The Case For 
Birth Control 
A Supplementary Brief and Statement Gf Facts 
PREPARED BY 
MARGARET H. SANGER 
To Aid the Court in its Consideration of the Statute designed 
to prevent the dissemination of information for 
Preventing Conception 
PUBLISHED, MAY 1917 
JONAH j. GOLDSTEIN 
COUNSEL Copyright by 
MARGARET H. SANGER 
1917 CONTENTS 
CHAPTER I. INTRODUCTORY 6 
Introductions to Birth Control by Margaret H. Sanger, 
Havelock Ellis, August Forel and G. F. Lydston. 
CHAPTER II. THE ORIGIN AND PRACTICE OF BIRTH 
CONTROL IN VARIOUS COUNTRIES 23 
Genesis of Movement, 
England, 
Holland, 
France, 
United States, 
Other Countries. 
CHAPTER III. POPULATION AND BIRTH RATE 43 
Birth Control, by Havelock Ellis, 
Population Facts in United States, 
Birth Rate of British Empire, 
Birth Rate of Other Countries (With Tables). 
CHAPTER IV. INFANT MORTALITY 93 
General Statistics, 
Results of Children’s Bureau Survey at Johnstown, Pa., 
by Emma Duke, 
Manchester Report. 
CHAPTER V. MATERNAL MORTALITY AND DISEASES 
AFFECTED BY PREGNANCY 155 
Children’s Bureau Report, by Grace L. Meigs, 
Death Rates from Child Birth in Foreign Countries, 
A Municipal Birth Control Clinic, 
Tuberculosis, 
Kidney Diseases, 
Eclampsia, 
Diabetes, 
Pelvic Deformities, 
Heart Disease, 
Too Frequent Pregnancies, 
Pernicious Vomiting. 
CHAPTER VI. HARMFUL METHODS PRACTICED TO 
AVOID LARGE FAMILIES 185 
Coitus Interruptus, 
Continence, 
The Objects of Marriage, by Havelock Ellis, 
Abortion. CONTENTS (Continued) 
CHAPTER VII. PROSTITUTION, FEEBLE-MINDEDNESS 
AND VENEREAL DISEASES 197 
The Social Evil, 
Feeble-mindedness, 
Syphilis, 
Gonnorrhea. 
CHAPTER VIII. OTHER TRANSMISSIBLE DISEASES AND 
PAUPERISM 223 
Insanity, 
Epilepsy, 
Alcoholism, 
Pauperism, 
Child Labor. 
CHAPTER IX. CONCLUSION: EMINENT OPINIONS 245 
The Progress of Holland, 
Eminent Opinions 
GLOSSARY 250 FOREWORD 
THE purpose of the Appellant in presenting the 
various statistics and medical and social facts 
incorporated in the supplementary brief, entitled 
THE CASE FOR BIRTH CONTROL, is to give 
the Court a clear conception of the meaning of birth 
control. The historical stages through which this 
question has gone have been reviewed, its status in foreign 
countries outlined. Finally, the effects upon the common- 
wealth 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 ot 
knowledge most necessary to human liberty, and has 
resulted in extreme harm to the individual, to the family 
and to society at large. 
The idea of the social and racial value of knowledge 
to prevent conception is new in the United States, and 
therefore it has been difficult to get first-hand facts 
and comprehensive statistics with a local bearing. 
Consequently, the Appellant has been obliged to lay 
emphasis upon data from foreign countries where the 
subject has been exhaustively studied, both theoretically 
and practically. However, the American case for birth 
control, as presented in this compilation, is the most 
complete possible in view of the records available. 
MARGARET H. SANGER CHAPTER I. 
INTRODUCTORY 
CJ-HB 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 au- 
thorities, whose opinions are selected as being the clearest exposition 
of the social philosophy—Birth Control. 
NOTE: All the notations of pages and tables refer to original documents and not 
to the present volume. CHAPTER I 
THE CASE FOR BIRTH CONTROL 
By Margaret H. Sanger 
(The following is the case for birth control, as I found it during my four- 
teen 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 sum- 
mary 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 con- 
trol 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 ignor- 
ance, 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 en- 
dures. 
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 6 
The Case for Birth Control 
every department of life was open to investigation and discussion except that 
shaded valley of sex. The explorer, scientist, inventor, may go forth in their 
various fields for investigation and return to lay the fruits of their discoveries 
at the feet of society. But woe to him who dares explore that forbidden 
realm of sex. No matter how pure the motive, no matter what miseries he 
sought to remove, slanders, persecutions and jail await him who dares bear 
the light of knowledge into that cave of darkness. 
So great was the ignorance of the women and girls I met concerning their 
own bodies that I decided to specialize in woman’s diseases and took up 
gynecological and obstetrical nursing. 
A few years of this work brought me to a shocking discovery—that knowl- 
edge 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 importing 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 thou- Introductory 
7 
sand more babies from coming into the world the next year to die of poverty 
and neglect ? 
I found from records concerning women of the underworld that eighty- 
five per cent, of them come from parents averaging nine living children. And 
that fifty per cent, of these are mentally defective. 
We know, too, that among mentally defective parents the birth rate is 
four times as great as that of the normal parent. Is this not cause for alarm ? 
Is it not time for our physicians, social workers and scientists to face this 
array of facts and stop quibbling about woman’s morality? I say this be- 
cause 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 free- 
dom. 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, transport- 
ation 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 dis- 
tricts 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 men- 
ace to our civilization, the problem of the day, is not the stationary birth-rate 8 
The Case eor Birth Control 
among the upper classes so much as the tremendous increase among the poor 
and diseased population of this country 
Is woman’s health not to be considered? Is she to remain a producing 
machine? Is she to have time to think, to study, to care for herself? Man 
cannot travel to his goal alone. And until woman has knowledge to control 
birth she cannot get the time to think and develop. Until she has the time 
to think, neither the suffrage question nor the social question nor the labor 
question will interest her, and she will remain the drudge that she is and her 
husband the slave that he is just as long as they continue to supply the market 
with cheap labor. 
Let me ask you: Has the State any more right to ravish a woman against 
her will by keeping her in ignorance than a man has through brute force? 
Has the State a better right to decide when she shall bear offspring? 
Picture a woman with five or six little ones living on the average work- 
ing 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? Be- 
cause it is still afraid of the untried and the unknown. Introductory 
9 
I saw that fortunes were being spent in establishing baby nurseries, where 
new babies are brought and cared for while the mothers toil in sweatshops 
during the day. I saw that society with its well-intentioned palliatives was 
in this respect like the quack, who cures a cancer by burning off the top while 
the deadly disease continues to spread underneath. I never felt this more 
strongly than I did three years ago, after the death of the patient in my last 
nursing case. 
' This patient was the wife of a struggling working man—the mother of 
three children—who was suffering from the results of a self-attempted abor- 
tion. 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 symp- 
toms 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 infor- 
mation 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 effi- 10 
The: Case: for Birth Control 
cient; certainly not to pass upon the opinions in the matter it conveys. If we 
concede this power to this institution, which is only a public service, we might 
just as well give to the street car companies and railroads the right to refuse 
to carry passengers whose ideas they do not like. 
I will not take up the story of the publication of “The Woman Rebel.” 
You know how I began to publish it, how it was confiscated and suppressed 
by the post office authorities, how I was indicted and arrested for bringing 
if out, and how the case was postponed time and time again and finally dis- 
missed 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 conse- 
quence 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 imme- 
diate 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. Introductory 
11 
The clinic I established in the Brownsville district of Brooklyn accom- 
plished 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) ; Affir- 
mations, 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 Re- 
lation 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 im- 
prove the dwellings, to introduce sanitation, and to combat disease. 2—The 12 
The Case for Birth Control 
attempt to attack the problem more thoroughly by regulating conditions of 
work, and introducing the elaborate system of factory legislation. 3—The 
still more fundamental step of taking in hand the children who have not yet 
reached the age of work, nationalizing education, and ultimately pushing 
back the care and over-sight of infants to the moment of birth. 4—Finally, 
most fundamental step of all, the effort, which is still only beginning to pro- 
vide 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 con- 
stantly spreading and at every point becoming more thorough, more harmoni- 
ously 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 move- 
ment 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—how- 
ever 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 work- 
ers 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 hos- 
pitals, 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 im- 
provement of the condition of our paupers. Yet so far as numbers are con- 
cerned, 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 in- 
effectiveness 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 be- 
ginnings of life, for that is precisely where our whole treatment of social Introductory 
13 
reform has been most at fault. Children under 16 form nearly one-third of the 
paupers relieved. In the United Kingdom the Poor Law authorities have 
cn their books as out-door 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 work- 
house babies is two or three times as high as that among the general popu- 
lation. And the Royal Commissioners pathetically ask, “To what is this re- 
trogression 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 efiforts 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 ex- 
perience, 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 gener- 
ation 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 feeble- 
minded 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 14 
The Case eor Birth Control 
the present generation and a menace to future generations. They are seen 
to be often a more serious danger when we realize that in large measure they 
form the reservoir from which the predatory classes are recruited. This is 
for instance the case as regards the fallen. Feebleminded girls of fairly high 
grade may often be said to be predestined to immorality if left to themselves, 
not because they are vicious, but because they are weak and have little power 
of resistance. They cannot properly weigh their actions against the results 
of their actions, and even if they are intelligent enough to do that, they are 
still too weak to regulate their actions accordingly. Moreover, even when, 
as so often happens among the high grade feebleminded, they are quite able 
and willing to work, after they have lost their respectability by having a child, 
the opportunities of work become more restricted and they drift into prosti- 
tution. 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 unemploy- 
able. 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 in- 
evitable 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 deter- 
iorate 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 be- Introductory 
15 
coming a sense of racial responsibility. It is that enlarged sense of respon- 
sibility 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 en- 
titled 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 cuntries in every part of the world has been a matter of con- 
cern to some people, who have realized that however desirable under the con- 
ditions, 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 gratifica- 
tion 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 
tion. 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 fore- 
thought 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 lament- 
able 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 16 
The; Case: for Birth Control 
of the size of families, and as it is social amelioration which brings this result 
about, it is a result that we may view with equanimity. It used to be feared 
that a falling birth rate was a national danger. We now know that this is 
not the case, for not only does a falling birth rate lead to a falling death rate, 
but in this matter no nation moves by itself. Civilization is international, 
though one nation may be a little before or behind another. Hitherto France 
has been ahead, but all other nations have followed. In Germany, for instance, 
sometimes regarded as a rival of England, the birth rate has fallen just as 
in England. Russia indeed is an exception, but Russia is not only behind 
England, but behind Germany in the march of civilization; its birth rate is 
high, its death rate is high; a large proportion of its population live on the 
verge of famine. We are not likely to take Russia as our guide in this 
matter; we have gone through that stage long ago. But at the stage we have 
now reached it is no longer a question of gaining control over the production 
of the new generation, but of using that control, and of using it in such a 
way that we may help to leave the world better than we found it. “What 
has posterity done for me that I should do anything for posterity,” someone is 
said to have asked? The answer is that to the human race that went before 
him he owes everything, and that he can only repay the debt to those who 
come after him. There is more than one way in which we can repay our 
debt to the race, but there is no better way than by leaving behind us those who 
are fit to carry on the tasks of life to higher ends than we have ourselves 
perhaps been able to attain. Children have been without value in the world 
because there have been too many of them; they have been produced by a blind 
and helpless instinct, and have been allowed to die by the hundred thousand. 
For more than half a century after the era of social reform set in there was 
no decline at all in the enormous infant mortality. It has only now begun, as 
the inevitable accompaniment of the decline in the birth rate. Not the least 
service done by the fall in the birth rate has been to teach us the worth of 
our children. We possess the power, if we will, deliberately and consciously 
to create a new race, to mold the world of the future. As we realize our 
responsibility we see that our new power of control is not merely for the end 
of limiting the quantity of human life, perhaps for a selfish object, but for 
the high end of improving its quality. It is in our power not only to generate 
life, but, if we will, to regenerate life. If we realize that possibility, and if 
we understand how the course of civilization has now brought it within our 
grasp, we have reached the heart of our problem. Our greatest foe, apart 
from indifference, is ignorance. Even science in this field is only beginning 
to feel its way, while the mass have still to unlearn many prejudices of the 
past. P. 48-54. 
Galton, during the last years of his life, believed that we are approaching 
a time when eugenic considerations will become a factor of religion, and when 
our existing religious conceptions will be reinterpreted in the light of a sense 
of social needs, so enlarged as to include the needs of the race which is to 
come. Certainly for those who have been taught to believe that man was in Introductory 
17 
the first place created by God, it should not be difficult to realize the divine 
nature of the task of human creation which has since been placed in the hands 
of man, to recognize it as a practical part of religion, and to cherish a sense 
of its responsibility. P. 63. 
THE SEXUAL QUESTION. August For el. 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 Forex: 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 In- 
sane 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; re- 
searches 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 im- 
proved 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 en- 
lighten the masses on the questions of sexual heredhy 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 18 
The Case eor Birth Control 
should sit still and watch our civilization go into decay and fall to pieces 
without raising the cry of warning and applying the remedy? 
The sexual appetite is very pronounced in tuberculous persons. They 
marry and beget children in the most wanton fashion. The law cannot and 
does not prevent them, and the carnal instinct is not to be killed. What is to 
be done when law and religion forbid the application of preventive measures 
and even prosecute the person that recommends them? Local diseases and 
pathological conditions in the woman (at times in man also) within wedlock, 
may render parturition and immediate danger to the life of the mother or of 
the child, or of both together. Surely in such cases it is the bounden duty 
of the physician to intervene and counsel against, nay absolutely forbid im- 
pregnation. 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 inter- 
dict 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 fol- 
lowing conclusions1 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 Introductory 
19 
for the mother or the child, or for both, and for that reason should be inter- 
dicted. 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 maritial love, secret illicit relations with others, and subsequent 
infidelity, nervous disorders, impotence, etc. In all these cases we are con- 
fronted 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 con- 
ception; 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 sym- 
pathy. But what is forgotten is that by concerning ourselves almost exclu- 
sively 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 nterested in it because it brings no honors, nor money, as 
we do not ourselves see the fruits of such efforts. In short, we amuse our- 
selves with repairing the ruins, but are afraid to attack what makes these 
ruins. P. 465-6. 20 
The Case for Birth Control 
The anti-conceptional measures recommended have been often con- 
demned, sometimes as immoral, sometimes as contrary to aesthetics. To inter- 
fere 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 main- 
tain 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 unneces- 
sary, 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 differ- 
ence. P. 497-8. 
She, (woman) ought to develop herself strongly and healthily by work- 
ing 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 to- 
ward 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 concern- 
ing 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 per- 
sonal 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. Introductory 
21 
THE DISEASES OF SOCIETY AND DEGENERACY. THE VICE 
AND CRIME PROBLEM. G. F. Lydston, M. D., Professor of Genito- 
urinary Surgery, State University of Illinois. Prof, of Criminal Anthro- 
pology, 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 citi- 
zens 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 simul- 
taneously 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 fret- 
ting 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 prac- 
tically 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 pos- 
terity. 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 doc- 
trine, but it does not uniformly fit modern conditions. The scriptural injunc- 
tion 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 hap- 
piness. CHAPTER II. 
ORIGIN AND PRACTICE OF BIRTH CONTROL IN VARIOUS 
COUNTRIES 
In the countries covered by this chapter Birth Control has been recog- 
nised 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 ALDBN HOPKINS. Harper’s 
Weekly, April 1C)th, 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 meth- 
ods may be supplied privately, but must not be publicly advertised. In Ger- 
many there is no law on the matter, but sentiment is strongly opposed to ad- 
vertising. In Switzerland it is forbidden to advertise or circularize. In Nor- 
way and Sweden advertising is not expected. Italy and France have no law 
on the subject. In Russia advertising in the newspapers is common. Every- 
where 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 limita- 
tion 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 be- 
tween the books of August Forel, a scientist revered in laboratories all over 
the world, and the obscene penny postcard sold by some slinking vendor. 24 
The Case for Birth Control 
THE MALTHUSIAN LEAGUE OF ENGLAND. The Origin and History 
of Birth Control in Great Britain. Reprinted from The Malthusian, April, 
1880. 
Little improvement can be expected in morality until the production of 
large families is regarded in the same light as drunkenness, or any other 
physical excess.—John Stuart Mill, 1872. 
In obedience to the request of the Nestor of political economists of Eu- 
rope, the distinguished editor of the Journal des Economistes of Paris, M. 
Joseph Gamier, we give a short account of the reasons which led to the foun- 
dation 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 doc- 
trines 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 bv pru- 
dence after marriage. Mr. Francis Place was one of the first to write a 
work on population, in which he recommended the physical checks so com- 
monly 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), him- 
self a believer in the conjugal prudence practised by the better class of peas- 
antry 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 pub- 
lish 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. Practice of Birth Control 
25 
Richard Carlile’s tract, entitled Every Woman’s Book, which was a most out- 
spoken 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’ imprinsonment 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 pro- 
prietor 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 pub- 
lishing 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 26 
The Case eor Birth Controe 
decided that there had been an error in the indictment, and thus the defend- 
ants 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. Drys- 
dale president, and Mrs. Annie Besant honarary 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. Ren- 
nick, Messrs. Rivers, Seyler, G. Standing, Truelove, and Young. Mr. Swaag- 
man 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 pre- 
sident 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: Practice; of' Birth Control 
27 
FEDERATION UNIVERSELLE DE LA REGENERATION HUMAINE 
(Federation of Neo-Malthusian Leagues). 
First President: The late Dr. Charles R. DrysdalE 
President: Dr. Alice DrysdalE Vickery 
Vice-Presidents 
Senor Aldecoa, Director of Govern- 
ment Charities, Madrid. 
Mr. G. Anderson, c. E. 
Major-General E. Begbie, C. B., 
D. S. O., Brighton. 
Dr. C. Callaway, Cheltenham. 
M. Victor Ernest, Belgium. 
M. G. Giroud, Paris. 
Herr Max Hausmeister, Stuttgart. 
Mrs. HeatherlEy. 
Mr. S. Van Houten, Depute of the 
First Chamber, The Hague. 
Dr. AlEtta Jacobs, Amsterdam. 
Mr. Joseph McCabe;. 
Dr. Mascaux, Courcelles, Belgium. 
Mr. Arthur B. Moss. 
P. Murugesa Mudaliar, Madras. 
Mr. Vivian Phelips. 
Rt. Hon. J. M. Robertson, M. P. 
Dr. J. Rutgers, Verhulststraat, 9 Den 
Haag, Holland. 
Me. Hoitsema Rutgers 
Frau Marie Stritt, Dresden. 
Dr. (Ph.) Helene Stocker, Berlin. 
Professor Knut Wicksell, Lund, 
Sweden. 
Constituent Bodies. 
England (1877).—The Malthusian League. Periodical, The Malthusian. 
Holland (1885).—De Nieuw-Malthusiaansche Bond. Secretary, Dr. J. Rut- 
gers, 9 Verhulststraat, Den Haag. Periodical, Het Gellukkig Huisgezin. 
Germany (1889).—Sozial Harmonische Verein. Secretary, Herr M. Haus- 
meister, Stuttgart. Periodical, Die Sozial FIarmonie. 
France (1895).—Generation Consciente. 27 Rue de la Duee, Paris XX. 
Spain (1904).—Liga Espanola de Regeneracion Humana. Secretary, Senor 
Luis Bulffi, Calle Provenza 177, Pral, la, Barcelona. Periodical, Salud y 
Fuerza. 
Belgium (1906).—Ligue Neo-Malthusienne. Secretary, Dr. Fernand Mas- 
caux, Echevin, Courcelles. Periodical: Generation Consciente, 27 Rue 
de la Duee, 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 Ziz- 
hov, Prague. 28 
The Case for Birth Control 
Portugal. Paz e Liberdade, Revista Anti-Militarist e Neo-Malthusiana. E. 
Silva, junior, L. da Memoria, 46 r/e, Lisbon. 
Brazil (1905).—Seccion brasilena de propaganda. Secretaries: Manuel 
Moscosa, Rua de’Bento Pires 29, San Pablo; Antonio Dominiguez, Rua 
Vizcande de Moranguapez 25, Rio de Janeiro. 
Cuba (1907).—Seccion de propaganda. Secretary, Jose Guardiola, Empe- 
drado 14, Havana. 
Sweden (1911).—Sallskapet for Humanitar Barnalstring. President: Mr. 
Hinke Bergegren, Vanadisvagen 15, Stockhold, Ya. 
Flemish Belgium (1912).—National Verbond ter Regeling van het Kinder- 
tal. 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 Neo-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 England1 
First President 
The late C. R. DRYSDALE, M.D., M.R.C.P., Lond., F.R.C.S, Eng.: 
President : Dr. ALICE DRYSDALE VICKERY. 
47 Rotherwick Road, Hampstead Garden Suburb, N. W. 
V ice-PrEsidents : 
Major-Gen. Elphinstone Begbie, 
C.B., D.S.O. 
Arnold Bennett, Esq. 
Chas. Callaway, Esq., M.A., D.Sc. 
Lieut.-Col. J. Fallon, L.R.C.P., 
R.A.M.C. 
E. S. P. Haynes, Esq. 
Dennis Hird, Esq., M.A., J.P. 
Mrs. HeathErlEy. 
Captain Kelso, R.N. 
Joseph McCabe, Esq. 
C. Killick Millard, Esq., M.D., 
A. B. Moss, Esq. [D.Sc., M.O.H. 
Vivian Phelips, Esq. 
Eden Phillpotts, Esq. 
Rig-ht Hon. J. M. Robertson, M.P. 
Lieut.-Colonel A. W. Warden, late 
Indian Army. 
H. G. Wells, Esq. 
Hon. Treasurer: 
W. V. OSBORNE, Esq. 
Hon. Secretary: 
BINNIE DUNLOP, Esq., M.B., Ch.B., Queen Anne’s Chambers, 
Westminster, S.W. 
(To whom all correspondence and subscriptions should be sent.) Practice of Birth Control 
29 
General Secretary: 
Miss O. M. JOHNSON, B.A. 
Editors of “The Malthusian”: 
DR. C. V. DRYSDAGE; MRS. B. DRYSDALE. 
Auditor : 
Mrs. E. AYRES PURDIE, A.L.A.A., Hampden House, Kingsway, W.C. 
Literary Secretary: 
Mr. GEORGE STANDRING, 7-9 Finsbury Street, London, E.C. 
(From whom Books on the Population Question can be obtained.) 
The following are some extracts from the League’s rules: 
II.—Objects. 
That the objects of this Society be:— 
1. To spread among the people, by all practicable means, a knowledge 
of the law of population, of its consequences, and of its bearing upon human 
conduct and morals. 
2. To urge upon the medical profession in general, and upon hospitals 
and public medical authorities in particular, the duty of giving instruction in 
hygienic contraceptive methods to all married people who desire to limit their 
families, or who are in any way unfit for parenthood; and to take any other 
steps which may be considered desirable for the provision of such instruction. 
III.—Principles. 
1. “That population (unless consciously and sufficiently controlled) has 
a constant tendency to increase beyond the means of subsistence.” 
2. That the checks which counteract this tendency are resolvable into 
positive or life-destroying, and prudential or birth-restricting. 
3. That the positive or life-destroying checks comprehend the premature 
death of children and adults by disease, starvation, war, and infanticide. 
4. That the prudential or birth-restricting check consists in the limita- 
tion of offispring (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 30 
The; Case: for Birth Control 
it is a grave social offence for men and women to bring into the world more 
children than they can adequately house, feed, clothe, and educate. 
6. That over-population is the most fruitful source of pauperism, ignor- 
ance, 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 physi- 
cally, 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 distri- 
bute 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 re- 
gard this as a matter which is strictly within the province of the medical pro- 
fession, 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 mar- 
ried 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 ad- 
dress 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 io help the League in its 
work. 
Under no circumstances zvhatever can the practical leaflet be supplied 
without a properly tilled up declaration, nor can more than one copy be sup- Practice; of Birth Control 
31 
plied to the same person. Those wishing- to help others, may have additional 
copies of the declaration form to hand on. 
The Malthusian League regrets that it is unable to comply with applica- 
tions 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 con- 
ference. 
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. Rut- 
gers 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 pro- 
created.” 
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 use- 32 
The; Case; f'or Birth Control 
lessness of drugs, and the non-necessity of abortions. (The Council of the 
Neo-Malthusian or Birth Control League calls attention to the fact that it 
has for its sole object the Prevention of Conception, and not the causing of 
abortion.) 
The clinic organized by Dr. Jacobs,—the first clinic in the world for the 
organized dissemination of information on Birth Control,—proved so efficient 
and beneficial to the standards of the community that others were opened and 
established until there are now more than fifty in operation. 
There is no doubt that the establishment of these clinics is one of the 
most important parts of the work of a Birth Control League. The written 
word and written directions are very good, but the fact remains that even 
the best educated women have very limited knowledge of the construction 
of their generative organs or their physiology. What, then, can be expected 
of the less educated women, who have had less advantages and opportunities? 
It is consequently most desirable that there be practical teaching of the meth- 
ods 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 sup- 
plied. 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 pre- 
ventive methods by trained workers, but the war prevented the returns from 
being anything like complete. And this in a country of only six million in- 
habitants.—The Malthusian, London, July 15, 1915. Practice; of Birth Control 
33 
RESULTS OF BIRTH CONTROL TEACHING IN HOLLAND 
There is no doubt that the Neo-Malthusian (Birth Control) League of 
Holland stands as the foremost in the world in organization, and also as a 
practical example of the results to be obtained from the teaching of the pre- 
vention 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 sta- 
tistics 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 in- 
crease 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 Ger- 
many, 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 Eng- 
land and Wales, etc., for 1912. 
Amsterdam (Malthusian (Birth Control) League started 1881; Dr. Aletta 
Jacobs gave advice to poor women, 1885.) 
Birth Rate 
1881-85 
37.1 
1906-10 
24.7 
1912 
23.3 
per 
1,000 
of 
population 
Death Rate 
25.1 
13.1 
11.2 
per 
1,000 
of 
population. 
Infantile Mortality: 
(Deaths in first year. . . 
203 
90 
64 
per 
thousand 
living births 
The Hague (now headquarters of the Neo-iMalthusian (Birth Control) 
League) 
1881-85 
1906-10 
1912 
38.7 
27.5 
23.6 
per 
1,000 of 
population 
Death Rate 
23.3 
13.2 
10.9 
per 
1,000 of 
population 
Infantile Mortality: 
(Deaths in first year) . . 
214 
99 
66 
per 
thousand 
living births 
iThese figures are the lowest in the whole list of death rates and infantile 
mortalities in the summary of births and deaths in cities in this Report. 34 
The Case for Birth Control 
Rotterdam. 
1881-85 
1906-10 
1912 
Birth Rate 
37.4 
32.0 
29.0 
per 
1,000 of population 
Death Rate 
Infantile Mortality 
24.2 
13.4 
11.3 
per 
1,000 of population 
(Deaths in first year). . 
209 
105 
79 
per 
thousand living births 
Fertility and Illegitimacy Rates. 
1880-2 
1890-2 
1900-2 
Legitimate Fertility . ... 
306.4 
296.5 
252.7 . 
, Legitimate birth per 1,000 
) Married women aged 15 
1 
( to 45. 
Illegitimate Fertility. .. . 
16.1 
16.3 
11.3 ! 
f Illegitimate births per 
1,000 Unmarried Wo- 
1 
' men, aged 15 to 45. 
The Hague. 
1880-2 
1890-2 
1900-2 
Legitimate 
Fertility . . . . 
346.5 
303.9 
255.0 
Illegitimate 
Fertility ... 
13.4 
13.6 
7.7 
Rotterdam. 
1880-2 
1890-2 
1900-2 
Legitimate Fertility . . . . 
331.4 
312.0 
299.0 
Illegitimate Fertility ... 
17.4 
16.5 
13.1 
There has been a marked improvement in the labor conditions in Holland 
during these last ten years especially, wages having increased and hours of 
labor decreased, with the cost of living taking a comparatively very small rise. 
There is no country in Europe where the educational advantages are so 
great as in Holland. 
That the Birth Control propaganda has been a success in Holland any 
one travelling through that delightful, clean and cheerful country can testify. 
In that enlightened country, Holland, the teaching by the medical pro- 
fession 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. 
zLowest figure for the Continent. Practice: of Birth Control 
35 
GERMANY 
Germany was the next to follow, in 1889, when Herr Max Hausmeister 
and Herr Karl Lotter founded the Sozial Harmonische Verein, with its paper 
Die Sozial Harmonie. Like the English League, this society has confined 
its teachings to the theoretical and economic aspects of the subject, in which 
it has especially distinguished itself. In Germany all such doctrines are of 
course anathema, but the enormous decline in the birth-rate in several towns 
testifies to the refusal of the German people to be hectored into misery. All 
the signs point at present to an extraordinary ferment of new ideas in Ger- 
many, 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-wis- 
senschaft, 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 respect- 
ively. 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 Emigres 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 con- 
tinued 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 36 
The: Case; for Birth Control 
countries. Bohemia, Spain, Brazil, Belgium, Cuba, Africa and Switzerland 
formed leagues in succession, most of them circulating periodicals dealing 
with Neo-Malthusian (Birth Control) theory and practice. At the same 
time M. Robin formed a Federation Universelle de la Regeneration Humaine, 
in which the various leagues have been associated and which has held two 
international meetings—the first at Paris in 1900 and the second at Liege in 
1905.—From The Malthusian (London) January, 1909. 
Fifteen years after the founding of M. Robin’s work, the propaganda in 
France is very complete and intense. Theoretical or practical, it appears 
under many forms. It acts through books, pamphlets, leaflets, journals, lec- 
tures, pictures, and even songs. Tens of thousands of theoretical volumes 
and pamphlets are disseminated, hundreds of thousands of leaflets are dis- 
tributed. 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 under- 
taken by Regeneration. The most active, the most enterprising, and the most 
combative of these organizations, Generation 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, work sby 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 fol- 
lowing 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 in- 
fertility 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 dura- 
tion of life is about fifty years, which is nearly the highest in Europe. The Practice of Birth Control 
37 
infantile mortality is the worst feature,1 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 dis- 
tressing problems which humanity has to face and as regards general happi- 
ness 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 tht 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 misrepre- 
sented. 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 in- 
creasing 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 
iNote: This is a problem of hygiene and infant welfare. If the same care 
were given the babies of France as is being given the infants of other advanced 
countries there is little doubt that the mortality rate would decline proportion- 
ately.—M. H. S. 38 
The; Case; for Birth Control 
25,988 in 1900, and of 19,920 in 1907. Despite these deficits the natural in- 
crease, or excess of births over deaths, was 1,232,744 in the twenty-five years 
from 1881 to 1905, while the total increase, including immigration, etc., was 
1,690,000 during the same period. It is worthy of note also in view of the 
suggestions that the deficit is about to become chronic, and that France is 
therefore a “dying nation,” that in 1893 and 1894, after three years of deficits, 
there were excesses of 7,000 and 39,000; in 1897 and 1898 of 93,700 and 
108,000; and in 1901 of 72,000. There has been no report since 1907, but Le 
Jour Officiel of Paris has given the figures for the first six months of 1908, 
which show an increase of 12,066, partly due to a rise of 8,657 in the births 
and partly a decline of 8,416 in the deaths.—From The Malthusian (London) 
of April 15th, 1909. 
BIRTH RATE IN FRANCE 
Compiled from The Malthusian, (London), for April 15th, 1909 
Year 
Increase 
Decrease 
1890 
38,446 
1891 
10,505 
1892 
20,041 
1893 
7,000 
1894 
39,000 
1895 
17,813 
1896 
No record available 
1897 
93,700 
1898 
108,000 
Total for 8 
years 247,700 
86,800 
86,800 
Total increase 160,900 
Rate of increase per year (approximately) 
20,100 
Increase in 
total population from 1783 
to 1907 
15,000,000 
UNITED STATES OF AMERICA 
It is interesting- to know that the present agitation for the dissemination 
of knowledge to prevent conception, as expressed in the various leagues 
throughout the world to-day had its greatest impetus and inspiration from two 
books written by Americans in the United States. Practice; of Birth Control 
39 
The first of these was a pamphlet entitled “Moral Physiology,” written by 
United States Senator Robert Dale Owen, son of Robert Owen, which was 
published in New York City in 1830 and gave a description of the physical 
checks made use of in France, where it was the custom to limit the number 
of children to the means at the command of the family. This book was much 
read and commented favorably upon in America. 
So favorably did this publication appeal to the thinking minds of the time, 
that Dr. Charles Knowlton, an able Boston physician, on reading Owen’s 
pamphlet, was so struck by its importance as a contribution to the science of 
hygiene that he brought out a similar work in 1833, entitled “The Fruits of 
Philosophy.” His book was addressed to young married people and gave a 
popular description of the anatomy of the organs of reproduction, especially 
in the female, and a somewhat more detailed account of the physical checks 
to prevent conception than had been given in Owen’s pamphlet. 
“The Fruits of Philosophy” circulated unchallenged for more than forty 
years, and finally, in 1876, was attacked as an obscene publication under the 
new act of Parliament called “Ford 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 Brad- 
laugh 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 prosecu- 
tion 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 hap- 
piness. 
The most advanced thinkers in America are with us in this movement, the 
sentiment being largely in favor of the establishment of clinics, similar The Case eor Birth Control 
40 
to those in Holland, where the poor and overburdened mothers may come 
for advice to be given by doctors, nurses or others competent to instruct. 
Following are some of the names of men and women in the United States 
who stand for the dissemination of such knowledge, have allied themselves to 
this great humanitarian < cause, and have come out in the press for birth con- 
trol as a national necessity: 
WELL KNOWN WOMEN WHO ENDORSE BIRTH CONTROL 
Mrs. J. Borden Harriman 
Mrs. Amos Pinchot 
Mrs. Charles Tiffany 
Mrs. Robert M. La Follete 
Mrs. Herbert Croly 
Mrs. Phillip Littell 
Mrs. Raymond B. Stevens 
Mrs. Simeon Ford 
Mrs. Philip Lydig 
Mrs. William I. Thomas 
Mrs. Robert P. Bass 
Mrs. Inez Haynes Irwin 
Mrs. Paul Manship 
Mrs. Frank Cothren 
Mrs. George B. Hopkins 
Mrs. J. Sargeant Cram 
Mrs. William Leon Graves 
Mrs. Gifford Pinchot 
Mrs. J. G. Phelps Stokes 
Mrs. Elsie Clews Parsons 
Mrs. Amy Walker Field 
Mrs. Mary Heaton Vorse 
Mrs. Juliet Barrett Rublee 
Mrs. Frances Hand 
Mrs. Mabel Foster Spinney 
Mrs. Belle I. Moskowitz 
Miss Caroline Rutz-Rees 
Miss Jessie Ashley 
Miss Lillian D. Wald 
Princess Troubetskoy 
NOTED PHYSICIANS WHO ENDORSE BIRTH CONTROL 
Dr. Abram Jacobi, ex-president, American Medical Association, New York 
City. 
Dr. Hermann M. Bigg's, 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. Practice: of Birth Control 
41 
Dr. S. Adolphus Knopf, professor of medicine, department of Phthisiotherapy, 
at New York Post-Graduate Medical School and Hospital, New York 
City. 
Dr. Lydia Allen de A ilbiss, formerly of New York State Department of 
Health, now in charge of the division of Child Hygiene of the State 
Board of Health of Kansas. 
NOTED WRITERS AND TEACHERS WHO ENDORSE BIRTH 
CONTROL 
Ernest Poole 
Will Irwin 
Walter Lippman 
Paul Kellogg 
Max Eastman 
Winthrop D. Lane 
John Reed 
Prof. Warner Fite 
Prof. William P. Montagu 
Prof. Charles Zueblin 
Prof. Durant Drake 
Prof. Thomas Nixon Carver 
Prof. Melvil Dewey 
Prof. William H. Allen 
Prof. Franklin H. Giddings 
Prof. Irving Fisher 
Hon. Homer Folks 
Hon. William H. Wadhams 
Dr. Henry Moskowitz 
Hiram Myers 
Dr. Scott Nearing 
Eugene V. Debs 
NOTED MINISTERS WHO ENDORSE BIRTH CONTROL 
Rev. Dr. Frank Crane, formerly pastor of the Union Congregational Church, 
Worcester, Mass., now notable writer of editorial articles for New York 
Globe, etc. 
Rev. Dr. Percy Stickney Grant, rector, Protestant Episcopal Church of the 
Ascension, New York City. 
Rev. Dr. Frank Oliver Hall, minister, Church of the Divine Paternity, New 
York City. 
Rev. Dr. John Haynes Holmes, minister, Unitarian Church of the Messiah, 
New York City. 
Rev. Dr. Harvey Dee Brown, minister, Unitarian Church of the Messiah, 
New York City. 
Rev. Dr. Stephen S. Wise, rabbi of the Free Synagogue, New York City. 
Rev. Dr. Sidney E. Goldstein, rabbi of the Free Synagogue, New York City. 
Rev. Dr. Waldo Adams Amos, rector, Protestant Episcopal Church of St 
Paul, Hoboken, N. J. 42 
The; Case: for Birth Control 
PROMINENT RESIDENTS OF CHICAGO, ILL., WHO ENDORSE 
BIRTH CONTROL 
Dr. Isaac A. Abt 
Rev. Myron E. Adams 
Rev. Edward S. Ames 
Dr. Charles S. Bacon 
Mrs. E. W. Bemis 
Mrs. I. S. Blackwelder 
Mrs. Tiffany Blake 
Dr. Anna E. Blount 
Ralph E. Blount 
Mrs. Joseph T. Bowen 
Mr. and Mrs. Horace Bridges 
Mr. and Mrs. Edward B. Burling 
Mrs. Benjamin Carpenter 
Dr. and Mrs. Frank Cary 
Mr. and Mrs. William L. Chenery 
Dr. Frank S. Churchill 
Mr. and Mrs. Samuel Dauchy 
Dr. J. B. De Lee 
Air. and Mrs. William F. Dummer 
Mrs. Joseph N. Eisendrath 
Mrs. Kellogg Fairbank 
Dr. John Favill 
Prof, and Airs. James A. Field 
Mrs. Walter L. Fisher 
Mr. and Mrs. Jerome Frank 
Rev. and Mrs. Charley W. Gilkey 
Dr. and Mrs. Maurice L. Goodkind 
Dr. Ethan A. Gray 
Mr. and Mrs. E. T. Gundlach 
Mrs. Alfred Hamburger 
Dr. and Airs. Ralph Hamill 
Dr. Alice Hamilton 
Mr. and Airs. Charles F. Harding 
Dr. N. Sproat Heaney 
Mrs. Charles Henrotin 
Dr. Rudolph W. Holmes 
Mrs. Leila K. Hutchins 
Dr. Karl K. Koessler 
Mr. and Mrs. Herman Landauer 
Dr. W. George Lee 
Prof, and Mrs. Frank R. Lillie 
Prof, and Mrs. J. Weber Linn 
Mrs. Edwin L. Lobdell 
Max Loeb 
Judge and Mrs. Julian W. Mack 
Prof, and Mrs. George H. Mead 
Dr. James H. Mitchell 
Mr. and Mrs. William S. Monroe 
Prof, and Mrs. Addison W. Moore 
Mrs. James W. Morrisson 
Mr. and Mrs. George Packard 
Mr. and Mrs. Benjamin Page 
Mrs. Elia W. Peattie 
Allen B. Pond 
Mr. and Mrs. James F. Porter 
Mrs. Julius Rosenwald 
Mrs. Dunlap Smith 
Mrs. Henry Solomon 
Dr. Alexander F. Stevenson 
Prof. Graham Taylor 
Mrs. Harriet W. Walker 
Mr. and Mrs. Willoughby Walling 
Mrs. George Watkins 
Mr. and Mrs. Payson Wild 
Mrs. Wilmarth 
Dr. Rachelle Yarros 
Victor S. Yarros 
Mr. and Mrs. Sigmund Zeisler 
Physicians, scientists, economists, social workers and others interested in 
the forward march of this country are simply marking time in progress until 
it is decided whether or not the medical profession and its assistants have the 
legal right to impart information to prevent conception to those who need it. 
A favorable decision would permit men and women to stem the incoming tide 
of feebleminded, unfit, degenerate individuals who undermine our present 
social structure and place a burden on generations yet unborn. CHAPTER III 
POPULATION AND BIRTH RATE 
In this chapter it is demonstrated that a high birth rate invariably means 
a high death rate, particularly a high infant mortality. Where a knowledge 
of methods to prevent conception sesults in a lowering of the birth rate, pro- 
portionately more of those children born survive, and a healthier, sturdier 
population is the result. 
BIRTH CONTROL 
By Havelock Ellis 
It may be said that Nature has been seriously troubled with the problem 
of reproduction even from the first creation of life. Our own doubts and 
difficulties in that sphere are but a continuation of those experienced on the 
earth long before Man’s ancestors descended from the forest trees. Nature’s 
first insistent impulse was for reproduction, and so the lowlier organisms 
increase at an enormous rate, though by far the greater number of the crea- 
tures 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- 44 
The; Case; for Birth Control 
rate and death-rate; by the mutual relationship of the two courses of the birth- 
rate and the death-rate we are able to estimate the evolutionary rank of a 
nation, and the degree in which it has succeeded in subordinating the primi- 
tive 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 knowl- 
edge 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 popu- 
lation of a country in those ages seems to have grown very slowly and some- 
times even to have retrograded. At the end of the sixteenth century the popu- 
lation 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. 
Small-pox, 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 chil- 
dren could tend machinery and thereby earn wages to increase the family 
takings. This led to an immediate result in increased population and in- 
creased 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 Population and Birth Rate 
45 
destitution arose; he old stability was lost, and the new prosperity produced 
unrest in place of well-being. The social consciousness was stdl oo im 
mature to deal collectively with the difficulties and frictions which theTnd ”- 
na 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 protec- 
tive 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 grati- 
fications and more remote aspirations. Foresight became a dominating motive 
e\en 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 differ- 
ent peoples. 
It is thus clear that the birth-rate combined with the death-rate consti- 
tutes 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. Ihe 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 uni- 
form 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 King- 
dom, Switzerland, Norway, Scotland, Denmark, Holland, the German Em- 
pire, 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 46 
The; Case; for Birth Control 
order: Holland, Denmark, Norway, Sweden, Switzerland, the United King- 
dom, 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 registra- 
tion, exert a disturbing effect. Roughly and on the whole, however, the fig- 
ures 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 off- 
spring do not always or at once produce the eugenic racial qualities possessed 
by hardier peoples living under simpler conditions. But with these reser- 
vations 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 popu- 
lations 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, with- 
out 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 
sleath-rate than Russia. So it is that among human peoples we find tb'- 
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 Population and Birth Rate 
47 
at a certain stage in the higher development of man without ceasing to be 
natural, it becomes conscious and deliberate. It is then that we have what 
may properly be termed Birth Control That is to say that a process which 
had before been working slowly through the ages, attaining every new for- 
ward 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 enlight- 
ened 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 repre- 
sented as entering an empty earth which it is their business to populate dili- 
gently. 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 48 
The Case eor Birth Control 
a sense of responsibility alike to herself and to the race, and determined to 
have no children but the best. 
Such were the two moralities which came into conflict during the nine- 
teenth 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 con- 
fused 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 en- 
lightened 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 con- 
spiracy 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 tradi- 
tional 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 sud- 
denly 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 signifi- 
cance to the whole world. 
BIRTH CONTROL. MARY ALDBN 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 inter- 
national tables of vital statistics our country's figures are omitted. 
Our 1910 census announced that 23 states had “fairly complete" death Population and Birth Rate 
49 
registration. They recorded about 90% of their deaths. But the birth regis- 
tration 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 our- 
selves 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 fig- 
ures 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 statis- 
tics we are confused by the effect of immigration. 
The birth rate of every civilized country is falling. The following com- 
parison of national birth rates is based on the ten largest countries of Europe. 
The less important ones show the same general characteristics. Asiatic coun- 
tries 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; Eng- 
land, 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 Regis- 
trar General of Great Britain for 1910. Five year periods are used in place 
of single years to eliminate variations of exceptional years. 
Seventy-third Annual Report of the Registrar-General of Births, Deaths 
and Marriages in England and Wales, 1910. London. Pub. by His Majesty s 
Stationery Office. Printed by Darling and Sons, Ltd., Bacon St., E» London. 
1912. 
Yearly Number of Births per 1000 Inhabitants. 
1881-5 
1906-10 
Russia (European 
49.1 
47.7* 
Hungary 
.... 44.6 
36.7 
German Empire 
37.0 
34.3* 
Spain 
36.4 
33.6 
Austria 
38.2 
33.6 
Italy 
38.0 
32.6 50 
The Case for Birth Control 
1881-5 
1906-10 
The Netherlands 
34.8 
29.6 
Belgium 
30.7 
27.7* 
England and Wales 
33.5 
26.6 
France 
24.7 
19.7 
*Figures for previous five years. 
The countries are arranged in order of 
their 1906-10 rates. 
By subtracting the figures in the second column from the first we obtain 
the fall in the rates between 1881-5 and 1906-10. Russia, in 1910, had the 
highest birth rate, and had suffered the slightest diminution, only 1.4 per 
thousand. Curiously Hungary, standing second in line, showed the greatest 
fall, 7.9 . England and Wales, far down the scale, had a drop of 6.9 per 
thousand. Italy, The Netherlands, France, and Austria kept a fairly even 
pace with a fall of around 5. Belgium, Spain, and the German Empire lost 
only about 3 per thousand. 
Much discussion has arisen concerning the cause of this decline. Two 
distinct stages occur in the fecundity of animal life. In the species below 
the human race it is checked by biological causes. In the human race it is 
checked by social and economic causes. As the scale of life rises, the number 
of offspring become fewer. The higher the animal, the fewer the offspring. 
When we reach the human animal, we and in addition to pestilence, war, 
and “acts of God,” various forms of voluntary check. Semi-civilized coun- 
tries 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 dis- 
seminated, and the means supplied. The birth rate, which had slowly de- 
clined 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. Population and Birth Rate; 
51 
Yearly Number of Deaths per 1,000 Inhabitants 
1881-5 
1906-10 
Russia (European) ...... 
35.4 
30.9* 
Hungary 
33.1 
25.0 
Spain 
32.6 
24.3 
Austria 
30.1' 
22.3 
Italy 
27.3 
21.0 
German Empire 
25.3 
19.9* 
France 
22 2 
19.2 
Belgium 
20.6 
17.0* 
England and Wales 
19.4 
14.7 
The Netherlands 
for previous five years. 
21.4 
14.3 
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. Bel- 
gium, 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-AIalthusians love tf 
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 52 
The: Case: for Birth Control 
births is greater than the number of deaths—so every country is increasing 
in population. 
