the people who live on the lower part of the -slope have wells sunk directly in the course of the drainage from above. -(See Plate E.) - -Cambria City, which is composed of the two most populous wards of -Johnstown, has the third highest infant mortality rate, 177.4. It has a -large foreign element, as is evidenced by the fact that 90.6 per cent. -of the mothers interviewed were foreign born. It is situated along the -river, between the hills of Minersville and Morrellville, and somewhat -to the north of Prospect. The sewage from other residential sections and -from the steel mills above them empties into the river at this point. In -warm, dry seasons the river is low, flows slowly, and forms -foul-smelling pools. - -Sewer connection is possible for most of the houses in Cambria City, -although all are not connected. Some, on the streets bordering the -river, have private drain pipes that empty out into the stream. Others -have their kitchen sinks connected with the sewer but still retain yard -privies, which, of course, are not sewer connected. - -There is considerable crowding of houses on lots, rear houses being -commonly built on lots intended for but one house. Density of population -and house congestion are greater here than elsewhere in the city. - -The streets of Cambria City are somewhat better graded and more -generally paved than those of Woodvale, but muddy streets and unpaved -sidewalks nevertheless exist here. Broad Street, however, which is the -business thoroughfare and runs through the center of the section, is the -widest and best constructed street in Johnstown. Bradley Alley, on the -other hand, running the length of Cambria City and parallel to Broad -Street, is the most conspicuous example in the city of a narrow lane or -alley used as a residence street. A number of small dwellings, generally -housing more than one family, have their frontage on this alley, which -is 19 feet 10 inches in width and without sidewalks. It is unpaved and -in bad condition, generally being either muddy or dusty and littered -with bottles, cans, and other trash. (See Plates F. and G.) - -Homerstown has an infant mortality rate of 156, ranking fourth among the -several sections of Johnstown in this respect. It has a fairly -prosperous and somewhat suburban appearance, but its comparatively high -infant mortality rate can perhaps be partly accounted for by the bad -street conditions and the fact that refuse of all sorts is dumped into -the shallow river at this point. - -Minersville is a district where a high rate would be expected from -prevailing conditions. The rate is 125, or less than the average for the -city but more than double that for the most favorable sections. This -ward is built on a hill and so located that the rising clouds of -grit-laden smoke from the steel mills envelop it much of the time. Only -one street in this section is well paved, and this is seldom clean. -Houses on some of the streets near the top of the hill are not sewer -connected, and streams of waste water trickle down the hill and give -rise to unpleasant odors. (See Plates H and I.) - -Conemaugh Borough, with an infant mortality rate of 117.6, ranks sixth -in this respect among the sections into which Johnstown has been -divided. It comprises wards 9 and 10 and begins at the edge of the -down-town section and spreads upward over the hills to the southwest. -Some of the houses on streets near the top of the hill are not sewer -connected, and streams of water constantly trickle down the numerous -alleys and streets that descend the hill. (See Plate J.) This section -makes a very unfavorable first impression because of the open drainage -and of the many dirty, badly paved streets. (See Plate K.) Unlike some -of the other wards, it has a rather evenly distributed population and is -without the vast uninhabited areas and acutely congested spots found in -some other sections. On the whole there is little crowding on the lots -and there are many good-sized yards. One-third of the population is -foreign born. Of these the Italians are the most numerous. Despite -certain ugly spots this section has not the unwholesome atmosphere that -characterizes Woodvale and to a lesser extent Prospect, Cambria City, -and Minersville. - -The infant mortality rate of 117.6 per thousand in Roxbury is the same -as that of Conemaugh Borough. For reasons not plainly apparent the rate -here is higher than in Moxham, Morrellville, Kernville, or the down-town -section, although it appears to be as favorably conditioned as these -sections are from a social, economic, and sanitary standpoint. Here, as -in all these sections, however, are many conditions not conducive to -health. For example, parts of Franklin Street are in bad repair. The -roadway is full of ruts and holes; the street, which is seldom -sprinkled, is dusty in dry weather and muddy in wet weather, and in -front of good houses along one section of this street runs an open ditch -that receives house drainage. - -Moxham has the eighth highest infant mortality rate, it being 89.2. -Conditions here are generally rather favorable, although there is some -complaint that at “high water” the sewage received by one of the runs in -this section backs into some of the houses and then the sinks and -water-closets overflow. Some of the homes here, near the city limits, -are not supplied with city water but are still dependent upon wells and -springs. - -One of the three wards constituting Morrellville (ward 18) has a rural -appearance; there is little house crowding on lots, big yards are -common, and the streets are not paved. It is, however, marred by an -offensive open-ditch sewer. Ward 19 of Morrellville has a more finished, -less rural appearance. One of its objectionable features is that house -drainage and the bloody waste of slaughterhouses are emptied into a -shallow stream that flows through it. Ward 20 adjoins ward 19, and -although it spreads out into a suburb it appears for the most part to be -a comfortable and busy little village. Strayer’s Run winds about here -and receives sewage. The fact that it is without a guardrail in some -places and that the railing is inadequate in others makes it a source of -danger, and according to common report such accidents as children -falling into the stream have occurred. The infant mortality rate for -Morrellville is 82.5. - -Kernville, a section with a considerable proportion of prosperous -people, has a very favorable infant mortality rate, it being 57.7. Parts -of this section, however, are on a hill stretching upward from Stony -Creek, which is both unsightly and offensive in warm weather and when -the water is low. - -The down-town section, i.e., wards 1, 2, 3, and 4, where are to be found -many of the best conditioned houses, the homes of many of the well-to-do -people, has the lowest infant mortality rate in the city, it being but -50. - -No infant mortality rate is presented in the tables for Coopersdale or -for Peelorville. In the first-named section only 36 live-born infants -were considered, and 8 of them died in their first year. But this high -rate need not be considered as especially significant, as the base -number is small for such a computation. Coopersdale, however, is a -suburban-appearing community in which one would expect the infant -mortality rate to be low. - -Peelorville is that part of the thirteenth ward which adjoins Prospect. -A number of company houses are located here in which sanitary conditions -are fairly good. The ward seems to have good drainage and no sewage -nuisances. It is a community of wage earners and not of prosperous -homes. Only 18 babies are included in the report for this district, one -of whom died. With such a small base the infant mortality rate is not -significant. (See Plate L.) - - - SANITARY CONDITIONS—SEWERAGE, PAVEMENTS, GARBAGE COLLECTIONS - -The general inadequacy of the sewerage system which has been indicated -for the city as a whole is due in part to the fact that the city is -largely an aggregation of sections, formerly independent of Johnstown -itself, which have been annexed at different periods. Some of these -boroughs had sewer systems more or less developed when they were taken -into Johnstown; others had none. Not only the sewerage of Johnstown but -that of outlying boroughs pollutes the two shallow rivers, the Conemaugh -and the Stony Creek, that flow through Johnstown. These are burdened -with more waste than they can properly carry away, and the deposits -which are left on the rocks in various sections of both rivers create -nuisances that are the subject of much complaint, especially during the -warm summer months. (See Plates M, N, O, and P.) At various times -agitation has been started to improve the rivers which, as they flow -through Johnstown, are, at the low-water stage, little better than -swamps of reeking slime from the waste matter emptied into them from the -hundreds of sewers along their banks. The pipes through which waste -matter is emptied into the streams go only to the river edge, leaving -their mouths uncovered and making the river beds at times pools of -slowly flowing filth. These unsightly, malodorous conditions could be -remedied if pipes were extended out into the middle of the streams, -where the water is deeper. - -With the exception of sprinkling a few wagon loads of lime along the -banks of the streams each year, the city has done nothing to abate the -nuisances arising from the use of these rivers as sewers or to restrain -the coal and steel companies from allowing the drainage from mines and -mills to enter the streams. - -The engineer’s records show that Johnstown had in 1911 a total of 41.1 -miles of sewers and 36 sewer outlets, and 82 miles of streets, 52.7 -miles being paved. The alleys in Johnstown are generally inhabited. They -are narrow and without sidewalks. Their length is 52.88 miles and 47.35 -miles are unpaved. The combined length of streets and alleys is 134.88 -miles. A comparison of this combined length of streets and alleys with -the 41.1 miles of sewers having 36 outlets shows the inadequacy of the -sewer system. - -Not only is there an absence of paving, but the roadways are in very bad -condition. A protest by “A Citizen” in the _Democrat_ of June 26, 1913, -says that there are nine months in the year when it would be impossible -for the proposed fire-department automobile engines to attend a fire in -the seventh, eighth, eleventh, seventeenth, eighteenth, nineteenth, -twentieth, and twenty-first wards owing to the condition of the streets. - -The scavenger system is also very defective. Citizens are required to -pay for the removal of their ashes, trash, and garbage. Garbage -collections are not made by the municipality, but by private -contractors, and any sort of receptacle, covered or uncovered, can or -box, is pressed into service by householders. It is by no means uncommon -to find streets and alleys littered with ashes, garbage, bottles, tin -cans, beer cases, and small kegs. Dirty streets are by no means -exceptional in Johnstown, even though the State of Pennsylvania has a -law (act of Apr. 20, 1905) which provides for the punishment of any -person who litters paved streets. It reads, in part, as follows (sec. 7 -of Pamphlet Laws, 227): - -“From and after the passage of this act, it shall be unlawful, and is -hereby forbidden, for any person or persons to throw waste paper, -sweepings, ashes, household waste, nails, or rubbish of any kind into -any street in any city, borough, or township in this Commonwealth, or to -interfere with, scatter, or disturb the contents of any receptacle or -receptacles containing ashes, garbage, household waste, or rubbish which -shall be placed upon any of said paved streets or sidewalks for the -collection of the contents thereof. - -“Any person or persons who shall violate any of the provisions of this -act shall, upon conviction thereof before any magistrate, be sentenced -to pay the cost of prosecution and to forfeit and pay a fine not -exceeding $10 for each offense, and in default of the payment thereof -shall be committed and imprisoned in the county jail of the proper -county for a period not exceeding ten days.” - -In a report on infant mortality to the registrar general of Ontario, -1910, Dr. Helen MacMurchy says: “Improve the water supply, the sewerage -system, and the system of disposing of refuse; introduce better -pavements, such as asphalt, and at once there is a decline in infantile -mortality.” All these are sanitary features in need of great improvement -in Johnstown, and unquestionably a lowered infant mortality rate would -reward any efforts for their betterment. - - - HOUSING - -In Johnstown the so-called “double” house predominates, usually frame. -The double house is in reality two semidetached houses built upon a -single lot. Rows of three or more houses of two, three, or four rooms -each are common, and they are known locally as three-family, or -six-family houses, as the case may be. Sometimes these are “rear -houses,” that is, they are built behind other houses that face the -street, on the same lots and in fact are approached by way of a narrow -alley running alongside the house that has its frontage directly on the -street. For this type of house water-closets or privies are often in -rows in the yard or court that is used in common by all families. (See -Plates Q and R.) In some places they are too few in number to permit -each family to have the exclusive use of one. - -Johnstown has three or four comparatively high-grade apartment houses, -and in several office buildings rooms are rented to families for -housekeeping. These are generally taken by native families. - -In one of these office buildings the two lower floors are used for -business purposes and the two upper floors are given over entirely to -tenement purposes. From 40 to 50 families live here, many of whom have -but one room. To serve the 20 or 25 families on each floor there is one -bath and toilet room for men and another for women. Adjoining the toilet -rooms is a small room containing garbage cans and trash receptacles for -the use of the tenants. - -The sanitary conditions in some of the best tenements or apartments, -however, are not up to the standards of other cities, and in those -occupied by the poorer people conditions are much worse than are usually -permitted to exist in cities having large tenement houses in great -numbers, where a tenement-house problem is recognized as such and active -efforts are made by the municipality to improve conditions. - -An absolute measure of the importance of each single housing defect in a -high mortality rate can not be secured from this study. But it is not -without interest to note that in homes where water is piped into the -house the infant mortality rate was 117.6 per thousand, as compared with -a rate of 197.9 in homes where the water had to be carried in from -outdoors. Or that in the homes of 496 live-born babies where bathtubs -were found the infant mortality rate was 72.6, while it was more than -double, or 164.8, where there were no bathtubs. Desirable as a bathtub -and bodily cleanliness may be, this does not prove that the lives of the -babies were saved by the presence of the tub or the assumed cleanliness -of the persons having them. In a city of Johnstown’s low housing -standards, the tub is an index of a good home, a suitable house from a -sanitary standpoint, a fairly comfortable income, and all the favorable -conditions that go with such an income. - -The same trend of a high infant mortality rate in connection with other -housing defects is noted in the next table. - - - TABLE 3.—DISTRIBUTION OF LIVE BIRTHS AND OF DEATHS DURING FIRST YEAR, - AND INFANT MORTALITY RATE, ACCORDING TO HOUSING CONDITIONS. - - Deaths during First Year - HOUSING CONDITIONS Live births Number Infant mortality rate - - Total 1,463 196 134.0 - Dry homes 808 99 122.5 - Moderately dry homes 336 47 139.9 - Damp homes 319 50 156.7 - Bath 496 36 72.6 - No bath 965 159 164.8 - Not reported 2 1 ([14]) - Water supply in house 1,173 138 117.6 - Water supply outside 288 57 197.9 - Not reported 2 1 ([14]) - City water available 1,333 176 132.0 - City water not available 128 19 148.4 - Not reported 2 1 ([14]) - Yard clean 801 80 99.9 - Yard not clean 632 107 169.3 - No yard 28 8 ([14]) - Not reported 2 1 ([14]) - Water-closet 739 80 108.3 - Yard privy 722 115 159.3 - Not reported 2 1 ([14]) - -Footnote 14: - - Total live births less than 50; base therefore considered too small to - use in computing an infant mortality rate. - -The following summary may be of interest in indicating some relation -between infant mortality and cleanliness or uncleanliness combined with -dryness or dampness of homes: - - - TABLE 4.—DISTRIBUTION OF LIVE BIRTHS AND OF DEATHS DURING FIRST YEAR, - AND INFANT MORTALITY, ACCORDING TO CLEANLINESS AND DRYNESS OF HOME. - - Deaths during First Year - TYPE OF HOME Live births Number Infant mortality - rate - - All types 1,463 196 134.0 - Clean 943 107 113.5 - Moderately clean 354 58 163.8 - Dirty 166 31 186.7 - Dry 807 99 122.7 - Damp 656 97 147.9 - Clean: - Dry 581 61 105.0 - Damp 362 46 127.1 - Moderately clean: - Dry 158 27 170.9 - Damp 196 31 158.2 - Dirty: - Dry 68 11 161.8 - Damp 98 20 204.1 - -Dirt is doubtless unhealthful, but the amount of ill health or the -number of infant deaths caused by a home being dirty can hardly be -measured, when, as is usually the case, the dirt is accompanied by so -many other bad conditions arising from poverty. For example, a home in -close proximity to railroad tracks or mills whose stacks send forth -clouds of soot, smoke, and ashes is generally the poorly built home of -those who have neither time nor means to secure and retain cleanliness -under such difficulties. - -Overcrowding in homes is another factor the relative importance of which -can not be exactly determined, because of its close connection with -other ills. But the degree of overcrowding is greatest in the small -cheaper houses, those of one, two, three, or four rooms. The average -number of persons per room in the homes of all live-born babies for whom -the data were secured was found to be 1.38. Homes of four rooms were -more numerous than those of any other size and they housed an average of -1.58 persons per room. The number of babies in homes of various sizes -with the number of persons per room for homes of each size was as -follows: - - - TABLE 5.—NUMBER OF BABIES LIVING IN HOMES OF - EACH SPECIFIED SIZE, AND AVERAGE NUMBER OF - PERSONS PER ROOM IN HOMES OF EACH SIZE. - - Size of home Live-born babies Persons per room - - All homes 1,463 - 1 room 33 4.42 - 2 rooms 165 2.27 - 3 rooms 147 1.83 - 4 rooms 526 1.58 - 5 rooms 222 1.22 - 6 rooms 233 1.07 - 7 rooms 38 .96 - 8 rooms 43 0.83 - 9 rooms 22 .93 - 10 rooms 4 .88 - 11 rooms 4 .64 - 12 rooms 1 .75 - 13 rooms 1 .69 - 14 rooms 2 .43 - Not reported 22 - -In homes of one, two, three, or four rooms or where the number of -occupants ranged from 4.42 to 1.58 persons per room the infant mortality -rate was 155, as compared with a rate of but 101.8 in larger homes, -where the number ranged from 1.22 to 0.43 persons per room. - -The 1910 census returns show that the greatest overcrowding was in ward -15, where the average number of persons per dwelling was 9.9. Wards 16, -11, and 14 came next with rates of 8.3, 7.7, and 7.2 respectively. The -infant mortality rate for these four wards is 190.2, which is over -one-third more than the rate for the whole city. - -The mortality rate among infants who slept in a room with no other -person than their parents was much lower than among those who slept in a -room with more than two persons. The babies that slept in separate beds -also had a much lower infant mortality rate than those who did not sleep -alone, as shown in the next table. (Table omitted.) - -In presenting statistics on sleeping and ventilation, only the babies -who lived at least one month have been considered, for the reason that -so many deaths during the first month of life were due to prenatal -causes. - -The incidence shown in the foregoing table is significant, even though -it can by no means be deduced therefrom that the health of a large -proportion of babies was so impaired by sleeping with older and more or -less unhealthy persons that death resulted. But irregular night feeding -and overfeeding are undoubtedly harmful, and the mother is tempted to -subject the baby to this when it sleeps with her and disturbs her rest. - -Of the 1,389 babies who lived at least one month, 600, or 43.2 per -cent., lived in homes where the baby slept in a room with not more than -two other persons. The fact that the baby slept in a room with no more -persons than its parents generally argues that the family’s means -permitted them to have one or more additional rooms for other members of -the family, but in other cases, of course, merely that there were no -other persons in the family. - -Almost every home visited had means for good ventilation of the baby’s -room at night, yet but 604, or 43.5 per cent., of the 1,389 babies who -lived at least a month slept at night in well-ventilated rooms—that is, -in rooms where, according to the mother’s statement, a window was open -all night. Some mothers opened windows when the weather was neither cold -nor damp; or opened them in a hall or room adjoining that where the baby -slept; others emphatically stated that at night the windows were “always -shut tight.” The babies subjected to differences of ventilation show -corresponding variations in infant mortality rates. - -A high death rate in badly ventilated homes can not be charged wholly to -bad air. The mother who did not, or could not, provide proper -ventilation was generally the mother without the means or the knowledge -necessary to enable her to care for her baby properly in other respects, -and yet the marked differences suggest that ventilation is itself a very -important ally of the baby in its first year of struggle for existence. - -In many rooms that were poorly ventilated, windows were not opened for -the reason that the room was not properly heated and the houses -themselves were flimsy and drafty. The problem in such houses is to keep -warm. If the windows were frequently or constantly opened, the houses -would be too cold to live in. In some localities the outside air is so -laden with soot, ashes, dirt, and smoke that every effort is made to -keep it out of the house. - -The foreigners, who generally have the most miserable homes, are not -dirty people who select bad living conditions through innate poor -judgment, low standards, and lack of taste. The squalid homes which -housed the natives and later the Germans and the Irish until the present -type of immigrants came to do the more poorly paid work were the only -homes available within the purchasing power of their low wages. The new -immigrants demanded practically nothing and the owners did practically -nothing in the matter of improving these homes, which naturally became -more and more squalid as time went on. An excessive infant mortality -rate and insanitary homes in unhealthful sections were found to be -coexistent. - - - NATIONALITY - - - GENERAL NATIVITY - -The investigation embraced 860 babies of native mothers (of whom 6 were -negroes) and 691 babies of foreign mothers, making a total of 1,551. The -infant mortality rate for the entire group was 134 per 1,000 live -births; for the babies of native mothers 104.3, and for those of foreign -mothers 171.3. The stillbirth rate for native mothers having children in -1911 was less than that for foreign mothers, being 52.3, as compared -with 62.2 per 1,000 total births. - -The line between the natives and foreigners is very sharply drawn in -Johnstown. The native population as a rule knows scarcely anything about -the foreigners, except what appears in the newspapers about misdemeanors -committed in foreign sections. The report of the Immigration -Commission[15] comments “on the attitude of the police department toward -foreigners ... with regard to Sunday desecration,” and states that “the -Croatians are accustomed to spend Sunday in singing, drinking, and noisy -demonstrations. The police have been instructed to show no leniency on -account of ignorance of the municipal regulations, and, without any -attempt at explaining the laws, they arrest the offenders in large -numbers.” Again, it states: “They are arrested more often for crimes -that make them a nuisance to the native population than for mere -infractions of the law.... Few arrests are made for immorality among -foreigners.” “Sabbath desecration” is the crime foreigners are most -frequently charged with. - -Footnote 15: - - United States Immigration Commission Reports, Volume VIII., - “Immigrants in Industries: Part 2, Iron and Steel Manufacturing in the - East,” p. 387. Reference is to Johnstown and is a very true picture of - various immigrant institutions and of the comparative progress and - assimilation of different races there. Although the immigration report - was made five years before our investigation, conditions remain - practically the same. - -Foreigners are employed largely in the less skilled occupations of the -steel mills, which operate 24 hours a day, seven days a week. At the -time the investigation was made some of the men in the steel mills -worked for a period of two weeks on a night shift of 14 hours, then two -weeks on a day shift of 10 hours, and back again to the night shift of -14 hours for another two weeks, and so on. When shifts were changed, one -group of men was required to work throughout a period of 24 hours -instead of for the usual 10 or 14 hour period and another group had 24 -hours off duty. Some departments of the steel mills, however, shut down -on Sundays, and in some departments for certain occupations an -eight-hour day prevails, but these more favorable conditions do not -prevail among the majority of the unskilled foreign workers whose homes -were visited. - -The foreigners who work on a 24-hour shift in a mill on one Sunday -frequently “desecrate” their alternate free Sabbath by “singing, -drinking, and noisy demonstrations,” in spite of the known danger of -arrest for “crimes that make them a nuisance to the native population” -or for “Sabbath desecration,” laws concerning which are strictly -enforced in Johnstown; for example, children are not permitted to play -in public playgrounds on Sunday and mercantile establishments are -required to be closed on that day. Also, it is “unlawful for any person -or persons to deliver ice cream, or to sell or deliver milk from wagon -or by person carrying same, within the city on the Sabbath day, commonly -called Sunday, after 12 o’clock m.” The ordinance from which the -foregoing sentence was quoted became a law on January 25, 1914. - - - SERBO-CROATIAN - -The foreign group having the highest infant mortality rate is the -Serbo-Croatian[16] where infant deaths numbered 263.9 per 1,000 live -births. - -Footnote 16: - - A distinct and homogenous race, from a linguistic point of view, among - Slavic peoples. They are divided into the groups “Croatian” and - “Servian,” on political and religious grounds, the former being Roman - Catholics and the latter Greek Orthodox. Their spoken language is the - same but they can not read each other’s publications, for the - Croatians use the Roman alphabet, or sometimes the strange old Slavic - letters, while the Servians use the Russian characters fostered by the - Greek Church. - - Three Krainers have also, for convenience, been included in this - group. Krainers are Slovenians from the Austro-Hungarian Province of - Carniola and are designated “close cousins of the Croatians but with a - different though nearly related language” by Emily Greene Balch in her - book entitled “Our Slavic Fellow Citizens.” - -The men of the Serbo-Croatian group are fine looking and powerful and -are employed in the heavy unskilled work of the steel mills and the -mines. They greatly outnumber the women of their race in Johnstown, and -a man with a wife frequently becomes a “boarding boss”; that is, he -fills his rooms with beds and rents out sleeping space to his fellow -countrymen at from $2.50 to $3 a month each. The same bed and bedding is -sometimes in service both night and day to accommodate men on the night -and the day shifts of the steel mills. - -The wife, without extra charge, makes up the beds, does the washing and -ironing, and buys and prepares the food for all the lodgers. Usually she -gets everything on credit and the lodgers pay their respective shares -biweekly. These conditions exist to some extent among other foreigners, -but are not as prevalent among other nationalities in Johnstown as among -the Serbo-Croatians. - -In a workingman’s family, it is sometimes said, the woman’s work-day is -two hours longer than the man’s. But if this statement is correct in -general, the augmentation stated is insufficient in these abnormal homes -where the women are required to have many meals and dinner buckets ready -at irregular hours to accommodate men working on different shifts. - -The Serbo-Croatian women who, more than any of the others, do all this -work are big, handsome, and graceful, proud and reckless of their -strength. During the progress of the investigation, in the winter -months, they were frequently seen walking about the yards and courts, in -bare feet, on the snow and ice-covered ground, hanging up clothes or -carrying water into the house from a yard hydrant. - -Whether it harmed them to expend their force and vigor as they did could -not be determined in individual cases, but their babies are the ones who -died off with the greatest rapidity, their infant mortality rate being -263.9, as compared with the rates of 171.3 for all the foreign; 104.3 -for the natives; and 134 for the entire group as shown in Table 18. -Excluding babies of Serbo-Croatian mothers, the infant mortality rate -for babies of foreign mothers is but 159.7. - - - ITALIAN - -The Italian mothers visited in Johnstown bore 75 children in 1911, 4 -being stillborn. The infant mortality rate among the live born was -183.1, the highest of any racial group excepting the Serbo-Croatian, -where it was 263.9. - -The Italians have been in Johnstown somewhat longer than the -Serbo-Croatians and they seem to have a little firmer grip on the -community life there. Their homes are a shade better, a trifle cleaner, -and somewhat less crowded than those of the Serbo-Croatians, although -their hygienic standards seem little if any higher and they rank no -better in literacy. The women do not perform the arduous duties that are -the lot of so many of the Serbo-Croatian women; they have not the robust -physique of the latter and the men are not found in those branches of -the steel industry which require the extraordinary strength possessed by -the Serbo-Croatians. The occupations of the Italian fathers were found -to be more diversified than those of the Serbo-Croatians, some being -fruit, grocery, or cheese merchants; steamship agents; bricklayers, -carpenters, or workers at other skilled and semiskilled trades. - - - SLOVAK, POLISH, ETC. - -The infant mortality rate in the group designated “Slovak, Polish, etc.” -is 177.1. In this group are included all the Slavic races represented in -the investigation excepting the Serbo-Croatian. The babies of Slovak[17] -mothers were found to be most numerous, there being 276 of them. There -were 108 babies of Polish,[18] 2 of Bohemian,[19] and 7 of Ruthenian[20] -mothers. In addition, one baby of a Scandinavian (Danish) mother was -included, not because Scandinavians bear the least racial resemblance to -the Slavic races, but because the few Scandinavians in Johnstown -happened to be on about the same economic footing as the “Slovak, -Polish, etc.” - -Footnote 17: - - Slovaks occupy practically all except the Ruthenian territory of - northern Hungary; also found in great numbers in southeast Moravia. - They are the Moravians conquered by Hungary. In physical type no - dividing line can be drawn between Slovaks and Moravians. It is often - claimed that Slovak is a Bohemian dialect. - -Footnote 18: - - The west Slavic race native to the former Kingdom of Poland. For the - most part they adhere to the Roman rather than the Greek Orthodox - Catholic Church. - -Footnote 19: - - The westernmost division or dialect of the Czech and the principal - people or language of Bohemia. Czech is the westernmost race or - linguistic division of the Slavic (except Wendish, in Germany), the - race or people residing mainly in Bohemia and Moravia. - -Footnote 20: - - Also known as Little Russians; live principally in southern Russia; - also share Galicia with the Poles but greatly surpassed by Poles in - number. In language and physical type resemble Slovaks. Generally - Greek Orthodox, but a few are Greek Catholics of the Roman Catholic - Church, whose priests marry, and are separated from other Roman - Catholics by marked religious differences. - -The rate for this group is lower than that for either the -Serbo-Croatians or the Italians, but it is nevertheless very high and -one exceeded by only a few European countries, as shown by the table on -page 12. - -Some of the “Slovaks, Poles, etc.,” live in the same squalid sections as -the Serbo-Croatians, and in the same type of inferior houses, but on the -whole they have been in Johnstown longer, are more prosperous, and are -therefore beginning to move from Cambria City and Woodvale, where -formerly practically all lived, into more desirable sections. Those who -have been in this country longest and intend to stay here are buying -homes with large yards in the less crowded sections and are raising -vegetables and flowers. Others, however, still remain in poor -neighborhoods and sometimes buy houses there for from $300 to $600 each, -built close together on rented ground. - -Lodgers are by no means uncommon among the people in this group, but -usually their homes are cleaner, less crowded, and possessed of more -comforts than those of the Serbo-Croatians and Italians. - - - OTHER NATIONALITIES - -The British[21] infant mortality rate in Johnstown is 129 and the German -127.7. The British and Germans in Johnstown are more prosperous than the -Slavic, Magyar, Jewish, Italian, Syrian, and Greek peoples, and regard -the others as “foreigners.” It was strange to hear a man, one who could -speak English, say, “We are not foreigners; we are Germans.” The British -and Germans occupy the same relative position economically that they -occupy in the infant mortality scale with relation to other races. - -Footnote 21: - - English, Irish, Scotch, and Welsh included in the term British. - -In the Magyar group, of 38 babies born alive 4 died in their first year, -making an infant mortality rate of 105.3, which is almost as low as that -for babies of native mothers. The Magyars are little if any better off -than the other “foreigners” among whom they live, but they possess -somewhat higher standards of living. They live in poor neighborhoods and -have inferior houses, but their homes are cleaner and they themselves -somewhat more alert, personally cleaner, and less illiterate than the -other foreigners. - -There were but 10 babies of Hebrew mothers and 12 of Syrian and Greek -mothers; among these there were no deaths. These groups are too small -numerically to be significant in a comparative race study of infant -mortality. - - - STILLBIRTHS - -In all there were but 88 stillbirths included in the investigation. They -were more numerous proportionately among the Germans than among the -mothers of any of the other nationalities. No single nationality group, -however, has a very large representation, and hence a comparison of the -rate for one with that for another nationality is not as significant as -the difference in rate between native and foreign mothers. Although a -special study of the causes of stillbirths was not made in connection -with a study of deaths of infants during their first year of life, -nevertheless the incidence of these births among the different -nationality groups is believed to be of some interest, and therefore -shown in the next table. (Omitted.) - - - ATTENDANT AT BIRTH - -The native mother usually had a physician at childbirth; the -foreign-born, a midwife. The more prosperous of the foreign mothers, -however, departed from their traditions or customs and had physicians, -while the American-born mothers, when very poor, resorted to midwives. -The midwives usually charged $5, and sometimes only $3; they waited for -payment or accepted it in installments, and they performed many little -household services that no physician would think of rendering. - -Two-thirds of those having no attendant were Serbo-Croatians. It was a -Polish woman, however, who gave the following account of the birth of -her last child: - -At 5 o’clock Monday evening went to sister’s to return washboard, having -just finished day’s washing. Baby born while there; sister too young to -assist in any way; woman not accustomed to midwife anyway, so she cut -cord herself; washed baby at sister’s house; walked home, cooked supper -for boarders, and was in bed by 8 o’clock. Got up and ironed next day -and day following; it tired her, so she then stayed in bed two days. She -milked cows and sold milk day after baby’s birth, but being tired hired -some one to do it later in week. - -This woman keeps cows, chickens, and lodgers; also earns money doing -laundry and char work. Husband deserts her at times; he makes $1.70 a -day. A 15-year-old son makes $1.10 a day in coal mine. Mother thin and -wiry; looks tired and worn. Frequent fights in home. - -The infant mortality rate was lower for babies delivered by physicians -than for those delivered by midwives or for those at whose birth no -properly qualified attendant was present. This is not necessarily an -indication of the quality of the care at birth, although in some cases -the inefficiency of the midwife may have directly or indirectly caused -deaths, just as in some instances a physician’s inefficiency may have -caused them. The midwife, however, is resorted to by the poor, and in -their homes are found other conditions that create a high infant -mortality rate. - -Frequently the Serbo-Croatian women dispense altogether with any -assistance at childbirth; sometimes not even the husband or a neighbor -assists. Over 30 per cent. of the births among the women of that race -took place without a qualified attendant. More than one-half of those -delivered by midwives, less than one-fifteenth of those delivered by -physicians, and about one-fifth of those delivered without a qualified -attendant had babies who died in their first year of life. - -Fifteen of the 19 Serbo-Croatian women whose babies died under 1 year of -age kept lodgers. - -In Johnstown the midwife is resorted to principally by the poor. Recent -laws that the State is now trying to enforce require that the standard -for the practice of midwifery be raised. If this can be done midwives -might become definitely helpful persons in the community. One or two of -the intelligent graduate midwives in Johnstown have been an educational -force among the foreign mothers for some years past. On the other hand -there were others who were so dirty and so ignorant that they were a -menace to the public health. - - - MOTHERS - - - LITERACY[22] - -There are differences in the infant mortality rate between the babies of -literate and the babies of illiterate mothers; between those with -mothers who can speak English and those with mothers who can not; and -between babies of the mothers who have been in this country for a -considerable period and those of the newer arrivals. Comparisons of this -nature are confined to the foreign mothers, as only three cases of -illiteracy were found among native mothers, and the other comparisons -would not, of course, be applicable in any case to native mothers. - -Footnote 22: - - By literacy is meant ability to read and write in any language and not - simply in English. - -The next table shows that the infant mortality rate among the children -of illiterate foreign mothers was 214, or 66 per thousand greater than -the rate among literate foreign mothers. - - - TABLE 13.—DISTRIBUTION OF BIRTHS AND OF DEATHS DURING FIRST YEAR, - INFANT MORTALITY RATE, AND NUMBER AND PER CENT OF STILLBIRTHS, - ACCORDING TO LITERACY OF FOREIGN MOTHERS. - - ═══════════════════════╤═══════╤═══════╤═════════════╤═════════════════ - LITERACY OF FOREIGN │ Total │ Live │STILLBIRTHS. │ DEATHS DURING - MOTHERS. │births.│births.│ │ FIRST YEAR. - ───────────────────────┼───────┼───────┼───────┬─────┼───────┬───────── - │ │ │ │ Per │ │ Infant - │ │ │Number.│cent.│Number.│mortality - │ │ │ │ │ │ rate. - ───────────────────────┼───────┼───────┼───────┼─────┼───────┼───────── - Foreign mothers │ 691│ 648│ 43│ 6.2│ 111│ 171.3 - ═══════════════════════╪═══════╪═══════╪═══════╪═════╪═══════╪═════════ - Literate │ 445│ 419│ 26│ 5.8│ 62│ 148.0 - Illiterate │ 246│ 229│ 17│ 6.9│ 49│ 214.0 - ───────────────────────┴───────┴───────┴───────┴─────┴───────┴───────── - - - ABILITY TO SPEAK ENGLISH - -The next table shows that babies whose mothers can not speak English -were characterized by a more unfavorable infant mortality rate than -other babies. - - - TABLE 14.—DISTRIBUTION OF BIRTHS AND OF DEATHS DURING FIRST YEAR, - INFANT MORTALITY RATE, AND NUMBER AND PER CENT OF STILLBIRTHS, - ACCORDING TO ABILITY OF FOREIGN MOTHER TO SPEAK ENGLISH. - - ═══════════════════════╤═══════╤═══════╤═════════════╤═════════════════ - ABILITY TO SPEAK │ Total │ Live │STILLBIRTHS. │ DEATHS DURING - ENGLISH. │births.│births.│ │ FIRST YEAR. - ───────────────────────┼───────┼───────┼───────┬─────┼───────┬───────── - │ │ │ │ Per │ │ Infant - │ │ │Number.│cent.│Number.│mortality - │ │ │ │ │ │ rate. - ───────────────────────┼───────┼───────┼───────┼─────┼───────┼───────── - Foreign mothers │ 691│ 648│ 43│ 6.2│ 111│ 171.3 - ═══════════════════════╪═══════╪═══════╪═══════╪═════╪═══════╪═════════ - Speak English │ 263│ 247│ 16│ 6.1│ 36│ 145.7 - Can not speak English │ 428│ 401│ 27│ 6.3│ 75│ 187.0 - ───────────────────────┴───────┴───────┴───────┴─────┴───────┴───────── - - - YEARS IN THE UNITED STATES - -In addition to a consideration of the babies according to their mothers’ -ability to speak English, it is of interest to note the infant mortality -rates among babies whose mothers have been in this country for different -periods of time. - -The high infant mortality rate for the children of newer immigrants, -illiterates, and those who can not speak English is perhaps affected by -the fact that they are at the same time generally of the poorest -families and are housed in the most insanitary and unhealthful part of -the city. - - - AGE - -The age of the mother is frequently believed to be a factor in the -health of the child. The highest infant mortality rate was found to be -that for the group of babies with mothers over 40 years of age, and the -lowest for babies of mothers from 20 to 24 years of age. - - - TABLE 16.—DISTRIBUTION OF BIRTHS AND OF DEATHS DURING FIRST YEAR, - INFANT MORTALITY RATE, AND NUMBER AND PER CENT OF STILLBIRTHS, - ACCORDING TO AGE OF MOTHER. - - ════════════════╤════════╤════════╤═════════════════╤══════════════════ - AGE OF MOTHER. │ Total │ Live │ STILLBIRTHS. │ DEATHS DURING - │births. │births. │ │ FIRST YEAR. - ────────────────┼────────┼────────┼────────┬────────┼────────┬───────── - │ │ │ │ Per │ │ Infant - │ │ │Number. │ cent. │Number. │mortality - │ │ │ │ │ │ rate. - ────────────────┼────────┼────────┼────────┼────────┼────────┼───────── - All mothers │ 1,551│ 1,463│ 88│ 5.7│ 196│ 134.0 - ════════════════╪════════╪════════╪════════╪════════╪════════╪═════════ - Under 20 │ 105│ 95│ 10│ 9.5│ 13│ 136.8 - 20 to 24 │ 476│ 454│ 22│ 4.6│ 55│ 121.1 - 25 to 29 │ 410│ 391│ 19│ 4.6│ 56│ 143.2 - 30 to 39 │ 480│ 449│ 31│ 6.5│ 61│ 135.9 - 40 and over │ 80│ 74│ 6│ 7.5│ 11│ 148.6 - ────────────────┴────────┴────────┴────────┴────────┴────────┴───────── - -The youngest mothers have a higher stillbirth rate than other mothers, -and the oldest group of mothers has the next highest rate. In this -connection not only the foregoing table is of interest, but also Table -XII, based upon the entire reproduction histories of the mothers -included in this study. As all the children borne by these mothers are -included, the base numbers in the latter table are larger and the -figures therefore somewhat more significant. - - - BABY’S AGE AT DEATH AND CAUSE (DISEASE) OF DEATH - -_A baby who comes into the world has less chance to live one week than -an old man of 90, and less chance to live a year than one of -80.—Bergeron._ - -The most dangerous time of life is early infancy; even old age seldom -has greater risk. Death strikes most often in infancy. The Johnstown -babies died during their first year of life at the rate of 134 per 1,000 -born alive, and they paid their heaviest toll in their very earliest -days. If the total of 196 deaths had been distributed evenly throughout -the 12 months, 8.3 per cent. of the babies would have died each month -and 25 per cent. during each quarter. But instead of that 37.8 per cent. -died in the first month; 9.2 per cent. in the second, and 8.2 per cent. -in the third, or over 55 per cent. in the first quarter. - - - TABLE 17.—NUMBER AND PER CENT DISTRIBUTION OF DEATHS OF BABIES, BY AGE - AT DEATH. - - ═══════════════════════════════════╤═══════════════════════════════════ - AGE AT DEATH. │ DEATHS OF BABIES OF ALL MOTHERS. - ───────────────────────────────────┼─────────────────┬───────────────── - │ Number. │ Per cent. - │ │ distribution. - ───────────────────────────────────┼─────────────────┼───────────────── - Total deaths in first year │ 196│ 100.0 - ═══════════════════════════════════╪═════════════════╪═════════════════ - First quarter │ 108│ 55.1 - First month │ 74│ 37.8 - ═══════════════════════════════════╪═════════════════╪═════════════════ - First week │ 45│ 23.0 - ───────────────────────────────────┼─────────────────┼───────────────── - Less than 1 day and 1 day │ 30│ 15.3 - 2 days │ 4│ 2.0 - 3 to 6 days │ 11│ 5.6 - │ │ - Second week │ 14│ 7.1 - Third week │ 7│ 3.6 - Fourth week │ 8│ 4.1 - │ │ - Second month │ 18│ 9.2 - Third month │ 16│ 8.2 - │ │ - Second quarter │ 42│ 21.4 - Third quarter │ 31│ 15.8 - Fourth quarter │ 15│ 7.7 - ───────────────────────────────────┴─────────────────┴───────────────── - -The large number of deaths in the first few hours or days of life -indicates that many babies are born with some handicap and that in many -instances the mother has been subjected to some condition which resulted -in the birth of a child incapable of withstanding the ordinary strain of -life. Of the 45 babies who died in Johnstown less than a week after -birth, 38 died of prematurity, congenital debility or malformations, or -injuries received at birth. In one other case the cause of death was -given as “bowel trouble” and in six other cases it was not clearly -defined. In addition to the 45 babies just referred to as having died in -their first week, 12 died later either from prematurity or from -congenital defects. - -Of the deaths from causes arising after birth, 52 were attributed by the -attending physicians to diarrhoea and enteritis, 50 to respiratory -diseases; and 44 to some other or to some ill-defined cause. - - - TABLE 18.—DISTRIBUTION OF DEATHS DURING FIRST YEAR AND INFANT MORTALITY - RATE, ACCORDING TO CAUSE OF DEATH AND NATIVITY OF MOTHER. - - ═════════════════╤═════════════════════════════════════════════════════ - CAUSE OF DEATH. │ DEATHS DURING FIRST YEAR OF BABIES OF— - ─────────────────┼─────────────────┬─────────────────┬───────────────── - │ All mothers. │ Native mothers. │Foreign mothers. - ─────────────────┼───────┬─────────┼───────┬─────────┼───────┬───────── - │ │ Infant │ │ Infant │ │ Infant - │Number.│mortality│Number.│mortality│Number.│mortality - │ │ rate. │ │ rate. │ │ rate. - ─────────────────┼───────┼─────────┼───────┼─────────┼───────┼───────── - All causes │ 196│ 134.0│ 85│ 104.3│ 111│ 171.3 - ═════════════════╪═══════╪═════════╪═══════╪═════════╪═══════╪═════════ - Diarrhea and │ 52│ 35.5│ 17│ 20.9│ 35│ 54.0 - enteritis │ │ │ │ │ │ - Respiratory │ 50│ 34.2│ 19│ 23.3│ 31│ 47.8 - diseases │ │ │ │ │ │ - Premature births │ 24│ 16.4│ 11│ 13.5│ 13│ 20.1 - Congenital │ │ │ │ │ │ - debility or │ 19│ 12.9│ 5│ 6.1│ 14│ 21.6 - malformation │ │ │ │ │ │ - Injuries at birth│ 7│ 4.8│ 6│ 7.4│ 1│ 1.5 - Other causes or │ 44│ 30.1│ 27│ 33.1│ 17│ 26.2 - not reported │ │ │ │ │ │ - ─────────────────┴───────┴─────────┴───────┴─────────┴───────┴───────── - -The latest census report on mortality statistics characterizes diarrhoea -and enteritis as the “most important preventable cause of infant -mortality” in the United States, and numerically at least it proves to -be the most important cause of infant death in Johnstown. - -Holt[23] says that one of the most striking facts about diarrheal -diseases in infants is their prevalence during the summer season. In -Johnstown the infant diarrheal deaths were least prevalent in the first -quarter of the year, next in the second, next prevalent in the fourth, -and most prevalent in the third or summer quarter. - -Footnote 23: - - The Diseases of Infancy and Childhood, by L. Emmett Holt. p. 345. New - York, 1912. - - - TABLE 19.—DISTRIBUTION OF DEATHS, ACCORDING TO CAUSE OF DEATH AND - QUARTER OF CALENDAR YEAR IN WHICH DEATH OCCURRED. - - ═══════════════════════════════╤═══════╤═══════════════════════════════ - CAUSE OF DEATH. │ All │ QUARTER OF CALENDAR YEAR IN - │deaths.│ WHICH DEATH OCCURRED. - ───────────────────────────────┼───────┼───────┬───────┬───────┬─────── - │ │First. │Second.