The Case For Birth Control
A Supplementary Brief and Statement of Facts

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.

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.

(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 6every 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 7more 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 8among 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.

9I 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; 10certainly 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.

11The 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 12attempt 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 13reform 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 14the 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 15a 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 16of 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 17the 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 18should 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 19for 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.

20The 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.

21THE 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.

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.

24THE 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. 25Richard 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 26decided 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:

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.

28Portugal.—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:

The following are some extracts from the League’s rules:

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.

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 30it 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 31to 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 32of 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.

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]

34There 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 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 36countries. 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 37infantile mortality is the worst feature,^[3] but it has been declining for some years.

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 3825,988 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.

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.

39The 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 40to 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

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.

41Dr. 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

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.

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.

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

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 44and 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 45destitution 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 46order: 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 47at 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 48a 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 49registration. 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.

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.

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 52births is greater than the number of deaths—so every country is increasing in population.

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”

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 53perishes 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.

Fig. 1.—POPULATION OF VARIOUS COUNTRIES.

VARIATIONS IN BIRTH RATE &c., IN ENGLAND & WALES

Fig. 2.—ENGLAND AND WALES.

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 54was 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 55natural 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.

56We need not consider Scotland further, as its variations resemble those of England and Wales.

Fig. 4.—AUSTRALIA.

Fig. 5.—NEW ZEALAND.

Fig. 6.—ONTARIO, CANADA.

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. 57On 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 58over 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.

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.

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 59to 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 60with 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:—

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, 61given 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.

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 62that 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.

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:—

63Of 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.

64

Fig. 8.—CEYLON.

Fig. 9.—FRANCE.

Fig. 10.—GERMANY.

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 65its 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 66from 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 67lowest 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.

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 68consequence. 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 69country 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.

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 71birth-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.

Fig. 1.

Fig. 2.

Fig. 3.

Fig. 4.

Fig. 5.

Fig. 5a

Fig. 6

Fig. 6a.

Fig. 7

Fig. 7a.

VARIOUS DISEASES.

Fig. 7b.

Fig. 8.

Fig. 9

Fig. 10.

Fig. 11.

SWEDEN.

Fig. 12.

Fig. 13.

BELGIUM.

Fig. 14.

Fig. 15.

SPAIN.

Fig. 16.

RUSSIA.

Fig. 17

ROUMANIA.

Fig. 18

JAMAICA.

Fig. 19

IRELAND.

Fig. 20

Figs. 21-23

CANADA (Ontario).

Fig. 24

AUSTRALIA (Commonwealth).

Fig. 25

NEW ZEALAND.

Fig. 26

Fig. 27

BERLIN.

Fig. 28

BERLIN.

Fig. 29

Fig. 30

WESTERN EUROPE.

Fig. 31

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 94of 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 95the 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).

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.

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.

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.

97According 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.

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.

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:

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 103were 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 104means 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.

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 10521 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.

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.

106Through 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. 107The 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 108constantly 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, 109however, 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.

110With 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, 111Dr. 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 112were 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.

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:

113Dirt 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:

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.

114The 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.

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.

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 116that 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.

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, 117on 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, 118one 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.”

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.

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.

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 120quality 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.

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.

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.

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.

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.

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.

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.

124The 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.

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.

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.

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.

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.

126Breast 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.

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:

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.

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.

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 128cares 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.

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 129consecutive groups are combined an invariable lowering of the infant mortality rate from one such combined group to that next higher results.

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.

130The 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.

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. 131of 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.

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 132among 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.

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.

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.

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.

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.

The statistics, based upon the results of all her reportable pregnancies, show a generally higher infant mortality rate where the mother has had many 134pregnancies, 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.

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.

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.

135The 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.

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.

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,” 136as here used, means the sum of infant deaths (or deaths in first year) and stillbirths.

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:

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 137babies born in 1911, namely that the economic factor is of far-reaching importance in determining the baby’s chance of life.