Natural Increase in Population per 1,000 Inhabitants 
1881-5 
1906-10 
Russia (European) 
13.7 
16.8* 
The Netherlands 
13.4 
15.3 
German Empire 
11.7 
14.4* 
Hungary 
11.5 
11.7 
England and Wales 
14.1 
11.5 
Italy 
10.7 
11.4 
Austria 
8.1 
11.3 
Belgium 
10.1 
10.7* 
Spain 
3.8 
9.3 
France 
2.5* 
.7 
*Figures for previous five years. 
From the second column we find that Russia is increasing- most rapidly. 
The Netherlands comes second in rate of increase—an honorable position to 
which the regulationists point triumphantly when they assert that control of 
the birth rate does not mean the ruin of the nation. The German Empire 
comes next, with Hungary following. England stands fifth in the rating of 
increase, and England takes the position with woeful lamentations. Italy, 
Austria, Belgium, and Spain are near the foot of the list, and France brings 
up the rear a long, long way behind. France is the only one that is anywhere 
in sight of a stationary population. 
Excepting France and England, every one of these countries is increasing 
at a faster rate than formerly, because though the birth rate has fallen fast, 
the death rate has fallen faster. By comparing the second column showing 
the increase in the 1906-10 period with the first column showing the increase 
in the 1881-5 period, in the preceding table, we see how much each country 
is gaining in her rate of increase. This increase may or may not be con- 
sidered 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 and with a falling birth rate an increasingly increasing popu- 
lation,—always excepting France and England. 
FROM “THE EMPIRE AND THE BIRTH-RATE” 
By C. V. DrysdaeE, DSc. 
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 Population and Birth Rate 
53 
perishes before entering on a productive existence is not an asset to the num- 
bers or efficiency of the community, but a drain upon it for which there is no 
compensating gain. 
VARIATIONS OF POPULATION, BIRTH-RATE, 6-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; (r) that families are now notoriously very small among the profes- 
sional 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. 
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 death- 54 
The Case for Birth Control 
rate was approximately stationary, or perhaps slightly rising; but since then 
there has been a rapid and steady fall from about 22 per thousand to a little 
VAfttAT/ONS W BIRTH-RATE 
ENGLAND & WALES. 
1 
s 
I 
* 
I 
I 
'l 
5 
8 
Fig. 2.—England and wales. 
Fig. 1.—population of various countries. 
Fig. 3.—Ireland. 
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 Population and Birth Rate; 
55 
natural increase of population (excess of birth-rate over death-rate) during 
the last five years has averaged 11 per thousand, which is nearly the same 
as in the first five years 1853-57, when it was 11.7 per thousand, although it 
temporarily increased to 14.3 per thousand in the quinquennium 1874-78. The 
cry of depopulation or of “race suicide’’ has little more justification to-day 
when our birth-rate is only 24 and the average family probably between three 
and four children than it had in 1855 with a birth-rate of 34 and an average 
of 5 births per marriage. In an article in the Daily Telegraph of January 17 
last, a writer pointed out that mortality was very high among the large fami- 
lies 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 Un- 
restricted 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.* 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. 
♦Further investigation appears to indicate that the official statistics con- 
cerning emigration and immigration are very unreliable. The Statistical Abstract 
for the United Kingdom for 1912 gives the total emigration in the ten years 1901- 
10 as 4,724,233, and the total immigration 2,409,490, leaving an outward balance 
of 2,314,723. In the same period there were 11,628,493 births and 6,780,266 
deaths, giving a natural increase of 4,848,227; and since the actual increase by 
the census returns was 3,757,944, the net loss by emigration could only have been 
1,091,283 or less than half of the officially recorded number. Thus it appears 
that little over one-fifth of our natural increase is lost by emigration. (Since 
writing this, I find the Registrar-General admits the returns prior to 1908 were 
defective.) 56 
The Case for Birth Control 
We need not consider Scotland further, as its variations resemble those of 
England and Wales. 
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- 
Fig. 4.—Australia. 
Fig. 5.—new Zealand. 
Fig. 6.—Ontario, Canada. 
Fig. 7.—Toronto. Population and Birth Rate 
57 
rates. On further studying the matter, however, we find that Ireland’s low 
birth-rate is not due to small families, but to a low marriage rate (probably 
due to imigration 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 popu- 
lation from eight to little over four millions. It should be observed ,how- 
ever, 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 atten- 
tion 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 ex- 
pressed 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 deter- 
mined 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. There are given in Figs. 
4 and 5. 
In both countries the birth-rate fifty years ago was remarkably high (well 58 
The: Case for Birth Control 
over 40 per thousand), and it has since fallen very rapidly to 26 or 27 per 
thousand. But in both of them the death-rate has fallen somewhat, and they 
now have the lowest death-rates in the world, that of New Zealand having 
been about 9.5 per thousand for many years past. So, instead of increasing 
slowly, their rate of natural increase by excess of births over deaths is actu- 
ally 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 de- 
clined ; so the natural increase has slightly accelerated. 
The foregoing statements are, of course, quite independent of immigra- 
tion, and the following are the actual census figures for the increase of popu- 
lation. 
1860 
1870 
1880 
1890 
1900 
1910 
Australia, population .... 
Per cent. increase in 
1,145,585 
1,647,756 
2,231.531 
3.151.355 
3.765.339 
4.425.083 
decade 
— 
43.8 
35.5 
41.2 
19.5 
17.5 
New Zealand, population.. 
Per cent. increase in 
— 
— 
— 
625,508 
768,278 
1,002,679 
decade 
— 
— 
— 
— 
22.6 
30.5 
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 immi- 
gration 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.* New Zealand, on the other hand, shows a phenomenally large in- 
crease 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 thou- 
sand 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 popu- 
lation 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 
♦In the five years 1901-05 there was an actual net loss of over 16,000 persons 
by excess of emigration. Population and Birth Rate 
59 
to her defences may be granted; but there seems no reason whatever to be 
dissatisfied with the increase of her population. 
Canada.—Little can be said about this part of our Empire, owing to 
paucity of statistical information; but that little is most interesting and sig- 
nificant. 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 Pro- 
vince 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 when 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 
thin kthat the slow rate of increase of the French population is due to its 
low birth-rate. 
The remarkable prenomenon now appears. The increase of the birth- 
rate in Ontario to 25 per thousand has been accompanied, not by a corres- 
ponding 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 grave- 
yards 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 oper- 
ation, owing to the shortness of the summer and the difficulties of transport. 
The frequently quoted statement that her food exports show signs of lessen- 
ing indicates that the inability of food to keep pace with an unrestricted popu- 
lation 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 combina- 60 
The; Case for Birth Control 
tion with the long distances from medical or other help, makes the bringing 
up of large families very precarious. 
South Africa.—Beyond the fact that the population of the Union of 
South Africa increased from 5,175,824 in 1904 to 5,973,394 in 1911 (i.e., an 
increase of 15.4 per cent, in seven years) little information appears to be 
available. The white population seems to have increased from 1,116,806 to 
L276,242 (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 pe rcent.). 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:— 
Tota lfor decade 
1901 11 Percentage of Excess Births, 
Actual 
Population 
1901 
—Deaths 
Increase 
Births 
Deaths 
Births 
Deaths 
Bengal, 
Behar and Orissa 29,351,442 
25,373,322 
39.10 
33.80 
3,978.120 
4.552.293 
Punjab 
8,843,708 
40.8 
43.5 
—557,447 
355,383 
Assam 
1,564,022 
35.70 
29.65 
319,523 
489,892 
It is possible that these figures are correct, even without any restraint 
upon births, as the census report of 1901 mentioned that premature and re- 
peated 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, Population and Birth Rate: 
61 
given by the Statesman’s Year Book, for the three years above quoted was 
no less than 34.3, leaving a natural increase of only 3.4 per thousand—the 
lowest in our Empire, and nearly as low as that of France. The figures for 
Bengal, etc., above only show a natural increase of 4.7 per thousand, half 
that of Ontario at its lowest birth-rate of 19 per thousand; those for the 
Punjab reveal, despite the high birth-rate, an actual diminution of population 
by excess of deaths over births. 
The emigration from India appears to be so infinitesimal in comparison 
with its population that the actual increase represents the natural increase 
almost exactly. In Fig. 1 is shown the variation of population in the whole 
of India and in the British Provinces according to the census returns. 
1872 
1881 
1891 
1901 
1911 
Total population 
Per cent. Increase 
in 
206,162,360 
253,896,330 
287,314,671 
294.361.056 
315.001.099 
decade 
— 
23.1 
13.1 
2.4 
7.0 
British Provinces 
Per cent. increase 
in 
195,840,000 
199,200,000 
221,380,000 
231.600.999 
244.279.888 
decade 
.08 
1.6 
11.0 
4.5 
5.5 
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 enumera- 
tions 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 62 
The; Case for Birth Control 
that at least seven millions of lives are wasted annually by starvation or the 
diseases to which it renders them an easy prey. 
There can be no doubt in the mind of anyone who studies the figures, 
that India is a chronically, seriously over-populated country, despite the oft- 
quoted dictum of Sir William Hunter. That India might produce food 
enough to feed her present population need not be contested. But that any 
action on the part of the authorities will succeed in providing for an increase 
of ten millions annually is inconceivable. The whole Empire owes a tribute 
of gratitude and admiration to Sir A. Cotton whose magnificient 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.* Noth- 
ing 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:— 
Census 
1891 
1901 
1911 
Population 
345,356,000 
385,572,000 
417,268,000 
Per cent, increase in decade 
. . . . — 
11.6 
8.3 
*In the article on India in the “Encyclopaedia Britannica” it is stated that 
the Irrigation Commission of 1901-03 emphatically asserted that irrigation alone 
could not cure famine. Population and Birth Rate 
63 
Of course the increase from 1891 to 1901 was swelled by the addition of 
the Union of South Africa, etc., but the addition in the second period prob- 
ably 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 in- 
creasing 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 Im- 
perialist 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 
1 id 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 
The; Case; for Birth Control 
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 
Pig. 8.—ceylon. 
Fig. 9.—France. 
FlO. 10.—GERMANY. 
Fig .-11beeliu- Population and Birth Rate: 
65 
its high death-rate, not to its low birth-rate, and an explanation or remedy 
should be found for the former before objection is made to the latter. 
6. Possibly as a result of the present agitation in France in favor of 
large families, the births in the first half of last year increased by 8,000 over 
those of the corresponding period of 1912. Instead of producing a greater 
increase of population, the deaths increased by 12,000, so that the survivals 
actually diminished. 
It appears from the foregoing that while it is true that France is in- 
creasing 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 ad- 
vantage 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 cer- 
tainly fear of Germany that is responsible for so much of the anxiety con- 
cerning 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 con- 
ducive 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 cor- 
respondence 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 de- 66 
The Case for Birth Control 
rived from her high birth-rate, and the disadvantages were so obvious that it 
is little wonder that the German people have decided in favor of a low one. 
Austria shows very similar variations to Germany. 
Russia.—Russia has the largest population of any European nation, 120,- 
588,000 in 1911. Its birth-rate for many years was the highest in the world, 
very nearly 50 per thousand. But its death-rate and infantile mortality have 
been the highest in Europe, so that its rate of increase of population, though 
rapid, has been less than that of New Zealand or Australia. Over two mil- 
lions 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 illus- 
trated 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 incon- 
ceivable 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 appre- 
ciated 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 Population and Birth Rate 
67 
lowest figure in Europe; and the natural increase has reached 15.7 per thou- 
sand, 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 Regis- 
trar-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 an- 
nually 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. 2*4 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 68 
The Case eor Birth Control 
consequence. Real wages which have fallen here and in Germany have ap- 
parently 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 success- 
ful coloniser. Her possessions in the East and West Indies occupy a narea 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 popu- 
lation 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 chal- 
lenged 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 recog- 
nised 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 mar- 
riage 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 recog- 
nise; and those who are anxious for the increase of the population of our Population and Birth Rate 
69 
country and Empire, should turn their attention to the acceleration of food 
production instead of deploring the declining birth-rate. No intelligent per- 
son 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. Irri- 
gation 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 humani- 
tarian 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 pro- 
ducers 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 per- 
sist 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 condi- 
tions, by a checking of the output of physical a!nd 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. 70 
The: Case for Birth Control 
DIAGRAMS OF INTERNATIONAL VITAL STATISTICS 
Prepared by Charles V. Drysdale, D.Sc., 1911 
In the accompanying diagrams white strips imply birth-rates, shaded 
strips death-rates, and black strips infantile mortality, or deaths of children 
under one year. The amount of the white strip visible above the shaded strip 
is, of course, the excess of birth over death-rate, or the rate of natural in- 
crease 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 arron- 
dissements of Paris in 1906. (Note that the increase in the Elyee 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 in- 
creasing, 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 vari- 
ation 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 Nether- 
lands. (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 Population and Birth Rate 
71 
birth-rate has taken place almost equally with that in the Protestant countries, 
and with the same result.) 
Figs. 17-20.—The only four countries in which the birth-rate is approxi- 
mately 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 are 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 com- 
menced in 1877, the year of the Knowlton Trial. 
CHARLES V. DRYSDALE, D.Sc. 
1911. 72 
The Case for Birth Control 
VARIOUS COUNTRIES 
Fig. l. Population and Birth Rath: 
73 
VARIOUS CQ(/A/r/?/£S. 
CftUO£#Cgff/!£Cr£0 Of/)TH-/?/ir£S. 
Fig. 2 74 
The Case eor Birth Control 
LOA/DOA/ 
/JOS -/909 
EGA ERE Pi/RRQSES re er/3 D'ACRAR ErE RRORORrvcR 0* r~e CRttO ROAiStAT/OR /R Each 
t/UTfOAcuTAR ffcROi/CR /At aetErbarce a r ere CCtfRCu/S ecrrch ras PEER oiCB AJ 
AN ‘NfitA CE ’social cordiEior ’rro ere 39 BOROUCRS RA*r BEERARRARCEO tRSCPOVPE 
AS VRBCR 
C*CUf‘ / BOBOvCffS 
//V WHICH less rMAm f9 r*F CH/ctMfrnArrervo r~e fWAffuSstAtOCt* 
*. 
• - /y - ... ... « 
# 
m *» 
. - •> 6ff-9t°/..» » ... . 
#> 
nr 
- - - 9* - 91% • * 
V 
" * MOfte TMAH 9f % •• » •• - . • 
Fig. 3. Population and Birth Rate 
75 
PARIS 
Fig 4. 76 
The Case for Birth Control 
UNITED KINGDOM. Growth of Population 
excess of girths over xxeafhs w norofeds of thousahos fer /uvnuAt. 
\ 
I 
§ 
1 
Fia, fl* Population and Birth Rate: 
77 
UNITED KINGDOM. Birth and Death Rates 
B/ATN SeOEATH-RATES F£A TROUSANO, AN0 infantile. MORTAL/TV % 
RfilSrHA* £€*£#*1% *?P6*rs /8S>'/> C, 8 //-4.. 
Fig. 5a 78 
The Case for Birth Control 
GERMAN EMPIRE. Growth of Population 
excels or h/rths over deaths /h hohoreds or thousands her an"uh». 
*>Ot></i.Ar/OH y/V MtLLiONS. 
Fig. 6 Population and Birth Rate 
79 
GERMAN EMPIRE. Birth and Death Rates 
d/hth & pat&s pep thousand, &/npant/ie- mortality % 
rs?A<ft-v«vu'S ww ft /33. 
Fig. 6a 80 
The Case eor Birth Control 
FRANCE 
FOPULAT/OM. 
**r*SS 0* &/ATAS l0rjr* J>£47/*S S'* At/AAVA/TtS VS* T/fA()SA/tfA$ 
**T*l *>**></* 4TS0A, JA, M/tt,OA,S 
/tea C£# A£pe*rs ittJ /t er>, /t tut 
Fig. 7 Introductory 
81 
FRANCE. 
Kjs/evso/sases. 
B/ffTN&DEA TN PATES. 
Ap/tr# r*a*t r/r//>tcff*4. GTt&em/e j>fSf*scy pr* nwv.fA*>.- 
P//TH/S/S 4 CANCER DEATH RATES PER THOUSAND 
nee. c,e* nenonrs teas /, cvr rye? p/e g 
MS Ct nr. H6POUT /faj p.Utir 
Fig. 7a 
Fig. 7b. The Case for Birth Control 
82 
FRANCE. 
birth fr death rates. 
'HGeAr* re# r*ousA”o 
Fig. 8 Population And Birth Rate 
83 
VARIOUS O/SEASES. 
ENGLAND V WALES. 
MARRIAGE, FERTILITY, frILLEGITIMACY. 
Fig. 9 
BIRTHS V OEATMS. 84 
The Case for Birth Controe 
THE NETHERLANDS. 
Fig. 10 Population and Birth Rate 
85 
NORWAY 
SWEDEN 
S* 
V 
K 
v 
* 
© 
<c 
M 
K 
* 
I 
s 
? 
<«: 
I' 
* 
© 
£ 
* 
<*i 
<4 
Vj 
k 
QC 
* 
k 
'C 
q 
5: 
k 
<k 
N. 
<* 
BIRTH if DEATH-RATE S PER THOUSAND, AND //VPAMT/EB PfORTALtTP % 
_ v v v u >« U U tit i iu k t. 
/retrST#*# crMCVAtj *£po»t3 
Fig. 11. 
<at) f C‘> (• 'fef/t tl? 
teea/sr#*# cr*****'* **>•**+* 
c/> &/f of A/a 
Fig. 12. 86 
The Case for Birth Control 
DENMARK 
BELGIUM 
&lAT# if DEATH-RATES PE* THOUSAND, AND tNEANTlt£ MORTALITY °/a 
Bi*Tm » DEATH RATES PE* THOUSAND MHO infantile MORTALITY % 
RCa CCN AN* REPORT 
& G,ervERAi S r-$ 
zees /> et & '9°? 
Fig. 14. 
Fig. 13 Population and Birth Rate 
87 
ITALY 
SPAIN 
3/<?T« 6 DEATH RATES PER THOUSAND AfO INPAAITILEHORTRL/TY % 
BIRTH a DEATH ROTES PER THOUSAND Aho IN PAN TILE HORTALITV % 
Fig. 15* 
Fig. 16. 88 
The: Case: for Birth Control 
COUNTRIES WITH NEARLY STATIONARY BIRTH-RATE 
***4 C*t* *Mro*r *T*9 /• 
+*0 436*9 *90~0*» *9*9** '*? 
*T*+**r *T°f /***S 
4f€€ 49*+ ifiraMPr '7°7/» +** Population and Birth Rate: 
89 
COUNTRIES WITH RISING BIRTH-RATES 
JAPAN, Fig. 23 
w? «/» «*•»» /n/ < 
wwr >/>/ /«o 90 
The Case for Birth Control 
BRITISH COLONIES 
Fjg. 24. 
Fia 25. 
Ficu Population and Birth Rate: 
91 
t£c trtrtArc e/BTHS re* /oo nABBtco worker* /s -<t3. 
b/b th * bsa r* ba res bbb /ooo 92 
The: Case: for Birth Control 
BIRTH v OB A TH /?A res £>£& /000\ 
Fig.:3i 
WESTERN EUROPE, 
8c D£A rn f?/\ res • Per? /ooo. 
Fig. 30 
EURO PE, CHAPTER IV 
INFANT MORTALITY 
In the preceding pages it was stated that a high birth-rate is always ac- 
companied by a high infant mortality. The material presented in this chapter 
demonstates 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., Pro- 
fessor of Gynecological Surgery in Johns Hopkins University, and Gyne- 
cologist to the Johns Hopkins Hospital, etc. D. Appleton Co. New 
York and London, 1912. 
As long as a community can rest content in the btlief 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. Pamph- 
let 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 94 
The Case for Birth Control 
of the individual, is rarely amenable to curative treatment. It is only through 
applied eugenics that the vast volume of disease and degeneracy which flows 
through the channels of heredity can be prevented. Obviously this can be 
accomplished only through education and legislative restriction upon the pro- 
creation 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 mother- 
hood 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 chil- 
dren 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 with 
out the art of producing healthy and vigorous children.” 
Neuman, the distinguished author of the work on “Infant Mortality” de- 
clares 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 un- 
selected marriages among miners that the mortality of children was least in Infant Mortality 
95 
the four first-born, and then increased to a very high rate. Following are 
Geissler’s figures, (marriages with only one or two children are omitted). 
1st born children 
Deaths during first year 
23% 
2nd born children 
20% 
3rd born children 
21% 
4th born children 
23% 
Sth born children 
26% 
6th born children 
29% 
7th born children 
31% 
8th born children 
33% 
9th born children 
36% 
10th born children 
41% 
11th born children 
51% 
12th born children 
60% 
INFANT MORTALITY. Results of a Field Study in Johnstown, Pa., based 
on Births in one calendar year. By Emma Duke, Infant Mortality Series, 
No. 3. Bureau Publication No. 9. U. S. Department of Labor, Chil- 
dren’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 con- 
ditions, 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 vary- 
ing 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 re- 
lation 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 mor- 
tality rate where the mother has had many pregnancies, but there is not al- 
ways an increase from one pregnancy to the next.” The following table 
shows this tendency. It is based on the reproductive histories of 1,491 mar- 
ried mothers who had 5,617 births. Miscarriages are not included. 96 
The Case for Birth Control 
Infant Mortality Rate for all Children borne by Married Mothers: Table 36 
Number of Pregnancies. 
Infant Mortality Rate. 
1 and 2 
3 and 4 
126.0 per 1,000 
5 and 6 
7 and 8 
176.4 per 1,000 
9 or more 
191.9 per 1,000 
Average 
149.9 per 1,000 
In contemplating these figures we think immediately of wage-earning 
mothers away from home, ignorant feeding, and lack of care. These are 
powerful factors in raising the death rate. 
Of all the 1911 babies who died before they were a year old, 37% died in 
the first month of life. So much pain and misery and then no baby after all. 
All the skill in the world could not have saved those babies who lived only 
long enough to die. ' 
The infant mortality rate for the babies whose fathers earn under $521 
is almost twice as great as for those born into families in the most prosperous 
group. These figures strengthen the conclusion reached in the study of the 
babies born in 1911, namely that the economic factor is of far-reaching im- 
portance in determining the baby’s chance of life. 
One of the tables showing the influence of the esonomic factor, is cal- 
culated o nthe basis of 1,431 live-born babies with fathers. 187 of these 
babies succumbed during the first year, giving a general mortality rate of 
130.7 per 1,000. In these families a very few of the mothers worked outside 
the homes. 
Father’s earnings 
Live-births Deaths 1st 
year 
Infant mortality rate 
Under $625 
384 
82 
213.5 
$625 to $899 .... 
385 
47 
122.1 
$900 or more . . . . 
186 
18 
96.8 
Ample 
476 
40 
84.0 
Expressed in words, this table asserts that when the family income is 
under $625 a year, the children born alive die before the first birthday at the 
rate of 213.5 to the 1,000. In striking contrast when the income is $900 or 
more, they die only 96.8 to the 1,000. “Ample” was the expression used when 
the investigator could not obtain exact information as to the amount, but saw 
no evidence of actual poverty. The same ratio held good when it was calcu- 
lated 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. Infant Mortality 
97 
According to this table the superiority which children in indigent house- 
holds show over children in well-to-do households is preeminent skill in dying. 
When father earns $12 a week the children die at the rate of 213 per 1,000; 
but when father earns $18 a week, only 96 children per 1,000 pass away the 
first year of their lives. The lower the father’s wages, the higher the babies’ 
death rate. Many a death certificate should read, “Died of poverty.” 
The following table is compiled from the 5,617 children borne by 1,491 
married mothers, in Johnstown, Pa. 
Order of Birth 
Deaths per 1,000 
1st and 2nd born children 
138.3 
3rd and 4th born children 
143.2 
5th and 6th born children 
177.0 
7th and 8th born children 
181.5 
9th and later born children . . . . 
201.1 
Apparently the size of the family has much to do with the child’s chance 
of living, and apparently the earlier in the succession the child is born, the 
better chance of life it possesses. Death warrants await the coming of the 
youngest born.' 
Table 42. Infant mortality rate for all children of married mothers in- 
cluded in this investigation, distributed according to the father’s earnings. 
Father’s annual earnings 
Infant mortality rate 
Under $521 
197.3 
$521 to $624 
193.1 
$625 to $779 
163.1 
$780 to $899 
168.4 
$900 to $1,199 
142.3 
$1,200 to $1,200 and over ... 
102.2 U. S. DEPARTMENT OF LABOR CHILDREN’S BUREAU 
Julia C. Lathrop, Chief 
INFANT MORTALITY 
RESULTS OF A FIELD STUDY IN JOHNSTOWN, PA., BASED ON 
BIRTHS IN ONE CALENDAR YEAR 
By Emma Duke 
1915 
(Certain tables omitted) INFANT MORTALITY: JOHNSTOWN, PA. 
INTRODUCTION 
The term infant mortality, used technically, applies to deaths of babies 
under 1 year of age. An infant mortality rate is a statement of the number 
of deaths of such infants in a given year per 1,000 births in the same year. 
Some countries include stillbirths in making the computations, but this method 
is not generally followed in this country nor has it been followed in this report. 
Ordinary procedure is to compare the live births in a single calendar year 
with the deaths of babies under 12 months of age occurring in that same year, 
even though those who died may not have been born within the calendar year 
of their death. The infant mortality rates in this report, however, have not 
been computed on the usual basis, but for the purpose of securing greater 
accuracy in measuring the incidence of death this bureau has considered, in 
making the computation, only so many of the babies born in the year 1911 as 
could be located by its agents, and has compared with this number the number 
of deaths within this group of babies who died within one year of birth, even 
though some of these deaths may have occurred during the calendar year 
19122 
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: 102 
The; Case; eor Birth Control 
Deaths oe Children under 1 Year oe Age per 1,000 Live Births, by Quin- 
quennial Periods from 1901 to 1910, and also for the Single Calendar 
Years 1909 to 1910.1 
COUNTRY. 
1901 to 
1905 
1906 to 
1910 
1909 
1910 
Chile 
306 
315 
315 
313 
% 
Hungary 
212 
204 
212 
194 
190 
168 
164 
157 
174 
191 
174 
183 
173 
171 
189 
2C2 
176 
168 
155 
154 
166 
149 
148 
137 
148 
139 
120 
138 
117 
109 
105 
136 
114 
99 
108 
134 
115 
131 
117 
111 
118 
120 
108 
119 
98 
114 
127 
131 
123 
Ireland 
98 
94 
92 
95 
97 
78 
72 
75 
91 
72 
81 
72 
New Zealand 
75 
70 
62 
68 
> From the Seventy-third Annual Report of the Registrar General of Births, Deaths, and Marriages in 
England and Wales (1910). London, 1912. 
2 Available only for the period from 1896 to 1900, when it was 261. 
When it had been decided by the Children’s Bureau to make infant mor- 
tality 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 decide dto 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 thor- 
oughly 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 in- 
terest be contrasted with conditions typical of other communities. Moreover, 
the State commissioner of health and the State registrar of vital statistics Infant Mortality 
103 
were both working zealously to enforce birth-registration laws; both were ac- 
tively 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 demo- 
cratic; 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 complete- 
ness 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; they 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 registra- 
tion. The omission of these babies meant the exclusion of a number of moth- 
ers in a group that was too important racially to be omitted from an investi- 
gation embracing all races and classes. Accordingly a list of babies chris- 
tened 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 num- 
ber 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 fur- 104 
Thf Case; for Birth Control 
ther means were resorted to to locate unregistered babies for the purpose of 
including them in the investigation. 
There were 1,763 certificates copied at Harrisburg, and 1,383 of the 
babies named in them were reached by the agents. In addition, 168 babies for 
whom there were no birth certificates, but who were located in the ways just 
noted, were included, making a total of 1,551 completed schedules secured. 
Of the 380 not included in the investigation there were 149 who could 
not be located at all; 220 others had moved out of reach—that is, into another 
city or State; 6 of the mothers had died; 3 could not be found at home after 
several calls, and 2 refused to be interviewed. 
‘From the following summary of data recorded on the certificates of the 
380 unlocated babies just referred to it appears that the infant mortality rate 
(134.3) among them is almost the same as that (134) shown in Table 1 for 
babies included in the investigation. In reality, however, it is perhaps a little 
higher, as some of these babies no doubt died outside of Johnstown and their 
deaths were recorded elsewhere. 
NATIONALITY OF MOTHER. 
Total 
births. 
Live 
births. 
Still- 
births. 
SEX OF BABY. 
ATTENDANT AT BIBTH. 
Certifi- 
cate 
showing 
deaths 
during 
first year. 
Male. 
Fe- 
male. 
Pxiysi- 
clan. 
Mid- 
wife. 
Un- 
known. 
Total 
330 
350 
30 
227 
153 
158 
189 
33 
47 
Native 
134 
113 
16 
76 
53 
122 
5 
7 
12 
Foreign 
246 
232 
14 
151 
95 
36 
184 
26 
35 
Slovak, Polish, etc 
43 
41 
2 
27 
16 
4 
37 
2 
3 
Croatian and Servian 
13 
11 
2 
10 
3 
7 
6 
5 
Magyar 
1 
1 
1 
1 
8 
8 
61 
6 
2 
5 
1 
2 
Italian 
41 
33 
2 
26 
15 
3 
36 
2 
4 
7 
6 
1 
3 
4 
3 
4 
1 
British 
7 
7 
3 
4 
5 
2 
Austrian (not otherwise 
specified) 
123 
116 
7 
73 
50 
19 
89 
15 
20 
Not reported 
3 
3 
2 
1 
3 
RELATION OF INFANT MORTALITY TO ENVIRONMENT 
NEIGHBORHOOD INCIDENCE 
The rate of infant mortality is regarded as a most reliable test of the 
sanitary condition of a district. (Sir Arthur Newsholme, Elements of Vital 
Statistics, p. 120. London, 1899.) 
Johnstown is a hilly, somewhat Y-shaped area of about 5 square miles 
which spreads itself out into long, narrow, irregularly shaped strips, detached 
by rivers and runs and steep hills. In some places it is not over a quarter of 
a mile wide, but its extreme length is about 4 miles. The city is composed of Infant Mortality 
105 
21 wards and is an aggregation of what were formerly separate unrelated 
boroughs or towns. The names of these different sections, together with the 
numerical designations of the wards included in or comprising them, are 
shown in the following table. This table gives for each section not only the 
total population according to the Federal census of 1910, but also the number 
of live-born babies included in the investigation and the number and propor- 
tion of deaths among such babies during their first year. 
Table: 1.—Distribution oe Population, Live Births and Deaths During 
First Year, and Ineant Mortality Rate According to Section oe 
Johnstown, eor all Children Included in this Investigation. 
SECTION OF CITY AND WARD. 
Popu- 
lation, 
1910.‘ 
Total 
R ve-born 
babies. 
IV v. 
1/Ca« Zj 
first yet-’ 
of babies 
born in 
1911. 
iy 
rale. 
The whole city 
55,482 
.1,463 
195 
134.0 
Down-town section (wards 1, 2, 3, 4) 
5.944 
6,070 
4.476 
2,862 
5,282 
3.945 
1,893 
1,443 
2,403 
-8,706 
5,735 
5,757 
966 
89 
104 
109 
85 
136 
107 
55 
18 
72 
310 
157 
194 
36 
4 
- 22:2 
Kernville (wards 5, 6) 
Hornerstown (ward 7) 
17 
10 
15 
Roxbury (ward 8) - 
117.6 
117.6 
271.0 
200.0 
(1) 
125.0 
Conemaugh Borough (wards 9, 10) 
Woodvale (ward 11) 
Prospect (ward 12). 
Peelorville (ward i3) 
Minersville (ward 14) 
Cambria City (wards 15, 16) 
rt 
Moxham (ward 17) ’ 
14 
16 
S 
Morrellvilie (wards 18, 19, 20) 
Coop6rsdale (ward 21) 
l1) 
1 Federal census of 1910. 
* Total live births less than 50; base therefore considered too small to use in computing an infant mor- 
tality rate. 
To learn where the babies die is perhaps the first step in solving the in- 
fant mortality problem. The modern health officer recognizes this and gener- 
ally 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 ra-te 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 in- 
terviewed in this ward being foreign born. 106 
The Case eor Birth Control 
Through Woodvale runs the main line of the Pennsylvania Railroad. To 
the north of the tracks rises a steep hill, toward the top of which is Wood- 
vale 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 ex- 
pense 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. Infant Mortality 
107 
The sewage from other residential sections and from the steel mills above 
them empties into the river at this point. In warm, dry seasons the river is 
low, flows slowly, and forms foul-smelling pools. 
Sewer connection is possible for most of the houses in Cambria City, 
although all are not connected. Some, on the streets bordering the river, 
have private drain pipes that empty out into the stream. Others have their 
kitchen sinks connected with the sewer but still retain yard privies, which, of 
course, are not sewer connected. 
There is considerable crowding of houses on lots, rear houses being com- 
monly 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 busi- 
ness 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.) 
Hornerstown 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 mor- 
tality 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 pre- 
vailing 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 downtown 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 108 
The Case for Birth Control 
constantly trickle down the numerous alleys and streets that descend the hill. 
(See Plate J.) This section makes a very unfavorable first impression be- 
cause 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 cer- 
tain ugly spots this section has not the unwholesome atmosphere that char- 
acterizes 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 sec- 
tions, 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. Con- 
ditions 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 ap- 
pears 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 Morrell- 
ville 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 sec- Infant Mortality 
109 
tion, however, are on a hill stretching upward from Stony Creek, which is 
both unsightly and offensive in warm weather and when the water is low. 
The down-town section, i.e., wards 1, 2, 3, and 4, where are to be found 
many of the best conditioned houses, the homes of many of the well-to-do 
people, has the lowest infant mortality rate in the city, it being but 50. 
No infant mortality rate is presented in the tables for Coopersdale or for 
Peelorville. In the first-named section only 36 live-born infants were con- 
sidered, 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 sys- 
tems 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 vari- 
ous sections of both rivers create nuisances that are the subject of much com- 
plaint, 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 reme- 
died if pipes were extended out into the middle of the streams, where the 
water is deeper. 110 
The; Case for Birth Control 
With the exception of sprinkling a few wagon loads of lime along the 
banks of the streams each year, the city has done nothing to abate the nuis- 
ances 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 un- 
paved. The combined length of streets and alleys is 134.88 miles. A com- 
parison 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 house- 
holders. 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 Penn- 
sylvania 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 lawful, 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 im- 
prisoned 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, Infant Mortality 
111 
Dr. Helen MacMurchy says: “Improve the water supply, the sewerage sys- 
tem, 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 un- 
questionably 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 house- 
keeping. 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 pur- 
poses. 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 tene- 
ment-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 112 
The Case for Birth Control 
were no bathtubs. Desirable as a bathtub and bodily cleanliness may be, this 
does not prove that the lives of the babies were saved by the presence of the 
tub or the assumed cleanliness of the persons having them. In a city of 
Johnstown’s low housing standards, the tub is an index of a good home, a 
suitable house from a sanitary standpoint, a fairly comfortable income, and 
all the favorable conditions that go with such an income. 
The same trend of a high infant mortality rate in connection with other 
housing defects is noted in the next table. 
Table 3.—Distribution of Live Births and of Deaths During First 
Year, and Infant Mortality Rate, According to Housing Conditions. 
HOUSING CONDITIONS 
Total 
Dry homes 
Moderately dry homes 
Damp homes 
Bath 
Live 
births 
496 
Deaths during 
First Year 
Infant 
Number mortality 
rate 
196 134.0 
99 122.5 
47 139.9 
60 156.7 
36 72.6 
965 
159 
164.8 
Not reported 
2 
1 
0) 
Water supply in house 
138 
117.6 
Water supply outside 
67 
197.9 
Not reported 
2 
1 
U) 
City water available 
176 
132.0 
City water not available 
19 
148.4 
Not reported 
1 
0) 
Yard clean 
80 
99.9 
Yard not clean 
632 
107 
169.3 
No yard 
28 
8 
0) 
Not reported 
1 
(l) 
Water-closet 
80 
108.3 
Yard privy 
116 
159.3 
Not reported 
1 
O) 
*Total live births less than 50; base therefore 
puting an infant mortality rate. 
considered too 
small to use 
in com- 
The following summary may be of interest in indicating some relation 
between infant mortality and cleanliness or uncleanliness combined with dry- 
ness or dampness of homes: 
Table) 4.—Distribution of Live Births and of Deaths During First 
Year, and Infant Mortality, According to Cleanliness and Dryness 
of Home. 
All types 
Clean 
Moderately clean . , 
Dirty 
TYPE OF HOME 
Live 
births 
166 
Deaths 
First 
Number 
196 
107 
68 
31 
99 
during 
Year 
Infant 
mortality 
rate. 
134.0 
113.5 
163.8 
186.7 
122.7 
Dry 
Damp 
97 
147.9 
Clean: 
Dry 
61 
105.0 
Damp 
46 
127.1 
Moderately clean: 
Dry 
27 
170.9 
Damp 
31 
168.2 
Dirty: 
Dry 
11 
161.8 
Damp 
20 
204.1 Infant Mortality 
113 
Dirt is doubtless unhealthful, but the amount of ill health or the number 
of infant deaths caused by a home being dirty can hardly be measured, when, 
as is usually the case, the dirt is accompanied by so many other bad conditions 
arising from poverty. For example, a home in close proximity to railroad 
tracks or mills whose stacks send forth clouds of soot, smoke, and ashes Is 
generally the poorly built home of those who have neither time nor means 
to secure and retain cleanliness under such difficulties. 
Overcrowding in homes is another factor the relative importance of which 
can not be exactly determined, because of its close connection with other ills. 
But the degree of overcrowding is greatest in the small cheaper houses, those 
of one, two, three, or four rooms. The average number of persons per room 
in the homes of all live-born babies for whom the data were secured was 
found to be 1.38. Homes of four rooms were more numerous than those ol 
any other size and they housed an average of 1.58 persons per room. Tht 
number of babies in homes of various sizes with the number of persons per 
room for homes of each size was as follows: 
Table: 5.—Number ob Babies Living in Homes oe Each SpEcieied 
Size, and Average Number ob Persons Per Room in Homes ob Eac* 
Size. 
Size of home 
Live-born 
Persons 
Size of home 
Live-born 
Persons 
babies 
per room 
babies 
per room 
All homes .... 
1,463 
8 rooms 
43 
0.83 
1 
33 
4.42 
22 
.93 
2 
165 
2.27 
4 
SS 
3 
147 
1.83 
4 
.61 
4 
526 
1.58 
1 
.75 
6 
222 
1.22 
1 
.63 
6 
233 
1.07 
2 
7 
rooms 
38 
.96 
Not reported 
22 . 
In homes of one, two, three, or four rooms or where the number oi 
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 72 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. 114 
The Case for Birth Control 
The incidence shown in the foregoing table is significant, even though 
it can by no means be deduced therefrom that the health of a large proportion 
of babies was so impaired by sleeping with older and more or less unhealthy 
persons that death resulted. But irregular night feeding and overfeeding are 
undoubtedly harmful, and the mother is tempted to subject the baby to this 
when it sleeps with her and disturbs her rest. 
Of the 1,389 babies who lived at least one month, 600, or 43.2 per cent, 
lived in homes where the baby slept in a room with not more than two other 
persons. The fact that the baby slept in a room with no more persons than 
its parents generally argues that the family’s means permitted them to have 
one or more additional rooms for other members of the family, but in other 
cases, of course, merely that there were no other persons in the family. 
Almost every home visited had means for good ventilation of the baby’s 
room at night, yet but 604, or 43.5 per cent, of the 1,389 babies who lived at 
least a month slept at night in well-ventilated rooms—that is, in rooms where, 
according to the mother’s statement, a window was open all night. Some 
mothers opened windows when the weather was neither cold nor damp; or 
opened them in a hall or room adjoining that where the baby slept; others 
emphatically stated that at night the windows were “always shut tight.” The 
babies subjected to differences of ventilation show corresponding variations 
in infant mortality rates. 
A high death rate in badly ventilated homes can not be charged wholly 
to bad air. The mother who did not, or could not, provide proper ventilation 
was generally the mother without the means or the knowledge necessary to 
enable her to care for her baby properly in other respects, and yet the marked 
differences suggest that ventilation is itself a very important ally of the baby 
in its first year of struggle for existence. 
In many rooms that were poorly ventilated, windows were not opened 
for the reason that the room was not properly heated and the houses them- 
selves 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 prac- 
tically nothing and the owners did practically nothing in the matter of im- 
proving these homes, which naturally became more and more squalid as time 
went on. An excessive infant mortality rate and insanitary homes in un- 
healthful sections were found to be coexistent. Infant Mortality 
115 
NATIONALITY 
GENERAL NATIVITY 
The investigation embraced 860 babies of native mothers (of whom 6 
were negroes) and 691 babies of foreign mothers, making a total of 1,551. 
The infant mortality rate for the entire group was 134 per 1,000 live births; 
for the babies of native mothers 104.3, and for those of foreign mothers 171.3. 
The stillbirth rate for native mothers having children in 1911 was less than 
that for foreign mothers, being 52.3, as compared with 62.2 per 1,000 total 
births. 
The line between the natives and foreigners is very sharply drawn in 
Johnstown. The native population as a rule knows scarcely anything about 
the foreigners, except what appears in the newspapers about misdemeanors 
committed in foreign sections. The report of the Immigration Commission1 
comments “on the attitude of the police department toward foreigners * * * 
with regard to Sunday desecration,” and states that “the Croatians are accus- 
tomed 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 popu- 
lation than for mere infractions of the law * * *. Few arrests are made 
for immorality among foreigners.” “Sabbath desecration” is the crime for- 
eigners 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 de- 
partments 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 
MJnited States Immigration Commission Reports, Volume VIII, “Immigrants in In- 
dustries: Part 2, Iron and Steel Manufacturing in the Bast,” p. 387. Reference is to 
Johnstown and is a very true picture of various immigrant institutions and of the 
comparative progress and assimilation of different races there. Although the immi- 
gration report was made five years before our investigation, conditions remain practi- 
cally the same. 116 
The; Case for Birth Control 
that make them a nuisance to the native population” or for “Sabbath dese- 
cration,” 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 de- 
liver milk from wagon or by person carrying same, within the city on the Sab- 
bath 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- 
Croatian1 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 gen- 
eral, the augmentation stated is insufficient in these abnormal homes where 
the women are required to have many meals and dinner buckets ready at ir- 
regular 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, 
*A distinct and homogenous race, from a linguistic point of view, among Slavic 
peoples. They are divided into the groups “Croatian” and “Servian,” on political and 
religious grounds, the former being Roman Catholics and the latter Greek Orthodox. 
Their spoken language is the same but they can not read each other’s publications, 
for the Croatians use the Roman alphabet, or sometimes the strange old Slavic letters, 
while the Servians use the Russian characters fosered by the Greek Church. 
Three Krainers have also, for convenience, been included in this group. Krainers 
are Slovenians from the Austro-Hungarian Province of Carniola and are designated 
“close cousins of the Croatians but with a different though nearly related language” 
by Emily Greene Balch in her book entitled “Our Slavic Fellow Citizens.” Infant Mortality 
117 
on the snow and ice-covered ground, hanging up clothes or carrying water 
into the house from a yard hydrant. 
Whether it harmed them to expend their force and vigor as they did 
could not be determined in individual cases, but their babies are the ones who 
died off with the greatest rapidity, their infant mortality rate being 263.9, as 
compared with the rates of 171.3 for all the foreign; 104.3 for the natives; 
and 134 for the entire group as shown in Table 8. 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 in- 
vestigation excepting the Serbo-Croatian. The babies of Slovak1 mothers 
were found to be most numerous, there being 276 of them. There were 108 
babies of Polish,2 2 of Bohemian,3 and 7 of Ruthenian4 mothers. In addition, 
Slovaks occupy practically all except the Ruthenian territory of northern Hun- 
gary; also found in great numbers in southeast Moravia. They are the Moravians 
conquered by Hungary. In physical type no dividing line can be drawn between 
Slovaks and Moravians. It is often claimed that Slovak is a Bohemian dialect. 
*The west Slavic race notive to the former Kingdom of Poland. For the most part 
they adhere to the Roman rather than the Greek Orthodox Catholic Church. 
3The westernmost division or dialect of the Czech and the principal people or lan- 
guage of Bohemia. Czech is the westernmost race or linguistic division of the Slavic 
(except Wendish, in Germany), the race or people residing mainly in Bohemia and 
Moravia. 
‘Also known as Little Russians; live principally In southern Russia; also share 
Galicia with the Poles but greatly surpassed by Poles in number. In language and 
physical type resemble Slovaks. Generally Greek Orthodox, but a few are Greek 
Catholics of the Roman Catholic Church, whose priests marry, and are separated from 
other Roman Catholics by marked religious differences. 118 
The; Case; f'or Birth Control 
one baby of a Scandinavian (Danish) mother was included, not because Scan- 
dinavians 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 prac- 
tically 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 com- 
forts than those of the Serbo-Croatians and Italians. 
OTHER NATIONALITIES 
The British5 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 
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. 
BEnglish, Irish, Scotch, and Welsh included in the term British. Infant Mortality 
119 
STILLBIRTHS 
In all there were but 88 stillbirths included in the investigation. They 
were more numerous proportionately among the Germans than among the 
mothers of any of the other notionalities. No single nationality group, how- 
ever, 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 physi- 
cian 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 The; Case for Birth Control 
120 
quality of the care at birth, although in some cases the inefficiency of the 
midwife may have directly or indirectly caused deaths, just as in some in- 
stances a physician’s inefficiency may have caused them. The midwife, how- 
ever, 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 as- 
sistance 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 
LITERACY1 
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. Infant Mortality 
121 
Table 13.—Distribution of Births and of Deaths During First Year, Infant 
Mortality Rate, and Number and Per Cent of Stillbirths, According to 
Literacy of Foreign Mothers. 
LITERACY OF FOREIGN MOTHERS. 
Total 
births. 
Live 
births. 
STILLBIRTHS. 
DEATHS DURING 
FIRST YEAR. 
Number. 
Per cent. 
Number. 
Infant 
mortality 
rate. 
Foreign mothers 
691 
648 
43 
6.2 
Ill 
171.3 
Literate. 
445 
419 
26 
5.8 
62 
148.0 
Illiterate. ....... 
24C 
229 
17 
6.9 
49 
214.0 
ABILITY TO SPEAK ENGLISH 
The next table shows that babies whose mothers can not speak English 
were characterized by a more unfavorable infant mortality rate than other 
babies. 