│Third. │Fourth. - ───────────────────────────────┼───────┼───────┼───────┼───────┼─────── - All causes │ 196│ 54│ 29│ 74│ 39 - ═══════════════════════════════╪═══════╪═══════╪═══════╪═══════╪═══════ - Diarrhea and enteritis │ 52│ 3│ 5│ 32│ 12 - Respiratory diseases │ 50│ 24│ 8│ 7│ 11 - Premature births │ 24│ 7│ 5│ 9│ 3 - Congenital debility or │ 19│ 5│ 2│ 8│ 4 - malformation │ │ │ │ │ - Injuries at birth │ 7│ 5│ 1│ │ 1 - Other causes or not reported │ 44│ 10│ 8│ 18│ 8 - ───────────────────────────────┴───────┴───────┴───────┴───────┴─────── - -Our figures are too small to admit of broad generalizations or a very -full discussion of infant deaths according to the period of the year. - -This excess of infant deaths from diarrhea in the summer months has been -established by statistics in many countries, and the cause of such an -excess has been the subject of much discussion, but as yet there is no -general agreement. Liefmann and Lindemann[24] conclude, however, that in -this field of controversy there are certain facts which are at present -well established, these being the dependence of the high summer -mortality on methods of feeding, on hot weather, and on the living and -social condition of the parents. The last factor mentioned by these -authors, including as it does housing conditions, economic status, and -degree of intelligence, is becoming more and more the subject of study -and investigation. It has been shown that the distinctly harmful effect -of hot weather on the infant is increased when the housing conditions -are bad; in overcrowded homes with bad ventilation the indoor -temperature may be many degrees higher than the outdoor temperature. The -ignorance and carelessness of mothers has also been shown to increase -the bad effect of hot weather. With hygienic care, including cool baths, -much fresh air, and careful feeding, many infants are able to pass -through extremely hot weather without diarrheal disturbances. - -Footnote 24: - - Liefmann, H., and Lindemann, H., Die Lokalization der - Sauglingsterblichkeit und ihre Beziehungen zur Wohnungsfrage. Med. - Klinik 1912, pp. 8, 1074. - -Respiratory diseases were reported as a cause of death with almost as -great frequency as diarrheal diseases. As shown by Table 19, these -deaths occurred principally in the colder months of the first and fourth -quarters of the calendar year. - - - FEEDING - -Food is recognized as of such importance in relation to infant mortality -that studies of this subject frequently resolve themselves into studies -of feeding only. Invariably these demonstrate the truth of the statement -of Dr. G. F. McCleary[25] that “in human milk we have a unique and -wonderful food for which the ingenuity of man may toil in vain to find a -satisfactory substitute.” Many mothers, however, still fail to -appreciate the risk their young babies face in being given any except -the natural infant food, and consequently babies are in large numbers -wholly or partly weaned from the breast in the earliest months of their -lives. - -Footnote 25: - - Infantile Mortality and Infants’ Milk Depots. London. - -Breast feeding is far more general, comparatively, among the poorer -mothers than among the well to do, as shown by the following summary -which gives the number and per cent. of babies of mothers with husbands -earning varying incomes, who had been completely weaned from the breast -when they were 3, 6, or 9 months of age, respectively. For each of the -periods indicated the percentage completely weaned from the breast is -much greater in the groups where earnings are highest. - - - TABLE 20.—DISTRIBUTION OF BABIES ALIVE AT 3, 6, AND 9 MONTHS OF AGE BY - TYPE OF FEEDING AT EACH OF SAID AGES, ACCORDING TO ANNUAL EARNINGS OF - FATHER AND NATIVITY OF MOTHER. - - ══════════════╤═════════════════════════════════════════ - ANNUAL │ - EARNINGS OF │ - FATHER AND │ BABIES LIVING AT AGE OF— - NATIVITY OF │ - MOTHER. │ - ──────────────┼────────────────────┬──────────────────── - │ 3 months. │ 6 months. - ──────────────┼──────┬─────────────┼──────┬───────────── - │ │ Completely │ │ Completely - │Total.│ weaned from │Total.│ weaned from - │ │ breast. │ │ breast. - ──────────────┼──────┼───────┬─────┼──────┼───────┬───── - │ │Number.│ Per │ │Number.│ Per - │ │ │cent.│ │ │cent. - ──────────────┼──────┼───────┼─────┼──────┼───────┼───── - Total │ 1,355│ 193│ 14.2│ 1,313│ 250│ 19.0 - ══════════════╪══════╪═══════╪═════╪══════╪═══════╪═════ - Under $624 │ 341│ 22│ 6.5│ 322│ 32│ 9.9 - $625 to $899│ 358│ 48│ 13.4│ 351│ 63│ 17.9 - $900 and │ 629│ 114│ 18.1│ 616│ 146│ 23.7 - over[26] │ │ │ │ │ │ - Not │ 27│ 9│ 33.3│ 24│ 9│ 37.5 - reported[27]│ │ │ │ │ │ - │ │ │ │ │ │ - Mother │ 765│ 155│ 20.3│ 747│ 195│ 26.1 - native │ │ │ │ │ │ - ──────────────┼──────┼───────┼─────┼──────┼───────┼───── - Under $624 │ 69│ 10│ 14.5│ 66│ 13│ 19.7 - $625 to $899 │ 180│ 36│ 20.0│ 177│ 46│ 26.0 - $900 and │ 491│ 100│ 20.4│ 482│ 127│ 26.3 - over[26] │ │ │ │ │ │ - Not │ 25│ 9│ 36.0│ 22│ 9│ 40.9 - reported[27]│ │ │ │ │ │ - │ │ │ │ │ │ - Mother │ 590│ 38│ 6.4│ 566│ 55│ 9.7 - foreign │ │ │ │ │ │ - ──────────────┼──────┼───────┼─────┼──────┼───────┼───── - Under $624 │ 272│ 12│ 4.4│ 256│ 19│ 7.4 - $625 to $899 │ 178│ 12│ 6.7│ 174│ 17│ 9.8 - $900 and │ 138│ 14│ 10.1│ 134│ 19│ 14.2 - over[26] │ │ │ │ │ │ - Not │ 2│ │ │ 2│ │ - reported[27]│ │ │ │ │ │ - ──────────────┴──────┴───────┴─────┴──────┴───────┴───── - - ══════════════╤════════════════════ - ANNUAL │ - EARNINGS OF │ - FATHER AND │BABIES LIVING AT AGE OF— - NATIVITY OF │ - MOTHER. │ - ──────────────┼──────────────────── - │ 9 months. - ──────────────┼──────┬───────────── - │ │ Completely - │Total.│ weaned from - │ │ breast. - ──────────────┼──────┼───────┬───── - │ │Number.│ Per - │ │ │cent. - ──────────────┼──────┼───────┼───── - Total │ 1,282│ 358│ 27.5 - ══════════════╪══════╪═══════╪═════ - Under $624 │ 309│ 57│ 18.4 - $625 to $899│ 342│ 85│ 24.9 - $900 and │ 608│ 201│ 33.1 - over[26] │ │ │ - Not │ 23│ 10│ 43.3 - reported[27]│ │ │ - │ │ │ - Mother │ 735│ 251│ 34.1 - native │ │ │ - ──────────────┼──────┼───────┼───── - Under $624 │ 65│ 18│ 27.7 - $625 to $899 │ 173│ 55│ 31.8 - $900 and │ 476│ 168│ 35.3 - over[26] │ │ │ - Not │ 21│ 10│ 47.6 - reported[27]│ │ │ - │ │ │ - Mother │ 547│ 102│ 18.6 - foreign │ │ │ - ──────────────┼──────┼───────┼───── - Under $624 │ 244│ 39│ 16.0 - $625 to $899 │ 169│ 30│ 17.8 - $900 and │ 132│ 33│ 25.0 - over[26] │ │ │ - Not │ 2│ │ - reported[27]│ │ │ - ──────────────┴──────┴───────┴───── -Footnote 26: - - Includes those reported as earning “ample.” “Ample,” as used in this - report has a somewhat technical meaning; when information concerning - the father’s earnings was not available and the family showed no - evidences of poverty, the word “ample” was used. When, however, the - family was clearly in a state of abject poverty, it was included in - the group “Under $521.” - -Footnote 27: - - Unmarried mothers’ babies also included. - -Breast feeding, wholly or in part, is continued for a longer period by -foreign than by native mothers, as indicated in the preceding table, -showing that 20.3, 26.1, and 34.1 per cent. of the native mothers’ -babies as compared with 6.4, 9.7, and 18.6 per cent. of the foreign -mothers’ babies had been weaned from the breast at the age of 3, 6, and -9 months, respectively. - - - TABLE 25.—DISTRIBUTION OF ALL BIRTHS, LIVE BIRTHS, AND STILLBIRTHS AND - OF DEATHS DURING FIRST YEAR, AND INFANT MORTALITY RATE, ACCORDING TO - SEX OF BABY AND NATIVITY OF MOTHER. - - ═══════════════════════╤═══════╤═══════╤══════════════╤════════════════ - SEX OF BABY AND │ All │ Live │ STILLBIRTHS.│ DEATHS DURING - NATIVITY OF MOTHER. │births.│births.│ │ FIRST YEAR. - ───────────────────────┼───────┼───────┼──────┬───────┼──────┬───────── - │ │ │ │ Rate │ │ Infant - │ │ │Total.│ per │Total.│mortality - │ │ │ │ 1,000 │ │ rate. - │ │ │ │births.│ │ - ───────────────────────┼───────┼───────┼──────┼───────┼──────┼───────── - BABIES OF NATIVE │ │ │ │ │ │ - MOTHERS. │ │ │ │ │ │ - │ │ │ │ │ │ - Total number │ 860│ 815│ 45│ 52.3│ 85│ 104.3 - ═══════════════════════╪═══════╪═══════╪══════╪═══════╪══════╪═════════ - Male: │ │ │ │ │ │ - Number │ 433│ 406│ 27│ 62.4│ 46│ 113.3 - Per cent. │ 50.3│ 49.8│ 60.0│ │ 54.1│ - Female: │ │ │ │ │ │ - Number │ 427│ 409│ 18│ 42.2│ 39│ 95.4 - Per cent. │ 49.7│ 50.2│ 40.0│ │ 45.9│ - │ │ │ │ │ │ - BABIES OF FOREIGN │ │ │ │ │ │ - MOTHERS. │ │ │ │ │ │ - │ │ │ │ │ │ - Total number │ 691│ 648│ 43│ 62.2│ 111│ 171.3 - ═══════════════════════╪═══════╪═══════╪══════╪═══════╪══════╪═════════ - Male: │ │ │ │ │ │ - Number │ 380│ 355│ 25│ 65.8│ 59│ 166.2 - Per cent. │ 55.0│ 54.8│ 58.1│ │ 53.2│ - Female: │ │ │ │ │ │ - Number │ 311│ 293│ 18│ 57.9│ 52│ 177.5 - Per cent. │ 45.0│ 45.2│ 41.9│ │ 46.8│ - ───────────────────────┴───────┴───────┴──────┴───────┴──────┴───────── - - - MOTHER’S HOUSEHOLD DUTIES, CESSATION AND RESUMPTION OF - -The extent to which the native and foreign mothers in Johnstown -relinquished a part of their household duties as the time for their -confinement approached is shown below: - - - TABLE 26.—DISTRIBUTION OF BIRTHS ACCORDING TO TIME OF THE MOTHER’S - RELINQUISHMENT OF PART OF HOUSEHOLD DUTIES BEFORE CONFINEMENT, BY - NATIVITY OF MOTHER. - - ════════════════════════════════════════════╤════════╤════════╤════════ - TIME OF RELINQUISHMENT OF PART OF HOUSEHOLD │ All │ To │ To - DUTIES BEFORE CONFINEMENT. │births. │ native │foreign - │ │mothers.│mothers. - ────────────────────────────────────────────┼────────┼────────┼──────── - All mothers │ 1,551│ 860│ 691 - ════════════════════════════════════════════╪════════╪════════╪════════ - No household duties relinquished to day of │ 1,350│ 695│ 655 - confinement │ │ │ - Part of duties relinquished: │ │ │ - Less than 7 days before confinement │ 3│ 1│ 2 - 7 to 13 days before confinement │ 7│ 5│ 2 - 2 weeks to 1 month before confinement │ 16│ 12│ 4 - 1 month or more before confinement │ 174│ 146│ 28 - Had no household duties │ 1│ 1│ - ────────────────────────────────────────────┴────────┴────────┴──────── - -Among the 174 babies of mothers who relinquished part of their household -duties a month before confinement, the infant mortality rate was 112.5, -as compared with 136.7 for those of other mothers. - - - TABLE 27.—DISTRIBUTION OF BIRTHS AND OF DEATHS DURING FIRST YEAR, AND - INFANT MORTALITY RATE, ACCORDING TO TIME OF RELINQUISHMENT OF PART OF - HOUSEHOLD DUTIES OF MOTHER BEFORE CONFINEMENT. - - ══════════════════════════════════╤════════╤════════╤════════╤═════════ - TIME OF RELINQUISHMENT OF PART OF │ │ │ Deaths │ Infant - HOUSEHOLD DUTIES BEFORE │ All │ Live │ during │mortality - CONFINEMENT. │births. │births. │ first │ rate. - │ │ │ year. │ - ──────────────────────────────────┼────────┼────────┼────────┼───────── - All mothers │ 1,551│ 1,463│ 196│ 134.0 - ══════════════════════════════════╪════════╪════════╪════════╪═════════ - No cessation or less than 1 month │ 1,376│ 1,302│ 178│ 136.7 - 1 month or more │ 171│ 160│ 18│ 112.5 - No housework │ 1│ 1│ │ - ──────────────────────────────────┴────────┴────────┴────────┴───────── - -To what extent the relinquishment of household duties at a given time -directly affected the health of the child can not be definitely shown. A -relation may exist, but on the other hand the difference in the -mortality rate may be due to the fact that the mothers could afford to -give consideration to their condition and escape some of their heaviest -tasks as their pregnancy approached its end, and were members of -families who were thoughtful of them and relieved them of these tasks or -employed extra household assistance at such times. - -Another indication of intelligence and of comfortable surroundings is -the care given a mother in the early days of her baby’s life, -particularly if she is a nursing mother. The duration of her rest period -before the resumption of part of her household duties is one measure of -this. The foreign mothers, with less education, more numerous and -arduous tasks, less opportunity for leisure, and smaller incomes, begin -to resume their housework sooner than the native mothers with young -babies. - - - TABLE 28.—DISTRIBUTION OF LIVE BIRTHS AND OF DEATHS DURING FIRST YEAR, - AND INFANT MORTALITY RATE, ACCORDING TO TIME OF MOTHER RESUMING PART OF - HOUSEHOLD DUTIES AFTER CONFINEMENT, BY NATIVITY OF MOTHER. - - ═══════════════════════════╤══════════════════════════╤════════════════ - TIME OF RESUMING PART OF │ │ DEATHS DURING - HOUSEHOLD DUTIES AFTER │ LIVE BIRTHS TO— │ FIRST YEAR. - CONFINEMENT. │ │ - ───────────────────────────┼────────┬────────┬────────┼──────┬───────── - │ All │ Native │Foreign │ │ Infant - │mothers.│mothers.│mothers.│Total.│mortality - │ │ │ │ │ rate. - ───────────────────────────┼────────┼────────┼────────┼──────┼───────── - Total │ 1,463│ 815│ 648│ 196│ 134.0 - ═══════════════════════════╪════════╪════════╪════════╪══════╪═════════ - 8 days or less │ 467│ 44│ 423│ 79│ 169.2 - 9 to 13 days │ 560│ 446│ 114│ 70│ 125.0 - 14 days or more │ 427│ 318│ 109│ 41│ 96.0 - Mother died or not reported│ 9│ 7│ 2│ 6│ ([28]) - ───────────────────────────┴────────┴────────┴────────┴──────┴───────── - -Footnote 28: - - Total number of live births less than 50; base therefore considered - too small to use in computing an infant mortality rate. - -The fact that a mother takes up her housework in the early days of her -baby’s life does not necessarily increase the danger of its death. In -some cases, however, mothers stated that the quantity of their breast -milk was noticeably impaired when they got up and resumed their work too -soon. Naturally this would affect the baby’s nutrition. In other cases a -mother’s cares and duties may be so absorbing that she can not give the -baby full attention. Whatever the exact explanation, attention should be -called to the greater frequency of infant deaths when the mother resumed -household duties very soon after childbirth. - -A statement of the time of the mother’s resumption of household duties -in full, like that giving the time of resumption in part, shows that the -native mothers have the longer period of rest. - - - TABLE 29.—DISTRIBUTION OF LIVE BIRTHS AND OF DEATHS DURING FIRST YEAR, - AND INFANT MORTALITY RATE, ACCORDING TO TIME OF MOTHER RESUMING ALL - HOUSEHOLD DUTIES AFTER CONFINEMENT, BY NATIVITY OF MOTHER. - - ═══════════════════════════╤══════════════════════════╤════════════════ - TIME OF RESUMING ALL │ │ DEATHS DURING - HOUSEHOLD DUTIES AFTER │ LIVE BIRTHS TO— │ FIRST YEAR. - CONFINEMENT. │ │ - ───────────────────────────┼────────┬────────┬────────┼──────┬───────── - │ All │ Native │Foreign │ │ Infant - │mothers.│mothers.│mothers.│Total.│mortality - │ │ │ │ │ rate. - ───────────────────────────┼────────┼────────┼────────┼──────┼───────── - Total │ 1,463│ 815│ 648│ 196│ 134.0 - ═══════════════════════════╪════════╪════════╪════════╪══════╪═════════ - 8 days or less │ 219│ 13│ 206│ 37│ 168.9 - 9 to 13 days │ 182│ 132│ 50│ 30│ 164.8 - 14 days or more │ 1,053│ 663│ 390│ 123│ 116.8 - Mother died or not reported│ 9│ 7│ 2│ 6│ ([29]) - ───────────────────────────┴────────┴────────┴────────┴──────┴───────── - -Footnote 29: - - Total live births less than 50; base therefore considered too small to - use in computing an infant mortality rate. - -The infant mortality rates for all mothers in the group just referred -to, according to the time of resuming housework in full after -childbirth, show fewer infant deaths proportionately when the mother has -had a longer rest; that is, a rest of two weeks or more. - - - ECONOMIC FACTORS - - - EARNINGS OF FATHER - -A grouping of babies according to the income of the father shows the -greatest incidence of infant deaths where wages are lowest, and the -smallest incidence where they are highest, indicating clearly the -relation between low wages and ill health and infant deaths. - -For all live babies born in wedlock the infant mortality rate is 130.7. -It rises to 255.7 when the father earns less than $521 a year or less -than $10 a week, and falls to 84 when he earns $1,200 or more or if his -earnings are “ample.”[30] The variation in the infant mortality rate -from one earnings group to another is not perfectly regular and -consistent, but if any two or more consecutive groups are combined an -invariable lowering of the infant mortality rate from one such combined -group to that next higher results. - -Footnote 30: - - “Ample” as used in this report has a somewhat arbitrary meaning. When - information concerning the father’s earnings was not available and the - family showed no evidences of actual poverty, the word “ample” was - used. If no information concerning earnings was available when, on the - other hand, the family was clearly in a state of abject poverty, then - the income was tabulated as “Under $521.” - - - TABLE 30.—DISTRIBUTION OF LIVE BIRTHS AND OF DEATHS DURING FIRST YEAR, - AND INFANT MORTALITY RATE, ACCORDING TO ANNUAL EARNINGS OF FATHER AND - NATIVITY OF MOTHER, FOR LEGITIMATE LIVE-BORN BABIES. - - ═════════════════════════════════════════╤═════════╤═════════╤═════════ - │ Total │ Deaths │ Infant - ANNUAL EARNINGS OF FATHER ACCORDING TO │ live │ during │mortality - NATIVITY OF WIFE. │ births. │ first │ rate. - │ │ year. │ - ─────────────────────────────────────────┼─────────┼─────────┼───────── - Total │ 1,431│ 187│ 130.7 - ═════════════════════════════════════════╪═════════╪═════════╪═════════ - Under $625 │ 384│ 82│ 213.5 - ─────────────────────────────────────────┼─────────┼─────────┼───────── - Under $521 │ 219│ 56│ 255.7 - $521 to $624 │ 165│ 26│ 157.6 - │ │ │ - $625 to $899 │ 385│ 47│ 122.1 - ─────────────────────────────────────────┼─────────┼─────────┼───────── - $625 to $779 │ 224│ 24│ 107.1 - $780 to $899 │ 161│ 23│ 142.9 - │ │ │ - $900 or more │ 186│ 18│ 96.8 - ─────────────────────────────────────────┼─────────┼─────────┼───────── - $900 to $1,199 │ 138│ 14│ 101.4 - $1,200 or more │ 48│ 4│ 83.3 - │ │ │ - Ample[1] │ 476│ 40│ 84.0 - │ │ │ - Husbands with native wives │ 785│ 76│ 96.8 - ═════════════════════════════════════════╪═════════╪═════════╪═════════ - Under $625 │ 80│ 16│ 200.0 - ─────────────────────────────────────────┼─────────┼─────────┼───────── - Under $521 │ 32│ 9│ ([31]) - $521 to $624 │ 48│ 7│ 145.8 - │ │ │ - $625 to $899 │ 193│ 20│ 103.6 - ─────────────────────────────────────────┼─────────┼─────────┼───────── - $625 to $779 │ 86│ 6│ 69.8 - $780 to $899 │ 107│ 14│ 130.8 - │ │ │ - $900 or more │ 129│ 10│ 77.5 - ─────────────────────────────────────────┼─────────┼─────────┼───────── - $900 to $1,199 │ 92│ 7│ 76.1 - $1,200 of more │ 37│ 3│ ([31]) - │ │ │ - Ample[1] │ 383│ 30│ 78.3 - │ │ │ - Husbands with foreign wives │ 646│ 111│ 171.8 - ═════════════════════════════════════════╪═════════╪═════════╪═════════ - Under $625 │ 304│ 66│ 217.1 - ─────────────────────────────────────────┼─────────┼─────────┼───────── - Under $521 │ 187│ 47│ 251.3 - $521 to $624 │ 117│ 19│ 162.4 - │ │ │ - $625 to $899 │ 192│ 27│ 140.6 - ─────────────────────────────────────────┼─────────┼─────────┼───────── - $625 to $779 │ 138│ 18│ 130.4 - $780 to $899 │ 54│ 9│ 166.7 - │ │ │ - $900 or more │ 57│ 8│ 140.6 - ─────────────────────────────────────────┼─────────┼─────────┼───────── - $900 to $1,199 │ 46│ 7│ 152.2 - $1,200 or more │ 11│ 1│ ([31]) - │ │ │ - Ample[32] │ 93│ 10│ 107.5 - ─────────────────────────────────────────┴─────────┴─────────┴───────── - -Footnote 31: - - Total live births less than 50; base therefore considered too small to - use in computing an infant mortality rate. - -Footnote 32: - - See note on page 45. - -In considering the babies of native and of foreign mothers separately in -the foregoing table, similar variations in mortality rates according to -earnings of father are found, although the foreign infant death rate is -higher in each group. The foreign are less numerous both actually and -relatively in the higher wage groups. - -The foreigners of a given wage group almost always live in a poorer -neighborhood than the natives earning the same amount. The foreigners go -where they find their own countrymen, most of whom are poor, and hence -even those who earn a fair wage find themselves, until they become -Americanized, surrounded by poor conditions and an ignorant class of -people. - -It is of interest to note what per cent. of the native and what per -cent. of the foreign are in the several earnings groups. The next table -shows this for all married mothers and not simply for those of live-born -babies as in the foregoing table. - - - TABLE 31.—NUMBER AND PER CENT OF MOTHERS BY NATIVITY, ACCORDING TO THE - ANNUAL EARNINGS OF HUSBAND. - - ═════════════════╤═════════════════╤═════════════════╤═════════════════ - ANNUAL EARNING OF│ ALL MOTHERS. │ NATIVE MOTHERS. │FOREIGN MOTHERS. - HUSBAND. │ │ │ - ─────────────────┼────────┬────────┼────────┬────────┼────────┬──────── - │Number. │ Per │Number. │ Per │Number. │ Per - │ │ cent. │ │ cent. │ │ cent. - ─────────────────┼────────┼────────┼────────┼────────┼────────┼──────── - Total │ 1,491│ 100.0│ 816│ 100.0│ 675│ 100.0 - ═════════════════╪════════╪════════╪════════╪════════╪════════╪════════ - Under $521 │ 233│ 15.6│ 36│ 4.4│ 197│ 29.2 - $521 to $624 │ 174│ 11.7│ 50│ 6.1│ 124│ 18.4 - $625 to $779 │ 229│ 15.4│ 86│ 10.5│ 143│ 21.2 - $780 to $899 │ 166│ 11.1│ 108│ 13.2│ 58│ 8.6 - $900 to $1,199 │ 146│ 9.8│ 98│ 12.0│ 48│ 7.1 - $1,200 and over │ 50│ 3.4│ 39│ 4.8│ 11│ 1.6 - Ample[33] │ 493│ 33.1│ 399│ 48.9│ 94│ 13.9 - ─────────────────┴────────┴────────┴────────┴────────┴────────┴──────── - -Footnote 33: - - See note on page 45. - -The 1,491 married mothers included in the foregoing table bore 1,517 -babies in 1911, the excess being due to plural births. The 33 unmarried -mothers and their 34 babies (one mother had twins), although included in -some of the general tables, are not included in those relative to the -earnings of the husband. - - - GAINFUL WORK OF MOTHER - -In localities where large numbers of women are engaged in industrial -work, comparisons are frequently made of the death rates among their -babies with those of the babies of mothers not so engaged. In Johnstown, -however, industrial occupations are not open to women, and but 3.1 per -cent. of the mothers visited went outside their homes to earn money. All -mothers who gained money by keeping lodgers or in any other way are, for -convenience, designated “wage-earning” mothers, even though their -earnings were not in the form of a definite wage at stated periods. - -Although not industrially engaged, nearly one-fifth of the mothers did -resort to some means of supplementing the earnings of their husbands. -Usually they kept lodgers. This was done by the foreign mothers -principally, exactly one-third of whom had lodgers, as compared with -less than 1 per cent. of the native women. Usually work done outside the -home consisted either of char work or of assisting husbands in their -stores. Generally these stores were in the same building with the home. - -When a mother of a young baby does not give her full time to her duties -within the home but resorts to means of earning money, it generally -indicates poverty. This is true to a greater degree in Johnstown than in -places which have many inducements for women to work. In Johnstown, with -its excess of males, especially in the foreign population, the woman’s -services are particularly needed to make the home. - -In the group where the husband earns $10 a week or less—that is, under -$521 a year—many of the women are wage earners. In each group showing -better earnings for the husband the number and percentage of -wage-earning wives decline. Such a tabulation as the following almost -automatically fixes the minimum wage on which a man, wife, and a child -or two can live with any degree of comfort in Johnstown at about $780 a -year. When the husband’s wage is less than $780 a year, it is shown that -the wives, in considerable number, must be wage earners. As shown in the -next table, in nearly half of the families where the husband earns $10 a -week or less (less than $521 a year), the wife resorted to some means of -earning money; when he earned as much as $900 a year, only 8.9 per cent. -of the wives worked, and in the small group where the man earns as much -as $1,200 a year, only 1 in 50. - - - TABLE 32.—NUMBER AND PER CENT OF HUSBANDS WITH WAGE-EARNING WIVES, BY - NATIVITY OF WIFE AND ANNUAL EARNINGS OF HUSBAND. - - ═══════════════╤══════════════════════════╤══════════════════════════ - │ TOTAL HUSBANDS. │ HUSBANDS HAVING NATIVE - │ │ WIVES. - ───────────────┼────────┬─────────────────┼────────┬───────────────── - ANNUAL EARNINGS│ │ Husbands with │ │ Husbands with - OF HUSBAND. │Number. │ wage-earning │Number. │ wage-earning - │ │ wives. │ │ wives. - ───────────────┼────────┼────────┬────────┼────────┼────────┬──────── - │ │Number. │ Per │ │Number. │ Per - │ │ │ cent. │ │ │ cent. - ───────────────┼────────┼────────┼────────┼────────┼────────┼──────── - Total │ 1,491│ 278│ 18.6│ 816│ 26│ 3.2 - ═══════════════╪════════╪════════╪════════╪════════╪════════╪════════ - Under $521 │ 233│ 111│ 47.6│ 36│ 9│ 25.0 - $521 to $624 │ 174│ 57│ 32.8│ 50│ 3│ 6.0 - $625 to $779 │ 229│ 51│ 22.3│ 86│ 4│ 4.7 - $780 to $899 │ 166│ 25│ 15.1│ 108│ 6│ 5.6 - $900 to $1,199 │ 146│ 13│ 8.9│ 98│ 1│ 1.0 - $1,200 and over│ 50│ 1│ 2.0│ 39│ │ - “Ample”[34] │ 493│ 20│ 4.1│ 399│ 3│ .8 - ───────────────┴────────┴────────┴────────┴────────┴────────┴──────── - - ═══════════════╤══════════════════════════ - │ HUSBANDS HAVING FOREIGN - │ WIVES. - ───────────────┼────────┬───────────────── - ANNUAL EARNINGS│ │ Husbands with - OF HUSBAND. │Number. │ wage-earning - │ │ wives. - ───────────────┼────────┼────────┬──────── - │ │Number. │ Per - │ │ │ cent. - ───────────────┼────────┼────────┼──────── - Total │ 675│ 252│ 37.3 - ═══════════════╪════════╪════════╪════════ - Under $521 │ 197│ 102│ 51.8 - $521 to $624 │ 124│ 54│ 43.5 - $625 to $779 │ 143│ 47│ 32.9 - $780 to $899 │ 58│ 19│ 32.8 - $900 to $1,199 │ 48│ 12│ 25.0 - $1,200 and over│ 11│ 1│ 9.1 - “Ample”[34] │ 94│ 17│ 18.1 - ───────────────┴────────┴────────┴──────── -Footnote 34: - - See note on page 45. - -It is impossible to judge from statistics alone whether or not the work -done by an individual woman, either her own housework or work for money, -is so excessive as to affect her during pregnancy or while nursing to -the extent of reacting on the health of the baby; but the fact is that -the infant mortality rate is higher among the babies of wage-earning -mothers than among others, being 188 as compared with a rate of 117.6 -among the babies of nonwage-earning mothers. Wage-earning mothers and -low-wage fathers are in practically the same groups, and it is difficult -to secure an exact measurement of the comparative weight of the two -factors in the production of a high infant mortality rate. - - - TABLE 33.—DISTRIBUTION OF LIVE BIRTHS AND OF DEATHS DURING FIRST YEAR, - AND INFANT MORTALITY RATE FOR BABIES OF WAGE-EARNING AND - NONWAGE-EARNING MOTHERS, ACCORDING TO ANNUAL EARNINGS OF FATHER. - - ═════════════════╤═════════════════╤═════════════════╤═════════════════ - ANNUAL EARNINGS │ MOTHER A WAGE │MOTHER NOT A WAGE│INFANT MORTALITY - OF FATHER. │ EARNER. │ EARNER. │ RATE. - ─────────────────┼────────┬────────┼────────┬────────┼────────┬──────── - │ │ Number │ │ Number │ │ Mother - │ Live │ of │ Live │ of │Mother a│ not a - │births. │ deaths │births. │ deaths │ wage │ wage - │ │in first│ │in first│earner. │earner. - │ │ year. │ │ year. │ │ - ─────────────────┼────────┼────────┼────────┼────────┼────────┼──────── - Total │ 266│ 50│ 1,165│ 137│ 188.0│ 117.6 - ═════════════════╪════════╪════════╪════════╪════════╪════════╪════════ - Under $521 │ 105│ 26│ 114│ 30│ 247.6│ 263.2 - $521 to $624 │ 53│ 8│ 112│ 18│ 150.9│ 160.7 - $625 to $779 │ 48│ 6│ 176│ 18│ 127.1│ 102.3 - $780 or over, or │ 60│ 10│ 763│ 71│ 166.7│ 93.1 - “ample”[35] │ │ │ │ │ │ - ─────────────────┴────────┴────────┴────────┴────────┴────────┴──────── - -Footnote 35: - - See note on page 45. - - - ILLEGITIMACY - -Of the 1,551 birth included in this investigation 34, or 2.2 per cent., -occurred out of wedlock. Nine of the 32 illegitimate babies who were -born alive died during their first year. It is recognized that these -figures are a very small base from which to draw conclusions concerning -the effect of illegitimacy on the infant mortality rate. It is of -interest, nevertheless, to note that the findings for this small group -are similar to those of countries which compute an infant mortality rate -for legitimate and illegitimate children separately, that is, a rate for -illegitimates more than twice as high as for children born in wedlock. - - - TABLE 34.—DISTRIBUTION OF BIRTHS AND OF DEATHS DURING FIRST YEAR, AND - INFANT MORTALITY RATE, ACCORDING TO LEGITIMACY. - - ════════════════════════╤═════════╤═════════╤══════════════════════════ - LEGITIMACY. │ Total │ Live │DEATHS DURING FIRST YEAR. - │ births. │ births. │ - ────────────────────────┼─────────┼─────────┼─────────┬──────────────── - │ │ │ Number. │Infant mortality - │ │ │ │ rates. - ────────────────────────┼─────────┼─────────┼─────────┼──────────────── - Illegitimate │ 34│ 32│ 9│ 281.3 - Legitimate │ 1,517│ 1,431│ 187│ 130.7 - ────────────────────────┴─────────┴─────────┴─────────┴──────────────── - -Thirty-two, or 3.7 per cent., of the 860 native mothers, as compared -with 2, or 0.3 per cent., of the 691 foreign mothers visited, had -illegitimate children in 1911. - - - REPRODUCTIVE HISTORIES - -In addition to the data relating exclusively to babies born in 1911, a -statement was secured from each mother as to the number and duration of -each of her pregnancies and the result thereof; that is, the number of -children she had borne, alive or dead, the number of miscarriages she -had had, and the age at death of each live-born child who had died. -Although this information was secured for all mothers, tabulations are -presented of the data furnished by married mothers only. Comparatively -few single mothers reported more than one child, and information from -them on this point is not believed to be as reliable as that from -married mothers. - -The 1,491 married mothers of babies born in 1911 had had an aggregate of -5,554 pregnancies, resulting in 5,617 births, the excess of 63 births -over pregnancies being due to plural births. Eight hundred and four of -these children died under 1 year of age, making an infant mortality rate -of 149.9 for all their babies, as compared with the rate of 134 for -those born in 1911. The stillbirths of these women numbered 194, or 4.5 -per cent. of the total number of births; miscarriages reported numbered -191, but these were not added to the total reportable[36] pregnancies. - -Footnote 36: - - “Reportable” pregnancies are those terminating either in the birth of - a live child or of a dead child when the period of gestation exceeds - 28 weeks; that is, when its registration or report is required by law. - -Details as to the infant mortality rates for all babies born to native -and foreign mothers included in this study, not only in the year 1911 -but at any other time, are presented in the next table, which classifies -the babies according to the total number of reportable pregnancies that -their mothers had had, to and including the pregnancy resulting in the -1911 birth. - - - TABLE 35.—DISTRIBUTION OF MOTHERS, OF LIVE BIRTHS, AND OF DEATHS DURING - FIRST YEAR, AND INFANT MORTALITY RATE FOR BABIES OF NATIVE AND FOREIGN - MARRIED MOTHERS, ACCORDING TO THE NUMBER OF REPORTABLE PREGNANCIES. - - ═════════════════╤════════╤═════════════════╤══════════════════════════ - REPORTABLE │ Number │ │ - PREGNANCIES FOR │ of │NUMBER OF BABIES.│ INFANT MORTALITY RATE - MARRIED MOTHERS. │married │ │ AMONG BABIES OF— - │mothers.│ │ - ─────────────────┼────────┼────────┬────────┼────────┬────────┬──────── - │ │ Born │Died in │ All │ Native │Foreign - │ │ alive. │ first │mothers.│mothers.│mothers. - │ │ │ year. │ │ │ - ─────────────────┼────────┼────────┼────────┼────────┼────────┼──────── - Total │ 1,491│ 5,363│ 804│ 149.9│ 113.1│ 184.6 - ═════════════════╪════════╪════════╪════════╪════════╪════════╪════════ - 1 │ 339│ 322│ 35│ 108.7│ 75.9│ 183.7 - 2 │ 283│ 544│ 59│ 108.5│ 76.5│ 156.7 - 3 │ 214│ 626│ 92│ 147.0│ 118.0│ 177.6 - 4 │ 186│ 723│ 78│ 107.9│ 99.4│ 116.3 - 5 │ 147│ 704│ 103│ 146.3│ 86.1│ 191.5 - 6 │ 94│ 546│ 88│ 161.2│ 157.4│ 163.6 - 7 │ 83│ 555│ 78│ 140.5│ 100.0│ 173.8 - 8 │ 54│ 426│ 95│ 223.0│ 157.6│ 272.7 - 9 │ 33│ 283│ 41│ 144.9│ 128.4│ 155.2 - 10 or more │ 58│ 634│ 135│ 212.9│ 164.5│ 257.6 - ─────────────────┴────────┴────────┴────────┴────────┴────────┴──────── - -The statistics, based upon the results of all her reportable -pregnancies, show a generally higher infant mortality rate where the -mother has had many pregnancies, but there is not always an increase -from one pregnancy to the next. This is more clearly shown when the -pregnancies are grouped as in the next table. - - - TABLE 36.—INFANT MORTALITY RATE FOR ALL CHILDREN BORNE BY MARRIED - MOTHERS, ACCORDING TO SPECIFIED NUMBER OF REPORTABLE PREGNANCIES. - - ════════════════════════════════════════════════╤══════════════════════ - REPORTABLE PREGNANCIES FOR MARRIED MOTHERS. │Infant mortality rate. - ────────────────────────────────────────────────┼────────────────────── - Total │ 149.9 - ════════════════════════════════════════════════╪══════════════════════ - 1 and 2 │ 108.5 - 3 and 4 │ 126.0 - 5 and 6 │ 152.8 - 7 and 8 │ 176.4 - 9 or more │ 191.9 - ────────────────────────────────────────────────┴────────────────────── - -This tendency is shown in still another form of summary: Combinations of -four or less pregnancies are, for convenience, considered as group 1, -while the combinations of over four are designated group 2. The -differences in rates in the two groups are notable. The infant mortality -rate is much lower for the first than for the second group. - - - TABLE 37.—INFANT MORTALITY RATE FOR ALL CHILDREN BORNE BY MARRIED - MOTHERS, ACCORDING TO SPECIFIED NUMBER OF REPORTABLE PREGNANCIES, BY - GROUPS - - ════════════════════════════════════════════════╤══════════════════════ - REPORTABLE PREGNANCIES FOR MARRIED MOTHERS. │Infant mortality rate. - ────────────────────────────────────────────────┼────────────────────── - │ - GROUP 1. │ - │ - 2 or less │ 108.5 - 3 or less │ 124.7 - 4 or less │ 119.2 - │ - GROUP 2. │ - │ - Over 4 │ 171.5 - Over 5 │ 178.8 - Over 6 │ 183.9 - ────────────────────────────────────────────────┴────────────────────── - -This influence of the size of the family upon the infant mortality rate -is shown in the computations giving the relative infant mortality rate -for the different children borne by married mothers. The rate is most -favorable for the second-born child, being 131.2. Among first born it is -143.6; for tenth or later born children 252.3. - - - TABLE 38.—INFANT MORTALITY RATE FOR ALL CHILDREN BORNE BY MARRIED - MOTHERS, ACCORDING TO THE ORDER IN WHICH THE CHILD WAS BORN - - ════════════════════════════════════════════════╤══════════════════════ - ORDER OF BIRTH. │Infant mortality rate. - ────────────────────────────────────────────────┼────────────────────── - First-born child │ 143.6 - Second-born child │ 131.2 - ────────────────────────────────────────────────┼────────────────────── - First and second born children │ 138.3 - ════════════════════════════════════════════════╪══════════════════════ - Third-born child │ 144.2 - Fourth-born child │ 142.0 - ────────────────────────────────────────────────┼────────────────────── - Third and fourth born children │ 143.2 - ════════════════════════════════════════════════╪══════════════════════ - Fifth-born child │ 178.1 - Sixth-born child │ 175.5 - ────────────────────────────────────────────────┼────────────────────── - Fifth and sixth born children │ 177.0 - ════════════════════════════════════════════════╪══════════════════════ - Seventh-born child │ 192.1 - Eighth-born child │ 165.4 - ────────────────────────────────────────────────┼────────────────────── - Seventh and eighth born children. │ 181.5 - ════════════════════════════════════════════════╪══════════════════════ - Ninth-born child │ 128.2 - Tenth or later born child │ 252.3 - ────────────────────────────────────────────────┼────────────────────── - Ninth and later born children │ 201.1 - ────────────────────────────────────────────────┴────────────────────── - -The next table gives a further elaboration of the same data; that is, it -shows the infant mortality rate where such rates are lowest and highest, -respectively, according to the age of the mother at the child’s birth -and the order in which the child was born. Attention is again directed -to the fact that the statistics presented in this section on -“Reproductive histories” are based upon the total number of reportable -pregnancies; that is, in addition to the pregnancies resulting in births -in 1911, all prior pregnancies of the women considered in the -investigation have been included. - - - TABLE 39.—LOWEST AND HIGHEST INFANT MORTALITY RATES, ACCORDING TO AGE - OF MOTHER AT BIRTH OF CHILD AND THE ORDER IN WHICH CHILD WAS BORN. - - ═══════════════════════╤═══════════════════════════════════════════════ - ORDER OF BIRTH. │ INFANT MORTALITY RATES, ACCORDING TO MOTHER’S - │ AGE. - ───────────────────────┼───────────────────────┬─────────────────────── - │ Lowest mortality. │ Highest mortality. - ───────────────────────┼───────────┬───────────┼───────────┬─────────── - │ Mother’s │ Mortality │ Mother’s │ Mortality - │ age. │ rate. │ age. │ rate. - ───────────────────────┼───────────┼───────────┼───────────┼─────────── - All children │ 20–24│ 140.0│ Under 17│ 367.3 - ═══════════════════════╪═══════════╪═══════════╪═══════════╪═══════════ - First child │ 25–29│ 92.1│ 17–19│ 190.4 - Second child │ 25–29│ 100.3│ 17–19│ 178.6 - Third child │ 30–39│ 106.4│ 25–29│ 160.8 - Fourth child │ 30–39│ 122.4│ 20–24│ 155.0 - Fifth child │ 30–39│ 105.8│ 25–29│ 236.6 - Sixth child │ 30–39│ 164.8│ 25–29│ 171.4 - ───────────────────────┴───────────┴───────────┴───────────┴─────────── - -The difference in size of family for native and foreign mothers of -different ages are indicated in the next table. The total and average -number of live-born children, not reportable pregnancies, are given. - - - TABLE 40.—TOTAL AND AVERAGE NUMBER OF LIVE-BORN CHILDREN BORNE BY - MARRIED MOTHERS HAVING EITHER A LIVE BIRTH OR A STILLBIRTH IN 1911, - CLASSIFIED BY NATIVITY AND AGE OF MOTHER. - - ══════════════════╤══════════════════════════╤══════════════════════════ - │ ALL MARRIED MOTHERS. │ NATIVE MARRIED MOTHERS. - ──────────────────┼────────┬─────────────────┼────────┬───────────────── - AGE OF MOTHER AT │ │ Live-born │ │ Live-born - BIRTH OF CHILD IN │ Total. │ children. │ Total. │ children. - 1911. │ │ │ │ - ──────────────────┼────────┼────────┬────────┼────────┼────────┬──────── - │ │Number. │Average.│ │Number. │Average. - ──────────────────┼────────┼────────┼────────┼────────┼────────┼──────── - All ages │ 1,465│ 5,363│ 3.7│ 801│ 2,600│ 3.2 - ══════════════════╪════════╪════════╪════════╪════════╪════════╪════════ - Under 20 years │ 81│ 96│ 1.2│ 62│ 70│ 1.1 - 20 to 24 years │ 456│ 908│ 2.0│ 258│ 483│ 1.9 - 25 to 29 years │ 389│ 1,261│ 3.2│ 196│ 536│ 2.7 - 30 to 39 years │ 459│ 2,480│ 5.4│ 240│ 1,188│ 5.0 - 40 years and over.│ 80│ 618│ 7.7│ 45│ 323│ 7.2 - ──────────────────┴────────┴────────┴────────┴────────┴────────┴──────── - - ══════════════════╤══════════════════════════ - │ FOREIGN MARRIED MOTHERS. - ──────────────────┼────────┬───────────────── - AGE OF MOTHER AT │ │ Live-born - BIRTH OF CHILD IN │ Total. │ children. - 1911. │ │ - ──────────────────┼────────┼────────┬──────── - │ │Number. │Average. - ──────────────────┼────────┼────────┼──────── - All ages │ 664│ 2,763│ 4.2 - ══════════════════╪════════╪════════╪════════ - Under 20 years │ 19│ 26│ 1.4 - 20 to 24 years │ 198│ 425│ 2.1 - 25 to 29 years │ 193│ 725│ 3.8 - 30 to 39 years │ 219│ 1,292│ 5.9 - 40 years and over.│ 35│ 295│ 8.4 - ──────────────────┴────────┴────────┴──────── - -The next table shows all losses of pregnancy sustained by 628 mothers -and the rate of loss per 1,000 births for mothers having different -numbers of births or reportable pregnancies. For all mothers it was -188.4. “Loss,” as here used, means the sum of infant deaths (or deaths -in first year) and stillbirths. - - - TABLE 41.—AGGREGATE NUMBER OF BIRTHS, LOSSES, AND RATE OF LOSS PER - 1,000 BIRTHS, ACCORDING TO NUMBER OF BIRTHS PER MOTHER. - - ══════════════════════════╤══════════════╤══════════════╤══════════════ - NUMBER OF BIRTHS PER │ Aggregate │ Aggregate │ Rate of loss - MOTHER. │ number of │ number of │ per 1,000 - │ births. │ losses. │ births. - ──────────────────────────┼──────────────┼──────────────┼────────────── - Total │ 5,617│ 1,058│ 188.4 - ══════════════════════════╪══════════════╪══════════════╪══════════════ - 1 │ 335│ 53│ 158.6 - 2 │ 554│ 87│ 157.0 - 3 │ 648│ 113│ 174.4 - 4 │ 748│ 109│ 145.7 - 5 │ 740│ 133│ 179.7 - 6 │ 576│ 119│ 206.6 - 7 │ 574│ 104│ 181.2 - 8 │ 432│ 102│ 236.1 - 9 │ 324│ 65│ 200.6 - 10 or more │ 686│ 173│ 252.2 - ──────────────────────────┴──────────────┴──────────────┴────────────── - -The influence of the economic factor on infant mortality among the -babies born prior to 1911 can not be determined with exactness, as no -inquiry was made concerning earnings of the father when the other -children were born. But it is believed that his earnings during the year -following the birth of the 1911 baby can be regarded as an index of the -economic standing of the family for some time past. In individual cases, -of course, revolutionary changes in the family’s income may have -occurred, but for the great mass of people in the group considered it is -not likely that within such a short space of time as that covered by the -child-bearing period of the women considered—most of whom had not had -numerous pregnancies—marked changes had taken place. If these known -earnings are accepted as an index, the following variations are found to -occur in the infant mortality rate for all the babies of whom a record -was secured: - - - TABLE 42.—INFANT MORTALITY RATE FOR ALL CHILDREN OF MARRIED MOTHERS - INCLUDED IN THIS INVESTIGATION, DISTRIBUTED ACCORDING TO THE FATHER’S - EARNINGS. - - ══════════════════════════════════════════╤════════════════════════════ - FATHER’S ANNUAL EARNINGS. │ Infant mortality rate. - ──────────────────────────────────────────┼──────────────────────────── - Under $521 │ 197.3 - $521 to $624 │ 193.1 - $625 to $779 │ 163.1 - $780 to $899 │ 168.4 - $900 to $1,199 │ 142.2 - $1,200 and over │ 102.2 - ──────────────────────────────────────────┴──────────────────────────── - -The infant mortality rate for the babies whose fathers earn under $521 -is almost twice as great as for those born into families in the most -prosperous group. These figures strengthen the conclusion reached in the -study of the babies born in 1911, namely that the economic factor is of -far-reaching importance in determining the baby’s chance of life. - - - TABLE V.—DISTRIBUTION OF LIVE BIRTHS AND OF DEATHS DURING FIRST YEAR, - ACCORDING TO NUMBER OF PERSONS AND NUMBER OF ROOMS PER FAMILY. - - ═════════════════╤═════════════════════════════════════ - │NUMBER OF BABIES WHO WERE BORN ALIVE - │AND NUMBER OF SUCH BABIES WHO DIED - │DURING FIRST YEAR IN HOMES HAVING— - ─────────────────┼───────┬─────┬─────┬─────┬─────┬───── - PERSONS PER │ All │ │ │ │ │ - FAMILY (NOT │ live │ 1 │ 2 │ 3 │ 4 │ 5 - INCLUDING BABY). │ born │room │rooms│rooms│rooms│rooms - │babies.│ │ │ │ │ - ─────────────────┼───────┼─────┼─────┼─────┼─────┼───── - {Births│ 1,463│ 33│ 165│ 147│ 526│ 222 - Total {Deaths│ 196│ 3│ 29│ 24│ 79│ 20 - ═════════════════╪═══════╪═════╪═════╪═════╪═════╪═════ - {Births│ 24│ 3│ 7│ 4│ 6│ 2 - 2 {Deaths│ 19│ 1│ 5│ 4│ 6│ 1 - │ │ │ │ │ │ - {Births│ 275│ 14│ 46│ 35│ 96│ 29 - 3 {Deaths│ 31│ │ 5│ 4│ 12│ 2 - │ │ │ │ │ │ - {Births│ 234│ 7│ 44│ 20│ 83│ 40 - 4 {Deaths│ 30│ 1│ 12│ 5│ 9│ 2 - │ │ │ │ │ │ - {Births│ 229│ │ 27│ 24│ 88│ 31 - 5 {Deaths│ 22│ │ 1│ 6│ 9│ 1 - │ │ │ │ │ │ - {Births│ 182│ 2│ 21│ 17│ 56│ 37 - 6 {Deaths│ 18│ │ 4│ │ 8│ 2 - │ │ │ │ │ │ - {Births│ 164│ 2│ 10│ 20│ 50│ 32 - 7 {Deaths│ 15│ │ 1│ 2│ 6│ 1 - │ │ │ │ │ │ - {Births│ 107│ 2│ 5│ 14│ 37│ 16 - 8 {Deaths│ 17│ │ │ 2│ 6│ 3 - │ │ │ │ │ │ - {Births│ 79│ 2│ 2│ 6│ 27│ 13 - 9 {Deaths│ 8│ 1│ │ │ 2│ 2 - │ │ │ │ │ │ - {Births│ 58│ 1│ 1│ 2│ 26│ 7 - 10 {Deaths│ 15│ │ │ 1│ 11│ 2 - │ │ │ │ │ │ - {Births│ 36│ │ 1│ 1│ 16│ 3 - 11 {Deaths│ 4│ │ 1│ │ 1│ 1 - │ │ │ │ │ │ - {Births│ 21│ │ 1│ 1│ 10│ 2 - 12 {Deaths│ 5│ │ │ │ 2│ 1 - │ │ │ │ │ │ - {Births│ 20│ │ │ 1│ 13│ 4 - 13 {Deaths│ 4│ │ │ │ 3│ 1 - │ │ │ │ │ │ - {Births│ 8│ │ │ 1│ 5│ 2 - 14 {Deaths│ 2│ │ │ │ 1│ 1 - │ │ │ │ │ │ - {Births│ 6│ │ │ │ 3│ 2 - 15 {Deaths│ 1│ │ │ │ │ - │ │ │ │ │ │ - {Births│ 4│ │ │ │ 4│ - 16 {Deaths│ 2│ │ │ │ 2│ - │ │ │ │ │ │ - {Births│ 3│ │ │ │ 1│ - 17 {Deaths│ │ │ │ │ │ - │ │ │ │ │ │ - {Births│ 5│ │ │ 1│ 1│ - 18 {Deaths│ 1│ │ │ │ 1│ - │ │ │ │ │ │ - {Births│ 2│ │ │ │ 2│ - 19 {Deaths│ │ │ │ │ │ - │ │ │ │ │ │ - {Births│ 3│ │ │ │ 1│ 1 - 20 {Deaths│ 1│ │ │ │ │ - │ │ │ │ │ │ - {Births│ 1│ │ │ │ │ - 22 {Deaths│ 1│ │ │ │ │ - │ │ │ │ │ │ - {Births│ 1│ │ │ │ 1│ - 23 {Deaths│ │ │ │ │ │ - │ │ │ │ │ │ - Not {Births│ 1│ │ │ │ │ 1 - reported. {Deaths│ │ │ │ │ │ - ─────────────────┴───────┴─────┴─────┴─────┴─────┴───── - - ═════════════════╤═════════════════════════════════════ - │NUMBER OF BABIES WHO WERE BORN ALIVE - │AND NUMBER OF SUCH BABIES WHO DIED - │DURING FIRST YEAR IN HOMES HAVING— - ─────────────────┼─────┬─────┬─────┬─────┬─────┬─────── - PERSONS PER │ │ │ │ │ 10 │Unknown - FAMILY (NOT │ 6 │ 7 │ 8 │ 9 │rooms│number - INCLUDING BABY). │rooms│rooms│rooms│rooms│ and │ of - │ │ │ │ │over.│rooms. - ─────────────────┼─────┼─────┼─────┼─────┼─────┼─────── - {Births│ 233│ 38│ 43│ 22│ 12│ 22 - Total {Deaths│ 20│ 6│ 6│ 4│ 2│ 3 - ═════════════════╪═════╪═════╪═════╪═════╪═════╪═══════ - {Births│ │ │ │ │ │ 2 - 2 {Deaths│ │ │ │ │ │ 2 - │ │ │ │ │ │ - {Births│ 37│ 4│ 6│ 1│ │ 7 - 3 {Deaths│ 3│ 3│ 2│ │ │ - │ │ │ │ │ │ - {Births│ 23│ 4│ 5│ 2│ 2│ 4 - 4 {Deaths│ │ │ │ │ 1│ - │ │ │ │ │ │ - {Births│ 43│ 4│ 5│ 1│ 1│ 5 - 5 {Deaths│ 4│ │ 1│ │ │ - │ │ │ │ │ │ - {Births│ 34│ 5│ 7│ 2│ │ 1 - 6 {Deaths│ 3│ │ 1│ │ │ - │ │ │ │ │ │ - {Births│ 30│ 9│ 6│ 3│ 1│ 1 - 7 {Deaths│ 3│ 1│ │ 1│ │ - │ │ │ │ │ │ - {Births│ 18│ 4│ 6│ 2│ 3│ - 8 {Deaths│ 1│ 2│ 1│ 1│ 1│ - │ │ │ │ │ │ - {Births│ 13│ 6│ 2│ 4│ 4│ - 9 {Deaths│ 1│ │ │ 2│ │ - │ │ │ │ │ │ - {Births│ 15│ 1│ 1│ 3│ │ 1 - 10 {Deaths│ 1│ │ │ │ │ - │ │ │ │ │ │ - {Births│ 10│ │ 3│ 2│ │ - 11 {Deaths│ 1│ │ │ │ │ - │ │ │ │ │ │ - {Births│ 6│ │ 1│ │ │ - 12 {Deaths│ 1│ │ 1│ │ │ - │ │ │ │ │ │ - {Births│ │ │ 1│ 1│ │ - 13 {Deaths│ │ │ │ │ │ - │ │ │ │ │ │ - {Births│ │ │ │ │ │ - 14 {Deaths│ │ │ │ │ │ - │ │ │ │ │ │ - {Births│ │ │ │ │ │ 1 - 15 {Deaths│ │ │ │ │ │ 1 - │ │ │ │ │ │ - {Births│ │ │ │ │ │ - 16 {Deaths│ │ │ │ │ │ - │ │ │ │ │ │ - {Births│ 1│ │ 1│ │ │ - 17 {Deaths│ │ │ │ │ │ - │ │ │ │ │ │ - {Births│ 1│ 1│ │ 1│ │ - 18 {Deaths│ │ │ │ │ │ - │ │ │ │ │ │ - {Births│ │ │ │ │ │ - 19 {Deaths│ │ │ │ │ │ - │ │ │ │ │ │ - {Births│ 1│ │ │ │ │ - 20 {Deaths│ 1│ │ │ │ │ - │ │ │ │ │ │ - {Births│ 1│ │ │ │ │ - 22 {Deaths│ 1│ │ │ │ │ - │ │ │ │ │ │ - {Births│ │ │ │ │ │ - 23 {Deaths│ │ │ │ │ │ - │ │ │ │ │ │ - Not {Births│ │ │ │ │ │ - reported. {Deaths│ │ │ │ │ │ - ─────────────────┴─────┴─────┴─────┴─────┴─────┴─────── - - - TABLE VIII.—DISTRIBUTION OF DEATHS OF INFANTS AT SPECIFIED AGE, - ACCORDING TO CAUSE OF DEATH OF INFANT AND NATIVITY OF MOTHER. - - ═══════════════╤══════╤═════════════════════════════════════════ - │ │ AGE AT DEATH. - ───────────────┼──────┼───────────────────────────┬───────────── - │Total │ │ - CAUSE OF DEATH │deaths│ │ 1 week but - OF INFANT AND │under │ Less than 1 week. │ less than 1 - NATIVITY OF │1 year│ │ month. - MOTHER. │ of │ │ - │ age. │ │ - ───────────────┼──────┼──────┬──────┬──────┬──────┼──────┬────── - │ │ │ │ │ │ │1 week - │ │ │1 day │ │ │ │ but - │ │Total.│ or │ 2 │3 to 6│Total.│ less - │ │ │less. │days. │days. │ │ than - │ │ │ │ │ │ │ 2. - │ │ │ │ │ │ │ - ───────────────┼──────┼──────┼──────┼──────┼──────┼──────┼────── - All causes │ 196│ 45│ 30│ 4│ 11│ 29│ 14 - ═══════════════╪══════╪══════╪══════╪══════╪══════╪══════╪══════ - Native mothers │ 85│ 25│ 18│ 3│ 4│ 9│ 2 - Foreign mothers│ 111│ 20│ 12│ 1│ 7│ 20│ 12 - │ │ │ │ │ │ │ - Diarrhea and │ 52│ 1│ │ │ 1│ 5│ - enteritis │ │ │ │ │ │ │ - ───────────────┼──────┼──────┼──────┼──────┼──────┼──────┼────── - Native mothers │ 17│ 1│ │ │ 1│ │ - Foreign mothers│ 35│ │ │ │ │ 5│ - │ │ │ │ │ │ │ - Respiratory │ 50│ │ │ │ │ 3│ 3 - diseases │ │ │ │ │ │ │ - ───────────────┼──────┼──────┼──────┼──────┼──────┼──────┼────── - Native mothers │ 19│ │ │ │ │ │ - Foreign mothers│ 31│ │ │ │ │ 3│ 3 - │ │ │ │ │ │ │ - Premature │ 24│ 21│ 19│ │ 2│ 3│ 3 - births │ │ │ │ │ │ │ - ───────────────┼──────┼──────┼──────┼──────┼──────┼──────┼────── - Native mothers │ 11│ 11│ 11│ │ │ │ - Foreign mothers│ 13│ 10│ 8│ │ 2│ 3│ 3 - │ │ │ │ │ │ │ - Congenital │ │ │ │ │ │ │ - debility or │ 19│ 10│ 7│ 1│ 2│ 6│ 2 - malformation │ │ │ │ │ │ │ - ───────────────┼──────┼──────┼──────┼──────┼──────┼──────┼────── - Native mothers │ 5│ 4│ 3│ │ 1│ 1│ - Foreign mothers│ 14│ 6│ 4│ 1│ 1│ 5│ 2 - │ │ │ │ │ │ │ - Injuries at │ 7│ 7│ 3│ 2│ 2│ │ - birth │ │ │ │ │ │ │ - ───────────────┼──────┼──────┼──────┼──────┼──────┼──────┼────── - Native mothers │ 6│ 6│ 3│ 2│ 1│ │ - Foreign mothers│ 1│ 1│ │ │ 1│ │ - │ │ │ │ │ │ │ - Other or not │ 44│ 6│ 1│ 1│ 4│ 12│ 6 - reported │ │ │ │ │ │ │ - ───────────────┼──────┼──────┼──────┼──────┼──────┼──────┼────── - Native mothers │ 27│ 3│ 1│ 1│ 1│ 8│ 2 - Foreign mothers│ 17│ 3│ │ │ 3│ 4│ 4 - ───────────────┴──────┴──────┴──────┴──────┴──────┴──────┴────── - - ═══════════════╤═══════════════════════════════════════════════════════ - │ AGE AT DEATH. - ───────────────┼─────────────┬───────────────────────────────────────── - CAUSE OF DEATH │3 weeks but │ - OF INFANT AND │less than 1 │ 1 week but less than 1 month. - NATIVITY OF │month. │ - MOTHER. │ │ - ───────────────┼──────┬──────┼──────┬──────┬──────┬──────┬──────┬────── - │ 2 │ 3 │ │ 1 │ 2 │ 3 │ 6 │ - │weeks │weeks │ │month │months│months│months│ 9 - │ but │ but │Total.│ but │ but │ but │ but │months - │ less │ less │ │ less │ less │ less │ less │ and - │ than │than 1│ │ than │ than │ than │ than │over. - │ 3. │month.│ │ 2. │ 3. │ 6. │ 9. │ - ───────────────┼──────┼──────┼──────┼──────┼──────┼──────┼──────┼────── - All causes │ 7│ 8│ 122│ 18│ 16│ 42│ 31│ 15 - ═══════════════╪══════╪══════╪══════╪══════╪══════╪══════╪══════╪══════ - Native mothers │ 1│ 6│ 51│ 9│ 7│ 18│ 12│ 5 - Foreign mothers│ 6│ 2│ 71│ 9│ 9│ 24│ 19│ 10 - │ │ │ │ │ │ │ │ - Diarrhea and │ 3│ 2│ 46│ 5│ 4│ 17│ 15│ 5 - enteritis │ │ │ │ │ │ │ │ - ───────────────┼──────┼──────┼──────┼──────┼──────┼──────┼──────┼────── - Native mothers │ │ │ 16│ 3│ 1│ 5│ 5│ 2 - Foreign mothers│ 3│ 2│ 30│ 2│ 3│ 12│ 10│ 3 - │ │ │ │ │ │ │ │ - Respiratory │ │ │ 47│ 7│ 4│ 15│ 13│ 8 - diseases │ │ │ │ │ │ │ │ - ───────────────┼──────┼──────┼──────┼──────┼──────┼──────┼──────┼────── - Native mothers │ │ │ 19│ 2│ 2│ 8│ 5│ 2 - Foreign mothers│ │ │ 28│ 5│ 2│ 7│ 8│ 6 - │ │ │ │ │ │ │ │ - Premature │ │ │ │ │ │ │ │ - births │ │ │ │ │ │ │ │ - ───────────────┼──────┼──────┼──────┼──────┼──────┼──────┼──────┼────── - Native mothers │ │ │ │ │ │ │ │ - Foreign mothers│ │ │ │ │ │ │ │ - │ │ │ │ │ │ │ │ - Congenital │ │ │ │ │ │ │ │ - debility or │ 3│ 1│ 3│ 1│ 2│ │ │ - malformation │ │ │ │ │ │ │ │ - ───────────────┼──────┼──────┼──────┼──────┼──────┼──────┼──────┼────── - Native mothers │ │ 1│ │ │ │ │ │ - Foreign mothers│ 3│ │ 3│ 1│ 2│ │ │ - │ │ │ │ │ │ │ │ - Injuries at │ │ │ │ │ │ │ │ - birth │ │ │ │ │ │ │ │ - ───────────────┼──────┼──────┼──────┼──────┼──────┼──────┼──────┼────── - Native mothers │ │ │ │ │ │ │ │ - Foreign mothers│ │ │ │ │ │ │ │ - │ │ │ │ │ │ │ │ - Other or not │ 1│ 5│ 26│ 5│ 6│ 10│ 3│ 2 - reported │ │ │ │ │ │ │ │ - ───────────────┼──────┼──────┼──────┼──────┼──────┼──────┼──────┼────── - Native mothers │ 1│ 5│ 16│ 4│ 4│ 5│ 2│ 1 - Foreign mothers│ │ │ 10│ 1│ 2│ 5│ 1│ 1 - ───────────────┴──────┴──────┴──────┴──────┴──────┴──────┴──────┴────── - - - TABLE X.—DISTRIBUTION OF BIRTHS TO MARRIED WAGE-EARNING MOTHERS, - ACCORDING TO HUSBAND’S ANNUAL EARNINGS AND NATIVITY AND EARNINGS OF - MOTHER. - - ═════════════════╤═══════╤═════════════════════════════════════════════ - NATIVITY AND │ │ - ANNUAL EARNINGS │ Total │ BIRTHS TO MARRIED WAGE-EARNING MOTHER WITH - OF MARRIED │births.│ HUSBAND EARNING ANNUALLY— - MOTHER. │ │ - ─────────────────┼───────┼─────┬─────┬─────┬─────┬───────┬──────┬────── - │ │Under│$521 │$625 │$780 │$900 to│$1,200│Ample. - │ │$521.│ to │ to │ to │$1,199.│ and │ [37] - │ │ │$624.│$779.│$899.│ │over. │ - ─────────────────┼───────┼─────┼─────┼─────┼─────┼───────┼──────┼────── - All wage-earning │ 281│ 112│ 57│ 51│ 25│ 14│ 1│ 21 - mothers │ │ │ │ │ │ │ │ - ═════════════════╪═══════╪═════╪═════╪═════╪═════╪═══════╪══════╪══════ - Under $53 │ 20│ 6│ 5│ 1│ 4│ 1│ —│ 3 - $53 to $103 │ 57│ 23│ 12│ 11│ 7│ 3│ —│ 1 - $104 to $207 │ 89│ 46│ 16│ 19│ 3│ 3│ —│ 2 - $208 to $311 │ 60│ 23│ 16│ 12│ 4│ 3│ 1│ 1 - $312 and over │ 46│ 14│ 8│ 8│ 7│ 2│ —│ 7 - Not reported │ 9│ —│ —│ —│ —│ —│ 2│ 7 - │ │ │ │ │ │ │ │ - Native │ │ │ │ │ │ │ │ - wage-earning │ 26│ 9│ 3│ 4│ 6│ 1│ —│ 3 - mothers │ │ │ │ │ │ │ │ - ─────────────────┼───────┼─────┼─────┼─────┼─────┼───────┼──────┼────── - Under $53 │ 6│ 2│ 1│ —│ 2│ 1│ —│ — - $53 to $103 │ 5│ 2│ 1│ 2│ —│ —│ —│ — - $104 to $207 │ 5│ 1│ 1│ 2│ 1│ —│ —│ — - $208 to $311 │ 4│ 3│ —│ —│ 1│ —│ —│ — - $312 and over │ 3│ 1│ —│ —│ 2│ —│ —│ — - Not reported │ 3│ —│ —│ —│ —│ —│ —│ 3 - │ │ │ │ │ │ │ │ - Foreign │ │ │ │ │ │ │ │ - wage-earning │ 255│ 103│ 54│ 47│ 19│ 13│ 1│ 18 - mothers │ │ │ │ │ │ │ │ - ─────────────────┼───────┼─────┼─────┼─────┼─────┼───────┼──────┼────── - Under $53 │ 14│ 4│ 4│ 1│ 2│ —│ —│ 3 - $53 to $103 │ 52│ 21│ 11│ 9│ 7│ 3│ —│ 1 - $104 to $207 │ 84│ 45│ 15│ 17│ 2│ 3│ —│ 2 - $208 to $311 │ 56│ 20│ 16│ 12│ 3│ 3│ 1│ 1 - $312 and over │ 43│ 13│ 8│ 8│ 5│ 2│ —│ 7 - Not reported │ 6│ —│ —│ —│ —│ 2│ —│ 4 - ─────────────────┴───────┴─────┴─────┴─────┴─────┴───────┴──────┴────── - -Footnote 37: - - See note on page 45. - - - TABLE XI.—DISTRIBUTION OF RESULTS OF REPORTABLE PREGNANCIES (LIVE BIRTHS - AND STILLBIRTHS) AND MISCARRIAGES, ACCORDING TO NUMBER PER MOTHER AND - NATIVITY OF MOTHER. - - ═══════════╤═════════════════════════════════════════════════════ - │ REPORTABLE PREGNANCIES AND RESULTS THEREOF. - │ - ───────────┼────────────┬───────┬───────┬────────┬─────────────── - │ │ │ │ │ - │ │ │ │ │ Live births. - │ │ │ │ │ - ───────────┼────────────┼───────┼───────┼────────┼───────┬─────── - NUMBER OF │ │ │ │ │ │ - REPORTABLE │ │ │ │ │ │ - PREGNANCIES│ │ │ │ │ │ - PER MOTHER │ │ │ │ │ │ - AND │ │ │ │ │ │ - NATIVITY OF│ │ │ │ │ │ - MOTHER. │ │ │ │ │ │ - ───────────┼────────────┼───────┼───────┼────────┼───────┼─────── - │ │ │ │ │ │Number - │ │ │Excess │ Number │ │ of - │ Total │ Total │due to │ of │Number.│mothers - │pregnancies.│births.│plural │mothers.│ │having - │ │ │births.│ │ │ live - │ │ │ │ │ │births. - ───────────┼────────────┼───────┼───────┼────────┼───────┼─────── - All married│ 5,554│ 5,617│ 63│ 1,491│ 5,363│ 1,465 - mothers │ │ │ │ │ │ - ═══════════╪════════════╪═══════╪═══════╪════════╪═══════╪═══════ - 1 │ 339│ 343│ 4│ 339│ 322│ 318 - 2 │ 566│ 576│ 10│ 283│ 544│ 279 - 3 │ 642│ 650│ 8│ 214│ 626│ 214 - 4 │ 744│ 752│ 8│ 186│ 723│ 180 - 5 │ 735│ 740│ 5│ 147│ 704│ 147 - 6 │ 564│ 568│ 4│ 94│ 546│ 93 - 7 │ 581│ 586│ 5│ 83│ 555│ 83 - 8 │ 432│ 437│ 5│ 54│ 426│ 54 - 9 │ 297│ 299│ 2│ 33│ 283│ 33 - 10 or more │ 654│ 666│ 12│ 58│ 634│ 58 - │ │ │ │ │ │ - Native │ 2,717│ 2,744│ 27│ 816│ 2,600│ 801 - ───────────┼────────────┼───────┼───────┼────────┼───────┼─────── - 1 │ 234│ 236│ 2│ 234│ 224│ 222 - 2 │ 346│ 351│ 5│ 173│ 327│ 170 - 3 │ 333│ 338│ 5│ 111│ 322│ 111 - 4 │ 376│ 377│ 1│ 94│ 362│ 94 - 5 │ 325│ 326│ 1│ 65│ 302│ 65 - 6 │ 222│ 222│ │ 37│ 216│ 37 - 7 │ 266│ 267│ 1│ 38│ 250│ 38 - 8 │ 184│ 187│ 3│ 23│ 184│ 23 - 9 │ 117│ 118│ 1│ 13│ 109│ 13 - 10 or more │ 314│ 322│ 8│ 28│ 304│ 28 - │ │ │ │ │ │ - Foreign│ 2,837│ 2,873│ 36│ 675│ 2,763│ 664 - ───────────┼────────────┼───────┼───────┼────────┼───────┼─────── - 1 │ 105│ 107│ 2│ 105│ 98│ 96 - 2 │ 220│ 225│ 5│ 110│ 217│ 109 - 3 │ 309│ 312│ 3│ 103│ 304│ 103 - 4 │ 368│ 375│ 7│ 92│ 361│ 92 - 5 │ 410│ 414│ 4│ 82│ 402│ 82 - 6 │ 342│ 346│ 4│ 57│ 330│ 56 - 7 │ 315│ 319│ 4│ 45│ 305│ 45 - 8 │ 248│ 250│ 2│ 31│ 242│ 31 - 9 │ 180│ 181│ 1│ 20│ 174│ 20 - 10 or more │ 340│ 344│ 4│ 30│ 330│ 30 - ───────────┴────────────┴───────┴───────┴────────┴───────┴─────── - - ═══════════╤═════════════════════════════════════════════════════ - │ REPORTABLE PREGNANCIES AND RESULTS THEREOF. - │ - ───────────┼─────────────────────────┬─────────────────────────── - │ │ - │ Live births. │ Stillbirths. - │ │ - ───────────┼─────────────────────────┼─────────────┬───────────── - NUMBER OF │ │ │ - REPORTABLE │ │ │ - PREGNANCIES│ │ │ - PER MOTHER │ Deaths in first year. │ │ - AND │ │ │ - NATIVITY OF│ │ │ - MOTHER. │ │ │ - ───────────┼───────┬───────┬─────────┼─────────────┼───────────── - │ │Number │ │ │ - │ │ of │ Infant │ │ Number of - │Number.│mothers│mortality│ Number of │ mothers - │ │having │ rate. │still-births.│ having - │ │babies │ │ │still-births. - │ │ die. │ │ │ - ───────────┼───────┼───────┼─────────┼─────────────┼───────────── - All married│ 804│ 509│ 149.9│ 254│ 194 - mothers │ │ │ │ │ - ═══════════╪═══════╪═══════╪═════════╪═════════════╪═════════════ - 1 │ 35│ 34│ 108.7│ 21│ 21 - 2 │ 59│ 54│ 108.5│ 32│ 28 - 3 │ 92│ 75│ 147.0│ 24│ 23 - 4 │ 78│ 64│ 107.9│ 29│ 21 - 5 │ 103│ 67│ 146.3│ 36│ 31 - 6 │ 88│ 60│ 161.2│ 22│ 13 - 7 │ 78│ 48│ 140.5│ 31│ 22 - 8 │ 95│ 42│ 223.0│ 11│ 7 - 9 │ 41│ 20│ 144.9│ 16│ 11 - 10 or more │ 135│ 45│ 212.9│ 32│ 17 - │ │ │ │ │ - Native │ 294│ 206│ 113.1│ 144│ 115 - ───────────┼───────┼───────┼─────────┼─────────────┼───────────── - 1 │ 17│ 17│ 75.9│ 12│ 12 - 2 │ 25│ 23│ 76.5│ 24│ 21 - 3 │ 38│ 31│ 118.0│ 16│ 16 - 4 │ 36│ 31│ 99.4│ 15│ 13 - 5 │ 26│ 21│ 86.1│ 24│ 19 - 6 │ 34│ 22│ 157.4│ 6│ 5 - 7 │ 25│ 18│ 100.0│ 17│ 11 - 8 │ 29│ 17│ 157.6│ 3│ 2 - 9 │ 14│ 7│ 128.4│ 9│ 6 - 10 or more │ 50│ 19│ 164.5│ 18│ 10 - │ │ │ │ │ - Foreign│ 510│ 303│ 184.6│ 110│ 79 - ───────────┼───────┼───────┼─────────┼─────────────┼───────────── - 1 │ 18│ 17│ 183.7│ 9│ 9 - 2 │ 34│ 31│ 156.7│ 8│ 7 - 3 │ 54│ 44│ 177.6│ 8│ 7 - 4 │ 42│ 33│ 116.3│ 14│ 8 - 5 │ 77│ 46│ 191.5│ 12│ 12 - 6 │ 54│ 38│ 163.6│ 16│ 8 - 7 │ 53│ 30│ 173.8│ 14│ 11 - 8 │ 66│ 25│ 272.7│ 8│ 5 - 9 │ 27│ 13│ 155.2│ 7│ 5 - 10 or more │ 85│ 26│ 257.6│ 14│ 7 - ───────────┴───────┴───────┴─────────┴─────────────┴───────────── - - ═══════════════════╤══════════════════════════════ - REPORTABLE│ MISCARRIAGES IN ADDITION TO - PREGNANCIES AND│ REPORTABLE PREGNANCIES. - RESULTS THEREOF.│ - ───────────┬───────┼────────────┬───────────────── - │Still- │ │Number of mothers - │births.│ │ reporting - │ │ │ miscarriages. - ───────────┼───────┼────────────┼────────┬──────── - NUMBER OF │ │ │ │ - REPORTABLE │ │ │ │ - PREGNANCIES│ │ │ │ - PER MOTHER │ │ │ │ - AND │ │ │ │ - NATIVITY OF│ │ │ │ - MOTHER. │ │ │ │ - ───────────┼───────┼────────────┼────────┼──────── - │ │ │ │ - │ Per │ Number of │ │ Per - │ cent. │miscarriages│ Total │cent. of - │of all │ reported. │mothers.│ all - │births.│ │ │mothers. - │ │ │ │ - ───────────┼───────┼────────────┼────────┼──────── - All married│ 4.5│ 191│ 130│ 8.7 - mothers │ │ │ │ - ═══════════╪═══════╪════════════╪════════╪════════ - 1 │ 6.1│ 8│ 8│ 2.4 - 2 │ 5.6│ 23│ 16│ 5.7 - 3 │ 3.7│ 26│ 18│ 8.4 - 4 │ 3.9│ 22│ 18│ 9.7 - 5 │ 4.9│ 20│ 14│ 9.5 - 6 │ 3.9│ 23│ 14│ 14.9 - 7 │ 5.3│ 27│ 15│ 18.1 - 8 │ 2.5│ 15│ 9│ 16.7 - 9 │ 5.4│ 13│ 8│ ([38]) - 10 or more │ 4.8│ 14│ 10│ 17.2 - │ │ │ │ - Native │ 5.2│ 136│ 92│ 11.3 - ───────────┼───────┼────────────┼────────┼──────── - 1 │ 5.1│ 7│ 7│ 3.0 - 2 │ 6.8│ 18│ 13│ 7.5 - 3 │ 4.7│ 21│ 15│ 13.5 - 4 │ 4.0│ 13│ 10│ 10.6 - 5 │ 7.4│ 13│ 10│ 15.4 - 6 │ 2.7│ 17│ 9│ ([38]) - 7 │ 6.4│ 25│ 13│ ([38]) - 8 │ 1.6│ 8│ 5│ ([38]) - 9 │ 7.6│ 4│ 3│ ([38]) - 10 or more │ 5.6│ 10│ 7│ ([38]) - │ │ │ │ - Foreign│ 3.8│ 55│ 38│ 5.6 - ───────────┼───────┼────────────┼────────┼──────── - 1 │ 8.4│ 1│ 1│ 1.0 - 2 │ 3.6│ 5│ 3│ 2.7 - 3 │ 2.6│ 5│ 3│ 2.9 - 4 │ 3.7│ 9│ 8│ 8.7 - 5 │ 2.9│ 7│ 4│ 4.9 - 6 │ 4.6│ 6│ 5│ 8.3 - 7 │ 4.4│ 2│ 2│ ([38]) - 8 │ 3.2│ 7│ 4│ ([38]) - 9 │ 3.9│ 9│ 5│ ([38]) - 10 or more │ 4.1│ 4│ 3│ ([38]) - ───────────┴───────┴────────────┴────────┴──────── -Footnote 38: - - Not shown when base is less than 50. - - - TABLE XII.—DISTRIBUTION OF RESULTS OF REPORTABLE PREGNANCIES (LIVE - BIRTHS AND STILLBIRTHS) AND MISCARRIAGES, ACCORDING TO NUMBER PER MOTHER - AND AGE OF MOTHER AT EACH PREGNANCY. - - ═════════════╤════════════════════════════════════╤════════════════ - NUMBER OF │ │ - REPORTABLE │ │ - PREGNANCIES │ │ - AND AGE OF │ REPORTABLE PREGNANCIES. │ LIVE BIRTHS. - MOTHER AT │ │ - BIRTH OF BABY│ │ - BORN IN 1911.│ │ - ─────────────┼──────┬────────────────────┬────────┼───────┬──────── - │ │ Resulting births. │ │ │ - │ │ │ │ │ - ─────────────┼──────┼───────┬────────────┼────────┼───────┼──────── - │ │ │Excess over │ Number │ │ Number - │Total.│Number.│pregnancies.│ of │Number.│ of - │ │ │ [39] │mothers.│ │mothers. - │ │ │ │ │ │ - ─────────────┼──────┼───────┼────────────┼────────┼───────┼──────── - All married │ 5,554│ 5,617│ 63│ 1,491│ 5,363│ 1,465 - mothers │ │ │ │ │ │ - ═════════════╪══════╪═══════╪════════════╪════════╪═══════╪════════ - Under 20 │ 107│ 108│ 1│ 89│ 96│ 81 - years │ │ │ │ │ │ - 20 to 24 │ 933│ 946│ 13│ 461│ 908│ 456 - years │ │ │ │ │ │ - 25 to 29 │ 1,316│ 1,329│ 13│ 395│ 1,261│ 389 - years │ │ │ │ │ │ - 30 to 39 │ 2,570│ 2,595│ 25│ 466│ 2,480│ 459 - years │ │ │ │ │ │ - 40 years │ 628│ 639│ 11│ 80│ 618│ 80 - and over │ │ │ │ │ │ - Average age: │ │ │ │ │ │ - 28 years. │ │ │ │ │ │ - │ │ │ │ │ │ - 1 reportable │ 339│ 343│ 4│ 339│ 322│ 318 - pregnancy │ │ │ │ │ │ - ─────────────┼──────┼───────┼────────────┼────────┼───────┼──────── - Under 20 │ 74│ 75│ 1│ 74│ 67│ 66 - years │ │ │ │ │ │ - 20 to 24 │ 178│ 179│ 1│ 178│ 176│ 175 - years │ │ │ │ │ │ - 25 to 29 │ 57│ 58│ 1│ 57│ 54│ 53 - years │ │ │ │ │ │ - 30 to 39 │ 30│ 31│ 1│ 30│ 25│ 24 - years │ │ │ │ │ │ - Average age: │ │ │ │ │ │ - 23 years. │ │ │ │ │ │ - │ │ │ │ │ │ - 2 reportable │ 566│ 576│ 10│ 283│ 544│ 279 - pregnancies│ │ │ │ │ │ - ─────────────┼──────┼───────┼────────────┼────────┼───────┼──────── - Under 20 │ 24│ 24│ │ 12│ 21│ 12 - years │ │ │ │ │ │ - 20 to 24 │ 312│ 317│ 5│ 156│ 302│ 154 - years │ │ │ │ │ │ - 25 to 29 │ 148│ 151│ 3│ 74│ 141│ 73 - years │ │ │ │ │ │ - 30 to 39 │ 78│ 80│ 2│ 39│ 76│ 38 - years │ │ │ │ │ │ - 40 years and │ 4│ 4│ │ 2│ 4│ 2 - over │ │ │ │ │ │ - Average age: │ │ │ │ │ │ - 25 years. │ │ │ │ │ │ - │ │ │ │ │ │ - 3 reportable │ 642│ 650│ 8│ 214│ 626│ 214 - pregnancies│ │ │ │ │ │ - ─────────────┼──────┼───────┼────────────┼────────┼───────┼──────── - Under 20 │ 9│ 9│ │ 3│ 8│ 3 - years │ │ │ │ │ │ - 20 to 24 │ 231│ 234│ 3│ 77│ 227│ 77 - years │ │ │ │ │ │ - 25 to 29 │ 285│ 288│ 3│ 95│ 277│ 95 - years │ │ │ │ │ │ - 30 to 39 │ 108│ 110│ 2│ 36│ 105│ 36 - years │ │ │ │ │ │ - 40 years and │ 9│ 9│ │ 3│ 9│ 3 - over │ │ │ │ │ │ - Average age: │ │ │ │ │ │ - 26 years. │ │ │ │ │ │ - │ │ │ │ │ │ - 4 reportable │ 744│ 752│ 8│ 186│ 723│ 186 - pregnancies│ │ │ │ │ │ - ─────────────┼──────┼───────┼────────────┼────────┼───────┼──────── - 20 to 24 │ 156│ 160│ 4│ 39│ 148│ 39 - years │ │ │ │ │ │ - 25 to 29 │ 300│ 301│ 1│ 75│ 290│ 75 - years │ │ │ │ │ │ - 30 to 39 │ 252│ 255│ 3│ 63│ 249│ 63 - years │ │ │ │ │ │ - 40 years and │ 36│ 36│ │ 9│ 36│ 9 - over │ │ │ │ │ │ - Average age: │ │ │ │ │ │ - 29 years. │ │ │ │ │ │ - │ │ │ │ │ │ - 5 reportable │ 735│ 740│ 5│ 147│ 704│ 147 - pregnancies│ │ │ │ │ │ - ─────────────┼──────┼───────┼────────────┼────────┼───────┼──────── - 20 to 24 │ 50│ 50│ │ 10│ 49│ 10 - years │ │ │ │ │ │ - 25 to 29 │ 280│ 283│ 3│ 56│ 266│ 56 - years │ │ │ │ │ │ - 30 to 39 │ 375│ 377│ 2│ 75│ 361│ 75 - years │ │ │ │ │ │ - 40 years and │ 30│ 30│ │ 6│ 28│ 6 - over │ │ │ │ │ │ - Average age: │ │ │ │ │ │ - 30 years. │ │ │ │ │ │ - │ │ │ │ │ │ - 6 reportable │ 564│ 568│ 4│ 94│ 546│ 93 - pregnancies│ │ │ │ │ │ - ─────────────┼──────┼───────┼────────────┼────────┼───────┼──────── - 20 to 24 │ 6│ 6│ │ 1│ 6│ 1 - years │ │ │ │ │ │ - 25 to 29 │ 132│ 133│ 1│ 22│ 127│ 21 - years │ │ │ │ │ │ - 30 to 39 │ 360│ 362│ 2│ 60│ 347│ 60 - years │ │ │ │ │ │ - 40 years and │ 66│ 67│ 1│ 11│ 66│ 11 - over │ │ │ │ │ │ - Average age: │ │ │ │ │ │ - 33 years. │ │ │ │ │ │ - │ │ │ │ │ │ - 7 reportable │ 581│ 586│ 5│ 83│ 555│ 83 - pregnancies│ │ │ │ │ │ - ─────────────┼──────┼───────┼────────────┼────────┼───────┼──────── - 25 to 29 │ 98│ 99│ 1│ 14│ 90│ 14 - years │ │ │ │ │ │ - 30 to 39 │ 392│ 395│ 3│ 56│ 377│ 56 - years │ │ │ │ │ │ - 40 years and │ 91│ 92│ 1│ 13│ 88│ 13 - over │ │ │ │ │ │ - Average age: │ │ │ │ │ │ - 34 years. │ │ │ │ │ │ - │ │ │ │ │ │ - 8 reportable │ 432│ 437│ 5│ 54│ 426│ 54 - pregnancies│ │ │ │ │ │ - ─────────────┼──────┼───────┼────────────┼────────┼───────┼──────── - 25 to 29 │ 16│ 16│ │ 2│ 16│ 2 - years │ │ │ │ │ │ - 30 to 39 │ 408│ 413│ 5│ 51│ 403│ 51 - years │ │ │ │ │ │ - 40 years and │ 8│ 8│ │ 1│ 7│ 1 - over │ │ │ │ │ │ - Average age: │ │ │ │ │ │ - 35 years. │ │ │ │ │ │ - │ │ │ │ │ │ - 9 reportable │ 297│ 299│ 2│ 33│ 283│ 33 - pregnancies│ │ │ │ │ │ - ─────────────┼──────┼───────┼────────────┼────────┼───────┼──────── - 30 to 39 │ 207│ 208│ 1│ 23│ 195│ 23 - years │ │ │ │ │ │ - 40 years and │ 90│ 91│ 1│ 10│ 88│ 10 - over │ │ │ │ │ │ - Average age: │ │ │ │ │ │ - 37 years. │ │ │ │ │ │ - │ │ │ │ │ │ - 10 or more │ 654│ 666│ 12│([41])58│ 634│ 58 - reportable │ │ │ │ │ │ - pregnancies│ │ │ │ │ │ - ─────────────┼──────┼───────┼────────────┼────────┼───────┼──────── - 30 to 39 │ 360│ 364│ 4│ 33│ 342│ 33 - years │ │ │ │ │ │ - 40 years and │ 294│ 302│ 8│ 25│ 292│ 25 - over │ │ │ │ │ │ - Average age: │ │ │ │ │ │ - 39 years. │ │ │ │ │ │ - ─────────────┴──────┴───────┴────────────┴────────┴───────┴──────── - - ═════════════╤══════════════════════════╤══════════════════════════ - NUMBER OF │ │ - REPORTABLE │ │ - PREGNANCIES │ BABIES DYING IN FIRST │ - AND AGE OF │ YEAR. │ STILLBIRTHS. - MOTHER AT │ │ - BIRTH OF BABY│ │ - BORN IN 1911.│ │ - ─────────────┼───────┬────────┬─────────┼───────┬────────┬───────── - │ │ │ │ │ │ - │ │ │ │ │ │ - ─────────────┼───────┼────────┼─────────┼───────┼────────┼───────── - │ │ Number │ Infant │ │ Number │Per cent. - │Number.│ of │mortality│Number.│ of │ of all - │ │mothers.│ rate. │ │mothers.│ births - │ │ │ │ │ │ - ─────────────┼───────┼────────┼─────────┼───────┼────────┼───────── - All married │ 804│ 509│ 149.9│ 254│ 194│ 4.5 - mothers │ │ │ │ │ │ - ═════════════╪═══════╪════════╪═════════╪═══════╪════════╪═════════ - Under 20 │ 12│ 11│ 125.0│ 12│ 12│ 11.1 - years │ │ │ │ │ │ - 20 to 24 │ 140│ 115│ 154.2│ 38│ 29│ 4.0 - years │ │ │ │ │ │ - 25 to 29 │ 185│ 132│ 146.7│ 68│ 55│ 5.1 - years │ │ │ │ │ │ - 30 to 39 │ 382│ 207│ 154.0│ 115│ 84│ 4.4 - years │ │ │ │ │ │ - 40 years │ 85│ 44│ 137.5│ 21│ 14│ 3.3 - and over │ │ │ │ │ │ - Average age: │ │ │ │ │ │ - 28 years. │ │ │ │ │ │ - │ │ │ │ │ │ - 1 reportable │ 35│ 34│ 108.7│ 21│ 21│ 6.1 - pregnancy │ │ │ │ │ │ - ─────────────┼───────┼────────┼─────────┼───────┼────────┼───────── - Under 20 │ 8│ 7│ 119.4│ 8│ 8│ 10.7 - years │ │ │ │ │ │ - 20 to 24 │ 18│ 18│ 102.3│ 3│ 3│ 1.7 - years │ │ │ │ │ │ - 25 to 29 │ 4│ 4│ 74.1│ 4│ 4│ 6.9 - years │ │ │ │ │ │ - 30 to 39 │ 5│ 5│ ([40]) │ 6│ 6│ ([40]) - years │ │ │ │ │ │ - Average age: │ │ │ │ │ │ - 23 years. │ │ │ │ │ │ - │ │ │ │ │ │ - 2 reportable │ 59│ 54│ 108.5│ 3│ 28│ 5.6 - pregnancies│ │ │ │ │ │ - ─────────────┼───────┼────────┼─────────┼───────┼────────┼───────── - Under 20 │ 3│ 3│ ([40]) │ 3│ 3│ ([40]) - years │ │ │ │ │ │ - 20 to 24 │ 42│ 37│ 139.1│ 15│ 13│ 4.7 - years │ │ │ │ │ │ - 25 to 29 │ 9│ 9│ 63.8│ 10│ 9│ 6.6 - years │ │ │ │ │ │ - 30 to 39 │ 5│ 5│ 65.8│ 4│ 3│ 5.0 - years │ │ │ │ │ │ - 40 years and │ │ │ │ ...│ │ - over │ │ │ │ │ │ - Average age: │ │ │ │ │ │ - 25 years. │ │ │ │ │ │ - │ │ │ │ │ │ - 3 reportable │ 92│ 75│ 147.0│ 24│ 23│ 3.7 - pregnancies│ │ │ │ │ │ - ─────────────┼───────┼────────┼─────────┼───────┼────────┼───────── - Under 20 │ 1│ 1│ ([40]) │ 1│ 1│ ([40]) - years │ │ │ │ │ │ - 20 to 24 │ 40│ 31│ 176.2│ 7│ 6│ 3.0 - years │ │ │ │ │ │ - 25 to 29 │ 41│ 33│ 148.0│ 11│ 11│ 3.8 - years │ │ │ │ │ │ - 30 to 39 │ 8│ 8│ 76.2│ 5│ 5│ 4.5 - years │ │ │ │ │ │ - 40 years and │ 2│ 2│ ([40]) │ │ │ - over │ │ │ │ │ │ - Average age: │ │ │ │ │ │ - 26 years. │ │ │ │ │ │ - │ │ │ │ │ │ - 4 reportable │ 78│ 64│ 107.9│ 29│ 21│ 3.9 - pregnancies│ │ │ │ │ │ - ─────────────┼───────┼────────┼─────────┼───────┼────────┼───────── - 20 to 24 │ 28│ 21│ 189.2│ 12│ 6│ 7.5 - years │ │ │ │ │ │ - 25 to 29 │ 26│ 23│ 89.7│ 11│ 10│ 3.7 - years │ │ │ │ │ │ - 30 to 39 │ 21│ 17│ 84.3│ 6│ 5│ 2.4 - years │ │ │ │ │ │ - 40 years and │ 3│ 3│ ([40]) │ │ │ - over │ │ │ │ │ │ - Average age: │ │ │ │ │ │ - 29 years. │ │ │ │ │ │ - │ │ │ │ │ │ - 5 reportable │ 103│ 67│ 146.3│ 36│ 31│ 4.9 - pregnancies│ │ │ │ │ │ - ─────────────┼───────┼────────┼─────────┼───────┼────────┼───────── - 20 to 24 │ 9│ 7│ 183.7│ 1│ 1│ 2.0 - years │ │ │ │ │ │ - 25 to 29 │ 51│ 31│ 191.7│ 17│ 15│ 6.0 - years │ │ │ │ │ │ - 30 to 39 │ 40│ 27│ 110.8│ 16│ 14│ 4.2 - years │ │ │ │ │ │ - 40 years and │ 3│ 2│ ([40]) │ 2│ 1│ ([40]) - over │ │ │ │ │ │ - Average age: │ │ │ │ │ │ - 30 years. │ │ │ │ │ │ - │ │ │ │ │ │ - 6 reportable │ 88│ 60│ 161.2│ 22│ 13│ 3.9 - pregnancies│ │ │ │ │ │ - ─────────────┼───────┼────────┼─────────┼───────┼────────┼───────── - 20 to 24 │ 3│ 1│ ([40]) │ │ │ - years │ │ │ │ │ │ - 25 to 29 │ 23│ 17│ 181.1│ 6│ 1│ 4.5 - years │ │ │ │ │ │ - 30 to 39 │ 54│ 36│ 155.6│ 15│ 11│ 4.1 - years │ │ │ │ │ │ - 40 years and │ 8│ 6│ 121.2│ 1│ 1│ 1.5 - over │ │ │ │ │ │ - Average age: │ │ │ │ │ │ - 33 years. │ │ │ │ │ │ - │ │ │ │ │ │ - 7 reportable │ 78│ 48│ 140.5│ 31│ 22│ 5.3 - pregnancies│ │ │ │ │ │ - ─────────────┼───────┼────────┼─────────┼───────┼────────┼───────── - 25 to 29 │ 23│ 13│ 255.6│ 9│ 5│ 10.0 - years │ │ │ │ │ │ - 30 to 39 │ 45│ 28│ 119.4│ 18│ 15│ 4.6 - years │ │ │ │ │ │ - 40 years and │ 10│ 7│ 113.6│ 4│ 2│ 4.3 - over │ │ │ │ │ │ - Average age: │ │ │ │ │ │ - 34 years. │ │ │ │ │ │ - │ │ │ │ │ │ - 8 reportable │ 95│ 42│ 223.0│ 11│ 7│ 2.5 - pregnancies│ │ │ │ │ │ - ─────────────┼───────┼────────┼─────────┼───────┼────────┼───────── - 25 to 29 │ 8│ 2│ ([40]) │ │ │ - years │ │ │ │ │ │ - 30 to 39 │ 87│ 40│ 215.9│ 10│ 6│ 2.4 - years │ │ │ │ │ │ - 40 years and │ │ │ │ 1│ 1│ ([40]) - over │ │ │ │ │ │ - Average age: │ │ │ │ │ │ - 35 years. │ │ │ │ │ │ - │ │ │ │ │ │ - 9 reportable │ 41│ 20│ 144.9│ 16│ 11│ 5.4 - pregnancies│ │ │ │ │ │ - ─────────────┼───────┼────────┼─────────┼───────┼────────┼───────── - 30 to 39 │ 32│ 15│ 164.1│ 13│ 8│ 6.3 - years │ │ │ │ │ │ - 40 years and │ 9│ 5│ 102.3│ 3│ 3│ 3.3 - over │ │ │ │ │ │ - Average age: │ │ │ │ │ │ - 37 years. │ │ │ │ │ │ - │ │ │ │ │ │ - 10 or more │ 135│ 45│ 212.9│ 32│ 17│ 4.8 - reportable │ │ │ │ │ │ - pregnancies│ │ │ │ │ │ - ─────────────┼───────┼────────┼─────────┼───────┼────────┼───────── - 30 to 39 │ 85│ 26│ 248.5│ 22│ 11│ 6.0 - years │ │ │ │ │ │ - 40 years and │ 50│ 19│ 171.2│ 10│ 6│ 3.3 - over │ │ │ │ │ │ - Average age: │ │ │ │ │ │ - 39 years. │ │ │ │ │ │ - ─────────────┴───────┴────────┴─────────┴───────┴────────┴───────── - - ═════════════╤═══════════════════════════ - NUMBER OF │ - REPORTABLE │ - PREGNANCIES │ - AND AGE OF │ MISCARRIAGES. - MOTHER AT │ - BIRTH OF BABY│ - BORN IN 1911.│ - ─────────────┼─────────┬───────────────── - │ │ Mothers - │ │ reporting. - ─────────────┼─────────┼────────┬──────── - │ │ │ Per - │ Number │Number. │cent. of - │reported.│ │ all - │ │ │mothers. - ─────────────┼─────────┼────────┼──────── - All married │ 191│ 130│ 8.7 - mothers │ │ │ - ═════════════╪═════════╪════════╪════════ - Under 20 │ │ │ - years │ │ │ - 20 to 24 │ 19│ 18│ 3.9 - years │ │ │ - 25 to 29 │ 46│ 27│ 6.8 - years │ │ │ - 30 to 39 │ 95│ 66│ 14.2 - years │ │ │ - 40 years │ 31│ 19│ 23.8 - and over │ │ │ - Average age: │ │ │ - 28 years. │ │ │ - │ │ │ - 1 reportable │ 8│ 8│ 2.4 - pregnancy │ │ │ - ─────────────┼─────────┼────────┼──────── - Under 20 │ │ │ - years │ │ │ - 20 to 24 │ 3│ 3│ 1.7 - years │ │ │ - 25 to 29 │ 3│ 3│ 5.3 - years │ │ │ - 30 to 39 │ 2│ 2│ ([40]) - years │ │ │ - Average age: │ │ │ - 23 years. │ │ │ - │ │ │ - 2 reportable │ 23│ 16│ 5.7 - pregnancies│ │ │ - ─────────────┼─────────┼────────┼──────── - Under 20 │ │ │ - years │ │ │ - 20 to 24 │ 6│ 6│ 3.8 - years │ │ │ - 25 to 29 │ 5│ 3│ 4.1 - years │ │ │ - 30 to 39 │ 12│ 7│ ([40]) - years │ │ │ - 40 years and │ │ │ - over │ │ │ - Average age: │ │ │ - 25 years. │ │ │ - │ │ │ - 3 reportable │ 26│ 18│ 8.4 - pregnancies│ │ │ - ─────────────┼─────────┼────────┼──────── - Under 20 │ │ │ - years │ │ │ - 20 to 24 │ 7│ 6│ 7.8 - years │ │ │ - 25 to 29 │ 14│ 7│ 7.4 - years │ │ │ - 30 to 39 │ 4│ 4│ ([40]) - years │ │ │ - 40 years and │ 1│ 1│ ([40]) - over │ │ │ - Average age: │ │ │ - 26 years. │ │ │ - │ │ │ - 4 reportable │ 22│ 18│ 9.7 - pregnancies│ │ │ - ─────────────┼─────────┼────────┼──────── - 20 to 24 │ 3│ 3│ ([40]) - years │ │ │ - 25 to 29 │ 10│ 6│ 8.0 - years │ │ │ - 30 to 39 │ 6│ 6│ 9.5 - years │ │ │ - 40 years and │ 3│ 3│ ([40]) - over │ │ │ - Average age: │ │ │ - 29 years. │ │ │ - │ │ │ - 5 reportable │ 20│ 14│ 9.5 - pregnancies│ │ │ - ─────────────┼─────────┼────────┼──────── - 20 to 24 │ │ │ - years │ │ │ - 25 to 29 │ 6│ 4│ 7.1 - years │ │ │ - 30 to 39 │ 12│ 8│ 10.7 - years │ │ │ - 40 years and │ 2│ 2│ ([40]) - over │ │ │ - Average age: │ │ │ - 30 years. │ │ │ - │ │ │ - 6 reportable │ 23│ 14│ 14.9 - pregnancies│ │ │ - ─────────────┼─────────┼────────┼──────── - 20 to 24 │ │ │ - years │ │ │ - 25 to 29 │ 6│ 3│ ([40]) - years │ │ │ - 30 to 39 │ 13│ 9│ 15.0 - years │ │ │ - 40 years and │ 4│ 2│ ([40]) - over │ │ │ - Average age: │ │ │ - 33 years. │ │ │ - │ │ │ - 7 reportable │ 27│ 15│ 18.1 - pregnancies│ │ │ - ─────────────┼─────────┼────────┼──────── - 25 to 29 │ 2│ 1│ ([40]) - years │ │ │ - 30 to 39 │ 19│ 11│ 19.6 - years │ │ │ - 40 years and │ 6│ 3│ ([40]) - over │ │ │ - Average age: │ │ │ - 34 years. │ │ │ - │ │ │ - 8 reportable │ 15│ 9│ 16.7 - pregnancies│ │ │ - ─────────────┼─────────┼────────┼──────── - 25 to 29 │ │ │ - years │ │ │ - 30 to 39 │ 15│ 9│ 17.6 - years │ │ │ - 40 years and │ │ │ - over │ │ │ - Average age: │ │ │ - 35 years. │ │ │ - │ │ │ - 9 reportable │ 13│ 8│ 24.2 - pregnancies│ │ │ - ─────────────┼─────────┼────────┼──────── - 30 to 39 │ 5│ 4│ ([40]) - years │ │ │ - 40 years and │ 8│ 4│ ([40]) - over │ │ │ - Average age: │ │ │ - 37 years. │ │ │ - │ │ │ - 10 or more │ 14│ 10│ 17.2 - reportable │ │ │ - pregnancies│ │ │ - ─────────────┼─────────┼────────┼──────── - 30 to 39 │ 7│ 6│ ([40]) - years │ │ │ - 40 years and │ 7│ 4│ ([40]) - over │ │ │ - Average age: │ │ │ - 39 years. │ │ │ - ─────────────┴─────────┴────────┴──────── -Footnote 39: - - Excess of births over pregnancies due to plural births. - -Footnote 40: - - Rate not computed because of small base. - -Footnote 41: - - Includes 21 having 10 pregnancies; 16 having 11; 11 having 12; 6 - having 13; 3 having 14; 1 having 16. - - - TABLE XIII.—DISTRIBUTION OF RESULTS OF REPORTABLE PREGNANCIES (LIVE - BIRTHS AND STILLBIRTHS) AND MISCARRIAGES, ACCORDING TO NUMBER PER MOTHER - AND HUSBAND’S EARNINGS. - - ═════════════╤════════════════════════════════════╤════════════════ - SPECIFIED │ │ - NUMBER OF │ │ - PREGNANCIES │ │ - FOR ALL │ │ - MARRIED │ REPORTABLE PREGNANCIES. │ LIVE BIRTHS. - MOTHERS AND │ │ - ANNUAL │ │ - EARNINGS OF │ │ - HUSBAND. │ │ - ─────────────┼──────┬────────────────────┬────────┼───────┬──────── - │ │ Resulting births. │ │ │ - │ │ │ │ │ - ─────────────┼──────┼───────┬────────────┼────────┼───────┼──────── - │ │ │Excess over │ Number │ │ Number - │Total.│Number.│pregnancies.│ of │Number.│ of - │ │ │ [42] │mothers.│ │mothers. - │ │ │ │ │ │ - ─────────────┼──────┼───────┼────────────┼────────┼───────┼──────── - All │ │ │ │ │ │ - reportable │ 5,554│ 5,617│ 63│ 1,491│ 5,363│ 1,465 - pregnancies │ │ │ │ │ │ - ═════════════╪══════╪═══════╪════════════╪════════╪═══════╪════════ - Husband │ │ │ │ │ │ - earns: │ │ │ │ │ │ - Under $521 │ 938│ 946│ 8│ 233│ 902│ 227 - $521 to $624│ 691│ 700│ 9│ 174│ 668│ 173 - $625 to $779│ 816│ 826│ 10│ 229│ 797│ 227 - $780 to $899│ 611│ 616│ 5│ 166│ 588│ 163 - $900 to │ 574│ 581│ 7│ 146│ 548│ 143 - $1,199 │ │ │ │ │ │ - $1,200 and │ 196│ 199│ 3│ 50│ 186│ 49 - over │ │ │ │ │ │ - Ample[43] │ 1,728│ 1,749│ 21│ 493│ 1,674│ 483 - │ │ │ │ │ │ - 1 reportable │ 339│ 343│ 4│ 339│ 322│ 318 - pregnancy │ │ │ │ │ │ - ─────────────┼──────┼───────┼────────────┼────────┼───────┼──────── - Husband │ │ │ │ │ │ - earns: │ │ │ │ │ │ - Under $521 │ 48│ 48│ │ 48│ 43│ 43 - $521 to $624│ 23│ 23│ │ 23│ 22│ 22 - $625 to $779│ 46│ 48│ 2│ 46│ 46│ 44 - $780 to $899│ 35│ 35│ │ 35│ 32│ 32 - $900 to │ 38│ 39│ 1│ 38│ 36│ 35 - $1,199 │ │ │ │ │ │ - $1,200 and │ 13│ 13│ │ 13│ 13│ 13 - over │ │ │ │ │ │ - Ample[43] │ 136│ 137│ 1│ 136│ 130│ 129 - │ │ │ │ │ │ - 2 reportable │ 566│ 576│ 10│ 283│ 544│ 279 - pregnancies│ │ │ │ │ │ - ─────────────┼──────┼───────┼────────────┼────────┼───────┼──────── - Husband │ │ │ │ │ │ - earns: │ │ │ │ │ │ - Under $521 │ 62│ 64│ 2│ 31│ 62│ 31 - $521 to $624│ 72│ 74│ 2│ 36│ 68│ 36 - $625 to $779│ 110│ 111│ 1│ 55│ 108│ 55 - $780 to $899│ 56│ 56│ │ 28│ 53│ 28 - $900 to │ 46│ 46│ │ 23│ 41│ 23 - $1,199 │ │ │ │ │ │ - $1,200 and │ 16│ 16│ │ 8│ 14│ 7 - over │ │ │ │ │ │ - Ample[43] │ 204│ 209│ 5│ 102│ 198│ 99 - │ │ │ │ │ │ - 3 reportable │ 642│ 650│ 8│ 214│ 626│ 214 - pregnancies│ │ │ │ │ │ - ─────────────┼──────┼───────┼────────────┼────────┼───────┼──────── - Husband │ │ │ │ │ │ - earns: │ │ │ │ │ │ - Under $521 │ 114│ 115│ 1│ 38│ 110│ 38 - $521 to $624│ 102│ 104│ 2│ 34│ 101│ 34 - $625 to $779│ 84│ 84│ │ 28│ 82│ 28 - $780 to $899│ 87│ 87│ │ 29│ 83│ 29 - $900 to │ 57│ 58│ 1│ 19│ 55│ 19 - $1,199 │ │ │ │ │ │ - $1,200 and │ 6│ 7│ 1│ 2│ 7│ 2 - over │ │ │ │ │ │ - Ample[43] │ 192│ 195│ 3│ 64│ 188│ 64 - │ │ │ │ │ │ - 4 reportable │ 744│ 752│ 8│ 186│ 723│ 186 - pregnancies│ │ │ │ │ │ - ─────────────┼──────┼───────┼────────────┼────────┼───────┼──────── - Husband │ │ │ │ │ │ - earns: │ │ │ │ │ │ - Under $521 │ 104│ 104│ │ 26│ 101│ 26 - $521 to $624│ 88│ 89│ 1│ 22│ 86│ 22 - $625 to $779│ 136│ 137│ 1│ 34│ 129│ 34 - $780 to $899│ 96│ 97│ 1│ 24│ 95│ 24 - $900 to │ 56│ 58│ 2│ 14│ 55│ 14 - $1,199 │ │ │ │ │ │ - $1,200 and │ 40│ 41│ 1│ 10│ 39│ 10 - over │ │ │ │ │ │ - Ample[43] │ 224│ 226│ 2│ 56│ 218│ 56 - │ │ │ │ │ │ - 5 reportable │ 735│ 740│ 5│ 147│ 704│ 147 - pregnancies│ │ │ │ │ │ - ─────────────┼──────┼───────┼────────────┼────────┼───────┼──────── - Husband │ │ │ │ │ │ - earns: │ │ │ │ │ │ - Under $521 │ 130│ 131│ 1│ 26│ 125│ 26 - $521 to $624│ 90│ 91│ 1│ 18│ 85│ 18 - $625 to $779│ 100│ 100│ │ 20│ 99│ 20 - $780 to $899│ 110│ 110│ │ 22│ 106│ 22 - $900 to │ 65│ 66│ 1│ 13│ 60│ 13 - $1,199 │ │ │ │ │ │ - $1,200 and │ 30│ 30│ │ 6│ 26│ 6 - over │ │ │ │ │ │ - Ample[43] │ 210│ 212│ 2│ 42│ 203│ 42 - │ │ │ │ │ │ - 6 reportable │ 564│ 568│ 4│ 94│ 546│ 93 - pregnancies│ │ │ │ │ │ - ─────────────┼──────┼───────┼────────────┼────────┼───────┼──────── - Husband │ │ │ │ │ │ - earns: │ │ │ │ │ │ - Under $521 │ 132│ 132│ │ 22│ 124│ 21 - $521 to $624│ 60│ 60│ │ 10│ 59│ 10 - $625 to $779│ 114│ 115│ 1│ 19│ 110│ 19 - $780 to $899│ 48│ 48│ │ 8│ 48│ 8 - $900 to │ 72│ 74│ 2│ 12│ 70│ 12 - $1,199 │ │ │ │ │ │ - $1,200 and │ 12│ 12│ │ 2│ 11│ 2 - over │ │ │ │ │ │ - Ample[43] │ 126│ 127│ 1│ 21│ 124│ 21 - │ │ │ │ │ │ - 7 reportable │ 581│ 586│ 5│ 83│ 555│ 83 - pregnancies│ │ │ │ │ │ - ─────────────┼──────┼───────┼────────────┼────────┼───────┼──────── - Husband │ │ │ │ │ │ - earns: │ │ │ │ │ │ - Under $521 │ 91│ 92│ 1│ 13│ 88│ 13 - $521 to $624│ 56│ 56│ │ 8│ 51│ 8 - $625 to $779│ 98│ 101│ 3│ 14│ 97│ 14 - $780 to $899│ 35│ 35│ │ 5│ 32│ 5 - $900 to │ 84│ 84│ │ 12│ 79│ 12 - $1,199 │ │ │ │ │ │ - $1,200 and │ 21│ 22│ 1│ 3│ 22│ 3 - over │ │ │ │ │ │ - Ample[43] │ 196│ 196│ │ 8│ 186│ 28 - │ │ │ │ │ │ - 8 reportable │ 432│ 437│ 5│ 54│ 426│ 54 - pregnancies│ │ │ │ │ │ - ─────────────┼──────┼───────┼────────────┼────────┼───────┼──────── - Husband │ │ │ │ │ │ - earns: │ │ │ │ │ │ - Under $521 │ 120│ 120│ │ 15│ 117│ 15 - $521 to $624│ 96│ 98│ 2│ 12│ 94│ 12 - $625 to $779│ 40│ 41│ 1│ 5│ 41│ 5 - $780 to $899│ 48│ 49│ 1│ 6│ 46│ 6 - $900 to │ 24│ 24│ │ 3│ 24│ 3 - $1,199 │ │ │ │ │ │ - $1,200 and │ 16│ 16│ │ 2│ 16│ 2 - over │ │ │ │ │ │ - Ample[43] │ 88│ 89│ 1│ 11│ 88│ 11 - │ │ │ │ │ │ - 9 reportable │ 297│ 299│ 2│ 33│ 283│ 33 - pregnancies│ │ │ │ │ │ - ─────────────┼──────┼───────┼────────────┼────────┼───────┼──────── - Husband │ │ │ │ │ │ - earns: │ │ │ │ │ │ - Under $521 │ 81│ 82│ 1│ 9│ 80│ 9 - $521 to $624│ 72│ 72│ │ 8│ 70│ 8 - $625 to $779│ 18│ 18│ │ 2│ 15│ 2 - $780 to $899│ 18│ 19│ 1│ 2│ 17│ 2 - $900 to │ 18│ 18│ │ 2│ 18│ 2 - $1,199 │ │ │ │ │ │ - $1,200 and │ 18│ 18│ │ 2│ 16│ 2 - over │ │ │ │ │ │ - Ample[43] │ 72│ 72│ │ 8│ 67│ 8 - │ │ │ │ │ │ - 10 or more │ │ │ │ │ │ - reportable │ 654│ 666│ 12│ 58│ 634│ 58 - pregnancies│ │ │ │ │ │ - ─────────────┼──────┼───────┼────────────┼────────┼───────┼──────── - Husband │ │ │ │ │ │ - earns: │ │ │ │ │ │ - Under $521 │ 56│ 58│ 2│ 5│ 52│ 5 - $521 to $624│ 32│ 33│ 1│ 3│ 32│ 3 - $625 to $779│ 70│ 71│ 1│ 6│ 70│ 6 - $780 to $899│ 78│ 80│ 2│ 7│ 76│ 7 - $900 to │ 114│ 114│ │ 10│ 110│ 10 - $1,199 │ │ │ │ │ │ - $1,200 and │ 24│ 24│ │ 2│ 22│ 2 - over │ │ │ │ │ │ - Ample[43] │ 280│ 286│ 6│ 25│ 272│ 25 - ─────────────┴──────┴───────┴────────────┴────────┴───────┴──────── - - ═════════════╤══════════════════════════╤══════════════════════════ - SPECIFIED │ │ - NUMBER OF │ │ - PREGNANCIES │ │ - FOR ALL │ BABIES DYING IN FIRST │ - MARRIED │ YEAR. │ STILLBIRTHS. - MOTHERS AND │ │ - ANNUAL │ │ - EARNINGS OF │ │ - HUSBAND. │ │ - ─────────────┼───────┬────────┬─────────┼───────┬────────┬───────── - │ │ │ │ │ │ - │ │ │ │ │ │ - ─────────────┼───────┼────────┼─────────┼───────┼────────┼───────── - │ │ Number │ Infant │ │ Number │Per cent. - │Number.│ of │mortality│Number.│ of │ of all - │ │mothers.│ rate. │ │mothers.│ births - │ │ │ │ │ │ - ─────────────┼───────┼────────┼─────────┼───────┼────────┼───────── - All │ │ │ │ │ │ - reportable │ 804│ 149.9│ 509│ 254│ 194│ 4.5 - pregnancies │ │ │ │ │ │ - ═════════════╪═══════╪════════╪═════════╪═══════╪════════╪═════════ - Husband │ │ │ │ │ │ - earns: │ │ │ │ │ │ - Under $521 │ 178│ 197.3│ 110│ 44│ 31│ 4.7 - $521 to $624│ 129│ 193.1│ 75│ 32│ 25│ 4.6 - $625 to $779│ 130│ 163.1│ 88│ 29│ 21│ 3.5 - $780 to $899│ 99│ 168.4│ 61│ 28│ 23│ 4.5 - $900 to │ 78│ 142.3│ 48│ 33│ 24│ 5.7 - $1,199 │ │ │ │ │ │ - $1,200 and │ 30│ 161.3│ 18│ 13│ 9│ 6.5 - over │ │ │ │ │ │ - Ample[43] │ 160│ 95.6│ 109│ 75│ 61│ 4.3 - │ │ │ │ │ │ - 1 reportable │ 35│ 108.7│ 34│ 21│ 21│ 6.1 - pregnancy │ │ │ │ │ │ - ─────────────┼───────┼────────┼─────────┼───────┼────────┼───────── - Husband │ │ │ │ │ │ - earns: │ │ │ │ │ │ - Under $521 │ 11│ │ 11│ 5│ 5│ - $521 to $624│ 2│ │ 2│ 1│ 1│ - $625 to $779│ 6│ │ 5│ 2│ 2│ - $780 to $899│ 3│ │ 3│ 3│ 3│ - $900 to │ 4│ │ 4│ 3│ 3│ - $1,199 │ │ │ │ │ │ - $1,200 and │ 1│ │ 1│ │ │ - over │ │ │ │ │ │ - Ample[43] │ 8│ 61.5│ 8│ 7│ 7│ 5.1 - │ │ │ │ │ │ - 2 reportable │ 59│ 108.5│ 54│ 32│ 28│ 5.6 - pregnancies│ │ │ │ │ │ - ─────────────┼───────┼────────┼─────────┼───────┼────────┼───────── - Husband │ │ │ │ │ │ - earns: │ │ │ │ │ │ - Under $521 │ 11│ 176.4│ 11│ 2│ 2│ 3.1 - $521 to $624│ 8│ 177.6│ 6│ 6│ 6│ 8.1 - $625 to $779│ 17│ 157.4│ 16│ 3│ 3│ 2.7 - $780 to $899│ 9│ 169.8│ 7│ 3│ 3│ 5.4 - $900 to │ 2│ │ 2│ 5│ 5│ - $1,199 │ │ │ │ │ │ - $1,200 and │ 1│ │ 1│ 2│ 1│ - over │ │ │ │ │ │ - Ample[43] │ 11│ 55.6│ 11│ 11│ 8│ 5.3 - │ │ │ │ │ │ - 3 reportable │ 92│ 147.0│ 75│ 24│ 23│ 3.7 - pregnancies│ │ │ │ │ │ - ─────────────┼───────┼────────┼─────────┼───────┼────────┼───────── - Husband │ │ │ │ │ │ - earns: │ │ │ │ │ │ - Under $521 │ 27│ 245.5│ 23│ 5│ 4│ 4.3 - $521 to $624│ 16│ 158.4│ 13│ 3│ 3│ 1.9 - $625 to $779│ 13│ 158.5│ 11│ 2│ 2│ 2.4 - $780 to $899│ 6│ 72.3│ 6│ 4│ 4│ 4.6 - $900 to │ 11│ 200.0│ 8│ 3│ 3│ 5.2 - $1,199 │ │ │ │ │ │ - $1,200 and │ 1│ │ 1│ │ │ - over │ │ │ │ │ │ - Ample[43] │ 18│ 95.7│ 13│ 7│ 7│ 3.6 - │ │ │ │ │ │ - 4 reportable │ 78│ 107.9│ 64│ 29│ 21│ 3.9 - pregnancies│ │ │ │ │ │ - ─────────────┼───────┼────────┼─────────┼───────┼────────┼───────── - Husband │ │ │ │ │ │ - earns: │ │ │ │ │ │ - Under $521 │ 13│ 128.7│ 9│ 3│ 2│ 1.9 - $521 to $624│ 10│ 116.3│ 9│ 3│ 1│ 3.4 - $625 to $779│ 19│ 147.3│ 15│ 8│ 6│ 5.8 - $780 to $899│ 13│ 136.8│ 12│ 2│ 1│ 2.1 - $900 to │ 4│ 72.7│ 2│ 3│ 1│ 5.2 - $1,199 │ │ │ │ │ │ - $1,200 and │ 5│ │ 4│ 2│ 2│ - over │ │ │ │ │ │ - Ample[43] │ 14│ 64.2│ 13│ 8│ 8│ 3.5 - │ │ │ │ │ │ - 5 reportable │ 103│ 146.3│ 67│ 36│ 31│ 4.9 - pregnancies│ │ │ │ │ │ - ─────────────┼───────┼────────┼─────────┼───────┼────────┼───────── - Husband │ │ │ │ │ │ - earns: │ │ │ │ │ │ - Under $521 │ 21│ 168.0│ 12│ 6│ 6│ 4.6 - $521 to $624│ 20│ 235.3│ 12│ 6│ 5│ 6.6 - $625 to $779│ 18│ 181.8│ 13│ 1│ 1│ 1.0 - $780 to $899│ 13│ 122.6│ 8│ 4│ 4│ 3.6 - $900 to │ 6│ 100.0│ 5│ 6│ 4│ 10.0 - $1,199 │ │ │ │ │ │ - $1,200 and │ 10│ │ 6│ 4│ 3│ - over │ │ │ │ │ │ - Ample[43] │ 15│ 73.9│ 11│ 9│ 8│ 4.2 - │ │ │ │ │ │ - 6 reportable │ 88│ 161.2│ 60│ 22│ 13│ 3.9 - pregnancies│ │ │ │ │ │ - ─────────────┼───────┼────────┼─────────┼───────┼────────┼───────── - Husband │ │ │ │ │ │ - earns: │ │ │ │ │ │ - Under $521 │ 26│ 209.7│ 14│ 8│ 3│ 6.1 - $521 to $624│ 9│ 152.5│ 8│ 1│ 1│ 1.7 - $625 to $779│ 14│ 127.3│ 11│ 5│ 2│ 4.3 - $780 to $899│ 7│ │ 6│ │ │ - $900 to │ 12│ 171.4│ 9│ 4│ 3│ 5.4 - $1,199 │ │ │ │ │ │ - $1,200 and │ 3│ │ 1│ 1│ 1│ - over │ │ │ │ │ │ - Ample[43] │ 17│ 137.1│ 11│ 3│ 3│ 2.4 - │ │ │ │ │ │ - 7 reportable │ 78│ 140.5│ 48│ 31│ 22│ 5.3 - pregnancies│ │ │ │ │ │ - ─────────────┼───────┼────────┼─────────┼───────┼────────┼───────── - Husband │ │ │ │ │ │ - earns: │ │ │ │ │ │ - Under $521 │ 13│ 147.7│ 8│ 4│ 4│ 4.3 - $521 to $624│ 15│ 294.1│ 6│ 5│ 4│ 8.9 - $625 to $779│ 16│ 164.9│ 9│ 4│ 3│ 4.0 - $780 to $899│ 6│ │ 5│ 3│ 2│ - $900 to │ 7│ 88.6│ 5│ 5│ 2│ 6.0 - $1,199 │ │ │ │ │ │ - $1,200 and │ 1│ │ 1│ │ │ - over │ │ │ │ │ │ - Ample[43] │ 20│ 107.5│ 14│ 10│ 7│ 5.1 - │ │ │ │ │ │ - 8 reportable │ 95│ 223.0│ 42│ 11│ 7│ 2.5 - pregnancies│ │ │ │ │ │ - ─────────────┼───────┼────────┼─────────┼───────┼────────┼───────── - Husband │ │ │ │ │ │ - earns: │ │ │ │ │ │ - Under $521 │ 31│ 265.0│ 12│ 3│ 2│ 2.5 - $521 to $624│ 22│ 234.0│ 10│ 4│ 2│ 4.1 - $625 to $779│ 11│ │ 4│ │ │ - $780 to $899│ 11│ │ 5│ 3│ 2│ - $900 to │ 6│ │ 3│ │ │ - $1,199 │ │ │ │ │ │ - $1,200 and │ 3│ │ 2│ │ │ - over │ │ │ │ │ │ - Ample[43] │ 11│ 125.0│ 6│ 1│ 1│ 1.1 - │ │ │ │ │ │ - 9 reportable │ 41│ 144.9│ 20│ 16│ 11│ 5.4 - pregnancies│ │ │ │ │ │ - ─────────────┼───────┼────────┼─────────┼───────┼────────┼───────── - Husband │ │ │ │ │ │ - earns: │ │ │ │ │ │ - Under $521 │ 15│ 187.5│ 6│ 2│ 2│ 2.4 - $521 to $624│ 10│ 142.9│ 6│ 2│ 1│ 2.8 - $625 to $779│ │ │ │ 3│ 1│ - $780 to $899│ 5│ │ 2│ 2│ 2│ - $900 to │ 2│ │ 2│ │ │ - $1,199 │ │ │ │ │ │ - $1,200 and │ │ │ │ 2│ 1│ - over │ │ │ │ │ │ - Ample[43] │ 9│ 134.3│ 4│ 5│ 4│ 6.9 - │ │ │ │ │ │ - 10 or more │ │ │ │ │ │ - reportable │ 135│ 212.9│ 45│ 32│ 17│ 4.8 - pregnancies│ │ │ │ │ │ - ─────────────┼───────┼────────┼─────────┼───────┼────────┼───────── - Husband │ │ │ │ │ │ - earns: │ │ │ │ │ │ - Under $521 │ 10│ 192.3│ 4│ 6│ 1│ 10.3 - $521 to $624│ 17│ │ 3│ 1│ 1│ - $625 to $779│ 16│ 228.6│ 4│ 1│ 1│ 1.4 - $780 to $899│ 26│ 342.1│ 7│ 4│ 2│ 5.0 - $900 to │ 24│ 218.2│ 8│ 4│ 3│ 3.5 - $1,199 │ │ │ │ │ │ - $1,200 and │ 5│ │ 1│ 2│ 1│ 8.3 - over │ │ │ │ │ │ - Ample[43] │ 37│ 136.0│ 18│ 14│ 8│ 4.9 - ─────────────┴───────┴────────┴─────────┴───────┴────────┴───────── - - ═════════════╤═══════════════════════════ - SPECIFIED │ - NUMBER OF │ - PREGNANCIES │ - FOR ALL │ - MARRIED │ MISCARRIAGES. - MOTHERS AND │ - ANNUAL │ - EARNINGS OF │ - HUSBAND. │ - ─────────────┼─────────┬───────────────── - │ │ Mothers - │ │ reporting. - ─────────────┼─────────┼────────┬──────── - │ │ │ Per - │ Number │Number. │cent. of - │reported.│ │ all - │ │ │mothers. - ─────────────┼─────────┼────────┼──────── - All │ │ │ - reportable │ 191│ 130│ 8.7 - pregnancies │ │ │ - ═════════════╪═════════╪════════╪════════ - Husband │ │ │ - earns: │ │ │ - Under $521 │ 27│ 17│ 7.31 - $521 to $624│ 22│ 14│ 8.0 - $625 to $779│ 21│ 15│ 6.6 - $780 to $899│ 30│ 19│ 11.4 - $900 to │ 25│ 18│ 12.3 - $1,199 │ │ │ - $1,200 and │ 8│ 6│ 12.0 - over │ │ │ - Ample[43] │ 58│ 41│ 8.3 - │ │ │ - 1 reportable │ 8│ 8│ 2.4 - pregnancy │ │ │ - ─────────────┼─────────┼────────┼──────── - Husband │ │ │ - earns: │ │ │ - Under $521 │ │ │ - $521 to $624│ 1│ 1│ - $625 to $779│ 2│ 2│ - $780 to $899│ │ │ - $900 to │ │ │ - $1,199 │ │ │ - $1,200 and │ │ │ - over │ │ │ - Ample[43] │ 5│ 5│ - │ │ │ - 2 reportable │ 23│ 16│ 5.7 - pregnancies│ │ │ - ─────────────┼─────────┼────────┼──────── - Husband │ │ │ - earns: │ │ │ - Under $521 │ │ │ - $521 to $624│ 3│ 1│ - $625 to $779│ 2│ 2│ 4.4 - $780 to $899│ 4│ 2│ - $900 to │ 4│ 4│ - $1,199 │ │ │ - $1,200 and │ 1│ 1│ - over │ │ │ - Ample[43] │ 9│ 6│ 5.9 - │ │ │ - 3 reportable │ 26│ 18│ 8.4 - pregnancies│ │ │ - ─────────────┼─────────┼────────┼──────── - Husband │ │ │ - earns: │ │ │ - Under $521 │ 5│ 3│ - $521 to $624│ 1│ 1│ - $625 to $779│ 3│ 2│ - $780 to $899│ 5│ 4│ - $900 to │ 7│ 3│ - $1,199 │ │ │ - $1,200 and │ │ │ - over │ │ │ - Ample[43] │ 5│ 5│ 7.8 - │ │ │ - 4 reportable │ 22│ 18│ 9.7 - pregnancies│ │ │ - ─────────────┼─────────┼────────┼──────── - Husband │ │ │ - earns: │ │ │ - Under $521 │ 4│ 2│ - $521 to $624│ 2│ 2│ - $625 to $779│ 3│ 2│ - $780 to $899│ 3│ 3│ - $900 to │ 2│ 2│ - $1,199 │ │ │ - $1,200 and │ 2│ 2│ - over │ │ │ - Ample[43] │ 6│ 5│ 8.9 - │ │ │ - 5 reportable │ 20│ 14│ 9.5 - pregnancies│ │ │ - ─────────────┼─────────┼────────┼──────── - Husband │ │ │ - earns: │ │ │ - Under $521 │ 3│ 3│ - $521 to $624│ 3│ 1│ - $625 to $779│ 3│ 2│ - $780 to $899│ 3│ 2│ - $900 to │ │ │ - $1,199 │ │ │ - $1,200 and │ 2│ 1│ - over │ │ │ - Ample[43] │ 6│ 5│ - │ │ │ - 6 reportable │ 23│ 14│ 14.9 - pregnancies│ │ │ - ─────────────┼─────────┼────────┼──────── - Husband │ │ │ - earns: │ │ │ - Under $521 │ 2│ 2│ - $521 to $624│ 6│ 2│ - $625 to $779│ 3│ 2│ - $780 to $899│ 4│ 2│ - $900 to │ 4│ 3│ - $1,199 │ │ │ - $1,200 and │ │ │ - over │ │ │ - Ample[43] │ 4│ 3│ - │ │ │ - 7 reportable │ 27│ 15│ 78.1 - pregnancies│ │ │ - ─────────────┼─────────┼────────┼──────── - Husband │ │ │ - earns: │ │ │ - Under $521 │ 4│ 2│ - $521 to $624│ 1│ 1│ - $625 to $779│ │ │ - $780 to $899│ 3│ 1│ - $900 to │ 5│ 3│ - $1,199 │ │ │ - $1,200 and │ 2│ 1│ - over │ │ │ - Ample[43] │ 12│ 7│ - │ │ │ - 8 reportable │ 15│ 9│ 16.7 - pregnancies│ │ │ - ─────────────┼─────────┼────────┼──────── - Husband │ │ │ - earns: │ │ │ - Under $521 │ 5│ 2│ - $521 to $624│ 1│ 1│ - $625 to $779│ 2│ 1│ - $780 to $899│ 5│ 3│ - $900 to │ 1│ 1│ - $1,199 │ │ │ - $1,200 and │ 1│ 1│ - over │ │ │ - Ample[43] │ │ │ - │ │ │ - 9 reportable │ 13│ 8│ - pregnancies│ │ │ - ─────────────┼─────────┼────────┼──────── - Husband │ │ │ - earns: │ │ │ - Under $521 │ 3│ 2│ - $521 to $624│ 3│ 3│ - $625 to $779│ 1│ 1│ - $780 to $899│ │ │ - $900 to │ │ │ - $1,199 │ │ │ - $1,200 and │ │ │ - over │ │ │ - Ample[43] │ 6│ 2│ - │ │ │ - 10 or more │ │ │ - reportable │ 14│ 10│ 17.2 - pregnancies│ │ │ - ─────────────┼─────────┼────────┼──────── - Husband │ │ │ - earns: │ │ │ - Under $521 │ 1│ 1│ - $521 to $624│ 1│ 1│ - $625 to $779│ 2│ 1│ - $780 to $899│ 3│ 2│ - $900 to │ 2│ 2│ - $1,199 │ │ │ - $1,200 and │ │ │ - over │ │ │ - Ample[43] │ 5│ 3│ - ─────────────┴─────────┴────────┴──────── -Footnote 42: - - Excess of births over pregnancies due to plural births. - -Footnote 43: - - See note on page 45. - - - TABLE XIV.—DISTRIBUTION ACCORDING TO NUMBER OF PREGNANCIES AND AGE - GROUPS OF MARRIED MOTHERS CLASSIFIED BY NATIVITY. - - ═══════════════════════╤═══════════════╤═══════════════╤═══════════════ - MOTHER’S AGE AND NUMBER│ │ │ FOREIGN - OF REPORTABLE │ ALL MOTHERS. │NATIVE MOTHERS.│ MOTHERS. - PREGNANCIES. │ │ │ - ───────────────────────┼───────┬───────┼───────┬───────┼───────┬─────── - │Number.│ Per │Number.│ Per │Number.│ Per - │ │ cent. │ │ cent. │ │ cent. - ───────────────────────┼───────┼───────┼───────┼───────┼───────┼─────── - Total pregnancies │ 1,491│ 100.0│ 816│ 100.0│ 675│ 100.0 - ═══════════════════════╪═══════╪═══════╪═══════╪═══════╪═══════╪═══════ - 1 │ 339│ 22.7│ 234│ 28.7│ 105│ 15.6 - 2 │ 283│ 19.0│ 173│ 21.2│ 110│ 16.3 - 3 │ 214│ 14.4│ 111│ 13.6│ 103│ 15.3 - 4 │ 186│ 12.5│ 94│ 11.5│ 92│ 13.6 - 5 │ 147│ 9.8│ 65│ 8.0│ 82│ 12.1 - 6 │ 94│ 6.3│ 37│ 4.5│ 57│ 8.4 - 7 │ 83│ 5.6│ 38│ 4.7│ 45│ 6.7 - 8 │ 54│ 3.6│ 23│ 2.8│ 31│ 4.6 - 9 │ 33│ 2.2│ 13│ 1.6│ 20│ 3.0 - 10 and over │ 58│ 3.9│ 28│ 3.4│ 30│ 4.4 - │ │ │ │ │ │ - Under 20 years, total│ 89│ 100.0│ 66│ 100.0│ 23│ 100.0 - pregnancies │ │ │ │ │ │ - ───────────────────────┼───────┼───────┼───────┼───────┼───────┼─────── - 1 │ 74│ 83.1│ 55│ 83.3│ 19│ 82.6 - 2 │ 12│ 13.5│ 10│ 15.2│ 2│ 8.7 - 3 │ 3│ 3.4│ 1│ 1.5│ 2│ 8.7 - │ │ │ │ │ │ - 20 to 24 years, total│ 461│ 100.0│ 261│ 100.0│ 200│ 100.0 - pregnancies │ │ │ │ │ │ - ───────────────────────┼───────┼───────┼───────┼───────┼───────┼─────── - 1 │ 178│ 38.6│ 114│ 43.7│ 64│ 32.0 - 2 │ 156│ 33.8│ 86│ 33.0│ 70│ 35.0 - 3 │ 77│ 16.7│ 42│ 16.1│ 35│ 17.5 - 4 │ 39│ 8.5│ 14│ 5.4│ 25│ 12.5 - 5 │ 10│ 2.2│ 4│ 1.5│ 6│ 3.0 - 6 │ 1│ .2│ 1│ 0.4│ │ - │ │ │ │ │ │ - 25 to 29 years, total│ 395│ 100.0│ 199│ 100.0│ 196│ 100.0 - pregnancies │ │ │ │ │ │ - ───────────────────────┼───────┼───────┼───────┼───────┼───────┼─────── - 1 │ 57│ 14.5│ 45│ 22.6│ 12│ 6.1 - 2 │ 74│ 18.7│ 46│ 23.1│ 28│ 14.3 - 3 │ 95│ 24.1│ 40│ 20.1│ 55│ 28.1 - 4 │ 75│ 19.0│ 40│ 20.1│ 35│ 17.9 - 5 │ 56│ 14.2│ 17│ 8.5│ 39│ 19.9 - 6 │ 22│ 5.6│ 7│ 3.6│ 15│ 7.7 - 7 │ 14│ 3.5│ 4│ 2.0│ 10│ 5.1 - 8 │ 2│ .4│ │ │ 2│ 1.0 - │ │ │ │ │ │ - 30 to 39 years, total│ 466│ 100.0│ 245│ 100.0│ 221│ 100.0 - pregnancies │ │ │ │ │ │ - ───────────────────────┼───────┼───────┼───────┼───────┼───────┼─────── - 1 │ 30│ 6.4│ 20│ 8.2│ 10│ 4.5 - 2 │ 39│ 8.4│ 29│ 11.8│ 10│ 4.5 - 3 │ 36│ 7.7│ 25│ 10.2│ 11│ 5.0 - 4 │ 63│ 13.5│ 33│ 13.5│ 30│ 13.6 - 5 │ 75│ 16.1│ 40│ 16.3│ 35│ 15.8 - 6 │ 60│ 12.9│ 24│ 9.8│ 36│ 16.3 - 7 │ 56│ 12.0│ 28│ 11.4│ 28│ 12.7 - 8 │ 51│ 10.9│ 23│ 9.4│ 28│ 12.7 - 9 │ 23│ 4.9│ 8│ 3.3│ 15│ 6.8 - 10 and over │ 33│ 7.1│ 15│ 6.1│ 18│ 8.1 - │ │ │ │ │ │ - 40 years and over, │ 80│ 100.0│ 45│ 100.0│ 35│ 100.0 - total pregnancies │ │ │ │ │ │ - ───────────────────────┼───────┼───────┼───────┼───────┼───────┼─────── - 2 │ 2│ 2.5│ 2│ 4.4│ │ - 3 │ 3│ 3.8│ 3│ 6.7│ │ - 4 │ 9│ 11.3│ 7│ 15.6│ 2│ 5.7 - 5 │ 6│ 7.5│ 4│ 8.9│ 2│ 5.7 - 6 │ 11│ 13.8│ 5│ 11.1│ 6│ 17.1 - 7 │ 13│ 16.3│ 6│ 13.3│ 7│ 20.0 - 8 │ 1│ 1.3│ │ │ 1│ 2.9 - 9 │ 10│ 12.5│ 5│ 11.1│ 5│ 14.3 - 10 and over │ 25│ 31.3│ 13│ 28.9│ 12│ 34.3 - ───────────────────────┴───────┴───────┴───────┴───────┴───────┴─────── - - - TABLE XV.—DISTRIBUTION OF MARRIED MOTHERS BY LOSSES SUSTAINED, ACCORDING - TO NATIVITY OF MOTHER AND NUMBER OF POSSIBLE LOSSES. - - ═════════╤════════╤══════════════════════════════════════════════ - NUMBER OF│ │ - BIRTHS OR│ │ - POSSIBLE │ │ - LOSSES │ │DISTRIBUTION OF MOTHERS ACCORDING TO NUMBER OF - AND │ │ LOSSES. - NATIVITY │ │ - OF │ │ - MOTHER. │ │ - ─────────┼────────┼──────┬───────┬───────┬───────┬───────┬─────── - │ Number │ 1 │ 2 │ 3 │ 4 │ 5 │ 6 - │ of │loss. │losses.│losses.│losses.│losses.│losses. - │mothers.│ │ │ │ │ │ - ─────────┼────────┼──────┼───────┼───────┼───────┼───────┼─────── - All │ 1,491│ 399│ 121│ 60│ 24│ 13│ 8 - mothers │ │ │ │ │ │ │ - ═════════╪════════╪══════╪═══════╪═══════╪═══════╪═══════╪═══════ - 1 birth │ 335│ 53│ │ │ │ │ - 2 births│ 277│ 67│ 10│ │ │ │ - 3 births│ 216│ 73│ 14│ 4│ │ │ - 4 births│ 187│ 55│ 13│ 8│ 1│ │ - 5 births│ 148│ 48│ 19│ 11│ 1│ 2│ - 6 births│ 96│ 44│ 13│ 8│ 2│ 1│ 2 - 7 births│ 82│ 22│ 19│ 10│ 2│ │ 1 - 8 births│ 54│ 18│ 8│ 10│ 4│ 2│ 2 - 9 births│ 36│ 9│ 10│ 5│ 1│ 1│ 2 - 10 or │ │ │ │ │ │ │ - more │ 60│ 10│ 15│ 4│ 13│ 7│ 1 - births │ │ │ │ │ │ │ - │ │ │ │ │ │ │ - Native │ 816│ 199│ 59│ 19│ 5│ 6│ 1 - mothers│ │ │ │ │ │ │ - ─────────┼────────┼──────┼───────┼───────┼───────┼───────┼─────── - 1 birth │ 232│ 29│ │ │ │ │ - 2 births │ 170│ 36│ 5│ │ │ │ - 3 births │ 111│ 35│ 7│ 1│ │ │ - 4 births │ 98│ 33│ 6│ 3│ │ │ - 5 births │ 65│ 19│ 10│ 4│ │ │ - 6 births │ 38│ 19│ 7│ 1│ │ 1│ - 7 births │ 37│ 10│ 8│ 3│ │ │ 1 - 8 births │ 21│ 8│ 5│ 3│ │ │ - 9 births │ 15│ 4│ 4│ 3│ 1│ │ - 10 or │ │ │ │ │ │ │ - more │ 29│ 6│ 7│ 1│ 4│ 5│ - births │ │ │ │ │ │ │ - │ │ │ │ │ │ │ - Foreign│ 675│ 200│ 62│ 41│ 19│ 7│ 7 - mothers│ │ │ │ │ │ │ - ─────────┼────────┼──────┼───────┼───────┼───────┼───────┼─────── - 1 birth │ 103│ 24│ │ │ │ │ - 2 births │ 107│ 31│ 5│ │ │ │ - 3 births │ 105│ 38│ 7│ 3│ │ │ - 4 births │ 89│ 22│ 7│ 5│ 1│ │ - 5 births │ 83│ 29│ 9│ 7│ 1│ 2│ - 6 births │ 58│ 25│ 6│ 7│ 2│ │ 2 - 7 births │ 45│ 12│ 11│ 7│ 2│ │ - 8 births │ 33│ 10│ 3│ 7│ 4│ 2│ 2 - 9 births │ 21│ 5│ 6│ 2│ │ 1│ 2 - 10 or │ │ │ │ │ │ │ - more │ 31│ 4│ 8│ 3│ 9│ 2│ 1 - births │ │ │ │ │ │ │ - ─────────┴────────┴──────┴───────┴───────┴───────┴───────┴─────── - - ═════════╤═══════════════ - NUMBER OF│ - BIRTHS OR│DISTRIBUTION OF - POSSIBLE │ MOTHERS - LOSSES │ ACCORDING TO - AND │ NUMBER OF - NATIVITY │ LOSSES. - OF │ - MOTHER. │ - ─────────┼───────┬─────── - │ 8 │ 10 or - │losses.│ more - │ │losses. - ─────────┼───────┼─────── - All │ 1│ 2 - mothers │ │ - ═════════╪═══════╪═══════ - 1 birth │ │ - 2 births│ │ - 3 births│ │ - 4 births│ │ - 5 births│ │ - 6 births│ │ - 7 births│ │ - 8 births│ │ - 9 births│ │ - 10 or │ │ - more │ 1│ 2 - births │ │ - │ │ - Native │ 1│ - mothers│ │ - ─────────┼───────┼─────── - 1 birth │ │ - 2 births │ │ - 3 births │ │ - 4 births │ │ - 5 births │ │ - 6 births │ │ - 7 births │ │ - 8 births │ │ - 9 births │ │ - 10 or │ │ - more │ 1│ - births │ │ - │ │ - Foreign│ │ 2 - mothers│ │ - ─────────┼───────┼─────── - 1 birth │ │ - 2 births │ │ - 3 births │ │ - 4 births │ │ - 5 births │ │ - 6 births │ │ - 7 births │ │ - 8 births │ │ - 9 births │ │ - 10 or │ │ - more │ │ 2 - births │ │ - ─────────┴───────┴─────── - - - POPULATION, REGISTERED BIRTHS, DEATHS OF INFANTS UNDER 1 YEAR OF AGE, - AND INFANT MORTALITY RATES FOR REGISTRATION STATES AND REGISTRATION - CITIES HAVING A POPULATION OF AT LEAST 50,000 IN 1910. - - ═══════════════════════╤═══════════╤═══════════╤═══════════════════════ - AREA. │ │ │ DEATHS[44] OF INFANTS - │ │ │ UNDER 1 YEAR OF AGE. - ───────────────────────┼───────────┼───────────┼───────────┬─────────── - │Population │Births.[45]│ Number. │ Per 1000 - │ in 1910. │ │ │births.