Table 14.—Distribution op Births and op Deaths During First Year, Infant 
Mortality Rate, and Number and Per Cent op Stillbirths, According to 
Ability op Foreign Mother to Speak English. 
ABILITY TO SPEAK ENGLISH. 
Total 
births. 
Live 
births. 
STILLBIRTHS. 
DEATHS DURING 
FIRST YEAR. 
Number. 
Per cent. 
Number. 
Infant 
mortality 
rate. 
Foreign mothers 
691 
648 
43 
6.2 
Ill 
171.3 
Speak English 
263 
247 
16 
6.1 
36 
145.7 
Can not speak English 
428 
401 
27 
6.3 
75 
187.0 
1 By literacy is meant ability to read and write in any language and not simply in. English. 
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 arid are 
housed in the most insanitary and unhealthful part of the city. 122 
The Case eor Birth Control 
AGE 
The age of the mother is frequently believed to be a factor in the health 
of the child. The highest infant mortality rate was found to be that for the 
group of babies with mothers over 40 years of age, and the lowest for babies 
of mothers from 20 to 24 years of age. 
Table 16.—Distribution of Births and of Deaths During First Year, Infant 
Mortality Rate, and Number and Per Cent of Stillbirths, According to Age 
of Mother. 
AGE OF MOTHER. 
Total 
births. 
Live 
births. 
STILLBIRTHS. 
DEATHS. 
Number. 
Per cent 
of total. 
Number. 
Infant 
mortality 
rate. 
All mothers 
1,551 
1,463 
88 
5.7 
196 
134.0 
Under 20 
105 
95 
10 
9.5 
13 
136.8 
20 to 24 
476 
454 
22 
4.6 
55 
121.1 
25 to 29 
410 
391 
19 
4.6 
56 
143.2 
30 to 39 
480 
449 
31 
6.5 
61 
135.9 
40 and over 
80 
74 
6 
7.5 
11 
148.6 
The youngest mothers have a higher stillbirth rate than other mothers, 
and the oldest group of mothers has the next highest rate. In this connection 
not only the foregoing table is of interest, but also Table XII, based upon the 
entire reproduction histories of the mothers included in this study. As all 
the children borne by these mothers are included, the base numbers in the 
latter table are larger and the figures therefore somewhat more significant. 
BABY’S AGE AT DEATH AND CAUSE (DISEASE) OF DEATH 
A baby who comes into the world has less chance to live one week than 
an old man of 90, and less chance to live a year than one of 80.—Bergeron. 
The most dangerous time of life is early infancy; even old age seldom 
has greater risk. Death strikes most often in infancy. The Johnstown babies 
died during their first year of life at the rate of 134 per 1,000 born alive, and 
they paid their heaviest toll in their very earliest days. If the total of 196 
deaths had been distributed evenly throughout the 12 months, 8.3 per cent of 
the babies would have died each month and 25 per cent during each quarter. 
But instead of that 37.8 per cent died in the first month; 9.2 per cent in the 
second, and 8.2 per cent, in the third, or over 55 per cent in the first quarter. Infant Mortality 
123 
Table 17.“—Number and Percent Distribution of Deaths of Babies, by Age 
at Death. 
AGE AT DEATH. 
DEATHS 
OF ALL 
Number. 
OF BABIES 
MOTHERS. 
Per cent 
distri- 
bution. 
Total deaths in first year 
196 
100.0 
First quarter.. 
First month ,,,.. 
First week 
Less than 1 day and 1 day 
2 days ' 
3 to 6 days 
lx 
? i 
Second week . » 
14 
Third week 
7 
6 
Fourth week 
$ 
Second month 
18 
9.2 
Third month.,..T . 
gg 
Second quarter.. 
42 
21.4 
Third quarter 
31 
15.8 
Fourth quarter 
15 
7.7 
The large number of deaths in the first few hours or days of life indicates 
that many babies are born with some handicap and that in many instances the 
mother has been subjected to some condition which resulted in the birth of a 
child incapable of withstanding the ordinary strain of life. Of the 45 babies 
who died in Johnstown less than a week after birth, 38 died of prematurity, 
congenital debility or malformations, or injuries received at birth. In one 
other case the cause of death was given as “bowel trouble” and in six other 
cases it was not clearly defined. In addition to the 45 babies just referred to 
as having died in their first week, 12 died later either from prematurity or 
from congenital defects. 
Of the deaths from causes arising after birth, 52 were attributed by the 
attending physicians to diarrhoea and enteritis, 50 to respiratory diseases; 
and 44 to some other or to some ill-defined cause. 
Table 18.—Distribution of Deaths During First Year and Infant MoRtAtfff 
Rate, According to Cause of Death and Nativity of Mother. 
CAUSE OF DEATH. 
DEATHS DURING FIRST TEAR OF BABIES OF— 
All mothers. 
Native mothers. 
Foreign mothers. 
Number. 
.Infant 
mortality 
rate. 
Number. 
Infant 
mortality 
rate. 
Number. 
Infant , 
mortality 
rate. 
All causes 
196 
134.0 
85' 
104.3 
Ill 
171.3 
Diarrhea and enteritis 
52 
35.5 
17 
20.9 
35 
54.0 
Respiratory diseases 
50 
34.2 
19 
23.3 
31 
47.8 
Premature births 
24 
16.4 
11 
13.5 
13 
20. r 
Congenital debility or malformation 
19 
12.9 
5 
6.1 
14 
21.6 
Injuries at birth 
7 
4.8 
6 
7.4 
1 
1.5 
Other causes or not reported 
44 
3p.l 
27 
33.1 
17 
26.2 124 
The Case eor Birth Control 
The latest census report on mortality statistics characterizes diarrhoea 
and enteritis as the “most important preventable cause of infant mortality” in 
the United States, and numerically at least it proves to be the most important 
cause of infant death in Johnstown. 
Holt1 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. 
Table 19.—Distribution of Deaths, According to Cause of Death and Quarter 
of Calendar Year in which Death Occurred. 
CAUSE OP DEATH. 
All 
deaths. 
QUARTER OP CALENDAR YEAR IN WHJCH. 
DEATH OCCURRED. 
First. 
Second. 
Third. 
Fourth. 
All causes 
196 
54 
29 
74 
39 
Diarrhea and enteritis 
52 
3 
5 
32 
12 
Respiratory diseases 
50 
24 
8 
7 
n 
Premature births 
24 
7 
5 
9 
3 
Congenital debility or malformation ....... 
19 
5 
2 
8 
4 
Injuries at birth _ 
7 
5 
1 
1 
Other causes or not reported 
44 
10 
8 
18 
8 
1 The Diseases of Infancy and Childhood, by L. Emmett Holt. p. 345. New York, 1912. 
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 Lindemann1 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 feed- 
ing, 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 con- 
ditions, 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 tempera- 
ture. The ignorance and carelessness of mothers has also been shown to in- 
crease 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. 
‘Liiefmann, H., and Lindemann, H., Die Legalization der Sauglingsterblichkett und 
ihre Beziehungen zur Wohnungsfrage. Med. Klinik 1912, pp. 8, 1074. Infant Mortality 
125 
FEEDING 
Food is recognized as of such importance in relation to infant mortality 
that studies of this subject frequently resolve themselves into studies of feed- 
ing only. Invariably these demonstrate the truth of the statement of Dr. G. 
F. McCleary2 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 peri- 
ods indicated the percentage completely weaned from the breast is much 
greater in the groups where earnings are highest. 
Table 20.—Distribution of Babies Alive at 3, 6, and 9 Months op Age by 
Type op Feeding at Each op Said Ages, According to Annual Earnings op 
Father and Nativity op Mother. 
.ANNUAL EARNINGS. Of 
FATHER AND NATIVITY 
OF MOTHER. 
BABIES LIVING AT AGE OF- 
3 months. 
6 months. 
9 months. 
Total. 
Completely 
weaned from 
breast. 
Total. 
Completely 
weaned from 
breast. 
Total. 
Completely 
weaned froin 
breast. 
Num- 
ber. 
Per 
cent. 
Num- 
ber. 
Per 
cent. 
Num- 
ber. 
Per 
cent. 
Total 
1,355 
193 
14.2 
1,313 
250 
19.0 
1,282 
353 
27.5 
Under 8624 
341 
22 
6.5 
322 
32 
9.9 
309 
57 
18.4 
8625 to $£*99 
358 
48 
13.4 
351 
63 
17.9 
342 
85 
24.9 
$900 and over i 
629 
114 
18.1 
616 
146 
23.7 
608 
201 
33.1 
Not reported 2 
27 
9 
33.3 
24 
9 
37.5 
23 
10 
43.3 
Mother native 
765 
155 
20.3 
747 
195 
26.1 
735 
251 
34.1 
Under $624 
69 
10 
14.5 
66 
13 
19.7 
65 
18 
27.7 
8625 to $899 
180 
36 
20.0 
177 
46 
26.0 
173 
55 
31.8 
$900 and over 1 
491 
100 
20.4 
482 
127 
26.3 
473 
16S 
35.3 
Not reported 2 
25 
9 
36.0 
22 
9 
40.9 
21 
10 
47.6 
Mother foreign 
590 
38 
6.4 
566 
55 
9.7 
547 
102 
18:6 
Under $624 
272 
12 
4.4 
256 
19 
7.4 
244 
39 
13.0 
$625 to $899 ....... 
178 
12 
6.7 
174 
17 
9.8 
169 
30 
17.8 
138 
14 
10.1 
134 
19 
14.2 
132 
33 
25.0 
2 
2 
2 
'i Includes those reported as earning “ample.” “Ample,” as used in this report has a somewhat techni- 
cal meaning; when information concerning the father’s earnings was not available and the family showed 
no evidences of poverty, the word “ample” was used. When, however, the family was clearly in a state 
of abject poverty, it was included in the group “Under $521.” 
* Unmarried mothers’ babies also included. 
aInfantile Mortality and Infants’ Milk Depots. London. 126 
The Case for Birth Control 
Breast feeding, wholly or in part, is continued for a longer period by 
foreign than by native mothers, as indicated in the preceding table, showing 
that 20.3, 26.1, and 34.1 per cent of the native mothers’ babies as compared 
with 6.4, 9.7, and 18.6 per cent of the foreign mothers’ babies had been weaned 
from the breast at the age of 3, 6, and 9 months, respectively. 
Table 25.—Distribution of All Births, Live Births, and Stillbirths and of 
Deaths During First Year, and Infant Mortality Rate, According to Sex 
of Baby and Nativity of Mother. 
Stillbirths. 
DEATHS DURING 
FIRST YEAR. 
All 
births. 
Live 
births. 
SEX OF BABY AND NATIVITY OF MOTHER. 
Total. 
Rate per 
1,000 
births. 
Total. 
Infant 
mortality 
rate. 
BABIES OF NATIVE MOTHERS. 
Total number 
860. 
815 
45 
52.3 
85 
104.3 
Male: 
Number 
433 
406 
27 
62.4 
46 
113.3 
50.3 
49.8 
409 
60.0 
54.1 
Female: 
Number 
427 
18 
42.2 
39 
95.4 
Per cent 
49.7 
50.2 
40.0 
45.9 
BABIES OF FOREIGN MOTHERS. 
Total number 
691 
648 
43 
62.2 
111 
171.3 
Male: 
Number 
380 
355 
25 
65.8 
59 
166.2 
Per cent 
55.0 
54.8 
58.1 
53.2 
Female: 
Number 
31 i 
293 
18 
57.9 
52 
177.5 
Per cent 
45.0 
45.2 
41.9 
46.8 
MOTHER’S HOUSEHOLD DUTIES, CESSATION AND 
RESUMPTION OF 
The extent to which the native and foreign mothers in Johnstown relin- 
quished a part of their household duties as the time for their confinement 
approached is shown below: 
Table 26.—Distribution of Births According to Time of the Mother’s Relin- 
quishment of Part of Household Duties Before Confinement, by Nativity 
of Mother. 
TIME OF RELINQUISHMENT OF PART OF HOUSEHOLD DUTIES BEFORE 
CONFINEMENT. 
All 
births. 
To native 
mothers. 
To foreign 
mothers. 
1,551 
860 
691 
No household duties relinquished to day of confinement 
1,350 
695 
655 
Part of duties relinquished: 
3 
1 
2 
7 
5 
2 
16 
12 
4 
174 
146 
28 
1 
1 
Among the 174 babies of mothers who relinquished part of their 
household duties a month before confinement, the infant mortality 
rate was 112.5, as compared with 136.7 for those of other mothers. Infant Mortality 
127 
Table 27.—Distribution of Births and of Deaths During First Year, and 
Infant Mortality Rate, According to Time of Relinquishment of Part of 
Household Duties of Mother Before Confinement. 
TIME OF RELINQUISHMENT OF PART OF HOUSEHOLD DUTIES 
BEFORE CONFINEMENT. 
All 
births. 
Live 
births. 
Deaths 
during 
first year. 
Infant 
mortal- 
ity rate. 
All mothers 
1,551 
1,463 
196 
134.0 
No cessation or less than 1 month 
1 month or more 
1,376 
171 
1 
1,302 
160 
1 
178 
18 
136.7 
112.5 
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 ap- 
proached 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 
ifie native mothers with young babies. 
Table 28.—Distribution op Live Births and op Deaths During First Yeah, 
and Infant Mortality Rate, According to Time op Mother Resuming Part 
op Household Duties After Confinement, by Nativity op Mother, 
tIMB OP RESUMING PART OF HOUSEH0M> DUTIES 
AFTER CONFINEMENT. 
LIVE BIRTHS TO— 
DEATHS DURING 
FIRST YEAR. 
All 
mothers. 
Native 
mothers. 
Foreign 
mothers. 
Total. 
Infant 
mortality 
rate. 
Total 
1,463 
815 
648 
196 
134.0 
467 
44 
423 
79 
169.2 
560 
446 
114 
70 
125.0 
427 
31S 
109 
41 
96.0 
9 
7 
2 
6 
(>> 
1Total number of live births less than 50; base therefore considered too small to use in corflputing an 
infant mortality rate. 
The fact that a mother takes up her housework in the early days of her 
baby’s life does not necessarily increase the danger of its death. In some 
cases, however, mothers stated that the quantity of their breast milk was 
noticeably impaired when they got up and resumed their work too soon. 
Naturally this would affect the baby’s nutrition. In other cases a mother’s 128 
The Case eor Birth Control 
cares and duties may be so absorbing that she can not give the baby full at- 
tention. Whatever the exact explanation, attention should be called to the 
greater frequency of infant deaths when the mother resumed household duties 
very soon after childbirth. 
A statement of the time of the mother's resumption of household duties 
in full, like that giving the time of resumption in part, shows that the native 
mothers have the longer period of rest. 
Table 29.—Distribution of Live Births and of Deaths During First Year, 
and Infant Mortality Rate, According to Time of Mother Resuming all 
Household Duties After Confinement, by Nativity of Mother. 
TIME OB’ RESUMING ALL HOUSEHOLD DUTIES AFTER 
CONFINEMENT. 
LIVE BIRTHS TO— 
DEATHS DURING 
FIRST YEAR. 
All 
mothers. 
Native 
mothers. 
Foreign 
mothers. 
Total. 
Infant 
mortality 
rate. 
Total 
1,463 
815 
648 
196 
134.0 
8 days or less 
219 
13 
206 
37 
168.9 
9 to 13 days 
182, 
132 
50 
30 
164.8 
14 days of more 
1,053 
663 
390 
123 
116.8 
Mother died or not reported 
9 
7 
2 
6 
(l) 
1 Total live births less than 50; base therefore considered too small to use in computing an infant mor* 
tality rate. 
The infant mortality rates for all mothers in the group just referred to, 
according to the time of resuming housework in full after childbirth, show 
fewer infant deaths proportionately when the mother has had a longer rest; 
that is, a rest of two weeks or more. 
ECONOMIC FACTORS 
EARNINGS OF FATHER 
A grouping of babies according to the income of the father shows the 
greatest incidence of infant deaths where wages are lowest, and the smallest 
incidence where they are highest, indicating clearly the relation between low 
wages and ill health and infant deaths. 
For all live babies born in wedlock the infant mortality rate is 130.7. It 
rises to 255.7 when the father earns less than $521 a year or less than $10 
a week, and falls to 84 when he earns $1,200 or more or if his earnings are 
“ample.”1 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 
x“Ample” as used in this report has a somewhat arbitrary meaning. When infor- 
mation concerning hte father’s earnings was not available and the family showed no 
evidences of actual poverty, the word “ample” was used. If no information concern- 
ing earnings was available when, on the other hand, the family was clearly in a state 
of abject poverty, then the income was tabulated as “Under $521.” Infant Mortality 
129 
consecutive groups are combined an invariable lowering of the infant mor- 
tality rate from one such combined group to that next higher results. 
Table 30.—Distribution op Live Births and op Deaths During First Year, 
and Infant Mortality Rate, According to Annual Earnings of Father and 
Nativity op Mother, for Legitimate Live-Born Babies. 
ANNUAL EARNINGS OP FATHER ACCORDING TO NATIVITY OF WIFE. 
Total 
live 
births. 
Deaths 
during 
first year. 
Infant 
mortality 
rate. 
Total 
1,431 
187 
130.7 
384 
82 
213.5- 
219 
56 
255.7 
$521 to $624 
165 
26 
157.6 
$625 to $899 
385 
47 
122.1 
$625 to 8779 
224 
24 
107.1 
$780 to $899 - 
161 
23 
142.9 
186 
18 
96.8 
$900 to $1,199 
138 
14 
101.4 
$1,200 or more 
48 
4 
83.3 
476 
40 
84.0 
Husbands with native wives 
785 
76 
96.8 
80 
16 
200.0 
32 
9 
(2) 
$521 to $624 
48 
7 
1«?8 
$625 to $899 
193 
20 
103.6 
$625 to $779 
86 
6 
69.8 
$780 to $899 
107 
14 
130.8 
129 
10 
77.5 
$900 to $1,199 
92 
7 
76.1 
37 
3 
(a) 
383 
30 
78.3 
Husbands with foreign wives.- 
646 
111 
171.8 
304 
66 
217.1 
Under $521 
187 
47 
251.3 
$521 to $624 —. 
117 
19 
162.4 
$625 to $899 
192 
27 
140.6 
$625 to $779 
138 
18 
130.4 
$780 to $899 
54 
9 
166.7 
57 
8 
140.6 
$900 to $1,199 
46 
7 
152.2 
11 
1 
(2) 
Ample1 - 
93 
10 
107.5 
> See note on page 45. 
•* Total live births less than 50; base therefore considered too small to use In computing an infant 
mortality rate. 
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. 130 
The: Case: for Birth Control 
The foreigners of a given wage group almost always live in a poorer 
neighborhood than the natives earning the same amount. The foreigners go 
where they find their own countrymen, most of whom are poor, and hence 
even those who earn a fair wage find themselves, until they become Ameri- 
canized, surrounded by poor conditions and an ignorant class of people. 
It is of interest to note what per cent of the native and what per cent 
of the foreign are in the several earnings groups. The next table shows this 
for all married mothers and not simply for those of live-born babies as in the 
foregoing table. 
Table 31.—Number and Per Cent of Mothers by Nativity, According to 
the Annual Earnings of Husband. 
ANNUAL EARNING OF 
HUSBAND. 
ALL MOTHERS. 
NATIVE MOTHERS. 
FOREIGN MOTHERS. 
Number. 
Per cent. 
Number. 
Per cent. 
Number. 
Per cent. 
Total.. 
1,491 
100.0 
816 
100.0 
675 
100.0 
Under $521 . 
$521 to $624 
$625 to $779 
$780 to $899 
$900 to $1.199 
51,200 and over 
Ample1 
233 
174 
229 
166 
146 
50 
493 
15.6 
11.7 
15.4- 
11.1 
H 
33.1 
36 
50 
86 
108 
98 
39 
399 
4.4 
6.1 
10.5 
13.2 
12.0 
4.8 
48.9 
197- 
124 
143 
58 
48 
11 
94 
2SL2 
18.4 
21.3 
8.6 
7.1 
1.6 
13.9 
i Bee note on page 45^ 
The 1,491 married mothers included in the foregoing- table bore 1,517 
babies in 1911, the excess being due to plural births. The 33 unmarried 
mothers and their 34 babies (one mother had twins), although included in 
some of the general tables, are not included in those relative to the earnings 
of the husband. 
GAINFUL WORK OF MOTHER 
In localities where large numbers of women are engaged in industrial 
work, comparisons are frequently made of the death rates among their babies 
with those of the babies of mothers not so engaged. In Johnstown, however, 
industrial occupations are not open to women, and but 3.1 per cent of the 
mothers visited went outside their homes to earn money. All mothers who 
gained money by keeping lodgers or in any other way are, for convenience, 
designated “wage-earning” mothers, even though their earnings were not in 
the form of a definite wage at stated periods. 
Although not industrially engaged, nearly one-fifth of the mothers did 
resort to some means of supplementing the earnings of their husbands. 
Usually they kept lodgers. This was done by the foreign mothers principally, 
exactly one-third of whom had lodgers, as compared with less than 1 per cent Infant Mortality 
131 
of the native women. Usually work done outside the home consisted either 
of char work or of assisting husbands in their stores. Generally these stores 
were in the same building with the home. 
When a mother of a young baby does not give her full time to her duties 
within the home but resorts to means of earning money, it generally indicates 
poverty. This is true to a greater degree in Johnstown than in places which 
have many inducements for women to work. In Johnstown, with its excess of 
males, especially in the foreign population, the woman’s services are particu- 
larly 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 num- 
ber, must be wage earners. As shown in the next table, in nearly half of the 
families where the husband earns $10 a week or less (less than $521 a year), 
the wife resorted to some means of earning money; when he earned as much 
as $900 a year, only 8.9 per cent of the wives worked, and in the small group 
where the man earns as much as $1,200 a year, only 1 in 50. 
Table 32.—Number and Per Cent of Husbands with Wage-Earning Wives, 
by Nativity of Wife and Annual Earnings of Husband. 
ANNUAL'' EARNINGS 
OF HUSBAND. 
total husbands. 
HUSBANDS HAVING 
NATIVE WIVES. 
HUSBANDS HAVING 
FOREIGN WIVES. 
Number. 
Husbands with 
wage-earning 
wives. 
Number. 
Husbands with 
wage-earning 
wives. 
Number. 
Husbands with 
wage-earning 
wives. 
Num- 
ber. 
Per 
cent. 
Num- 
ber. 
Per 
cent. 
Num- 
ber. 
Per 
cent. 
Total 
1,491 
278 
18.6 
816 
26 
3.2 
675 
252 
37.3 
Under $521 
233 
111 
47.6 
36 
9 
25.0 
197 
102 
51.8 
$521 to $624.. 
174 
57 
32.8 
50 
3 
6.0 
124 
54 
43.5 
$625 to S779 
229 
51 
22.3 
86 
4 
4.7 
143 
47 
32.9 
$780 to $899 
166 
25 
15.1 
108 
6 
5.6 
58 
19 
32.8 
$900 to $1,199 
146 
13 
8.9 
98 
1 
1.0 
48 
12 
25.0 
$1,200 and over.\ 
50 
1 
2.0 
39 
11 
1 
9.1 
“Ample”1 
493 
20 
4.1 
39!T 
3 
.8 
94 
17 
18.1 
1 See note on page 45. 
It is impossible to judge from statistics alone whether or not the work 
done by an individual woman, either her own housework or work for money, 
is so excessive as to affect her during pregnancy or while nursing to the 
extent of reacting on the health of the baby; but the fact is that the infant 
mortality rate is higher among the babies of wage-earning mothers than 132 
The: Case: for Birth Control 
among others, being 188 as compared with a rate of 117.6 among the babies 
of nonwage-earning mothers. Wage-earning mothers and low-wage fathers 
are in practically the same groups, and it is difficult to secure an exact meas- 
urement of the comparative weight of the two factors in the production of a 
high infant mortality rate. 
Table 33.—Distribution of Live Births and of Deaths During First Year, 
and Infant Mortality Rate of Wage-earning and Nonwage- 
earning Mothers, According to Annual Earnings of Father. 
annual earnings of father. 
MOTHER A WAGE 
EARNER. 
MOTHER NOT A 
WAGE EARNER. 
INFANT MORTAL- 
ITY RATE. 
Live 
births. 
Number 
of deaths 
in first 
year. 
Live 
births. 
Number 
of deaths 
in first 
year. 
Mother 
a wage 
earner. 
Mother 
not a 
wage 
earner. 
Total 
266 
50 
1,165 
137 
188.0 
117.6 
Under $521 
105 
26 
114 
30 
1 247.6 
263.2 
$521 to $624 
53 
8 
112 
18 
150.9 
160.7 
$625 to $779 
48 
6 
176 
18 
127.1 
102.3 
$780 or over, or “ample ” • 
60 
10 
763 
71 
166.7 
93.1 
1 See note on page 45. 
ILLEGITIMACY 
Of the 1,551 birth included in this investigation 34, or 2.2 per cent, oc- 
curred 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 ille- 
gitimacy 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 sep- 
arately, that is, a rate for illegitimates more than twice as high as for children 
born in wedlock. 
Table 34,—Distribution op Births and of Deaths During First Year, and 
Infant Mortality Rate, According to LEGrriMACY. 
LEGITIMACY. 
Total 
births. 
Live 
births. 
DEATHS DURING 
FIRST YEAR. 
Number. 
Infant 
mortality 
rates. 
34 
1,517 
32 
1,431 
9 
187 
281.3 
130.7 
Thirty-two, or 3.7 per cent, of the 860 native mothers, as compared with 
2, or 0.3 per cent, of the 691 foreign mothers visited, had illegitimate children 
in 1911. Infant Mortality 
133 
REPRODUCTIVE HISTORIES 
In addition to the data relating exclusively to babies born in 1911, a state- 
ment 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 informa- 
tion was secured for all mothers, tabulations are presented of the data fur- 
nished 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 reportable1 pragnancies. 
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 accord- 
ing to the total number of reportable pregnancies that their mothers had had, 
to and including the pregnancy resulting in the 1911 birth. 
Table 35.—Distribution op Mothers, of Live Births, and of Deaths During 
First Year, and Infant Mortality Rate for Babies of Native and Foreign 
Married Mothers, According to the Number of Reportable Pregnancies. 
REPORTABLE PREGNANCIES FOR MARRIED 
Number 
of married 
mothers. 
NUMBER OF BABIES. 
INFANT MORTALITY RATE 
AMONG BABIES OF— 
MOTHERS. 
Bora 
alive. 
Died in 
first year. 
All 
mothers. 
Native 
mothers. 
Foreign 
mothers. 
1,491 
5,363 
804 
149.9 
113.1 
184.6 
1 
339 
322 
35 
108.7 
75.9 
183.7 
2 
283 
544 
59 
108.5 
76.5 
156.7 
3 
214 
626 
92 
147.0 
118.0 
177.6 
4 
186 
723 
78 
107.9 
99.4 
116.3 
5 
147 
704 
103 
146.3 
86.1 
191.5 
6 
94 
546 
88 
161.2 
157.4 
163.6 
7 
83 
555 
78 
140.5 
100.0 
173.8 
8 
54 
426 
95 
223.0 
157.6 
272.7 
9 
33 
283 
41 
144.9 
128.4 
155.2 
10 or more 
58 
634 
135 
212.9 
164.5 
257.6 
The statistics, based upon the results of all her reportable pregnancies, 
show a generally higher infant mortality rate where the mother has had many 
pregnancies are those terminating either in the birth of a live child 
or of a dead child when the period of gestation exceeds 28 weeks; that is, when its 
registration or report is required by law. 134 
The; Case; for Birth Control 
pregnancies, but there is not always an increase from one pregnancy to the 
next. This is more clearly shown when the pregnancies are grouped as in 
the next table. 
Table 36.—Infant Mortality Rate for all Children Borne by Married 
Mothers, According to Specified Number of Reportable Pregnancies. 
REPORTABLE PREGNANCIES FOR MARRIED MOTHERS. 
Infant 
mortality 
rate. 
149 9 
ins a 
126 0 
152 8 
176 4 
191,9 
This tendency is shown in still another form of summary: Combinations 
cf four or less pregnancies are, for convenience, considered as group 1, while 
the combinations of over four are designated group 2. The differences in 
rates in the two groups are notable. The infant mortality rate is much lower 
for the first than for the second group. 
Table 37.—Infant Mortality Rate for All Children Borne by Married 
Mothers, According to Specified Number of Reportable Pregnancies, 
by Groups 
REPORTABLE PREGNANCIES FOR MARRIED 
MOTHERS. 
Infant 
mortality 
rate. 
REPORTABLE PREGNANCIES FOB MARRIED 
MOTHERS. 
Infant 
mortality 
rate. 
GROUP 1. 
108.5 
124.7 
119.2 
GROUP 2. 
Over 4 
171.8 
178.8 
183.9 
Over 5 
Over 6 
This influence of the size of the family upon the infant mortality rate is 
shown in the computations giving the relative infant mortality rate for the 
different children borne by married mothers. The rate is most favorable for 
the second-born child, being 131.2. Among first born it is 143.6; for tenth 
or later born children 252.3. 
Table 38.—Infant Mortality Rate for All Children Borne by Married 
Mothers, According to the Order in which the Child was Born 
ORDER OF 
Infant 
mortality 
rate. 
ORDER OF BIRTH. 
Infant 
mortality 
rate. 
143.6 
131.2 
Seventh-born child 
192.1 
165.4 
Eighth-born child 
First and second born children— 
138.3 
Seventh and eighth born children. 
Ninth-born child 
181.5 
144.2 
142.0 
128.2 
252.3 
Tenth or later born child 
Third and fourth born children 
Ninth and later born children 
143.2 
201.1 
178.1 
175.5 
Fifth and sixth born children 
177.0 Infant Mortality 
135 
The next table gives a further elaboration of the same data; that is, it 
shows the infant mortality rate where such rates are lowest and highest, re- 
spectively, 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 preg- 
nancies resulting in births in 1911, all prior pregnancies of the women con- 
sidered in the investigation have been included. 
Table 39.—Lowest and Highest Infant Mortality Rates, According to Age 
of Mother at Birth of Child and the Order in which Child was Born. 
ORDER OF BIRTH. 
INFANT MORTALITY RATES, ACCORDING 
TO MOTHER’S AGE. 
Lowest mortality. 
Highest mortality. 
Mother’s 
age. 
Mortality 
rate. 
Mother’s 
age. 
Mortality 
rate. 
20-24 
140.0 
Under 17 
367.3 
25-29 
25-29 
30-39 
30-39 
30-39 
30-39 
92.1 
100.3 
106.4 
122.4 
105.8 
164.8 
17-19 
17-19 
25-29 
20-24 
25-29 
25-29 
190.4 
178.6 
160.8 
155.0 
236.6 
171.4 
The difference in size of family for native and foreign mothers of differ- 
ent ages are indicated in the next table. The total and average number of 
live-born children, not reportable pregnancies, are given. 
Table 40.—Total and Average Number op Live-Born Children Borne by 
Married Mothers Having Either a Live Birth or a Stillbirth in 1911, 
Classified by Nativity and Age of Mother. 
AGE OF MOTHER 
AT BIRTH OF 
CHILD IN 1911. 
ALL MARRIED MOTHERS. 
NATIVE MARRIED MOTHERS. 
FOREIGN MARRIED MOTHERS. 
Total. 
Live-bora chil- 
dren. 
Total. 
Live-bora chil- 
dren. 
Total. 
Live-born chil- 
dren. 
Number. 
Average. 
Number. 
Average. 
Number. 
Average. 
All ages 
1,465 
5,363 
3.7 
801 
2,600 
3.2 
664 
2,763 
4.2 
Under 20years.. 
81 
96 
1.2 
62 
70 
1.1 
19 
26 
L4 
20 to 24 years 
456 
908 
2.0 
258 
483 
1.9 
198 
425 
2.1 
25 to 29 years 
389 
1,261 
3.2 
196 
536 
2.7 
193 
725 
3.8 
30 to 39 years 
459 
2,480 
5.4 
240 
1,188 
5.0 
219 
1,292 
5.9 
40 years and over. 
80 
618 
7.7 
45 
323 
7.2 
35 
'295 
8.4 
The next table shows all losses of pregnancy sustained by 628 mothers 
and the rate of loss per 1,000 births for mothers having different numbers 
of births or reportable pregnancies. For all mothers it was 188.4. “Loss,” 136 
The Case for Birth Control 
as here used, means the sum of infant deaths (or deaths in first year) and 
stillbirths. 
Table 41.—Aggregate Number of Births, Losses, and Rate of Loss fek 1,000 
Births, According to Number of Births per Mother. 
NUMBER OF BIRTHS PER MOTHER. 
Aggregate 
number 
of births. 
Aggregate 
number 
of losses. 
Bate of 
loss per 
1,000 
births. 
5,617 
1,058 
188.4 
335" 
53* 
158.8 
554 
87 
157.0 
648 
113 
109 
174.4 
748 
145.7 
740 
133 
17d. 7 
576 
119 
206.6 
574 
104 
181.2 
432 
102 
236.1 
324 
65 
200.6 
686 
173 
252.2 
The influence of the economic factor on infant mortality among the babies 
born prior to 1911 can not be determined with exactness, as no inquiry was 
made concerning earnings of the father when the other children were born. 
But it is believed that his earnings during the year following the birth of the 
1911 baby can be regarded as an index of the economic standing of the family 
for some time past. In individual cases, of course, revolutionary changes in 
the family’s income may have occurred, but for the great mass of people in 
the group considered it is not likely that within such a short space of time 
as that covered by the child-bearing period of the women considered—most 
of whom had not had numerous pregnancies—marked changes had taken place. 
If these known earnings are accepted as an index, the following variations 
are found to occur in the infant mortality rate for all the babies of whom \ 
record was secured: 
Table 42.—Infant Mortality Rate for all Children of Married Mothers 
Included in this Investigation, Distributed According to the Father’s 
Earnings. 
father’s annual EARNINGS. 
Infant 
mortal- 
ity rate. 
FATHER’S ANNUAL EARNINGS. 
Intent 
mortal- 
ity rate. 
197.3 
193.1 
163.1 
$780 to $899 
168.4 
142.3 
102.2 
$521 to $624 
S900 to $1,199 
$625 to $779... 
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 Infant Mortality 
137 
babies born in 1911, namely that the economic factor is of far-reaching- im- 
portance in determining the baby’s chance of life. 
Table V.—Distribution of Live Births and of Deaths During First Year, 
According to Number of Persons and Number of Rooms per Family. 
PERSONS PER FAMILY 
(NOT INCLUDING BABY). 
All live-bom ba- 
bies. 
NUMBER OF BABIES WHO WERE BORN ALIVE AND NUMBER OF SUCH 
BABIES WHO DIED DURING FIRST YEAR IN HOMES HAVING^- 
1 room. 
2 rooms. 
3 rooms. 
4 rooms. 
5 rooms. 
6 rooms. 
7 rooms. 
8 rooms. 
9 rooms. 
i 10 rooms 
1 and over. 
ill 
& 
fBirths... 
1,463 
33 
165 
147 
526 
222 
233 
38 
43 
22 
12 
22 
[Deaths.. 
196 
3 
29 
24 
79 
20 
20 
6 
6 
4 
2 
3 
o' 
fBirths... 
24 
3 
7 
4 
6 
2 
2 
2 
[Deaths.. 
19 
1 
5 
4 
6 
1 
a 
fBirths... 
275 
14 
46 
35 
96 
29 
37 
4 
6 
1 
9 
3 
[Deaths.. 
31 
5 
4 
12 
2 
3 
3 
2 
Births... 
234 
7 
44 
20 
83 
40 
23 
4 
5 
2 
2 
« 
4 
[Deaths.. 
30 
1 
12 
5 
9 
2 
fBirths... 
229 
27 
24 
88 
31 
43 
4 
5 
1 
1 1 
5 
5 
[Deaths.. 
22 
1 
6 
9 
1 
4 
1 
fBirths... 
182 
2 
21 
17 
56 
37 
34 
5 
7 
2 
1 
6 
Deaths.. 
18 
4 
8 
2 
3 
1 
fBirths... 
164 
2 
10 
20 
50 
32 
30 
9 
6 
3 
1 
i 
7 
[Deaths.. 
15 
1 
2 
6 
1 
3 
1 
1 
3 
fBirths... 
107 
2 
5 
14 
37 
16 
18 
4 
6 
2 
t a 
[Deaths.. 
17 
2 
6 
3 
1 
2 
1 
1 
fBirths... 
79 
2 
2 
6 
27 
13 
13 
6 
2 
4 
4 
8 
Deaths.. 
8 
1 
2 
2 
1 
2 
fBirths... 
58 
1 
1 
2 
26 
7 
15 
1 
1 
3 
| 
% 
Deaths.. 
15 
1 
11 
2 
1 
11 
fBirths... 
36 
1 
1 
16 
3 
10 
3 
2 
[Deaths.. 
4 
1 
1 
1 
1 
12 
fBirths... 
21 
1 
1 
10 
2 
6 
i 
5 
2 
1 
1 
i 
18 
fBirths... 
20 
1 
13 
4 
i 1 
j r 
[Deaths.. 
4 
3 
1 
M 
fBirths... 
8 
1 
5 
2 
| 
f 
2 
1 
1 
15 
fBirths... 
6 
3 
2 
[Deaths.. 
1 
1 
16 
Births... 
4 
4 
fBirths... 
2 
3 
1 
1 
l 
17 
[Deaths.. 
18 
fBirths... 
5 
1J 
1 
1 
1 
1 
[Deaths.. 
1 
1 
19 
fBirths... 
2 
2 
[Deaths.. 
....... 
....... 
...... 
— 
20. 
Births... 
3 
1 
I 
1 
Deaths.. 
Births...’ 
1 
1 
1 
I 
22.. ■ 
Deaths.. 
1 
lv 
23. 
fBirths... 
i 
1 
k i 
i*oi reported . < Deaths., 
r , 
#*'v*** 138 
The; Case eor Birth Control 
Table VIII.—Distribution of Deaths of Infants at Specified Age, ACCORD* 
ing to Cause of Death of Infant and Nativity of Mother. 
CAUSE OF DEATH OF INFANT AND 
NATIVITY OF MOTHER. 
Total deaths under 1 year of age. 
AGE AT DEATH. 
Less than 
week. 
1 
1 week but less 
than 1 month. 
1 month but less than 1 
year. 
| Total. 
| 1 day or less. 
| 2 days. 
3 to 6 days. 
| Total. 
j 1 week but less than 2. 
| 2 weeks but less than 3. 
1 3 weeks but less than 1 
month. 
Total. 
| 1 month but less than 2. 
2 months but less than 3. 
•CD 
J 
4-3 
D 
rO 
CO 
5 
a 
o 
a 
CO 
| 6 months but less than 9. 
Q 
3 
3 
(4 
o 
a 
All causes 
196 
45 
30 
4 
11 
29 
14 
7 
8 
122 
18 
16 
42 
31 
15 
Native mothers 
8.5 
25 
18 
3 
4 
9 
2 
1 
6 
51 
9 
7 
18 
12 
5 
Foreign mothers 
111 
20 
12 
1 
7 
20 
12 
6 
2 
71 
9 
9 
24 
19 
10 
Diarrhea and enteritis 
52 
1 
1 
5 
.... 
3 
2 
46 
5 
4 
17 
15 
5 
17 
1 
1 
16 
3 
1 
5 
*) 
2 
Foreign mothers 
35 
5 
.... 
3 
2 
30 
2 
3 
12 
10 
3 
Respiratory diseases 
50 
3 
3 
47 
7 
4 
15 
13 
8 
19 
19 
2 
2 
8 
5 
2 
31 
3 
3 
28 
5 
2 
7 
8 
6 
24 
21 
19 
2 
3 
3 
11 
11 
11 
13 
10 
8 
2 
3 
3 
Congenital debility or mal- 
19 
10 
7 
1 
2 
6 
2 
3 
1 
3 
1 
2 
Native mothers 
5 
4 
3 
1 
1 
1 
14 
6 
4 
1 
1 
5 
2 
3 
3 
1 
2 
Injuries at birth 
7 
7 
3 
2 
2 
Native mothers 
6 
G 
3 
2 
1 
Foreign mothers 
1 
1 
1 
Other or not reported 
44 
6 
1 
1 
4 
12 
6 
1 
5 
26 
5 
6 
10 
3 
2 
Native mothers 
27 
3 
1 
1 
1 1 
8 
2 
1 
5 
16 
4 
4 
5 
2 
1 
Foreign mothers 
17 
3 
3 
4 
4 
10 
) 
2 
f) 
j 
1 Infant Mortality 
139 
Table X.—Distribution of Births to Married Wage-earning Mothers, 
According to Husband’s Annual Earnings and Nativity and Earnings of 
Mother. 
NATIVITY AND ANNUAL EARNINGS OF 
married mother. 
Total 
births. 
BIRTHS TO MARRIED WAGE-EARNING MOTHER WITH HUS- 
BAND EARNING ANNUALLY— 
Under 
$521. 
$521 
to 
$624. 
$625 
to 
$779. 
$780 
to 
$899. 
$900 
to 
$1,199. 
$1,200 
and 
over. 
Ample.! 
All wage-earning mothers.. 
281 
112 
57 
51 
25 
14 
1 
21 
20 
6 
5 
1 
4 
1 
3 
$53 to $103 
57 
23 
12 
11 
7 
3 
1 
$104 to $207 
89 
46 
16 
19 
3 
3 
2 
$208 to $311 
60 
23 
16 
12 
4 
3 
1 
i 
46 
14 
8 
8 
7 
2 
7 
Not reported 
9 
2 
7 
Native wage-earning mothers... 
26 
9 
3 
4 
6 
1 
3 
6 
2 
1 
2 
1 
$53 to $103 
5 
2 
1 
2 
$104 to $207 
5 
1 
1 
2 
1 
$208 to $311 ... 
4 
3 
1 
3 
1 
2 
Not reported 
3 
Foreign wage-e&ming mothers.. 
255 
103 
54 
47 
19 
13 
i 
is 
14 
4 
4 
1 
2 
3 
$53 to $103 
52 
21 
11 
y 
7 
3 
J 
$104 to $207 
84 
45 
15 
17' 
2 
3 
2 
1 
$208 to $311 
56 
20 
16 
12 
3 
3 
i 
43 
13 
8 
8 
5 
2 
7, 
Not reported 
6 
f 
4 
1 See note on page 45. 140 
The Case eor Birth Control 
Table XI.—Distribution of Results of Reportable Preonanoies (Live Births and Stillbirths) and Miscarriages, According 
to Number per Mother and Nativity op Mother. 
i 
NUMBER OP REPORTABLE PREG- 
NANCIES PER MOTHER AND 
nativity OP MOTHER. 
REPORTABLE PREGNANCIES AND RESULTS THEREOF. 
MISCARRIAGES IN ADDITION TO 
REPORTABLE PREGNANCIES. 
Total 
preg- 
nancies^ 
Total 
births. 
Excess 
due to 
plural 
births. 
Number 
of 
mothers. 
Live births. 
Stillbirths. 
Number 
of miscar- 
riages re- 
ported. 
Number of mothers 
reporting miscar- 
Num- 
ber. 
Number 
of 
mothers 
having 
live 
births. 
Deaths in first year. 
Num- 
ber of 
still- 
births. 
.Number 
of 
mothers 
having 
still- 
births. 
Per cent 
of all 
births. 
riages. 
Total 
mothers. 
Per cent 
of.all 
mothers. 
Num- 
ber. 
Number 
of 
mothers 
having 
babies 
die. 
Infant 
mortality 
rate. 
All married mothers.. 
5,554 
5,617 
63 
1,491 
5,363 
1,465 
804 
509 
149.9 
254 
194 
4.5' 
191 
130 
8.7 
1 
339 
343 
4 
339 
322 
318 
35 
34 
108.7 
21 
21 
6.1 
8 
8 
2.4' 
2 
566 
576 
10 
283 
544 
279 
59 
54 
108.5 
32 
28 
6.6 
23 
16 
5.7 
3 
642 
650 
8 
214 
626 
214 
92 
75 
147.0 
24 
23 
3.7 
26 
18 
8.4 
4 
744 
752 
8 
186 
723 
186 
78 
64 
107.9 
29 
21 
3.9 
22 
18 
9.7 
5 
735 
740 
5 
147 
704 
147 
103 
67 
146.3 
36 
31 
4.9 
20 
14 
9.5 
6 
564 
568 
4 
94 
546 
93 
88 
60 
161.2 
22 
13 
3.9 
23 
14 
14.9 
7 
581 
586 
5 
83 
555 
83 
78 
48 
140.5 
31 
22 
5.3 
27 
15 
18.1 
8 
432 
437 
5 
54 
426 
54 
95 
42 
223.0 
11 
7 
2.5 
15 
9 
16.7 
9 
297 
299 
2 
33 
283 
33 
41 
20 
144.9 
16 
11 
5.4 
13 
8 
(») 
10 pr more 
654 
666 
12 
58 
634 
58 
135 
45 
212.9 
32 
17 
4.8 
14 
10 
17.2 
'Native 
2,717 
2,744 
27 
816 
2,600 
801 
294 
206 
113.1 
144 
115 
5.2 
136 
92 
11.3 
234 
236 
2 
234 
224 
222 
17 
17 
75.9 
12 
12 
5.1 
7 
7 
3.0 
2 
346 
351 
5 
173 
327 
170 
25 
23 
76.5 
24 
21 
6.8 
18 
13 
7.5 
333 
338 
5 
111 
322 
111 
38 
31 
118.0 
16 
16 
4.7 
21 
15 
13.5 
4.* 
376 
377 
1 
94 
362 
94 
36 
31 
99. 4 
15 
13 
4.0 
13 
10 
10. 6 
5 
325 
326 
1 
65 
302 
65 
.26 
21 
86.1 
24 
19 
7.4 
13 
10 
15. 4 
6 
222 
222 
37 
216 
37 
34 
22 
157. 4 
6 
5 
2. 7 
17 
9 
(i) 
7 
266 
267 
1 
38 
250 
38 
25 
18 
100.0 
17 
11 
6.4 
25 
13 
(‘) 
184 
187 
3 
23 
184 
23 
29 
17 
157. 6 
3 
2 
1. 6 
8 
5 
(i) 
117 
118 
1 
13 
109 
13 
14 
7 
128. 4 
9 
6 
7.6 
4 
3 
(l> 
lQprjnpr® «t ....... 
314 
322 
8 
28 
304 
28 
50 
19 
164.5 
18 
10 
5.6 
10 
7 
(l> Infant Mortality 
141 
Foreign 
2,837 
2,873 
36 
675 
2,763 
664 
510 
303 
184.6 
110 
79 
3.8 
55 
38 
5.6 
105 
220 
'107 
225 
312 
2 
5 
105 
110 
103 
98 
217 
304 
96 
109 
103 
92 
82 
56 
45 
18 
34 
54 
42 
77 
54 
53 
66 
17 
183.7 
9 
9 
8.4 
1 
1 
1.0 
309 
3 
44 
33 
46 
38 
30 
25 
13 
26 
5 
3 
2.7 
a..... 
368 
375 
7' 
92 
82 
361 
116.3 
3,7 
9 
3 
2.9 
c 
410 
414 
4 
402 
8 
8.7 
6.... 
342 
346 
4 
57 
330 
7 
6 
4 
4.9 
7 
315 
319 
4 
45 
305 
14 
8 
5 
8.8 
s ; 
248 
250 
2 
31 
242 
31 
272.7 
155.2 
257.6 
2 
0 
9 
180 
181 
1 
20 
174 
20 
30 
27 
85 
3,9 
4.1 
9 
4 
0 
10 or more 
340 
344 
4 
30 
330 
14 
5 
0 
4 
3 
0 
1 Not shown when base is less than 6a 142 
The: Case* for Birth Control 
Table XII.—Distribution op Results op Reportable Pregnancies (Live Births and Stillbirths) and Miscarriages, According 
to Number per Mother and Age op Mother at Each Pregnancy. 
Number of reportable preg- 
nancies AND AGE OF MOTHER 
AT BIRTH OF BABY BORN IN 1911. 
REPORTABLE PREGNANCIES. 
LIVE BIRTHS. 
BABIES DYING IN FIRST YEAR. 
STILLBIRTHS. 
MISCARTPAGES. 
Total. 
Resulting births. 
Number 
of 
mothers. 
Num- 
ber. 
Number 
of 
mothers. 
Num- 
ber. 
Number1 
of 
mothers. 
Infant 
mortal- 
ity rate. 
Num- 
ber. 
Number 
of 
mothers. 
.. 
Per cent 
of all 
births. 
Num- 
ber re- 
ported. 
Mothers reporting. 
Num- 
ber. 
Excess 
over preg- 
nancies.1 
Number. 
Per cent 
of all 
mothers. 
All married mothers 
5,554 
5,617 
63 
1,491 
5,363 
1,465 
804 
509 
149.9 
254 
194 
4.5 
191 
130 
8.7 
107 
108 
1 
89 
96 
81 
12 
11 
125.0 
12 
12 
11.1 
20 to 24 years 
933 
946 
13 
461 
908 
456 
140 
115 
154.2 
38 
29 
4.0 
19 
18 
3.9 
25 to 29 years 
1,316 
1,329 
13 
395 
1,261 
389 
185 
132 
146.7 
68 
55 
5.1 
46 
27 
6.8 
30 to 39 years 
2,570 
2,595 
25 
466 
2,480 
459 
382 
207 
154.0 
115 
84 
4.4 
95 
66 
14.2 
40 years and over 
628 
639 
11 
80 
618 
80 
85 
44 
137.5 
21 
14 
3.3 
31 
19 
23.8 
Average age: 28 years. 
1 reportable pregnancy 
339 
343 
4 
339 
322 
318 
35 
34 
108.7 
21 
21 
6.1 
8 
8 
2.4 
74 
75 
1 
74 
67 
66 
8 
7 
119.4 
8 
8 
10.7 
20 to 24 years 
178 
179 
1 
1781 
176 
175 
18 
18 
102.3 
3 
3 
1.7 
3 
3 
1.7 
25 to 29 years 
57 
58 
1 
57 
54 
53 
4 
4 
74.1 
4 
4 
6.9 
3 
3 
5.3 
30 to 39 years 
30 
31 
1 
30 
25 
24 
5 
5 
(2) 
6 
6 
(2) 
2 
2 
(2) 
Average age: 23 years. 
2 reportable pregnancies.... 
566 
576 
10 
283 
544 
279 
59 
54 
108.5 
3 
28 
5.6 
23 
16 
5.7 
24 
24 
12 
21 
12 
3 
3 
(2) 
3 
3 
(2) 
20 to 24 years 
312 
317 
5 
156 
302 
154 
42 
37 
139.1 
15 
13 
4.7 
6 
6 
3.8 
25 to 29 years 
148 
151 
3 
74 
141 
73 
9 
9 
63.8 
10 
9 
6.6 
5 
3 
4.1 
30 to 39 years 
78 
80 
2 
39 
76 
38 
5 
5 
65.8 
4 
3 
5.0 
12 
7 
(2) 
4 
4 
2 
4 
2 
Average age: 25 years. 
3 reportable pregnancies 
642 
650 
8 
214 
626 
214 
92 
75 
147.0 
24 
23 
3.7 
26 
18 
8.4 
9 
9 
3 
8 
3 
1' 
1 
(2) 
1 
1 
(2) 
20 to 24 years 
231 
234 
3 
77 
227 
77 
40 
31 
176.2 
7 
6 
3.0 
7 
6 
7.8 
25 to 29 years 
285 
288 
3 
95 
277 
95 
41 
33 
148.0 
11 
11 
3.8 
14 
7 
7.4 
30 to 39 years 
108 
no 
2 
36 
105 
36 
8 
8 
76.2 
5 
5 
4.5 
4 
4 
(*) 
9 
9 
3 
9 
3 
2 
2 
(2) 
1 
1 
Average age: 26 years. Infant Mortality 
143 
4 reportable pregnancies 
744 
752 
8 
186 
723 
186 
78 
64 
107.9 
29 
21 
3.9 
22 
18 
9.7 
20 to 24 years 
156 
160 
4 
39 
148 
39 
28 
21 
189.2 
12 
6 
7.5 
3 
3 
(2) 
25 to 29 years 
300 
301 
1 
75 
290 
75 
26 
23 
89.7 
11 
10 
3.7 
10 
6 
8 0 
30 to 39 years 
252 
255 
3 
63 
249 
63 
21 
17 
84.3 
6 
5 
2.4 
6 
6 
9 a 
40 years and over 
36 
36 
9 
36 
9 
3 
3 
(J) 
(J) 
Average age: 29 years. 
5 reportable pregnancies 
735 
740 
5 
147 
704 
147 
103 
67 
146.3 
36 
31 
4.9 
20 
14 
9.5 
20 to 24 years 
50 
50 
10 
49 
10 
9 
7 
183.7 
1 
1 
2 0 
25 to 29 years 
280 
283 
3 
56 
266 
56 
51 
31 
191.7 
17 
15 
6.0 
6 
4 
7 1 
30 to 39 years 
375 
377 
2 
75 
361 
75 
40 
27 
110.8 
16 
14 
4.2 
12 
8 
in 7 
40 years and over 
30 
30 
6 
28 
(J) 
(*) 
(s) 
' Average age: 30 years. 
6 reportable pregnancies 
564 
568 
4 
94 
546 
93 
88 
60 
161.2 
22 
.13 
3.9 
23 
14 
14.9 
20 to 24 years... 
6 
6 
1 
6 
1 
3 
1 
(2) 
25 to 29 years 
132 
133 
1 
22 
127 
21 
23 
17 
181.1 
6 
1 
4.5 
6 
3 
(2) 
30 to 39 years 
360 
362 
2 
60 
347 
60 
54 
36 
155.6 
15 
11 
4.1 
13 
9 
15 0 
40 years and over 
66 
67 
1 
11 
66 
11 
8 
6 
121.2 
1 
1 
1.5 
4 
2 
(t) 
Average age: 33 years. 
7 reportable pregnancies 
581 
586 
5 
83 
555 
83 
78 
48 
140.5 
31 
22 
5.3 
27 
15 
18.1 
25 to 29 years 
98 
99 
1 
14 
90 
14 
23 
13 
255.6 
9 
5 
10.0 
2 
1 
(3) 
30 to 39 years 
392 
395 
3 
56 
377 
56 
45 
28 
119.4 
18 
15 
4.6 
19 
11 
19 6 
40 years and over 
91 
92 
1 
13 
88 
13 
10 
7 
113.6 
4 
2 
4.3 
6 
3 
(*) 
Average age: 34 years. 
8 reportable pregnancies 
432 
437 
5 
54 
426 
54 
95 
42 
223.0 
11 
7 
2.5 
16 
9 
16.7 
25 to 29 years 
16 
16 
2 
16 
2 
8 
2 
(2) 
30 to 39 years 
408 
413 
5 
51 
403 
51 
87 
40 
215.9 
10 
6 
2.4 
15 
9 
17.6 
40 years and over 
8 
8 
1 
7 
1 
1 
1 
(J) 
Average age: 35 years. 
9 reportable pregnancies 
297 
299 
2 
33 
283 
33 
41 
20 
144.9 
16 
11 
5.4 
13 
8 
24.2 
30 to 39 years 
207 
208 
1 
23 
195 
23 
32 
15 
40 years'and over 
90 
91 
1 
10 
88 
10 
9 
5 
102.3 
3.3 
8 
$ 
’ Average age: 37 years. 
10 or more reportable preg- 
nancies 
654 
666 
12 
3 58 
634 
58 
135 
45 
212.9 
32 
17 
4.8 
14 
10 
17.2 
30 to 39 years 
360 
364 
4 
33 
342 
33 
85 
26 
248.5 
22 
11 
6 0 
7 
5 
40 years and over 
294 
302 
8 
25 
292 
25 
50 
19 
171.2 
10 
6 
3.3 
7 
4 
(2i 
Average age: 39 years. 
1 Excess of births over pregnancies due to plural birth9. »Includes 21 having 10 pregnancies; 16 having 11; 11 having 12; 6 having 13; 3 having 14; 1 having 16. 
o Rate not computed because of small base. 144 
The Case eor Birth Control 
Tajble XIII.—Distribution of Results of Reportable Pregnancies (Live Births and Stillbirths) and Miscarriages, According 
to Number per Mother and Husband’s Earnings. 
SPECIFIED NUMBER OF PREG- 
NANCIES FOR ALE MARRIED 
MOTHERS AND ANNUAL EARN- 
INGS OF HUSBAND. 
REPORTABLE PREGNANCIES. 
LIVE BIRTHS. 
BABIES DYING IN FIRST YEAR. 
STILLBIRTHS. 
MISCARRIAGES. 
Total. 
Resulting births. 
Number 
of 
mothers. 
Num- 
ber. 
Number 
of 
mothers. 
Num- 
ber. 
Infant 
mortality 
rate.1 
Number 
of 
mothers. 
Num- 
ber. 
Number 
of 
mothers. 
Per cent 
of all 
births.1 
Num- 
ber re- 
ported. 
Mothers reporting. 
Number. 
Excess 
over preg- 
nancies. 
Number. 
Per cent 
of all 
mothers. 
All reportable pregnancies.. 
5,554 
5,617 
63 
1,491 
5,363 
1,465 
804 
149.9 
509 
254 
194 
4.5 
191 
130 
8.7 
Husband earns: 
Under $521 
938 
946 
8 
233 
902 
227 
178 
197.3 
110 
44 
31 
4.7 
27 
17 
7.31 
*521 to $624 
691 
700 
9 
174 
668 
173 
129 
193.1 
75 
32 
25 
4.6 
22 
14 
8.0 
$625to $779 
816 
826 
10 
229 
797 
227 
130 
163.1 
88 
29 
21 
3.5 
21 
15 
6.6 
$780 to $899 
611 
616 
5 
166 
588 
163 
99 
168.4 
61 
28 
23 
4.5 
30 
19 
11.4 
$900 to $1,199 
574 
581 
7 
146 
548 
143 
78 
142.3 
48 
33 
24 
5.7 
25 
18 
12.3 
$1,200 ana over 
196 
199 
3 
50 
186 
49 
30 
161.3 
18 
13 
9 
6.5 
8 
6 
12.0 
Ample2 
1,728 
1,749 
21 
493 
1,674 
483 
160 
95.6 
109 
75 
61 
4.3 
58 
41 
8.3 
1 reportable pregnancy... 
339 
343 
4 
339 
322 
318 
35 
108.7 
34 
21 
21 
6.1 
8 
8 
2.4 
Husband earns: 
Under $521 
48 
48 
48 
43 
43 
11 
11 
5 
5 
*521 to $624 
23 
23 
23 
22 
22 
2 
2 
1 
1 
1 
1 
*625 to $779 
46 
48 
2 
46 
46 
44 
6 
5 
2 
2 
2 
2 
$780 to$899 
35 
35 
35 
32 
32 
3 
3 
3 
3 
$900 to $1.199 
38 
39 
i 
38 
36 
35 
4 
4 
3 
3 
$1,200 ana over 
13 
13 
13 
13 
13 
1 
1 
Ample2 
136 
137 
i 
136 
130 
129 
8 
61.5 
8 
7 
7 
5 1 
2 reportable pregnancies.. 
566 
576 
10 
283 
544 
279 
59 
108.5 
54 
32 
28 
5.6 
23 
16 
5.7 
Husband earns: 
Under $521 
62 
64 ■. 
2 
31 
62 
31 
11 
176.4 
11 
2 
2 
3.1 
$521 to $624 
72 
74 
2 
36 
68 
36 
8 
177. 6 
6 
6 
6 
8.1 
3 
$625 to $779 
110 
111 
1 
55 
108 
55 
17 
157.4 
16 
3 
3 
4.4 
*780 to $899 
56 
56 
28 
53 
28 
9 
169.8 
7 
3 
3 
5.4 
$900 to $1,199 
46 
46 
23 
41 
23 
2 
2 
5 
5 
4 
$1,200 and over 
16 
16 
8 
14 
7 
1 
1 
2 
1 
1 
Ample 2 
2041 
209 
5 
102 
198 
99 
11 
55.6 
11 
ii 
8 
5.3 
9 
6 
5.9 Infant Mortality 
145 
3 reportable pregnancies.. 
642 
650 
8 
214 
626 
214 
02 
147.0 
75 
24 
23 
3.7 
86 
18 
8.4 
Husband earns: 
Under $521...... 
114 
1^2 
115 
1 
2 
38 
110 
38 
27 
245.5 
158 4 
23 
13 
5 
3 
4 
3 
4.3 
1.9 
5 
1 
3 
1 
$$25 tn $77Q t , „..T 
84 
84 
28 
13 
158 5 
ix 
2 
2 
2.4 
3 
2 
$780 to $899 
87 
57 
87 
58 
20 
83 
29 
6 
72.3 
6 
g 
4 
3 
4 
3 
4.6 
5.2 
5 
7 
4 
3 
A 
7 
1 
Ample* 
192 
195 
3 
64 
188 
64 
18 
95.7 
13 
7 
7 
3.6 
5 
5 
7.8 
4 reportable pregnancies.. 
744 
752 
8 
186 
723 
186 
78 
107.9 
64 
29 
21 
3.9 
22 
18 
9.7 
Husband earns: 
TTndp.r $521 
104 
88 
104 
89 
26 
101 
26 
13 
128 7 
9 
3 
2 
1.9 
4 
2 
$521 tn $624 
1 
86 
22 
116 3 
9 
15 
3 
1 
3.4 
2 
2 
$625tr»$77Q . ... 
136 
137 
34 
147 3 
8 
6 
5.8 
3 
2 
$7*0 tn $8QQ 
06 
97 
136 8 
12 
2 
1 
2.1 
3 
3 
$900tn$1 1QQ 
56 
58 
2 
72 7 
2 
3 
1 
. 5.2 
2 
2 
40 
41 
\ 
39 
10 
4 
2 
2 
2 
2 
Ample*. ................... 
224 
226 
2 
56 
218 
56 
14 
64.2 
13 
8 
8 
3.5 
6 
5 
8.9 
5 reportable pregnancies.. 
735 
740 
5 
147 
704 
147 
103 
146.3 
67 
36 
31 
4.9 
20 
14 
9.5 
Husband earns: 
130 
121 
l 
26 
175 
26 
18 
21 
168 0 
12 
6 
6 
4.6 
3 
3 
$521 tn $524- 
20 
235 3 
12 
6 
5 
6.6 
3 
1 
$525 to $779 
too 
100 
20 
99 
20 
18 
13 
181.8 
13 
i 
i 
1.0 
3 
2 
$780 to $899 
110 
110 
22 
106 
22 
122. 6 
8 
4 
4 
3.6 
3 
2 
$900 to $1 199 . 
66 
13 
6 
100.0 
5 
6 
4 
10.0 
30 
30 
5 
26 
6 
10 
6 
4 
3 
2 
1 
210 
212 
2 
42 
203 
42 
15 
73.9 
11 
9 
8 
4.2 
6 
5 
6 reportable pregnancies.. 
564 
568 
4 
94 
546 
93 
88 
161.2 
60 
22 
13 
3.9 
23 
14 
14.9 
Husband earns: 
132 
132 
22 
124 
21 
26 
209.7 
14 
8 
3 
6.1 
2 
2 
$521 to $624 
60 
60 
10 
59 
10 
9 
152.5 
8 
1 
1 
1.7 
6 
2 
$625 to $779 
114 
115 
i 
19 
110 
19 
14 
127.3 
11 
5 
2 
4.3 
3 
2 
S7R0toS899 . 
48 
48 
s 
48 
8 
7 
6 
4 
2 
£900 to Sul .199 
72 
74 
2 
12 
70 
12 
12 
171.4 
9 
4 
3 
6.4 
4 
3 
12 
12 
2 
H 
2 
3 
1 
1 
1 
Ample*..... 
126 
1271 
i 
21 
124 
21 
17 
X37. i 
11 
3 
3 
2.4 
4 
3 
* Sea note on page 45. 
J'Not shown when base is less than 50. 146 
The Case for-Birth Control 
Table XIII.—Distribution op Results op Reportable Pregnancies (Live Births and Stillbirths) and Miscarriages, According 
to Number per Mother and Husband’s Earnings—Continued. 
SPECIFIED NUMBER OF PREG- 
NANCIES FOR ALL MARRIED 
MOTHERS AND ANNUAL EARN- 
INGS OF HUSBAND. 
REPORTABLE PREGNANCIES. 
LIVE BIRTHS. 
BABIES DYING IN FIRST YEAR- 
STILLBIRTHS. 
MISCARRIAGES. 
Total. 
Resulting births. 
Number 
of 
mothers. 
Num- 
ber. 
Number 
of 
mothers. 
Num- 
ber. 
Infant 
mortality 
rate.1 
Number 
of 
mothers. 
Num- 
ber. 
Number 
of 
mothers. 
Per cent 
of all 
births.1 
Num- 
ber re- 
ported. 
Mothers reporting. 
Number. 
Excess 
over preg- 
nancies. 
Number. 
Per cent 
of all 
mothers. 
7 reportable pregnancies.. 
581 
586 
5 
83 
555 
83 
78 
140.5 
48 
31 
22 
5.3 
27 
15 
78.1 
Husband earns: 
91 
92 
1 
13 
88 
]3 
13 
147.7 
8 
4 
4 
4.3 
4 
2 
$521 to $624 
56 
56 
8 
51 
8 
15 
294.1 
6 
5 
4 
8.9 
1 
1 
$625 to $779 
98 
101 
3 
14 
97 
14 
16 
164.9 
9 
4 
3 
4.0 
$780 to $899 
35 
35 
5 
32 
5 
6 
5 
3 
2 
3 
1 
$900 to $1.199 
84 
84 
12 
79 
12 
7 
88.6 
5 
5 
2 
6.0 
5 
3 
21 
22 
1 
3 
22 
3 
1 
1 
2 
1 
136 
196 
8 
186 
28 
20 
107.5 
14 
10 
7 
5.1 
12 
7 
8 reportable pregnancies.. 
432 
437 
5 
2 
64 
426 
54 
95 
223.0 
42 
11 
7 
2.5 
15 
9 
16.7 
Husband earns: 
120 
120 
15 
117 
15 
31 
265.0 
12 
3 
2 
2.5 
5 
2 
$521 to $624 
96 
98 
2 
12 
94 
12 
22 
234.0 
10 
4 
2 
4.1 
1 
1 
$625 to $779 
40 
41 
1 
5 
41 
5 
11 
4 
2 
1 
$780 to $899 
48 
49 
1 
6 
46 
6 
11 
5 
3 
2 
5 
3 
$900 to $1,199 
24 
24 
3 
24 
3 
6 
3 
1 
1 
16 
16 
2 
16 
2 
3 
2 
1 
1 
88 
89 
i 
u 
88 
ii 
11 
125.0 
6 
1 
i 
1. 1 
9 reportable pregnancies.. 
297 
299 
2 
33 
283 
33 
41 
144.9 
20 
16 
H 
5.4 
13 
8 
Husband earns: 
Under $521 
81 
82 
1 
9 
80 
9 
15 
187.5 
6 
2 
2 
2.4 
3 
2 
$521 to $624 
72 
72 
8 
70 
8 
10 
142.9 
6 
2 
1 
2.8 
3 
3 
$625 to $779.. 
18 
18 
2 
15 
2 
3 
1 
i 
1 
$780 to $899 
18 
19 
1 
2 
17 
2 
2 
2, 
2 
$900 to $1,199 
18 
18 
2 
18 
2 
2 
2. 
$1,200 and over 
18 
18 
2 
16 
2 
2 
1 
Ample* 
72 
72 
8 
67 
S 
9 
134.3 
4 
5 
4 
6-9 
6 
2 Infant Mortality 
147 
10 or more reportable 
pregnaaoies 
654 
666 
12 
68 
634 
58 
135 
212.9 
45 
32 
17 
4.8 
14 
10 
17.2 
Husband earns: 
Under 8521 
56 
58 
2 
5 
52 
5 
10 
192.3 
4 
6 
1 
10.3 
1 
1 
8521 to $624 
32 
33 
1 
3 
32 
3 
17 
3 
1 
1 
1 j 
1 
$625 to $779 
70 
71 
1 
6 
70 
6 
16 
228.6 
4 
1 
1 
1.4 
2 
1 
$780 to $899 
78 
80 
2 
7 
76 
7 
26 
342.1 
7 
4 
2 
5.0 
3 
2 
$900 to $1,199 
114 
114 
10 
110 
10 
24 
218.2 
8 
4 
3 
3.5 
2 
2 
24 
24 
2 
22 
2 
5 
1 
2 
1 
8.3 
Ample 2 
280 
286 
6 
25 
272 
25 
37 
136.0 
18 
14 
8 
4.9 
5 
3 
* See mote on page 45. 
i Not sbowa when base is less than 60. 148 
The Case for/Birth Control 
Table XIV.—Distribution According to Number of Pregnancies and Age 
Groups op Married Mothers Classified by Nativity. 
MOTHER’S age and number or REPORT- 
ABLE PREGNANCIES. 
ALL MOTHERS. 
NATIVE MOTHERS. 
FOREIGN MOTHERS. 
Number. 
Per cent. 
Number. 
Per cent. 
Number. 
Per cent. 
Total pregnancies 
1.491 
100.0 
816 
100.0 
675 
100.0 
1 
339 
22.7 
234 
28.7 
105 
15.6 
2 
283 
19.0 
173 
21.2 
110 
16.3 
3 
214 
14.4 
111 
13.6 
103 
15.3 
4 
186 
12.5 
94 
11.5 
92 
13.6 
5 
147 
9.8 
65 
8.0 
82 
12.1 
6 
94 
6.3 
37 
4.5 
57 
8.4 
7 
83 
5.6 
38 
4.7 
45 
6.7 
8 
54 
3.6 
23 
2.8 
31 
4.6 
9 
33 
2.2 
13 
1.6 
20 
3.0 
10 and over 
58 
3.9 
28 
3.4 
30 
4.4 
Under 20 years, total pregnancies 
89 
100.0 
66 
100.0 
23 
100.0 
74 
83.1 
55 
83.3 
19 
82.6 
2 
12 
13.5 
10 
15.2 
2 
8.7 
3 
3 
3.4 
1 
1.5 
2 
8.7 
20 to 24 years, total pregnancies 
461 
100.0 
261 
100.0 
200 
100.0 
1 
178 
38.6 
114 
43.7 
64 
32.0 
2 
156 
33.8 
86 
33.0 
70 
35.0 
3 
77 
16.7 
42 
16.1 
35 
17.5 
4 
39 
8.5 
14 
5.4 
25 
12.5 
5 
10 
2.2 
4 
1.5 
6 
3.0 
6 
1 
.2 
1 
0.4 
25 to 29 years, total pregnancies 
395 
100.0 
199 
100.0 
196 
100.0 
1 
57 
14.5 
45 
22.6 
12 
6.1 
2 
74 
18.7 
46 
23.1 
28 
14.3 
3 
95 
24.1 
40 
20.1 
55 
281 
4 
75 
19.0 
40 
20.1 
35 
17.9 
5 
56 
14.2 
17 
8.5 
39 
19.9 
6 
22 
5.6 
7 
3.6 
15 
7.7 
7 
14 
3.5 
4 
2.0 
10 
5.1 
2 
.4 
2 
1.0 
30 to 39 years, total pregnancies 
466 
100.0 
245 
100.0 
221 
100.0 
30 
6.4 
20 
8.2 
10 
45 
39 
8.4 
29 
11.8 
10 
4.5 
3 
36 
7.7 
25 
10.2 
11 
5.0 
4 
63 
13.5 
33 
13.5 
30 
13.6 
5 
75 
16.1 
40 
16.3 
35 
15.8 
60 
12.9 
24 
9.8 
36 
16.3 
7 
56 
12.0 
28 
11.4 
28 
12.7 
51 
10.9 
23 
9.4 
28 
12.7 
9 
23 
4.9 
8 
3.3 
15 
6.8 
10 and over 
33 
7.1 
15 
6.1 
18 
8.1 
40 years and over, total pregnancies. 
80 
100.0 
45 
100.0 
35 
100.0 
2 
2 
2.5 
2 
4.4 
3 
3 
3.8 
3 
6.7 
9 
11.3 
7 
15.6 
2 
5.7 
5 
6 
7.5 
4 
8.9 
2 
5.7 
11 
13.8 
5 
11.1 
6 
17.1 
13 
16.3 
6 
13.3 
7 
20.0 
8 
1 
1.3 
1 
2.9 
10 
12.5 
5 
11.1 
5 
14.3 
10 and over 
25 
31.3 
13 
28.9 
12 
34.3 Infant Mortality 
149 
Table XV.—Distribution op Married by Losses Sustained, Accord- 
ing to Nativity op Mother and Number of'Possible Losses. 
NUMBER OF BIRTHS OR POS- 
SIBLE LOSSES AND NA- 
TIVITY OF MOTHER. 
Number 
of 
mothers. 
DISTRIBUTION OP MOTHERS ACCORDING TO NUMBER OP LOSSES. 
1 
loss. 
2 
losses. 
3 
losses. 
4 
losses. 
5 
losses. 
6 
losses. 
8 
losses. 
10 or 
more 
losses. 
All mothers. 
1,491 
399 
121 
60 
24 
13 
8 
1 
2 
335 
53 
277 
67 
10 
216 
73 
14 
4 
187 
55 
13 
8 
1 
5 births . 
148 
48 
19 
11 
1 
2 
96 
44 
13 
8 
2 
1 
2 
7 births 
82 
22 
19 
10 
2 
1 
8 births.... 
54 
18 
8 
10 
4 
2 
2 
9 births 
36 
9 
10 
5 
1 
1 
2 
* 
10 or more births 
60 
10 
15 
4 
13. 
7 
1 
1. 
2 
Native mothers. 
816 
199 
59 
19 
5 
6 
1 
1 
I birth 
232 
29 
« . 
2 births 
170 
36 
5 
3births... 
111 
35 
7 
1 
, * 
4 births 
98 
33 
6 
3 
65 
19 
10 
4 
6 births ( 
38 
19 
7 
1 
1 
7 births i 
37 
10 
8 
3 
1 
8 births 4* 
21 
8 
5 
3 
9 births .'1 
15 
4 
4 
3 
1 
10 or more births 
29 
6 
7 
1 
4 
5 
i 
Foreign mothers 
675 
200 
62 
41 
19 
7 
7 
2 
1 birth 
103 
24 
2 births 
107 
31 
-5 
3 birthsl 
105 
38 
7 
3 
4 births 
89 
22 
7 
5 
1 
S births 
83 
29 
9 
7 
1 
2 
6 births 
58 
25 
6 
7 
2 
2 
7 births 
45 
12 
11 
7 
2 
8 births 
33 
10 
3 
7 
4 
2 
2 
9 births 
21 
5 
6 
2 
1 
2 
10 or more births 
31 
> 4 
8 
3 
9 
2 
i 
2 150 
The Case for Birth Control 
Population, Registered Births, Deaths oe Infants under 1 Year of Age, 
and Infant Mortality Rates for Registration States and Registra- 
tion Cities having a Population of at Least 50,000 in 1910. 
abea. 
Popula- 
tion in 
1910. 
Births.* 
DEATHS * OF IN- 
FANTS UNDER 1 
YEAR OF AGE. 
Number. 
Per 1,000 
births.* 
REGISTRATION STATES. 
Connecticut 
1,114,756 
742,371 
3,366,416 
2,810,173 
430,572 
7,665,111 
542,610 
355,956 
102,054 
98,915 
133,605 
73,141 
331,069 
58,571 
670,585 
56,878 
104,839 
119,295 
57,730 
85,892 
106,294 
89,336 
96,652 
77,236 
88,926 
145,986 
465,766 
112,571 
50,510 
70,063 
4,766,883 
430,980 
1,634,351 
2,331,542 
284,041 
85,969 
51,913 
52,127 
66,525 
64,186 
55,482 
1,549,008 
533,905 
96,071 
129,867 
67,105 
51,622 
224,326 
27,291 
15,578 
86,765 
63,566 
9,385 
202,631 
4 6,595 
7,343 
2,976 
2,411 
3,772 
2,150 
7,016 
1,163 
17,760 
1,359 
2,462 
4,591 
1,702 
3,165 
2,630 
2,218 
3,873 
1,728 
2,438 
3,918 
11,960 
2,693 
897 
1,939 
129,316 
10,926 
43,128 
66,112 
7,095 
2,055 
1,406 
1,392 
1,713 
1,308 
1,628 
38,666 
15,059 
2,370 
3,512 
1,840 
(4) 
(5) 
3,476 
2,108 
11.377 
7,912 
1,373 
28.377 
<1,111 
791 
367 
286 
406 
320 
1,068 
167 
2,246 
134 
293 
854 
362 
529 
607 
216 
685 
174 
302 
536 
2,138 
329 
130 
375 
6,159 
11,047 
5,063 
8,900 
865 
284 
202 
166 
197 
169 
268 
5,334 
2,259 
336 
520 
269 
191 
827 
127 
135 
131 
124 
146 
140 
<168 
168 
123 
119 
108 
149 
152 
144 
126 
99 
119 
186 
213 
167 
231 
97 
177 
101 
124 
137 
179 
122 
146 
193 
125 
96 
117 
135 
122 
138 
144 
119 
116 
129 
166 
138 
150 
142 
148 
146 
8 
REGISTRATION CITIES OF 60,000 POPULATION OR OVER IN 1910. 
Connecticut: 
Washington, D. C 
Massachusetts: 
Boston 
Brockton 
Cambridge 
Fall River 
Lowell , c.• 
New Bedford 
Somerville 
Worcester 
Michigan: 
'Manchester, N. H 
!New York, N. Y 
Bronx Borough 
Pennsylvania: 
Allentown 
Altoona 
Erie 
Wilkes-Barre 
Rhode Island: 
> Provisional figures; exclusive of stillbirths. 
* Exclusiveof stillbirths. 
* Based on provisional figures for births. 
A-The figures for Rhode Island are exclusive of Providence and Pawtucket. 
» Returns of births not received from State board in time for inclusion^ Infant Mortality 
151 
It will be seen by this table that Johnstown is among the 10 cities of more 
than 50,000 population which had an infant mortality rate of 1910 in excess of 
150 per 1,000 births. These 10 cities and their respective rates are as fol- 
lows: Lowell, Mass., 231; Holyoke, Mass., 213 ; Manchester, N. H., 193; Fall 
River, Mass., 186; Detroit, Mich., 179; New Bedford, Mass., 177; Lawrence, 
Mass., 167; Johnstown, Pa., 165; Washington, D. C., 152; and Pittsburgh, 
Pa., 150. 
It should be borne in mind that the absolute infant mortality rate of 134, 
computed for the group of babies included in this investigation, that is, for 
those born in Johnstown in 1911, can not be compared with any of the approxi- 
mate rates in the foregoing table, since the basis of computation is entirely 
different. But the method used in this report seemed to be the only practicable 
one for our purpose, namely, to measure the infant mortality rate in different 
districts of the city where the babies are subjected to varying conditions. The: Case: for Birth Control 
152 
Conditions similar to those existing in Johnstown were found in Chicago 
h§r Dr. Alice Hamilton, Bacteriologist in the Memorial Institute for In- 
fectious Diseases, Hull House. The results of a study made of 1,600 families 
in the neighborhood was published in 1910. The investigation was under- 
taken to find out the truth or falsity of a general feeling among the district 
nurses that a high birth rate was accompanied by a high death rate. It was 
found that a high birth rate was not so much accompanied as outrun by a 
high death rate. The number of children live-born was compared with the 
number of children who reached the age of three, so it is a study of child 
mortality, rather than of infant mortality. The child mortality rate rises and 
falls very much as does the infant mortality rate in Johnstown. A table cal- 
culated from the data of all the families shows an ascending mortality rate: 
No. in Family 
Child Mortality Rate 
4 children and less 
118 
6 children and more 
267 
7 children and more 
280 
8 children and more 
291 
9 children and more 
303 
Expressed in words this table says that child mortality increases as the. 
number of children per family increases, until we have a death rate in families 
of eight and more, which is two and a half times as great as that in families 
of four children and under. 
FOURTH ANNUAL REPORT OF THE CHIEF, CHILDREN’S 
BUREAU, U. S. DEPARTMENT OF LABOR, Washington, 
October 7, 1916 
INFANT MORTALITY—MANCHESTER 
The findings of the bureau’s earlier study in Johnstown, Pa., are con- 
firmed in many respects by the findings in Manchester—the coincidence of a 
high infant mortality rate with low earnings, poor housing, mother’s work, 
and large families. 
The mortality rate among the 1,564 live-born babies studied in Man- 
chester was 165 per 1,000 births, which is considerably higher than the esti- 
mated rate for the whole country. 
Manchester is primarily a textile town, and the textile mills employed 
36.3 per cent of all the fathers of babies born in Manchester during the 12 Infant Mortality 
153 
months covered by the study. Of the fathers, 13.7 per cent were earning 
less than $450 per year; 48.5 per cent less than $6.50; 22.9 per cent $850 or 
more; 6.4 per cent $1,250 or more. 
Of the babies with fathers earning less than $450, about 1 in 4 died before 
it was 12 months old. The great majority of the babies had fathers in the 
wage group from $450 to $849, and of these about 1 in 6 died. Of the babies 
whose fathers earned $850 but less than $1,050, 1 in 8 failed to survive. Where 
the fathers earned $1,050 or more, 1 baby in 16 died in the first year. 
Where families lived two or more persons per room, the infant death 
rate was twice as high as where they lived less than one person per room. 
The babies living in houses occupied by a single family died at the rate of 
86.1 per 1,000, but those in tenements occupied by more than six families died 
at the rate of 236.6 per 1,000. 
When the mother was a wage earner the baby’s chances of living were 
less than when she was not. Babies of mothers who had worked at some 
time during the year before the baby’s birth died at the rate of 199.2 per 1,000, 
while babies of nonworking mothers died at the rate of 133.9. Babies of 
mothers employed away from home some time during the year after child- 
birth while the baby was still alive and under four months old had a rate of 
277.3, while babies of mothers not employed during that time had a rate of 122. 
Babies of foreign-born mothers did not fare so well as babies of native 
mothers. The differences of rates, however, are only partly accounted for by 
their lower earnings. The largest foreign element in Manchester is Cana- 
dian French, and among them the infant mortality rate, 224 per 1,000 live 
births, is greater than that among any other group of the population, although 
their earnings are in general higher than those of other foreigners. 
Sheer size of family appears to be one factor in this high Canadian- 
French rate, one-third of their babies being sixth or later in order of birth, 
while over one-sixth of these mothers had had from 9 to 18 children. These 
Canadian-French babies in families of 6 or more children died at the rate of 
246.2 per 1,000 and the rate rises to 277.2 per 1,000 when only babies ninth 
or later in order of birth are considered. CHAPTER V 
MATERNAL MORTALITY AND DISEASES AFFECTED BY 
PREGNANCY 
This chapter shows that the female death-rate is much greater during the 
child-bearing age than at other periods and notably greater than the male 
death-rate at any period. The outstanding fact is that this abnormal female 
death-rate, between the ages of 15 and 45, must be ascribed to too frequent 
pregnancies and to those diseases of the lungs, heart and kidneys which are 
hastened by pregnancy. Ninety-five per cent, of such deaths could be averted 
by the dissemination of knowledge to prevent conception. 
THE SEXUAL LIFE OF WOMAN IN ITS PHYSIOLOGICAL BIO- 
LOGICAL AND HYGIENIC ASPECTS. E. HEINRICH KISCH, 
M.D., Professor of the German Medical Faculty of the University of 
Prague, Physician to the Hospital and Spa of Marienbad, Member of the 
Board of Health, etc. Translated by M. Eden Paul, M.D. Rebman Co., 
New York. 
' It is astonishing to observe the number of full term deliveries and mis- 
carriages that a woman will experience within a comparatively short period 
of time, as is seen too frequently among the laboring classes, and more especi- 
ally, among the factory workers. If we assume the original mortality of child- 
birth to be 6 per mille, a woman who in the course of 15 years undergoes 
labor (at full term or prematurely) 16 times, runs a risk of death to be ex- 
pressed by the ratio of 6 16—96 per mille; that is to say, on the average of 
1,000 women who became pregnant as often as this, nearly one in ten will 
die in childbed. P. 278. 
In certain serious general disorders, in diseases of the heart, or of the 
lungs, in pelvic deformity, and in pathological changes of the female repro- 
ductive organs, it may be right to employ means for the prevention of preg- 
nancy—not merely sexual abstinence, but actual measures to prevent ferti- 
lization. P. 395. 
Based upon the observations of Schauta and Fellner, the latter author 
advances the rule that in the case of a woman suffering from disease, mar- 
riage should be forbidden only when the mortality from the disease in ques- 
tion is not less than 10%. In this category we must include severe cases only 156 
The; Case eor Birth Control 
of pulmonary tuberculosis, whilst cases of laryngneal tuberculosis will, accord- 
ing to this rule, be absolutely unfit for marriage. Among heart affections 
contra-indicating marriage, he includes mitral stenosis, other valvular affec- 
tions in which there is serious disturbance of compensation, and myocarditis; 
he considers marriage inadmissable also in cases of chronic nephritis, and 
among surgical affections, in case of malignant tumor. No case in which 
during a previous pregnancy the patient has been affected by one of the fol- 
lowing diseases; viz. severe chorea, mental disorders, severe epilepsy, pul- 
monary tuberculosis which progressed much during pregnancy, morbus cor- 
dis, with considerable disturbance of compensation, severe heart trouble due 
to Graves disease—in all such cases a repetition of pregnancy should be 
avoided. P. 261. 
FOURTH ANNUAL REPORT OF THE CHIEF OF CHILDREN’S 
BUREAU OF THE U. S. DEPARTMENT OF LABOR, 
JUNE 30, 1916 
MATERNAL MORTALITY 
A study of maternal mortality, by Dr. Grace L. Meigs, head of the 
hygiene division of this bureau, has been undertaken as a direct corollary to 
the infant mortality inquiry. The sickness or death of the mother inevitably 
lessens the chances of the baby for life and health. A large proportion of 
the deaths of babies occur in the first days and weeks of life, and these early 
deaths can be prevented only through proper care of the mother before and 
at the birth of her baby. 
In the introduction to the report on “Maternal mortality in connection 
with childbearing,” issued as a supplement to his report as medical officer of 
the local government board of Great Britain for 1914-15, Sir Arthur News- 
holme says: 
The present report is intended to draw attention to this unnecessary mor- 
tality from childbearing, to stimulate further local inquiry on the subject, and 
to encourage measures which will make the occurrence of illness and dis- 
ability due to childbearing a much rarer event than at present. 
The attainment of these ends is important as much in the interest of the 
child as of its mother. That the welfare of the child is wrapped up in that of 
the mother was fully recognized in the board’s circular letter of 31st July, 
1914, and the schedule appended to that letter; and each year it is becoming 
more fully realized that, in order to insure healthy infancy and childhood, it 
is necessary that, both during pregnancy and at and after the birth of the Maternal Mortality 
157 
infant, increased maternal care and guidance and medical assistance should be 
provided. 
The Children’s Bureau studies of infant mortality in town and country 
reveal clearly the connection between maternal and infant welfare and make 
plain that infancy can not be protected without the protection of maternity. 
In her report Dr. Meigs undertakes to do no more than to assemble and 
interpret figures already published by the United States Bureau of the Census 
and in the mortality reports of various foreign countries and to state accepted 
scientific views as to the proper care of maternity. She shows that maternal 
mortality, although in great measure preventable, is not decreasing in the 
United States. Her report reveals an unconscious public neglect due to age- 
long ignorance and fatalism. As soon as the public realizes the facts to 
which Dr. Meigs calls attention it doubtless will awake to action, and suitable 
provision for maternal and infant welfare will become an integral part of all 
plans for local protection of public health. 
The report is summarized as follows: 
“In 1913 in this country at least 15,000 women, it is estimated, died from 
conditions caused by childbirth; about 7,000 of these died from childbed fever, 
a disease proved to be almost entirely preventable, and the remaining 8,000 
from diseases now known to be to a great extent preventable or curable. 
Physicians and statisticians agree that these figures are a great underestimate. 
“In 1913 the death rate per 100,000 population from all conditions caused 
by childbirth was but little lower than that from typhoid fever; this rate would 
be almost quadrupled if only the group of the population which can be affected, 
women of childbearing age, were considered. 
“In 1913 childbirth caused more deaths among women 15 to 44 years old 
than any disease except tuberculosis. 
“The death rate due to this cause is almost twice as high in the colored 
as in the white population. 
“Only 2 of a group of 15 important foreign countries show higher rates 
from this cause than the rate in the registration area of the United States. 
The rates of three countries, Sweden, Norway, and Italy, which are notably 
low, show that low rates for these conditions are attainable. 
“The death rates from childbirth and from childbed fever for the regis- 
tration area of this country are not falling; during the 13 years from 1900 
to 1913 they have shown no demonstrable decrease. These years have been 
marked by a revolution in the control of certain other preventable diseases, 
such as typhoid, diphtheria, and tuberculosis. During that time the typhoid 
rate has been cut in half, the rate of tuberculosis markedly reduced, and the 
rate for diphtheria reduced to less than one-half. During this period the 
death rate from childbirth has decreased in England and Wales, Ireland, Aus- 158 
The Case eor Birth Controe 
tralia, and Japan. The other foreign countries studied show stationary or 
slightly increasing rates. The death rate from childbed fever has decreased 
only in England and Wales, Ireland, and Scotland. 
“These facts point to the need in this country and in foreign countries of 
higher standards of care for women at the time of childbirth. 
“The low standards at present existing in this country result chiefly from 
two causes: (1) General ignorance of the dangers connected with childbirth 
and of the need for proper hygiene and skilled care in order to prevent them; 
(2) difficulty in the provision of adequate care due to special problems char- 
acteristic of this country. Such problems vary greatly in city and in country. 
In the country inaccessibility of any skilled care, due to pioneer conditions, is 
a chief factor. 
“Improvement will come about only through a general realization of the 
necessity for better care at childbirth. If women demand better care, phy- 
sicians will provide it, medical colleges will furnish better training in obste- 
trics, and communities will realize the vital importance of community meas- 
ures to insure good care for all classes of women.” 
While the figures given by Dr. Meigs are a startling indication of the 
great number of maternal fatalities occurring in various parts of the country, 
no estimates can be made of the number of mothers who survive only to suffer 
from a degree of preventable ill health which limits or defeats the well-being 
and happiness of their households. 
MATERNAL MORTALITY FROM ALL CONDITIONS CONNECTED 
WITH CHILD BIRTH IN THE UNITED STATES AND CERTAIN 
OTHER COUNTRIES. By Grace L. Meigs, M.D. U. S. Department 
of Labor, Children’s Bureau, 1917. 
STATISTICS RELATING TO CHILDBIRTH IN THE UNITED 
STATES AND IN CERTAIN FOREIGN COUNTRIES 
For the last two decades civilized countries have been absorbed in the 
problem of preventing the enormous and needless waste of human life repre- 
sented by their infant death rates. The importance of this problem has been 
felt more keenly in the last two years in the countries now at war; in these 
countries the efforts toward saving the lives of babies have redoubled since 
the war began. Side by side with this problem, another, which is only of late 
finding its true place, is that of the protection of the lives and health of 
mothers during their pregnancy and confinement. This is a question so 
closely bound up with that of the prevention of infant mortality that the two 
can not be separated. Maternal Mortality 
159 
It is now realized that a large proportion of the deaths of babies occur in 
the first days and weeks of life, and that these deaths can be prevented only 
through proper care of the mother before and at the birth of her baby. It is 
also realized that breast feeding through the greater part of the first year of 
the baby’s life is the chief protection from all diseases; and that mothers are 
much more likely to be able to nurse their babies successfully if they receive 
proper care before, at, and after childbirth. Moreover, in the progress of 
work for the prevention of infant mortality it has become ever clearer that all 
such work is useful only in so far as it helps the mother to care better for 
her baby. It must be plain, then, to what a degree the sickness or death of the 
mother lessens the chances of the baby for life and health. 
This question has also another side. Each death at childbirth is a serious 
loss to the country. The women who die from this cause are lost at the time 
of their greatest usefulness to the State and to their families; and they give 
their lives in carrying out a function which must be regarded as the most 
important in the world. 
Questions then of the most vital interest to the whole Nation are these: 
How are the lives of the mothers in this country and other countries being 
protected? To what degree are the diseases caused by pregnancy and child- 
birth preventable? If preventable, how far are they being prevented in this 
country? Has there been the same great decrease in the last few years in 
sickness and death from these causes as that which has marked the great 
campaigns against other preventable diseases such as typhoid, tuberculosis, or 
diphtheria? How do the conditions in the United States compare with those 
in other countries? 
Puerperal septicemia (childbed fever).—The fact is now well known 
that puerperal septicemia, or childbed fever, is in reality a wound infection, 
similar to such an infection after an accident or an operation, and that it can 
be prevented by the same measures of cleanliness and asepsis which are used 
so universally in modern surgery to prevent infection. The proof of the 
nature of this disease is one of the tremendous results of the scientific dis- 
coveries which were made in the latter part of the nineteenth century. 