[46] - ───────────────────────┼───────────┼───────────┼───────────┼─────────── - REGISTRATION STATES. │ │ │ │ - │ │ │ │ - Connecticut │ 1,114,756│ 27,291│ 3,476│ 127 - Maine │ 742,371│ 15,578│ 2,108│ 135 - Massachusetts │ 3,366,416│ 86,765│ 11,377│ 131 - Michigan │ 2,810,173│ 63,566│ 7,912│ 124 - New Hampshire │ 430,572│ 9,385│ 1,373│ 146 - Pennsylvania │ 7,665,111│ 202,631│ 28,377│ 140 - Rhode Island │ 542,610│([47])6,595│([47])1,111│ ([47])168 - Vermont │ 355,956│ 7,343│ 791│ 168 - │ │ │ │ - REGISTRATION CITIES OF │ │ │ │ - 50,000 POPULATION OR │ │ │ │ - OVER IN 1910. │ │ │ │ - │ │ │ │ - Connecticut: │ │ │ │ - Bridgeport │ 102,054│ 2,976│ 367│ 123 - Hartford │ 98,915│ 2,411│ 286│ 119 - New Haven │ 133,605│ 3,772│ 406│ 108 - Waterbury │ 73,141│ 2,150│ 320│ 149 - │ │ │ │ - Washington, D. C. │ 331,069│ 7,016│ 1,068│ 152 - Portland, Me. │ 58,571│ 1,163│ 167│ 144 - │ │ │ │ - Massachusetts: │ │ │ │ - Boston │ 670,585│ 17,760│ 2,246│ 126 - Brockton │ 56,878│ 1,359│ 134│ 99 - Cambridge │ 104,839│ 2,462│ 293│ 119 - Fall River │ 119,295│ 4,591│ 854│ 186 - Holyoke │ 57,730│ 1,702│ 362│ 213 - Lawrence │ 85,892│ 3,165│ 529│ 167 - Lowell │ 106,294│ 2,630│ 607│ 231 - Lynn │ 89,336│ 2,218│ 216│ 97 - New Bedford │ 96,652│ 3,873│ 685│ 177 - Somerville │ 77,236│ 1,728│ 174│ 101 - Springfield │ 88,926│ 2,438│ 302│ 124 - Worcester │ 145,986│ 3,918│ 536│ 137 - │ │ │ │ - Michigan: │ │ │ │ - Detroit │ 465,766│ 11,960│ 2,138│ 179 - Grand Rapids │ 112,571│ 2,693│ 329│ 122 - Saginaw │ 50,510│ 897│ 130│ 145 - │ │ │ │ - Manchester, N. H. │ 70,063│ 1,939│ 375│ 193 - │ │ │ │ - New York, N. Y. │ 4,766,883│ 129,316│ 6,159│ 125 - Bronx Borough │ 430,980│ 10,926│ 11,047│ 96 - Brooklyn Borough │ 1,634,351│ 43,128│ 5,063│ 117 - Manhattan Borough │ 2,331,542│ 66,112│ 8,900│ 135 - Queens Borough │ 284,041│ 7,095│ 865│ 122 - Richmond Borough │ 85,969│ 2,055│ 284│ 138 - │ │ │ │ - Pennsylvania: │ │ │ │ - Allentown │ 51,913│ 1,406│ 202│ 144 - Altoona │ 52,127│ 1,392│ 166│ 119 - Erie │ 66,525│ 1,713│ 197│ 116 - Harrisburg │ 64,186│ 1,308│ 169│ 129 - Johnstown │ 55,482│ 1,628│ 268│ 165 - Philadelphia │ 1,549,008│ 38,666│ 5,334│ 138 - Pittsburgh │ 533,905│ 15,059│ 2,259│ 150 - Reading │ 96,071│ 2,370│ 336│ 142 - Scranton │ 129,867│ 3,512│ 520│ 148 - Wilkes-Barre │ 67,105│ 1,840│ 269│ 146 - │ │ │ │ - Rhode Island: │ │ │ │ - Pawtucket │ 51,622│ ([48]) │ 191│ ([48]) - Providence │ 224,326│ ([48]) │ 827│ ([48]) - ───────────────────────┴───────────┴───────────┴───────────┴─────────── - -Footnote 44: - - Exclusive of stillbirths. - -Footnote 45: - - Provisional figures; exclusive of stillbirths. - -Footnote 46: - - Based on provisional figures for births. - -Footnote 47: - - The figures for Rhode Island are exclusive of Providence and - Pawtucket. - -Footnote 48: - - Returns of births not received from State board in time for inclusion. - -It will be seen by this table that Johnstown is among the 10 cities of -more than 50,000 population which had an infant mortality rate of 1910 -in excess of 150 per 1,000 births. These 10 cities and their respective -rates are as follows: Lowell, Mass., 231; Holyoke, Mass., 213; -Manchester, N. H., 193; Fall River, Mass., 186; Detroit, Mich., 179; New -Bedford, Mass., 177; Lawrence, Mass., 167; Johnstown, Pa., 165; -Washington, D. C., 152; and Pittsburgh, Pa., 150. - -It should be borne in mind that the absolute infant mortality rate of -134, computed for the group of babies included in this investigation, -that is, for those born in Johnstown in 1911, can not be compared with -any of the approximate rates in the foregoing table, since the basis of -computation is entirely different. But the method used in this report -seemed to be the only practicable one for our purpose, namely, to -measure the infant mortality rate in different districts of the city -where the babies are subjected to varying conditions. - -Conditions similar to those existing in Johnstown were found in Chicago -by Dr. Alice Hamilton, Bacteriologist in the Memorial Institute for -Infectious Diseases, Hull House. The results of a study made of 1,600 -families in the neighborhood was published in 1910. The investigation -was undertaken to find out the truth or falsity of a general feeling -among the district nurses that a high birth rate was accompanied by a -high death rate. It was found that a high birth rate was not so much -accompanied as outrun by a high death rate. The number of children -live-born was compared with the number of children who reached the age -of three, so it is a study of child mortality, rather than of infant -mortality. The child mortality rate rises and falls very much as does -the infant mortality rate in Johnstown. A table calculated from the data -of all the families shows an ascending mortality rate: - - - No. in Family Child Mortality Rate - 4 children and less 118 - 6 children and more 267 - 7 children and more 280 - 8 children and more 291 - 9 children and more 303 - -Expressed in words this table says that child mortality increases as the -number of children per family increases, until we have a death rate in -families of eight and more, which is two and a half times as great as -that in families of four children and under. - - - FOURTH ANNUAL REPORT OF THE CHIEF, CHILDREN’S BUREAU, U. S. DEPARTMENT - OF LABOR, Washington, - October 7, 1916 - - - INFANT MORTALITY—MANCHESTER - -The findings of the bureau’s earlier study in Johnstown, Pa., are -confirmed in many respects by the findings in Manchester—the coincidence -of a high infant mortality rate with low earnings, poor housing, -mother’s work, and large families. - -The mortality rate among the 1,564 live-born babies studied in -Manchester was 165 per 1,000 births, which is considerably higher than -the estimated rate for the whole country. - -Manchester is primarily a textile town, and the textile mills employed -36.3 per cent. of all the fathers of babies born in Manchester during -the 12 months covered by the study. Of the fathers, 13.7 per cent. were -earning less than $450 per year; 48.5 per cent. less than $650; 22.9 per -cent. $850 or more; 6.4 per cent. $1,250 or more. - -Of the babies with fathers earning less than $450, about 1 in 4 died -before it was 12 months old. The great majority of the babies had -fathers in the wage group from $450 to $849, and of these about 1 in 6 -died. Of the babies whose fathers earned $850 but less than $1,050, 1 in -8 failed to survive. Where the fathers earned $1,050 or more, 1 baby in -16 died in the first year. - -Where families lived two or more persons per room, the infant death rate -was twice as high as where they lived less than one person per room. The -babies living in houses occupied by a single family died at the rate of -86.1 per 1,000, but those in tenements occupied by more than six -families died at the rate of 236.6 per 1,000. - -When the mother was a wage earner the baby’s chances of living were less -than when she was not. Babies of mothers who had worked at some time -during the year before the baby’s birth died at the rate of 199.2 per -1,000, while babies of nonworking mothers died at the rate of 133.9. -Babies of mothers employed away from home some time during the year -after childbirth while the baby was still alive and under four months -old had a rate of 277.3, while babies of mothers not employed during -that time had a rate of 122. - -Babies of foreign-born mothers did not fare so well as babies of native -mothers. The differences of rates, however, are only partly accounted -for by their lower earnings. The largest foreign element in Manchester -is Canadian French, and among them the infant mortality rate, 224 per -1,000 live births, is greater than that among any other group of the -population, although their earnings are in general higher than those of -other foreigners. - -Sheer size of family appears to be one factor in this high -Canadian-French rate, one-third of their babies being sixth or later in -order of birth, while over one-sixth of these mothers had had from 9 to -18 children. These Canadian-French babies in families of 6 or more -children died at the rate of 246.2 per 1,000 and the rate rises to 277.2 -per 1,000 when only babies ninth or later in order of birth are -considered. - - - - - CHAPTER V - MATERNAL MORTALITY AND DISEASES AFFECTED BY PREGNANCY - - -_This chapter shows that the female death-rate is much greater during -the child-hearing age than at other periods and notably greater than the -male death-rate at any period. The outstanding fact is that this -abnormal female death-rate, between the ages of 15 and 45, must be -ascribed to too frequent pregnancies and to those diseases of the lungs, -heart and kidneys which are hastened by pregnancy. Ninety-five per cent. -of such deaths could be averted by the dissemination of knowledge to -prevent conception._ - - - _THE SEXUAL LIFE OF WOMAN IN ITS PHYSIOLOGICAL BIOLOGICAL AND HYGIENIC - ASPECTS. E. HEINRICH KISCH, M.D., Professor of the German Medical - Faculty of the University of Prague, Physician to the Hospital and - Spa of Marienbad, Member of the Board of Health, etc. Translated - by M. Eden Paul, M.D. Rebman Co., New York._ - -It is astonishing to observe the number of full term deliveries and -miscarriages that a woman will experience within a comparatively short -period of time, as is seen too frequently among the laboring classes, -and more especially, among the factory workers. If we assume the -original mortality of childbirth to be 6 per mille, a woman who in the -course of 15 years undergoes labor (at full term or prematurely) 16 -times, runs a risk of death to be expressed by the ratio of 6 × 16 = 96 -per mille; that is to say, on the average of 1,000 women who became -pregnant as often as this, nearly one in ten will die in childbed. P. -278. - -In certain serious general disorders, in diseases of the heart, or of -the lungs, in pelvic deformity, and in pathological changes of the -female reproductive organs, it may be right to employ means for the -prevention of pregnancy—not merely sexual abstinence, but actual -measures to prevent fertilization. P. 395. - -Based upon the observations of Schauta and Fellner, the latter author -advances the rule that in the case of a woman suffering from disease, -marriage should be forbidden only when the mortality from the disease in -question is not less than 10%. In this category we must include severe -cases only of pulmonary tuberculosis, whilst cases of laryngeal -tuberculosis will, according to this rule, be absolutely unfit for -marriage. Among heart affections contra-indicating marriage, he includes -mitral stenosis, other valvular affections in which there is serious -disturbance of compensation, and myocarditis; he considers marriage -inadmissible also in cases of chronic nephritis, and among surgical -affections, in case of malignant tumor. No case in which during a -previous pregnancy the patient has been affected by one of the following -diseases; viz. severe chorea, mental disorders, severe epilepsy, -pulmonary tuberculosis which progressed much during pregnancy, morbus -cordis, with considerable disturbance of compensation, severe heart -trouble due to Graves disease—in all such cases a repetition of -pregnancy should be avoided. P. 261. - - - FOURTH ANNUAL REPORT OF THE CHIEF OF CHILDREN’S BUREAU OF THE U. S. - DEPARTMENT OF LABOR, - JUNE 30, 1916 - - - MATERNAL MORTALITY - -A study of maternal mortality, by Dr. Grace L. Meigs, head of the -hygiene division of this bureau, has been undertaken as a direct -corollary to the infant mortality inquiry. The sickness or death of the -mother inevitably lessens the chances of the baby for life and health. A -large proportion of the deaths of babies occur in the first days and -weeks of life, and these early deaths can be prevented only through -proper care of the mother before and at the birth of her baby. - -In the introduction to the report on “Maternal mortality in connection -with childbearing,” issued as a supplement to his report as medical -officer of the local government board of Great Britain for 1914–15, Sir -Arthur Newsholme says: - -The present report is intended to draw attention to this unnecessary -mortality from childbearing, to stimulate further local inquiry on the -subject, and to encourage measures which will make the occurrence of -illness and disability due to childbearing a much rarer event than at -present. - -The attainment of these ends is important as much in the interest of the -child as of its mother. That the welfare of the child is wrapped up in -that of the mother was fully recognized in the board’s circular letter -of 31st July, 1914, and the schedule appended to that letter; and each -year it is becoming more fully realized that, in order to insure healthy -infancy and childhood, it is necessary that, both during pregnancy and -at and after the birth of the infant, increased maternal care and -guidance and medical assistance should be provided. - -The Children’s Bureau studies of infant mortality in town and country -reveal clearly the connection between maternal and infant welfare and -make plain that infancy can not be protected without the protection of -maternity. - -In her report Dr. Meigs undertakes to do no more than to assemble and -interpret figures already published by the United States Bureau of the -Census and in the mortality reports of various foreign countries and to -state accepted scientific views as to the proper care of maternity. She -shows that maternal mortality, although in great measure preventable, is -not decreasing in the United States. Her report reveals an unconscious -public neglect due to age-long ignorance and fatalism. As soon as the -public realizes the facts to which Dr. Meigs calls attention it -doubtless will awake to action, and suitable provision for maternal and -infant welfare will become an integral part of all plans for local -protection of public health. - -The report is summarized as follows: - -“In 1913 in this country at least 15,000 women, it is estimated, died -from conditions caused by childbirth; about 7,000 of these died from -childbed fever, a disease proved to be almost entirely preventable, and -the remaining 8,000 from diseases now known to be to a great extent -preventable or curable. Physicians and statisticians agree that these -figures are a great underestimate. - -“In 1913 the death rate per 100,000 population from all conditions -caused by childbirth was but little lower than that from typhoid fever; -this rate would be almost quadrupled if only the group of the population -which can be affected, women of childbearing age, were considered. - -“In 1913 childbirth caused more deaths among women 15 to 44 years old -than any disease except tuberculosis. - -“The death rate due to this cause is almost twice as high in the colored -as in the white population. - -“Only 2 of a group of 15 important foreign countries show higher rates -from this cause than the rate in the registration area of the United -States. The rates of three countries, Sweden, Norway, and Italy, which -are notably low, show that low rates for these conditions are -attainable. - -“The death rates from childbirth and from childbed fever for the -registration area of this country are not falling; during the 13 years -from 1900 to 1913 they have shown no demonstrable decrease. These years -have been marked by a revolution in the control of certain other -preventable diseases, such as typhoid, diphtheria, and tuberculosis. -During that time the typhoid rate has been cut in half, the rate of -tuberculosis markedly reduced, and the rate for diphtheria reduced to -less than one-half. During this period the death rate from childbirth -has decreased in England and Wales, Ireland, Australia, and Japan. The -other foreign countries studied show stationary or slightly increasing -rates. The death rate from childbed fever has decreased only in England -and Wales, Ireland, and Scotland. - -“These facts point to the need in this country and in foreign countries -of higher standards of care for women at the time of childbirth. - -“The low standards at present existing in this country result chiefly -from two causes: (1) General ignorance of the dangers connected with -childbirth and of the need for proper hygiene and skilled care in order -to prevent them; (2) difficulty in the provision of adequate care due to -special problems characteristic of this country. Such problems vary -greatly in city and in country. In the country inaccessibility of any -skilled care, due to pioneer conditions, is a chief factor. - -“Improvement will come about only through a general realization of the -necessity for better care at childbirth. If women demand better care, -physicians will provide it, medical colleges will furnish better -training in obstetrics, and communities will realize the vital -importance of community measures to insure good care for all classes of -women.” - -While the figures given by Dr. Meigs are a startling indication of the -great number of maternal fatalities occurring in various parts of the -country, no estimates can be made of the number of mothers who survive -only to suffer from a degree of preventable ill health which limits or -defeats the well-being and happiness of their households. - - - _MATERNAL MORTALITY FROM ALL CONDITIONS CONNECTED WITH CHILD BIRTH IN - THE UNITED STATES AND CERTAIN OTHER COUNTRIES. By Grace L. Meigs, - M.D. U. S. Department of Labor, Children’s Bureau, 1917._ - - - STATISTICS RELATING TO CHILDBIRTH IN THE UNITED STATES AND IN CERTAIN - FOREIGN COUNTRIES - -For the last two decades civilized countries have been absorbed in the -problem of preventing the enormous and needless waste of human life -represented by their infant death rates. The importance of this problem -has been felt more keenly in the last two years in the countries now at -war; in these countries the efforts toward saving the lives of babies -have redoubled since the war began. Side by side with this problem, -another, which is only of late finding its true place, is that of the -protection of the lives and health of mothers during their pregnancy and -confinement. This is a question so closely bound up with that of the -prevention of infant mortality that the two can not be separated. - -It is now realized that a large proportion of the deaths of babies occur -in the first days and weeks of life, and that these deaths can be -prevented only through proper care of the mother before and at the birth -of her baby. It is also realized that breast feeding through the greater -part of the first year of the baby’s life is the chief protection from -all diseases; and that mothers are much more likely to be able to nurse -their babies successfully if they receive proper care before, at, and -after childbirth. Moreover, in the progress of work for the prevention -of infant mortality it has become ever clearer that all such work is -useful only in so far as it helps the mother to care better for her -baby. It must be plain, then, to what a degree the sickness or death of -the mother lessens the chances of the baby for life and health. - -This question has also another side. Each death at childbirth is a -serious loss to the country. The women who die from this cause are lost -at the time of their greatest usefulness to the State and to their -families; and they give their lives in carrying out a function which -must be regarded as the most important in the world. - -Questions then of the most vital interest to the whole Nation are these: -How are the lives of the mothers in this country and other countries -being protected? To what degree are the diseases caused by pregnancy and -childbirth preventable? If preventable, how far are they being prevented -in this country? Has there been the same great decrease in the last few -years in sickness and death from these causes as that which has marked -the great campaigns against other preventable diseases such as typhoid, -tuberculosis, or diphtheria? How do the conditions in the United States -compare with those in other countries? - -_Puerperal septicemia (childbed fever)._—The fact is now well known that -puerperal septicemia, or childbed fever, is in reality a wound -infection, similar to such an infection after an accident or an -operation, and that it can be prevented by the same measures of -cleanliness and asepsis which are used so universally in modern surgery -to prevent infection. The proof of the nature of this disease is one of -the tremendous results of the scientific discoveries which were made in -the latter part of the nineteenth century. - -During the early part of that century childbed fever was one of the -greatest hospital scourges known. It occurred also in private practice; -but in hospitals where there was great opportunity for the spreading of -infection the death rate from this disease was appalling. The average -death rate in hospitals in all countries was 3 to 4 per cent. of all -women confined; sometimes it reached 10 to 20 per cent. and even over 50 -per cent. during short periods of epidemics. In the face of this -terrific mortality many obstetrical hospitals were closed. Commissions -were appointed to investigate the cause of these epidemics, and medical -congresses devoted sessions to the discussion of the problem. In 1843 -Oliver Wendell Holmes, and in 1847 Semmelweiss, published articles -stating the theory that this fever was similar to a wound infection and -was due chiefly to the carrying of infectious material on the hands of -attendants from one case to another. - - - NUMBER OF DEATHS IN THE UNITED STATES FROM CHILDBIRTH - -In 1913 in the “death-registration area” of the United States 10,010 -deaths were reported as due to conditions caused by pregnancy and -childbirth. Of these deaths, 4,542 were reported as caused by puerperal -septicemia or childbed fever. - -Using the death-registration area as a basis, we are justified in -estimating that in 1913 in the whole United States 15,376 deaths were -due to childbirth, and 6,977 of these were due to childbed fever. As -will be shown later, these figures are without doubt a gross -underestimate. As it is, they are striking enough—almost 7,000 deaths in -one year in this country due to childbed fever, a disease to a large -degree easily preventable; and over 8,000 due to the other diseases -caused by pregnancy and confinement, most of which are preventable or -curable by means well known to science. - - - DEATH RATES IN THE UNITED STATES FROM CHILDBIRTH - -The death rate from all diseases caused by pregnancy and confinement in -1913 in the registration area was 15.8 per 100,000 population (which -includes all ages and both sexes). The death rate from puerperal -septicemia was 7.2. - -These figures, however, mean little to us unless we compare them with -the death rates from other preventable diseases. In the same year and -area the typhoid rate was 17.9 per 100,000 population; the rate from -diphtheria and croup 18.8. The highest death rate from any one disease -was that from tuberculosis, 147.6 per 100,000 population. Any such -comparison with the rates from diseases to which both sexes and all ages -are liable is of course very misleading; but in spite of that fact it is -interesting to note that typhoid fever, the disease against which so -great an amount of effort is now directed, has a rate at present but 2 -per 100,000 population higher than that from the diseases caused by -pregnancy and confinement. - -_Death rates per 100,000 women._—The death rates from childbirth are -approximately doubled when worked on the basis of 100,000 women. This -will be seen when Tables IV and III (p. 50) are compared. The former -gives for the period 1900 to 1910, the annual death rates per 100,000 -women in the group of 11 States which were in the death-registration -area in 1900, the latter the death rates per 100,000 population in the -same group of States for the same period. It is evident that the rates -in Table IV for each year are slightly more than twice those in Table -III for the same year. - -_Death rates per 100,000 women of childbearing age...._ Again, a much -higher but a more accurate death rate from these diseases is found when -the basis taken is the group which alone is affected by these -diseases—women of childbearing age. When the rate is based not upon -100,000 population of both sexes and all ages but upon 100,000 women 15 -to 44 years of age, the rate as ordinarily given is multiplied several -times. - -In 1900, the only year for which the rates can be computed, the death -rate in the registration area per 100,000 women 15 to 44 years of age -from all diseases of pregnancy and confinement was 50.3; from puerperal -infection, 21.6. The corresponding rates for the same year per 100,000 -population were 13.1 and 5.6. In this year, therefore, the rates are -almost quadrupled when based on that group of the population which alone -can be affected by these diseases. - -Moreover, the death rates as ordinarily given per 100,000 population -conceal the fact that the diseases of pregnancy and childbirth are -indeed among the most important causes of death of women between 15 and -44 years of age; the actual number of deaths shows this to be the case. -In 1913 in the registration area these diseases caused more deaths than -any other one cause of death except tuberculosis. In that year there -were, among women 15 to 44 years of age, 26,265 deaths from -tuberculosis; 9,876 deaths from the diseases of pregnancy and -confinement; 6,386 from heart disease; 5,741 from acute nephritis and -Bright’s disease; 5,065 from cancer; and 4,167 from pneumonia. Other -diseases, such as typhoid, appendicitis, and the infectious diseases -show far fewer deaths. - -_Death rates per 1,000 live births._—This rate, as will be shown -repeatedly throughout the report gives a far clearer picture of the -actual risk of childbirth than do any of the rates so far considered. -This rate can be given only for one year, 1910, and only for the -provisional birth-registration area for that year. The rate from all -diseases caused by pregnancy and confinement is 6.5, from puerperal -septicemia, 2.9, and from all other diseases of pregnancy and -confinement, 3.6 per 1,000 live births. That is, in this area for every -154 babies born alive one mother lost her life. - - -COMPARISON OF THE AVERAGE DEATH RATES FROM CHILDBIRTH IN CERTAIN FOREIGN - COUNTRIES AND IN THE UNITED STATES - -Are the death rates from these diseases in the death-registration area -of the United States higher or lower than those in other civilized -countries? Have these rates in other countries been falling or rising in -the last 13 years, while the rates of this country have been apparently -stationary? These questions, like all those of comparative international -statistics, are of immense interest, but they involve many difficulties -and sources of error. They should be considered in reading the following -summary. - -In order to make possible a comparison of the death rates from these -causes for 15 foreign countries with those for the United States, an -average rate has been computed for the years 1900 to 1910 for each of -the countries, using the same method as that in use in the United -States. When the 16 countries studied are arranged in order, with the -one having the lowest rate first, the death-registration area of the -United States stands fourteenth on the list. (See Table XII, p. 56.) -Only two countries, Switzerland and Spain, have higher rates; many of -the countries, however, show rates differing but little from that of the -United States. Markedly low rates are those of Sweden (6), Norway (7.8), -and Italy (8.9); a strikingly high rate is that of Spain (19.6). - -The death rate from childbirth per 1,000 live births is not available -for the death-registration area of the United States, but can be given -only for the small number of States and cities included in the -provisional birth-registration area and for one year, 1910. (See p. 31.) -This rate, 6.5, is considerably higher than that for 1910 of any of the -countries studied. When the average rates for a number of years of the -15 countries are reckoned per 1,000 live births and arranged in order, -it will be seen that the same group of countries—Sweden, Italy, and -Norway—shows the lowest rates. (See Table XIII, p. 56.) Spain in this -table shows the rate which is next to the highest, while Belgium now has -the highest rate. For a comparative study of the rates of these -countries the rates per 1,000 live births give undoubtedly the clearest -picture of the actual conditions. - -These rates show a wide variation. While in Sweden but one mother is -lost for every 430 babies born alive, in Belgium one mother dies for -every 172 babies, and in Spain one for every 175 babies born alive. The -rates in Belgium and Spain are two and a half times as high as the rate -in Sweden. - -Far more significant than a comparison of actual death rates of various -countries is a comparison of the changes which have occurred in these -death rates in each country in recent years. England and Wales, Ireland, -Japan, New Zealand, and Switzerland have shown a decrease in the death -rate per 1,000 live births from all diseases caused by pregnancy and -confinement; but, in this group, only in England and Wales and in -Ireland has the death rate from puerperal septicemia decreased; in the -other three countries this rate has remained practically the same, -though the total rate has decreased. - -In Australia, Belgium, Hungary, Italy, Norway, Prussia, Spain, and -Sweden both the rate from childbirth and that from puerperal septicemia -remained almost stationary during the periods studied. - -The total rate for Scotland shows a definite increase, though the rate -from puerperal septicemia has decreased. (See Table XVI, p. 66.) - -Communities are still to a great extent indifferent to or ignorant of -the number of lives of women lost yearly from childbirth; many -communities which are proud of their low typhoid or diphtheria rates -ignore their high rates from childbed fever. Communities are only -beginning to realize that among their chief concerns is the protection -of the babies born within their limits, and necessarily also of the -mothers of those babies before and at confinement. - - - DEATH-REGISTRATION AREA - -The statistics of causes of death are available only for a certain -portion of the United States, included in the so-called -“death-registration area.” Unlike other civilized countries, the United -States has no uniform laws for the registration of births and deaths. -Moreover, the efficiency of enforcement of existing laws varies greatly -in the different States. The Bureau of the Census in 1880 therefore -established a “death-registration area,” which comprises “States and -cities in which the registration of deaths is returned as fairly -complete (at least 90 per cent. of the total), and from which -transcripts of the deaths recorded under the State laws or municipal -ordinances are obtained by the Bureau of the Census.” In 1880 this area -included but 17 per cent. of the total population of the United States. -As States and cities have passed better laws and obtained better -enforcement they have been added to the registration area; the latter -has increased greatly in size, but even in 1913 included only 65.1 per -cent. of the population of the United States. For the remaining 34.9 per -cent. of the population of the country we have no reliable statistics. -This 34.9 per cent. includes the population of the greater number of the -Southern States and of many Middle Western and Western States outside of -certain registration cities in these States which are included in the -area. No statements can be made, therefore, of the number of deaths from -any cause in the United States as a whole; only an estimate can be made -on the assumption that for any cause of death the same rate prevails in -the remainder of the United States as in the death-registration area. - - - PROVISIONAL BIRTH-REGISTRATION AREA - -The registration of births is still more incomplete in this country than -is the registration of deaths. For 1910 the United States Bureau of the -Census established a “provisional birth-registration area,” including -the New England States, Pennsylvania, Michigan, New York City and -Washington, D. C. - -_Death rates per 1,000 births._—As shown above, the method of -computation of death rates which gives the clearest picture of the -hazards of childbirth is that which takes into account only the women -giving birth to children in that year. This is the method in use in a -large number of foreign countries. The advantages of the method are -self-evident. A demonstration of the superiority of this method of -computation is obtained by a study of the tables giving the death rates -from these diseases for foreign countries. In certain countries, as for -instance Belgium and Hungary, there has been in recent years an apparent -fall in the average death rates as computed per 100,000 population, -while the average rates computed per 1,000 live births have remained -stationary or risen. This phenomenon is due, evidently, to a decline in -the birth rate in these countries during these years, and shows how -misleading the rates as given per 100,000 population undoubtedly are in -countries with declining birth rates. Whether a fall in the birth rate -has occurred in the United States is not known. If it has occurred in -the registration area, it would mean that the slight rise in rates per -100,000 population between 1900 and 1913 means a greater rise in rates -computed according to the number of births. Such an error might -compensate for the opposite error due to the more complete registration -of deaths from childbirth in the later years of this period. - -Miscarriages are not reportable in any country, although a number of -miscarriages (as the term is usually defined) probably are reported as -stillbirths in certain countries. The fact that women having -miscarriages are not considered in the base would lead to a somewhat -higher death rate than that which would express absolutely the number of -deaths per 1,000 women at risk. - - -COMPARISON OF THE CHANGES IN THE DEATH RATES FROM CHILDBIRTH IN CERTAIN - FOREIGN COUNTRIES FOR THE YEARS 1900 TO 1913 - -Far more valuable than a comparison of average rates of foreign -countries is a study of the rates of each country for a series of years -in order to discover whether they are decreasing or increasing and to -compare such changes in the various countries. While it may be dangerous -on account of different countries, no such source of error is attached -to the comparison of rates in the same country for a number of years. -The period 1900 to 1913 (or the latest year for which figures are -available) is a very short one for a study of a change in death rates. -It would have been far more interesting to study the death rates for a -long series of years in each country, choosing a period beginning before -the introduction of methods of asepsis. But such a study for the -complete list of countries considered was not thought advisable, because -of the difficulties caused by variations in classification of causes of -death in the earlier years. - -In order to study the rates for any increase or decrease occurring -during the last 13 years, the rates per 1,000 live births will be used -rather than those per 100,000 population. In several countries—Belgium, -Hungary, Italy, Norway, Prussia, and Spain—the rate from childbirth per -100,000 population apparently has fallen during the period, while the -rate per 1,000 live births has remained almost the same, or has risen. -The cause of this inconsistency is the fact that in these countries the -birth rate or the proportionate number of births to the number of -inhabitants has decreased. - - - _Number of deaths of women from 15 to 44 years of age in the - death-registration area from each cause and class of causes - included in the abridged International List of Causes of Death - (revision of 1909),[49] 1913._ - -Footnote 49: - - Except No. 25, diarrhea and enteritis (under 2 years), and No. 34, - senility. - -(Computed from figures in Mortality Statistics, 1913, pp. 338 to 349, in -which causes of death are given according to the detailed International -List of Causes of Death.) - - - Abridged Number - International Cause of death. of - List No. deaths. - - 13, 14, 15 Tuberculosis of the lungs, tuberculous 26,265 - meningitis, other forms of tuberculosis - - Puerperal septicemia (puerperal fever, - 31, 32 peritonitis) and other puerperal accidents of 9,876 - pregnancy and labor - - 19 Organic diseases of the heart 6,386 - - 29 Acute nephritis and Bright’s disease 5,741 - - 16 Cancer and other malignant tumors 5,065 - - 22 Pneumonia 4,167 - - 35 Violent deaths (suicide excepted) 3,262 - - 1 Typhoid fever 2,706 - - 30 Noncancerous tumors and other diseases of the 2,669 - female genital organs - - 26 Appendicitis and typhlitis 1,620 - - 36 Suicide 1,562 - - 23 Other diseases of the respiratory system 1,458 - (tuberculosis excepted) - - 18 Cerebral hemorrhage and softening 1,398 - - 24 Diseases of the stomach (cancer excepted) 940 - - 27 Hernia, intestinal obstruction 854 - - 28 Cirrhosis of the liver 598 - - 9 Influenza 489 - - 17 Simple meningitis 484 - - 8 Diphtheria and croup 330 - - 12 Other epidemic diseases 312 - - 6 Scarlet fever 307 - - 5 Measles 304 - - 3 Malaria 250 - - 21 Chronic bronchitis 184 - - 20 Acute bronchitis 90 - - 33 Congenital debility and malformations 24 - - 11 Cholera nostras 18 - - 4 Smallpox 16 - - 7 Whooping cough 9 - - 2 Typhus fever 2 - - 10 Asiatic cholera - - 37 Other diseases 11,688 - - 38 Unknown or ill-defined diseases 458 - - - _A MUNICIPAL BIRTH CONTROL CLINIC. MORRIS H. KAHN, M. D., in New York - Medical Journal for April 28, 1917._ - -_Showing that large families among the poor are the result of ignorance -of methods to prevent conception among the mothers._ - -The following studies were undertaken with a view to determining whether -there was an actual need and demand for birth control education and -whether such a demand, if it existed, could be supplied with any effect -by a scientifically conducted clinic in the dispensaries of the -Department of Health of the City of New York; we felt that it might be -of scientific and sociological interest to publish a report and an -analysis of the observations made, probably the first of their kind in -this country. Section 1142 of our Penal Code was ignored in conducting -this birth control study. - -The social and economic status of the patients was fairly uniform, about -the same as that of patients attending the other dispensary institutions -in this city. A tabulation of the results was made under the following -headings: Name and nationality; age; number of years married; number of -living children and their ages; number of deceased children; number of -miscarriages or abortions; contraceptive methods known or practised. -More or less complete data were secured in 464 cases. - -The average number of procreative years of married life was 16.1, the -age of fifty years being considered in this study as the end of the -procreative period for the seventy-two women who were older than that. -The average number of living children was 3.27 and of deceased children -1.2, making a total average of 4.47 children born to each family. Of the -464 women, 176, or three eighths, had had abortions or miscarriages, the -total number of such interruptions of pregnancy being 324, or an average -of 1.8 each for the women involved. - -Of the 464 women, 192 knew of no contraceptive methods and therefore had -used none. The remaining 272 women knew of one or more methods, more or -less effectual, for the prevention of conception. Of the 192 women who -were ignorant of the use of contraceptives, practically one half, or -104, had a history of abortions, with a total of 202 abortions, or an -average of two apiece. In contrast with this, of the 272 women who knew -of one or more contraceptives, only one fourth, or seventy-two, had -undergone abortions, with a total of 122 abortions, or an average of -only 1.6 apiece. - -A further analysis of our tables shows an interesting and striking -relationship between ignorance of methods for the prevention of -conception and the number of children. Sixty-eight women had had three -children each. Of these, twenty-six, or thirty-eight per cent., were -ignorant of contraceptives. Twenty-eight women had had four children -each. Of these fourteen, or fifty per cent., were ignorant of -contraceptives. Fifty-five women had had five children each. Of these -thirty were ignorant of contraceptives, or fifty-four per cent. -Thirty-two women had had six children each. Of these twenty were -ignorant of contraceptives, or sixty-two per cent. Forty women had had -seven children each. Of these thirty-eight were ignorant of -contraceptives, or ninety-five per cent. Twenty-one women had had eight -children each. Of these twenty were ignorant of contraceptives, or -ninety-five per cent. Forty-four women had had nine or more children -each, and of these all were ignorant of contraceptive measures. Arranged -in tabular form, these data would appear as follows: - - - Number of Women Number of Number Ignorant Percentage - Children of Contraceptives - 68 3 26 38 - 28 4 14 50 - 55 5 30 54 - 32 6 20 62 - 40 7 38 95 - 21 8 20 95 - 44 9 to 17 all 100 - -It is sometimes stated by opponents of birth control that contraceptive -methods are known by every married person and that the fault and -immorality of having a large family of unprovided for dependents lies -not in ignorance of contraceptives but rather in a lack of determination -on the part of one or both parents to use preventive measures; in other -words, that the failure to use contraceptives results from the -inconvenience attending some methods and also from the influence of -religious sentiment. - -The above data, however, tend to show that ignorance of contraceptives -not only is a great factor in the production of large families, but is -also a great factor in increasing the number of abortions. From the fact -that two thirds of these women knew absolutely no contraceptive method, -while the methods used by many of the others were ineffectual or -positively harmful, it is apparent that there is a definite opportunity -for educating these women in methods of regulating conception. That -there is need and demand for such education is voiced in unmistakable -language by the multitude of poor who seek advice from all practising -physicians. - - - MATERNAL MORTALITY - -Prof. Theodate L. Smith, director of the Library Department, Child Study -Institute, Clark University, investigated the records of the families of -early graduates of Yale University (1701 to 1745) and of Harvard -University (1658 to 1690); and found that of the wives of Harvard men, -37.3 per cent. died under the age of 45 years, while of the wives of -Yale men, 40 per cent. died under 50 years. Prof. Smith also showed that -there is a tendency for families very large in the first generation to -die out in the third or fourth generation. One family of twenty -children, by two wives, has living descendent by one son only, one -daughter being untraceable. A family of ten brothers and sisters, only -two of whom lived until 50, produced three surviving children, who in -turn have produced one, and that a sickly specimen. Another family had -fourteen in the first generation, eight in the second, six in the third -and only two in the fourth.—Mary Alden Hopkins in _Harper’s Weekly_, -June, 1915. - - -TUBERCULOSIS, CAUSE OF THE GREATEST NUMBER OF DEATHS OF WOMEN DURING THE - CHILD-BEARING PERIOD - - - _OBSTETRICS. A Text Book for the Use of Students and Practitioners. J. - Whitridge Williams, Professor of Obstetrics, John Hopkins - University, Obstetrician-in-Chief to the John Hopkins Hospital, - Gynaecologist to the Union Protestant Infirmary, Baltimore, Md. D. - Appleton & Co. 1912._ - -As a rule, all diseases which subject the organism to a considerable -strain are much more serious when occurring in the pregnant woman. In -general it may be said that pregnancy exerts a deleterious influence -upon all chronic organic maladies, while its effect is usually less -marked in acute infectious processes. The latter, however, frequently -lead to premature delivery and the additional physical strain attending -the latter matter render the course of the disease much less favorable. -Page 489. - -“Owing to the well known fact that pulmonary tuberculosis usually -progresses much more rapidly after child bearing, it is advisable that -tubercular women take every precaution to avoid the possibility of -conception.” Page 383. - -It would appear therefore that in the vast majority of cases the disease -(tuberculosis) is not transmitted directly from the mother to the fetus, -and that the latter is born with a tendency to tuberculosis, rather than -with the disease itself. Hence it follows that the children of -tubercular mothers should be brought under the best hygienic -surroundings, and should not be suckled by their mothers. In view of the -fact that the tubercular process usually becomes exacerbated either -during pregnancy or after child birth, most authorities recommend that -abortion be induced as a matter of routine in all tubercular women, and -many that they be rendered sterile by artificial means. This appears to -be a somewhat too extreme point of view, but I consider that abortion -should be induced in the first pregnancy occurring after the onset of -the disease, and whenever it makes its appearance during the early -months of pregnancy. Page 494. - - - _THE PRACTICE OF OBSTETRICS. In original contributions by American - Authors. Edited by Reuben Peterson, A.B., M.D., Professor of - Obstetrics and Gynaecology in the University of Michigan, Ann - Arbor, Mich. Obstetrician-in-Chief to the University of Michigan - Hospital. Lea Bros. & Co. Philadelphia and New York. 1907. Chapter - IX._ - - - COMPLICATIONS ARISING FROM MATERNAL DISEASES AND ANOMALIES - -Exact observations on a large number of cases have demonstrated beyond -doubt that with very rare exceptions a pregnancy exerts a harmful effect -upon the course of the disease (tuberculosis). Page 344. - -So seriously is the tubercular process affected by a concomitant -pregnancy that it seems the duty of the physician to warn every -tubercular girl against marriage. Especially deleterious to the patient -are pregnancies which follow each other at short intervals. In such -instances the patient must be strongly advised against a new -impregnation. It hardly can be denied that in some of these cases -artificial sterilization may be justified. An additional argument in -favor of this procedure is the comparative frequency with which, if not -the infection itself, at least a marked disposition to it is transmitted -to the fetus in utero. P. 344. - - - _A TEXT BOOK OF OBSTETRICS. Barton Cooke Hirst, M.D., Professor of - Obstetrics in the University of Pennsylvania; Gynaecologist to the - Howard and Orthopaedic and the Philadelphia Hospitals, etc. W. B. - Saunders Co. 1909._ - -The influence of pregnancy upon tuberculosis is most unfavorable and in -women predisposed to tuberculosis, gestation may be the determining -factor in lighting up an attack. It is the duty of a physician to advise -strongly against marriage and maternity in the case of a woman already -infected, or predisposed to tuberculosis. If the patient is pregnant an -induction of labor should be considered. P. 427. - - - _THE PRINCIPLES AND PRACTICE OF OBSTETRICS. Jos. B. De Lee, M.D., - Professor of Obstetrics at the Northwestern University Medical - School; Obstetrician to the Chicago Lying-in-Hospital and to - Wesley and Mercy Hospitals, etc. W. B. Saunders Co. 1913._ - -Women with tuberculosis should not marry, first, because this aggravates -their own disease. Second, they may infect the husband, and third, they -propagate tuberculous children. Knowing the tendency for a latent -tuberculosis to break out in pregnancy, marriage is to be forbidden. If -the woman marries, she should avoid conception. P. 481. - -If tuberculosis of the lungs is manifested in early pregnancy, if there -is fever, wasting, hemoptysis and advancing consolidation, that is, the -process seems to be florid, abortion should be induced without delay. -Trembley, of Saranac Lake induces abortion in the early months in all -cases. Urgent symptoms of cardiac nature, persistent hemoptysis and -dyspnea may require emptying of the uterus. Complicating nephritis, -heart disease, and contracted pelvis, which is said to be more frequent -in the tuberculous, will give early indications for interference. P. -481. - - - _TUBERCULOSIS. Jos. B. De Lee._ - -The woman should be instructed how to avoid pregnancy in the future. -Something must be done until the woman is cured of her tuberculosis, so -that she may safely go through a confinement, because every accoucheur -recoils with horror from the task of repeatedly doing abortions on these -tuberculous women. P. 482. - - - _THE PRACTICE OF OBSTETRICS. Designed for the use of Students and - Practitioners of Medicine. J. Clifton Edgar, Prof. of Obstetrics - and Clinical Midwifery in the Cornell University Medical College; - Visiting Obstetrician to Bellevue Hospital, New York City; Surgeon - to the Manhattan Maternity and Dispensary; Consulting Obstetrician - to the New York Maternity and Jewish Maternity Hospitals. 5th - Edition. Revised. P. Blakiston’s Co., Phil._ - -The subject of the relationship between tuberculosis and pregnancy has -recently attained an increased degree of importance through the -agitation in favor of the justification of abortion in the tuberculous -pregnant woman. P. 314. - -Statistics appear to show, according to Lancereaux, that a considerable -number of cases of tuberculosis develop solely as a result of pregnancy. -If pregnancy can thus affect health, how much more likely would it be -for the disease to assert itself in a woman who is a fit subject for it, -or in one who is actually consumptive. In the former class are so called -candidates for tuberculosis who have a family history of the disease of -much significance under these circumstances. One should strongly -dissuade girls with tubercular history and antecedents from early -marriage, fearing that repeated childbearing will infallibly light up -the dreaded malady. What has been said of the candidate for tuberculosis -applies with the same, or greater force in the case of so-called latent -tuberculosis and of apparent recovery from the disease. Present -sentiment is beginning to dissuade such women from marriage, not less -for their own benefit than for the sake of posterity, and all organized -movements which are seeking to eradicate tuberculosis from the world lay -much stress on discouraging marriage in tuberculosis suspects. Until -this view prevails there will necessarily be some justification for -interrupting a pregnancy already under way. P. 314. - -Sanatoria for consumptives do not care to admit pregnant women, and this -prohibition is equivalent to ranking them as incurable. The fact that a -candidate for tuberculosis runs a very great risk of becoming -consumptive through childbirth is a most stubborn one, and when in -addition to becoming a consumptive herself she also brings into the -world an individual who is likely to become tubercular, it readily -becomes apparent that the question of the propriety of therapeutic -abortion is bound to become an issue in the future in the practice of -obstetrics. P. 315. - - - EXCEPTIONAL CASES - -A tubercular woman may go through gestation with no undue acceleration -of her malady, only to succumb after delivery to acute general -tuberculosis, or acute tubercular pneumonia. P. 315. - -Tubercular pregnant women also show no little tendency to abort. P. 316. - - - _TUBERCULOSIS A PREVENTABLE AND CURABLE DISEASE. S. Adolphus Knopf, - M.D.; Professor of Phthisio-therapy at the New York Post-Graduate - Medical School and Hospital; Associate Director of the Clinic for - Pulmonary Disease of the Health Department; Attending Physician to - the Riverside Sanitorium for Consumptives of the City of New York, - etc. Moffat Yard & Co., 1909. New York._ - -We have emphasized the fact that tuberculosis is very rarely directly -hereditary, but that what is often transmitted by tuberculous parents is -a weakened system, or physiological poverty. Nevertheless it is evident -that tuberculous individuals ought not to marry, and when tuberculosis -develops in a married couple it is best that they should have no -children. P. 354. - - - _PULMONARY TUBERCULOSIS. Its Modern Prophylaxis and the Treatment in - Special Institutions and at Home. S. Adolphus Knopf, M.D. P. - Blakiston’s Sons & Co., Phil., 1899._ - -If conception has taken place in a tuberculous woman institute -treatment, preferably in a sanatorium near the home of the patient. But -as Treaudeau says, it is essential that the treatment be continued for a -long time afterwards, and I should like to add that a repetition of -pregnancy must be prevented. P. 283. - - - _THE TUBERCULOSIS PROBLEM AND SECTION 1142 OF THE PENAL CODE OF THE - STATE OF NEW YORK. S. Adolphus Knopf, M.D. Reprinted from the New - York Medical Journal for June 12th, 1915._ - -There seems to be no difference of opinion in the minds of men and women -who have studied rational eugenics and sociology concerning the -necessity of beginning to work with the preceding generation, and of -teaching parents that quality is better than quantity, and that a large -number of children, underfed or of mental, moral and physical -inferiority, means race suicide, while the reverse means race -preservation. - -I cannot defend my attitude better than by telling you the conclusions I -have arrived at in my study of the tuberculosis situation in the United -States. In the families of the poor where there are usually numerous -children, it really matters little whether it is the father or the -mother who is acutely tuberculous. Since almost invariably they live in -close and congested quarters, are underfed and insufficiently clad, it -is of relatively rare occurrence when most of the children do not become -infected with tuberculosis. In some of our tuberculosis clinics where we -insist on an examination of all the children of the tuberculous parents -visiting these special dispensaries, we find as many as fifty per cent. -of the children to be afflicted with tuberculosis as the result of -postnatal infection. In taking the history of a patient in my private -consultation work, it is my invariable custom to ask whether he comes -from a large family, and if so whether he was among the first or latter -born children. As a rule, especially among the poor, it proves to be one -of the latter born, (the fifth, sixth, seventh, eighth, ninth, etc.) who -contracts tuberculosis, and I believe this to be because when he came to -the world there were already many mouths to feed and food was scant, for -the father’s income rarely increases with the increase of the family; -and the mother, worn out with repeated pregnancies, cannot bestow upon -the latter born children the same care which was bestowed upon the -first. We know tuberculosis to be a preventable and curable disease, but -we also know that it is the disease of poverty, privation, malnutrition, -and bad sanitation. P. 4. - -I do not know the penalty to be visited upon a physician who offends the -majesty of the law as set forth in section 1142 of the penal code, but I -for one am willing to take the responsibility before the law and before -my God for every time I have counselled, and every time I shall counsel -in the future, the prevention of a tuberculous conception, with a view -to preserving the life of the mother, increasing her chances of -recovery, and, last, but not least, preventing the procreation of a -tuberculous race. P. 5. - - - _THE SEXUAL LIFE OF WOMAN IN ITS PHYSIOLOGICAL, BIOLOGICAL AND - HYGIENIC ASPECTS. E. Heinrich Kisch, M.D., Professor of the German - Medical Faculty of the University of Prague; Physician to the - Hospital and Spa of Marienbad; Member of the Board of Health, etc. - Translated by M. Eden Paul, M.D. Rebman Co., New York._ - -As regards the marriage of any woman suffering from tuberculosis we must -take into consideration a fact that medical experience has conclusively -established, namely, that the processes of generation have an -unfavorable influence upon pulmonary tuberculosis. P. 259. - -During pregnancy tuberculosis advances with such rapid strides that -pregnancy and lying-in accelerate the fatal event. In some cases of -consumption it is the first pregnancy that is the most perilous, but in -other cases a later pregnancy proves more perilous. P. 260. - - - _Dr. S. Adolphus Knopf, M.D., Professor of Medicine, Department of - Phthisio-therapy of the New York Post Graduate Medical School - and Hospital; Senior Visiting Physician to Riverside - Hospital-Sanatorium for the Consumptive Poor of the City of New - York, etc._ - - Reprinted from the _Women’s Medical Journal_, September, 1915. - -Of the 150,000 who it is estimated die annually from tuberculosis in the -United States, I venture to say 50,000 have been bread winners. -Estimating the value of such a single life to the community at only -about $5,000, this makes a loss of $250,000,000 each year. Another -third, I venture to say, represents children at school age. They have -died without having been able to give any return to their parents or to -the community. Making the average duration of their young life only 7.5 -years, and estimating the cost to parents and the community at only $200 -per annum, the community loses another $75,000,000. The value of lives -of little babes, children below and above school age, adolescents not -yet bread winners, and men and women no longer able to earn their living -can not be estimated in exact figures, but is reasonable to suppose the -total annual financial loss from tuberculosis in the United States to be -at least half a billion dollars. This does not include the expenditures -for hospitals, sanatoria, clinics, dispensaries, colonies, preventoria -and other agencies, devoted to the solution of the tuberculosis problem. - -In the face of these figures and the suffering, misery and -disappointment of parents who lose their children after having tenderly -loved and cared for them for some years, I wonder if there can be any -doubt in the minds of sane men that it would have been better if these -children had never been born. Surely all this is race suicide instead of -race preservation. - -Not so very long ago I was asked by a young colleague to aid in the -diagnosis of tuberculosis in a day laborer. The man earned $12 a week, -was thirty-six years of age on the day the examination and diagnosis was -made, had been married fourteen years, and his eleventh child had been -born on his last birthday; four or five had already died, two of them of -tuberculous meningitis. A glance at the rest of the family showed that -nearly all of them were predisposed to tuberculosis, if not already -infected, and that a few years of continued underfeeding and bad housing -would finish their earthly career. With two or three children to provide -for the family might have lived in relative comfort; with better food -and better home environments the father might never have become -tuberculous and none of the children might have contracted the disease. -The commonwealth would have been the gainer by two or three mentally and -physically vigorous future citizens. - -Only a few days ago, while an article for the _Journal of Sociologic -Medicine_ was in preparation, an Italian woman presented herself to me -for examination. She gave her age as fifty-six, and had married quite -young. She had borne her husband seventeen children, of which, however, -only four were living. Some had died in infancy, some at school age, and -some during adolescence. What useless suffering! What useless economic -loss to the individual family and society at large. Upon examination, I -found the woman’s mental condition even worse than her physical status. -The repeated pregnancies, the frequent diseases in the family, thirteen -deaths among her children, had made a mental and physical wreck of her. -Yet the woman belonged to the better and well-to-do class of our -population of Italian birth. What would her condition have been if she -had also had to share in the struggle for the existence of the family, -and had had to work in sweatshops or factories, as so many of the poor -Italians have to do? - -When pregnancy means danger to the life of the mother, or exacerbation -of an existant mental or physical ailment, as, for example, -tuberculosis, which is always aggravated by child-bearing, every -conscientious physician should do his utmost to prevent childbirth in -such an invalid. - -Where there is tuberculosis or any other serious transmissible disease -in one or both of the parents, or there is danger that it may be -transmitted to the offspring, it should not only be the right but the -sacred duty of the physician to prevent the conception of any physically -and mentally handicapped offspring destined to become a burden to the -community. - - - KIDNEY DISEASES - - - _THE PRACTICE OF OBSTETRICS. In Original Contributions by American - Authors. Edited by Reuben Peterson, A.B., M.D., Professor of - Obstetrics and Gynecology in the University of Michigan, Ann - Arbor, Mich. Obstetrician and Gynecologist in Chief to the - University of Michigan Hospital. Lea Bros. & Co., Phil. and New - York. 1907. Chapter XIX._ - -Pephritis. From statistics we find that even excluding the cases of -eclampsia, the maternal mortality from nephritis during pregnancy is -33%, and the fetal mortality between 50% and 60%. P. 352. - -Women suffering from a chronic nephritis should be advised strongly -against marriage, especially in the presence of a cardiac or pulmonary -lesion. Married women should be warned against impregnation. P. 354. - -Pyelitis. “On account of the increased dangers of pyelitic and -especially of a pyelonephritic process during pregnancy, women suffering -from these diseases should be warned against marriage. Married women -should be warned against a new impregnation, on account of the marked -tendency of pyelitis to recur with every pregnancy.” P. 355. - - - _PRACTICAL OBSTETRICS. Thos. Watts Eden. Obstetrician, Physician and - Lecturer on Midwifery and Gynecology, Charing Cross Hospital; - Consulting Physician to Queen Charlotte’s Lying-in-Hospital; - Surgeon to In-Patient Chelsea Hospital for Women. 4th Edition. C. - V. Mosby Co. 1915._ - -Certain of the conditions enumerated form _absolute_ indications for the -induction to abortion. These are nephritis, (a form of kidney disease), -uncompensated valvular lesions of the heart, advanced tuberculosis, -insanity, irremediable malignant tumors, hydatidiform mole, -uncontrollable uterine haemorrhage, and acute hydramnios. P. 652. - - - _PRINCIPLES AND PRACTICE OF OBSTETRICS. Jos. B. De Lee, M.D., - Professor of Obstetrics at the Northwestern University Medical - School; Obstetrician to the Chicago Lying-in-Hospital and - Dispensary, and to Wesley and Mercy Hospitals, etc. W. B. Saunders - Co. 1913._ - -All forms of nephritis have a very bad influence on the pregnancy, -abortion and premature labor being common. (66% Hofmeier) Seitz found -that only from 20% to 30% of the children survived. One of the causes of -habitual death of the fetus, abortion, and premature labor is chronic -nephritis. P. 497. - -“The children of nephritics are usually puny and pale.” P. 497. - -Both mother and child are seriously jeopardized by chronic nephritis, -the mortalities being about 30% respectively. P. 497. - -Women with chronic nephritis should not marry, and if married, should -not conceive. P. 498. - -Diabetes. Sterility is common. Abortion and premature labor occur in 33% -of the pregnancies. The children, if the pregnancy goes to term, often -die shortly after birth, the total mortality being 66%. P. 502. - -True diabetes has a very bad diagnosis. Offergold found over 50% -mortality. Of the children 51% were still born, 10% died within a few -days after birth, and 5% more before six months. P. 503. - -If a woman comes under treatment with a history of diabetes it is best -to terminate the pregnancy at once. P. 503. - - - _THE PRACTICE OF OBSTETRICS. Designed for the use of Students and - Practitioners of Medicine. J. Clifton Edgar. Professor of - Obstetrical and Clinical Midwifery in the Cornell University - Medical College; Visiting Obstetrician to Bellevue Hospital, New - York City; Surgeon to the Manhattan Maternity Dispensary; - Consulting Obstetrician to the New York Maternity and Jewish - Hospitals. 5th Edition, Revised. P. Blakiston’s & Co., - Philadelphia._ - -Statistics appear to show that labors in these women, (diabetes) are -quite apt to end unfavorably, in one or another way. When diabetic women -become pregnant their disease usually takes a turn for the worse. -According to Lecorche, true diabetes who become pregnant, usually -succumb to the disease within a short time after delivery. P. 305. - - - ECLAMPSIA - - - _THE PRINCIPLES AND PRACTICE OF OBSTETRICS. By Joseph B. De Lee, M.D._ - -Over 20% of women with eclampsia die and statistics show that 10% of -such cases developed in the maternities. For the child the chances are -not good, nearly one half of the children dying as a result, that is, -due to: prematurity, toxemia, asphyxiation by repeated convulsions of -the mother, drugs administered to the mother, and injuries sustained -during birth, especially forced delivery. Eclampsia is more easily -developed in a pregnant woman because the kidneys are carrying an -increased burden, and too often diseased through the pregnancy changes. -The cause of eclampsia are unknown but in 20% of cases the convulsions -begin during pregnancy, in 60% during labor, and in 20% after delivery. -Page 365. - -The treatment is to stop the gestation at a point before either mother -or child, or both, are in danger either to life or to health. Page 1041. - - - _MATERNAL MORTALITY. Grace L. Meigs, M.D., U. S. Department of Labor. - 1917._ - -Puerperal albuminuria and convulsions, called also eclampsia, or toxemia -of pregnancy, is a disease which occurs most frequently during pregnancy -but may occur at or following confinement. It is a relatively frequent -complication among women bearing their first children. When fully -established its chief symptoms are convulsions and unconsciousness. In -the early stages of the disease the symptoms are slight puffiness of the -face, hands, and feet; headache; albumen in the urine; and usually a -rise in blood pressure. Very often proper treatment and diet at the -beginning of such early symptoms may prevent the development of the -disease; but in many cases where the disease is well established before -the physician is consulted, the woman and baby can not be saved by any -treatment. In the prevention of deaths from this cause it is essential, -therefore, that each woman, especially each woman bearing her first -child, should know what she can do, by proper hygiene and diet, to -prevent the disease; that she should know the meaning of these early -symptoms if they arise, so that she may seek at once the advice of her -doctor; and that she should have regular supervision during pregnancy, -with examination of the urine at intervals. - - - DIABETES - - - _THE PRINCIPLES AND PRACTICE OF OBSTETRICS. Joseph B. De Lee, M.D. - Page 514._ - -Without doubt pregnancy has a bad effect on the course of this disease. -It may develop a latent diabetes, there being cases where severe -symptoms appeared only during successive pregnancies, and others where -the disease grew progressively worse each time. Coma occurs in 30% of -the cases and is almost always fatal. It may be brought on by a slight -shock in pregnancy, but more often during and just after labor. Delivery -seems to have a worse effect than most surgical operations, causing -collapse, coma, or sudden death. Bronchitis has been noted in the -puerperium, and this has been found to eventuate in tuberculosis. True -diabetes has a very bad prognosis, authorities finding over 50% -mortality, of which 30% died in coma, within two and one half years, and -too often the child dies in utero. - - - PELVIC DEFORMITIES - - - _MATERNAL MORTALITY. Grace L. Meigs, M.D., U. S. Department of Labor, - 1917._ - -Some obstruction to labor in the small size or abnormal shape of the -pelvic canal causes many deaths of mothers included in the class “other -accidents of labor” and also many stillbirths. If such difficulty is -discovered before labor, proper treatment will in almost all cases -insure the life of mother and child; if it is not discovered until labor -has begun, or perhaps until it has continued for many hours, the danger -to both is greatly increased. Every woman, therefore, should have during -pregnancy—and above all during her first pregnancy—an examination in -which measurements are made to enable the physician to judge whether or -not there will be any obstruction to labor. A case in which a -complication of this kind is found requires the greatest skill and -experience in treatment, but with such treatment the life and health of -the mother are almost always safe. - - - _PRINCIPLES AND PRACTICE OF OBSTETRICS. Jos. B. De Lee, M.D., - Professor of Obstetrics at the Northwestern University Medical - School; Obstetrician to the Chicago Lying-in-Hospital and - Dispensary, and to Wesley and Mercy Hospitals, etc. W. B. Saunders - Co. 1913._ - -No subject in medicine presents greater difficulties in all its aspects -than this one, (treatment of contracted pelves) and none demands such -art or practical skill. Science aids little here. P. 709. - -Outside factors must also be considered: 1—The environment, whether the -parturient is in a squalid tenement, in the country, in a home where -every appliance is attainable, or in a well equipped maternity. -2—Whether in the hands of a general practitioner or a trained -specialist. 3—If the patient is a Catholic, all medically indicated -procedures not being permitted. 4—The age of the parturient, and the -probability of her having more children. Even with these enumerations, -the possible factors which might influence a labor, or our decision -regarding the course to pursue have not all been mentioned. P. 709. - - - _THE PRACTICE OF OBSTETRICS. Designed for the use of Practitioners and - Students of Medicine. J. Clifton Edgar, Professor of Obstetrics - and Clinical Midwifery in the Cornell University Medical College. - Visiting Obstetrician to Bellevue Hospital, New York City; Surgeon - to the Manhattan Maternity Dispensary; Consulting obstetrician to - the New York Maternity and Jewish Maternity Hospitals. 5th - Edition, Revised. P. Blakiston’s & Co., Phila._ - -A knowledge of the female bony pelvis is the very alphabet of -obstetrical science, and the foundation of obstetrical art. This -structure is most important since it is from the disproportion between -its size and that of the fetus, or from its abnormal shape that many of -the difficulties of labor arise. - - - _PRACTICAL OBSTETRICS. Thos. Watts Eden. Obstetrician; Physician and - Lecturer on Midwifery and Gynecology, Charing Cross Hospital; - Consulting Physician to Queen Charlotte’s Lying-in-Hospital; - Surgeon to In-Patient Chelsea Hospital for Women. 4th Edition. C. - V. Mosby Co. 1915._ - -The general course of labor is modified by pelvic contractions in -various ways. 1—Abnormal presentations are three or four times commoner -in contracted than in normal pelves. 2—Prolapse of the cord is much -commoner than in normal pelves. 3—When natural delivery occurs labor is -prolonged and the mechanism is modified. 4—Unless the true conjugate is -at least 3¼ inches, even with artificial aid the survival of the child -is seriously jeopardized. 5—The maternal risks are increased by the -greater length and difficulty of the labor and by the frequent necessity -of employing artificial methods of delivery. 6—The fetal risks are -increased in natural delivery by severe compression of the head during -its passage through the narrow pelvis, and other circumstances by the -operations required to effect delivery, some of which involve the -destruction of the fetus. P. 409. - - - _THE PRACTICE OF OBSTETRICS. In Original Contributions by American - authors. Edited by Reuben Peterson, A.B., M.D. Lea Bros. & Co., - Phil. and New York. 1907._ - -Labor complicated by anomalies of the Bony Pelvis. John F. Moran, M.D. - -The frequency with which pelvic contraction occurs can only be -determined with relative accuracy. There is in existence a comparatively -large amount of statistical data on this subject, but the reports of -different investigators vary within wide limits, and these variations -are naturally not to be explained entirely on the assumption of racial -conditions, or geographic distribution. Between these wide limits are -arrayed the figures of about 20 modern observers in different parts of -the civilized world who have reported statistics of cases. The combined -figures of 19 observers include a total of over 150,000 cases examined -for pelvic contraction. In these cases the average of contraction is -found to be about 10%. Williams concludes that contracted pelves occur -in from 7% to 8% of the white women of this country. P. 658–659. - - - HEART DISEASE - - - _THE SEXUAL LIFE OF WOMAN IN ITS PHYSIOLOGICAL, BIOLOGICAL AND - HYGIENIC ASPECTS. E. Heinrich Kisch, M.D. Professor of the German - Medical faculty of the University of Prague; Physician to the - Hospital and Spa of Marienbad; Member of the Board of Health, etc. - Translated by M. Eden Paul, M.D. Rebman Co., New York._ - -These are cases (severe heart disease) in which, in my opinion, it is -the physician’s duty to concern himself with the subject of the use of -preventive measures, and having regard for the preservation of a woman’s -life, and uninfluenced by any false delicacy, but with simple -earnestness to inform his patient with respect to the needful -prophylactic measures. The artificial termination of pregnancy, which -unquestionably is often justified in women suffering from heart disease, -but which unfortunately is apt to have very unfavorable results, will -rarely need to be discussed if by the proper employment of preventive -measures care is taken that pregnancy does not recur too frequently. P. -255. - - - _OBSTETRICS. A Text Book for the use of Students and Practitioners. - Whitridge Williams, Professor of Obstetrics, Johns Hopkins - University; Obstetrician in Chief to the Johns Hopkins Hospital; - Gynecologist to the Union Protestant Infirmary, Baltimore, Md. D. - Appleton & Co., 1912._ - -Some authorities recommend that women suffering from heart lesions -should be dissuaded from marriage, or if married, from becoming -pregnant. This, however, appears to be an extreme view, though of course -when the lesion is serious and the compensation faulty the dangers of -child-bearing should be carefully explained. P. 498. - - - _THE PRACTICE OF OBSTETRICS. In Original Contributions by American - authors. Edited by Reuben Peterson, A.B., M.D., Professor of - Obstetrics and Gynecology in the University of Michigan, Ann - Arbor, Mich.; Obstetrician and Gynecologist-in-Chief to the - University of Michigan Hospital. Lea Bros. & Co., Phil. and New - York. 1907. Chapter XIX._ - -“Leyden claims that about 40% of all women with serious heart lesions -meet their death in connection with childbirth. Still greater than the -demands upon the heart during pregnancy are those made by labor. The -strain, mental excitement, and especially the sudden changes in the -blood pressure, conditions which are well recognized as extremely -harmful to every patient with a chronic heart lesion, and which cannot -be avoided in the course of labor, make the situation extremely -dangerous.” (Hugo Ehrenfest, M.D.) P. 357. - -“The prognosis for the fetus is unfavorable. Fellner, whose figures -undoubtedly are low, places the frequency of premature, spontaneous -interruption of pregnancy as 20%, other writers at from 40% to 60%.” P. -358. - -“No marriage for the unmarried, no pregnancy for the married, no nursing -for the confined,” is a statement which has been made by a French -author, and has been accepted by many writers. It is incompatible with -the results of recent investigations. It would be too harsh and -unjustifiable to deny marriage to a woman who has a well compensated -valvular lesion. She should be informed of the risks of impregnation, -but should be warned against marriage only where there exist distinct -evidences of incompensation, especially in cases of mitral stenosis. P. -359. - - - _A TEXT BOOK OF OBSTETRICS. Barton Cooke Hirst, M.D.; Professor of - Obstetrics in the University of Pennsylvania; Gynecologist to the - Howard and Orthopaedic, and the Philadelphia Hospitals, etc. 7th - Edition. W. B. Saunders Co., Philadelphia and London. 1912._ - -Abortion is induced in about 25% of all cases, as the result of -placental apoplexies, or of the stimulation of the uterus to contraction -by the accumulation of carbondioxid gas in the blood. Pregnancy -distinctly increases the danger of the heart lesion. In 58 serious -cases, 23 died after premature delivery of the child. In milder cases -prognosis is not grave, yet the woman’s condition is by no means free -from danger. If the disease be of long standing and serious in -character, it appears from statistical studies that about half the women -die. P. 423. - - - _PRINCIPLES AND PRACTICE OF OBSTETRICS. Jos. B. De Lee, M.D.; - Professor of Obstetrics at the Northwestern University Medical - School; Obstetrician to the Chicago Lying-in-Hospital, and to - Wesley and Mercy Hospitals, etc. W. B. Saunders Co. 1913._ - -Abortion and premature labor, especially the latter, occur in cases of -dis-compensation, in from 20% to 40%, and stillbirth in 29% to 70%, -giving figures collected from various sources by Fellner. P. 489. - - - _THE PRACTICE OF OBSTETRICS. Designed for the use of Students and - Practitioners of Medicine. J. Clifton Edgar, Professor of - Obstetrics and clinical midwifery in the Cornell University - Medical School; Visiting Obstetrician to Bellevue Hospital, New - York City; Surgeon to the Manhattan Maternity and Dispensary; - Consulting Obstetrician to the New York Maternity and Jewish - Maternity Hospitals. 5th Edition, Revised. P. Blakiston’s & Co., - Philadelphia._ - -Acute Endocarditis not only has an injurious influence upon pregnancy, -but it is also apt itself to become extremely grave. Regarding -treatment, induced labor will be demanded. P. 310. - - - TOO FREQUENT PREGNANCIES - - - _BEING WELL BORN. An Introduction to Eugenics. Michael F. Guyer, - Ph.D., Professor of Zoology, University of Wisconsin. - Bobbs-Merrill Co. Indianapolis. 1916._ - -Too short an interval between childbirths would also seem to be an -infringement on the rights of the child as well as of the mother. Thus -Dr. R. J. Ewart, (“The Influence of Parental Age on Offspring,” _Eugenic -Review_, Oct., 1911) finds that children born at intervals of less than -two years after the birth of the previous child still show at the age of -six a notable deficiency in height, weight and intelligence, when -compared with the children born after a longer interval, or even with -first-born children. P. 166. - - - _FREQUENT PREGNANCIES. The Contributions of Demography to Eugenics. - Dr. Corrado Gini, Professor of Statistics at the Royal University - of Cagliari, Italy._ - -If the possibility of generation at any season of the year cannot, as -has been shown, have any deleterious effect on the vitality of human -offspring, it can none the less have indirect deleterious consequences, -in so far as it allows pregnancies to succeed each other at too short -intervals. P. 323. - -“The deleterious consequences which too short a period after the -preceding birth have upon the vitality of the child are indisputable, at -least during the first year of life.” P. 323. - - - _THE SEXUAL LIFE OF WOMAN IN ITS PHYSIOLOGICAL, BIOLOGICAL AND - HYGIENIC ASPECTS. E. Heinrich Kisch. Rebman Co., N. Y._ - -“Frequently recurring pregnancies and childbirth, according to Kronig, -act as the predisposing cause in the production of neurasthenia.” P. -257. - - - _NEO-MALTHUSIANISM AND RACE HYGIENE, IN “PROBLEMS IN EUGENICS.” Vol. - 2. Dr. Alfred Ploetz, President of the International Society for - Race Hygiene. London, 1913._ - -Malthusianism further affects the quality of the offspring by increasing -the intervals between single births. In families in which the parents -intend to have only a few children, the mother is usually exempt from so -frequent child-bearing, and she has ample time for regaining her -strength. The greater interval between births has evidently a favorable -effect upon the expectation of life of the children that are born. -Westergard has stated that in 21,000 births, if the interval between -birth is:— - - - The percentage of deaths before - five years of age is - Less than one year 20% - One to two years 14% - More than two years 12% - -That means a difference in the mortality between first and last class of -40% in favor of the longer interval. P. 186. - - - _THE LIFE INSURANCE EXAMINER. A Practical Treatise by Charles F. - Stillman, M.S., M.D., Medical Examiner for the Mutual Life - Insurance Co.; Clinical Professor of Orthopaedic Surgery in the - Women’s Medical College of the N. Y. Infirmary; Orthopaedic - Surgeon to the N. Y. Infant Asylum; Member of the Am. Orthopaedic - Association; Permanent member of the American Medical Association; - Fellow N. Y. Academy of Medicine, etc. 3rd Edition. Spectator Co., - N. Y., 1890._ - -“Postpone (as dangerous insurance risks) all cases of pregnancy; all -instances where the mother seems, in the judgment of the Examiner, to -have been bearing children too fast.” P. 186. - - - _RASSENVERBESSERUNG. Translated from the Dutch of Dr. J. Rutgers. 2nd - Edition. Dresden, 1911._ - -The combatting of self-induced abortion is one of the problems of Sexual -Hygiene. The two causes of most weight in this situation are syphilis -and too frequent pregnancy. It is quite evident that both of these -causes would be favorably influenced by the use of contraceptive -measures. P. 81. - - - _THE MALTHUSIAN, May 15, 1914. Sexual Ethics. A Study of Borderland - Questions. Robert Michels, (Review)._ - -Prof. Michels perceives that race control has two aspects; it may be an -urgent duty, and it is in any case an inalienable human right. It may be -regarded as a duty to actual or potential children, in view of either -bad economic conditions,—such as affect the bulk of all European -populations,—or defective heredity, and it may also be considered as an -obligation of humanity towards the wife and mother. Prof. Michels here -speaks with no uncertain voice: “The type of woman continually engaged -in child-bearing is a primitive one, out of harmony with the needs and -ideas of modern civilized life. Even as few as six pregnancies that go -to full term rob a woman of about ten years of her life, and these the -best. It is evidently far easier to provide a clear-sighted affection -and a wisely conceived and individualized upbringing for two or three -children than it is for eight or nine.” - - - _MR. SIDNEY WEBB, in The Times of October 16, 1906._ - -Assuming, as I think we may, that no injury to physical health is -necessarily involved (in the volitional regulation of the marriage -state); aware, on the contrary, that the result is to spare the wife -from an onerous and even dangerous illness for which in the vast -majority of homes no adequate provision in the way of medical -attendance, nursing, privacy, rest, and freedom from worry can possibly -be made, it is, to say the least of it, difficult on any rationalist -morality to formulate any blame of a married couple for the deliberate -regulation of their family according to their means and opportunities. - - - PERNICIOUS VOMITING - - - _THE PRINCIPLES AND PRACTICE OF OBSTETRICS. By Joseph B. De Lee, M.D._ - -Among diseases incidental to pregnancy must be counted pernicious -vomiting. Page 370. - -Statistics are uncertain, but out of 118 cases there were 46 deaths. -Page 357. - -The keynote of treatment is to stop the gestation at a point before -either mother or child, or both, are in danger to life or to health. -Page 1041. - - - _THE PRACTICE OF OBSTETRICS. By J. Clifton Edgar, M.D., Professor of - Obstetrics and Clinical Midwifery in the Cornell University - Medical College; Visiting Obstetrician to Bellevue Hospital, New - York City; Surgeon to the Manhattan Maternity and Dispensary; - Consulting Obstetrician of the New York Maternity and Jewish - Maternity Hospitals, New York City._ - -Under certain circumstances labor may be much disturbed by pernicious -vomiting. The causes comprise actual organic disease of the stomach and -functional disturbances from errors in diet. The determining cause of a -paroxysm of vomiting is a severe labor pain. The coincidence of labor -and vomiting is not unusual in anemic primiparae. Mental emotion is also -a cause. As this vomiting may presage the development of eclampsia or -some other affection it is best to terminate labor at once. Page 648. - - - - - CHAPTER VI - HARMFUL METHODS PRACTICED TO AVOID LARGE FAMILIES - - -_In this chapter it is shown that ignorance of scientific means of -preventing conception involves women in harmful practices. The most -common is coitus interruptus which results in nervous disorders. Long -continued celibacy or unnatural continence leads to sex inversions. -When, in spite of these unscientific practices, pregnancy follows, -abortion, the greatest disgrace of modern civilization, is the only -resort of the harassed mother, unless she will bear unwanted offspring._ - - - COITUS INTERRUPTUS - - - _THE SEXUAL LIFE OF WOMAN IN ITS PHYSIOLOGICAL, BIOLOGICAL AND - HYGIENIC ASPECTS. E. Heinrich Kisch, M.D._ - -The prevailing practice of coitus interruptus leads, in my experience in -consequence of the intense hyperaemia of the uterus and the uterine -annexa unrelieved by the occurrence of the orgasm, to a condition of -stasis in the female reproductive organs, and this ultimately passes on -into chronic netritis, (with relaxation of the uterus, retro-flexion, or -ante-flexion, catarrhal diseases of the mucous membrane, erosions and -follicular laceration of the portio vaginalis) oophoritis and -perimetritis. The evil effects of coitus interruptus for a woman are -dependent on the fact that the woman fails to obtain complete sexual -gratification, and that this has an important influence on her entire -organism. If this ungratifying coitus interruptus is frequently repeated -in a voluptuous woman disorders of the reproductive organs ensue, and -even more frequently nervous disorders in the form of neurasthenia -sexualis. P. 403. - -Mantegazza believes that organic disease of the spinal cord may actually -result from coitus interruptus. - -Hirt considers that even when marital intercourse is carefully regulated -with respect to frequency, coitus interruptus may lead to neurasthenic -manifestations. - -Eulenberg also declares that coitus interruptus is already a frequent -cause of sexual neurasthenia in women and that its evil influence in -this respect is becoming more and more frequently manifest. P. 405. - -Valenta declared that coitus interruptus was one of the chief causes of -chronic netritis. - -According to Kleinwachter, coitus interruptus is harmful to the woman to -an extent by no means trivial, whereas the man in whom ejaculation -occurs, suffers comparatively little. P. 407. - - - _DISORDERS OF THE SEXUAL FUNCTION. By Max Huhner, M.D., Chief of - Clinic, Genitourinary Department, Mt. Sinai Hospital Dispensary, - New York City._ - -If the act of coitus is stopped before it is completed, the seminal -vesicles have not been able to completely empty themselves, or to empty -themselves as completely as during a normal coitus, and are thus left -more or less filled. The mucous membrane in the prostalic urethra has -not been able to completely deplethorize itself, and thus remains more -or less congested after the act. As a result of all this, impulses are -sent much sooner from the distended vesicles and the prostatic urethra -to the erection center and the cerebrum, so that the desire for coitus -is felt sooner than after normal coitus. The seminal vesicles, being -never completely emptied during withdrawal coitus, are constantly -sending impulses to the erection center, while the mucous membrane of -the prostatic urethra, being in a condition of chronic congestion in -consequence of repeated acts of withdrawal, is likewise sending -continuous impulses to the same center whether coitus is indulged or -not. The result of these continued impulses sent from both sources, as -well as the repeated demands made upon the center itself from the oft -repeated acts of coitus, is, that the erection center does not -completely recover itself and finally remains in a state of -hyperexcitability.... It must be remembered, however, that all this does -not occur as a result of a single act of withdrawal; and it is often -only after years of this practice that the harmful effects above -described become evident. Page 227. - - - CONTINENCE - - - _THE SEXUAL LIFE OF WOMAN IN ITS PHYSIOLOGICAL, BIOLOGICAL AND - HYGIENIC ASPECTS. E. Heinrich Kisch, M.D._ - -Grafe, with reference to the view that if for any reason conception must -be avoided this should be done by abstinence from sexual intercourse, -remarks, “doubtless the ideal demand, but one which even those with -exceptional strength of will are unlikely to satisfy. And the worst of -it is that even a single indiscretion will often result in -impregnation.” Moreover, it is distinctly contrary to natural conditions -that a healthy married couple, united by an intimate affection should -live together, abstaining completely from sexual intercourse. The -question has already been much discussed, both in speech and writing, -and this will continue in the future without altering the fact that the -physician will be asked, and will be compelled to give advice regarding -the use of means of prevention of pregnancy. P. 399. - -The desired goal of artificial sterility will not, however, be reached -through advocacy of moderation and continence. P. 400. - - - _EFFECTS OF ABSTINENCE. Rassenverbesserung. Translated from the Dutch - of Dr. J. Rutgers._ - -And if we could penetrate still more deeply into the recesses of the -instincts, and project into the light of day the world of phantasy of -those who live in enforced continence, we would draw away in horror from -the spectacle of what each individual must conceal from himself and -others. We would not then be so eager for the consummation of what is -called sexual abstinence. P. 14. - -Physiology teaches that every function gains in power and efficiency -through a certain degree of control, but that the too-extended -suppression of a desire gives rise to pathological disturbances and in -time cripples the function. Especially in the case of women may the -damage entailed by too long continued sexual abstinence, bring about -deep disturbances, all the more because women more often than men -misunderstand, or are unaware of this etiological moment, and have not -the slightest idea of the true cause of their psychic and somatic -injury. P. 15. - -The unmarried state is a trying and often injurious condition for a man -as well as a woman, when they live in strict continence; and if the -latter is not the case and they resort to prostitution, there are even -more pain and suffering in store for them. P. 16. - -We must not forget that there are always two parties to the situation. -What can a physically weaker and spiritually stronger woman do even if -she desires continence with her whole soul, but her husband will have -none of it? Is it not then her duty to protect herself in order that she -may not give birth to a weakly progeny? - - - _HARPER’S WEEKLY. 1915._ - -When Dr. A. A. Brill, Lecturer in Abnormal Psychology, New York -University, and formerly Chief of Clinic in Psychiatry, Columbia -University, was asked how he regarded contraception in relation to -nervous diseases, he replied emphatically: “You can say that I am for -it. It is much better than an abortion. For instance, I have in mind a -woman who was discharged from the insane hospital. She had three -children and had been three times insane. What chance in life has a -child born between two attacks of insanity, whose mother is mentally -defective? Even sane women, if they are nervous and emotional, should -never bear children against their will. It is foolish to talk about -making people have children when they do not want them. It’s bad for the -woman and bad for the child. It is very bad for a child to be born into -a home where he is not desired. I find that many adult, nervous patients -were unwished-for-children, and it was the early attitude of their -parents toward them that contributed much to their bent toward nervous -invalidism.” In reply to the contention of the anti-regulationists that -contraception is physically and mentally harmful, he stated that certain -methods are injurious, while others are not. He commented on the -unfortunate fact that it is the undesirable methods which are employed -by the poorer people, because druggists put a high price upon the better -means on the plea that they run a risk in selling them at all. -Remembering that Dr. Brill was for years connected with Central Islip, -he was asked if he did not consider it demanding a good deal to expect a -man discharged from an insane asylum and sent home to his wife, to live -a sexually abstinent life. He replied: “Only people who know nothing of -the sex impulse can make such a demand of a person who has a poor mental -organization. Of course it is impossible. It is impossible even for the -average normal man, and especially for those who live crowded in two or -three rooms.” - - - _THE SEXUAL LIFE. By P. W. Malchow, M.D., Professor of Proctology, and - Associate in Clinical Medicine, Hamline University, College of - Physicians and Surgeons; member Hennepin County Medical Society, - Minnesota State Medical Society, American Medical Association, - etc._ - -There can be no doubt that the influence of prolonged continence upon -either the male or female is to dwarf and in many respects destroy that -which goes to make a broad and full physical and intellectual -personality and that to perform the sexual act whenever there is an -existing state of sexual excitement, with the usual marital -restrictions, is rather beneficial that otherwise. Page 201. - -In cases of nervousness in either sex it may be found that, as a rule, -the first indication is a disturbance of the sexual function, following -which there will be digestive troubles, then affections of special -nerves, of which disorders of sight are the first and most frequent, -with neuralgias, etc., later. Observation has shown this to be the -general rule, and that is also in accordance with the law of -self-preservation. With the conviction that nervousness is first -manifested and begins with an alteration in the natural sexual function -we may conclude that other functional disorders are a natural sequence. -It thus becomes evident that the most prolific cause of nervousness is -an inability for natural sexual living. Page 296. - -A life of celibacy cannot be said to be a natural one, and when this -state of celibacy is combined with propinquity, in which there must of -necessity be a source of repeated and more or less constant sexual -excitability there is added to one already incomplete life a greater -burden of increased tension, which must be a very considerable factor in -the causation of unrest or nervousness. Page 155. - -How best to circumvent family complications is the burning question of -the hour with the average young wife, and a satisfactory solution of -this problem would be a boon to society and prevent untold suffering. -When confronted with the question, the usual answer is, in effect, “be -natural,” which in these days of stress, is no answer at all, as it is -not practical. Page 158. - - - THE OBJECTS OF MARRIAGE - - BY HAVELOCK ELLIS - -What are the legitimate objects of marriage? We know that many people -seek to marry for ends that can scarcely be called legitimate, that men -may marry to obtain a cheap domestic drudge or nurse, and that women may -marry to be kept when they are tired of keeping themselves. These -objects in marriage may or may not be moral, but in any case they are -scarcely its legitimate ends. We are here concerned to ascertain those -ends of marriage which are legitimate when we take the highest ground as -moral and civilized men and women living in an advanced state of society -and seeking, if we can, to advance that state of society still further. - -The primary end of marriage is to beget and bear offspring, and to rear -them until they are able to take care of themselves. On that basis Man -is at one with all the mammals and most of the birds. If, indeed, we -disregard the originally less essential part of this end,—that is to -say, the care and tending of the young,—this end of marriage is not only -the primary but usually the sole end of sexual intercourse in the whole -mammal world. As a natural instinct, its achievement involves -gratification and well-being, but this bait of gratification is merely a -device of Nature’s and not in itself an end having any useful function -at the periods when conception is not possible. This is clearly -indicated by the fact that among animals the female only experiences -sexual desire at the season of impregnation, and that desire ceases as -soon as impregnation takes place, though this is only in a few species -true of the male, obviously because, if his sexual desire and aptitude -were confined to so brief a period, the chances of the female meeting -the right male at the right moment would be too seriously diminished; so -that the attentive and inquisitive attitude towards the female by the -male animal—which we may often think we see still traceable in the human -species—is not the outcome of lustfulness for personal gratification -(“wantonly to satisfy carnal lusts and appetites like brute beasts,” as -the Anglican Prayer Book incorrectly puts it) but implanted by Nature -for the benefit of the female and the attainment of the primary object -of procreation. This primary object we may term the animal end of -marriage. - -This object remains not only the primary but even the sole end of -marriage among the lower races of mankind generally. The erotic idea in -its deeper sense, that is to say the element of love, arose very slowly -in mankind. It is found, it is true, among some lower races, and it -appears that some tribes possess a word for the joy of love in a purely -psychic sense. But even among European races the evolution was late. The -Greek poets, except the latest, showed little recognition of love as an -element of marriage. Theognis compared marriage with cattle-breeding. -The Romans of the Republic took much the same view. Greeks and Romans -alike regarded breeding as the one recognizable object of marriage; any -other object was mere wantonness and had better, they thought, be -carried on outside marriage. Religion, which preserves so many ancient -and primitive conceptions of life, has consecrated this conception also, -and Christianity—though, as I will point out later, it has tended to -enlarge the conception—at the outset only offered the choice between -celibacy on the one hand and on the other marriage for the production of -offspring. - -Yet from an early period in human history a secondary function of sexual -intercourse had been slowly growing up to become one of the great -objects of marriage. Among animals, it may be said, and even sometimes -in man, the sexual impulse, when once aroused, makes but a short and -swift circuit through the brain to reach its consummation. But as the -brain and its faculties develop, powerfully aided indeed by the very -difficulties of the sexual life, the impulse for sexual union has to -traverse ever longer, slower, more painful paths, before it reaches—and -sometimes it never reaches—its ultimate object. This means that sex -gradually becomes intertwined with all the highest and subtlest human -emotions and activities, with the refinements of social intercourse, -with high adventure in every sphere, with art, with religion. The -primitive animal instinct, having the sole end of procreation, becomes -on its way to that end the inspiring stimulus to all those psychic -energies which in civilization we count most precious. This function is -thus, we see, a by-product. But, as we know, even in our human -factories, the by-product is sometimes more valuable even than the -product. That is so as regards the functional products of human -evolution. The hand was produced out of the animal fore-limb with the -primary end of grasping the things we materially need, but as a -by-product the hand has developed the function of making and playing the -piano and the violin, and that secondary functional by-product of the -hand we account, even as measured by the rough test of money, more -precious, however less materially necessary, than its primary function. -It is, however, only in rare and gifted natures that transformed sexual -energy becomes of supreme value for its own sake without ever attaining -the normal physical outlet. For the most part the by-product accompanies -the product, throughout, thus adding a secondary, yet peculiarly sacred -and specially human, object of marriage to its primary animal object. -This may be termed the spiritual object of marriage. - -By the term “spiritual” we are not to understand any mysterious and -supernatural qualities. It is simply a convenient name, in distinction -from animal, to cover all those higher mental and emotional processes -which in human evolution are ever gaining greater power. It is needless -to enumerate the constituents of this spiritual end of sexual -intercourse, for everyone is entitled to enumerate them differently and -in different order. They include not only all that makes love a gracious -and beautiful erotic art, but the whole element of pleasure in so far as -pleasure is more than a mere animal gratification. Our ancient ascetic -traditions often make us blind to the meaning of pleasure. We see only -its possibilities of evil and not its mightiness for good. We forget -that, as Romain Rolland says, “Joy is as holy as Pain.” No one has -insisted so much on the supreme importance of the element of pleasure in -the spiritual ends of sex as James Hinton. Rightly used, he declares, -Pleasure is “the Child of God,” to be recognized as “a mighty storehouse -of force,” and he pointed out the significant fact that in the course of -human progress its importance increases rather than diminishes. While it -is perfectly true that sexual energy may be in large degree arrested, -and transformed into intellectual and moral forms, yet it is also true -that pleasure itself, and above all, sexual pleasure, wisely used and -not abused, may prove the stimulus and liberator of our finest and most -exalted activities. It is largely this remarkable function of sexual -pleasure which is decisive in settling the argument of those who claim -that continence is the only alternative to the animal end of marriage. -That argument ignores the liberating and harmonising influences, giving -wholesome balance and sanity to the whole organism, imparted by a sexual -union which is the outcome of the psychic as well as physical needs. -There is, further, in the attainment of the spiritual end of marriage, -much more than the benefit of each individual separately. There is, that -is to say, the effect on the union itself. For through harmonious sex -relationships a deeper spiritual unity is reached than can possibly be -derived from continence in or out of marriage, and the marriage -association becomes an apter instrument in the service of the world. -Apart from any sexual craving, the complete spiritual contact of two -persons who love each other can only be attained through some act of -rare intimacy. No act can be quite so intimate as the sexual embrace. In -its accomplishment, for all spiritually evolved persons, the communion -of bodies becomes the communion of souls. The outward and visible sign -has been the consummation of an inward and spiritual grace. “I would -base all my sex teaching to children and young people on the beauty and -sacredness of sex,” writes a distinguished woman of today; “sex -intercourse is the great sacrament of life, he that eateth and drinketh -unworthily eateth and drinketh his own damnation; but it may be the most -beautiful sacrament between two souls who have no thought of children.” -To many the idea of a sacrament seems merely typo for ecclesiastical, -but that is a misunderstanding. The word “sacrament” is the ancient -Roman name of a soldier’s oath of military allegiance, and the idea, in -the deeper sense, existed long before Christianity, and has ever been -regarded as the physical sign of the closest possible union with some -great spiritual reality. From our modern standpoint we may say, with -James Hinton, that the sexual embrace, worthily understood, can only be -compared with music and with prayer. “Every true lover,” it has been -well said by a woman, “knows this, and the worth of any and every -relationship can be judged by its success in reaching, or failing to -reach, this standpoint.” - -I have mentioned how the Church—in part influenced by that clinging to -primitive conceptions which always marks religions and in part by its -ancient traditions of asceticism—tended to insist mainly if not -exclusively on the animal object of marriage. It sought to reduce sex to -a minimum because the pagans magnified sex; it banned pleasure because -the Christian’s path on earth was the way of the Cross; and though -theologians accepted the idea of a “Sacrament of Nature” they could only -allow it to operate when the active interference of the priest was -impossible, though it must in justice be said that, before the Council -of Trent, the Western Church recognized that the sacrament of marriage -was effected entirely by the act of the two celebrants themselves and -not by the priest. Gradually, however, a more reasonable and humane -opinion crept into the Church. Intercourse outside the animal end of -marriage was indeed a sin, but it became merely a venial sin. The great -influence of St. Augustine was on the side of allowing much freedom to -intercourse outside the aim of procreation. At the Reformation, John à -Lasco, a Catholic Bishop who became a Protestant and settled in England, -laid it down, following various earlier theologians, that the object of -marriage, besides offspring, was to serve as a “sacrament of -consolation” to the united couple, and that view was more or less -accepted by the founders of the Protestant churches. It is the generally -accepted Protestant view today.