During the early part of that century childbed fever was one of the 
greatest hospital scourges known. It occurred also in private practice; but 
in hospitals where there was great opportunity for the spreading of infection 
the death rate from this disease was appalling. The average death rate in 
hospitals in all countries was 3 to 4 per cent of all women confined; some- 
times it reached 10 to 20 per cent and even over 50 per cent during short 
periods of epidemics. In the face of this terrific mortality many obstetrical 
hospitals were closed. Commissions were appointed to investigate the cause 
of these epidemics, and medical congresses devoted sessions to the discussion 
of the problem. In 1843 Oliver Wendell Holmes, and in 1847 Semmelweiss, 160 
The Case eor Birth Control 
published articles stating the theory that this fever was similar to a wound 
infection and was due chiefly to the carrying of infectious material on the 
hands of attendants from one case to another. 
NUMBER OF DEATHS IN THE UNITED STATES FROM 
CHILDBIRTH 
In 1913 in the “death-registration area” of the United States 10,010 
deaths were reported as due to conditions caused by pregnancy and childbirth. 
Of these deaths, 4,542 were reported as caused by puerperal septicemia or 
childbed fever. 
Using the death-registration area as a basis, we are justified in estimating 
that in 1913 in the whole United States 15,376 deaths were due to childbirth, 
and 6,977 of these were due to childbed fever. As will be shown later, these 
figures are without doubt a gross underestimate. As it is, they are striking 
enough—almost 7,000 deaths in one year in this country due to childbed fever, 
a disease to a large degree easily preventable; and over 8,000 due to the other 
diseases caused by pregnancy and confinement, most of which are preventable 
or curable by means well known to science. 
DEATH RATES IN THE UNITED STATES FROM CHILDBIRTH 
The death rate from all diseases caused by pregnancy and confinement in 
1913 in the registration area was 15.8 per 100,000 population (which includes 
all ages and both sexes). The death rate from puerperal septicemia was 7.2. 
These figures, however, mean little to us unless we compare them with 
the death rates from other preventable diseases. In the same year and area 
the typhoid rate was 17.9 per 100,000 population; the rate from diphtheria and 
croup 18.8. The highest death rate from any one disease was that from tuber- 
culosis, 147.6 per 100,000 population. Any such comparison with the rates 
from diseases to which both sexes and all ages are liable is of course very 
misleading; but in spite of that fact it is interesting to note that typhoid fever, 
the disease against which so great an amount of effort is now directed, has a 
rate at present but 2 per 100,000 population higher than that from the dis- 
eases caused by pregnancy and confinement. 
Death rates per 100,000 women.—The death rates from childbirth are 
approximately doubled when worked on the basis of 100,000 women. This 
will be seen when Tables IV and III (p. 50) are compared. The former gives 
for the period 1900 to 1910, the annual death rates per 100,000 women in the 
group of 11 States which were in the death-registration area in 1900, the 
latter the death rates per 100,000 population in the same group of States for MATemAi, Mortality ? 
161 
the 'same period. It is evident that the rates in Table IV for each year are 
slightly more than twice those m Table III for the same year. 
Death mtes per 100,000 women of childbearing age. ..Again, a much 
higher but a more accurate death rate from these diseases is found when the 
basis taken is the group which alone is affected by these diseases—women of 
childbearing age. When the rate is based not upon 100,000 population of 
both sexes and all ages but upon 100,000 women 15 to 44 years of age, the 
rate as-ordinarily given is multiplied several times. 
In 11900, the only year for which the rates can be computed, the death 
rate in The registration area per 100,000 women 15 to 44 years of age from 
nil diseases of pregnancy and confinement was 50.3; from puerperal infection, 
21.6. The corresponding rates for the same year per 100,000 population were 
13:1 and 5.6. In this year, therefore, the rates are almost quadrupled when 
based on that group of the population which alone can be affected by these 
diseases. 
Moreover, the death rates as ordinarily given per 100,000 population con- 
ceal The fact that the diseases of pregnancy and childbirth are indeed among 
the most important causes of death of women between 15 and 44 years of age; 
the actual number of deaths shows this to be the case. In 1913 in the regis- 
tration area these diseases caused more deaths than any other one cause of 
death except tuberculosis. In that year there were, among women 15 to 44 
yearstof age, 26,265 deaths from tuberculosis; 9,876 deaths from the diseases 
of pregnancy and confinement; 6,386 from heart disease; 5,741 from acute 
nephritis and Bright’s disease; 5,065 from cancer; and 4,167 from pneumonia. 
Other diseases, such as typhoid, appendicitis, and the infectious diseases show 
iar fewer deaths. 
Death rates per 1,000 live births.—This rate, as will be shown repeatedly 
throughout the report gives a far clearer picture of the actual risk 
risk of childbirth than do any of the rates so far considered. This rate can 
be given only for one year, 1910, and only for the provisional birth-registration 
area for that year. The rate from all diseases caused by pregnancy and con- 
finement is 6.5, from puerperal septicemia, 2.9, and from all other diseases 
of pregnancy and confinement, 3.6 per 1,000 live births. That is, in this area 
for every 154 babies born alive one mother lost her life. 
COMPARISON OF THE AVERAGE DEATH RATES FROM CHILD- 
BIRTH IN CERTAIN FOREIGN COUNTRIES AND IN THE 
UNITED STATES 
Are the death rates from these diseases in the death-registration area of 
the United States higher or lower than those in other civilized countries? 
Have these rates in other countries been falling or rising in the last 13 years, 
while the rates of this country have been apparently stationary? These ques- 162 
The Case for Birth Control 
tions, like all those of comparative international statistics, are of immense 
interest, but they involve many difficulties and sources of error. They should 
be considered in reading the following summary. 
In order to make possible a comparison of the death rates from these 
causes for 15 foreign countries with those for the United States, an average 
rate has been computed for the years 1900 to 1910 for each of the countries, 
using the same method as that in use in the United States. When the 16 
countries studied are arranged in order, with the one having the lowest rate 
first, the death-registration area of the United States stands fourteenth on 
the list. (See Table XII, p. 56.) Only two countries, Switzerland and 
Spain, have higher rates; many of the countries, however, show rates differ- 
ing but little from that of the United States. Markedly low rates are those of 
Sweden (6), Norway (7.8), and Italy (8.9) ; a strikingly high rate is that of 
Spain (19.6). 
The death rate from childbirth per 1,000 live births is not available for 
the death-registration area of the United States, but can be given only for 
the small number of States and cities included in the provisional birth-regis- 
tration area and for one year, 1910. (See p. 31.) This rate, 6.5, is con- 
siderably higher than that for 1910 of any of the countries studied. When 
the average rates for a number of years of the 15 countries are reckoned per 
1,000 live births and arranged in order, it will be seen that the same group of 
countries—Sweden, Italy, and Norway—shows the lowest rates. (See Table 
XIII, p. 56.) Spain in this table shows the rate which is next to the highest, 
while Belgium now has the highest rate. For a comparative study of the rates 
of these countries the rates per 1,000 live births give undoubtedly the clearest 
picture of the actual conditions. 
These rates show a wide variation. While in Sweden but one mother is 
lost for every 430 babies born alive, in Belgium one mother dies for every 
172 babies, and in Spain one for every 175 babies born alive. The rates in 
Belgium and Spain are two and a half times as high as the rate in Sweden. 
Far more significant than a comparison of actual death rates of various 
countries is a comparison of the changes which have occurred in these death 
rates in each country in recent years. England and Wales, Ireland, Japan, 
New Zealand, and Switzerland have shown a decrease in the death rate per 
1,000 live births from all diseases caused by pregnancy and confinement; but, 
in this group, only in England and Wales and in Ireland has the death rate 
from puerperal septicemia decreased; in the other three countries this rate has 
remained practically the same, though the total rate has decreased. 
In Australia, Belgium, Hungary, Italy, Norway, Prussia, Spain, and 
Sweden both the rate from childbirth and that from puerperal septicemia re- 
mained almost stationary during the periods studied. Maternal Mortality 
163 
The total rate for S''ot!n>'d =h'\v i increase, though the rate 
from puerperal septicemia has decreased. (See Table XVI, p. 66.) 
Communities are still to a great extent indifferent to or ignorant of the 
number of lives of women lost yearly from childbirth; many communities 
which are proud of their low typhoid or diphtheria rates ignore their high 
rates from childbed fever. Communities are only beginning to realize that 
among their chief concerns is the protection of the babies born within their 
limits, and necessarily also of the mothers of those babies before and at con- 
finement. 
DEATH-REGISTRATION AREA 
The statistics of causes of death are available only for a certain portion 
of the United States, included in the so-called “death-registration area.” Un- 
like other civilized countries, the United States has no uniform laws for the 
registration of births and deaths. Moreover, the efficiency of enforcement 
of existing laws varies greatly in the different States. The Bureau of the 
Census in 1880 therefore established a “death-registration area,” which com- 
prises “States and cities in which the registration of deaths is returned as 
fairly complete (at least 90 per cent of the total), and from which transcripts 
of the deaths recorded under the State laws or municipal ordinances are ob- 
tained by the Bureau of the Census.” In 1880 this area included but 17 per 
cent of the total population of the United States. As States and cities have 
passed better laws and obtained better enforcement they have been added to 
the registration area; the latter has increased greatly in size, but even in 1913 
included only 65.1 per cent of the population of the United States. For the 
remaining 34.9 per cent of the population of the country we have no reliable 
statistics. This 34.9 per cent includes the population of the greater number 
of the Southern States and of many Middle Western and Western States out- 
side of certain registration cities in these States which are included in the 
area. No statements can be made, therefore, of the number of deaths from 
any cause in the United States as a whole; only an estimate can be made on 
the assumption that for any cause of death the same rate prevails in the re- 
mainder of the United States as in the death-registration area. 
PROVISIONAL BIRTH-REGISTRATION AREA 
The registration of births is still more incomplete in this country than is 
the registration of deaths. For 1910 the United States Bureau of the Census 
established a “provisional birth-registration area,” including the New Eng- 
land States, Pennsylvania, Michigan, New York City and Washington, D. C. 
Death rates per 1,000 births.—As shown above, the method of computa- 
tion of death rates which gives the clearest picture of the hazards of child- 
birth is that which takes into account only the women giving birth to children 
in that year. This is the method in use in a large number of foreign coun- 
tries. The advantages of the method are self-evident. A demonstration of 164 
The Case eor Birth Control 
the superiority of this method of computation is obtained by a study of the 
tables giving the death rates from these diseases for foreign countries. In 
certain countries, as for instance Belgium and Hungary, there has been in 
recent years an apparent fall in the average death rates as computed per 
100,000 population, while the average rates computed per 1,000 live births 
have remained stationary or risen. This phenomenon is due, evidently, to 
a decline in the birth rate in these countries during these years, and shows 
how misleading the rates as given per 100,000 population undoubtedly are in 
countries with declining birth rates. Whether a fall in the birth rate has 
occurred in the United States is not known. If it has occurred in the regis- 
tration area, it would mean that the slight rise in rates per 100,000 population 
between 1900 and 1913 means a greater rise in rates computed according to 
the number of births. Such an error might compensate for the opposite error 
due to the more complete registration of deaths from childbirth in the later 
years of this period. 
Miscarriages are not reportable in any country, although a number of 
miscarriages (as the term is usually defined) probably are reported as still 
births in certain countries. The fact that women having miscarriages are not 
considered in the base would lead to a somewhat higher death rate than that 
which would express absolutely the number of deaths per 1,000 women at 
risk. 
COMPARISON OF THE CHANGES IN THE DEATH RATES FROM 
CHILDBIRTH IN CERTAIN FOREIGN COUNTRIES FOR THE 
YEARS 1900 TO 1913 
Far more valuable than a comparison of average rates of foreign coun- 
tries is a study of the rates of each country for a series of years in order to 
discover whether they are decreasing or increasing and to compare such 
changes in the various countries. While it may be dangerous on account of 
different countries, no such source of error is attached to the comparison of 
different countries, no such source of error it attached to the comparison of 
rates in the same country for a number of years. The period 1900 to 1913 
(or the latest year for which figures are available) is a very short one for a 
study of a change in death rates. It would have been far more interesting to 
study the death rates for a long series of years in each country, choosing a 
period beginning before the introduction of methods of asepsis. But such a 
study for the complete list of countries considered was not thought advisable, 
because of the difficulties caused by variations in classification of causes of 
death in the earlier years. 
In order to study the rates for any increase or decrease occurring during 
the last 13 years, the rates per 1,000 live births will be used rather than those 
per 100,000 population. In several countries—Belgium, Hungary, Italy, Nor- 
way, Prussia, and Spain—the rate from childbirth per 100,000 population ap- 
parently has fallen during the period, while the rate per 1,000 live births has Maternal Mortality 
165 
remained almost the same, or has risen. The cause of this inconsistency is 
the fact that in these countries the birth rate or the proportionate number of 
births to the number of inhabitants has decreased. 
Number of deaths of women from 15 to 44 years of age in the death-registra- 
tion area from each cause and class of causes included in the abridged 
International List of Causes of Death (revision of 1909),1 1913. 
(Computed from figures in Mortality Statistics, 1913, pp. 338 to 349, in which 
causes of death are given according to the detailed International List of Causes 
of Death.) 
Abridged 
Number 
Inter- 
of 
national 
Cause of death. 
deaths. 
List No. 
13, 14, 15 
Tuberculosis of the lungs, tuberculous 
meningitis, other 
forms of tuberculosis 
26,265 
31, 32 
Puerperal septicemia (puerperal fever, 
peritonitis) and 
other puerperal accidents of pregnancy 
and labor 
9,876 
19 
Organic diseases of the heart 
6,386 
29 
Acute nephritis and Bright’s disease . . . . 
5,741 
16 
Cancer and other malignant tumors 
5,065 
22 
Pneumonia 
4,167 
35 
Violent deaths (suicide excepted) 
3,262 
1 
Typhoid fever 
2,706 
30 
Noncancerous tumors and other diseases of the female genital 
2,669 
26 
Appendicitis and typhlitis 
1,620 
36 
Suicide 
1,562 
23 
Other diseases of the respiratory system 
(tuberculosis 
excepted) 
1,458 
18 
Cerebral hemorrhage and softening 
1,398 
24 
Diseases of the stomach (cancer excepted) 
940 
27 
Hernia, intestinal obstruction 
854 
28 
Cirrhosis of the liver 
598 
9 
489 
17 
Simple meninnitis 
484 
8 
Diphtheria and croup 
330 
12 
Other epidemic diseases 
312 
6 
307 
5 
304 
3 
250 
21 
Chronic bronchitis 
184 
2 0 
90 
33 
Congenital debility and malformations . . . 
24 
18 
4 
16 
7 
9 
2 
2 
1 0 
07 
11,688 
38 
Unknown or ill-defined diseases 
458 
lExcept No. 25, diarrhea and enteritis (under 2 years), and No. 34, senility. 166 
The Case for Birth Control 
A MUNICIPAL BIRTH CONTROL CLINIC. MORRIS H. KAHN, M. 
D., in Nezu York Medical Journal for April 28, 1917. 
Showing that large families among the poor are the result of ignorance of 
methods to prevent conception among the mothers. 
The following studies were undertaken with a view to determining 
whether there was an actual need and demand for birth control education and 
whether such a demand, if it existed, could be supplied with any effect by a 
scientifically conducted clinic in the dispensaries of the Department of Health 
of the City of New York; we felt that it might be of scientific and sociological 
interest to publish a report and an analysis of the observations made, probably 
the first of their kind in this country. Section 1142 of our Penal Code was 
ignored in conducting this birth control study. 
The social and economic status of the patients was fairly uniform, about 
the same as that of patients attending the other dispensary institutions in this 
city. A tabulation of the results was made under the following headings: 
Name and nationality; age; number of years married; number of living chil- 
dren and their ages; number of deceased children; number of miscarriages 
or abortions; contraceptive methods known or practised. More or less com- 
plete data were secured in 464 cases. 
The average number of procreative years of married life was 16.1, the 
age of fifty years being considered in this study as the end of the procreative 
period for the seventy-two women who were older than that. The average 
number of living children was 3.27 and of deceased children 1.2, making a 
total average of 4.47 children born to each family. Of the 464 women, 176, 
or three eighths, had had abortions or miscarriages, the total number of such 
interruptions of pregnancy being 324, or an average of 1.8 each for the 
women involved. 
Of the 464 women, 192 knew of no contraceptive methods and therefore 
had used none. The remaining 272 women knew of one or more methods, 
more or less effectual, for the prevention of conception. Of the 192 women 
who were ignorant of the use of contraceptives, practically one half, or 104, 
had a history of abortions, with a total of 202 abortions, or an average of two 
apiece. In contrast with this, of the 272 women who knew of one or more 
cntraceptives, only one fourth, or seventy-two, had undergone abortions, with 
a total of 122 abortions, or an average of only 1.6 apiece. 
A further analysis of our tables shows an interesting and striking rela- 
tionship between ignorance of methods for the prevention of conception and 
the number of children. Sixty-eight women had had three children each. 
Of these, twenty-six, or thirty-eight per cent., were ignorant of contraceptives. 
Twenty-eight women had had four children each. Of these fourteen, or fifty 
per cent., were ignorant of contraceptives. Fifty-five women had had five 
children each. Of these thirty were ignorant of contraceptives, or fifty-four Maternal Mortality 
167 
per cent. Thirty-two women had had six children each. Of these twenty 
were ignorant of contraceptives, or sixty-two per cent. Forty women had 
had seven children each. Of these thirty-eight were ignorant of contracep- 
tives, or ninety-five per cent. Twenty-one women had had eight children 
each. Of these twenty were ignorant of contraceptives, or ninety-five per 
cent. Forty-four women had had nine or more children each, and of these 
all were ignorant of contraceptive measures. Arranged in tabular form, 
these data would appear as follows: 
Number of 
Women 
Number of 
Children 
Number Ignorant 
of Contraceptives 
Percentage 
68 
3 
26 
38 
28 
4 
14 
50 
55 
5 
30 
54 
32 
6 
20 
62 
40 
7 
38 
95 
21 
8 
20 
95 
44 
9 to 17 
all 
100 
It is sometimes stated by opponents of birth control that contraceptive 
methods are known by every married person and that the fault and immor- 
ality of having a large family of unprovided for dependents lies not in ignor- 
ance of contraceptives but rather in a lack of determination on the part of one 
or both parents to use preventive measures; in other words, that the failure 
to use contraceptives results from the inconvenience attending some methods 
and also from the influence of religious sentiment. 
The above data, however, tend to show that ignorance of contraceptives 
not only is a great factor in the production of large families, but is also a 
great factor in increasing the number of abortions. From the fact that two 
thirds of these women knew absolutely no contraceptive method, while the 
methods used by many of the others were ineffectual or positively harmful, 
it is apparent that there is a definite opportunity for educating these women 
in methods of regulating conception. That there is need and demand for 
such education is voiced in unmistakable language by the multitude of poor 
who seek advice from all practising physicians. 
MATERNAL MORTALITY 
Prof. Theodate L. Smith, director of the Library Department, Child 
Study Institute, Clark University, investigated the records of the families of 
early graduates of Yale University (1701 to 1745) and of Harvard Univer- 
sity (1658 to 1690) ; and found that of the wives of Harvard men, 37.3 per 
cent died under the age of 45 years, while of the wives of Yale men, 40 per 
cent died under 50 years. Prof. Smith also showed that there is a tendency 
for families very large in the first generation to die out in the third or fourth 
generation. One family of twenty children, by two wives, has living descen- 168 
The Case for Birth Control 
dent by one son only, one daughter being untraceable. A family of ten 
brothers and sisters, only two of whom lived until 50, produced three sur- 
viving children, who in turn have produced one, and that a sickly specimen. 
Another family had fourteen in the first generation, eight in the second, six 
in the third and only two in the fourth.—Mary Alden Hopkins in Harper’s 
Weekly, June, 1915. 
TUBERCULOSIS, CAUSE OF THE GREATEST NUMBER OF 
DEATHS OF WOMEN DURING THE CHILD-BEARING PERIOD 
OBSTETRICS. A Text Book for the Use of Students and Practitioners. 
J. Whitridge Williams, Professor of Obstetrics, John Hopkins Univer- 
sity, Obstetrician-in-Chief to the John Hopkins Hospital, Gynaecologist to 
the Union Protestant Infirmary, Baltimore, Md, D. Appleton & Co. 
1912. 
As a rule, all diseases which subject the organism to a considerable strain 
are much more serious when occurring in the pregnant woman. In general 
it may be said that pregnancy exerts a deleterious influence upon all chronic 
organic maladies, while its effect is usually less marked in acute infectious 
processes. The latter, however, frequently lead to premature delivery and 
the additional physical strain attending the latter matter render the course 
of the disease much less favorable. Page 489. 
Owing to the well known fact that pulmonary tuberculosis usually pro- 
gresses much more rapidly after child bearing, it is advisable that tubercular 
women take every precaution to avoid the possibility of conception.” Page 383. 
It would appear therefore that in the vast majority of cases the disease 
(tuberculosis) is not transmitted directly from the mother to the fetus, and 
that the latter is born with a tendency to tuberculosis, rather than with the 
disease itself. Hence it follows that the children of tubercular mothers should 
be brought under the best hygienic surroundings, and should not be suckled 
by their mothers. In view of the fact that the tubercular process usually be- 
comes exacerbated either during pregnance or after child birth, most authori- 
ties recommend that abortion be induced as a matter of routine in all tuber- 
cular women, and many that they be rendered sterile by artificial means. This 
appears to be a somewhat too extreme point of view, but I consider that abor- 
tion should be induced in the first pregnancy occurring after the onset of the 
disease, and whenever it makes its appearance during the early months of 
pregnancy. Page 494. Maternal Mortality 
169 
THE PRACTICE OF OBSTETRICS. In original contributions by Ameri- 
can Authors. Edited by Reuben Peterson, A.B., M.D., Professor of 
Obstetrics and Gynaecology in the University of Michigan, Ann Harbor, 
Mich. Obstetrician-in-Chief to the University of Michigan Hospital. 
Lea Bros. & Co. Philadelphia and New York. 1907. Chapter IX. 
COMPLICATIONS ARISING FROM MATERNAL DISEASES 
AND ANOMALIES 
Exact observations on a large number of cases have demonstrated be- 
yond doubt that with very rare exceptions a pregnancy exerts a harmful effect 
upon the course of the disease (tuberculosis). Page 344. 
So seriously is the tubercular process affected by a concomitant preg- 
nancy that it seems the duty of the physician to warn every tubercular girl 
against marriage. Especially deleterious to the patient are pregnancies which 
follow each other at short intervals. In such instances the patient must be 
strongly advised against a new impregnation. It hardly can be denied that in 
some of these cases artificial sterilization may be justified. An additional argu- 
ment in favor of this procedure is the comparative frequency with which, if 
not the infection itself, at least a marked disposition to it is transmitted to 
the fetus in utero. P. 344. 
A TEXT BOOK OF OBSTETRICS. Barton Cooke Hirst, M.D., Professor 
of Obstetrics in the University of Pennsylvania; Gynaecologist to the 
Howard and Othopaedic and the Philadelphia Hospitals, etc. W. B. 
Saunders Co. 1909. 
The influence of pregnancy upon tuberculosis is most unfavorable and 
in women predisposed to tuberculosis, gestation may be the determining factor 
in lighting up an attack. It is the duty of a physician to advise strongly 
against marriage and maternity in the case of a woman already infected, or 
predisposed to tuberculosis. If the patient is pregnant an induction of labor 
should be considered. P. 427. 
THE PRINCIPLES AND PRACTICE OF OBSTETRICS. Jos. B. De Lee, 
M.D., Professor of Obstetrics at the Northwestern University Medical 
School; Obstetrician to the Chicago Lying-in-Hospital and to Wesley and 
Mercy Hospitals, etc. W. B. Saunders Co. 1913. 
Women with tuberculosis should not marry, first, because this aggravates 
their own disease. Second, they may infect the husband, and third, they 
propagate tuberculous children. Knowing the tendency for a latent tuber- 170 
The Case for Birth Control 
culosis to break out in pregnancy, marriage is to be forbidden. If the woman 
marries, she should avoid conception. P. 481. 
If tuberculosis of the lungs is manifested m early pregnancy, if there 
is fever, wasting, hemoptysis and advancing consolidation, that is, the process 
seems to be florid, abortion should be induced without delay. Trembley, of 
Saranac Lake induces abortion in the early months in all cases. Urgent symp- 
toms of cardiac nature, persistent hemoptysis and dyspnea may require empty- 
ing of the uterus. Complicating nephritis, heart disease, and contracted 
pelvis, which is said to be more frequent in the tuberculous, will give early 
indications for interference. P. 481. 
TUBERCULOSIS. Jos. B. De Lee. 
The woman should be instructed how to avoid pregnancy in the future. 
Something must be done until the woman is cured of her tuberculosis, so that 
she may safely go through a confinement, because every accoucheur recoils 
with horror from the task of repeatedly doing abortions on these tuberculous 
women. P. 482. 
THE PRACTICE OF OBSTETRICS. Designed for the use of Students 
and Practitioners of Medicine. J. Clifton Edgar, Prof, of Obstetrics and 
Clinical Midwifery in the Cornell University Medical College; Visiting 
Obstetrician to Bellevue Hospital, New York City; Surgeon to the Man- 
hattan Maternity and Dispensary; Consulting Obstetrician to the New 
York Maternity and Jewish Maternity Hospitals. 5th Edition. Revised. 
P. Blakiston’s Co., Phil. 
The subject of the relationship between tuberculosis and pregnancy has 
recently attained an increased degree of importance through the agitation in 
favor of the justification of abortion in the tuberculous pregnant woman. P. 
314. 
Statistics appear to show, according to Lancereaux, that a considerable 
number of cases of tuberculosis develop solely as a result of pregnancy. If 
pregnancy can thus affect health, how much more likely would it be for the 
disease to assert itself in a woman who is a fit subject for it, or in one who is 
actually consumptive. In the former class are so called candidates for tuber- 
culosis who have a family history of the disease of much significance under 
these circumstances. One should strongly dissuade girls with tubercular his- 
tory and antecedents from early marriage, fearing that repeated childbearing 
will infallibly light up the dreaded malady. What has been said of the can- 
didate for tuberculosis applies with the same, or greater force in the case of 
so-called latent tuberculosis and of apparent recovery from the disease. Pre- Maternal Mortality 
171 
sent sentiment is beginning to dissuade such women from marriage, not less 
for their own benefit than for the sake of posterity, and all organized move- 
ments which are seeking to eradicate tuberculosis from the world lay much 
stress on discouraging marriage in tuberculosis suspects. Until this view 
prevails there will necessarily be some justification for interrupting a preg- 
nancy already under way. P. 314. 
Sanatoria for consumptives do not care to admit pregnant women, and 
this prohibition is equivalent to ranking them as incurable. The fact that a 
candidate for tuberculosis runs a very great risk of becoming consumptive 
through childbirth is a most stubborn one, and when in addition to becoming 
a consumptive herself she also brings into the world an individual who is 
likely to become tubercular, it readily becomes apparent that the question of 
the propriety of therapeutic abortion is bound to become an issue in the future 
in the practice of obstetrics. P. 315. 
EXCEPTIONAL CASES 
A tubercular woman may go through gestation with no undue accelera- 
tion of her malady, only to succumb after delivery to acute general tuber- 
culosis, or acute tubercular pneumonia. P. 315. 
Tubercular pregnant women also show no little tendency to abort. 
P. 316. 
TUBERCULOSIS A PREVENTABLE AND CURABLE DISEASE. S. 
Adolphus Knopf, M.D.; Professor of Phthisio-therapy at the New York 
Post-Graduate Medical School and Hospital; Associate Director of the 
Clinic for Pulmonary Disease of the Health Department; Attending Phy- 
sician to the Riverside Sanitorium for Consumptives of the City of New 
York, etc. Moffat Yard & Co., 1909. New York. 
We have emphasized the fact that tuberculosis is very rarely directly 
hereditary, but that what is often transmitted by tuberculous parents is a 
weakened system, or physiological poverty. Nevertheless it is evident that 
tuberculous individuals ought not to marry, and when tuberculosis develops in 
a married couple it is best that they should have no children. P. 354. 
PULMONARY TUBERCULOSIS. Its Modern Prophylaxis and the 
Treatment in Special Institutions and at Home. S. Adolphus Knopf, M.D. 
P. Blakiston s Sons & Co., Phil., 1899. 
If conception has taken place in a tuberculous woman institute treat- 
ment, preferably in a sanatorium near the home of the patient. But as 
Treaudeau says, it is essential that the treatment be continued for a long 
time afterwards, and I should like to add that a repetition of pregnancy must 
be prevented. P. 283. 172 
The; Case for Birth Control 
THE TUBERCULOSIS PROBLEM AND SECTION 1142 OF THE 
PENAL CODE OF THE STATE OF NEW YORK. S. Adolphus 
Knopf, M.D. Reprinted from the New York Medical Journal for June 
12th, 1915. 
There seems to be no difference of opinion in the minds of men and 
women who have studied rational eugenics and sociology concerning the neces- 
sity of beginning to work with the preceding generation, and of teaching par- 
ents that quality is better than quantity, and that a large number of children, 
underfed or of mental, moral and physical inferiority, means race suicide, 
while the reverse means race preservation. 
I cannot defend my attitude better than by telling you the conclusions I 
have arrived at in my study of the tuberculosis situation in the United States. 
In the families of the poor where there are usually numerous children, it really 
matters little whether it is the father or the mother who is acutely tuberculous. 
Since almost invariably they live in close and congested quarters, are under- 
fed and insufficiently clad, it is of relatively rare occurrence when most of the 
children do not become infected with tuberculosis. In some of our tuber- 
culosis clinics where we insist on an examination of all the children of the 
tuberculous parents visiting these special dispensaries, we find as many as 
fifty per cent of the children to be afflicted with tuberculosis as the result of 
postnatal infection. In taking the history of a patient in my private consultation 
work, it is my invariable custom to ask whether he comes from a large family, 
and if so whether he was among the first or latter born children. As a rule, 
especially among the poor, it proves to be one of the latter born, (the fifth, 
sixth, seventh, eighth, ninth, etc.) who contracts tuberculosis, and I believe 
this to be because when he came to the world there were already many mouths 
to feed and food was scant, for the father’s income rarely increases with the 
increase of the family; and the mother, worn out with repeated pregnancies, 
cannot bestow upon the latter born children the same care which was be- 
stowed upon the first. We know tuberculosis to be a preventable and curable 
disease, but we also know that it is the disease of poverty, privation, mal- 
nutrition, and bad sanitation. P. 4. * 
I do not know the penalty to be visited upon a physician who offends 
the majesty of the law as set forth in section 1142 of the penal code, but I for 
one am willing to take the responsibility before the law and before my God 
for every time I have counselled, and every time I shall counsel in the future, 
the prevention of a tuberculous conception, with a view to preserving the 
life of the mother, increasing her chances of recovery, and, last, but not least, 
preventing the procreation of a tuberculous race. P. 5. Maternal Mortality 
173 
THE SEXUAL LIFE OF WOMAN IN ITS PHYSIOLOGICAL, BIO- 
LOGICAL AND HYGIENIC ASPECTS. E. Heinrich Kisch, M.D., 
Professor of the German Medical Faculty of the University of Prague; 
Physician to the Hospital and Spa of Marienhad; Member of the Board 
of Health, etc. Translated by M. Eden Paul, M.D. Rebman Co., New 
York. 
As regards the marriage of any woman suffering from tuberculosis we 
must take into consideration a fact that medical experience has conclusively 
established, namely, that the processes of generation have an unfavorable in- 
fluence upon pulmonary tuberculosis. P. 259. 
During pregnancy tuberculosis advances with such rapid strides that 
pregnancy and lying-in accelerate the fatal event. In some cases of con- 
sumption it is the first pregnancy that is the most perilous, but in other cases 
a later pregnancy proves more perilous. P. 260. 
Dr. S. Adolphus Knopf, M.D., Professor of Medicine, Department of Phthisio- 
therapy of the New York Post Graduate Medical School and Hospital; 
Senior Visiting Physician to Riverside Hospital-Sanatorium for the Con- 
sumptive Poor of the City of New York, etc. 
Reprinted from the Women’s Medical Journal, September, 1915. 
Of the 150,000 who it is estimated die annually from tuberculosis in the 
United States, I venture to say 50,000 have been bread winners. Estimating 
the value of such a single life to the community at only about $5,000, this 
makes a loss of $250,000,000 each year. Another third, I venture to say, 
represents children at school age. They have died without having been able 
to give any return to their parents or to the community. Making the average 
duration of their young life only 7.5 years, and estimating the cost to parents 
and the community at only $200 per annum, the community loses another 
$75,000,000. The value of lives of little babes, children below and above 
school age, adolescents not yet bread winners, and men and women no longer 
able to earn their living can not be estimated in exact figures, but is is reason- 
able to suppose the total annual financial loss from tuberculosis in the United 
States to be at least half a billion dollars. This does not include the expendi- 
tures for hospitals, sanatoria, clinics, dispensaries, colonies, preventoria and 
other agencies, devoted to the solution of the tuberculosis problem. 
In the face of these figures and the suffering, misery and disappointment 
of parents who lose their children after having tenderly loved and cared for 
them for some years, I wonder if there can be any doubt in the minds of 
sane men that it would have been better if these children had never been 
born. Surely all this is race suicide instead of race preservation. 
Not so very long ago I was asked by a young colleague to aid in the 
diagnosis of tuberculosis in a day laborer. The man earned $12 a week, was 174 
The Case for Birth Control 
thirty-six years of age on the day the examination and diagnosis was made, 
had been married fourteen years, and his eleventh child had been born on 
his last birthday; four or five had already died, two of them of tuberculous 
meningitis. A glance at the rest of the family showed that nearly all of them 
were predisposed to tuberculosis, if not already infected, and that a few 
years of continued underfeeding and bad housing would finish their earthly 
career. With two or three children to provide for the family might have 
lived in relative comfort; with better food and better home environments the 
father might never have become tuberculous and none of the children might 
have contracted the disease. The commonwealth would have been the gainer 
by two or three mentally and physically vigorous future citizens. 
Only a few days ago, while an article for the Journal of Sociologic Medi- 
cine was in preparation, an Italian woman presented herself to me for exam- 
ination. She gave her age as fifty-six, and had married quite young. She 
had borne her husband seventeen children, of which, however, only four were 
living. Some had died in infancy, some at school age, and some during 
adolescence. What useless suffering! What useless economic loss to the in- 
dividual family and society at large. Upon examination, I found the woman’s 
mental condition even worse than her physical status. The repeated preg- 
nancies, the frequent diseases in the family, thirteen deaths among her chil- 
dren, had made a mental and physical wreck of her. Yet the woman be- 
longed to the better and well-to-do class of our population of Italian birth. 
Whal 'would her condition have been if she had also had to share in the 
struggle for the existence of the family, and had had to work in sweatshops 
or factories, as so many of the poor Italians have to do? 
When pregnancy means danger to the life of the mother, or exacerbation 
of an existant mental or physical ailment, as, for example, tuberculosis, which 
is always aggravated by child-bearing, every conscientious physician should 
do his utmost to prevent childbirth in such an invalid. 
Where there is tuberculosis or any other serious transmissible disease in 
one or both of the parents, or there is danger that it may be transmitted to 
the offspring, it should not only be the right but the sacred duty of the phy- 
sician to prevent the conception of any physically and mentally handicapped 
offspring destined to become a burden to the community. 
KIDNEY DISEASES 
THE PRACTICE OF OBSTETRICS. In Original Contributions by Amer- 
ican Authors. Edited by Reuben Peterson, A.B., M.D., Professor of 
Obstetrics and Gynecology in the University of Michigan, Ann Harbor, 
Mich. Obstetrician and Gynecologist in Chief to the University of Michi- 
gan Hospital. Lea Bros. & Co., Phil, and New York. 1907. Chapter 
XIX. 
Pephritis. From statistics we find that even excluding the cases of Maternal Mortality 
175 
eclampsia, the maternal mortality from nephritis during pregnancy is 33%, 
and the fetal mortality between 50% and 60%. P. 352. 
Women suffering from a chronic nephritis should be advised strongly 
against marriage, especially in the presence of a cardiac or pulmonary lesion. 
Married women should be warned against impregnation. P. 354. 
Pyelitis. “On account of the increased dangers of pyelitic and especially 
of a pyelonephritic process during pregnancy, women suffering from these 
diseases should be warned against marriage. Married women should be 
warned against a new impregnation, on account of the marked tendency of 
pyelitis to recur with every pregnancy. P. 355. 
PRACTICAL OBSTETRICS. Thos. Watts Eden. Obstetrician, Physician 
and Lecturer on Midwifery and Gynecology, Charing Cross Hospital; 
Consulting Physician to Queen Charlotte’s Lying-in-Hospital; Surgeon to 
In-Patient Chelsea Hospital for Women. Ath Edition. C. V. Mosby 
Co. 1915. 
Certain of the conditions enumerated form absolute indications for the 
induction to abortion. These are nephritis, (a form of kidney disease), un- 
compensated valvular lesions of the heart, advanced tuberculosis, insanity, 
irremediable malignant tumors, hydatidiform mole, uncontrollable uterine 
haemorrhage, and acute hydramnios. P. 652. 
PRINCIPLES AND PRACTICE OF OBSTETRICS. Jos. B. De Lee, 
M.D., Professor of Obstetrics at the Northwestern University Medical 
School; Obstetrician to the Chicago Lying-in-H ospital and Dispensary, 
and to Wesley and Mercy Hospitals, etc. W. B. Saunders Co. 1913. 
All forms of nephritis have a very bad influence on the pregnancy, 
abortion and premature labor being common. (66% Hofmeier) Seitz found 
that only from 20% to 30% of the children survived. One of the causes of 
habitual death of the fetus, abortion, and premature labor is chronic neph- 
ritis. P. 497. 
The children of nephritics are usually puny and pale.” P. 497. 
Both mother and child are seriously jeopardized by chronic nephritis, 
the mortalities being about 30% respectively. P. 497. 
Women with chronic nephritis should not marry, and if married, should 
not conceive. P. 498. 
Diabetes. Sterility is common. Abortion and premature labor occur in 
33% of the pregnancies. The children, if the pregnancy goes to term, often 
die shortly after birth, the total mortality being 66%. P. 502. 176 
The Case eor Birth Control 
True diabetes has a very bad diagnosis. Offergold found over 50% 
mortality. Of the children 51% were still born, 10% died within a few days 
after birth, and 5% more before six months. P. 503. 
If a woman comes under treatment with a history of diabetes it is best 
to terminate the pregnancy at once. P. 503. 
THE PRACTICE OF OBSTETRICS. Designed for the use of Students 
and Practitioners of Medicine. J. Clifton Edgar. Professor of Obste- 
trical and Clinical Midwifery in the Cornell University Medical College; 
Visiting Obstetrician to Bellevue Hospital, New York City; Surgeon to 
the Manhattan Maternity Dispensary; Consulting Obstetrician to the 
New York Maternity and Jewish Hospitals. 5th Edition, Revised. P. 
Blakiston’s & Co., Philadelphia. 
Statistics appear to show that labors in these women, (diabetes) are 
quite apt to end unfavorably, in one or another way. When diabetic women 
become pregnant their disease usually takes a turn for the worse. According 
to Lecorche, true diabetes who become pregnant, usually succumb to the dis- 
ease within a short time after delivery. P. 305. 
ECLAMPSIA 
THE PRINCIPLES AND PRACTICE OF OBSTETRICS. By Joseph B. 
De Lee, M.D. 
Over 20% of women with eclampsia die and statistics show that 10% of 
such cases developed in the maternities. For the child the chances are not 
good, nearly one half of the childrn dying as a result, that is, due to; pre- 
maturity, toxemia, asphyxiation by repeated convulsions of the mother, drugs 
administered to the mother, and injuries sustained during birth, especially 
forced delivery. Eclampsia is more easily developed in a pregnant woman be- 
cause the kidneys are carrying an increased burden, and too often diseased 
through the pregnancy changes. The cause of eclampsia are unknown but 
in 20% of cases the convulsions begin during pregnancy, in 60% during 
labor, and in 20% after delivery. Page 365. 
The treatment is to stop the gestation at a point before either mother or 
child or both, are in danger either to life or to health. Page 1041. 
child, or both, are in danger either to life or to health. 
MATERNAL MORTALITY. Grace L. Meigs, M.D., U. S. Department of 
Labor. 1917. 
Pureperal albuminuria and convulsions, called also eclampsia, or toxemia 
of pregnancy, is a disease which occurs most frequently during pregnancy Maternal Mortality 
177 
but may occur at or following' confinement. It is a relatively frequent com- 
plication among women bearing their first children. When fully established 
its chief symptoms are convulsions and unconsciousness. In the early stages, 
of the disease the symptoms are slight puffiness of the face, hands, and feet; 
headache; albumen in the urine; and usually a rise in blood pressure. Very 
often proper treatment and diet at the beginning of such early symptoms may 
prevent the development of the disease; but in many cases where the disease 
is well established before the physician is consulted, the woman and baby can 
not be saved by any treatment. In the prevention of deaths from this cause 
it is essential, therefore, that each woman, especially each woman bearing her 
first child, should know what she can do, by proper hygiene and diet, to pre- 
vent the disease; that she should know the meaning of these early symptoms 
if they arise, so that she may seek at once the advice of her doctor; and that 
she should have regular supervision during pregnancy, with examination of 
the urine at intervals. 
DIABETES 
THE PRINCIPLES AND PRACTICE OF OBSTETRICS. Joseph B. De 
Lee, M.D. Page 514. 
Without doubt pregnancy has a bad effect on the course of this disease. 
It may develop a latent diabetes, there being cases where severe symptoms 
appeared only during successive pregnancies, and others where the disease grew 
progressively worse each time. Coma occurs in 30% of the cases and is 
almost always fatal. It may be brought on by a slight shock in pregnancy, 
but more often during and just after labor. Delivery seems to have a worse 
effect than most surgical operations, causing collapse, coma, or sudden death. 
Bronchitis has been noted in the puerperium, and this has been found to even- 
tuate in tuberculosis. True diabetes has a very bad prognosis, authorities 
finding over 50% mortality, of which 30% died in coma, within two and one 
half years, and too often the child dies in utero. 
PELVIC DEFORMITIES 
MATERNAL MORTALITY. Grace L. Meigs, M.D. U. S. Department 
of Labor, 1917. 
Some obstruction to labor in the small size or abnormal shape of the 
pelvic canal causes many deaths of mothers included in the class “other acci- 
dents of labor” and also many stillbirths. If such difficulty is discovered 
before labor, proper treatment will in almost all cases insure the life of mother 
and child; if it is not discovered until labor has begun, or perhaps until it 
has continued for many hours, the danger to both is greatly increased. Every 178 
Thl Case for Birth Control 
woman, therefore, should have during pregnancy—and above all during her 
first pregnancy—an examination in which measurements are made to enable 
the physician to judge whether or not there will be any obstruction to labor. 
A case in which a complication of this kind is found requires the greatest 
skill and experience in treatment, but with such treatment the life and health 
of the mother are almost always safe. 
PRINCIPLES AND PRACTICE OF OBSTETRICS. Jos. B. De Lee, 
M.D., Professor of Obstetrics at the Northwestern University Medical 
School; Obstetrician to the Chicago Lying-in-Hospital and Dispensary, 
and to Wesley and Mercy Hospitals, etc. W. B. Saunders Co. 1913. 
No subject in medicine presents greater difficulties in all its aspects than 
this one, (treatment of contracted pelves) and none demands such art or 
practical skill. Science aids little here. P. 709. 
1 Outside factors must also be considered: 1—The environment, whether 
the parturient is in a squalid tenement, in the country, in a home where every 
appliance is attainable, or in a well equipped maternity. 2—Whether in the 
hands of a general practitioner or a trained specialist. 3—If the patient is a 
Catholic, all medically indicated procedures not being permitted. 4—The 
age of the parturient, and the probability of her having more children. Even 
with these enumerations, the possible factors which might influence a labor, 
or our decision regarding the course to pursue have not all been mentioned. 
P. 709. 
THE PRACTICE OF OBSTETRICS. Designed for the use of Practitioners 
and Students of Medicine. J. Clifton Edgar, Professor of Obstetrics 
and Clinical Midwifery in the Cornell University Medical College. Visiting 
Obstetrician to Bullevue Hospital, New York City; Surgeon to the Man- 
hattan Maternity Dispensary; Consulting obstetrician to the New York 
Maternity and Jewish Maternity Hospitals. 5th Edition, Revised. P. 
Blakiston’s & Co., Phila. 
A knowledge of the female bony pelvis is the very alphabet of obstetrical 
science, and the foundation of obstetrical art. This structure is most import- 
ant since it is from the disproportion between its size and that of the fetus, or 
from its abnormal shape that many of the difficulties of labor arise. Maternal Mortality 
179 
PRACTICAL OBSTETRICS. Thos. Watts Eden. Obstetrician; Physician 
and Lecturer on Midwifery and Gynecology, Charing Cross Hospital; 
Consulting Physician to Queen Charlotte’s Lying-in-Hospital; Surgeon to 
In-Patient Chelsea Hospital for Women. 4th Edition. C. V. Mosby 
Co. 1915. 
The general course of labor is modified by pelvic contractions in various 
ways. 1—Abnormal presentations are three or four times commoner in con- 
tracted than in normal pelves. 2—Prolapse of the cord is much commoner 
than in normal pelves. 3—When natural delivery occurs labor is prolonged 
and the mechanism is modified. 4—Unless the true conjugate is at least 3% 
inches, even with artificial aid the survival of the child is seriously jeopardized. 
5— The maternal risks are increased by the greater length and difficulty of the 
labor and by the frequent necessity of employing artificial methods of delivery. 
6— The fetal risks are increased in natural delivery by severe compression of 
the head during its passage through the narrow pelvis, and other circum- 
stances by the operations required to effect delivery, some of which involve 
the destruction of the fetus. P. 409. 
THE PRACTICE OF OBSTETRICS. In Original Contributions by Ameri- 
can authors. Edited by Reuben Peterson, A.B., M.D. Lea Bros. & Co., 
Phil, and New York. 1907. 
Labor complicated by anomalies of the Bony Pelvis. John F. Moran, 
M.D. 
The frequency with which pelvic contraction occurs can only be deter- 
mined with relative accuracy. There is in existence a comparatively large 
amount of statistical data on this subject, but the reports of different investi- 
gators vary within wide limits, and these variations are naturally not to be 
explained entirely on the assumption of racial conditions, or geographic dis- 
tribution. Between these wide limits are arrayed the figures of about 20 
modern observers in different parts of the civilized world who have reported 
statistics of cases. The combined figures of 19 observers include a total of 
over 150,000 cases examined for pelvic contraction. In these cases the aver- 
age of contraction is found to be about 10%. Williams concludes that con- 
tracted pelves occur in from 7% to 8% of the white women of this country. 
P. 658-659. 
HEART DISEASE 
THE SEXUAL LIFE OF WOMAN IN ITS PHYSIOLOGICAL, BIO- 
LOGICAL AND HYGIENIC ASPECTS. E. Heinrich Kisch, M.D. 
Professor of the German Medical faculty of the University of Prague; 
Physician to the Hospital and Spa of Marienbad; Member of the Board 
of Health, etc. Translated by M. Eden Paul, M.D. Rebman Co., New 
York. 
These are cases (severe heart disease) in which, in my opinion, it is the 180 
The: Case: e'or Birth Control 
physician’s duty to concern himself with the subject of the use of preven- 
tive measures, and having regard for the preservation of a woman’s life, and 
uninfluenced by any false delicacy, but with simple earnestness to inform his 
patient with respect to the needful prophylactic measures. The artificial ter- 
mination of pregnancy, which unquestionably is often justified in women 
suffering from heart disease, but which unfortunately is apt to have very 
unfavorable results, will rarely need to be discussed if by the proper employ- 
ment of preventive measures care is taken that pregnancy does not recur too 
frequently. P. 255. 
OBSTETRICS. A Text Book for the use of Students and Practitioners. 
Whitridge Williams, Professor of Obstetrics, Johns Hopkins University; 
Obstetrician in Chief to the Johns Hopkins Hospital; Gynecologist to the 
Union Protestant Infirmary, Baltimore, Md. D. Appleton & Co., 1912. 
Some authorities recommend that women suffering from heart lesions 
should be dissuaded from marriage, or if married, from becoming pregnant. 
This, however, appears to be an extreme view, though of course when the 
lesion is serious and the compensation faulty the dangers of child-bearing 
should be carefully explained. P. 498. 
THE PRACTICE OF OBSTETRICS. In Original Contributions by Amer- 
ican authors. Edited by Reuben Peterson, A.B., M.D., Professor of 
Obstetrics and Gynecology in the University of Michigan, Ann Harbor, 
Mich.; Obstetrician and Gynecologist-in-Chief to the University of Michi- 
gan Hospital. Lea Bros. & Co., Phil, and New York 1907. Chapter 
XIX. 
Leyden claims that about 40% of all women with serious heart lesions 
meet their death in connection with childbirth. Still greater than the demands 
upon the heart during pregnancy are those made by labor. The strain, mental 
excitement, and especially the sudden changes in the blood pressure, conditions 
which are well recognized as extremely harmful to every patient with a 
chronic heart lesion, and which cannot be avoided in the course of labor, make 
the situation extremely dangerous.” (Hugo Ehrenfest, M.D.) P. 357. 
“The prognosis for the fetus is unfavorable. Fellner, whose figures un- 
doubtedly are low, places the frequency of premature, spontaneous interrup- 
tion of pregnancy as 20%, other writers at from 40% to 60%.” P. 358. 
“No marriage for the unmarried, no pregnancy for the married, no 
nursing for the confined,” is a statement which has been made by a French 
author, and has been accepted by many writers. It is incompatible with the 
results of recent investigations. It would be too harsh and unjustifiable to 
deny marriage to a woman who has a well compensated valvular lesion. She Maternal Mortality 
181 
should be informed of the risks of impregnation, but should be warned against 
marriage only where there exist distinct evidences of incompensation, especi- 
ally in cases of mitral stenosis. P. 359. 
A TEXT BOOK OF OBSTETRICS. Barton Cooke Hirst, M.D.; Professor 
of Obstetrics in the University of Pennsylvania; Gynecologist to the How- 
ard and Orthopaedic, and the Philadelphia Hospitals, etc. 7th Edition. 
W. B. Saunders Co., Philadelphia and London. 1912. 
Abortion is induced in about 25% of all cases, as the result of placental 
apaplexies, or of the stimulation of the uterus to contraction by the accumu- 
lation of carbondioxid gas in the blood. Pregnancy distinctly increases the 
danger of the heart lesion. In 58 serious cases, 23 died after premature 
delivery of the child. In milder cases prognosis is not grave, yet the woman’s 
condition is by no means free from danger. If the disease be of long stand- 
ing and serious in character, it appears from statistical studies that about half 
the women die. P. 423. 
PRINCIPLES AND PRACTICE OF OBSTETRICS. Jos. B. De Lee, 
M.D.; Professor of Obstetrics at the Northwestern University Medical 
School; Obstetrician to the Chicago Lying-in-Hospital, and to Wesley 
and Mercy Hospitals, etc. W. B. Saunders Co. 1913. 
Abortion and premature labor, especially the latter, occur in cases of 
discompensation, in from 20% to 40%, and stillbirth in 29% to 70%, giving 
figures collected from various sources by Fellner. P. 489. 
THE PRACTICE OF OBSTETRICS. Designed for the use of Students 
and Practitioners of Medicine. J. Clifton Edgar, Professor of Obstetrics 
and clinical midwifery in the Cornell University Medical School; Visiting 
Obstetrician to Bellevue Hospital, New York City; Surgeon to the Man- 
hattan Maternity and Dispensary; Consulting Obstetrician to the New 
York Maternity and Jewish Maternity Hospitals. 5th Edition, Revised. 
P. Blakiston’s & Co., Philadelphia. 
Acute Endocarditis not only has an injurious influence upon pregnancy, 
but it is also apt itself to become extremely grave. Regarding treatment, in- 
duced labor will be demanded. P. 310. 
TOO FREQUENT PREGNANCIES 
BEING WELL BORN. An Introduction to Eugenics. Michael F. Guyer, 
Ph. D., Professor of Zoology, University of Wisconsin. Bobbs-Merrill 
Co. Indianapolis. 1916. 
Too short an interval between childbirths would also seem to be an in- 
fringement on the rights of the child as well as of the mother. Thus Dr. 182 
The Case eor Birth Control 
R. J. Ewart, (“The Influence of Parental Age on Ofifspring,” Eugenic Review, 
Oct., 1911) finds that children born at intervals of less than two years after 
the birth of the previous child still show at the age of six a notable deficiency 
in height, weight and intelligence, when compared with the children born after 
a longer interval, or even with first-born children. P. 166. 
FREQUENT PREGNANCIES. The Contributions of Demography to 
Eugenics. Dr. Corrado Gini, Professor of Statistics at the Royal Uni- 
versity of Cagliari, Italy. 
If the possibility of generation at any season of the year cannot, as has 
been shown, have any deleterious effect on the vitality of human offspring, it 
can none the less have indirect deleterious consequences, in so far as it allows 
pregnancies to succeed each other at too short intervals. P. 323. 
The deleterious consequences which too short a period after the pre- 
ceeding birth have upon the vitality of the child are indisputable, at least 
during the first year of life.” P. 323. 
THE SEXUAL LIFE OF WOMAN IN ITS PHYSIOLOGICAL, BIO- 
LOGICAL AND HYGIENIC ASPECTS. E. Heinrich Kisch. Reb- 
man Co., N. Y. 
“Frequently recurring pregnancies and childbirth, according to Kronig, 
act as the predisposing cause in the production of neurasthenia. P. 257. 
NEO-MALTHUSIANISM AND RACE HYGIENE, IN “PROBLEMS IN 
EUGENICS.” Vol. 2. Dr. Alfred Ploetz, President of the International 
Society for Race Hygiene. London, 1913. 
Malthusianism further affects the quality of the offspring by increasing 
the intervals between single births. In families in which the parents intend 
to have only a few children, the mother is usually exempt from so frequent 
child-bearing, and she has ample time for regaining her strength. The greater 
interval between births has evidently a favorable effect upon the expectation 
of life of the children that are born. Westergard has stated that in 21,000 
births, if the interval between birth is:— 
The percentage of deaths before 
five years of age is 
Less than one year 20% 
One to two years 14% 
More than two years 12% 
That means a difference in the mortality between first and last class of 40% 
in favor of the longer interval. P. 186. Maternal Mortality 
183 
THE LIFE INSURANCE EXAMINER. A Practical Treatise by Charles 
F. Stillman, M. S., M. D., Medical Examiner for the Mutual Life Insur- 
ance Co.; Clinical Professor of Orthopaedic Surgery in the Women’s 
Medical College of the N. Y. Infirmary; Orthopaedic Surgeon to the 
N. Y. Infant Asylum; Member of the Am. Orthopaedic Association; 
Permanent member of the American Medical Association; Fellow N. Y. 
Academy of Medicine, etc. 3rd Edition. Spectator Co., N. Y'., 1890. 
Postpone (as dangerous insurance risks) all cases of pregnancy; all 
instances where the mother seems, in the judgment of the Examiner, to have 
been bearing children too fast.” P. 186. 
RASSENVERBESSERUNG. Translated from the Dutch of Dr. J. Rutgers. 
2nd Edition. Dresden, 1911. 
The combatting of self-induced abortion is one of the problems of 
Sexual Hygiene. The two causes of most weight in this situation are syphilis 
and too frequent pregnancy. It is quite evident that both of these causes 
would be favorably influenced by the use of contraceptive measures P. 81. 
THE MALTHUSIAN, May 15, 1914. Sexual Ethics. A Study of Border- 
land Questions. Robert Michels, (Review). 
Prof. Michels perceives that race control has two aspects; it may be an 
urgent duty, and it is in any case an inalienable human right. It may be re- 
garded as a duty to actual or potential children, in view of either bad economic 
conditions,—such as affect the bulk of all European populations,—or defective 
heredity, and it may also be considered as an obligation of humanity towards 
the wife and mother. Prof. Michels here speaks with no uncertain voice: “The 
type of woman continually engaged in child-bearing is a primitive one, out 
of harmony with the needs and ideas of modern civilized life. Even as few 
as six pregnancies that go to full term rob a woman of about ten years of her 
life, and these the best. It is evidently far easier to provide a clear-sighted 
affection and a wisely conceived and individualized upbringing for two or 
three children than it is for eight or nine. 
MR. SIDNEY WEBB, in The Times of October 16, 1906. 
Assuming, as I think we may, that no injury to physical health is neces- 
sarily involved (in the volitional regulation of the marriage state) ; aware, on 
the contrary, that the result is to spare the wife from an onerous and even 
dangerous illness for which in the vast majority of homes no adequate pro- 
vision in the way of medical attendance, nursing, privacy, rest, and freedom 
from worry can possibly be made, it is, to say the least of it, difficult on any 
rationalist morality to formulate any blame of a married couple for the 
deliberate regulation of their family according to their means and oppor- 
tunities. 184 
The: Case for Birth Control 
PERNICIOUS VOMITING 
THE PRINCIPLES AND PRACTICE OF OBSTETRICS. By Joseph B. 
De Lee, M.D. 
Among diseases incidental to pregnancy must be counted pernicious 
vomiting. Page 370. 
Statistics are uncertain, but out of 118 cases there were 46 deaths. Page 
357. 
The keynote of treatment is to stop the gestation at a point before either 
mother or child, or both, are in danger to life or to health. Page 1041. 
THE PRACTICE OF OBSTETRICS. By J. Clifton Edgar, M.D., Profes- 
sor of Obstetrics and Clinical Midwifery in the Cornell University Medical 
College; Visiting Obstetrician to Bellevue Hospital, New York City; Sur- 
geon to the Manhattan Maternity and Dispensary; Consulting Obstetrician 
of the New York Maternity and Jewish Maternity Hospitals, New York 
City. 
Under certain circumstances labor may be much disturbed by pernicious 
vomiting. The causes comprise actual organic disease of the stomach and 
functional disturbances from errors in diet. The determining cause of a 
paroxysm of vomiting is a severe labor pain. The coincidence of labor and 
vomiting is not unusual in anemic primiparae. Mental emotion is also a 
cause. As this vomiting may presage the development of eclampsia or some 
other affection it is best to terminate labor at once. page 648. CHAPTER VI 
HARMFUL METHODS PRACTICED TO AVOID LARGE FAMILIES 
In this chapter it is shown that ignorance of scientific means of prevent- 
ing conception involves women in harmful practices. The most common is 
coitus interruptus which results in nervous disorders. Long continued celi- 
bacy or unnatural continence leads to sex inversions. When, in spite of these 
unscientific practices, pregnancy follows, abortion, the greatest disgrace of 
modern civilisation, is the only resort of the harassed mother, unless she'will 
bear unwanted offspring. 
COITUS INTERRUPTUS 
THE SEXUAL LIFE OF WOMAN IN ITS PHYSIOLOGICAL, BIO- 
LOGICAL AND HYGIENIC ASPECTS. E. Heinrich Kisch, M.D. 
The prevailing- practice of coitus interruptus leads, in my experience 
in consequence of the intense hyperaemia of the uterus and the uterine annexia 
unrelieved by the occurrence of the orgasm, to a condition of stasis in the 
female reproductive organs, and this ultimately passes on into chronic netritis, 
(with relaxation of the uterus, retro-flexion, or ante-flexion, catarrhal diseases 
of the mucous membrane, erosions and follicular laceration of the portio vagin- 
alis) oophoritis and perimetritis. The evil effects of coitus interruptus for a 
woman are dependent on the fact that the woman fails to obtain complete 
sexual gratification, and that this has an important influence on her entire 
organism. If this ungratifying coitus interruptus is frequently repeated in a 
voluptuous woman disorders of the reproductive organs ensue, and even more 
frequently nervous disorders in the form of neurasthenia sexualis. P. 403. 
Mantegazza believes that organic disease of the spinal cord may actually 
result from coitus interruptus. 
Hirt considers that even when marital intercourse is carefully regulated 
with respect to frequency, coitus interruptus may lead to neurasthenic mani- 
festations. 
Eulenberg also declares that coitus interruptus is already a frequent cause 
of sexual neurasthenia in women and that its evil influence in this respect 
is becoming more and more frequently manifest. P. 405. 
Valenta declared that coitus interruptus was one of the chief causes of 
chronic netritis. 
According to Kleinwachter, coitus interruptus is harmful to the woman 
to an extent by no means trivial, whereas the man in whom ejaculation occurs, 
suffers comparatively little. P. 407. 186 
The Case for Birth Control 
DISORDERS OF THE SEXUAL FUNCTION. By Max Hubner, M.D., 
Chief of Clinic, Genitourinary Department, Mt. Sinai Hospital Dispen- 
sary, Nezv York City. 
If the act of coitus is stopped before it is completed, the seminal vesicles 
have not been able to completely empty themslves, or to empty themselves as 
completely as during a normal coitus, and are thus left more or less filled. 
The mucous membrane in the prostalic urethra has not been able to com- 
pletely diplethorize itself, and thus remains more or less congested after the 
act. As a result of all this, impulses are sent much sooner from the dis- 
tended vesicles and the prostalic urethra to the erection center and the cere- 
brum, so that the desire for coitus is felt sooner than after normal coitus. 
The seminal vesicles, being never completely emptied during withdrawal coitus, 
are constantly sending impulses to the erection center, while the mucous 
membrane of the prostalic urethra, being in a condition of chronic suggestion 
in consequence of repeated acts of withdrawal, is likewise sending continuous 
impulses to the same center whether coitus is indulged or not. The result of 
these continued impulses sent from both sources, as well as the repeated de- 
mands made upon the center itself from the oft repeated acts of coitus, is, 
that the erection center does not completely recover itself and finally remains 
in a state of hyperexcitability. ... It must be remembered, however, that 
all this does not occur as a result of a single act of withdrawal; and it is 
often only after years of this practice that the harmful effects above described 
become evident. Page 227. 
CONTINENCE 
THE SEXUAL LIFE OF WOMAN IN ITS PHYSIOLOGICAL, BIO- 
LOGICAL AND HYGIENIC ASPECTS. E. Heinrich Kisch, M.D. 
Grafe, with reference to the view that if for any reason conception must 
be avoided this should be done by abstinence from sexual intercourse, remarks, 
“doubtless the ideal demand, but one which even those with exceptional 
strength of will are unlikely to satisfy. And the worst of it is that even a 
single indiscretion will often result in impregnation.” Moreover, it is dis- 
tinctly contrary to natural conditions that a healthy married couple, united by 
an intimate affection should live together, abstaining completely from sexual 
intercourse. The question has already been much discussed, both in speech 
and writing, and this will continue in the future without altering the fact that 
the physician will be asked, and will be compelled to give advice regarding 
the use of means of prevention of pregnancy. P. 399. 
The desired goal of artificial sterility will not, however, be reached 
through advocacy of moderation and continence. P. 400. Harmful Methods 
187 
EFFECTS OF ABSTINENCE. Rassenverbesserung. Translated from the 
Dutch of Dr. J. Rutgers. 
X 
And if we could penetrate still more deeply into the recesses of the in- 
stincts, and project into the light of day the world of phantasy of those who 
live in enforced continence, we would draw away in horror from the spectacle 
of what each individual must conceal from himself and others. We would 
not then be so eager for the consummation of what is called sexual abstinence. 
P. 14. 
Physiology teaches that every function gains in power and efficiency 
through a certain degree of control, but that the too-extended suppression of 
a desire gives rise to pathological disturbances and in time cripples the func- 
tion. Especially in the case of women may the damage entailed by too long 
continued sexual abstinence, bring about deep disturbances, all the more be- 
cause women more often than men misunderstand, or are unaware of this 
etiological moment, and have not the slightest idea of the true cause of their 
physic and somatic injury. P. 15. 
The unmarried state is a trying and often injurious condition for a man 
as well as a woman, when they live in strict continence; and if the latter is 
not the case and they resort to prostitution, there are even more pain and 
suffering in store for them. P. 16. 
We must not forget that there are always two paries to the situation. 
What can a physically weaker and spiritually stronger woman do even if she 
desires continence with her whole soul, but her husband will have none of it? 
Is it not then her duty to protect herself in order that she may not give birth 
to a weakly progeny ? 
HARPER’S WEEKLY. 1915. 
When Dr. A. A. Brill, Lecturer in Abnormal Psychology, New York 
University, and formerly Chief of Clinic in Psychiatry, Columbia University, 
was asked how he regarded contraception in relation to nervous diseases, he 
replied emphatically: “You can say that I am for it. It is much better than 
an abortion. For instance, I have in mind a woman who was discharged from 
the insane hospital. She had three children and had been three times insane. 
What chance in life has a child born between two attacks of insanity, whose 
mother is mentally defective? Even sane women, if they are nervous and 
emotional, should never bear children against their will. It is foolish to talk 
about making people have children when they do not want them. It’s bad 
for the woman and bad for the child. It is very bad for a child to be born 
into a home where he is not desired. I find that many adult, nervous patients 
were unwished-for-children, and it was the early attitude of their parents 
toward them that contributed much to their bent toward nervous invalidism.” 188 
The: Case: for Birth Control 
In reply to the contention of the anti-regulationists that contraception is phy- 
sically and mentally harmful, he stated that certain methods are injurious, 
while others are not. He commented on the unfortunate fact that it is the 
undesirable methods which are employed by the poorer people, because drug- 
gists put a high price upon the better means on the plea that they run a risk 
in selling them at all. Remembering that Dr. Brill was for years connected 
with Central Islip, he was asked if he did not consider it demanding a good deal 
to expect a man discharged from an insant asylum and sent home to his wife, 
to live a sexually abstinent life. He replied: “Only people who know nothing 
of the sex impulse can make such a demand of a person who has a poor mental 
organization. Of course it is impossible. It is impossible even for the aver- 
age normal man, and especially for those who live crowded in two or three 
rooms. 
THE SEXUAL LIFE. By P. W. Malchow, M.D., Professor of Proctology, 
and Associate in Clinical Medicine, Hamline University, College of Phy- 
sicians and Surgeons; member Hennepin County Medical Society, Min- 
nesota State Medical Society; American Medical Association, etc. 
There can be no doubt that the influence of prolonged continence upon 
either the male or female is to dwarf and in many respects destroy that which 
gos to make a broad and full physical and intellectual personality and that 
to perform the sexual act whenever there is an existing state of sexual excite- 
ment, with the usual marital restrictions, is rather beneficial that otherwise. 
Page 201. 
In cases of nervousness in either sex it may be found that, as a rule, the 
first indication is a disturbance of the sexual function, following which there 
will be digestive troubles, then affections of special nerves, of which dis- 
orders of sight are the first and most frequent, with neuralgias, etc., later. 
Observation has shown this to be the general rule, and that is also in accord- 
ance with the law of self-preservation. With the conviction that nervousness 
is first manifested and begins with an alteration in the natural sexual function 
we may conclude that other functional disorders are a natural sequence. It 
thus becomes evident that the most prolific cause of nervousness is an in- 
ability for natural sexual living. Page 296. 
A life of celibacy cannot be said to be a natural one, and when this state 
of celibacy is combined with propinjuity, in which there must of necessity be 
a source of repeated and more or less constant sexual excitability there is 
added to one already incomplete life a greater burden of increased tension, 
which must be a very considerable factor in the causation of unrest or ner- 
vourness. Page 155. 
How best to circumvent family complications is the burning question of 
the hour with the average young wife, and a satisfactory solution of this 
problem would be a boon to society and prevent untold suffering. When 
confronted with. the question, the usual answer is, in effect, “be natural,” 
which in these days of stress, is no answer at all, as it is not practical. Page 
158. Harmful Methods 
189 
THE OBJECTS OF MARRIAGE 
By Havelock Ellis 
What are the legitimate objects of marriage? We know that many 
people seek to marry for ends that can scarcely be called legitimate, that men 
may marry to obtain a cheap domestic drudge or nurse, and that women may 
marry to be kept when they are tired of keeping themselves. These objects 
in marriage may or may not be moral, but in any case they are scarcely its 
legitimate ends. We are here concerned to ascertain those ends of marriage 
which are legitimate when we take the highest ground as moral and civilized 
men and women living in an advanced state of society and seeking, if we 
can, to advance that state of society still further. 
The primary end of marriage is to beget and bear offspring, and to rear 
them until they are able to take care of themselves. On that basis Man is at 
one with all the mammals and most of the birds. If, indeed, we disregard 
the originally less essential part of this end,—that is to say, the care and 
tending of the young,—this end of marriage is not only the primary but 
usually the sole end of sexual intercourse in the whole mammal world. As a 
natural instinct, its achievement involves gratification and well-being, but this 
bait of gratification is merely a device of Nature’s and not in itself an end 
having any useful function at the periods when conception is not possible. 
This is clearly indicated by the fact that among animals the female only ex- 
periences sexual desire at the season of impregnation, and that desire ceases 
as soon as impregnation takes place, though this is only in a few species true 
of the male, obviously because, if his sexual desire and aptitude were con- 
fined to so brief a period, the chances of the female meeting the right male at 
the right moment would be too seriously diminished; so that the attentive and 
inquisitive attitude towards the female by the male animal—which we may 
often think we see still traceable in the human species—is not the outcome 
of lustfulness for personal gratification (“wantonly to satisfy carnal lusts and 
appetites like brute beasts,” as the Anglican Prayer Book incorrectly puts it) 
but implanted by Nature for the benefit of the female and the attainment 
of the primary object of procreation. This primary object we may term the 
animal end of marriage. 
This object remains not only the primary but even the sole end of mar- 
riage among the lower races of mankind generally. The erotic idea in its 
deeper sense, that is to say the element of love, arose very slowly in mankind. 
It is found, it is true, among some lower races, and it appears that some 
tribes possess a word for the joy of love in a purely psychic sense. But even 
among European races the evolution was late. The Greek poets, except the 
latest, showed little recognition of love as an element of marriage. Theognis 
compared marriage with cattle-breeding. The Romans of the Republic took 
much the same view. Greeks and Romans alike regarded breeding as the 
one recognizable object of marriage; any other object was mere wantonness 
and had better, they thought, be carried on outside marriage. Religion, which 190 
The Case for Birth Control 
preserves so many ancient and primitive conceptions of life, has consecrated 
this conception also, and Christianity—though, as I will point out later, it has 
tended to enlarge the conception—at the outset only offered the choice be- 
tween celibacy on the one hand and on the other marriage for the production 
of offspring. 
Yet from an early period in human history a secondary function of 
sexual intercourse had been slowly growing up to become one of the great 
objects of marriage. Among animals, it may be said, and even sometimes 
in man, the sexual impulse, when once aroused, makes but a short and swift 
circuit through the brain to reach its consummation. But as the brain and 
its faculties develop, powerfully aided indeed by the very difficulties of the 
sexual life, the impulse for sexual union has to traverse ever longer, slower, 
more painful paths, before it reaches—and sometimes it never reaches—its 
ultimate object. This means that sex gradually becomes intertwined with all 
the highest and subtlest human emotions and activities, with the refinements 
of social intercourse, with high adventure in every sphere, with art, with re- 
ligion. The primitive animal instinct, having the sole end of procreation, be- 
comes on its way to that end the inspiring stimulus to all those psychic ener- 
gies which in civilization we count most precious. This function is thus, we 
see, a by-product. But, as we know, even in our human factories, the by- 
product is sometimes more valuable even than the product. That is so as re- 
gards the functional products of human evolution. The hand was produced 
out of the animal fore-limb with the primary end of grasping the things we 
materially need, but as a by-product the hand has developed the function of 
making and playing the piano and the violin, and that secondary functional 
by-product of the hand we account, even as measured by the rough test of 
money, more precious, however less materially necessary, than its primary 
function. It is, however, only in rare and gifted natures that transformed 
sexual energy becomes of supreme value for its own sake without ever attain- 
ing the normal physical outlet. For the most part the by-product accompanies 
the product, throughout, thus adding a secondary, yet peculiarly sacred and 
specially human, object of marriage to its primary animal object. This may 
be termed the spiritual object of marriage. 
By the term “spirtual” we are not to understand any mysterious and 
supernatural qualities. It is simply a convenient name, in distinction from 
animal, to cover all those higher mental and emotional processes which in 
human evolution are ever gaining greater power. It is needless to enumerate 
the constituents of this spiritual end of sexual intercourse, for everyone is 
entitled to enumerate them differently and in different order. They include 
not only all that makes love a gracious and beautiful erotic art, but the whole 
element of pleasure in so far as pleasure is more than a mere animal grati- 
fication. Our ancient ascetic traditions often make us blind to the meaning 
of pleasure. We see only its possibilities of evil and not its mightiness for 
good. We forget that, as Romain Rolland says, “Joy is as holy as Pain.” Harmful Methods 
191 
No one has insisted so much on the supreme importance of the element of 
pleasure in the spiritual ends of sex as James Hinton. Rightly used, he de- 
clares, Pleasure is “the Child of God,” to be recognized as “a mighty store- 
house of force,” and he pointed out the significant fact that in the course of 
human progress its importance increases rather than diminishes. While it is 
perfectly true that sexual energy may be in large degree arrested, and trans- 
formed into intellectual and moral forms, yet it is also true that pleasure it- 
self, and above all, sexual pleasure, wisely used and not abused, may prove 
the stimulus and liberator of our finest and most exalted activities. It is 
largely this remarkable function of sexual pleasure which is decisive in set- 
tling the argument of those who claim that continence is the only alternative 
to the animal end of marriage. That argument ignores the liberating and 
harmonising influences, giving wholesome balance and sanity to the whole 
organism, imparted by a sexual union which is the outcome of the psychic 
as well as physical needs. There is, further, in the attainment of the spiritual 
end of marriage, much more than the benefit of each individual separately. 
There is, that is to say, the effect on the union itself. For through harmoni- 
ous sex relationships a deeper spiritual unity is reached than can possibly be 
derived from continence in or out of marriage, and the marriage association 
becomes an apter instrument in the service of the world. Apart from any 
sexual craving, the complete spiritual contact of two persons who love each 
other can only be attained through some act of rare intimacy. No act can 
be quite so intimate as the sexual embrace. In its accomplishment, for all 
spiritually evolved persons, the communion of bodies becomes the communion 
of souls. The outward and visible sign has been the consummation of an 
inward and spiritual grace. “I would base all my sex teaching to children 
and young people on the beauty and sacredness of sex,” writes a distin- 
guished woman of today; “sex intercourse is the great sacrament of life, he 
that eateth and drinketh unworthily eateth and drinketh his own damnation; 
but it may be the most beautiful sacrament between two souls who have no 
thought of children.” To many the idea of a sacrament seems merely eclesi- 
astical, but that is a misunderstanding. The word “sacrament” is the ancient 
Roman name of a soldier’s oath of military allegiance, and the idea, in the 
deeper sense, existed long before Christianity, and has ever been regarded 
as the physical sign of the closest possible union with some great spiritual 
reality. From our modern standpoint we may say, with James Hinton, that 
the sexual embrace, worthily understood, can only be compared with music 
and with prayer. “Every true lover,” it has been well said by a woman, 
“knows this, and the worth of any and every relationship can be judged by 
its success in reaching, or failing to reach, this standpoint.” 
I have mentioned how the Church—in part influenced by that clinging 
to primitive conceptions which always marks religions and in part by its 
ancient traditions of asceticism—tended to insist mainly if not exclusively on 
the animal object of marriage. It sought to reduce sex to a minimum because 
the pagans magnified sex; it banned pleasure because the Christian’s path on 192 
The Case eor Birth Control 
earth was the way of the Cross; and though theologians accepted the idea of 
a “Sacrament of Nature’’ they could only allow it to operate when the active 
interference of the priest was impossible, though it must in justice be said 
that, before the Council of Trent, the Western Church recognized that the 
sacrament of marriage was effected entirely by the act of the two celebrants 
themselves and not by the priest. Gradually, however, a more reasonable and 
humane opinion crept into the Church. Intercourse outside the animal end 
of marriage was indeed a sin, but it became merely a venial sin. The great 
influence of St. Augustine was on the side of allowing much freedom to inter- 
course outside the aim of procreation. At the Reformation, John a Lasco, a 
Catholic Bishop who became a Protestant and settled in England, laid it down, 
following various earlier theologians, that the object of marriage, besides off- 
spring, was to serve as a “sacrament of consolation” to the united couple, 
and that view was more or less accepted by the founders of the Protestant 
churches. It is the generally accepted Protestant view today.* The import- 
ance of the spiritual end of intercourse in marriage, alike for the higher de- 
velopment of each member of the couple and for the intimacy and stability 
of their union, is still more emphatically set forth by the more advanced 
thinkers of today. 
There is something pathetic in the spectacle of those among us who are 
still only able to recognize the animal end of marriage, and who point to the 
example of the lower animals—among whom the biological conditions are 
entirely different—as worthy of our imitation. It has taken God—or Nature, 
if we will—unknown millions of years of painful struggle to evolve Man, 
and to raise the human species above that helpless bondage to reproduction 
which marks the lower animals. But on these people it has all been wasted. 
They are at the animal stage still. They have yet to learn the A. B. C. of 
love. A representative of these people in the person of an Anglican bishop, 
the Bishop of Southwark, appeared as a witness before the National Birth- 
Rate Commission which, two years ago, met in London to investigate fhe 
decline of the birth-rate. He declared that procreation is the sole legitimate 
object of marriage and that intercourse for any other end was a degrading 
act of mere “self-gratification.” This declaration had the interesting result 
of evoking the comments of many members of the Commission, formed of 
representative men and women with various standpoints,—Protestant, Cath- 
olic, and other,—and it is notable that while not one identified himself with 
the Bishop’s opinion, several decisively opposed that opinion, as contrary to 
the best beliefs of both ancient and modern times, as representing a low and 
not a high moral standpoint, and as involving the notion that the whole 
sexual activity of an individual should be reduced to perhaps two or three 
effective acts of intercourse in a life-time. Such a notion obviously cannot 
*It is well set forth by the Rev. H. Northcote in his excellent book, 
Christianity and Sex Problems, (2nd edition, 1916, F. A. Davis Company, 
Philadelphia), especially Ch. XIII. Harmful Methods 
193 
be carried into general practice, putting aside the question as to whether it 
would be desirable, and it may be added that it would have the further result 
of shutting out from the life of love altogether all those persons who, for 
whatever reason, feel that it is their duty to refrain from having children at 
all. It is the attitude of a handful of Pharisees seeking to thrust the bulk of 
mankind into Hell. All this confusion and evil comes of the blindness which 
cannot know that, beyond the primary animal end of propagation in marriage, 
there is a secondary but more exalted spiritual end. 
It is needless to insist how intimately that secondary end of marriage is 
bound up with the practice of birth control. Without birth control, indeed, 
it could frequently have no existence at all, and even at the best seldom be 
free from disconcerting possibilities fatal to its very essence. Against these 
disconcerting possibilities is often placed, on the other side, the un-esthetic 
nature of the contraceptives associated with birth control. Yet, it must be 
remembered, they are of a part with the whole of our civilized human life. 
We at no point enter the spiritual save through the material. Forel has in 
this connection compared the use of contraceptives to the use of eye-glasses. 
Eye-glasses are equally un-esthetic, yet they are devices, based on Nature, 
wherewith to supplement the deficiencies of Nature. However in themselves 
un-esthetic, for those who need them they make the esthetic possible. Eye- 
glasses and contraceptives alike are a portal to the spiritual world for many 
who, without them, would find that world largely a closed book. 
Birth control is effecting, and promising to effect, many functions in our 
social life. By furnishing the means to limit the size of families which would 
otherwise be excessive it confers the greatest benefit on the family and especi- 
ally on the mother. By rendering easily possible a selection in parentage and 
the choice of the right time and circumstances for conception it is again, the 
chief key to the eugenic improvement of the race. There are many other 
benefits, as is now generally becoming clear, which will be derived from the 
rightly applied practice of birth control. To many of us it is not the least of 
these that birth control effects finally the complete liberation of the spiritual 
object of marriage. 
• ABORTION 
THE PRINCIPLES AND PRACTICE OF OBSTETRICS. By Joseph De 
Lee, M.D... 
It is said that there is one abortion to eight labors, but in all probability 
it is more frequent than this. Almost half of the child-bearing women have 
had a miscarriage before the year. Statistics are of questionable 
value because hospital figures do not represent the conditions of private 
practice. Further, many occur in first weeks and pass under the diagnosis 
of delayed or profuse menstruation. Finally, many abortions are deliberately 
concealed. Page 426. 194 
The Case eor Birth Control 
PRACTICE OF OBSTETRICS. By J. Clifton Edgar, M.D. 
Immediate dangers of abortions are: hemorrhage, retention of an ad- 
herent placenta, sepsis, tetanus, perforation of the uterus. They also cause: 
sterility, anemia, malignant diseases, displacements, neurosis, and endometritis. 
Pages 338-9. 
TRUCHTABTREIBUNG UND PRAVENTIVVERKEHR, IN ZUSAM- 
MENHANG MIT DEM GEBURTENRUCKGANG; Eine Medi- 
zinische, Juristische und Sozialpolitische Betrachtung von Dr. Max 
Hirsch. Wurtzburg, Kabitzsch Verlag, 1914. 
He who would combat abortion and at the same time assail contraceptive 
measures may be likened to the person who would fight contagious diseases 
and forbid disinfection. For contraceptive measures are important weapons 
in the fight against abortion. The use of contraceptive measures is largely 
responsible for the fact that the number of abortions does not increase im- 
measurably. The apprehension is perfectly justified that the prohibition of 
contraceptive measures would enormously increase the practice of abortion 
with its dangerous consequences for the life and health of women. P. 131-2. 
America has a law since 1873, if I am not mistaken, which prohibits by 
criminal statute the distribution and regulation of contraceptive measures. 
It follows therefore, as I have already stated in my introduction, that America 
stands at the head of all nations in the huge number of abortions. P. 132. 
THE DISEASES OF SOCIETY AND DEGENERACY. The Vice and 
Crime Problem. G. F. Lydston, M. D., Professor of Genito-Urinary 
Surgery, State University of Illinois; Professor of Criminal Anthro- 
pology, Chicago; Kent College of Law; Member of the American Medi- 
cal Association, etc., etc. The Riverton Press, Chicago, 1912. 
The familiar cry of “public demand” would fit the abortion business 
better than it does some other things. The evil is wide-spread, both in and 
out of matrimony. Its existence is recognized “under the rose” as a social 
necessity, yet the law calls it murder. For every man and woman caught in 
its commission and punished a thousand ecape detection. 
THE DISEASES OF SOCIETY AND DEGENERACY. G. F. Lydston. 
In many instances abortion results directly in the death of the woman. 
Such are the consequences resulting from ungoverned natural law on the one 
side, and moral on the other. It must be confessed that an element of sym- 
pathy is evoked by the mental distress of the unfortunate woman who is extra- 
rmatrimonally pregnant. P. 370. Harmful Methods 
195 
SEXUAL PROBLEMS OF TO-DAY. Wm. J. Robinson, Critic and Guide. 
1912. 
I have gone on record with the statement that about a million abortions 
are brought about every year in the U. S. Exact statistics are not and never 
will be available, but I am sure that my estimate is very conservative, and 
that three million would be nearer the truth. Justice John Proctor Clark 
stated that 100,000 abortions are performed annually in New York City alone, 
and if these figures are correct, then the number for the U. S. would be in 
the neighborhood of two and a half million. P. 158. 
There is one measure and one only which will positively do away with 
the evil of abortion and that is teaching people how to prevent conception. 
P. 164. 
ABORTION AND ECONOMIC NECESSITY. (Hirsch). 
According to a report in the Medical Record 80,000 abortions are per- 
formed annually in New York and only one case in 1,000 is brought before 
the authorities. 
According to Lewin it has been determined by court investigations that 
there are at least 200 people in New York who make a profession of perform- 
ing abortions. 
It has been estimated that 2,000,000 abortions are performed annually in 
the U. S. P. 7. 
Bertillon estimates the number of criminal abortions in Paris at 50,000 
annually, in Lyons at 19,000. (Le depopulation de la France). P.8. 
We must first attack a very widespread fallacy, namely that abortion is 
more prevalent among unmarried girls than among married women. In other 
words, that it is concomitant with free sex relations. This fallacy is exploded 
by practical medical experience as well as by observation and statistics of social 
conditions. P. 23. 
Among the causes of criminal abortion the fear on the part of the woman 
of the pains and dangers of confinement plays a not inconsiderable role. P. 54. 
In marriage the cause for the practice of abortion springs in most cases 
from economic necessity. Most frequently this necessity is a genuine dire 
need arising from overcrowded quarters, lack of food and clothing, sickness 
and lack of employment. P. 33. 
This economic need finds its most obvious expression in the congestion of 
the city populations. P. 34. 
The dangers of childbirth are still serious enough to cause a certain 196 
The Case eor Birth Control 
degree of uneasiness in the woman and the family circle. This foreboding is 
due partly to our higher valuation upon health and life, and also to a shifting 
of pre-eminence from a solely generative function in women to other interests 
in their life. P. 84. 
This greater consideration and valuation of woman’s individuality is the 
expression of continued progress and a higher culture. P. 87. 
TRUCHTABTRBIBUNG UND PRAVENTIVVBRKBHR, In Zusammen- 
hang mit dem Geburtenruckzang; Bine medizinische, juristische und so- 
zialpolitische Betrachtung von Dr. Max Hirsch, Wurtzburg, Kabitzsch 
Verlag, 1914. 
In Chicago six to ten thousand abortions are performed yearly, of which 
75-90% are married women. P. 7. 
I believe I may say without exaggeration that absolutely spontaneous or 
unprovoked abortions are extremely rare, that the vast majority—I should 
estimate it at more than 80% of abortions have a criminal origin. P. 9. 
We may affirm that next to sexual diseases, abortion and its consequences 
are the most important factor in the etiology of chronic genital inflammations 
and of sterility. P. 9. 
Our examinations have informed us that the largest number of abortions 
are performed on married women. This fact brings us to the conclusion that 
contraceptive measures among the upper class, the practice of abortion among 
the lower class, are the real means employed to regulate the number of off- 
spring. P. 32. 
THE SEXUAL LIFE OF WOMAN IN ITS PHYSIOLOGICAL, BIO- 
LOGICAL AND HYGIENIC ASPECTS. E. Heinrich Kisch. Trans- 
lated by M. Eden Paul, M. D. Rebman & Co., New York. 
A means of insuring artificial sterility, which in all civilized countries is 
punishable as a criminal offense, and which is nevertheless very frequently 
practiced, is the artificial induction of abortion. Especially in North America 
it would appear that there exist regular professional abortionists. P. 413. 
THE FAMILY AND THE NATION. A Study in Natural Inheritance and 
Social Responsibility. Wm. Cecil Dampier Whetham, M. A., F. R. S. 
Fellow and Tutor of Trinity College, Cambridge, and Catherine Durning 
Whetham. Longmans Green & Co., N. Y., Bombay and Calcutta, 1909. 
There is no finality, a nation must either be losing or gaining ground, 
either improving or degenerating. Hence the scientific study of the effect 
of the existing conditions of any time on the rates of reproduction of different 
stocks of the nation, should be the chief work of the sociologist, and the con- 
trol of these conditions the supreme duty of the statesman. P. 5. CHAPTER VII 
PROSTITUTION, FEEBLE-MINDEDNESS AND VENEREAL 
DISEASES 
In this chapter it is shown that the feeble-minded parent is many times 
as prolific as the normal parent. A considerable percentage of girls living 
in prostitution are mentally defective, and if careful statistics were collated 
it would be found that 95 per cent of these women come from large families. 
The feeble-minded should be instructed how to prevent conception, thereby 
diminishing prostitution and its invariable accompaniment,—venereal disease. 
SOME PROBLEMS OF THE SOCIAL EVIL. Hon. Chas. N. Doodnow, 
Judge of the Morals Court, Chicago. “The Light.” B. S. Steadwell, 
Editor. Jan.-Feb., 1915. 
The Court of Morals conducted an investigation of prostitution along 
three lines, social, physical and mental. In the first report, April 10th, to 
December 31st, 1913, 639 cases were examined, representing every race, creed, 
and nationality. 334 were colored, 298 white, 2 Armenian, 1 Japanese. 
Occupations: 225 housework, 174 waitresses, 136 laundresses, 83 clerks or 
cashiers, 6 seamstresses, 4 stenographers, 1 trained nurse, 1 manicurist, 24 
scrub women, 110 had no occupation. Venereal disease in infectious stage 
was diagnosed in 108 cases. 315 showed evidence of having syphilis, and of 
the remaining, 116, had bacteriological tests been made, 50% at least would 
have been found victims of the disease. As to intelligence, over 400 were 
mentally deficient, two were found to be insane, and 68 were little more than 
imbeciles, having mental capacity of less than a seven year old child. Later 
statistics of 100 women going through the Court were taken showing again 
that usually their work was of a character which required the least skill and 
mental effort, and that 97% either were, or had been afflicted with disease, 
and that the majority were mentally deficient. We did not have any imbe- 
ciles, or idiots from the Morals Court, though quite a number of the morons 
were of the low grade type bordering on the imbecile group. In other words, 
89.37% of our cases are feeble-minded, or borderland. If we leave out the 
borderland cases it shows that 85% of our cases, exclusive of the insane, alco- 
holics, and drug habitues are distinctly feeble-minded. This finding is in- 
teresting since it corresponds to our findings in the Boys’ Court, where we 
found 84.49% were feeble-minded. It is therefore to be clearly seen here 
that with the girl defective-delinquent, as with the boy, the basic cause is 
feeble-mindedness. This is the intrinsic cause, which environment and other 
causes on the whole, are extrinsic. 198 
The; Case; for Birth Control 
REPORT OF CHICAGO MORALS COURT. December, 1913. 
Dr. W. J. Hickson of the Psychopathic Laboratory tested 126 cases ex- 
cluding insane, alcoholics and drug addicts, for the Chicago Morals Courts, 
and found 85.83% distinctly feeble-minded. 
Of 639 prostitutes examined by a woman physician for the Chicago 
Morals Court, over 400 were mentally deficient; 2 were found to be insane; 
68 were little above imbeciles, having mental capacities of less than a seven 
year old child. 
The State Training School for Girls, at Geneva, 111., has a population of 
about 400, of whom a great majority have been committed for sexual im- 
morality. Dr. Olga Bridgman reports that of 118 consecutive cases that were 
examined upon entry, 105 (or 89%) were graded as feeble-minded. 14 of 
the 118 had been committed as dependents or uncontrollable. Of the 104 
remaining all of whom had been sexually immoral 101 were graded as feeble- 
minded while only 3 were found normal according to the Binet test. 
THE LAW OF POPULATION. Its Consequences and its Bearing upon 
Human Conduct and Morals. Annie Besant. Asa K. Butts, Publisher. 
1879. 
The more marriage is delayed the more prostitution spreads. Prostitu- 
tion is an evil we should strive to eradicate, not to perpetuate, and late mar- 
riage, generally adopted would most certainly perpetuate. Marriage is de- 
ferred owing to the ever increasing difficulty of maintaining a large family in 
anything like comfort. Celibacy is not natural to man or to woman, all bodily 
needs require their legitimate satisfaction, and celibacy is a disregard of nat- 
ural law. Until nature evolves a neuter sex, celibacy will ever be a mark of 
imperfection. P. 27-8. 
But the knowledge of these scientific checks would, it is argued, make 
vice bolder, and would increase unchastity among women by making it safe. 
And if so, are all to suffer, so that one or two already corrupt at heart may 
be preserved from becoming corrupt in act? Are mothers to die solely that 
impure women may be held back, and wives to be sacrificed that the unchaste 
may be curbed. As well say that no knives must be used because throats 
may be cut, no matches sold because incendiarism may result from them, no 
pistols allowed, because murders may be committed by them. P. 38. 
SLAVERY OF PROSTITUTION. A Plea for Emancipation. Maude E. 
Miner, Secretary of the New York Probation and Protective Association. 
McMillan Co., 1916. 
The study of young women in prostitution shows that mental deficiency 
is an important factor in delinquency. 34%, or approximately 1/3 of 577 Prostitution and Venereal Diseases 
199 
delinquent young women at Waverly House were so retarded in mental de- 
velepment as to be considered feeble-minded, and others were mentally retarded 
enough to need protection and over-sight. Close knowledge of the individual 
girls convince us that their deficiency facilitates their entrance into prosti- 
tution. P. 43. 
Explanation of the mental deficiency of these wayward girls which has 
predisposed them to prostitution is usually found in bad inheritance. P. 44. 
A feeble-minded girl was found to be one of 13 illegitimate children to 
whom her mentally deficient mother had given birth. P. 46. 
Over-crowding in rooms, tenements, and neighborhoods is an obvious 
menace. In congested sections of the lower part of New York, large families, 
to which these girls belong, were herded into two or three narrow rooms, 12 
in three small rooms, seven in two rooms, or a family of five eating and 
sleeping and living in a single room. P. 55. 
Have we realized that every feeble-minded girl is a potential prostitute? 