[50] The importance of the spiritual end -of intercourse in marriage, alike for the higher development of each -member of the couple and for the intimacy and stability of their union, -is still more emphatically set forth by the more advanced thinkers of -today. - -Footnote 50: - - It is well set forth by the Rev. H. Northcote in his excellent book, - _Christianity and Sex Problems_, (2nd edition, 1916, F. A. Davis - Company, Philadelphia), especially Ch. XIII. - -There is something pathetic in the spectacle of those among us who are -still only able to recognize the animal end of marriage, and who point -to the example of the lower animals—among whom the biological conditions -are entirely different—as worthy of our imitation. It has taken God—or -Nature, if we will—unknown millions of years of painful struggle to -evolve Man, and to raise the human species above that helpless bondage -to reproduction which marks the lower animals. But on these people it -has all been wasted. They are at the animal stage still. They have yet -to learn the A. B. C. of love. A representative of these people in the -person of an Anglican bishop, the Bishop of Southwark, appeared as a -witness before the National Birth-Rate Commission which, two years ago, -met in London to investigate the decline of the birth-rate. He declared -that procreation is the sole legitimate object of marriage and that -intercourse for any other end was a degrading act of mere -“self-gratification.” This declaration had the interesting result of -evoking the comments of many members of the Commission, formed of -representative men and women with various standpoints,—Protestant, -Catholic, and other,—and it is notable that while not one identified -himself with the Bishop’s opinion, several decisively opposed that -opinion, as contrary to the best beliefs of both ancient and modern -times, as representing a low and not a high moral standpoint, and as -involving the notion that the whole sexual activity of an individual -should be reduced to perhaps two or three effective acts of intercourse -in a life-time. Such a notion obviously cannot be carried into general -practice, putting aside the question as to whether it would be -desirable, and it may be added that it would have the further result of -shutting out from the life of love altogether all those persons who, for -whatever reason, feel that it is their duty to refrain from having -children at all. It is the attitude of a handful of Pharisees seeking to -thrust the bulk of mankind into Hell. All this confusion and evil comes -of the blindness which cannot know that, beyond the primary animal end -of propagation in marriage, there is a secondary but more exalted -spiritual end. - -It is needless to insist how intimately that secondary end of marriage -is bound up with the practice of birth control. Without birth control, -indeed, it could frequently have no existence at all, and even at the -best seldom be free from disconcerting possibilities fatal to its very -essence. Against these disconcerting possibilities is often placed, on -the other side, the un-esthetic nature of the contraceptives associated -with birth control. Yet, it must be remembered, they are of a part with -the whole of our civilized human life. We at no point enter the -spiritual save through the material. Forel has in this connection -compared the use of contraceptives to the use of eye-glasses. -Eye-glasses are equally un-esthetic, yet they are devices, based on -Nature, wherewith to supplement the deficiencies of Nature. However in -themselves un-esthetic, for those who need them they make the esthetic -possible. Eye-glasses and contraceptives alike are a portal to the -spiritual world for many who, without them, would find that world -largely a closed book. - -Birth control is effecting, and promising to effect, many functions in -our social life. By furnishing the means to limit the size of families -which would otherwise be excessive it confers the greatest benefit on -the family and especially on the mother. By rendering easily possible a -selection in parentage and the choice of the right time and -circumstances for conception it is again, the chief key to the eugenic -improvement of the race. There are many other benefits, as is now -generally becoming clear, which will be derived from the rightly applied -practice of birth control. To many of us it is not the least of these -that birth control effects finally the complete liberation of the -spiritual object of marriage. - - - ABORTION - - - _THE PRINCIPLES AND PRACTICE OF OBSTETRICS. By Joseph De Lee, M.D...._ - -It is said that there is one abortion to eight labors, but in all -probability it is more frequent than this. Almost half of the -child-bearing women have had a miscarriage before the thirty-fifth year. -Statistics are of questionable value because hospital figures do not -represent the conditions of private practice. Further, many occur in -first weeks and pass under the diagnosis of delayed or profuse -menstruation. Finally, many abortions are deliberately concealed. Page -426. - - - _PRACTICE OF OBSTETRICS. By J. Clifton Edgar, M.D._ - -Immediate dangers of abortions are: hemorrhage, retention of an adherent -placenta, sepsis, tetanus, perforation of the uterus. They also cause: -sterility, anemia, malignant diseases, displacements, neurosis, and -endometritis. Pages 338–9. - - - _TRUCHTABTREIBUNG UND PRAVENTIVVERKEHR, IN ZUSAMMENHANG MIT DEM - GEBURTENRUCKGANG; Eine Medizinische, Juristische und - Sozialpolitische Betrachtung von Dr. Max Hirsch. Wurtzburg, - Kabitzsch Verlag, 1914._ - -He who would combat abortion and at the same time assail contraceptive -measures may be likened to the person who would fight contagious -diseases and forbid disinfection. For contraceptive measures are -important weapons in the fight against abortion. The use of -contraceptive measures is largely responsible for the fact that the -number of abortions does not increase immeasurably. The apprehension is -perfectly justified that the prohibition of contraceptive measures would -enormously increase the practice of abortion with its dangerous -consequences for the life and health of women. P. 131–2. - -America has a law since 1873, if I am not mistaken, which prohibits by -criminal statute the distribution and regulation of contraceptive -measures. It follows therefore, as I have already stated in my -introduction, that America stands at the head of all nations in the huge -number of abortions. P. 132. - - - _THE DISEASES OF SOCIETY AND DEGENERACY. The Vice and Crime Problem. - G. F. Lydston, M.D., Professor of Genito-Urinary Surgery, State - University of Illinois; Professor of Criminal Anthropology, - Chicago; Kent College of Law; Member of the American Medical - Association, etc., etc. The Riverton Press, Chicago, 1912._ - -The familiar cry of “public demand” would fit the abortion business -better than it does some other things. The evil is wide-spread, both in -and out of matrimony. Its existence is recognized “under the rose” as a -social necessity, yet the law calls it murder. For every man and woman -caught in its commission and punished a thousand escape detection. - - - _THE DISEASES OF SOCIETY AND DEGENERACY. G. F. Lydston._ - -In many instances abortion results directly in the death of the woman. -Such are the consequences resulting from ungoverned natural law on the -one side, and moral on the other. It must be confessed that an element -of sympathy is evoked by the mental distress of the unfortunate woman -who is extra-matrimonially pregnant. P. 370. - - - _SEXUAL PROBLEMS OF TO-DAY. Wm. J. Robinson, Critic and Guide. 1912._ - -I have gone on record with the statement that about a million abortions -are brought about every year in the U. S. Exact statistics are not and -never will be available, but I am sure that my estimate is very -conservative, and that three million would be nearer the truth. Justice -John Proctor Clark stated that 100,000 abortions are performed annually -in New York City alone, and if these figures are correct, then the -number for the U. S. would be in the neighborhood of two and a half -million. P. 158. - -There is one measure and one only which will positively do away with the -evil of abortion and that is teaching people how to prevent conception. -P. 164. - - - _ABORTION AND ECONOMIC NECESSITY. (Hirsch)._ - -According to a report in the _Medical Record_ 80,000 abortions are -performed annually in New York and only one case in 1,000 is brought -before the authorities. - -According to Lewin it has been determined by court investigations that -there are at least 200 people in New York who make a profession of -performing abortions. - -It has been estimated that 2,000,000 abortions are performed annually in -the U. S. P. 7. - -Bertillon estimates the number of criminal abortions in Paris at 50,000 -annually, in Lyons at 19,000. (Le depopulation de la France). P. 8. - -We must first attack a very wide-spread fallacy, namely that abortion is -more prevalent among unmarried girls than among married women. In other -words, that it is concomitant with free sex relations. This fallacy is -exploded by practical medical experience as well as by observation and -statistics of social conditions. P. 23. - -Among the causes of criminal abortion the fear on the part of the woman -of the pains and dangers of confinement plays a not inconsiderable role. -P. 54. - -In marriage the cause for the practice of abortion springs in most cases -from economic necessity. Most frequently this necessity is a genuine -dire need arising from overcrowded quarters, lack of food and clothing, -sickness and lack of employment. P. 33. - -This economic need finds its most obvious expression in the congestion -of the city populations. P. 34. - -The dangers of childbirth are still serious enough to cause a certain -degree of uneasiness in the woman and the family circle. This foreboding -is due partly to our higher valuation upon health and life, and also to -a shifting of pre-eminence from a solely generative function in women to -other interests in their life. P. 84. - -This greater consideration and valuation of woman’s individuality is the -expression of continued progress and a higher culture. P. 87. - - - _TRUCHTABTREIBUNG UND PRAVENTIVVERKEHR, In Zusammenhang mit dem - Geburtenruckzang; Eine medizinische, juristische und - sozialpolitische Betrachtung von Dr. Max Hirsch, Wurtzburg, - Kabitzsch Verlag, 1914._ - -In Chicago six to ten thousand abortions are performed yearly, of which -75–90% are married women. P. 7. - -I believe I may say without exaggeration that absolutely spontaneous or -unprovoked abortions are extremely rare, that the vast majority—I should -estimate it at more than 80% of abortions have a criminal origin. P. 9. - -We may affirm that next to sexual diseases, abortion and its -consequences are the most important factor in the etiology of chronic -genital inflammations and of sterility. P. 9. - -Our examinations have informed us that the largest number of abortions -are performed on married women. This fact brings us to the conclusion -that contraceptive measures among the upper class, the practice of -abortion among the lower class, are the real means employed to regulate -the number of offspring. P. 32. - - - _THE SEXUAL LIFE OF WOMAN IN ITS PHYSIOLOGICAL, BIOLOGICAL AND - HYGIENIC ASPECTS. E. Heinrich Kisch. Translated by M. Eden Paul, - M.D. Rebman & Co., New York._ - -A means of insuring artificial sterility, which in all civilized -countries is punishable as a criminal offense, and which is nevertheless -very frequently practiced, is the artificial induction of abortion. -Especially in North America it would appear that there exist regular -professional abortionists. P. 413. - - - _THE FAMILY AND THE NATION. A Study in Natural Inheritance and Social - Responsibility. Wm. Cecil Dampier Whetham, M.A., F.R.S. Fellow and - Tutor of Trinity College, Cambridge, and Catherine Durning - Whetham. Longmans Green & Co., N. Y., Bombay and Calcutta, 1909._ - -There is no finality, a nation must either be losing or gaining ground, -either improving or degenerating. Hence the scientific study of the -effect of the existing conditions of any time on the rates of -reproduction of different stocks of the nation, should be the chief work -of the sociologist, and the control of these conditions the supreme duty -of the statesman. P. 5. - - - - - CHAPTER VII - PROSTITUTION, FEEBLE-MINDEDNESS AND VENEREAL DISEASES - - -_In this chapter it is shown that the feeble-minded parent is many times -as prolific as the normal parent. A considerable percentage of girls -living in prostitution are mentally defective, and if careful statistics -were collated it would be found that 95 per cent. of these women come -from large families. The feeble-minded should be instructed how to -prevent conception, thereby diminishing prostitution and its invariable -accompaniment,—venereal disease._ - - - _SOME PROBLEMS OF THE SOCIAL EVIL. Hon. Chas. N. Doodnow, Judge of the - Morals Court, Chicago. “The Light.” B. S. Steadwell, Editor. - Jan.-Feb., 1915._ - -The Court of Morals conducted an investigation of prostitution along -three lines, social, physical and mental. In the first report, April -10th, to December 31st, 1913, 639 cases were examined, representing -every race, creed, and nationality. 334 were colored, 298 white, 2 -Armenian, 1 Japanese. Occupations: 225 housework, 174 waitresses, 136 -laundresses, 83 clerks or cashiers, 6 seamstresses, 4 stenographers, 1 -trained nurse, 1 manicurist, 24 scrub women, 110 had no occupation. -Venereal disease in infectious stage was diagnosed in 108 cases. 315 -showed evidence of having syphilis, and of the remaining 116, had -bacteriological tests been made, 50% at least would have been found -victims of the disease. As to intelligence, over 400 were mentally -deficient, two were found to be insane, and 68 were little more than -imbeciles, having mental capacity of less than a seven year old child. -Later statistics of 100 women going through the Court were taken showing -again that usually their work was of a character which required the -least skill and mental effort, and that 97% either were, or had been -afflicted with disease, and that the majority were mentally deficient. -We did not have any imbeciles, or idiots from the Morals Court, though -quite a number of the morons were of the low grade type bordering on the -imbecile group. In other words, 89.37% of our cases are feeble-minded, -or borderland. If we leave out the borderland cases it shows that 85% of -our cases, exclusive of the insane, alcoholics, and drug habitues are -distinctly feeble-minded. This finding is interesting since it -corresponds to our findings in the Boys’ Court, where we found 84.49% -were feeble-minded. It is therefore to be clearly seen here that with -the girl defective-delinquent, as with the boy, the basic cause is -feeble-mindedness. This is the intrinsic cause, which environment and -other causes on the whole, are extrinsic. - - - _REPORT OF CHICAGO MORALS COURT. December, 1913._ - -Dr. W. J. Hickson of the Psychopathic Laboratory tested 126 cases -excluding insane, alcoholics and drug addicts, for the Chicago Morals -Courts, and found 85.83% distinctly feeble-minded. - -Of 639 prostitutes examined by a woman physician for the Chicago Morals -Court, over 400 were mentally deficient; 2 were found to be insane; 68 -were little above imbeciles, having mental capacities of less than a -seven year old child. - -The State Training School for Girls, at Geneva, Ill., has a population -of about 400, of whom a great majority have been committed for sexual -immorality. Dr. Olga Bridgman reports that of 118 consecutive cases that -were examined upon entry, 105 (or 89%) were graded as feeble-minded. 14 -of the 118 had been committed as dependents or uncontrollable. Of the -104 remaining all of whom had been sexually immoral 101 were graded as -feeble-minded while only 3 were found normal according to the Binet -test. - - - _THE LAW OF POPULATION. Its Consequences and its Bearing upon Human - Conduct and Morals. Annie Besant. Asa K. Butts, Publisher. 1879._ - -The more marriage is delayed the more prostitution spreads. Prostitution -is an evil we should strive to eradicate, not to perpetuate, and late -marriage, generally adopted would most certainly perpetuate. Marriage is -deferred owing to the ever increasing difficulty of maintaining a large -family in anything like comfort. Celibacy is not natural to man or to -woman, all bodily needs require their legitimate satisfaction, and -celibacy is a disregard of natural law. Until nature evolves a neuter -sex, celibacy will ever be a mark of imperfection. P. 27–8. - -But the knowledge of these scientific checks would, it is argued, make -vice bolder, and would increase unchastity among women by making it -safe. And if so, are all to suffer, so that one or two already corrupt -at heart may be preserved from becoming corrupt in act? Are mothers to -die solely that impure women may be held back, and wives to be -sacrificed that the unchaste may be curbed. As well say that no knives -must be used because throats may be cut, no matches sold because -incendiarism may result from them, no pistols allowed, because murders -may be committed by them. P. 38. - - - _SLAVERY OF PROSTITUTION. A Plea for Emancipation. Maude E. Miner, - Secretary of the New York Probation and Protective Association. - McMillan Co., 1916._ - -The study of young women in prostitution shows that mental deficiency is -an important factor in delinquency. 34%, or approximately ⅓ of 577 -delinquent young women at Waverly House were so retarded in mental -development as to be considered feeble-minded, and others were mentally -retarded enough to need protection and over-sight. Close knowledge of -the individual girls convince us that their deficiency facilitates their -entrance into prostitution. P. 43. - -Explanation of the mental deficiency of these wayward girls which has -predisposed them to prostitution is usually found in bad inheritance. P. -44. - -A feeble-minded girl was found to be one of 13 illegitimate children to -whom her mentally deficient mother had given birth. P. 46. - -Over-crowding in rooms, tenements, and neighborhoods is an obvious -menace. In congested sections of the lower part of New York, large -families, to which these girls belong, were herded into two or three -narrow rooms, 12 in three small rooms, seven in two rooms, or a family -of five eating and sleeping and living in a single room. P. 55. - -Have we realized that every feeble-minded girl is a potential -prostitute? Have we realized that feeble-minded mothers give birth to -large numbers of children doomed to mental deficiency? Have we realized -what this will ultimately mean in deterioration of human stock and in -the complication of social problems? To stop the stream which is -bringing into prostitution large numbers of mentally deficient girls and -women, we must safe-guard these girls and prevent them from having -offspring. Evidence presented to the Royal Commission on the Care and -Control of the Feeble-minded in Great Britain, and careful studies in -America, show conclusively that mental deficiency tends strongly to be -inherited, and that feeble-minded mothers are more prolific than normal -women. P. 267. - - - _DOWNWARD PATHS. An Inquiry into the Causes which Contribute to the - Making of the Prostitute. With a foreword by A. Maude Royden. T. - Bell & Sons, Ltd. London._ - -It is astonishing to find experts denying the element of economic -pressure as a factor in the creation of the prostitute. It is an -influence constantly present and it is only when we interpret it to mean -actual physical starvation that we can say it is rarely a determining -factor. Economic pressure does not begin with starvation, it ends there. -There is again the long strain of underfeeding and overwork, of the -absence of interest, variety and color, and all that makes life worth -living to a human being. Poverty often means isolation, and isolation -the absence of all those ties which keep us in our place in the social -order, and make it worth while to preserve our self-respect. To be -without this is to be constantly in danger and it is economic pressure -which has thrust many over the brink of the precipice, though few would -say their fall was due to actual starvation. P. 10. - -Intimately connected with this aspect of the question is that of home -and housing, especially of the child. The age at which children are -first corrupted is almost incredibly early, until we consider the nature -of the surroundings in which they grow up. Insufficient space, -over-crowding, the herding together of all ages and both sexes, these -things break down the barriers of a natural modesty and reserve. Where -decency is practically impossible, unchastity will follow, and follow -almost as a matter of course. There are certainly natural defences in -the right instincts of young people brought up in the right kind of -home, which we look for in vain among those who have never had space -enough for growth, or privacy enough for refinement. P. 11. - -We must allot to bad housing and over-crowding a foremost place, not -only as undermining the physical health which conduces to normal sexual -relationship, but also as a danger to the wholesome innocence of youth. -P. 21. - -It cannot be too strongly impressed upon persons interested in the -housing problem that over-crowding means a violation of childhood in -every degree, from the indecencies of mere childish horse-play to -complete debauchery. P. 22. - -There are two types of feeble-minded girls who are almost inevitably -destined to prostitution. There is first the large proportion whose -sexual inclinations are abnormally strong, or whose power of -self-control over natural impulses is abnormally weak. 2—There is the -large class who are non-resistant. They have no active impulse to seek -out men, but they will yield to any one who approaches them. There are -three important factors that drive the feeble-minded into prostitution -by excluding them from other occupations. 1—They often lose their -characters at a very early age. A marked characteristic of the -feeble-minded is the precocity of their sexual impulse. 2—It is easy -enough for any feeble-minded girl to get and keep light, unskilled work -at girl’s wages, but not so easy for her to pass like the girl of normal -intelligence, from girl’s to woman’s work at the age of 17 or 18, for -she is rarely worth woman’s wages. Therefore she finds herself bored by -monotonous work and low pay just at the time that she is particularly -attractive to man, and her sexual impulses are at their strongest. Very -naturally the feeble-minded girl with her incapacity to perceive the -consequences turns from her unsatisfying employment to the new life of -excitement and easy gain that offers itself. 3—If feeble-minded girls do -succeed in getting respectable situations they are very likely to lose -them because of their lack of intelligence and general inefficiency. And -even if they should discharge their duties in a satisfactory manner they -have a curious distaste for staying for any time in one place, and tend -to drift from situation to situation. P. 127–128. - -Another characteristic of the feeble-minded is their notorious -fertility. The superior fertility of the feeble-minded has been proved -beyond dispute by statistical inquiry. - - - _DELINQUENCY AND MENTAL DEFICIENCY. Dr. Olga Bridgman. The Survey, - June 13, 1914._ - -Report of examination of 118 consecutive admissions at the Illinois -Training School for Girls at Geneva. Of the 118, 105, or 89%, showed a -retardation of three years or more, thus ranking as mentally deficient, -6% were backward, being one or two years retarded, and six, or 5% were -graded as normal. According to the Binet tests then, 97% of the children -sent to this institution are mentally defective. - - - _COMMERCIALIZED PROSTITUTION IN NEW YORK CITY. George Kneelands. - Century Co., New York, 1913. (Chapter by Katherine B. Davis on a - Study of Prostitutes Committed from New York City to the State - Reformatory for Women at Bedford Hills.)_ - -It is difficult to get at the actual truth as to the number of children -the unmarried women have had. The Table shows the admission of 209 women -on this point. There are 73 unmarried women who admit having had -children, 16 were pregnant at the time of entering, and 18 had -previously been pregnant. 428 claimed to have had no children. In this -connection it may not be amiss to note the fact that an unmarried woman -who has had a child is more apt to belong to the mentally defective -class. Of the 647, 20.09% were shown to have hereditary degenerate -strains, and 20.56% venereal disease. Page 180. - - - FEEBLE-MINDEDNESS - - - _SOCIAL HYGIENE. March 1915. Vol. 1, No 2. Recent Progress in Social - Hygiene in Europe. James B. Reynolds, Counsel, The American Social - Hygiene Association._ - -Recent studies of prostitutes there (in Europe) as here have strikingly -brought to light the significant relationship between prostitution and -mental defectiveness. A far reaching contribution to the solution of the -problems of sex education and prostitution was the Mental Deficiency Act -of 1913 for England and Wales. This Act was based on the Report of a -Royal Commission on the Care and Control of the Feeble-minded which made -a careful and exhaustive study of the entire subject, including the -methods of treatment of the mentally defective in all countries. The -Commission declares that a great proportion of the evidence unmistakably -indicates that mentally defective children are greatly lacking in -self-control and peculiarly open to suggestion and hence specially -susceptible to the influence of depraving companions. The testimony of -numerous experts who appeared before the Commission is highly -illuminating on these points. Dr. Kerr, medical officer of the London -County Council, declared that sooner or later many of these children -will be found in the hands of the police, or in maternity hospitals. Dr. -Ashby, late medical officer of the Manchester Special Schools stated -that the mental defectives tend to an increase of the criminal and -immoral classes. Dr. Whittell, Medical Superintendent of the Suffolk -County Asylum, argued that the natural and physical evolution of this -class is apt to result in various offenses of sexual, or perverted -sexual, nature. Dr. Corner, Lecturer on Mental Diseases in the North -East London Post Graduate Hospital, said, “One of the most common and -dangerous characteristics of the feeble-minded is that they tend to sink -socially.” Another expert testified that mentally defective girls in -large cities are subject to overwhelming temptations and pressure toward -sexual immorality, while still another, looking to the larger aspects of -the problem, called attention to the danger resulting from the immoral -laxness of mentally defective girls, and the lowering of the mental -stamina of the whole nation by the increase of a population of defective -intellect. Sir Francis Galton went so far as to declare that mentally -defective women commonly become prostitutes. The feeble-minded, as -distinguished from idiots, are an exceptionally fecund class, mostly of -illegitimate children, and a terrible proportion of their offspring are -born mentally deficient. All these experts were in agreement that -mentally defective girls are in great danger of becoming immoral, hence -prostitutes. - - - _DEGENERACY, ITS CAUSES, SIGNS AND RESULTS. Eugene S. Talbot, M.D. - Walter Scott, Ltd., London; Chas. Scribner’s Sons, N. Y. 1898._ - -Pauline Tarnowsky in her study “Etudes Anthropometriques sur les -Prostituées” finds that in Russia prostitution is crime in women taking -the line of least resistance. She concludes from her researches, which -mine tend to verify, that the prostitute as a rule is a degenerate -being, the subject of an arrest of development, tainted with a morbid -heredity, and presenting stigmata of physical and mental degeneracy -fully in consonance with her imperfect evolution. C. Andronico of -Messina, Italy, arrived some time previously at the same conclusions as -those of Tarnowsky. - - - _FEEBLE-MINDEDNESS, ITS CAUSES AND CONSEQUENCES. Henry Herbert - Goddard, Director of the Research Laboratory of the Training - School at Vineland, N. J., for Feeble-minded Boys and Girls. - McMillan Co., 1914._ - -Among the different causes for the social evil feeble-mindedness has -been suggested, but nowhere has it been given the prominence that is due -it. Anyone who understands feeble-mindedness, especially the moron, -cannot expect anything less than that great numbers of these girls will -fall into the life of prostitution. As to the actual statistics on this -subject we have almost none. One very significant record comes from -Geneva, Illinois, made by Dr. Bridgman. She found that of 104 girls in -the Reformatory who were committed for an immoral life 97% were -feeble-minded. This does not by any means indicate that 97% of -prostitutes are feeble-minded, because it is only natural to expect that -the feeble-minded ones would be the ones to be caught and sent to an -institution. These figures, nevertheless, give us some idea of the -prevalence of feeble-mindedness in this traffic. Many competent judges -estimate that 50% of prostitutes are feeble-minded. Pages 14–15. - -The 327 cases here presented constitute a unitary group. They have not -been selected. They are of all ages and grades of defect. Page 7. - -Our 327 families naturally fall into six fundamental groups, as follows: -4—Accident Group, 57; 5—No Cause, 8; 6—Unclassifiable, 27. Pages 47–48. - -The following table gives an idea of the fecundity of these groups of -women. - - - No. of Mothers No. of Children Average - Hereditary 139 992 7.1 - Probably Hereditary 27 168 6.2 - Neuropathic 36 204 5.6 - Accident 50 258 5.1 - No Cause 8 258 5.7 - Unclassified 27 118 4.3 - ——— ————— ——— - 287 1,786 6.2 - -In addition to the mentality, whether normal or feeble-minded, record -has been kept of certain diseases and conditions supposed to be more or -less associated with feeble-mindedness in a causal relation. These are -the following: 1—Alcohol; 2—Tuberculosis; 3—Sexual Immorality; -4—Paralysis, Insanity, Epilepsy, Neurotic Condition, Syphilis, -Criminality, Deafness, Blindness, Migraine, Goitre, Vagrancy. Page 473. - -Sexual immorality is closely associated with hereditary -feeble-mindedness. Closely connected with the subject of sexual -immorality is the one of illegitimacy. Our records show 278 illegitimate -children of whom 259, or 93% are in the pure Hereditary group, 12 in the -Probably Hereditary group, 3 in the Neuropathic, and 4 in the Accident -group. There is nothing new in these facts. They are simply confirmatory -of what we have found in other lines. Page 499. - -The feeble-minded person is not desirable; he is a social encumbrance, -even a burden to himself. In short, it were better, both for him and for -Society had he never been born. Should we not then in our attempt to -improve the race begin by preventing the birth of more feeble-minded? -Page 558. - - - _THE FEEBLE-MINDED A SOCIAL DANGER. A. F. Tredgold, L.R.C.P., London. - M.R.C.S., England. Medical Expert to the Royal Commission on the - Feeble-minded, etc. Eugenics Review. Vol. 1, April, 1909. Pub. - Eugenics Education Society, London._ - -In England and Wales on January 1st, 1906 there were a total of 138,529 -persons in the country who were defective in mind. This corresponds to -4.03 per thousand population, or to one mentally defective person in -every 248. In England and Wales on January 1st, 1906, there were no less -than 125,827 insane persons. If we add these to the number of the -mentally deficient which I have just stated, we find that in this -country there is one person out of every 130 who suffers from severe -disease of the mind. P. 98–99. - -According to the Registrar General, the average number of births to a -marriage in the whole population of this country is 4.6. I have -ascertained that the average number of births in these degenerate -families is no less than 7.3. It is obvious that if this alarming -propagation is not checked, the time must inevitably come when our -nation will contain a preponderance of citizens lacking in that -intellectual and physical vigor which is absolutely essential to -progress. P. 98. - - - _RASSENVERBESSERUNG. Translated from the Dutch of Dr. J. Rutgers. - Second Edition, Dresden, 1911._ - -A not insignificant factor in the use of houses of prostitution is -furnished by married men who in the “old fashioned” way wish to -“protect” their wives, in order not to be burdened with too many -children. Neo-Malthusianism is also the best weapon against this class -of supporters of prostitution. P. 73. - - - _MASSACHUSETTS COMMISSION FOR INVESTIGATION OF THE WHITE SLAVE - TRAFFIC._ - -This investigation under Dr. Walter Fernald, included a physical -examination study of family and personal history, social reactions, and -standards, etc. Out of the 300 prostitutes 154 were feeble-minded (all -doubtful were called normal). The 154 were so pronounced as to warrant -legal commitment. None of them had the mentality of a normal child of 12 -years old. Majority were that of 10 or 9 years old. - - - _INVESTIGATION OF VIRGINIA STATE BOARD OF CHARITIES._ - -This investigation presents a very high percentage of aments among the -prostitute residents of the Richmond red light district. Of 120 persons -tested the examiner found 42 or 35% imbeciles and 58 or 48.3% to be -morons. That is 100 or 83.3% were mentally defective and only twenty or -16.7% were declared normal. Out of this number 93 were found to be -between the ages of 20 to 30 and 16 between 30 to 40. All in the -child-bearing age, as one will note. That 100 out of the 120 needed -institutional care, that they should not reproduce their kind, was of -course apparent. - - - _THE MENTALITY OF THE CRIMINAL WOMAN. A Comparative Study of the - Criminal Woman, the Working Girl and the Efficient Working Woman - in a Series of Mental and Physical Tests. Jean Weidensall, - formerly Director of the Department of Psychology, Laboratory of - Social Hygiene, Bedford Hills, N. Y. Warnick and York Inc. 1916._ - -Tests applied to a group of children of working age by the Bureau of -Educational Guidance of Cincinnati were also used on a group of 20 maids -at Vassar as a norm for testing the women committed to Bedford. 100 -reformatory subjects were used for the tests. It is a matter for -question whether loss of the parent is the cause of the child’s leaving -school and going to work early and of the ultimate unsocial conduct in -the case of the Bedford group, or whether loss of parent, retardation, -misconduct, etc., are not for the most part but manifestations of the -same thing—irresponsibility, mental, physical and social inferiority on -the part of both parents and child. The facts at our disposal and -eugenic investigations lead us to believe that the latter is in the -larger measure true. Out of 100 women recorded 30 had had from one to -five illegitimate children. Of the 100 tests for syphilis and -gonorrhoea, 45% positive, 4% doubtful, 51% negative, for syphilis. 60% -positive, 22% doubtful, 18% negative for gonorrhoea. At best strong -character cannot be the rule among individuals ⅔ of whom have less -intelligence than that possessed by the average individual among a group -of children of 15, (of whom half are themselves retarded), and almost -surely not when they have been too untrained industrially and too -unschooled socially to have acquired simple every-day habits of -restraint and inhibition. Even the more intelligent third of the -reformatory subjects differed very obviously and unmistakably in -stability and emotional control from the group of Vassar maids. - - - _THE MENACE OF MENTAL DEFICIENCY FROM THE STANDPOINT OF HEREDITY.[51] - By Henry H. Goddard, Ph.D., Vineland, N. J. New Jersey Training - School._ - -Footnote 51: - - Read before the conference of the Massachusetts Society for Mental - Hygiene, Boston, November 19, 1915. - -From the standpoint of the child, something can be done to make them a -little happier; from the standpoint of society, no amount of mental -hygiene can ever render them efficient citizens. Society can, by proper -treatment, render them less of a menace than they are naturally, and the -ills that we now suffer on account of them can be largely reduced. - -It is estimated that there are from 300,000 to 400,000 mental defectives -in the United States. That is based upon the United States census of -1890, in which the question was asked “Whether defective in mind, sight, -hearing or speech, or whether crippled, maimed or deformed, with name of -defect.” Now if anyone can estimate what proportion of the true number -of the feeble-minded would be returned in answer to that question, he -will be able to estimate how near the truth is the 200,000 which the -census report gives. Three hundred thousand or 400,000 seems to be a -conservative estimate. - -I am to discuss this topic from the standpoint of heredity. It has not -yet been successfully contradicted that two-thirds of this army of -300,000 or 400,000, owe their condition to heredity. A quarter of a -million of these people are feeble-minded because their ancestors were -feeble-minded. They have inherited the condition just as you have -inherited the color of your eyes, the color of your hair, and the shape -of your head. There is a tendency in these days to attribute a great -deal to heredity. But of this particular thing there seems to be no -question. The menace of the problem comes, not from the fact that a -quarter of a million inherited their condition, but because they are -transmitting that condition to their offspring. Of that quarter of a -million feeble-minded persons in the United States, do you know how many -are being cared for, guarded and kept from propagating their kind? About -24,000 out of 250,000 are to-day being cared for in such institutions as -you have here at Waverley. The rest are living their lives, are raising -families, and providing abundant opportunity for the exercise of the -charitable impulses of numberless generations to come. And that -condition of things is getting worse rather than better. - -What shall we do? There have been two answers. Some say, “Segregate, -shut them up. Keep the sexes apart.” We are told that if we could do -this for a generation our problem would be largely solved. The -two-thirds in which the condition is largely hereditary would be -eliminated. I want to assure you that the problem is larger than that. -In the first place, looked at from the practical standpoint, we do not -seem to be able to segregate. We are taking care of 24,000, and there -are at least 250,000 to be cared for. If the State of New York cared for -its estimated proportion of mental defectives, it would require thirty -institutions of 1,000 each. They find it hard to raise money for the -three or four institutions they now have. Their appropriations are cut -every year. In the State of Massachusetts there are at least 14,000 -feeble-minded persons. It would require ten institutions the size of -Waverley,—a demand upon the public treasury which we are not willing to -meet. I have not found anyone yet who is optimistic enough to think that -we shall meet the demand within any reasonable length of time,—a time so -short that we can safely rely upon that as a solution of the problem. - -I have said that this quarter of a million, this army of feeble-minded -people, are propagating. They are propagating a progeny of feeble-minded -at somewhere from two to six times as fast as the intelligent people are -propagating their kind. That is another serious part of the problem. I -should like to digress from my particular field for a moment to make a -suggestion on the other side. It makes one feel pessimistic when we find -that the good stock here in New England—the stock than which there is no -better in the world—is gradually disappearing for lack of issue. Of one -family after another one reads all too frequently, “The last of his -family has passed away.” We are told sometimes that two children in a -family are all that can be properly reared; that it is better to rear -two children and rear them properly than to rear a larger family and -rear them badly. If _two children in a family_ are all that our best and -finest and nobler families can properly raise, _how many children_ ought -to be raised in a family of these low-grade people? The average in the -United States is, for all classes, something less than two, and the -average for these defectives is from four to twelve. In that little -family that we ran across down in New Jersey, which we call the -Kallikaks, you will recall that the good side started from six -ancestors. That is to say, Old Martin Kallikak, after he married, had -seven children, one of whom died without marrying. From the six who -lived and married, sprang all the normal descendants. Martin’s -illegitimate son, the child of the feeble-minded girl, was the only one -on the bad side, and yet to-day the number of descendants from the -illegitimate mating is practically the same as the number descended from -the six legitimate children. You can see that it does not take many -generations for the progeny of the unrestrained feeble-minded to equal -and even outstrip the normal. Our good stock is multiplying very slowly. -Our poor stock—the lowest strata of society—multiplies in what might -really be called a brutal ratio. If civilization is to advance, our best -people must replenish the earth. I think it should be a part of our -religion to replenish the world with good, clean people. - -We need to know vastly more than we know to-day before we can give -definite answers, except in the case of marriage between two -feeble-minded persons. Now, that being the case, the argument that I -want to make to you is: the propagation of the feeble-minded is going on -at an enormous rate. If we could do, and if we did, everything that we -wanted to do, and that we knew enough to do, we should be getting only -at the surface of the problem, and should be sure in only about one case -out of the six possibilities. Now if that is the case, my friends, does -it seem that we ought to put off attacking the problem until we cannot -stand it any longer? Or does it mean that we had better attack it right -away? Is it not best to begin hunting for these defective children -wherever they may be found? And they can be found in the school, in our -juvenile courts, in our almshouses, in our insane hospitals, in our -reform schools, in our homes for cripples, in our asylums for the -blind,—in short, wherever there is a dependent group there is an undue -proportion of these mental defectives. - -Some will say, “If they are in almshouses they are being cared for.” In -reality they are being raised and brought to manhood and womanhood and -then sent out, to propagate their kind. Fifty years ago the problem was -not as serious as it is to-day, because these defectives were out in the -world by themselves, getting killed by a runaway horse, or falling into -machinery, or in some way meeting an untimely death. To-day we are -exceedingly careful; we are protecting them in every possible way; we -are taking care of them in our institutions and giving them every -advantage, and then sending them out into the world—a menace to the rest -of humanity. - -It would be a dreadful thing if all these problems were solved and we -didn’t have any people to give our money and charity to. I suppose we -should become hard-hearted if we didn’t have any to befriend. Perhaps we -want to keep enough of these unfortunates so that we can still -contribute to their safety and welfare. But, my friends, when we realize -the suffering, the terrors, the losses of all kinds that these people -unintentionally, unwittingly cause us, we have another side of the -problem. The menace of the feeble-minded is not a figure of speech. It -is no undue sentimentalism that assures us that we need to take care of -this group of people. We need to study them very seriously and very -thoroughly; we need to hunt them out in every possible place and take -care of them, and see to it that they do not propagate and make the -problem worse, and that those who are alive to-day do not entail loss of -life and property and moral contagion in the community by the things -that they do because they are weak-minded. - - - _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. - - - _HEREDITARY SYPHILIS IN THE LIGHT OF RECENT CLINICAL STUDIES. - Pamphlet. Borden S. Veeder, M.D., St. Louis, Mo. From the American - Journal of the Medical Sciences, October, 1916. No. 4, Vol. CXII. - P. 522._ - -In the present state of our knowledge we can summarize the evidence as -pointing to the view that in hereditary syphilis the mother is always -infected, although very frequently the infection is latent and that true -germinal infection does not occur. - -SYPHILIS AS A SOCIAL PROBLEM. No accurate figures are available as to -the incidence of hereditary syphilis. The disease is not reportable, and -even if it were it is doubtful if the records obtained in this way would -be of any value, as the condition is frequently overlooked, and when -recognized would be concealed in many cases because of the stigmata -attached. With improved methods of diagnosis we are beginning to learn -that it is far more common than previously thought, as many conditions -in which the etiology was obscure have been found to be the result of a -syphilitic infection. Hospital statistics are of little value in this -connection. In St. Louis we have been particularly interested in -hereditary syphilis, and have admitted many cases to the Children’s -Hospital for study which would normally have been cared for in the -out-patient clinic, and hence the proportion of syphilis to the total -number of admissions is relatively high. We have seen between 300 and -350 children with an hereditary infection in three and a half years and -have undoubtedly failed to recognize a number of cases. We have also -found many cases of latent syphilis by testing the apparently healthy -children of syphilitic families. What is more important is the number of -obscure clinical conditions which have been found to be syphilitic in -origin. - -The importance and cost of syphilis to the family and the community is -not generally appreciated. About this point we have collected some -interesting information: For a period of about a year an attempt was -made to obtain extensive data in regard to the family of every -syphilitic child coming to the clinic, to examine all of the other -living children as well as the parents, and to test the blood of each -member by the complement-deviation method. In this way data was -assembled for 100 syphilitic families. Many marriages (10 to 30 per -cent.) remain sterile as a result of syphilis and others (13 per cent. -according to Haskell) result only in abortions. Our material includes -only those families in which a living child came under our direct -observation and care. - -In these 100 syphilitic families 331 pregnancies occurred which resulted -as follows: - - - Abortions 100 or 30.2 per cent. - Stillbirths 31 or 9.3 per cent. - Living births 200 or 60.5 per cent. - -Thus 40 per cent. of the pregnancies terminated in the death of the -fetus before term. If the parents had been healthy and of the same -social strata we might have expected 30 to 35 deaths before term, or a -mortality of 10 per cent. instead of 40 per cent. - -Considering next the 200 living births: At the time the data were -collected 39 were dead and 161 alive, but 12 of the 161 died during the -course of the investigation. Of the 161 examined 107 had both clinical -signs of syphilis and a positive Wassermann; 5 were clinically positive -but gave negative tests (in all of these the family gave a history of -syphilis); 16, although negative as regards clinical manifestations, -gave positive reactions, and therefore belong to the group of latent -syphilitics. Thus but 33 of the 161 living children were free from the -infection, and if we attribute the deaths occurring before term to -syphilis, we find that of the 331 pregnancies in 100 syphilitic families -but 10 per cent. escaped the infection. The toll is summarized in the -following table: - - - 331 PREGNANCIES IN 100 SYPHILITIC FAMILIES - - 131 or 40 per cent. died before term } - 51 or 15 per cent. died after birth } 55 per cent. dead - 116 or 35 per cent. living but syphilitic 35 per cent. syphilitic - 33 or 10 per cent. living and free from 10 per cent. escaped - syphilis - ——— - 331 - -If we add to this record and take into consideration the physical -condition of the parents—both of whom were syphilitic in almost all of -our cases—we begin to grasp the appalling importance of syphilis from a -social standpoint. - -In order to show this in another way, studies[52] were made in our -clinic in which the waste (total deaths to total pregnancies) occurring -in 100 families in which we were treating children with contagious -disease, and in 100 families selected at random from our records, were -contrasted with the waste in 100 syphilitic families. These groups are -designated as C. R. and S. respectively and the data briefly summarized -in the following table: - -Footnote 52: - - Jeans and Butler, Hereditary Syphilis as a Social Problem, Am. Jour. - Dis. Child., 1914, viii, 327. - - - Total Deaths Born living Per cent. - Group pregnancies before now dead Total waste - birth - - C. 444 46 70 116 26 - - R. 442 42 59 101 22 - - S. 453 116 104 220 48 - -The increase in the waste for the syphilitic group of 100 per cent. does -not represent the total waste, as it is fair to assume that -three-quarters of the living children are syphilitic and many of these -defective. - -SYPHILIS. None of the causes supposed to be potent causes of -feeble-mindedness is so difficult of investigation, so enigmatical as -Syphilis. Not only in the popular mind but in the professional thought, -it is given a prominent place, yet of all the causes there is perhaps -none for which there is less evidence. This does not necessarily mean it -is not a cause, but simply that it is not proved. The terrible nature of -the disease, the serious results that it is known to produce, such as -miscarriage, deaths in infancy, general paralysis of the insane, the -fact that it is one of the two diseases that can be transmitted from the -mother to the child because the germs can pass through the chorion -cells, the fact of its close connection with sexual immorality, all tend -to render it in the minds of most people a horror of which anything can -be believed. It is well understood by the medical profession that a -mating which shows, first a number of miscarriages followed by deaths in -infancy, and finally live offspring, is a picture that means syphilis in -one or both of the parents almost without question. In conclusion, there -is abundant evidence that syphilis produces miscarriages and early -death. - -It is claimed that syphilis is responsible for 42 per cent. of abortions -and miscarriages, the remaining 58 per cent. embracing all cases of -whatever character, artificial or otherwise. - - - SYPHILIS IN THE OFFSPRING OF SYPHILITIC PARENTS - - - _FAMILIAL SYPHILIS. By P. C. Jeans, M.D., “American Journal of - Diseases of Children.” January, 1916. Vol. XI. pp. 11–19._ - -As the result of syphilis numerous families remain sterile. The figures -for sterility vary from 10 per cent. to 30 per cent., depending on the -material studied. When there is an embryo there is a variety of fates to -which it may come. Many marriages result only in abortions (nearly 13 -per cent. in Haskell’s material[53]). Since the starting point in our -material was a syphilitic child, we have no data bearing on this phase. - -Footnote 53: - - Haskell: Jour. Am. Med. Assn., 1915, lxiv, 890. - -Among our syphilitic patients all the living children of 100 families -have been examined, Wassermann tests made and the family history -studied. In these 100 families there were 331 pregnancies. Of these 100 -(30.2 per cent.) were abortions, 31 (9.3 per cent.) still births and 200 -(60.4 per cent.) living births. Of the 200 living births 35 children -died early and 4 died late, and 161 remained alive and