Have we realized that feeble-minded mothers give birth to large numbers of 
children doomed to mental deficiency? Have we realized what this will 
ultimately mean in deterioration of human stock and in the complication of 
social problems? To stop the stream which is bringing into prostitution 
large numbers of mentally deficient girls and women, we must safe-guard 
these girls and prevent them from having offspring. Evidence presented to 
the Royal Commission on the Care and Control of the Feeble-minded in Great 
Britain, and careful studies in America, show conclusively that mental de- 
ficiency tends strongly to be inherited, and that feeble-minded mothers are 
more prolific than normal women. P. 267. 
DOWNWARD PATHS. An Inquiry into the Causes which Contribute to 
the Making of the Prostitute. With a foreword by A. Maude Royden. 
T. Bell & Sons, Ltd. London. 
It is astonishing to find experts denying the element of economic pressure 
as a factor in the creation of the prostitute. It is an influence constantly 
present and it is only when we interpret it to mean actual physical starvation 
that we can say it is rarely a determining factor. Economic pressure does not 
begin with starvation, it ends there. There is again the long strain of under- 
feeding and over-work, of the absence of interest, variety and color, and all 
that makes life worth living to a human being. Poverty often means isola- 
tion, and isolation the absence of all those ties which keep us in our place in 
the social order, and make it worth while to preserve our self-respect. To be 
without this is to be constantly in danger and it is economic pressure which 
has thrust many over the brink of the precipice, though few would say their 
fall was due to actual starvation. P. 10. 200 
The Case for Birth Control 
Intimately connected with this aspect of the question is that of home and 
housing, especially of the child. The age at which children are first corrupted 
is almost incredibly early, until we consider the nature o"f the surroundings in 
which they grow up. Insufficient space, over-crowding, the herding together 
of all ages and both sexes, these things break down the barriers of a natural 
modesty and reserve. Where decency is practically impossible, unchastity 
will follow, and follow almost as a matter of course. There are certainly 
natural defences in the right instincts of young people brought up in the right 
kind of home, which we look for in vain among those who have never had 
space enough for growth, or privacy enough for refinement. P. 11. 
We must allot to bad housing and over-crowding a foremost place, not 
only as undermining the physical health which conduces to normal sexual 
relationship, but also as a danger to the wholesome innocence of youth. P. 21. 
It cannot be too strongly impressed upon persons interested in the 
housing problem that over-crowding means a violation of childhood in every 
degree, from the indecencies of mere childish horse-play to complete debau- 
chery. P. 22. 
There are two types of feeble-minded girls who are almost inevitably 
destined to prostitution. There is first the large proportion whose sexual 
inclinations are abnormally strong, or whose power of self-control over natural 
impulses is abnormally weak. 2—There is the large class who are non- 
resistant. They have no active impulse to seek out men, but they will yield 
to any one who approaches them. There are three important factors that 
drive the feeble-minded into prostitution by excluding them from other occu- 
pations. 1—They often lose their characters at a very early age. A marked 
characteristic of the feeble-minded is the precocity of their sexual impulse. 
2—It is easy enough for any feeble-minded girl to get and keep light, un- 
skilled work at girl’s wages, but not so easy for her to pass like the girl of 
normal intelligence, from girl’s to woman’s work at the age of 17 or 18, for 
she is rarely worth woman’s wages. Therefore she finds herself bored by 
monotonous work and low pay just at the time that she is particularly at- 
tractive to man, and her sexual impulses are at their strongest. Very natur- 
ally the feeble-minded girl with her incapacity to perceive the consequences 
turns from her unsatisfying employment to the new life of excitement and 
easy gain that offers itself. 3—If feeble-minded girls do succeed in getting 
respectable situations they are very likely to lose them because of their lack 
of intelligence and general inefficiency. And even if they should discharge 
their duties in a satisfactory manner they have a curious distaste for staying 
for any time in one place, and tend to drift from situation to situation. P. 
127-128. 
Another characteristic of the feeble-minded is their notorious fertility. 
The superior fertility of the feeble-minded has been proved beyond dispute 
by statistical inquiry. Prostitution and Venereal Diseases 
201 
DELINQUENCY AND MENTAL DEFICIENCY. Dr. Olga Bridgman. 
The Survey, June 13, 1914. 
Report of examination of 118 consecutive admissions at the Illinois 
Training School for Girls at Geneva. Of the 118, 105, or 89%, showed a 
retardation of three years or more, thus ranking as mentally deficient, 6% 
were backward, being one or two years retarded, and six, or 5% were graded 
as normal. According to the Binet tests then, 97% of the children sent to 
this institution are mentally defective. 
COMMERCIALIZED PROSTITUTION IN NEW YORK CITY. George 
Kneelands. Century Co., New York, 1913. (Chapter by Katherine B. 
Davis on a Study of Prostitutes Committed from New York City to the 
State Reformatory for Women at Bedford Hills. 
It is difficult to get at the actual truth as to the number of children the 
unmarried women have had. The Table shows the admission of 209 women 
on this point. There are 73 unmarried women who admit having had chil- 
dren, 16 were pregnant at the time of entering, and 18 had previously been 
pregnant. 428 claimed to have had no children. In this connection it may 
not be amiss to note the fact that an unmarried woman who has had a child 
is more apt to belong to the mentally defective class. Of the 647, 20.09% 
were shown to have hereditary degenerate strains, and 20.56% venereal 
disease. Page 180. 
FEEBLE-MINDEDNESS 
SOCIAL HYGIENE. March. 1915 Vol. 1, N« 2 Rerent Progtess in 
Social Hygiene in Europe. James B. Reynolds, Counsel The American 
Social Hygiene Association. 
Recent studies of prostitutes there (in Europe) as here have strikingly 
brought to light the significant relationship between prostitution and mental 
defectiveness. A far reaching contribution to the solution of the problems of 
sex education and prostitution was the Mental Deficiency Act of 1913 for Eng- 
land and Wales. This Act was based on the Report of a Royal Commission 
on the Care and Control of the Feeble-minded which made a careful and 
exhaustive study of the entire subject, including the methods of treatment of 
the mentally defective in all countries. The Commission declares that a great 
proportion of the evidence unmistakably indicates that mentally defective 
children are greatly lacking in self-control and peculiarly open to suggestion 
and hence specially susceptible to the influence of depraving companions. The 
testimony of numerous experts who appeared before the Commission is highly 
illuminating on these points. Dr. Kerr, medical officer of the London County 202 
The Case for Birth Controe 
Council, declared that sooner or later many of these children will be found in 
the hands of the police, or in maternity hospitals. Dr. Ashby, late medical 
officer of the Manchester Special Schools stated that the mental defectives tend 
to an increase of the criminal and immoral classes. Dr. Whittell, Medical Sup- 
erintendent of the Suffolk County Asylum, argued that the natural and physical 
evolution of this class is apt to result in various offenses of sexual, or per- 
verted sexual, nature. Dr. Corner, Lecturer on Mental Diseases in the North 
East London Post Graduate Hospital, said, “One of the most common and 
dangerous characteristics of the feeble-minded is that they fend to sink 
socially.” Another expert testified that mentally defective girls in large cities 
are subject to overwhelming temptations and pressure toward sexual immor- 
ality, while still another, looking to the larger aspects of the problem, called 
attention to the danger resulting from the immoral laxness of mentally defec- 
tive girls, and the lowering of the mental stamina of the whole nation by the 
increase of a population of defective intellect. Sir Francis Galton went so 
far as to declare that mentally defective women commonly become prostitutes. 
The feeble-minded, as distinguished from idiots, are an exceptionally fecund 
class, mostly of illegitimate children, and a terrible proportion of their off- 
spring are born mentally deficient. All these experts were in agreement that 
mentally defective girls are in great danger of becoming immoral, hence 
prostitutes. 
DEGENERACY, ITS CAUSES, SIGNS AND RESULTS. Eugene S. 
Talbot, M.D. Walter Scott, Ltd., London; Chas. Scribner’s Sons, N. Y. 
1898. 
Pauline Tarnowsky in her study “Etudes Anthropometriques sur les 
Prostituees” finds that in Russia prostitution is crime in women taking the 
line of least resistance. She concludes from her researches, which mine tend 
to verify, that the prostitute as a rule is a degenerate being, the subject of 
an arrest of development, tainted with a morbid heredity, and presenting 
stigmata of physical and mental degeneracy fully in consonance with her im- 
perfect evolution. C. Andronico of Messina, Italy, arrived some time pre- 
viously at the same conclusions as those of Tarnowsky. 
FEEBLE-MINDEDNESS, ITS CAUSES AND CONSEQUENCES. 
Henry Herbert Goddard, Director of the Research Laboratory of the 
Training School at Vineland, N. J., for Feeble-minded Boys and Girls. 
McMillan Co., 1914. 
Among the different causes for the social evil feeble-mindedness has been 
suggested, but nowhere has it been given the prominence that is due it. Any- 
one who understands feeble-mindedness, especially the moron, cannot expect 
anything less than that great numbers of these girls will fall into the life of Prostitution and Venereal Diseases 
203 
prostitution. As to the actual statistics on this subject we have almost none. 
One very significant record comes from Geneva, Illinois, made by Dr. Bridg- 
man. She found that of 104 girls in the Reformatory who were committed 
for an immoral life 97% were feeble-minded. This does not by any means 
indicate that 97% of prostitutes are feeble-minded, because it is only natural 
to expect that the feeble-minded ones would be the ones to be caught and sent 
to an institution. These figures, nevertheless, give us some idea of the pre- 
valence of feeble-mindedness in this traffic. Many competent judges estimate 
that 50% of prostitutes are feeble-minded. Pages 14-15. 
The 327 cases here presented constitute a unitary group. They have not 
been selected. They are of all ages and grades of defect. Page 7. 
Our 327 families naturally fall into six fundamental groups, as follows: 
A—Accident Group, 57; 5—No Cause, 8; 6—Unclassifiable, 27. Pages 47-48. 
The following table gives an idea of the fecundity of these groups of 
women. 
No. 
of Mothers 
No. of Children 
Average 
Hereditary 
139 
992 
7.1 
Probably Hereditary 
.... 27 
168 
6.2 
Neuropathic 
36 
204 
5.6 
Accident 
50 
258 
5.1 
No Cause 
8 
258 
5.7 
Unclassified 
27 
118 
4.3 
287 
1,786 
6.2 
In addition to the mentality, whether normal or feeble-minded, record 
has been kept of certain diseases and conditions supposed to be more or less 
associated with feeble-mindedness in a causal relation. These are the follow- 
ing: 1—Alcohol; 2—Tuberculosis; 3—Sexual Immorality; A—Paralysis, In- 
sanity, Epilepsy, Neurotic Condition, Syphilis, Criminality, Deafness, Blind- 
ness, Migraine, Goitre, Vagrancy. Page 473. 
Sexual immorality is closely associated with hereditary feeble-mindedness. 
Closely connected with the subject of sexual immorality is the one of illegiti- 
macy. Our records show 278 illegitimate children of whom 259, or 93% are 
in the pure Hereditary group, 12 in the Probably Hereditar ygroup, 3 in the 
Neuropathic, and 4 in the Accident group. There is nothing new in these 
facts. They are simply confirmatory of what we have found in other lines. 
Page 499. 
The feeble-minded person is not desirable; he is a social encumbrance, 
even a burden to himself. In short, it were better, both for him and for 
Society had he never been born. Should we not then in our attempt to im- 
prove the race begin by preventing the birth of more feeble-minded ? Page 558. 204 
The Case for Birth Control 
THE FEEBLE-MINDED A SOCIAL DANGER. A. F. Tredgold, L.R.C.P. 
London. M.R.C.S., England. Medical Expert to the Royal Commission 
on the Feeble-minded, etc. Eugenics Review. Vol. 1, April, 1909. Pub. 
Eugenics Education Society, London. 
In England and Wales on January 1st, 1906 there were a total of 138,529 
persons in the country who were defective in mind. This corresponds to 4.03 
per thousand population, or to one mentally defective person in every 248. 
In England and Wales on January 1st, 1906, there were no less than 125,827 
insane persons. If we add these to the number of the mentally deficient which 
I have just stated, we find that in this country there is one person out of 
every 130 who sutlers from severe disease of the mind. P. 98-99. 
According to the Registrar General, the average number of births to a 
marriage in the whole population of this country is 4.6. I have ascertained 
that the average number of births in these degenerate families is no less than 
7.3. It is obvious that if this alarming propagation is not checked, the time 
must inevitably come when our nation will contain a preponderance of citizens 
lacking in that intellectual and physical vigor which is absolutely essential to 
progress. P. 98. 
RASSENVERBESSERUNG. Translated from the Dutch of Dr. /. Rutgers. 
Second Edition, Dresden, 1911. 
A not insignificant factor in the use of houses of prostitution is furnished 
by married men who in the “old fashioned” way wish to “protect” their wives, 
in order not to be burdened with too many children. Neo-Malthusianism is 
also the best weapon against this class of supporters of prostitution. P. 73. 
MASSACHUSETTS COMMISSION FOR INVESTIGATION OF THE 
WHITE SLAVE TRAFFIC. 
This investigation under Dr. Walter Fernald, included a physical exami- 
nation study of family and personal history, social reactions, and standards, etc. 
Out of the 300 prostitutes 154 were feeble-minded (all doubtful were called 
normal). The 154 were so pronounced as to warrant legal commitment. 
None of them had the mentality of a normal child of 12 years old. Majority 
were that of 10 or 9 years old. 
INVESTIGATION OF VIRGINIA STATE BOARD OF CHARITIES. 
This investigation presents a very high percentage of aments among the 
prostitute residents of the Richmond red light district. Of 120 persons tested 
the examiner found 42 or 35% imbeciles and 58 or 48.3% to be morons. That 
is 100 or 83.3% were mentally defective and only twenty or 16.7% were de- Prostitution and Venereal Diseases 
205 
dared normal. Out of this number 93 were found to be between the ages 
of 20 to 30 and 16 between 30 to 40. All in the child-bearing age, as one will 
note. That 100 out of the 120 needed institutional care, that they should not 
reproduce their kind, was of course apparent. 
THE MENTALITY OF THE CRIMINAL WOMAN. A Comparative 
Study of the Criminal Woman, the Working Girl and the Efficient Work- 
ing Woman in a Series of Mental and Physical Tests. Jean Weidensall, 
formerly Director of the Department of Psychology, Laboratory of Social 
Hygiene, Bedford Hills, N. Y. Warnick and York Inc. 1916. 
Tests applied to a group of children of working age by the Bureau of 
Educational Guidance of Cincinnati were also used on a group of 20 maids 
at Vassar as a norm for testing the women committed to Bedford. 100 re- 
formatory subjects were used for the tests. It is a matter for question 
whether loss of the parent is the cause of the child’s leaving school and going 
to work early and of the ultimate unsocial conduct in the case of the Bedford 
group, or whether loss of parent, retardation, misconduct, etc., are not for 
the most part but manifestations of the same thing—irresponsibility, mental, 
physical and social inferiority on the part of both parents and child. The 
facts at our disposal and eugenic investigations lead us to believe that the 
latter is in the larger measure true. Out of 100 women recorded 30 had had 
from one to five illegitimate children. Of the 100 tests for syphilis and 
gonorrhoea, 45% positive, 4% doubtful, 51% negative, for Syphilis. 60 
positive, 22% doubtful, 18% negative for gonorrhoea. At best strong char- 
acter cannot be the rule among individuals 2/3 of whom have less intelligence 
than that possessed by the average individual among a group of children of 
15, (of whom half are themselves retarded), and almost surely not when they 
have been too untrained industrially and too unschooled socially to have ac- 
quired simple every-day habits of restraint and inhibition. Even the more 
intelligent third of the reformatory subjects differed very obviously and 
unmistakably in stability and emotional control from the group of Vassar 
maids. 
THE MENACE OF MENTAL DEFICIENCY FROM THE STAND- 
POINT OR HEREDITY* By Henry H. Goddard, Ph.D., Vineland, 
N. J. New Jersey Training School. 
From the standpoint of the child, something can be done to make them 
a little happier; from the standpoint of society, no amount of mental hygiene 
can ever render them efficient citizens. Society can, by proper treatment, 
render them less of a menace than they are naturally, and the ills that we now 
suffer on account of them can be largely reduced. 
♦Read before the conference of the Massachusetts Society for Mental Hygiene, 
Boston, November 19, 1915. 206 
The Case eor Birth Control 
It is estimated that there are from 300,000 to 400,000 mental defectives 
in the United States. That is based upon the United States census of 1890, 
in which the question was asked “Whether defective in mind, sight, hearing 
or speech, or whether crippled, maimed or deformed, with name of defect.” 
Now if anyone can estimate what proportion of the true number of the feeble- 
minded would be returned in answer to that question, he will be able to esti- 
mate how near the truth is the 200,000 which the census report gives. Three 
hundred thousand or 400,000 seems to be a conservative estimate. 
I am to discuss this topic from the standpoint of heredity. It has not 
yet been successfully contradicted that two-thirds of this army of 300,000 or 
400,000, owe their condition to heredity. A quarter of a million of these 
people are feeble-minded because their ancestors were feeble-minded. They 
have inherited the condition just as you have inherited the color of your eyes, 
the color of your hair, and the shape of your head. There is a tendency in 
these days to attribute a great deal to heredity. But of this particular thing 
there seems to be no question. The menace of the problem comes, not from 
the fact that a quarter of a million inherited their condition, but because they 
are transmitting that condition to their offspring. Of that quarter of a 
million feeble-minded persons in the United States, do you know how many 
are being cared for, guarded and kept from propagating their kind? About 
24,000 out of 250,000 are to-day being cared for in such institutions as you 
have here at Waverley. The rest are living their lives, are raising families, 
and providing abundant opportunity for the exercise of the charitable im- 
pulses of numberless generations to come. And that condition of things is 
getting worse rather than better. 
What shall we do? There have been two answers. Some say, “Segre- 
gate, shut them up. Keep the sexes apart.” We are told that if we could 
do this for a generation our problem would be largely solved. The two- 
thirds in which the condition is largely hereditary would be eliminated. I 
want to assure you that the problem is larger than that. In the first place, 
looked at from the practical standpoint, we do not seem to be able to segregate 
We are taking care of 24,000, and there are at least 250,000 to be cared for. 
If the State of New York cared for its estimated proportion of mental de- 
fectives, it would require thirty institutions of 1,000 each. They find it hard 
to raise money for the three or four institutions they now have. Their appro- 
priations are cut every year. In the State of Massachusetts there are at 
least 14,000 feeble-minded persons. It would require ten institutions the size 
of Waverley,—a demand upon the public treasury which we are not willing 
to meet. I have not found anyone yet who is optimistic enough to think that 
we shall meet the demand within any reasonable length of time,—a time so 
short that we can safely rely upon that as a solution of the problem. 
I have said that this quarter of a million, this army of feeble-minded 
people, are propagating. They are propagating a progeny of feeble-minded 
at somewhere from two to six times as fast as the intelligent people are Prostitution and Venereal Diseases 
207 
propagating their kind. That is another serious part of the problem. I 
should like to digress from my particular field for a moment to make a 
suggestion on the other side. It makes one feel pessimistic when we find 
that the good stock here in New England—the stock than which there is no 
better in the world—is gradually disappearing for lack of issue. Of one 
family after another one reads all too frequently, “The last of his family has 
passed away.” We are told sometimes that two children in a family are all 
that can be properly reared; that it is better to rear two children and rear 
them properly than to rear a larger family and rear them badly. If two 
children in a family are all that our best and finest and nobler families can 
properly raise, how many children ought to be raised in a family of these low- 
grade people ? The average in the United States is, for all classes, something 
less than two, and the average for these defectives is from four to twelve. 
In that little family that we ran across down in New Jersey, which we call 
the Kallikaks, you will recall that the good side started from six ancestors. 
That is to say, Old Martin Kallikak, after he married, had seven children, 
one of whom died without marrying. From the six who lived and married, 
sprang all the normal descendants. Martin’s illegitimate son, the child of the 
feeble-minded girl, was the only one on the bad side, and yet to-day the num- 
ber of descendants from the illegitimate mating is practically the same as 
the number descended from the six legitimate children. You can see that it 
does not take many generations for the progeny of the unrestrained feeble- 
minded to equal and even outstrip the normal. Our good stock is multiplying 
very slowly. Our poor stock—the lowest strata of society—multiplies in 
what might really be called a brutal ratio. If civilization is to advance, our 
best people must replenish the earth. I think it should be a part of our re- 
ligion to replenish the world with good, clean people. 
We need to know vastly more than we know to-day before we can give 
definite answers, except in the case of marriage between two feeble-minded 
persons. Now, that being the case, the argument that I want to make to you 
is: the propagation of the feeble-minded is going on at an enormous rate. 
If we could do, and if we did, everything that we wanted to do, and that we 
knew enough to do, we should be getting only at the surface of the problem, 
and should be sure in only about one case out of the six possibilities. Now if 
that is the case, my friends, does it seem that we ought to put off attacking 
the problem until we cannot stand it any longer? Or does it mean that we 
had better attack it right away? Is it not best to begin hunting for these 
defective children wherever they may be found? And they can be found in 
the school, in our juvenile courts, in our almshouses, in our insane hospitals, 
in our reform schools, in our homes for cripples, in our asylums for the blind, 
—in short, wherever there is a dependent group there is an undue proportion 
of these mental defectives. 
Some will say, “If they are in almshouses they are being cared for.” In 
reality they are being raised and brought to manhood and womanhood and 208 
The Case for Birth Control 
then sent out, to propagate their kind. Fifty years ago the problem was not 
as serious as it is to-day, because these defectives were out in the world by 
themselves, getting killed by a runaway horse, or falling into machinery, or in 
some way meeting an untimely death. To-day we are exceedingly careful; 
we are protecting them in every possible way; we are taking care of them in 
our institutions and giving them every advantage, and then sending them 
out into the world—a menace to the rest of humanity. 
It would be a dreadful thing if all these problems were solved and we 
didn’t have any people to give our money and charity to. I suppose we should 
become hard-hearted if we didn’t have any to befriend. Perhaps we want to 
keep enough of these unfortunates so that we can still contribute to their 
safety and welfare. But, my friends, when we realize the suffering, the 
terrors, the losses of all kinds that these people unintentionally, unwittingly 
cause us, we have another side of the problem. The menace of the feeble- 
minded is not a figure of speech. It is no undue sentimentalism that assures 
us that we need to take care of this group of people. We need to study them 
very seriously and very thoroughly; we need to hunt them out in every pos- 
sible place and take care of them, and see to it that they do not propagate and 
make the problem worse, and that those who are alive to-day do not entail 
loss of life and property and moral contagion in the community by the things 
that they do because they are weak-minded. 
HEALTH FIRST AND MATRIMONY AFTERWARD. By Edward C. 
Spitzka, M.D. The Semi-Monthly Magazine Section of the Boston 
Globe, the Washington Post, the Philadelphia North-American, the Pitts- 
burgh Dispatch, the Chicago Tribune, the St. Louis Globe-Democrat, the 
Cincinnati Enquirer, etc. May 11, 1913. 
We cannot tell men and women how they should mate in order to insure 
positive types of offspring. But we can state, emphatically, and without re- 
serve, that persons suffering from certain diseases should not enter into the 
marriage relationship, at peril of the health and happiness of children that 
may be born to them and the well being of the community at large. 
I believe that municipal and state governments should take cognizance 
of this fact. Eventually it will be regarded as a matter for Federal, perhaps 
for international action. Every candidate, man or woman, applying for a 
marriage license should be required to present a physician’s certificate de- 
claring him or her to be free from insanity and certain virulent transmissible 
diseases. 
What then are these diseases? I will list them in the order of import- 
ance as menaces to humanity. 
1. Constitutional insanity. Prostitution and Venereal Diseases 
209 
2. The two great forms of constitutional venereal disease: syphilis and 
gonorrhoea—the former as a source of danger to both the marriage partner 
and offspring, the latter to the marriage partner only. 
3. Deformities that are likely to be associated with the transmission of 
serious defects of the nervous system, such as cleft palate, hermaphroditism,, 
etc. 
4. Epilepsy of the standing of more than one generation. 
Medical statistics prove that a proportion of three out of every five chil- 
dren born to imbicile parents are certain to be weak-minded, and that the 
marriage of such unfortunates is a calamity to the race. Syphilis persists 
from generation to generation. Any sufferer from this disease who marries 
before he is certain that it has been eradicated from his system is guilty of a 
crime against society. 
I have hesitated about including epilepsy in this list. It is undoubtedly 
transmissible to the offspring, though transmission does not occur in every 
case. A conservative ruling would be that an epileptic who is believed to be 
the first of his line to contract the disease should be permitted to marry, in the 
event of his being declared cured. But the epileptic sons and daughters of 
epileptic parents should, under no circumstances, be licensed to marry. 
Note: The late Dr. Spitzka, along with other authorities quoted as being 
opposed to the marriage of the unfit, was concerned with the diseased offspring 
which almost invariably result from such marriages. Except in the case of 
gonorrhoea, which can be transmitted to the marriage partner, he did not 
object to the union itself, provided the latter remained childless. He would 
have recommended the use of contraceptives, as the solution of the problem, 
had he not been prohibited by the law from doing so. 
HEREDITARY SYPHILIS IN THE LIGHT OF RECENT CLINICAL 
STUDIES. Pamphlet. Borden S. Veeder, M.D., St. Louis, Mo. From 
the American Journal of the Medical Sciences, October, 1916. No. 4,, 
Vol. CXII. P. 522. 
In the present state of our knowledge we can summarize the evidence as 
pointing to the view that in hereditary syphilis the mother is always infected, 
although very frequently the infection is latent and that true germinal infec- 
tion does not occur. 
Syphilis as a Social Problem. No accurate figures are available as 
to the incidence of hereditary syphilis. The disease is not reportable, and even 
if it were it is doubtful if the records obtained in this way would be of any 
value, as the condition is frequently overlooked, and when recognized would 
be concealed in many cases because of the stigmata attached. With improved 210 
The Case eor Birth Control 
methods of diagnosis we are beginning to learn that it is far more common 
than previously thought, as many conditions in which the etiology was obscure 
have been found to be the result of a syphilitic infection. Hospital statistics 
are of little value in this connection. In St. Louis we have been particularly 
interested in hereditary syphilis, and have admitted many cases to the Chil- 
dren’s Hospital for study which would normally have been cared for in the 
out-patient clinic, and hence the proportion of syphilis to the total number of 
admissions is relatively high. We have seen between 300 and 350 children 
with an hereditary infection in three and a half years and have undoubtedly 
failed to recognize a number of cases. We have also found many cases of 
latent syphilis by testing the apparently healthy children of syphilitic families. 
What is more important is the number of obscure clinical conditions which 
have been found to be syphilitic in origin. 
The importance and cost of syphilis to the family and the community is 
not generally appreciated. About this point we have collected some interest- 
ing information: For a period of about a year an attempt was made to obtain 
extensive data in regard to the family of every syphilitic child coming to the 
clinic, to examine all of the other living children as well as the parents, and 
to test the blood of each member by the complement-deviation method. In this 
way data was assembled for 100 syphilitic families. Many marriages (10 to 
30 per cent.) remain sterile as a result of syphilis and others (13 per cent, 
according to Haskell) result only in abortions. Our material includes only 
those families in which a living child came under our direct observation and 
care. 
In these 100 syphilitic families 331 pregnancies occurred which resulted 
as follows: 
Abortions 100 or 30.2 per cent. 
Stillbirths 31 or 9.3 per cent. 
Living births 200 or 65.5 per cent. 
Thus 40 per cent, of the pregnancies terminated in the death of the fetus 
before term. If the parents had been healthy and of the same social strata 
we might have expected 30 to 35 deaths before term, or a mortality of 10 per 
cent, instead of 40 per cent. 
Considering next the 200 living births: At the time the data were col- 
lected 39 were dead and 161 alive, but 12 of the 161 died during the course of 
the investigation. Of the 161 examined 107 had both clinical signs of syphilis 
and a positive Wassermann; 5 were clinically positive but gave negative tests 
(in all of these the family gave a history of syphilis) ; 16, although negative 
as regards clinical manifestations, gave positive reactions, and therefore be- 
long to the group of latent syphilitics. Thus but 33 of the 161 living children 
were free from the infection, and if we attribute the deaths occurring before 
term to syphilis, we find that of the 331 pregnancies in 100 syphilitic families Prostitution and Venereal Diseases 
211 
but 10 per cent, escaped the infection. The toll is summarized in the follow- 
ing table: 
331 PREGNANCIES IN 100 SYPHILITIC FAMILIES 
131 
or 
40 
per 
cent. 
died before term 
> 55 
cent. 
dead 
51 
or 
15 
per 
cent. 
died after 
birth 
per 
116 
or 
35 
per 
cent. 
living but 
syphilitic 
> 35 
per 
cent. 
syphilitic 
33 
331 
or 
10 
per 
cent. 
living and 
free from syphilis 
10 
per 
cent. 
escaped 
If we add to this record and take into consideration the physical condi- 
tion of the parents—both of whom were syphilitic in almost all of our cases 
—we begin to grasp the appalling importance of syphilis from a social stand- 
point. 
In order to show this in another way, studies1 were made in our clinic in 
which the waste (total deaths to total pregnancies) occurring in 100 families 
in which we were treating children with contagious disease, and in 100 fam- 
ilies selected at random from our records, were contracted with the waste in 
100 syphilitic families. These groups are designated as C. R. and S. re- 
spectively and the data briefly summarized in the following table: 
Total 
Deaths before 
Born living 
Per cent. 
Group 
pregnancies 
birth 
now dead 
Total 
waste 
C. 
444 
46 
70 
116 
26 
R. 
442 
42 
59 
101 
22 
S. 
453 
116 
104 
220 
48 
The increase in the waste for the syphilitic group of 100 per cent, does 
not represent the total waste, as it is fair to assume that three-quarters of 
the living children are syphilitic and many of these defective. 
Syphilis.. .None of the causes supposed to be potent causes of feeble- 
mindedness is so difficult of investigation, so enigmatical as Syphilis. Not 
only in the popular mind but in the professional thought, it is given a promin- 
ent place, yet of all the causes there is perhaps none for which there is less 
evidence. This does not necessarily mean it is not a cause, but simply that 
it is not proved. The terrible nature of the disease, the serious results that 
it is known to produce, such as miscarriage, deaths in infancy ,general paraly- 
sis of the insane, the fact that it is one of the two diseases that can be trans- 
mitted from the mother to the child because the germs can pass through the 
chorion cells, the fact of its close connection with sexual immorality, all tend 
to render it in the minds of most people a horror of which anything can be 
believed. It is well understood by the medical profession that a mating 
which shows, first a number of miscarriages followed by deaths in infancy, 
and finally live offspring, is a picture that means syphilis in one or both of 
the parents almost without question. In conclusion, there is abundant evi- 
dence that syphilis produces miscarriages and early death. 
It is claimed that syphilis is responsible for 42 per cent .of abortions and 
miscarriages, the remaining 58 per cent, embracing all cases of whatever 
character, artificial or otherwise. 
Lleans and Butler, Hereditary Syphilis as a Social Problem, Am. Jour. Dis. Child., 
1914, viii, 327. 212 
The) Cass for Birth Control 
SYPHILIS IN THE OFFSPRING OF SYPHILITIC PARENTS 
FAMILIAL SYPHILIS. By P. C. Jeans, M.D., American Journal of 
Diseases of ChildrenJanuary, 1916. Vol. XI. pp. 11-19. 
As the result of syphilis numerous families remain sterile. The figures 
for sterility vary from 10 per cent, to 30 per cent., depending on the material 
studied. When there is an embryo there is a variety of fates to which it 
may come. Many marriages result only in abortions (nearly 13 per cent, in 
Haskell’s material1). Since the starting point in our material was a syphilitic 
child, we have no data bearing on this phase. 
Among our syphilitic patients all the living children of 100 families have 
been examined, Wassermann tests made and the family history studied. In 
these 100 families there were 331 pregnancies. Of these 100 (30.2 per cent.) 
were abortions, 31 (9.3 per cent.) still births and 200 (60.4 per cent.) living 
births. Of the 200 living births 35 children died early and 4 died late, and 
161 remained alive and were examined. Of these, 12 are now dead. Of the 
35 who died early, 5 gave an undoubted history of syphilis and a number 
gave suspicious histories. Of the four who died late, one was an idiot. Of 
the 161 examined, 107 were clinically positive and had positive Wassermann 
tests. Five were clinically positive and had negative Wassermann reactions. 
Sixteen, who showed no evidence of syphilis, gave positive Wassermann re- 
actions. Thirty-three, who gave no clinical proof of syphilis, gave a negative 
Wassermann reaction. 
Of the five who were clinically positive but gave negative Wassermann 
reactions, one was a young infant who had snuffles and a large spleen. The 
mother and sister both gave a positive history and a positive Wassermann 
reaction. Shortly after beginning treatment the baby developed a syphilitic 
rash. The baby was removed from the hospital and a second Wassermann 
was not done. The second case was a nursing baby. The 'mother had active 
syphilis and was taking treatment. The baby had an active process in the 
nose. The third case was a 7-year-old girl who had a markedly sunken nose 
and who for that reason was the starting point for investigating that family. 
Both the mother and younger brother gave a positive Wassermann. The 
fourth case was a 4-year-old girl whose mother and younger sister were both 
positive and the patient had a general rash which was thought to be syphilitic. 
The fifth case was a 3-year-old boy with a positive history, and who had had 
some treatment. His mother and younger brother both had syphilis. 
A negative Wassermann reaction is obtained in the presence of active 
syphilis only under certain definite conditions. As had been noted in cases 
not of this series, very young babies, even with undoubted active syphilis, not 
infrequently give a negative Wassermann. It has also been noted that even 
small amounts of mercury tend to cause a positive blood to react negatively. 
1Haskell: Jour. Am. Med. Assn., 1915, lxiv, 890. Prostitution and Venereal Diseases 
213 
H. Boas2 states that of fifty-seven babies of syphilitic mothers giving nega- 
tive Wassermann reactions at birth, thirteen during a three months’ period 
of observation developed syphilitic manifestations and a positive Wassermann, 
and two others showed syphilitic changes at necropsy, having had no mani- 
festations during life. 
LATENT SYPHILIS 
It is seen that 10 per cent, of the children examined had latent syphilis, 
i.e., a positive Wassermann and no clinical evidence of syphilis. One of these 
children gave a history of epiphysitis at 3 months. Other than this no early 
history was acknowledged by any of the mothers. The question naturally 
arises, Are these children actively infected with syphilis? When we inquire 
into the history of those showing late manifestations, we frequently find, so 
far as obtainable history is concerned, that there has been no previous warning 
that the disease existed. One of our patients developed, as her first known 
symptom, an interstitial keratitis at 20 years. We know that the spirochete 
can lie dormant much longer than this and then manifest itself. One patient 
of this latent group who had taken very irregular treatment for about a year 
and who had never had previous manifestations, recently developed an active 
lesion in the throat. Another developed an interstitial keratitis after about two 
months of anti-syphilitic treatment. A positive Wassermann reaction in these 
apparently healthy children has the same significance that it does in the 
parent, and it is our belief that the children in this group are actively infected. 
The fact that there are thirty-three children, 10 per cent, of the total 
pregnancies, who show no evidence of syphilis, and at the same time give a 
negative Wassermann reaction, is rather hopeful. Yet the pleasure to be 
taken in this fact is not altogether unalloyed. In this small group there were 
two mental defectives and an idiot, and it is impossible to say that all of this 
group are free from syphilitic infection. In one instance, one such negative 
child returned about a year after his original examination with a tertiary type 
of lesion and a positive Wassermann. Though no classification of those in 
this group showing stigmata of degeneration was attempted, it can be truth- 
fully stated that a goodly proportion did show degenerative influences, either 
physical or mental. 
TOTAL SYPHILIS IN THE FAMILIES STUDIED 
In summing up the total syphilitic infection in these families, we find 
that where marital relations are uninvolved, all of the fathers and probably 
all of the mothers have been infected. Presuming that the abortions, still- 
births, all of the early deaths and at least one of the late deaths were due 
directly or indirectly to syphilitic infection, syphilis among the offspring 
amounts to 89 per cent, of the total pregnancies, and total syphilis in the family 
amounts to 93 per cent, of all its members. 
2Quoted by Haberman: Jour. Am. Med. Assn., 19i5, lxiv, 1146. 214 
The Case eor Birth Control 
SUMMARY 
It is highly probable that all the mothers of syphilitic children have 
been infected with syphilis. Of eighty-five mothers of syphilitic children 86 
per cent, gave positive Wassermann reactions. All of the remaining cases 
but six gave a history of infection or treatment, or both. Five of these six 
patients were examined at least ten years after the birth of their last syphilitic 
children and the infection is probably dying out. 
Eighty-seven per cent of the mothers deny all knowledge of the infection. 
The mothers are for the most part infected during the latent stage of the 
father. 
Of 331 pregnancies in 100 families, 30 per cent, were abortions, 9 per 
cent, stillbirths, 61 per cent, living births. Of the living births 24 per cent. ha<f 
died. Of those living 80 per cent, had syphilis. 
Of the total pregnancies 90 per cent, were presumably syphilitic and al- 
though 10 per cent, seem free from syphilis, there is no proof that they all 
are. The total syphilis in these families amounts to 93 per cent, of the entire 
family. 
For the most part our families followed Kassowitz’s rule; i.e., decreasing 
grades of infection in the children. 
In case of syphilitic mothers bearing nonsyphilitic children, it is probable 
that the infection in the mother is localized in places where it is not readily 
transmitted. 
The idea that there are different strains of spirochetes receives some 
support from these families. 
Transmission to the third generation, though not proved, is distinctly an 
occasional probability. 
OBSTETRICS. A Text-book for the Use of Students and Practitioners. 
Whitridge Williams, Professor of Obstetrics Johns Hopkins University. 
Obstetrician-in-Chief to the Johns Hopkins Hospital; Gynecologist to 
Union Protestant Infirmary, Baltimore, Md. D. Appleton and Co., 1912. 
Syphilis is one of the most important complications of pregnancy as it is 
one of the most frequent causes of repeated abortion, or premature labor. 
The influence of syphilis upon pregnancy differs materially, and three classes 
of cases are distinguished, according as infection has taken place: 1—before 
pregnancy; 2—at the time of conception; or, 3—during pregnancy. When 
inoculation with the specific poison has occurred before conception the dis- 
ease nearly always gives rise to abortion or premature labor, more frequently 
the latter. Le Pileur obtained a striking illustration of the disastrous effects 
of syphilis from a study of the reproductive histories of 130 women, before Prostitution and Venereal Diseases 
215 
and after its inception, 3.8 per cent, of the children being born dead before, 
as compared with 78 per cent, after infection. In premature labor due to 
syphilis the child is usually dead when it comes into the world; less fre- 
quently it is born alive with definite manifestations of the disease. When the 
mother is suffering from the affection at the time of conception the offspring 
is always syphilitic. P. 495. 
THE PRACTICE OF OBSTETRICS. In Original Contributions by Amer- 
ican Authors. Edited by Reuben Peterson, A.B., M.D., Professor of 
Obstetrics and Gynecology in the University of Michigan, Ann Arbor, 
Mich.; Obstetrician-in-Chief to the University of Michigan Hospital. 
Lea Bros, and Co., Philadelphia and Nezv York, 1907. 
In marked contrast to the comparatively slight interference of pregnancy 
with the course of syphilis is the decidedly unfavorable influence of syphilis 
upon the course of pregnancy. Syphilis, more often than any other infectious 
disease, is responsible for a great variety of pathological changes in the fetus 
placenta and uterus, and for the premature interruption of gestation. Stat- 
istics show that the fetal mortality in this disease averages 50%. This figure 
is lower than that given in the preceding paragraphs for some of the acute 
infectious diseases, but considering the prevalence of syphilis among all civi- 
lized and uncivilized races, it is obvious that the effect of this disease deserves 
a most careful consideration, not only from the medical, but also from the 
economic and sociologic point of view. Fournier gives the fetal mortality for 
cases in which the maternal infection occurs simultaneously with fecundation 
as 75%, the fetal morbidity being above 91%. Page 347. (Hugo Ehrenfest, 
M.D.) 
A TEXT BOOK OF OBSTETRICS. Barton Cooke Hirst, M.D., Professor 
of Obstetrics in the University of Pennsylvania; Gynecologist to the How- 
ard and Orthopaedic and Philadelphia Hospitals, etc. W. B. Saunders 
Co., Philadelphia and London, 1912. 
Syphilitis as the most frequent cause of habitual death of the fetus must 
be excluded before another cause is sought. P. 352. 
Of 657 pregnancies in syphilitic women collected by Charpentier 35% 
ended in abortion, and of the children that went to term a large number were 
still-born. Of 100 conceptions in syphilitic women only seven children were 
alive a year later. P. 333. 
PRACTICAL OBSTETRICS. Thomas Watts Eden, Obstetrical Physician 
and Lecturer on Midwifery and Gynecology, Charing Cross Hospital; 
Consulting Physician to Queen Charlotte’s Lying-in-Hospital; Surgeon to 
In-Patient Hospital for Women. 4th Edition. C. V. Mosby Co. 1915. 
Of all the systematic causes of abortion however, the most important in 216 
The Case for Birth Control 
all respects is syphilis. In all probability more abortions are due to this disease 
than to any other cause. P. 220. 
It will be clear from this enumeration of the conditions which cause it 
that abortion is not an uncommon event. From some recent statistics pre- 
sented by Professor Malins to the Obstetrical Society of London it appears 
that in this country about 16% of pregnancies terminate by abortion, i.e., one 
abortion occurs to every five births of viable children, and further, it appears 
that abortion is nearly twice as frequent among the classes from which hos- 
pital patients are drawn as among the well-to-do. Women who are the sub- 
jects of syphilis or Bright’s disease often sustain a succession of abortions 
without carrying any pregnancy to term. P. 221. 
THE PRINCIPLES AND PRACTICE OF OBSTETRICS. Jos. B. De 
Lee, M.D., Professor of Obstetrics at the Northwestern University Medical 
School; Obstetrician to the Chicago Lying-in-Hospital and Dispensary 
and to Wesley and Mercy Hospitals, etc. W. B. Saunders Co. 1913. 
Premature labor is produced by the same factors that bring on abortion, 
but syphilis plays the most common role here, it being estimated that from 50% 
to 80% of the cases are thus caused. Next comes nephritis. Habitual abor- 
tion means that successive pregnancies are interrupted at the same period of 
development. Syphilis is usually found as the active factor and more especi- 
ally in miscarriages of the later months. Each successive abortion occurs at 
a later period until a living child is born, but it perishes from congenital 
syphilis, and finally the disease has become so attenuated that a viable child 
is born. P. 419. 
Obstetricians should constantly be on the alert for this protean disease. 
Its baneful action is often discovered when least expected and it spreads its 
blight on all three individuals concerned in the procreation of the species, 
often being transmitted to the second generation. Ricord says that in Paris 
one in eight is syphilitic, and while in America conditions are better, the disease 
is not rare and in its lesser manifestations quite common, though often not 
diagnosed. P. 482. 
Interruption of gestation is the commonest symptom (of syphilis) and 
von Winckel found 61% fetal mortality. P. 483. 
THE PRACTICE OF OBSTETRICS. Designed for the use of Students 
and Practitioners of Medicine. J. Clifton Edgar, Professor of Obstetrics 
and Clinical Midwifery in the Cornell University Medical College; Visit- 
ing Obstetrician to Bellevue Hospital, New York City; Surgeon to the 
Manhattan Maternity and Dispensary; Consulting Obstetrician to the 
New York Maternity and Jewish Maternity Hospitals. 5th Edition Re- 
vised. P. Blakistons & Co., Philadelphia. 
This (syphilis) is one of the most common causes of abortion. P. 321. Prostitution and VenerEae Diseases 
217 
The causes of interrupted pregnancy may be placed in three classes. The 
maternal causes are divisible into systemic and the local. The systemic causes 
include obesity, marriages of consanguinity, pregnancies in rapid succession, 
etc., and the toxemia of kidney insufficiency. The local causes include all cases 
of acute and chronic pelvic congestion. P. 332. 
Chief among the paternal causes is syphilis, tuberculosis, extreme youth 
or old age, great constitutional depression, exhaustion from any cause. P. 333. 
MEDICAL GYNECOLOGY. Howard Kelly, A.B., M.D., LLD., F.R.C.S., 
Professor of Gynecological Surgery in Johns Hopkins University, and 
Gynecologist to the Johns Hopkins Hospital; Fellow of the American 
Gynecology Society; Honorary Fellow of the Edinburgh Obstetrical So- 
ciety; Hon. Fellozv Royal Academy of Medicine in Ireland; Fellow British 
Gynecology Society, etc., etc., etc. D. Appleton & Co., New York and 
London, 1912. 
The susceptibility of syphilis to hereditary transmission is a fundamental 
character of the disease. It may be transmitted to the offspring directly by 
the infected sperm of the father, or from the infected ovule of the mother at 
the time of impregnation, or the infective principle may be conveyed through 
the medium of the utero-placental circulation during the course of pregnancy. 
P. 432. 
Whether the infection is communicated through the sperm solely, the 
ovule, or the utero-placental circulation, the uterine death of the fetus is the 
most habitual expression of hereditary syphilis. Hereditary syphilis is one 
of the most common causes of abortion. P. 434. 
Clinical observation shows most conclusively that certain dystrophies and 
organic defects in the subjects of hereditary syphilis may be transmitted to the 
third generation. P. 436. 
While we cannot conclude that syphilis is transmitted in its essential 
nature as a virulent contagious disease, to the third generation, yet it is well 
known that heredo-syphilis kills the product of conception, or transmits to the 
survivor an impaired vitality with various dystrophies, and thus constitutes a 
chief factor in the physical, mental and moral degeneration of the race. From 
an exhaustive study of heredo-syphilis, Tarnowsky concludes that syphilis has 
an incomparably more fatal influence upon the species and on society than on 
the individual. P. 437. 
PRINCE A. MORROW, M.D. Eugenics and Racial Poisons. Pamphlet 
published by the Society of Sanitary and Moral Prophylaxis, 105 W. 40th 
St., New York. 1912. 
Syphilis is the only disease transmitted to the offspring in full virulence, 
killing them outright, or blighting their normal development. When the 218 
The; Case: for Birth Control 
father alone is infected the mortality is about 38%. When the mother also 
becomes infected the mortality averages from 60% to 80%. Fully 1/3 of all 
infected children die within the first six months. Even when the subjects of 
inherited syphilis successfully run the gauntlet of diseases incident to infancy 
and childhood they do not always escape the effects of the parental disease. 