were examined. Of -these, 12 are now dead. Of the 35 who died early, 5 gave an undoubted -history of syphilis and a number gave suspicious histories. Of the four -who died late, one was an idiot. Of the 161 examined, 107 were -clinically positive and had positive Wassermann tests. Five were -clinically positive and had negative Wassermann reactions. Sixteen, who -showed no evidence of syphilis, gave positive Wassermann reactions. -Thirty-three, who gave no clinical proof of syphilis, gave a negative -Wassermann reaction. - -Of the five who were clinically positive but gave negative Wassermann -reactions, one was a young infant who had snuffles and a large spleen. -The mother and sister both gave a positive history and a positive -Wassermann reaction. Shortly after beginning treatment the baby -developed a syphilitic rash. The baby was removed from the hospital and -a second Wassermann was not done. The second case was a nursing baby. -The mother had active syphilis and was taking treatment. The baby had an -active process in the nose. The third case was a 7-year-old girl who had -a markedly sunken nose and who for that reason was the starting point -for investigating that family. Both the mother and younger brother gave -a positive Wassermann. The fourth case was a 4-year-old girl whose -mother and younger sister were both positive and the patient had a -general rash which was thought to be syphilitic. The fifth case was a -3-year-old boy with a positive history, and who had had some treatment. -His mother and younger brother both had syphilis. - -A negative Wassermann reaction is obtained in the presence of active -syphilis only under certain definite conditions. As had been noted in -cases not of this series, very young babies, even with undoubted active -syphilis, not infrequently give a negative Wassermann. It has also been -noted that even small amounts of mercury tend to cause a positive blood -to react negatively. - -H. Boas[54] states that of fifty-seven babies of syphilitic mothers -giving negative Wassermann reactions at birth, thirteen during a three -months’ period of observation developed syphilitic manifestations and a -positive Wassermann, and two others showed syphilitic changes at -necropsy, having had no manifestations during life. - -Footnote 54: - - Quoted by Haberman: Jour. Am. Med. Assn., 1915, lxiv, 1146. - - - LATENT SYPHILIS - -It is seen that 10 per cent., of the children examined had latent -syphilis, i.e., a positive Wassermann and no clinical evidence of -syphilis. One of these children gave a history of epiphysitis at 3 -months. Other than this no early history was acknowledged by any of the -mothers. The question naturally arises, Are these children actively -infected with syphilis? When we inquire into the history of those -showing late manifestations, we frequently find, so far as obtainable -history is concerned, that there has been no previous warning that the -disease existed. One of our patients developed, as her first known -symptom, an interstitial keratitis at 20 years. We know that the -spirochete can lie dormant much longer than this and then manifest -itself. One patient of this latent group who had taken very irregular -treatment for about a year and who had never had previous -manifestations, recently developed an active lesion in the throat. -Another developed an interstitial keratitis after about two months of -anti-syphilitic treatment. A positive Wassermann reaction in these -apparently healthy children has the same significance that it does in -the parent, and it is our belief that the children in this group are -actively infected. - -The fact that there are thirty-three children, 10 per cent. of the total -pregnancies, who show no evidence of syphilis, and at the same time give -a negative Wassermann reaction, is rather hopeful. Yet the pleasure to -be taken in this fact is not altogether unalloyed. In this small group -there were two mental defectives and an idiot, and it is impossible to -say that all of this group are free from syphilitic infection. In one -instance, one such negative child returned about a year after his -original examination with a tertiary type of lesion and a positive -Wassermann. Though no classification of those in this group showing -stigmata of degeneration was attempted, it can be truthfully stated that -a goodly proportion did show degenerative influences, either physical or -mental. - - - TOTAL SYPHILIS IN THE FAMILIES STUDIED - -In summing up the total syphilitic infection in these families, we find -that where marital relations are uninvolved, all of the fathers and -probably all of the mothers have been infected. Presuming that the -abortions, stillbirths, all of the early deaths and at least one of the -late deaths were due directly or indirectly to syphilitic infection, -syphilis among the offspring amounts to 89 per cent. of the total -pregnancies, and total syphilis in the family amounts to 93 per cent. of -all its members. - - - SUMMARY - -It is highly probable that all the mothers of syphilitic children have -been infected with syphilis. Of eighty-five mothers of syphilitic -children 86 per cent. gave positive Wassermann reactions. All of the -remaining cases but six gave a history of infection or treatment, or -both. Five of these six patients were examined at least ten years after -the birth of their last syphilitic children and the infection is -probably dying out. - -Eighty-seven per cent. of the mothers deny all knowledge of the -infection. The mothers are for the most part infected during the latent -stage of the father. - -Of 331 pregnancies in 100 families, 30 per cent. were abortions, 9 per -cent. stillbirths, 61 per cent. living births. Of the living births 24 -per cent. had died. Of those living 80 per cent. had syphilis. - -Of the total pregnancies 90 per cent. were presumably syphilitic and -although 10 per cent., seem free from syphilis, there is no proof that -they all are. The total syphilis in these families amounts to 93 per -cent. of the entire family. - -For the most part our families followed Kassowitz’s rule; i.e., -decreasing grades of infection in the children. - -In case of syphilitic mothers bearing non-syphilitic children, it is -probable that the infection in the mother is localized in places where -it is not readily transmitted. - -The idea that there are different strains of spirochetes receives some -support from these families. - -Transmission to the third generation, though not proved, is distinctly -an occasional probability. - - - _OBSTETRICS. A Text-book for the Use of Students and Practitioners. - Whitridge Williams, Professor of Obstetrics Johns Hopkins - University. Obstetrician-in-Chief to the Johns Hopkins Hospital; - Gynecologist to Union Protestant Infirmary, Baltimore, Md. D. - Appleton and Co., 1912._ - -Syphilis is one of the most important complications of pregnancy as it -is one of the most frequent causes of repeated abortion, or premature -labor. The influence of syphilis upon pregnancy differs materially, and -three classes of cases are distinguished, according as infection has -taken place: 1—before pregnancy; 2—at the time of conception; or, -3—during pregnancy. When inoculation with the specific poison has -occurred before conception the disease nearly always gives rise to -abortion or premature labor, more frequently the latter. Le Pileur -obtained a striking illustration of the disastrous effects of syphilis -from a study of the reproductive histories of 130 women, before and -after its inception, 3.8 per cent. of the children being born dead -before, as compared with 78 per cent. after infection. In premature -labor due to syphilis the child is usually dead when it comes into the -world; less frequently it is born alive with definite manifestations of -the disease. When the mother is suffering from the affection at the time -of conception the offspring is always syphilitic. P. 495. - - - _THE PRACTICE OF OBSTETRICS. In Original Contributions by American - Authors. Edited by Reuben Peterson, A.B., M.D., Professor of - Obstetrics and Gynecology in the University of Michigan, Ann - Arbor, Mich.; Obstetrician-in-Chief to the University of Michigan - Hospital. Lea Bros. and Co., Philadelphia and New York, 1907._ - -In marked contrast to the comparatively slight interference of pregnancy -with the course of syphilis is the decidedly unfavorable influence of -syphilis upon the course of pregnancy. Syphilis, more often than any -other infectious disease, is responsible for a great variety of -pathological changes in the fetus, placenta and uterus, and for the -premature interruption of gestation. Statistics show that the fetal -mortality in this disease averages 50%. This figure is lower than that -given in the preceding paragraphs for some of the acute infectious -diseases, but considering the prevalence of syphilis among all civilized -and uncivilized races, it is obvious that the effect of this disease -deserves a most careful consideration, not only from the medical, but -also from the economic and sociologic point of view. Fournier gives the -fetal mortality for cases in which the maternal infection occurs -simultaneously with fecundation as 75%, the fetal morbidity being above -91%. Page 347. (Hugo Ehrenfest, M.D.) - - - _A TEXT BOOK OF OBSTETRICS. Barton Cooke Hirst, M.D., Professor of - Obstetrics in the University of Pennsylvania; Gynecologist to the - Howard and Orthopaedic and Philadelphia Hospitals, etc. W. B. - Saunders Co., Philadelphia and London, 1912._ - -Syphilitis as the most frequent cause of habitual death of the fetus -must be excluded before another cause is sought. P. 352. - -Of 657 pregnancies in syphilitic women collected by Charpentier 35% -ended in abortion, and of the children that went to term a large number -were stillborn. Of 100 conceptions in syphilitic women only seven -children were alive a year later. P. 333. - - - _PRACTICAL OBSTETRICS. Thomas Watts Eden, Obstetrical Physician and - Lecturer on Midwifery and Gynecology, Charing Cross Hospital; - Consulting Physician to Queen Charlotte’s Lying-in-Hospital; - Surgeon to In-Patient Hospital for Women. 4th Edition. C. V. Mosby - Co. 1915._ - -Of all the systematic causes of abortion however, the most important in -all respects is syphilis. In all probability more abortions are due to -this disease than to any other cause. P. 220. - -It will be clear from this enumeration of the conditions which cause it -that abortion is not an uncommon event. From some recent statistics -presented by Professor Malins to the Obstetrical Society of London it -appears that in this country about 16% of pregnancies terminate by -abortion, i.e., one abortion occurs to every five births of viable -children, and further, it appears that abortion is nearly twice as -frequent among the classes from which hospital patients are drawn as -among the well-to-do. Women who are the subjects of syphilis or Bright’s -disease often sustain a succession of abortions without carrying any -pregnancy to term. P. 221. - - - _THE PRINCIPLES AND PRACTICE OF OBSTETRICS. Jos. B. De Lee, M.D., - Professor of Obstetrics at the Northwestern University Medical - School; Obstetrician to the Chicago Lying-in-Hospital and - Dispensary and to Wesley and Mercy Hospitals, etc. W. B. Saunders - Co. 1913._ - -Premature labor is produced by the same factors that bring on abortion, -but syphilis plays the most common role here, it being estimated that -from 50% to 80% of the cases are thus caused. Next comes nephritis. -Habitual abortion means that successive pregnancies are interrupted at -the same period of development. Syphilis is usually found as the active -factor and more especially in miscarriages of the later months. Each -successive abortion occurs at a later period until a living child is -born, but it perishes from congenital syphilis, and finally the disease -has become so attenuated that a viable child is born. P. 419. - -Obstetricians should constantly be on the alert for this protean -disease. Its baneful action is often discovered when least expected and -it spreads its blight on all three individuals concerned in the -procreation of the species, often being transmitted to the second -generation. Ricord says that in Paris one in eight is syphilitic, and -while in America conditions are better, the disease is not rare and in -its lesser manifestations quite common, though often not diagnosed. P. -482. - -Interruption of gestation is the commonest symptom (of syphilis) and von -Winckel found 61% fetal mortality. P. 483. - - - _THE PRACTICE OF OBSTETRICS. Designed for the use of Students and - Practitioners of Medicine. J. Clifton Edgar, Professor of - Obstetrics and Clinical Midwifery in the Cornell University - Medical College; Visiting Obstetrician to Bellevue Hospital, New - York City; Surgeon to the Manhattan Maternity and Dispensary; - Consulting Obstetrician to the New York Maternity and Jewish - Maternity Hospitals. 5th Edition Revised. P. Blakiston’s & Co., - Philadelphia._ - -This (syphilis) is one of the most common causes of abortion. P. 321. - -The causes of interrupted pregnancy may be placed in three classes. The -maternal causes are divisible into systemic and the local. The systemic -causes include obesity, marriages of consanguinity, _pregnancies in -rapid succession_, etc., and the toxemia of kidney insufficiency. The -local causes include all cases of acute and chronic pelvic congestion. -P. 332. - -Chief among the paternal causes is syphilis, tuberculosis, extreme youth -or old age, great constitutional depression, exhaustion from any cause. -P. 333. - - - _MEDICAL GYNECOLOGY. Howard Kelly, A.B., M.D., LLD., F.R.C.S., - Professor of Gynecological Surgery in Johns Hopkins University, - and Gynecologist to the Johns Hopkins Hospital; Fellow of the - American Gynecology Society; Honorary Fellow of the Edinburgh - Obstetrical Society; Hon. Fellow Royal Academy of Medicine in - Ireland; Fellow British Gynecology Society, etc., etc., etc. D. - Appleton & Co., New York and London, 1912._ - -The susceptibility of syphilis to hereditary transmission is a -fundamental character of the disease. It may be transmitted to the -offspring directly by the infected sperm of the father, or from the -infected ovule of the mother at the time of impregnation, or the -infective principle may be conveyed through the medium of the -utero-placental circulation during the course of pregnancy. P. 432. - -Whether the infection is communicated through the sperm solely, the -ovule, or the utero-placental circulation, the uterine death of the -fetus is the most habitual expression of hereditary syphilis. Hereditary -syphilis is one of the most common causes of abortion. P. 434. - -Clinical observation shows most conclusively that certain dystrophies -and organic defects in the subjects of hereditary syphilis may be -transmitted to the third generation. P. 436. - -While we cannot conclude that syphilis is transmitted in its essential -nature as a virulent contagious disease, to the third generation, yet it -is well known that heredo-syphilis kills the product of conception, or -transmits to the survivor an impaired vitality with various dystrophies, -and thus constitutes a chief factor in the physical, mental and moral -degeneration of the race. From an exhaustive study of heredo-syphilis, -Tarnowsky concludes that syphilis has an incomparably more fatal -influence upon the species and on society than on the individual. P. -437. - - - _PRINCE A. MORROW, M.D. Eugenics and Racial Poisons. Pamphlet - published by the Society of Sanitary and Moral Prophylaxis, 105 W. - 40th St., New York. 1912._ - -Syphilis is the only disease transmitted to the offspring in full -virulence, killing them outright, or blighting their normal development. -When the father alone is infected the mortality is about 38%. When the -mother also becomes infected the mortality averages from 60% to 80%. -Fully ⅓ of all infected children die within the first six months. Even -when the subjects of inherited syphilis successfully run the gauntlet of -diseases incident to infancy and childhood they do not always escape the -effects of the parental disease. They are subject to various organic -defects or stigma of degeneration, as they are termed. A final result of -hereditary syphilis is the inability to procreate healthy children. If -the subjects of inherited syphilis grow up and marry they are liable to -transmit the same class of organic defects to the third generation. - - - _FEWER AND BETTER BABIES, OR THE LIMITATION OF OFFSPRING. Wm. J. - Robinson, M.D., Chief of the Department Genito-Urinary Diseases - and Dermatology, Bronx Hospital and Dispensary; Fellow of the - American Medical Association and of the New York Academy of - Medicine._ - -There are thousands of syphilitic men and women who are perfectly safe -as far as their partner is concerned, but are not safe enough to become -parents. They cannot infect, but they must not give birth to children -for fear that the children may have the taint in them. The use of -preventives settles this problem and saves the world from thousands of -pitiable hereditary syphilitics. P. 126. - - - _MEDICAL GYNECOLOGY. Howard A. Kelly._ - -Two fundamental characteristics, contagiousness and susceptibility of -hereditary transmission, give to syphilis an altogether special -importance in relation to marriage. The statement has been made that -syphilis constitutes a far greater danger to Society and the race than -to the individual. The chief significance of syphilis as a racial danger -comes from its hereditary effects. In addition, hereditary syphilis -undoubtedly creates a terrain, or soil, favorable for the reception and -germination of tubercle bacilli, and perhaps other bacilli. It does this -by impoverishing the organism and diminishing the capacity of resistance -against microbic invasion. From the view point of race perpetuation, -syphilis is antagonistic to all the family represents in our social -system. The essential aim of marriage is not simply the procreation of -children, but of children born in conditions of vital health and -physical vigor. The effect of syphilis is to so vitiate the procreative -process as to produce abortions, or else a race of inferior beings, -endowed with defects and infirmities and unfit for the struggle of life. -It is this pernicious effect of syphilis upon the offspring which gives -to the disease a dominant influence as a factor in the degeneration and -depopulation of the race. P. 444. - -When a married man has syphilis the first indication is to prevent -contamination of his wife, the second is to guard against pregnancy. The -interdiction of pregnancy should be absolute until time and treatment -have exerted an attenuating and curative influence upon the diathesis. -P. 448. - -A consultation of the works of most authorities shows them to agree that -the frequency of abortion to births at full term is from one in five or -six to one in ten. P. 453. - - - _SOCIAL DISEASES AND MARRIAGE. Social Prophylaxis. Prince Morow, M.D., - Emeritus Professor of Genito Urinary Diseases in the University - and Bellevue Hospital Medical College, New York; Surgeon to the - City Hospital; Consulting Dermatologist to St. Vincent’s Hospital, - etc. Lea Bros. & Co., New York and Phil., 1904._ - -The influence of inherited syphilis is manifest in the production of -various dystrophies, malformations, and lesions of important organs, it -seriously compromises the physical development, mental vigor and vital -stamina of the descendants and constitutes a harmful factor in the -degeneration of the race. The social aim of marriage is not simply the -production of children who are to continue the race, but of children -born in conditions of vitality and physical health fit to produce a race -well-formed and vigorous, not to procreate beings malformed and stamped -with physical and mental infirmity, destined to early death, or to drag -out a miserable existence of invalidism. P. 21. - -The statistics of European observers which have been collected from both -private and hospital practice show in a most positive manner the noxious -influence of syphilis upon the offspring. An analysis of these -statistics taken from all quarters and aspects of the social condition -of the parents show that when both parents are infected the mortality is -68 per 100. P. 27. - -No other disease is so susceptible of hereditary transmission, so -pronounced in its influence, and so fatal to the offspring. - -While death in utero may occur as the most habitual expression of -hereditary syphilis, its lethal influence is not limited to the period -of intra-uterine existence. The child may be born alive, but in many -cases the sentence of death is not commuted, it is simply reprieved, it -may be for a few months, weeks, or only days. P. 212. - - - _THE WORLD’S SOCIAL EVIL. A Historical Review and Study of the - Problems Relating to the Subject. Wm. Burgess. With Supplementary - chapter on a constructive policy by Judge Harry Olson, Chief - Justice Municipal Court, Chicago. Saul Bros., Publishers, Chicago, - 1914._ - -Based upon statements, experiences and opinions of physicians, public -officials and other responsible persons, 50% to 80% of all men between -the ages of 18 and 30 years contract gonorrhea. 10% to 18% of the male -population contract syphilis. 40% to 60% of all operations upon women -for diseases of the generative organs result from gonorrheal infection. -80% of the inflammatory diseases peculiar to women are the result of -gonorrheal infection. A large per cent., some say one half, of still -born and premature deaths of children is due to syphilis. 25% to 35% of -all cases of insanity are caused by syphilis contracted years before. -15% to 20% of all blindness is attributed to these diseases. P. 159. - - - _A CONSTRUCTIVE POLICY WHEREBY THE SOCIAL EVIL MAY BE REDUCED. Harry - Olson._ - -The large group of mentally retarded persons who may be included in the -term “sub-normal” number in this country, according to the best -authorities about 300,000. An important distinction must be made between -two groups of the defective classes, those who may, and those who should -not enjoy social privileges as members of the community. From a racial -and eugenic point of view the inborn, or heredity defectives are by far -the most important because the defect is germinal and therefore -transmissible to the offspring. This class forms 75% or more of the -defective classes. When so many as 75% of the feeble-minded are such by -reason of germinal or hereditary taint, and since perhaps 50% of the -women of the underworld are sub-normal, it becomes at once apparent that -not only in order to reduce the number of women in public prostitution, -but also to protect the race itself, we must adopt other methods of -eliminating vice than those now employed. P. 358–359. - - - _PROCEEDINGS OF THE NATIONAL CONFERENCE ON RACE BETTERMENT. January - 8–12, 1914. Published by the Race Betterment Foundation. Edited by - the Secretary._ - -Statistical Studies. The Significance of a Declining Birth Rate. -Frederick L. Hoffman, Statistician of the Prudential Insurance Company, -Newark, N. J. - -From an economic and social point of view a low birth rate and a low -death rate would unquestionably be more advantageous than the opposite -condition, which involves much needless waste of human energy and -pecuniary expenditure. For reasons which require no discussion, every -civilized country desires a normal increase in population, though a high -degree of social and economic well-being is not at all inconsistent with -even a stationary population condition such as for some years past has -prevailed in France. P. 23. - -All the available statistical information seems to justify the -conclusion that the world’s population in general, and of the more -civilized countries in particular is increasing at the present time at a -more rapid rate than in earlier years—a condition largely the result of -a persistent and considerable decline in the birth rate. P. 28. - -The important causes of death which have increased during the five years -ending 1910, as compared with the previous five years, are briefly the -following:—Syphilis increased from 4.1 to 5.4, per 100,000 of -population. Cancer, and other malignant tumors from 11.5 to 13.7; -locomotor ataxia, and other diseases of the spinal cord from 7.3 to 8.4; -all diseases of the circulatory system combined from 161.2 to 171.7; -ulcers of the stomach from 2.9 to 3.6; diarrhea and enteritis under two -years, from 89.0 to 96.2; diseases of the puerperal state considered as -a group from 14.2 to 15.5; malformations, chiefly congenital, from 12.2 -to 14.9; diseases of early infancy, chiefly congenital debility and -premature births, from 73.9 to 75.0. P. 45. - - - GONORRHEA - - - _THE PRACTICE OF OBSTETRICS. In Original Contributions by American - Authors. Edited by Reuben Peterson, A.B., M.D. Lea Bros. & Co., - Phil. and New York. 1907._ - -The reciprocal relation of gonorrhea and pregnancy is most unfavorable. -Gonorrhea exerts a very unfavorable effect upon pregnancy and is -responsible for a large number of abortions in the early months. Finally -the gonococcus is a great source of danger to the fetus whose eyes may -become affected during his passage through the diseased maternal parts. -P. 373. - - - _THE PRINCIPALS AND PRACTICE OF OBSTETRICS. Jos. B. De Lee, M.D., - Professor of Obstetrics at the Northwestern University Medical - School; Obstetrician to the Chicago Lying-in-Hospital and - Dispensary and to Wesley and Mercy Hospitals, etc. W. B. Saunders - Co. 1913._ - -Abortion is probably often the result of gonorrhea, acute or chronic. -Chronic endometritis is most often the result of gonorrhea. P. 516. - - - _THE SEXUAL LIFE OF WOMAN IN ITS PHYSIOLOGICAL, BIOLOGICAL AND - HYGIENIC ASPECTS. E. Heinrich Kisch, Professor of the German - Medical Faculty of the University of Prague, Physician to the - Hospital and Spa of Marienbad; Member of the Board of Health, etc. - Translated by M. Eden Paul, M.D. Rebman Co., New York._ - -The physician should lend his skilled assistance in producing -facultative sterility only when his own special scientific knowledge -leads him to consider this urgently necessary. A woman’s life and well -being must appear to him of greater importance than the existence, or -non-existence of a possible infant. That this view is morally sound is -shown by the fact that public opinion justifies the accoucheur in the -destruction of a living child when the mother’s life is in danger. P. -395. - - - _EUGENICS AND RACIAL POISONS. Prince A. Morrow, M.D., Emeritus - Professor of Genito Urinary Diseases in the University and - Bellevue Hospital Medical College, New York; Surgeon to the City - Hospital; Consulting Dermatologist to St. Vincent’s Hospital, etc. - Lea Bros. Co., New York and Philadelphia, 1904._ - -While the gonococcus is not transmissible through heredity it carries -with it serious infective risks to the offspring. Fully 80%, and some -authorities declare practically all of the blindness of the new born is -caused by the gonococcus. - - - - - CHAPTER VIII - OTHER TRANSMISSIBLE DISEASES AND PAUPERISM - - -_When authorities prohibit marriage for the unfit, they have in mind the -probable fruits of such marriage. Women suffering from the diseases -mentioned in this chapter give birth to children mentally and physically -inferior, likely to sink into pauperism and certain to be in some way a -burden upon society. If physicians were free to instruct parents how to -prevent conception, the reproduction of their kind by defective and -diseased parents living outside of institutions would be eliminated as a -social problem._ - - - INSANITY - - - _DR. S. ADOLPHUS KNOPF IN THE SURVEY FOR NOVEMBER, 1916_ - -That insanity, idiocy, epilepsy and alcoholic predisposition are often -transmitted from parent to child is now universally admitted and -corroborated by every-day experience and by an abundance of statistics. -Countless are the millions of dollars expended for the maintenance of -these mentally unfit. The state of New York alone spends $2,000,000 -annually for the care of its insane. Whether sterilization of these -individuals would be the best remedy is a question still open for -discussion. The constitutionality of the procedure is doubted by some of -our legal authorities. Segregation is resorted to in the meantime with -more or less rigor according to state laws. Every year, however, many of -the individuals who had been committed to institutions for the treatment -of mental disorders are discharged as cured. They are allowed to -procreate their kind. Would it not be an economic saving if at least the -individuals whose intelligence has been restored were instructed in the -prevention of bringing into the world children who are most likely to be -mentally tainted and to become a burden to the community? - -Of approximately every 500 persons in the United States in 1910, there -was one an inmate of an insane asylum. - -The exact figures expressed in a recent report (Hill, Joseph A. Report -on the Insane in the United States, Bureau of the Census, Department of -Commerce) that in a typical community of 200,000 persons, equally -divided as to sex, 208 of the males and 200 of the females would be -found in the insane asylums. In the course of a year 72 males and 60 -females would be admitted to the asylums. - -In 1880 the total of inmates in insane asylums in the United States -included 20,695 males and 20,307 females. In 1910, thirty years later, -the number of male inmates had increased to 98,695 and the number of -female inmates to 80,096. The excess of men among admissions in 1910 -indicated a still further increase in the proportion, namely, 128 males -to 100 females. - - - _BEING WELL-BORN. An Introduction to Eugenics. Michael F. Guyer, Prof. - Zoology, University of Wisconsin. Bobbs-Merrill Co., Indianapolis, - Ind. 1916._ - -The records of the inheritance of insanity, imbecility, -feeble-mindedness and other forms of nervous and mental defects are -truly startling. Active researches in this field have been in progress -now for several years, and as each new set of investigations comes in -the tale is always the same. It is questionable if there is a single -genuine case on record where a normal child has been born from a union -of two imbeciles. Yet the universal tendency is for defective to mate -with defective. Davenport gives a list of examples, beginning with such -a one as this: “A feeble-minded man of thirty-eight has a delicate wife -who in twenty years has borne him nineteen defective children.” Little -wonder, in the light of such facts as these, that the number of -degenerates is rapidly increasing in what are called civilized -countries. But it may be urged, these are exceptional cases, there is -surely no considerable number of mental defectives who are married. Let -us look at the available facts. In Great Britain in 1901, of 60,000 -known feeble-minded, imbeciles and idiots, 19,000 were married, and in -the same year, of 117,000 lunatics, 47,000 were married; that is a sum -total of 66,000 mentally defective individuals were legally multiplying, -or had had the opportunity to multiply their kind, to say nothing of the -unmarried who were known to have produced children. - -In the State of Wisconsin I note from the tenth Biennial Report of the -Board of Control that of 574 patients admitted to the Northern Hospital -for the Insane during the year from July 1st, 1908 to June 30th, 1909, -274 were married, and 29 others were known to have been married; this is -a total of 303 out of 574, considerably over half. At the Wisconsin -State Hospital for the Insane we find the conditions are no better, for -out of 499 admitted in the year of 1909–10, 208 were married and 65 -others had at some time been married, or a total of 273 out of 499. -There is every reason to believe that conditions are approximately -similar in other states. P. 231–232. - -One of the most disquieting facts in the situation in most states is -that many patients—an average of approximately 1,000 a year, in -Wisconsin for example—are on parole, subject to recall. This means that -although it is recognized that these patients are likely to have to be -returned to the asylum or hospital, little or no restraint in the -meantime is placed on their marital relations. P. 234. - - - _SOCIAL ASPECTS. Wm. E. Kellicott._ - -In the U. S. the census of 1880 reported 40,942 insane in hospitals, and -51,017 not in hospitals, a total of 91,959 known insane. In 1903 the -number in hospitals had increased to 150,151. The number not in -hospitals was not known and cannot be determined accurately, but it is -conservatively estimated as certainly not less than 30,000, and probably -it is far greater than this. But taking a total of 180,000 known insane -as a conservative figure, the ratio of known insane in the total -population was 225 per 100,000 in 1903, as compared with 183 per 100,000 -in 1880. P. 33. - -The latest census reports for the U. S. give data relative to the -dependents and defective in institutions. Insane and feeble-minded, at -least 100,000; paupers in institutions 80,000, ⅔ of whom have children -and are also physically and mentally deficient: prisoners 100,000; -juvenile delinquents 23,000 in institutions; the number cared for in -hospitals, dispensaries, homes of various kinds in the year 1904 was in -excess of 2,000,000. From these figures we get a rough total of nearly -3,000,000. The foregoing are representative data:—they are published by -the volume. It is always the same story—rapid increase of the unfit, -defective, insane, criminal, slow increase, even decrease, of the normal -and gifted stocks. It is with such conditions in mind that Whetham -writes: “This suppression of the best blood of the country is a new -disease in modern Europe; it is an old story in the history of nations, -and has been the prelude to the ruin of states and the decline and fall -of empires.” P. 35. - - - _EUGENICS RECORD BULLETIN. No. 5. A Study of Heredity of Insanity in - the Light of the Mendelian Theory. A. J. Rosanoff, M.D., and - Florence I. Orr, B.S. Reprinted from American Journal of Insanity. - Vol. XXVIII ... 1911. Cold Spring Harbor, N. Y._ - -In the report of the year ending September 30th, 1909, the New York -State Commission in Lunacy gives the number of insane patients in state -hospitals and private institutions as 31,540, or one to 276 in the -general population. This figure does not include the inmates of -institutions for the feeble-minded and for epileptics, it does not -include the neuropathic subjects who find their way into prisons, -reformatories, almshouses, dispensaries, hospitals for incurables, -general hospitals, neurological clinics, etc., and above all, it does -not include the many neuropathic subjects whose infirmities are latent, -or of such nature as not to incapacitate them for ordinary occupations -and life at large. P. 245. - - - _EUGENICS RECORD OFFICE. Bulletin No. 10 A. Report of the Committee to - study and to report on the best practical means to cut off the - defective germ-plasm in the American population. The scope of the - Committee’s work. By Harry H. Laughlin, Secretary to the - Committee. Cold Spring Harbor, N. Y. 1914._ - -According to the last census, 1910, .914% of the total population, or -841,244 persons, were inmates of institutions in the anti-social and the -unfortunate classes in the U. S. Besides these persons who have been -committed to institutions, there are many others of equally unworthy -personality and hereditary qualities, who have, through the caprice of -circumstances never been committed to institutions. In so far as the -defective traits of the members of these varieties are inborn, they are -to be cut off only by cutting off the inheritance lines of the strains -that produce them. This is the natural outcome of an awakened social -conscience, which is in keeping, not only with humanitarianism, but with -law and order and national efficiency. Society must look upon germ-plasm -as belonging to Society, and not solely to the individual who carries -it. Humanitarianism demands that every individual born be given every -opportunity for decent and effective life that our civilization can -offer. Racial instinct demands that defectives shall not continue their -unworthy traits to menace Society. There appears to be no compatibility -between the two ideals and demands. P. 15–16. - - - _J. H. KELLOGG, LLD., M.D., Superintendent of Battle Creek Sanitarium, - Battle Creek, Mich._ - -A careful study of the returns of the Registrar General of England, -according to Dr. Tredgold, an eminent English authority shows that out -of every 1,000 children born to-day, as many infants die from “innate -defects of constitution” as 50 years ago, and this notwithstanding that -the total death rate of infants has been diminished nearly ⅓. The -increase of insanity, is cited by Dr. Tredgold, as another evidence of -race degeneracy. While the increase of the population of England and -Wales in 52 years has been 85.8%, the increase of the certified insane -has been 262.2%. At present there is one insane person to 275 of the -normal population of England and Wales. Tredgold shows that mental -unsoundness, lunacy, idiocy, imbecility and feeble-mindedness may be -traced to hereditary influence in 90% of the cases. Mr. David Heron and -others have shown that while there has been a marked decline in the -birth rate in the population in general, the diminution is almost -entirely confined to the healthy and thrifty class. In a section of -population numbering a million and a quarter persons, thrifty and -healthy artisans, the decline in the birth rate in 24 years, 1889—1904 -was over 52%, or three times that in England and Wales as a whole. Study -of a large number of families of the working class of incompetent and -parasitic character found that the average number of children to the -family was 7.4, while in thrifty and competent working families, the -number was 3.7. In other words, the incompetent and defective classes -are multiplying much more rapidly than are the competent and efficient. -P. 440. - - - _THE INCREASE OF INSANITY. James T. Searcy, A.B., M.D., LLD., - Superintendent Alabama Hospitals for Insane. First National - Conference on Race Betterment. January, 1914._ - -The population of the State of Alabama, according to the census during -the ten years which the census includes, insanity increased 16%; the -admissions into the insane hospitals increased 45%. These are appalling -figures, and we can parallel them all over the U. S., not like them -exactly in each state, for they differ. The general population of the U. -S. increased 18%, and that of the insane hospitals increased 28% during -the years of the census. P. 167. - - - EPILEPSY - - - _THE PRACTICE OF OBSTETRICS. Joseph De Lee, M.D._ - -Epilepsy may practically be regarded as an in-hereditary affection, and -children of one subject to this disorder are almost sure to be -epileptic. Under no circumstances should parents who are both epileptics -bring children into the world. - - - _THE PRACTICE OF OBSTETRICS. In Original Contributions by American - Authors. Edited by Reuben Peterson, A.B., M.D., Prof. of - Obstetrics and Gynecology in the University of Michigan, Ann - Arbor, Mich.; Obstetrician and Gynecologist-in-Chief to the - University of Michigan Hospital. Lea Bros. & Co., Phil. and New - York. 1907. Chapter XIX._ - -Marriage should always be discouraged on account of the marked tendency -of epilepsy to be transmitted to the offspring. In all grave cases, -marriage, or new impregnation, should be prohibited. P. 363. (Hugo -Ehrenfest, M.D.) - - - ALCOHOLISM - - - _PARENTHOOD AND RACE CULTURE. An Outline of Eugenics. C. W. Saleeby, - M.D., Ch.B., F.Z.S., F.R.S., Edinburgh; Fellow of the Obstetrical - Society of Edinburgh; Member of Council of the Eugenics Education - Society; of the Psychological Society, and of the National League - for Physical Education and Improvement; Member of the Royal - Institution and of the Society for the Study of Inebriety, etc., - etc. Cassell & Co., Ltd., London, N. Y., Toronto and Melbourne. - 1909._ - -A foremost authority, Dr. F. W. Mott, has independently reached the same -conclusion as Dr. Branthwaite, that the chronic inebriate comes as a -rule of an inherently tainted stock. Dr. Mott, however, reminds us that -if alcohol is a weed killer, preventing the perpetuation of poor types, -it is probably even more effective as a weed producer. Professor David -Ferrier, the great pioneer of brain localisation, in reference to these -people speaks of the “risk of propagation of a race of drunkards and -imbeciles.” Dr. J. C. Dunlop, Inspector under the Inebriates Act, -Scotland, states that his experience leads him to precisely the same -conclusion as that of Dr. Branthwaite. Dr. A. R. Urquhart, an Asylum -authority, affirms that chronic inebriety is largely an affair of habit, -is a symptom of mental defect, disorder, or disease. Dr. Fleck, another -authority, says, “It is my strong conviction that a large percentage of -our mentally defective children, including idiots, imbeciles and -epileptics, are the descendants of drunkards. Mr. McAdam Eccles, the -distinguished surgeon agrees; so does Dr. Langdon Down, physician to the -National Association for the Welfare of the Feeble-minded; so does Mr. -Thos. Holmes, the Secretary of the Howard Association.” - - - _MARRIAGE AND GENETICS. Laws of Human Breeding and Applied Eugenics. - Chas. A. L. Reed, M.D., F.C.S.; Fellow of the College of Surgeons - of America; Member and former president of the American Medical - Association; Professor in the University of Cincinnati. The Galton - Press, Cincinnati, Ohio._ - -The present demand for alcohol is generally the demand of the system for -something with which to make up for some persistent defect. In other -words, alcoholism is the sign and index of some form of degeneration. -Thus the degeneracy that finds expression in alcoholism in one -generation may be manifested in the next in the form of epilepsy, -feeble-mindedness, insanity, immorality, or criminality. Unfortunately, -alcoholism does not seem to lessen the fecundity of its victims. The -quality of their progeny is, however, progressively lowered. It is due -to the combined influence of transmitted degeneracy and the pernicious -effect of environment. As a genetic factor, alcoholism, considered in -its immediate relation to the marriage state may be summarised as -follows:— - -1—The chronic alcoholist generally develops lowered sexual efficiency. - -2—General failure of sexual power, associated with strong desire, -generally manifested by alcoholics, often results in sexual promiscuity, -associated with perversion. - -3—Progressive alcoholism destroys the normal psychic type and thus -breaks up family ties. - -4—Lowered general efficiency of alcoholics tends to pauperism and crime. - -5—Lowered general resistance of alcoholics makes them the easier prey of -infections and shortens their expectancy of life. - -6—Alcoholism is a germinal defect, the degeneracy underlying which is -transmitted in some form to 100% of the progeny of two alcoholic -parents. - -Marriage with or between degenerates of the alcoholic type is advised -against and should be prohibited by law. P. 125–126. - -Pauline Tarnowsky in _Etudes Anthrope metriques sur le Prostitutees_ -1887 gives figures derived from measurements of fifty prostitutes in -Petrograd in which she found four-fifths of her cases were offspring of -alcoholic parents while one fifth were the last survivors of very large -families. - - - _THE PRACTICE OF OBSTETRICS. In Original Contributions by American - Authors. Edited by Reuben Peterson, M.D._ - -A chronic state of intoxication may be found in patients (Mothers) with -such bad habits as alcoholism, morphinism, cocainism, etc., and in -sufferers of trade poisoning, plumbism, nicotism of workers in tobacco -factories, etc. Most of these diseases are characterized by a tendency -to abortion and a high infantile mortality and morbidity. P. 368. - -It is generally admitted that the effect of chronic alcoholism upon -pregnancy is most harmful. On account of the frequency with which -drunkards are afflicted with venereal diseases, especially syphilis, it -is almost impossible to obtain reliable statistics and exact figures, -but the fact has been established that chronic alcoholism predisposes -the woman to abortion, and that the children of dipsomaniac parents show -a strikingly large percentage of malformations and mental abnormalities, -especially imbecility and epilepsy. P. 370 (Hugo Ehrenfest, M.D.) - - - _THE PATHOLOGY OF THE FETUS. Aldred Scott Warthin, M.D. (The Practice - of Obstetrics, in original Contributions by American Authors, Ed. - by Reuben Peterson, M.D.)_ - -Of the antenatal treatment of fetal diseases we at present know little -or nothing, but there can be no doubt that a wonderful field is here -offered to the medicine of the future. According to our present -knowledge such germinal and fetal therapeutics must be chiefly in the -line of prevention. We are already in a position to apply some knowledge -toward this end. The effects upon the fetus of intoxications, such as -plumbism, alcoholism, etc., may be avoided. The production of syphilitic -offspring may be restricted, and our knowledge of the later effects upon -the fetus of certain diseases, or pathologic states of one or both -parents may be utilized toward the bringing into existence of progeny -under such conditions as to escape such evils. Our knowledge of -heredity, of morbid conditions and predispositions should also be -brought to bear upon the question of marriage and fitness to produce -healthy children. Moral, as well as physical considerations should here -be gravely weighed. The health of parents, the hygiene of pregnancy -throughout its entire course, etc., are important factors in the -improvement of the race, to which the coming civilization and the new -medicine must give increasing attention. P. 535. - - - _THE SEXUAL LIFE OF WOMAN IN ITS PHYSIOLOGICAL, BIOLOGICAL AND - HYGIENIC ASPECTS. E. Heinrich Kisch. Rebman Co., New York._ - -A woman with a tendency to alcoholism should under no circumstances be -allowed to marry. In the cases, fortunately rare, in which the drink -craving exists in women, marriage is even more undesirable than it is in -the case of men similarly afflicted, for the female drunkard is in a -position in which she can mishandle and neglect her children throughout -the entire day. P. 258. - - - _RASSENVERBESSERUNG. Translated from the Dutch of Dr. J. Rutgers. - Second Edition. Dresden, 1911._ - -Pelman examined 709 of the 834 descendants of an alcoholic vagrant, -named Ada Inke, who died in 1740. Among these were found 106 -illegitimate children, 142 were vagrant beggars, 64 were charity -dependents, 181 prostitutes, 96 were tried for various offenses, among -these 7 were for murder. These descendants during 75 years cost the -State 5,000,000 marks. P. 97. - -August Forel, who for years was the psychiatrist at the head of a large -insane asylum at Zurich, Switzerland, has this to say about the effects -of narcotic poisons and alcohol in particular: “The offspring tainted -with alcoholic blastophthoria suffer various bodily and physical -anomalies, among which are dwarfism, rickets, a predisposition to -tuberculosis and epilepsy, moral idiocy in general, a predisposition to -crime and mental diseases, sexual perversions, loss of suckling in -women, and many other misfortunes. But what is of much greater -importance is the fact that acute and chronic alcoholic intoxication -deteriorates the germinal protoplasm of the procreators.” - - - _MICHAEL F. GUYER, Ph.D., Professor of Zoology, University of - Wisconsin in “Being Well Born.”_ - -In an investigation on the effects of parental alcoholism on the -offspring, Sullivan (Journal of Mental Science, Vol. 45, 1899) gives -some important figures. To avoid other complications he chose female -drunkards in whom no other degenerative features were evident. He found -that among these the percentage of abortions, still-births and deaths of -infants before their third year was 55.8% as against 23.9% in sober -mothers. In answer to the objection that this high percentage may be due -merely to neglect, and not to impairment of the fetus by alcoholism, he -points out the fact, based on the history of the successive births, that -there was a progressive increase in the death-rate of offspring in -proportion to the length of time the mother had been an inebriate. P. -169. - - - _A TEXT BOOK OF OBSTETRICS. Barton Cooke Hirst, M.D., Professor of - Obstetrics in the University of Penn.; Gynecologist to the Howard, - the Orthopaedic and the Phil. Hospitals, etc. 7th Edition. W. B. - Saunders Co., Phil, and London, 1912._ - -The effect of chronic diseases of the mother upon the fetus. Women -affected with tuberculosis, cancer, or chronic malarial poisons may give -birth to a succession of dead children. P. 353. - -Fetal mortality exceeds that of any other period of life. For every four -or five labors there is one abortion, and if to this number is added -still-births the proportion of fetal deaths to living births is larger. -P. 332. - - - _THE DISEASES OF SOCIETY AND DEGENERACY. G. F. Lydston, M.D._ - -That a multiplicity of children in poverty-stricken families often -impels to abortion, is evident. The necessary evils of our prohibitive -laws and ethics bearing upon illegitimacy, are obvious; viz: - -First, and worst, is infanticide, committed usually before, but only too -often after birth. In the latter category I would place abandoned -children who die of exposure or starvation, and the bulk of mortalities -in foundling asylums and for baby farms. The social ostracism placed -upon the mother is a prime factor in this child’s murder. Condemnation -and shame are hers if she allows nature to take its course, and the -penalty of infanticide stares her in the face if she interferes with the -conception. A rarely anomalous state of affairs this. - -Second—The brand of infamy placed upon the unborn child, from which only -its murder can save it. - -Third—The prostitution or suicide of the woman who is found out. - -Branded with ignominy from the moment of conception, a burden to -society, and a still greater burden to its parent, or parents from the -moment of its birth, with no systematic endeavor on the part of society -to prevent its growing up a criminal, a drunkard, a pauper, a -prostitute, or a physical wreck, what wonder that many a poor woman’s -fingers become too tightly entwined around her offspring’s neck. If her -motive for the act were always as altruistic as its consequences, so far -as the child’s welfare is concerned, there are some clear-minded -thinkers in the world who could not be brought to judge her harshly. P. -371. - -The rights of the unborn will one day be considered. Until they are so -considered, and practical efforts made to secure them, we cannot hope -for much improvement in the prevention of degeneracy. P. 559. - - - _AMERICAN JOURNAL OF DISEASES OF CHILDREN, November 1914. Vol. 8, pp. - 327–335. Question of Hereditary syphilis as a social problem._ - -Of all deaths of infants in St. Louis in 1913, 1,070 were illegitimate. - -Of all deaths in infants due to syphilis 1,550 were illegitimate. - - - _AUGUST FOREL. The Sexual Question. A Scientific, Psychological, - Hygienic and Sociological Study. Translated by C. F. Marshall, - M.D., F.R.C.S., Late Assistant Surgeon to the Hospital for - Diseases of the Skin. London._ - -The stigma of shame which has branded all illegitimate maternity -unfortunately justifies the many cases of abortion, and even -infanticide. Things ought to change in this respect, and in the future -no pregnancy ought to be a source of shame for any healthy woman -whatever, nor furnish the least motive for dissimulation. P. 411. - - - _THE SMALL FAMILY SYSTEM. C. V. Drysdale, D.Sc._ - -ILLEGITIMACY.—As far as statistics are concerned, the most valuable -evidence is that relating to illegitimacy. The Registrar General’s -Reports contain a useful amount of information upon this point, and give -us the number of illegitimate births per thousand unmarried women within -the fertile period, between the ages of 15 and 45. This illegitimacy -rate for England and Wales is represented in Fig. 13, and it is -noticeable that the fall since the year 1876 has been extremely rapid, -much more so in fact than that of the fall in the general birth-rate or -in the fertility rate of the married women. While the general birth-rate -has fallen from 36.3 to 25.6 (or by 26.5 per cent.), the illegitimate -birth-rate has fallen from 14.6 to 7.9 per thousand unmarried women (or -by nearly 50 per cent.). This is most striking and satisfactory. An -extreme instance is given in the county of Radnorshire, which in 1870–2 -had a fertility rate of 308.6 births per 1,000 married women, which sank -to 188.7 in 1909, or by 39 per cent. In the same interval the -illegitimate birth-rate fell from 41.8 per 1,000 unmarried women to 7.2, -or by no less than 83 per cent. In Holland a drop of the legitimate -fertility from 347 to 315 per 1,000 coincided with a fall of the -illegitimate fertility from 9.7 to 6.8 per 1,000, _i.e._, at a much -greater rate. It is true that France, with its low and decreasing -fertility rate (from 196 to 158 per 1,000 between 1881 and 1901), has -had a comparatively high and increasing illegitimacy rate (from 17.6 to -19.1 per 1,000); and that Ireland, with a somewhat high and slightly -increasing fertility (from 283 to 289 per 1,000), has the lowest and a -falling illegitimacy rate (from 4.4 to 3.8 per 1,000). But this has been -heavily outweighed by Austria with an equally high and steady fertility -(from 281 to 284 per 1,000) with the highest illegitimacy rate known -(43.4 to 40.1 per 1,000), while Germany comes second with an -illegitimacy rate of 27.4 per 1,000 in 1901. Though it cannot be said, -therefore, that the lowest birth-rate produces the lowest illegitimacy -rate, it most certainly cannot be said that family limitation has had -any evil effect in increasing legitimacy. The bulk of the evidence is -quite decidedly the other way. In the case of the most notable -exception—that of France—we have the authority of Dr. Bertillon for -saying that the greatest decency and lowest illegitimacy are found where -the birth-rate is lowest. We may also quote from our own Registrar -General, who said in his Annual Report for 1909:— - - “Except in the cases of the German Empire, Sweden, France, - Belgium, and the Australian Commonwealth, the falls shown in - illegitimate fertility in Table LXXXIV are greater than the - corresponding falls in legitimate fertility.” - -So far as the evidence of illegitimacy is concerned, therefore, it may -be taken as definitely established that the adoption of family -restriction has not led to greater laxity among the unmarried. But it -would, of course, be quite unjustifiable to claim that this evidence is -final. It may not mean that there is less lax conduct but only that -there are fewer results of lax conduct. It is perfectly open for the -orthodox moralist to claim that the greater knowledge of preventive -methods has permitted an increase of laxity with a reduction of the -ordinary effects. This must remain a matter of conjecture. When we find, -however, that not only has illegitimacy decreased, but also deaths from -abortion and from the diseases ordinarily associated with irregularity, -there seems no justification whatever for the contention that chastity -has been relaxed. It must not be forgotten in this connection that the -encouragement to early marriage afforded by the possibility of avoiding -the economic burden of a too early or too large family affords the most -likely of all methods for removing the temptations to unchastity and for -conquering the hitherto untractable “social evil.” Although the average -age of marriage in this country has been rising somewhat lately -(probably on account of the increasing cost of living), it is -interesting to note that it is lower and fairly steadily decreasing in -France. For first marriages the average age at marriage of French men -has fallen from 28.6 in 1856 to 27.88 in 1896–1900, and of French women -from 24.25 to 23.5 in the same period. This cannot be regarded as -otherwise than a very good sign. - -(NOTE: It is noteworthy in this connection that the French marriage laws -are so strict that many thousands of couples live out of wedlock in -preference to complying with them.) - - - PAUPERISM - -We need not dwell upon this question, as the amount of pauperism depends -upon a large variety of circumstances. But it is satisfactory to note -that pauperism in England and Wales, _i.e._, the number of persons -relieved annually per thousand of the population, has fairly steadily -fallen from 34.5 in 1875 to 26.4 in 1910, or by 23.5 per cent. during -the period of the declining birth-rate. This is so far reassuring, in -that it indicates that the easier circumstances engendered by smaller -families do not lead to idleness, as is frequently contended. The -industry and saving habits of the French peasantry are world-renowned, -and it is worthy of note that France is almost the only country in which -the real wages of the working classes have been _increasing_ of late -years, while they have dropped 15 per cent. in this country, and nearly -25 per cent. in prolific Germany. - - - _THE REPORT OF THE POOR LAW COMMISSION. By Sir Edward Bradbrook, C.B. - Eugenics Review, Vol. 1, April 1909. Eugenics Education Society, - London._ - -The Commissioners throw a strong light upon the ineffectiveness of -existing measures when they show that the great and growing expenditure -upon education and upon the public health has had no result in reducing -pauperism, which is on the contrary of late years deplorably increasing, -and that the advance in the rate of wages, and the diminution in the -cost of living have been equally ineffectual. - -In the words of the Commissioners, children who are brought up in such -conditions, surrounded by disease and immorality and drunkenness are -almost doomed to pauperism. If relief be given it should be used to -check the creation of another generation of paupers. Much that is very -instructive is contained in the report on the subject of children who -come by one means or another to be under the control of the Guardians of -the Poor, and important suggestions are made for reforms in the manner -and training of such children. This, however, we need not discuss, as -the spread of eugenic principles would tend to reduce their number until -the time should come when the children dependent on public care should -be few and exceptional. In their discussion of the causes of pauperism, -the Commissioners quote a statement from a relief officer of Leeds, that -one of the most important causes is early marriage of persons dependent -upon casual labor. Large families are the rule. Unless we can cut off -some of the sources from which that stream is being fed, the attempt to -do more constructive work, whether by public assistance or by voluntary -charity will continue to be swamped by hopeless cases—men and women -ruined by bad habits or disease from infancy who propagate their own -misery and hand on another generation of hopeless cases to the future. A -great evil justifies strong measures to remedy it. This is true eugenic -doctrine. P. 47–50. - - - _THE METHODS OF RACE REGENERATION. C. W. Saleeby, M.D., CH.B., F.Z.S., - F.R.S., Edinburgh; Fellow of the Obstetrical Society of Edinburgh; - Member of Council of the Eugenic Education Society, of the - Psychological Society, and of the National League for Physical - Education and Improvement; Member of the Royal Institution and of - the Society for the Study of Inebriety, etc., etc. New Tracts for - the Times. Cassell & Co., Ltd., London, New York, Toronto and - Melbourne. 1911._ - -At the National Conference on the Prevention of Destitution, held in -London at Whitsuntide, 1911, we gathered together in the section dealing -with this subject a number of papers by authoritative writers, whose -knowledge of the problem is first-hand, and the following is an extract -from the paper, the Eugenic Summary and Demand, in which I endeavored to -express the substance of the evidence. The mentally defective and -diseased, existing in it and as part of it, injure the community in the -following ways: - -1—They contribute largely to the ranks of chronic alcoholism and -inebriety, with all their consequences. - -2—They contribute largely to the illegitimate birth rate, that is to -say, to the production of children for whose nurture, quite apart from -the question of their natural defect, adequate and satisfactory -provision is not, or indeed cannot be made. - -3—They contribute largely to the ranks of prostitution. - -4—They thus contribute largely to the propagation of the venereal -diseases, with all their consequences to the present and the future. - -5—They are responsible for much crime, major and minor. - -6—Both directly, as chronically inefficient, and indirectly, in the ways -here cited, they contribute to the number of the destitute, constituting -the majority of the naturally, as distinguished from the nurturally -unemployable. - -7—They contribute largely as parents, married or unmarried, to parental -neglect and cruelty to children which is probably more injurious to the -adult life of the next generation, than most, or any of us realize. - -8—They contribute largely to the ranks of the wastrel and the hooligan. -In such ways, and to such a degree these persons injure the community. -But it is particularly to be noted that therein the community also -injures them. The fact is obvious to all of us here. The injury wrought -by the present relations between the community and these unfortunate -persons is mutual, they injure it and it injures them. And not until we -recall the words of Burke, in the light of modern genetics, shall we -realize the full measure of this injury, for as that great thinker said, -a community is “a partnership, not only between those who are living, -but between those who are living and those who are dead, and those who -are to be born.” To the foregoing indictment of the present state of -things, and remembering that whatever is inherent is transmissible, I -therefore add: - -9—They become parents and thus contribute incalculably to the -maintenance of these evils after we are dead, but not after we are -responsible. P. 49–50. - -But it does not suffice to pursue positive methods, the encouragement of -parenthood on the part of the worthy, and negative methods, the -discouragement of parenthood on the part of the unworthy, if there be -any agencies in the world which are forever turning worthy stocks into -unworthy stocks. If there be such racial poisons, plainly we must stand -between healthy stocks and their influence. By the term racial poisons I -mean to indicate those agents, whatever they may be which, in greater or -less degree, injurious to individuals as individuals, prejudices their -subsequent parenthood. The racial poisons are very various, they include -substances inorganic, such as lead, organic, such as alcohol, and -organized, such as the living causes of certain forms of disease. -Circulating in the parental blood, they reach and injure the racial -tissues, or germ-plasm. P. 56. - - - _WOMEN AND LABOR. New York Evening World, May 8, 1917._ - -With American industry preparing to put women into the places of male -workers called to the war, it is a rather surprising thing to learn that -there already are 7,438,686 women in the United States who earn their -own living. Of these no less than one-fourth are married. Here are the -figures: Single, 4,401,000; married, 1,890,626; widowed or divorced, -1,147,060. - -In 1900 only 4,833,630 women left their homes to work, showing an -increase of approximately one-half since then. - -In 1890 the married formed 14.3 per cent. of all women sixteen years of -age and over engaged in gainful occupations. By 1900 this proportion had -increased to 15.9 per cent. From 1900 to 1910 it jumped to the -unprecedented proportion of 25.4 per cent. While there were important -variations, the great increase was not confined to any one occupation or -group of occupations, nor to any one State or group of States. In every -occupation examined the married formed a larger proportion of all women -sixteen years of age and over in 1910 than in 1900. - -The proportions were exceptionally high in the South and Arizona—50.8 -per cent. in South Carolina, 46.8 per cent. in Georgia, 46.7 per cent. -in Florida, 47.4 per cent. in Alabama, 54.2 per cent. in Mississippi, -45.6 per cent. in Arkansas, 40.7 per cent. in Arizona. In contrast, the -proportion was only 15.8 per cent. in Connecticut, 15.1 per cent. in -Pennsylvania, 13.1 per cent. in Wisconsin, 11.9 per cent. in Minnesota, -and 15.7 per cent. in Iowa. - -The unusually large proportion of married women engaged outside their -homes in the South is explained by the number of negroes living in that -section of the country. The total of white women working for a living in -the same States is perhaps smaller than in any other part of the United -States. - -Even more significant than the great increase in the proportion which -the married form of all women sixteen years of age and over engaged in -gainful occupations is the marked increase in the proportion of all -women so employed. - -Statistics show that in 1890 just 4.6 per cent. of married women went to -work. The figures had expanded to 5.6 per cent. ten years later, and in -1910 had reached 10.7 per cent. - -It may be safely assumed that in the years which have elapsed between -then and now the increase has more than kept pace with earlier figures. -And it is equally certain that once men have been replaced by women -under war conditions neither they nor employers will be inclined to -restore ante-bellum conditions. The problem is one to give economists -grave concern. - - - CHILD LABOR - - - _MARY ALDEN HOPKINS, Harper’s Weekly, 1915._ - -“Too many children is as great a danger to family life as too few -children,” said Mr. Owen Lovejoy, General Secretary of the National -Child Labor Committee. A secretary of this Committee, working for the -abolition of child labor, the improvement of the compulsory education -laws, and the raising of the standards of education in backward states, -Mr. Lovejoy has first knowledge of the condition of children in every -state in the Union. - -“How many are too many?” he was asked. “I should say any more than the -mother can look after and the father earn a living for. There are always -too many children in a family if they have to go to work before they get -their growth and schooling. It may be that some day the state will help -support the children, but under present conditions, as soon as there are -too many children for the father to feed, some of them go to work in the -mine or factory or store or mill near by. In doing this they not only -injure their tender growing bodies, but indirectly they drag down the -father’s wage. They go to work to help the family, but they really -injure it. The wage tends to become an individual wage, the father -receiving only enough for his personal maintenance, the mother working -both at home and outside, and the children supporting themselves as soon -as they can toddle into the cotton fields or hang onto the back of a -delivery wagon. Thus the home is dissolved into constituent parts and -the burden of the struggle for existence is laid on each. The more that -children work, the lower the father’s wages become; the lower the -father’s wages become, the more the children must work. So we evolve the -vicious circle. The home becomes a mere rendezvous for the nightly -gathering of bodies numb with weariness and minds drunk with sleep. No -fine spiritual relation can exist between parents and children where the -children are an economic asset to the parents. There are people who -approve this state of affairs, but no one can who really cares for the -welfare of children. We fight this condition with Child Labor Laws. If -the children stay out of industry, the fathers have more work and make -more money in the end. But one of the strongest factors against getting -laws passed or enforced after they are passed, is the families’ -immediate need of the children’s pitiful earnings. If there were fewer -children in these families, it would be possible to keep them in school -and leave the mines and factories to the fathers. There is another -aspect to the matter. Not only do these unfortunate children drag down -the physique and mentality of the race, but they keep many children of -more thoughtful parents from being born at all. Just as long as there -are many families that are too large, there will be other families that -are too small. Yet these small families are potentially the best -families of all. Serious-minded laboring people whose trades are being -captured by child laborers are reluctant to bring offspring into a world -which cannot promise a life of the simplest comforts in reward for hard -labor. Here is the real danger of that race suicide so vigorously -condemned by Ex-President Roosevelt and others; for while the man of -virtue and strength is deterred from propagating his kind because of the -jeopardy in which his children would stand, the vicious and the -ignorant, the physically unfit and the discouraged are not deterred by -any such consideration, but, regardless of consequences, continue to -propagate their kind and swell the proportion of those who will be from -birth to death a heavy liability against society. We regard the -family—one father, one mother, a group of children to be fed, clothed, -and educated during the years that precede maturity—as the fundamental -institution of our civilization and the glory, thus far, of all social -evolution. One of the causes out of which the family grew has direct -bearing upon this matter—that to which Professor Fisk called attention -as his chief contribution to the evolutionary theory—the prolonged -period of infancy. The evolutionary trend has been to prolong infancy -and adolescence, and thus to launch upon society better individuals. -This is impossible where the older children in a family are crowded out -of the home into the workshop.” - -The Child Labor Bulletin, November, 1912, contains special articles on -the child workers in New York tenement houses. Record after record shows -a two-child income supporting a six-child family. - -In connection with Mr. Lovejoy’s statement that a high birth rate -encourages child labor, it is significant to find from the Galton -Laboratories of the University of London, the statement that drastic -child labor laws directly lower the birth rate. In “The Report on the -English Birth Rate,” from the Eugenics Laboratory, Memoir XIX, Part 1, -England, North of the Humber, Ethel M. Elderton, after touching on the -influence of the raised standard of decency and comfort, lays the -responsibility of the change chiefly upon the lessened economic value of -the child to its parents. - -Miss Elderton says, “Between 1871 and 1901 the number of children -employed largely diminished. Neo-Malthusianism spread and the child -ceased largely to be born, because it was no longer an economic asset. -The Compulsory Education Act of 1876, the Factories and Workshops Act of -1878, and the Bradlaugh-Besant Trial of 1877 (concerning the lawfulness -of publishing pamphlets on contraception) are not unrelated movements; -they are connected with the lowered economic value of the child, and -with the corresponding desire to do without it.” The relation which Miss -Elderton traced between the higher ideals of protection to childhood and -the lowered birth rate is the more interesting because she is deeply, -passionately alarmed at England’s falling birth rate. - -Mr. Lovejoy does not regard the falling birth rate as a wholly -undesirable phenomenon. He says: “Children should be born when the -parents are in good health, at intervals that will allow the mother to -recover her strength, and only as many should be born as the parents can -care for. There is no deeper sorrow than to know that a child has died -for causes that might have been prevented if the parents had had more -wisdom and foresight. The ideals of care and education which we have for -our own children should be our ideals for all children. I shall not -consider it a calamity if the birth rate falls to a point where every -child is so precious to the nation that not one will be allowed to work -in a factory or workshop or mine or store under the age of sixteen, and -up to that time every one will have proper food and clothes and -education. Our race-suicide danger is a danger, nor of quantity, but of -quality.” - - - _LATEST OFFICIAL FIGURES ON CHILD LABOR. From United States Census of - Occupations, 1910. New York State._ - - - Age 10 to 13 14 to 15 - years years - - Manufacturing and mechanical 518 18,502 - - Extraction of Minerals 3 47 - - Agriculture 1,566 5,034 - - All other occupations 2,765 36,659 - - Total in all gainful occupations New York State 4,852 60,242 - - Total in all gainful occupations United States of 895,976 1,094,249 - America - - Total child laborers in the United States of 1,990,225 - America - - - _WAGES AND THE COST OF LIVING. Together with its relation to - Prevention of Conception. Compiled by C. V. Drysdale, D.Sc._ - -Apart from the special problems of experts, the great economic question -of the day is that of the remuneration of labor and its relation to the -cost of living. In Parliament and the press the questions of a minimum -or living wage and of the purchasing power of existing wages are -continually debated; and it is perfectly evident from the tone of these -debates that we are confronted with a most serious difficulty, for which -none of the political parties or economic authorities has any -satisfactory solution. The recognition of this difficulty is due not to -the fact that any new phenomena are present, or that the workers are -worse off than at many periods in the past; but to the fact that the -compilation of more accurate and official statistics during recent years -has brought to light facts which were formerly only surmised, and has -made two important conclusions practically indisputable. These are as -follows: - -A. That the wages of a large fraction of the working classes are -insufficient, even when most skilfully employed, for the adequate -support of a normal family. - -B. That during the last ten or fifteen years of social legislation and -of strenuous effort on the part of the working classes and social -reformers, the purchasing power of average wages has declined instead of -increasing, and this decline shows no definite sign of being arrested. - -In order to improve the efficiency of production, it is important that -the efficiency of the race should be improved. Hence the reduction of -births should be especially encouraged among the poor and those -suffering from physical or mental defect or disease, who, it may be -noted, should have the strongest personal motives for voluntary -restriction. - -The restriction of births in proportion to economic or physiological -deficiency would steadily improve economic conditions in the following -ways: - -(a) It would immediately reduce the burden upon the poor with their -existing wages. - -(b) It would immediately check increased demand, and therefore a further -rise in price of food. - -(c) It would reduce the burden of charity and taxation. - -(d) It would permit the workers to be better nourished and educated. - -(e) It would permit the children to be better educated and technically -trained. - -(f) In course of time it would reduce the number of workers competing -and further raise wages. - -(g) The evils of overcrowding, with its serious hygienic and moral -dangers, would be rapidly diminished, and the housing problem made -easier of solution. A three bedroom house only provides decency for a -family not exceeding four children. - -(h) It would give better opportunities for thrift among the workers and -for their emancipation from the position of “wage slaves.” It would then -give them an opportunity of co-operating and owning their own -instruments of production. - -In support of these statements it may be recalled that in Prof. Thorold -Rogers’s Six Centuries of Work and Wages a striking example is given of -the continued rise of wages after the Black Death of 1349, despite all -efforts of Parliament to fix them. - -“It is certain that the immediate consequence of the plague was a dearth -of labor, an excessive enhancement of wages, and a serious difficulty in -collecting the harvests of those landowners who depended on a supply of -hired labor for the purpose of getting in their crops.... The plague, in -short, had almost emancipated the surviving serfs. - -“I shall point out below what were the actual effects of this great and -sudden scarcity of labor. At present I merely continue the narrative. -Parliament was broken up when the plague was raging. The King, however, -issued a proclamation, which he addressed to William, the Primate, and -circulated among the sheriffs of the different counties, in which he -directed all officials that no higher than customary wages should be -paid, under the penalties of amercement. The King’s mandate, however, -was universally disobeyed, for the farmers were compelled to leave their -crops ungathered or to comply with the demands of the laborers. When the -King found that his proclamation was unavailing, he laid, we are told, -heavy penalties on abbots, priors, barons, crown tenants, and those who -held lands under mesne lords, if they paid more than customary rates. -But the laborers remained masters of the situation. Many were said to -have been thrown into prison for disobedience; many, to avoid punishment -or restraint, fled into forests, where they were occasionally captured. -The captives were fined, and obliged to disavow under oath that they -would take higher than customary wages for the future. But the -expedients were vain; labor remained scarce and wages, according to all -previous experience, excessive.” - -Mr. Thorold Rogers tells us of all the expedients employed by -Parliament, in the Statute of Laborers, in order to check the rise of -wages, and how they broke down and were evaded by the employers -themselves. “The rise in agricultural labor is, all kinds of men’s work -being taken together, about 50 per cent., of women’s work fully 100 per -cent.” Artisans fare equally well. And, despite the rise in price of -manufactured articles consequent upon this rise of wages, “there was no -corresponding rise in the price of provisions.... The free laborer, and, -for the matter of that, the serf, was in his way still better off. -Everything he needed was as cheap as ever, and his labor was daily -rising in value.” - -It would, of course, be absurd to apply the lesson of one period of -history to another, without consideration of the changed circumstances. -But it is equally absurd to pass over such a vivid object lesson as the -above without giving it due consideration, especially when it has a -sound theoretical basis. Prof. Thorold Rogers was not a disciple of the -Malthusian school, and he takes Mill and others to task for the -importance they ascribed to the population difficulty. Yet he tells us -that the reign of prosperity lasted for some time after the reduction of -population by the Black Death, and that a rapid growth of population -followed. This is quite in accordance with the doctrine of Malthus, and -justifies our belief that, if this increase had been prudentially -restricted, prosperity would have been permanently maintained. - -A modern illustration of the same principle appears to be given in New -Zealand, where the practice of family restriction seems to be almost -universal. In the _Standard_ of June 20th, 1912, appeared a note -commenting upon the great and increasing prosperity of New Zealand; and -it contains the following significant passage:— - -“The wages paid to employees and the output of the printing -establishments in the country have pretty nearly doubled in the same ten -years, rising respectively from £284,605 to £490,246 and £704,285 to -£1,377,926. A curious point in connection with the grain mills is that -while there were fewer establishments and fewer hands employed in 1910 -than in the previous years—although wages are higher—yet the value of -the output has almost doubled, being £1,248,001 as against £682,884.” - -Some mention should be made of the question of emigration. Strange as it -may seem, emigration does not, as a rule, greatly mitigate the -population difficulty (though it may have done so to a certain extent in -Ireland), and it may even enhance it. The reason for this apparent -paradox is not far to seek, and it serves to explain a good many common -fallacies as regards the population question. Human beings are not all -of equal producing power. Each child born into the world is an immediate -consumer, and he remains a consumer without being a producer until his -education and training are completed. After that time he becomes a -producer, and, if of average talents, he may _for a certain period_ -produce enough to support himself and perhaps a wife. It is at the -beginning of the effective period that emigration so frequently takes -place, so that the old country is burdened with all the consumption of -immature children, without any possible return. Emigration can only be a -remedy for over-population when it is emigration of non-producers, i.e., -children, aged people, tramps, paupers, or lunatics; and it need hardly -be said that these are not the types which emigrate, or who are wanted -by the colonies. It is quite possible for an already greatly -over-populated country to be in great need of further accessions of -ready trained workers; but until someone discovers how our children may -be born at this stage of development it is absolutely absurd to say that -such a country is “calling out for population,” in the sense of needing -a higher birth-rate. The fact that Ontario, in Canada, has experienced -an increase of its death-rate following on an increase of its birth-rate -is a vivid illustration of this absurdity. - -It is interesting to note, as a confirmation of this theory, that -considerable changes in the rate of emigration appear to have had very -little influence upon the death-rate. It may be, however, that -emigration increases in times of dearth, and thus tends to prevent -increased mortality. - - - _NEO-MALTHUSIANISM AND EUGENICS. C. V. Drysdale, D.Sc._ - -The last few years has been a period of continual persecution of the -Neo-Malthusians whenever they try to instruct the poorer classes, and -more stringent laws are being framed against them in many countries. - -I am glad to say that a recent attempt on the part of the dominant -agrarian party in Hungary in this direction has been foiled by a -judgment of the Hungarian Medical Senate, which has strongly reported -against any attempt to check the practice of family limitation, in the -interests of the quality of the race. - - - - - CHAPTER IX - CONCLUSION: EMINENT OPINIONS - - - THE PROGRESS OF HOLLAND - - - _WAGES AND THE COST OF LIVING. C. V. Drysdale, D.Sc._ - -Unlike those of other countries, who, in Lord Morley’s words, have -shirked the population question, the statesmen of Holland have been -fully alive to it, and have made their country the only one where -facilities have been given to the poorer classes to freely obtain -knowledge as to the best means of restricting families. The following -strong statement by Heer S. van Houten, late Minister of the Interior in -the Netherlands (Staats Kundige Brieven, 1899), leaves no doubt as to -this difference of outlook:— - -“Wage-slavery exists as a consequence of the carelessness with which the -former generation produced wage-slaves; and this slavery will continue -so long as the adult children of these wage-slaves have nothing better -to do than to reproduce wage-slaves. The fault lies in our poorer -classes themselves, and also in some clergymen and _orthodox pedants_ -who, in their preaching about morality, only permit a choice between an -unnaturally lengthened celibacy or an ever-increasing family with the -bonds of marriage, and who prevent the acceptance of the higher -morality, which finds such easy acceptance among the better classes, of -marriage and restriction of the family to the number which the parents -can feed and comfortably rear.” - -And Heer N. G. Pierson, late Dutch Minister of Finance, has expressed -himself equally strongly in his Political Economy, which has just been -translated into English:— - -“No improvement in the economic situation can be hoped for if the number -of births be not considerably diminished.” - -Under the ægis of these gentlemen and of Heer Gerritsen, a prominent -Councillor of Amsterdam, a Dutch Neo-Malthusianische Bond was formed in -1881, and has carried on an active propaganda among the working classes, -with the help of a number of qualified medical men and trained midwives. -So great has its success been that it now numbers over 5,000 members, -and it was recognised by Royal Decree in 1895 as a society of public -utility. An enormous number of practical brochures describing methods of -limitation are sent out gratis annually, and poor men and women can get -gratuitous advice in every important centre in Holland. - -The result of this work, as indicated by the vital statistics, is -clearly seen in Fig. 11. The birth-rate has fallen from 37 in 1876 to 28 -in 1912, and with especial regularity and rapidity during the last few -years. The death-rate has fallen more regularly and rapidly than in any -other country in the world (from a value averaging about 25 per 1,000 to -only just over 12 per 1,000 in 1912), and the infantile mortality has -similarly shown the most rapid fall on record. It will be observed that, -far from this decline in the birth-rate having checked the increase of -population, the rate of “natural increase” is now higher than at any -previous period, and the highest in Western Europe. This indicates not -only that social conditions are rapidly improving, but that the -productive efficiency of the population is increasing, instead of -diminishing, as in our own country, where the “natural increase” has -fallen from 12 to 10 per 1,000. This is explainable on the eugenic -ground that in Holland family restriction has taken place among the -poor, and has thus tended to eliminate unfitness; while in this and -other countries the poor are almost entirely ignorant of restrictive -methods. And this view is strikingly confirmed by the paper read by Dr. -Soren Hansen at the Eugenics Congress of 1912, in which he stated that -the average stature of the Dutch people had increased by four inches -within the last fifty years. An examination of the heights of the young -men drawn for military service shows that since 1865 the proportion -under 5 ft. 2½ in. in height has fallen from 25 per cent. to under 8 per -cent., while that of those above 5 ft. 7 in. has increased from 24.5 per -cent. to 47.5 per cent. This is a most decided evidence of increased -well-being and elimination of unfitness. On the many occasions that I -have been in Holland, I have never yet seen any cases of that terrible -physical deterioration and economic misery which are so conspicuous in -this country. Further, the emigration of the Dutch population is almost -infinitesimal. - -As regards wages and cost of living, Dutch statistics do not give -weighted index numbers to compare with the other figures. But the -unweighted mean of money wages of workers in the different government -services show the most rapid increase recorded, being about 25 per cent. -in Holland between 1894 and 1908, as against 18 per cent. in France and -10 per cent. in England and Wales. (Fig. 12). - -As to prices, it is not easy to come to a definite conclusion, as some -articles have risen and some fallen in price; but there seems good -ground for believing that the cost of living has risen comparatively -little in Holland, and that real wages have therefore risen very -materially during the period when they have been declining in this and -other countries. It is certainly difficult in any case to see how the -undoubtedly great advance in health and physique experienced by the -Dutch population could have taken place without a great increase in real -wages. - -According to a diagram given in the Manchester Guardian of August 16th -last the cost of living in Holland had gone up by 23 per cent. in 1912. -An examination of detailed prices, however, showed a relatively small -rise up to 1909. - -These facts, together with many others which could be adduced, make it -clear that in Holland, the only country in which the population problem -has been realised and facilities for family limitation been extended to -the poor, the expectations of the Neo-Malthusians have been completely -justified, and their doctrines have received the confirmation of -experience. Amsterdam, in which the first lady doctor in Holland opened -a gratuitous clinic for the instruction of poor women in preventive -methods, has now the lowest deathrate and infantile mortality of any -European capital. And this is in no way attributable to any extension of -State help either of a socialistic type, or of that familiar to us in -this country, as Holland has been distinguished for its adherence to -individualism, and has apparently adopted hardly any measure of State -assistance. - - - _DR. S. ADOLPHUS KNOPF IN THE SURVEY, quoting Dr. J. Rutgers, - Honorable Secretary to Neo-Malthusian League of Holland._ - -“All children you now see are suitably dressed, they look now as neat as -formerly only the children of the village clergyman did. In the families -of the laborers there is now a better personal and general hygiene, a -finer moral and intellectual development. All this has become possible -by limitation in the number of children in these families. It may be -that now and then this preventive teaching has caused illicit -intercourse, but on the whole morality is now on a much higher level, -and mercenary prostitution with its demoralizing consequences and -propagation of contagious diseases is on the decline. - -The best test (the only possible mathematical test) of our moral, -physiological and financial progress is the constant increase in -longevity of our population. In 1890 to 1899 it was 46.20; in 1900 to -1909 it was 51 years. Such rise cannot be equalled in any other country -except in Scandinavia where birth limitation was preached long before it -was in Holland. None of the dreadful consequences anticipated by the -advocates of clericalism, militarism and conservatism have occurred. In -spite of our low birth-rate the population in our country is rising -faster than ever before, simply because it is concomitant with a greater -economic improvement and better child hygiene.” - -The good doctor closes his letter by saying: “One must have been a -family physician for twenty-five years like myself in a large city -(Rotterdam) to appreciate the blessings of conscious motherhood -resulting in the better care of children, the higher moral standard. And -all these blessings are taken away from you by your government’s -peculiar laws, made to please the Puritans.” - -Dr. Jacobi, Ex-President of the American Medical Association and the New -York Academy of Medicine, said: - -“The future of mankind is conditioned by its children. Unless they be -healthy and fit to work physically and mentally, they can not perform -any duty in the service of the family, the municipality or the state. -Hereditary influences propagate epilepsy, idiocy, feeble-mindedness and -cretinism. Such children should not have been permitted to be born. Yet -the prohibition of unnecessary and not wanted accessions of human beings -is considered criminal.” - -Dr. Lydia Allen de Vilbis of the New York State Department of Health, -said that among the 25,000 deaths of children under one year of age that -occur annually in New York State, half were due to causes with which -medical boards could not hope to cope—the defective, the deformed, the -crippled, the diseased. - -“What are we going to do about these babies who are born only to suffer -and die?” she asked. “There are at least 12,000 a year, 1,000 for each -month, more than thirty a day. What for? Because we are so stupid that -we still believe a pound of cure is better than an ounce of prevention.” - - - _MARY ALDEN HOPKINS. Harper’s Weekly, 1915._ - -“Last year more than ten thousand children were proposed to the -Department of Charities of New York City for commitment to -institutions,” writes John A. Kingsbury, Commissioner of Charities in -the Department of Public Charities of New York City, in reply to my -inquiry concerning his view of the limitation of families. “Poverty or -sickness or unemployment has outworn the welcome of more than ten -thousand innocent little citizens in their own homes. These children are -paying the penalty of the social error of too large families. It is -frequently remarked that children are often found in the largest number -in those homes which are least equipped to properly provide for them. I -believe it is as serious a mistake for parents in adverse circumstances -to bring children into the world for whom they are not prepared, as for -parents in affluent circumstances to decline to bear children because of -the inconvenience or embarrassment to their scheme of living. If -contraception can benefit the born by limiting the unborn, without -bringing about any physical or moral deterioration in human lives, I am -unqualifiedly in sympathy with it.” - - - _JUDGE WM. H. WADHAMS, Court of General Sessions, New York. “The - Spreading Movement for Birth Control.” The Survey, Oct. 21, 1916._ - -In the Court of General Sessions, New York City, Judge Wadhams suspended -sentence upon a woman, mother of six children, who had pleaded guilty to -a charge of burglary, her second offense. His investigation showed, the -judge declared, that the mother had made a hard, but unsuccessful -attempt to support her children since the father had been driven from -his work in garment working five years ago. Meantime, two of the -children had been born. Said Judge Wadhams:— - -“Her husband is not permitted by the authorities to work because of his -being ill with tuberculosis. It would be dangerous for him to work on -children’s garments. It might spread consumption to the innocents. There -is a law against that. As a result of this law the husband has had no -work for four years. Nevertheless, he goes on producing children who -have very little chance under the conditions to be anything but -tubercular, and, themselves growing up, repeat the process with society. -There is no law against that. But we have not only no birth regulation -in such cases, but if information is given with respect to birth -regulation people are brought to the bar of justice for it. There is a -law they violate. The question is whether we have the most intelligent -law on this subject we might have. These matters are regulated better in -some of the old countries, particularly in Holland, than they are in -this country. I believe we are living in an age of ignorance, which at -some future time will be looked on aghast.” - - - _LETTER ADDRESSED TO PRESIDENT WILSON BY A GROUP OF NOTABLE ENGLISH - WRITERS AND SOCIOLOGISTS, September, 1915._ - - To the President of the United States, - White House, Washington, D.C. - -Sir,—We understand that Mrs. Margaret Sanger is in danger of criminal -prosecution for circulating a pamphlet on birth-problems. We therefore -beg to draw your attention to the fact that such work as that of Mrs. -Sanger receives appreciation and circulation in every civilised country -except the United States of America, where it is still counted as a -criminal offence. - -We, in England, passed a generation ago, through the phase of -prohibiting the expressions of serious and disinterested opinion on a -subject of such grave importance to humanity, and in our view to -suppress any such treatment of vital subjects is detrimental to human -progress. - -Hence, not only for the benefit of Mrs. Sanger, but of humanity, we -respectfully beg you to exert your powerful influence in the interests -of free speech and the betterment of the race. - - We beg to remain, Sir, - Your humble Servants, - (Signed) - - Lena Ashwell, - Dr. Percy Ames, - William Archer, - Arnold Bennett, - Edward Carpenter, - Aylmer Maude, - Prof. Gilbert Murray, - M. C. Stopes, - H. G. Wells. - - - - - _GLOSSARY OF MEDICAL TERMS USED IN THIS VOLUME._ - - -_Abortion_: As soon as the male _sperm_ has met and joined with the -female _ova_ any attempt at removing it or preventing its development or -further growth is called _Abortion_. _Abortion_ is not to be confused -with the _prevention of conception_. The practice of _Birth Control_, -founded on the _prevention of conception_ will eventually do away with -the necessity of _abortion_. - -_Abortion_: the expulsion of the fetus before it is viable.—Dorland’s -Medical Dictionary. - -_Abortion_: the arrest of any action or process before its normal -completion, as the _abortion_ of pneumonia.—Stedman’s Medical -Dictionary. - -_Birth_: the delivery of a child—Gould’s Practitioner’s Medical -Dictionary. - -_Birth Control_: a new social philosophy dedicated to conscious and -voluntary motherhood, and racial betterment. - -_Conception_: the act of becoming pregnant.—Stedman’s Medical -Dictionary. - -_Conception_: the fecundation of the _ovum_ by the -_spermatozoon_.—Gould’s Practitioner’s Medical Dictionary. - -_Contraception_: the prevention of conception.—Stedman’s Medical -Dictionary. - -_Contraceptive_: anything used to prevent conception.—Dorland’s Medical -Dictionary. - -_Contraceptive_: an agent for the prevention of conception.—Stedman’s -Medical Dictionary. - -_Fecundation_: impregnation or fertilization.—Dorland’s Medical -Dictionary. - -_Fetus_: the unborn offspring of any viviparous animal; the child in the -womb after the end of the third month: before that time it is called the -_embryo_. - -_Malthusianism_: (Thomas Robert Malthus, English political economist, -1766–1834). The doctrine that population increases in geometrical -progression; and the teaching, founded on this doctrine, that -over-population should be prevented.—Stedman’s Medical Dictionary. - -_Doctrine of Malthus_: the doctrine that the increase of population is -proportionately greater than the increase of subsistence.—Gould’s -Practitioner’s Medical Dictionary. - -_Theory of Malthus_: that small families will abolish poverty and -disease; recommends _continence_ and _late marriage_ to bring about this -result. - -_Theory of Neo-Malthusians_: that small families will abolish poverty -and disease; recommends _early marriage_ and use of _preventive checks_ -to bring about this result. - -_Pregnancy_: gestation, fetation, gravidity.—Stedman’s Medical -Dictionary. - -_Pregnancy_: results from the meeting and fusion of two living cells, -the cell furnished by the male (_spermatozoon_) and that by the female -(_ovum_). To avoid or to prevent conception or pregnancy, then, consists -of stopping the male cell from uniting with the female cell. - -_Prevention of Conception_: to prevent the male _sperm_ from meeting the -female _ova_. - -_Prevention of Conception_: the only logical and practical means for -eliminating _abortions_ when a child cannot be carried to full term. - -_Preventive_: anything which arrests the threatened onset of -disease.—Stedman’s Medical Dictionary. - - - - -Modern Art Printing Co., New York. - ------------------------------------------------------------------------- - - - - - TRANSCRIBER’S NOTES - - - 1. Changed ‘importing’ to ‘imparting’ on p. 6. - 2. Added missing targets for the footnotes on pp. 33 and 34. - 3. Changed ‘There are given’ to ‘These are given’ on p. 57. - 4. Changed ‘since when’ to ‘since then’ on p. 59. - 5. Changed ‘dotted are’ to ‘dotted area’ on p. 71. - 6. Added missing caption ‘Fig. 21-23’ to the three illustrations on p. - 90 per discussion on p. 71. Since no countries were identified the - three were left as one image. - 7. Added missing caption ‘Fig. 24’ to the first illustration on p. 90 - per discussion on p. 71. - 8. Added missing caption ‘Fig. 25’ to the second illustration on p. 90 - per discussion on p. 71. - 9. Added missing caption ‘Fig. 26’ to the third illustration on p. 90 - per discussion on p. 71. -10. Added missing caption ‘Fig. 27’ to the first illustration on p. 91 - per discussion on p. 71. -11. Added missing caption ‘Fig. 28’ to the second illustration on p. 91 - per discussion on p. 71. -12. Added missing caption ‘Fig. 29’ to the third illustration on p. 91 - per discussion on p. 71. -13. Changed ‘Neuman’ to ‘Newman’ on p. 94. -14. Changed ‘they they’ to ‘that they’ on p. 103. -15. Changed ‘it shall be lawful’ to ‘it shall be unlawful’ on p. 110. -16. Changed ‘Table 8’ to ‘Table 18’ on p. 117. -17. Changed all mentions of the Michigan city from ‘Ann Harbor’ to ‘Ann - Arbor’. -18. Changed ‘Hubner’ to ‘Huhner’ on p. 186. -19. Changed ‘prostalic’ to ‘prostatic’, ‘diplethorize’ to - ‘deplethorize’, and ‘chronic suggestion’ to ‘chronic congestion’ - on p. 186. -20. Changed ‘physic and somatic’ to ‘psychic and somatic’ on p. 187. -21. Changed ‘always two paries’ to ‘always two parties’ on p. 187. -22. Changed ‘STANDPOINT OR’ to ‘STANDPOINT OF’ on p. 205. -23. Changed ‘65.5’ to ‘60.5’ on p. 210. -24. Changed ‘records, were contracted’ to ‘records, were contrasted’ on - p. 211. -25. Changed ‘Alfred Scott Warthin’ to ‘Aldred Scott Warthin’ on p. 229. -26. Changed ‘which is 1870–2’ to which in 1870–2’ on p. 232. -27. Changed ‘provision is’ to ‘provision is not’ on p. 235. -28. Changed ‘contions’ to ‘relations’ on p. 236. -29. Changed ‘about mortality’ to ‘about morality’ on p. 245. -30. Silently corrected typographical errors. -31. Retained anachronistic and non-standard spellings as printed. -32. 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