They are subject to various organic defects or stigma of degeneration, as 
they are termed. A final result of hereditary syphilis is the inability to pro- 
create healthy children. If the subjects of inherited syphilis grow up and 
marry they are liable to transmit the same class of organic defects to the 
third generation. 
FEWER AND BETTER BABIES, OR THE LIMITATION OF OFF- 
SPRING. Wm. J. Robinson, M.D., Chief of the Department Genito- 
urinary Diseases and Dermatology, Bronx Hospital and Dispensary; 
Fellow of the American Medical Association and of the New York Ac- 
ademy of Medicine. 
There are thousands of syphilitic men and women who are perfectly safe 
as far as their partner is concerned, but are not safe enough to become parents. 
They cannot infect, but they must not give birth to children for fear that the 
children may have the taint in them. The use of preventives settles this prob- 
lem and saves the world from thousands of pitiable hereditary syphilitics. 
P. 126. 
MEDICAL GYNECOLOGY. Howard A. Kelly. 
Two fundamental characteristics, contagiousness and susceptibility of 
hereditary transmission, give to syphilis an altogether special importance in 
relation to marriage. The statement has been made that syphilis constitutes 
a far greater danger to Society and the race than to the individual. The chief 
significance of syphilis as a racial danger comes from its hereditary effects. 
In addition, hereditary syphilis undoubtedly creates a terrain, or soil, favor- 
able for the reception and germination of tubercle bacilli, and perhaps other 
bacilli. It does this by impoverishing the organism and diminishing the cap- 
acity of resistance against microbic invasion. From the view point of race 
perpetuation, syphilis is antagonistic to all the family represents in our social 
system. The essential aim of marriage is not simply the procreation of chil- 
dren, but of children born in conditions of vital health and physical vigor. 
The effect of syphilis is to so vitiate the procreative process as to produce abor- 
tions, or else a race of inferior beings, endowed with defects and infirmities 
and unfit for the struggle of life. It is this pernicious effect of syphilis upon 
the offspring which gives to the disease a dominant influence as a factor in 
the degeneration and depopulation of the race. P. 444. 
When a married man has syphilis the first indication is to prevent con- 
tamination of his wife, the second is to guard against pregnancy. The inter- Prostitution and Venereal Diseases 
219 
diction of pregnancy should be absolute until time and treatment have exerted 
an attenuating and curative influence upon the diathesis. P. 448. 
A consultation of the works of most authorities shows them to agree that 
the frequency of abortion to births at full term is from one in five or six to 
one in ten. P. 453. 
SOCIAL DISEASES AND MARRIAGE. Social Prophylaxis. Prince 
Morow, M.D., Emeritus Professor of Genito Urinary Diseases in the 
University and Bellevue Hospital Medical College, New York; Surgeon 
to the City Hospital; Consulting Dermatologist to St. Vincent's Hospital, 
etc. Lea Bros. & Co., New York and Phil., 1904. 
The influence of inherited syphilis is manifest in the production of various 
dystrophies, malformations, and lesions of important organs, it seriously com- 
promises the physical development, mental vigor and vital stamina of the 
descendants and constitutes a harmful factor in the degeneration of the race. 
The social aim of marriage is not simply the production of children who are 
to continue the race, but of children born in conditions of vitality and physical 
health fit to produce a race well-formed and vigorous, not to procreate beings 
malformed and stamped with physical and mental infirmity, destined to early 
death, or to drag out a miserable existence of invalidism. P. 21. 
The statistics of European observers which have been collected from 
both private and hospital practice show in a most positive manner the noxious 
influence of syphilis upon the offspring. An analysis of these statistics taken 
from all quarters and aspects of the social condition of the parents show that 
when both parents are infected the mortality is 68 per 100. P. 27. 
No other disease is so susceptible of hereditary transmission, so pro- 
nounced in its influence, and so fatal to the offspring. 
While death in utero may occur as the most habitual expression of heredi- 
tary syphilis, its lethal influence is not limited to the period of intra-uterine 
existence. The child may be born alive, but in many cases the sentence of 
death is not commuted, it is simply reprieved, it may be for a few months, 
weeks, or only days. P. 212. 
THE WORLD’S SOCIAL EVIL. A Historical Review and Study of the 
Problems Relating to the Subject. Wm. Burgess. With Supplementary 
chapter on a constructive policy by Judge Harry Olson, Chief Justice 
Municipal Court, Chicago. Saul Bros., Publishers, Chicago, 1914. 
Based upon statements, experiences and opinions of physicians, public 
officials and other responsible persons, 50% to 80% of all men between the 
ages of 18 and 30 years contract gonorrhea. 10% to 18% of the male popu- 
lation contract syphilis. 40% to 60% of all operations upon women for di- 
seases of the generative organs result from gonorrheal infection. 80% of the 220 
The Case eor Birth Control 
inflammatory diseases peculiar to women are the result of gonorrheal infec- 
tion. A large per cent, some say one half, of still born and premature deaths 
of children is due to syphilis. 25% to 35% of all cases of insanity are caused 
by syphilis contracted years before. 15% to 20% of all blindness is attri- 
buted to these diseases. P. 159. 
A CONSTRUCTIVE POLICY WHEREBY THE SOCIAL EVIL MAY 
BE REDUCED. Harry Olson. 
The large group of mentally retarded persons who may be included in 
the term “sub-normal” number in this country, according to the best authori- 
ties about 300,000. An important distinction must be made between two 
groups of the defective classes, those who may, and those who should not 
enjoy social privileges as members of the community. From a racial and 
eugenic point of view the inborn, or heredity defectives are by far the most 
important because the defect is germinal and therefore transmissible to the 
offspring. This class forms 75% or more of the defective classes. When so 
many as 75% of the feeble-minded are such by reason of germinal or here- 
ditary taint, and since perhaps 50% of the women of the underworld are 
subnormal, it becomes at once apparent that not only in order to reduce the 
number of women in public prostitution, but also to protect the race itself, 
we must adopt other methods of eliminating vice than those now employed. 
P. 358-359. 
PROCEEDINGS OF THE NATIONAL CONFERENCE ON RACE 
BETTERMENT. January 8-12, 1914. Published by the Race Better- 
ment Foundation. Edited by the Secretary. 
Statistical Studies. The Significance of a Declining Birth Rate. Fred- 
erick L. Hoffman, Statistician of the Prudential Insurance Company, Newark, 
N. J. 
From an economic and social point of view a low birth rate and a low 
death rate would unquestionably be more advantageous than the opposite 
condition, which involves much needless waste of human energy and pecuniary 
expenditure. For reasons which require no discussion, every civilized country 
desires a normal increase in population, though a high degree of social and 
economic well-being is not at all inconsistent with even a stationary population 
condition such as for some years past has prevailed in France. P. 23. 
All the available statistical information seems to justify the conclusion 
that the world’s population in general, and of the more civilized countries in 
particular is increasing at the present time at a more rapid rate than in earlier 
years—a condition largely the result of a persistent and considerable decline 
in the birth rate. P. 28. Prostitution and Venereal Diseases 
221 
The important causes of death which have increased during the five 
years ending 1910, as compared with the previous five years, are briefly the 
following:—Syphilis increased from 4.1 to 5.4, per 100,000 of population. 
Cancer, and other malignant tumors from 11.5 to 13.7; locomotor ataxia, and 
other diseases of the spinal cord from 7.3 to 8.4; all diseases of the circulatory 
system combined from 161.2 to 171.7; ulcers of the stomach from 2.9 to 3.6; 
diarrhea and enteritis under two years, from 89.0 to 96.2; diseases of the 
puerperal state considered as a group from 14.2 to 15.5; malformations, chiefly 
congenital, from 12.2 to 14.9; diseases of early infancy, chiefly congenital 
debility and premature births, from 73.9 to 75.0. P. 45. 
GONNORRHEA 
THE PRACTICE OF OBSTETRICS. In Original Contributions by Amer- 
ican Authors. Edited by Reuben Peterson, A.B., M.D. Lea Bros. & 
Co., Phil, and New York. 1907. 
The reciprocal relation of gonorrhea and pregnancy is most unfavorable. 
Gonorrhea exerts a very unfavorable effect upon pregnancy and is responsible 
for a large number of abortions in the early months. Finally the gonococcus 
is a great source of danger to the fetus whose eyes may become affected 
during his passage through the diseased maternal parts. P. 373. 
THE PRINCIPALS AND PRACTICE OF OBSTETRICS. Jos. B. De 
Lee, M.D., Professor of Obstetrics at the Northwestern University Medi- 
cal School; Obstetrician to the Chicago Lying-in-Hospital and Dispensary 
and to Wesley and Mercy Hospitals, etc. W. B. Saunders Co. 1913. 
Abortion is probably often the result of gonorrhea, acute or chronic. 
Chronic endometritis is most often the result of gonorrhea. P. 516. 
THE SEXUAL LIFE OF WOMAN IN ITS PHYSIOLOGICAL, BIO- 
LOGICAL AND HYGIENIC ASPECTS. E. Heinrich Kisch, Pro- 
fessor of the German Medical Faculty of the University of Prague, Physi- 
cian to the Hospital and Spa of Marienbad; Member of the Board of 
Health, etc. Translated by M. Eden Paul, M.D. Rebman Co., New 
York. 
The physician should lend his skilled assistance in producing facultative 
sterility only when his own special scientific knowledge leads him to consider 
this urgently necessary. A woman’s life and well being must appear to him 
of greater importance than the existence, or non-existence of a possible infant. 
That this view is morally sound is shown by the fact that public opinion justi- 
fies the accoucheur in the destruction of a living child when the mother’s life 
is in danger. P. 395. 222 
The Case eor Birth Control 
EUGENICS AND RACIAL POISONS. Prince A. Morrow, M.D., Emer- 
itus Professor of Genito Urinary Diseases in the University and Bellevue 
Hospital Medical College, New York; Surgeon to the City Hospital; Con- 
sulting Dermatologist to St. Vincent’s Hospital, etc. Lea Bros. Co., New 
York and Philadelphia, 1904. 
While the gonococcus is not transmissible through heredity it carries with 
it serious infective risks to the offspring. Fully 80%, and some authorities 
declare practically all of the blindness of the new born is caused by the gonoc- 
occus. CHAPTER VIII 
OTHER TRANSMISSIBLE DISEASES AND PAUPERISM 
When authorities prohibit marriage for the unfit, they have in mind the 
probable fruits of such marriage. Women suffering from the diseases men- 
tioned in this chapter give birth to children mentally and physically inferior, 
likely to sink into pauperism and certain to be in some way a burden upon 
society. If physicians were free to instruct parents how to prevent concep- 
tion, the reproduction of their kind by defective and diseased parents living 
outside of institutions would be eliminated as a social problem. 
INSANITY 
DR. S. ADOLPHUS KNOPF IN THE SURVEY FOR NOVEMBER, 1916 
That insanity, idiocy, epilepsy and alcoholic predisposition are often trans- 
mitted from parent to child is now universally admitted and corroborated by 
every-day experience and by an abundance of statistics. Countless are the 
millions of dollars expended for the maintenance of these mentally unfit. The 
state of New York alone spends $2,000,000 annually for the care of its insane. 
Whether sterilization of these individuals would be the best remedy is a 
question still open for discussion. The constitutionality of the procedure is 
doubted by some of our legal authorities. Segregation is resorted to in the 
meantime with more or less rigor according to state laws. Every year, how- 
ever, many of the individuals who had been committed to institutions for the 
treatment of mental disorders are discharged as cured. They are allowed to 
procreate their kind. Would it not be an economic saving if at least the in- 
dividuals whose intelligence has been restored were instructed in the preven- 
tion of bringing into the world children who are most likely to be mentally 
tainted and to become a burden to the community? 
Of approximately every 500 persons in the United States in 1910, there 
was one an inmate of an insane asylum. 
The exact figures expressed in a recent report (Hill, Joseph A. Report 
on the Insane in the United States, Bureau of the Census, Department of 
Commerce) that in a typical community of 200,000 persons, equally divided 
as to sex, 208 of the males and 200 of the females would be found in the 
insane asylums. In the course of a year 72 males and 60 females would be 
admitted to the asylums. 
In 1880 the total of inmates in insane asylums in the United States in- 224 
The; Case eor Birth Control 
eluded 20,695 males and 20,307 females. In 1910, thirty years later, the 
number of male inmates had increased to 98,695 and the number of female 
inmates to 80,096. The excess of men among admissions in 1910 indicated 
a still further increase in the proportion, namely, 128 males to 100 females. 
BEING WELL-BORN. An Introduction to Eugenics. Michael F. Guyer, 
Prof. Zoology, University of Wisconsin. Bobbs-Merrill Co., Indian- 
apolis, Ind. 1916. 
The records of the inheritance of insanity, imbecility, feeble-mindedness 
and other forms of nervous and mental defects are truly startling. Active 
researches in this field have been in progress now for several years, and as 
each new set of investigations comes in the tale is always the same. It is 
questionable if there is a single genuine case on record where a normal child 
has been born from a union of two imbeciles. Yet the universal tendency is 
for defective to mate with defective. Davenport gives a list of examples, be- 
ginning with such a one as this: “A feeble-minded man of thirty-eight has a 
delicate wife who in twenty years has borne him nineteen defective children.” 
Little wonder, in the light of such facts as these, that the number of degen- 
erates is rapidly increasing in what are called civilized countries. But it may 
be urged, these are exceptional cases, there is surely no considerable number 
of mental defectives who are married. Let us look at the available facts. 
In Great Britain in 1901, of 60,000 known feeble-minded, imbeciles and idiots, 
19,000 were/narried, and in the same year, of 117,000 lunatics, 47,000 were 
married; that is a sum total of 66,000 mentally defective individuals were 
legally multiplying, or had had the opportunity to multiply their kind, to say 
nothing of the unmarried who were known to have produced children. 
In the State of Wisconsin I note from the tenth Biennial Report of the 
Board of Control that of 574 patients admitted to the Northern Hospital for 
the Insane during the year from July 1st, 1908 to June 30th, 1909, 274 were 
married, and 29 others were known to have been married; this is a total of 
303 out of 574, considerably over half. At the Wisconsin State Hospital for 
the Insane we find the conditions are no better, for out of 499 admitted in the 
year of 1909-10, 208 were married and 65 others had at some time been mar- 
ried, or a total of 273 out of 499. There is every reason to believe that con- 
ditions are approximately similar in other states. P. 231-232. 
One of the most disquieting facts in the situation in most states is that 
many patients—an average of approximately 1,000 a year, in Wisconsin for 
example—are on parole, subject to recall. This means that although it is 
recognized that these patients are likely to have to be returned to the asylum 
or hospital, little or no restraint in the meantime is placed on their marital 
relations. P. 234. Other Transmissible Diseases 
225 
SOCIAL ASPECTS. Wm. E. Kellieott. 
In the U. S. the census of 1880 reported 40,942 insane in hospitals, and 
51,017 not in hospitals, a total of 91,959 known insane. In 1903 the number 
in hospitals had increased to 150,151. The number not in hospitals was not 
known and cannot be determined accurately, but it is conservatively estimated 
as certainly not less than 30,000, and probably it is far greater than this. But 
taking a total of 180,000 known insane as a conservative figure, the ratio of 
known insane in the total population was 225 per 100,000 in 1903, as compared 
with 183 per 100,000 in 1880. P. 33. 
The latest census reports for the U. S. give data relative to the depend- 
ents and defective in institutions. Insane and feeble-minded, at least 100,000; 
paupers in institutions 80,000, 2/3 of whom have children and are also physi- 
cally and mentally deficient: prisoners 100,000; juvenile delinquents 23,000 in 
institutions; the number cared for in hospitals, dispensaries, homes of various 
kinds in the year 1904 was in excess of 2,000,000. From these figures we 
get a rough total of nearly 3,000,000. The fore-going are representative 
data:—they are published by the volume. It is always the same story—rapid 
increase of the unfit, defective, insane, criminal, slow increase, even decrease, 
of the normal and gifted stocks. It is with such conditions in mind that 
Whetham writes: “This suppression of the best blood of the country is a new 
disease in modern Europe; it is an old story in the history of nations, and 
has been the prelude to the ruin of states and the decline and fall of empires. 
P. 35. 1 , j 
EUGENICS RECORD BULLETIN. No. 5. A Study of Heredity of In- 
sanity in the Light of the Mendelian Theory. A. J. Rosanoff, M.D., and 
Florence I. Orr, B.S. Reprinted from American Journal of Insanity. 
Vol. XXVIII.. .1911. Cold Spring Harbor, N. Y. 
In the report of the year ending September 30th, 1909, the New York 
State Commission in Lunacy gives the number of insane patients in state 
hospitals and private institutions as 31,540, or one to 276 in the general popu- 
lation. This figure does not include the inmates of institutions for the feeble- 
minded and for epileptics, it does not include the neuropathic subjects who 
find their way into prisons, reformatories, almshouses, dispensaries, hospitals 
for incurables, general hospitals, neurological clinics, etc., and above all, it 
does not include the many neuropathic subjects whose infirmities are latent, or 
of such nature as not to incapacitate them for ordinary occupations and life 
at large. P. 245. 226 
The Case for Birth Control 
EUGENICS RECORD OFFICE. Bulletin No. 10 A. Report of the Com- 
mittee to study and to report on the best practical means to cut off the de- 
fective germ-plasm in the American population. The scope of the Com- 
mittee's work. By Harry H. Laughlin, Secretary to the Committee. 
Cold Spring Harbor, N. Y. 1914. 
According to the last census, 1910, .914% of the total population, or 
841,244 persons, were inmates of institutions in the anti-social and the un- 
fortunate classes in the U. S. Besides these persons who have been com- 
mitted to institutions, there are many others of equally unworthy personality 
and hereditary qualities, who have, through the caprice of circumstances never 
been committed to institutions. In so far as the defective traits of the mem- 
bers of these varieties are inborn, they are to be cut off only by cutting off the 
inheritance lines of the strains that produce them. This is the natural out- 
come of an awakened social conscience, which is in keeping, not only with 
humanitarianism, but with law and order and national efficiency. Society 
must look upon germ-plasm as belonging to Society, and not solely to the 
individual who carries it. Humanitarianism demands that every individual 
born be given every opportunity for decent and effective life that our civil- 
ization can offer. Racial instinct demands that defectives shall not continue 
their unworthy traits to menace Society. There appears to be no compati- 
bility between the two ideals and demands. P. 15-16. 
/. H. KELLOGG, LLD., M.D., Superintendent of Battle Creek Sanitarium, 
Battle Creek, Mich. 
A careful study of the returns of the Registrar General of England, ac- 
cording to Dr. Tredgold, an eminent English authority shows that out of 
every 1,000 children born to-day, as many infants die from “inate defects of 
constitution” as 50 years ago, and this notwithstanding that the total death 
rate of infants has been diminished nearly 1/3. The increase of insanity, is 
cited by Dr. Tredgold, as another evidence of race degeneracy. While the 
increase of the population of England and Wales in 52 years has been 85.8%, 
the increase of the certified insane has been 262.2%. At present there is one 
insane person to 275 of the normal population of England and Wales. Tred- 
gold shows that mental unsoundness, lunacy, idiocy, imbecility and feeble- 
mindedness may be traced to hereditary influence in 90% of the cases. Mr. 
David Heron and others have shown that while there has been a marked de- 
cline in the birth rate in the population in general, the diminution is almost 
entirely confined to the healthy and thrifty class. In a section of population 
numbering a million and a quarter persons, thrifty and healthy artisans, the 
decline in the birth rate in 24 years, 1889—1904 was over 52%, or three 
times that in England and Wales as a whole. Study of a large number of 
families of the working class of incompetent and parasitic character found 
that the average number of children to the family was 7.4, while in thrifty Other Transmissible Diseases 
227 
and competent working families, the number was 3.7. In other words, the 
incompetent and defective classes are multiplying much more rapidly than 
are% the competent and efficient. P. 440. 
THE INCREASE OF INSANITY. lames T. Searcy, A.B., M.D., LED., 
Superintendent Alabama Hospitals for Insane. First National Conference 
on Race Betterment. January, 1914. 
The population of the State of Alabama, according to the census during 
the ten years which the census includes, insanity increased 16% ; the admis- 
sions into the insane hospitals increased 45%. These are appalling figures, 
and we can parallel them all over the U. S., not like them exactly in each state, 
for they differ. The general population of the U. S. increased 18%, and that 
of the insane hospitals increased 28% during the years of the census. P. 167. 
EPILEPSY 
THE PRACTICE OF OBSTETRICS. Joseph De Lee, M.D. 
Epilepsy may practically be regarded as an inhereditary affection, and 
children of one subject to this disorder are almost sure to be epileptic. Under 
no circumstances should parents who are both epileptics bring children into 
the world. 
THE PRACTICE OF OBSTETRICS. In Original Contributions by Amer- 
ican Authors. Edited by Reuben Peterson, A.B., M.D., Prof, of Obste- 
trics and Gynecology in the University of Michigan, Ann Harbor, Mich.; 
Obstetrician and Gynecologist-in-Chief to the University of Michigan 
Hospital. Lea Bros. & Co., Phil, and New York. 1907. Chapter XIX. 
Marriage should always be discouraged on account of the marked ten- 
dency of epilepsy to be transmitted to the offspring. In all grave cases, mar- 
riage, or new impregnation, should be prohibited. P. 363. (Hugo Ehren- 
fest, M.D.) 
ALCOHOLISM 
PARENTHOOD AND RACE CULTURE. An Outline of Eugenics. C. 
W. Saleeby, M.D., Ch.B., F.Z.S., F.R.S:, Edinburgh; Fellow of the Ob- 
stetrical Society of Edinburgh; Member of Council of the Eugenics Edu- 
cation Society; of the Psychological Society, and of the National League 
for Physical Education and Improvement; Member of the Royal Institu- 
tion and of the Society for the Study of Inebriety, etc., etc. Cassell & Co., 
Ltd., London, N. Y., Toronto and Melbourne. 1909. 
A foremost authority, Dr. F. W. Mott, has independently reached the 
same conclusion as Dr. Branthwaite, that the chronic inebriate comes as a rule 228 
The Case for Birth Control 
of an inherently tainted stock. Dr. Mott, however, reminds us that if alcohol 
is a weed killer, preventing the perpetuation of poor types, it is probably even 
more effective as a weed producer. Professor David Ferrier, the great pioneer 
of brain localisation, in reference to these people speaks of the “risk of propa- 
gation of a race of drunkards and imbeciles.” Dr. J. C. Dunlop, Inspector 
under the Inebriates Act, Scotland, states that his experience leads him to 
precisely the same conclusion as that of Dr. Branthwaite. Dr. A. R. Urquhart, 
an Asylum authority, affirms that chronic inebriety is largely an affair of 
habit, is a symptom of mental defect, disorder, or disease. Dr. Fleck, another 
authority, says, “It is my strong conviction that a large percentage of our 
mentally defective children, including idiots, imbeciles and epileptics, are the 
descendants of drunkards. Mr. Me Adam Eccles, the distinguished surgeon 
agrees; so does Dr. Langdon Down, physician to the National Association for 
the Welfare of the Feeble-minded; so does Mr. Thos. Holmes, the Secretary 
of the Howard Association. 
MARRIAGE AND GENETICS. Laws of Human Breeding and Applied 
Eugenics. Chas. A. L. Reed, M.D., F.C.S.; Fellow of the College of 
Surgeons of America; Member and former president of the American 
Medical Association; Professor in the University of Cincinnati. The 
Galton Press, Cincinnati, Ohio. 
The present demand for alcohol is generally the demand of the system 
for something with which to make up for some persistent defect. In other 
words, alcoholism is the sign and index of some form of degeneration. Thus 
the degeneracy that finds expression in alcoholism in one generation may be 
manifested in the next in the form of epilepsy, feeble-mindedness, insanity, 
immorality, or criminality. Unfortunately, alcoholism does not seem to lessen 
the fecundity of its victims. The quality of their progeny is, however, pro- 
gressively lowered. It is due to the combined influence of transmitted degen- 
eracy and the pernicious effect of environment. As a genetic factor, alco- 
holism, considered in its immediate relation to the marriage state may be sum- 
marised as follows:— 
1— The chronic alcoholist generally develops lowered sexual efficiency. 
2— General failure of sexual power, associated with strong desire, gener- 
ally manifested by alcoholics, often results in sexual promiscuity, associated 
with perversion. 
3— Progressive alcoholism destroys the normal psychic type and thus 
breaks up family ties. 
4— feneral efficiency of alcoholics tends to pauperism and crime. 
5— Lowered general resistance of alcoholics makes them the easier prey 
of infections and shortens their expectancy of life. Other Transmissible Diseases 
229 
6—Alcoholism is a germinal defect, the degeneracy underlying which is 
transmitted in some form to 100% of the progeny of two alcoholic parents. 
Marriage with or between degenerates of the alcoholic type is advised 
against and should be prohibited by law. P. 125-126. 
Pauline Tarnowsky in Etudes Anthrope metriques sur le Prostitutees 
1887 gives figures derived from measurements of fifty prostitutes in Petro- 
grad in which she found four-fifths of her cases were offspring of alcoholic 
parents while one fifth were the last survivors of very large families. 
THE PRACTICE OF OBSTETRICS. In Original Contributions by Amer- 
ican Authors. Edited by Reuben Peterson, M.D. 
A chronic state of intoxication may be found in patients (Mothers) with 
such bad habits as alcoholism, morphinism, cocainism, etc., and in sufferers of 
trade poisoning, plumbism, nicotism of workers in tobacco factories, etc. Most 
of these diseases are characterized by a tendency to abortion and a high in- 
fantile mortality and morbidity. P. 368. 
It is generally admitted that the effect of chronic alcoholism upon preg- 
nancy is most harmful. On account of the frequency with which drunkards 
are afflicted with venereal diseases, especially syphilis, it is almost impossible 
to obtain reliable statistics and exact figures, but the fact has been established 
that chronic alcoholism predisposes the woman to abortion, and that the chil- 
dren of dipsomaniac parents show a strikingly large percentage of malforma- 
tions and mental abnormalities, especially imebcility and epilepsy. P. 370 
(Hugo Ehrenfest, M.D.) 
THE PATHOLOGY OF THE FETUS. Alfred Scott Warthin, M.D. (The 
Practice of Obstetrics, in original Contributions by American Authors, 
Ed. by Reuben Peterson, M.D.) 
Of the antenatal treatment of fetal diseases we at present know little or 
nothing, but there can be no doubt that a wonderful field is here offered to 
the medicine of the future. According to our present knowledge such ger- 
minal and fetal therapeutics must be chiefly in the line of prevention. We 
are already in a position to apply some knowledge toward this end. The 
effects upon the fetus of intoxications, such as plumbism, alcoholism, etc., 
may be avoided. The production of syphilitic offspring may be restiicted, 
and our knowledge of the later effects upon the fetus of certain diseases, or 
pathologic states of one or both parents may be utilized toward the bringing 
'nto existence of progeny under such conditions as to escape such evils. Our 
knowledge of heredity, of morbid conditions and predispositions should also 
be brought to bear upon the question of marriage and fitness to produce 230 
The; Case: for Birth Control 
healthy children. Moral, as well as physical considerations should here be 
gravely weighed. The health of parents, the hygiene of pregnancy through- 
out its entire course, etc., are important factors in the improvement of the 
race, to which the coming civilization and the new medicine must give in- 
creasing attention. P. 535. 
THE SEXUAL LIFE OF WOMAN IN ITS PHYSIOLOGICAL, BIO- 
LOGICAL AND HYGIENIC ASPECTS. E. Heinrich Kisch. Reb- 
man Co., New York. 
A woman with a tendency to alcoholism should under no circumstances 
be allowed to marry. In the cases, fortunately rare, in which the drink craving 
exists in women, marriage is even more undesirable than it is in the case of 
men similarly afflicted, for the female drunkard is in a position in which she 
can mishandle and neglect her children throughout the entire day. P. 258. 
RASSENVERBESSERUNG. Translated from the Dutch of Dr. J. Rutgers. 
Second Edition. Dresden, 1911. 
Pelman examined 709 of the 834 descendants of an alcoholic vagrant, 
named Ada Inke, who died in 1740. Among these were found 106 illegitimate 
children, 142 were vagrant beggars, 64 were charity dependents, 181 pros- 
titutes, 96 were tried for various offenses, among these 7 were for murder. 
These descendants during 75 years cost the State 5,000,000 marks. P. 97. 
August Forel, who for years was the psychiatrist at the head of a large 
insane asylum at Zurich, Switzerland, has this to say about the effects of nar- 
cotic poisons and alcohol in particular: “The offspring tainted with alcoholic 
blastophthoria suffer various bodily and physical anomalies, among which are 
dwarfism, rickets, a predisposition to tuberculosis and epilepsy, moral idiocy 
in general, a predisposition to crime and mental diseases, sexual perversions, 
loss of suckling in women, and many other misfortunes. But what is of much 
greater importance is the fact that acute and chronic alcoholic intoxication de- 
teriorates the germinal protoplasm of the procreators.” 
MICHAEL F. GUYER, Ph.D., Professor of Zooligy, University of Wis- 
consin in “Being Well Born.” 
In an investigation on the effects of parental alcoholism on the offspring, 
Sullivan (Journal of Mental Science, Vol. 45, 1899) gives some important 
figures. To avoid other complications he chose female drunkards in whom no 
other degenerative features were evident. He found that among these the 
percentage of abortions, still-births and deaths of infants before their third 
year was 55.8% as against 23.9% in sober mothers. In answer to the objec- Other Transmissible Diseases 
231 
tion that this high percentage may be due merely to neglect, and not to im- 
pairment of the fetus by alcoholism, he points out the fact, based on the his- 
tory of the successive births, that there was a progressive increase in the 
death-rate of offspring in proportion to the length of time the mother had 
been an inebriate. P. 169. 
A TEXT BOOK OF OBSTETRICS. Barton Cooke Hirst, M.D., Professor 
of Obstetrics in the University of Penn.; Gynecologist to the Howard, 
the Orthopaedic and the Phil. Hospitals, etc. 7th Edition. W. B. Saun- 
ders Co., Phil, and London, 1912. 
The effect of chronic diseases of the mother upon the fetus. Women af- 
fected with tuberculosis, cancer, or chronic malarial poisons may give birth 
to a succession of dead children. P. 353. 
Tetal mortality exceeds that of any other period of life. For every four 
or five labors there is one abortion, and if to this number is added still-births 
the proportion of fetal deaths to living births is larger. P. 332. 
THE DISEASES OF SOCIETY AND DEGENERACY. G. F. Lydston, 
M.D. 
That a multiplicity of children in poverty-stricken families often impells 
to abortion, is evident. The necessary evils of our prohibitive laws and ethics 
bearing upon illegitimacy, are obvious; viz: 
First, and worst, is infanticide, committed usually before, but only too 
often after birth. In the latter category I would place abandoned children 
who die of exposure or starvation, and the bulk of mortalities in foundling 
asylums and for baby farms. The social ostracism placed upon the mother is 
a prime factor in this child’s murder. Condemnation and shame are her’s if 
she allows nature to take its course, and the penalty of infanticide stares her 
in the face if she interferes with the conception. A rarely anomalous state 
of affairs this. 
Second—The brand of infamy placed upon the unborn child, from which 
only its murder can save it. 
Third—The prostitution or suicide of the woman who is found out. 
Branded with ignominy from the moment of conception, a burden to 
society, and a still greater burden to its parent, or parents from the moment of 
its birth, with no systematic endeavor on the part of society to prevent its 
growing up a criminal, a drunkard, a pauper, a prostitute, or a physical wreck, 
what wonder that many a poor woman’s fingers become too tightly entwined 
around her offspring’s neck. If her motive for the act were always as altru- 232 
The Case for Birth Control 
istic as its consequences, so far as the child’s welfare is concerned, there are 
some clear-minded thinkers in the world who could not be brought to judge 
her harshly. P. 371. 
The rights of the unborn will one day be considered. Until they are so 
considered, and practical efforts made to secure them, we cannot hope for 
much improvement in the prevention of degeneracy. P. 559. 
AMERICAN JOURNAL OF DISEASES OF CHILDREN, November 
1914. Vol. 8, pp. 327-335. Question of Hereditary syphilis as a social 
problem. 
Of all deaths of infants in St. Louis in 1913, 1,070 were illegitimate. 
Of all deaths in infants due to syphilis 1,550 were illegitimate. 
AUGUST FOREL. The Sexual Question. A Scientific, Psychological, Hy- 
gienic and Sociological Study. Translated by C. F. Marshall, M.D., 
F.R.C.S., Late Assistant Surgeon to the Hospital for Diseases of the 
Skin. London. 
The stigma of shame which has branded all illegitimate maternity unfor- 
tunately justifies the many cases of abortion, and even infanticide. Things 
ought to change in this respect, and in the future no pregnancy ought to be a 
source of shame for any healthy woman whatever, nor furnish the least motive 
for dissimulation. P. 411. 
THE SMALL FAMILY SYSTEM. C. V. Drysdale, D.Sc. 
Illegitimacy.—As far as statistics are concerned, the most valuable evi- 
dence is that relating to illegitimacy. The Registrar General’s Reports con- 
tain a useful amount of information upon this point, and give us the number 
of illegitimate births per thousand unmarried women within the fertile period, 
between the ages of 15 and 45. This illegitimacy rate for England and Wales 
is represented in Fig. 13, and it is noticeable that the fall since the year 1876 
has been extremely rapid, much more so in fact than that of the fall in the 
general birth-rate or in the fertility rate of the married women. While the 
general birth-rate has fallen from 36.3 to 25.6 (or by 26.5 per cent), the ille- 
gitimate birth-rate has fallen from 14.6 to 7.9 per thousand unmarried women 
(or by nearly 50 per cent.). This is most striking and satisfactory. An ex- 
treme instance is given in the county of Radnorshire, which is 1870-2 had a 
fertility rate of 308.6 births per 1,000 married women, which sank to 188.7 
in 1909, or by 39 per cent. In the same interval the illegitimate birth-rate 
fell from 41.8 per 1,000 unmarried women to 7.2, or by no less than 83 per Other Transmissible Diseases 
233 
cent. In Holland a drop of the legitimate fertility from 347 to 315 per 1,000 
coincided with a fall of the illegitimate fertility from 9.7 to 6.8 per 1,000, i.e., 
at a much greater rate. It is true that France, with its low and decreasing 
fertility rate (from 196 to 158 per 1,000 between 1881 and 1901), has had a 
comparatively high and increasing illegitimacy rate (from 17.6 to 19.1 per 
1,000) ; and that Ireland, with a somewhat high and slightly increasing fer- 
tility (from 283 to 289 per 1,000), has the lowest and a falling illegitimacy 
rate (from 4.4 to 3.8 per 1,000). But this has been heavily outweighed by 
Austria with an equally high and steady fertility (from 281 to 284 per 1,000) 
with the highest illegitimacy rate known (43.4 to 40.1 per 1,000), while Ger- 
many comes second with an illegitimacy rate of 27.4 per 1,000 in 1901. Though 
it cannot be said, therefore, that the lowest birth-rate produces the lowest 
illegitimacy rate, it most certainly cannot be said that family limitation has 
had any evil effect in increasing legitimacy. The bulk of the evidence is quite 
decidedly the other way. In the case of the most notable exception—that of 
France—we have the authority of Dr. Bertillon for saying that the greatest 
decency and lowest illegitimacy are found where the birth-rate is lowest. We 
may also quote from our own Registrar General, who said in his Annual 
Report for 1909:— 
“Except in the cases of the German Empire, Sweden, France, Belgium, 
and the Australian Commonwealth, the falls shown in illegitimate fertility in 
Table LXX'XIV are greater than the corresponding falls in legitimate fer- 
tility.” 
So far as the evidence of illegitimacy is concerned, therefore, it may be 
taken as definitely established that the adoption of family restriction has not 
led to greater laxity among the unmarried. But it would, of course, be quite 
unjustifiable to claim that this evidence is final. It may not mean that there 
is less lax conduct but only that there are fewer results of lax conduct. It 
is perfectly open for the orthodox moralist to claim that the greater knowl- 
edge of preventive methods has permitted an increase of laxity with a reduc- 
tion of the ordinary effects. This must remain a matter of conjecture. When 
we find, however, that not only has illegitimacy decreased, but also deaths 
from abortion and from the diseases ordinarily associated with irregularity, 
there seems no justification whatever for the contention that chastity has been 
relaxed. It must not be forgotten in this connection that the encouragement 
to early marriage afforded by the possibility of avoiding the economic burden 
of a too early or too large family affords the most likely of all methods for 
removing the temptations to unchastity and for conquering the hitherto untract- 
able “social evil.” Although the average age of marriage in this country has 
been rising somewhat lately (probably on account of the increasing cost of 
living), it is interesting to note that it is lower and fairly steadily decreasing 
in France. For first marriages the average age at marriage of French men 
has fallen from 28.6 in 1856 to 27.88 in 1896-1900, and of French women from 234 
The Case eor Birth Control 
24.25 to 23.5 in the same period. This cannot be regarded as otherwise than 
a very good sign. 
(Note: It is noteworthy in this connection that the French marriage laws 
are so strict that many thousands of couples live out of wedlock in preference 
to complying with them.) 
PAUPERISM 
We need not dwell upon this question, as the amount of pauperism de- 
pends upon a large variety of circumstances. But it is satisfactory to note 
that pauperism in England and Wales, i.e., the number of persons relieved 
annually per thousand of the population, has fairly steadily fallen from 34.5 in 
1875 to 26.4 in 1910, or by 23.5 per cent, during the period of the declining 
birth-rate. This is so far reassuring, in that it indicates that the easier cir- 
cumstances engendered by smaller families do not lead to idleness, as is fre- 
quently contended. The industry and saving habits of the French peasantry 
are world-renowned, and it is worthy of note that France is almost the only 
country in which the real wages of the working classes have been increasing 
of late years, while they have dropped 15 per cent, in this country, and nearly 
25 per cent, in prolific Germany. 
THE REPORT OF THE POOR LAW COMMISSION. By Sir Edward 
Bradbrook, C.B. Eugenics Review, Vol. 1, April 1909. Eugenics Edu- 
cation Society, London. 
The Commissioners throw a strong light upon the ineffectiveness of exist- 
ing measures when they show that the great and growing expenditure upon 
education and upon the public health has had no result in reducing pauperism, 
which is on the contrary of late years deplorably increasing, and that the ad- 
vance in the rate of wages, and the diminution in the cost of living have been 
equally ineffectual. 
In the words of the Commissioners, children who are brought up in such 
conditions, surrounded by disease and immorality and drunkenness are almost 
doomed to pauperism. If relief be given it should be used to check the 
creation of another generation of paupers. Much that is very instructive is 
contained in the report on the subject of children who come by one means or 
another to be under the control of the Guardians of the Poor, and important 
suggestions are made for reforms in the manner and training of such children. 
This, however, we need not discuss, as the spread of eugenic principles would 
tend to reduce their number until the time should come when the children de- 
pendent on public care should be few and exceptional. In their discussion of 
the causes of pauperism, the Commissioners quote a statement from a relief 
officer of Leeds, that one of the most important causes is early marriage of Other Transmissible Diseases 
235 
persons dependent upon casual labor. Large families are the rule. Unless 
we can cut off some of the sources from which that stream is being fed, the 
attempt to do more constructive work, whether by public assistance or by 
voluntary charity will continue to be swamped by hopeless cases—men and 
women ruined by bad habits or disease from infancy who propagate their own 
misery and hand on another generation of hopeless cases to the future. A 
great evil justifies strong measures to remedy it. This is true eugenic doc- 
trine. P. 47-50. 
THE METHODS OF RACE REGENERATION. C. W. Saleeby, M.D., 
CH.B., F.Z.S., F.R.S., Edinburgh; Fellow of the Obstetrical Society of 
Edinburgh; Member of Council of the Eugenic Education Society, of the 
Psychological Society, and of the National League for Physical Education 
and Improvement; Member of the Royal Institution and of the Society for 
the Study of Inebriety, etc., etc. New Tracts for the Times. Cassell & 
Co., Ltd., London, New York, Toronto and Melbourne. 1911. 
At the National Conference on the Prevention of Destitution, held in 
London at Whitsuntide, 1911, we gathered together in the section dealing 
with this subject a number of papers by authoritative writers, whose knowl- 
edge of the problem is first-hand, and the following is an extract from the 
paper, the Eugenic Summary and Demand, in which I endeavored to express 
the substance of the evidence. The mentally defective and diseased, existing 
in it and as part of it, injure the community in the following ways: 
1— They contribute largely to the ranks of chronic alcoholism and in- 
ebriety, with all their consequences. 
2— They contribute largely to the illegitimate birth rate, that is to say, 
to the production of children for whose nurture, quite apart from the question 
of their natural defect, adequate and satisfactory provision is, or indeed cannot 
be made. 
3— They contribute largely to the ranks of prostitution. 
A—They thus contribute largely to the propagation of the venereal di- 
seases, with all their consequences to the present and the future. 
5— They are responsible for much crime, major and minor. 
6— Both directly, as chronically inefficient, and indirectly, in the ways here 
cited, they contribute to the number of the destitute, constituting the majority 
of the naturally, as distinguished from the nurturally unemployable. 
7— They conribute largely as parents, married or unmarried, to parental 
neglect and cruelty to children which is probably more injurious to the adult 
life of the next generation, than most, or any of us realize. 
8— They contribute largely to the ranks of the wastrel and the hooligan. 236 
The Case eor Birth Control 
In such ways, and to such a degree these persons injure the community. But 
it is particularly to be noted that therein the community also injures them. 
The fact is obvious to all of us here. The injury wrought by the present con- 
tions between the community and these unfortunate persons is mutual, they 
injure it and it injures them. And not until we recall the words of Burke, 
in the light of modern genetics, shall we realize the full measure of this injury, 
for as that great thinker said, a community is “a partnership, not only be- 
tween those who are living, but between those who are living and those who 
are dead, and those who are to be born.” To the foregoing indictment of the 
present state of things, and remembering that whatever is inherent is trans- 
missible, I therefore add: 
9—They become parents and thus contribute incalculably to the mainten- 
ance of these evils after we are dead, but not after we are responsible. P. 
49-50. 
But it does not suffice to pursue positive methods, the encouragement of 
parenthood on the part of the worthy, and negative methods, the discourage- 
ment of parenthood on the part of the unworthy, if there be any agencies 
in the world which are forever turning worthy stocks into unworthy stocks. 
If there be such racial poisons, plainly we must stand between healthy stocks 
and their influence. By the term racial poisons I mean to indicate those 
agents, whatever tehy may be which, in greater or less degree, injurious to 
individuals as individuals, prejudices their subsequent parenthood. The racial 
poisons are very various, they include substances inorganic, such as lead, or- 
ganic, such as alcohol, and organized, such as the living causes of certain 
forms of disease. Circulating in the parental blood, they reach and injure 
the racial tissues, or germ-plasm. P. 56. 
WOMEN AND LABOR. New York Evening World, May 8, 1917. 
With American industry preparing to put women into the places of male 
workers called to the war, it is a rather surprising thing to learn that there 
already are 7,438,686 women in the United States who earn their own living. 
Of these no less than one-fourth are married. Here are the figures: Single, 
4,,401,000; married, 1,890,626; widowed or divorced, 1,147,060. 
In 1900 only 4,833,630 women left their homes to work, showing an in- 
crease of approximately one-half since then. 
In 1890 the married formed 14.3 per cent, of all women sixteen years of 
age and over engaged in gainful occupations. By 1900 this proportion had 
increased to 15.9 per cent. From 1900 to 1910 it jumped to the unprecedented 
proportion of 25.4 per cent. While there were important variations, the great 
increase was not confined to any one occupation or group of occupations, noi 
to any one State or group of States. In every occupation examined the mar- Other Transmissible Diseases 
237 
ried formed a larger proportion of all women sixteen years of age and over 
in 1910 than in 1900. 
The proportions were exceptionally high in the South and Arizona—50.8 
per cent, in South Carolina, 46.8 per cent, in Georgia, 46.7 per cent, in Florida, 
47.4 per cent, in Alabama, 54.2 per cent, in Mississippi, 45.6 per cent in Ar- 
kansas, 40.7 per cent, in Arizona. In contrast, the proportion was only 15.8 
per cent, in Connecticut, 15.1 per cent, in Pennsylvania, 13.1 per cent, in Wis- 
consin, 11.9 per cent, in Minnesota, and 15.7 per cent, in Iowa. 
The unusually large proportion of married women engaged outside their 
homes in the South is explained by the number of negroes living in that sec- 
tion of the country. The total of white women working for a living in the 
same States is perhaps smaller than in any other part of the United States. 
Even more significant than the great increase in the proportion which the 
married form of all women sixteen years of age and over engaged in gainful 
occupations is the marked increase in the proportion of all women so employed. 
Statistics show that in 1890 just 4.6 per cent, of married women went to 
work. The figures had expanded to 5.6 per cent, ten years later, and in 1910 
had reached 10.7 per cent. 
It may be safely assumed that in the years which have elapsed between 
then and now the increase has more than kept pace with earlier figures. And 
it is equally certain that once men have been replaced by women under war 
conditions neither they nor employers will be inclined to restore ante-bellum 
conditions. The problem is one to give economists grave concern. 
CHILD LABOR 
MARY AID BN HOPKINS, Harper’s Weekly, 1915. 
“Too many children is as great a danger to family life as too few chil- 
dren,” said Mr. Owen Love joy, General Secretary of the National Child Labor 
Committee. A secretary of this Committee, working for the abolition of child 
labor, the improvement of the compulsory education laws, and the raising of 
the standards of education in backward states, Mr. Lovejoy has first knowl- 
edge of the condition of children in every state in the Union. 
“How many are too many?” he was asked. “I should say any more than 
the mother can look after and the father earn a living for. There are always 
too many children in a family if they have to go to work before they get their 
growth and schooling. It may be that some day the state will help support 
the children, but under present conditions, as soon as there are too many 
children for the father to feed, some of them go to work in the mine or fac- 
tory or store or mill near by. In doing this they not only injure their tender 238 
The Case eor Birth Control 
growing bodies, but indirectly they drag down the father’s wage. They go to 
work to help the family, but they really injure it. The wage tends to become 
an individual wage, the father receiving only enough for his personal main- 
tenance, the mother working both at home and outside, and the children sup- 
porting themselves as soon as they can toddle into the cotton fields or hang 
onto the back of a delivery wagon. Thus the home is dissolved into consti- 
tuent parts and the burden of the struggle for existence is laid on each. The 
more that children work, the lower the father’s wages become; the lower the 
father’s wages become, the more the children must work. So we evolve the 
vicious circle. The home becomes a mere rendezvous for the nightly gather- 
ing of bodies numb with weariness and minds drunk with sleep. No fine 
spiritual relation can exist between parents and children where the children are 
an economic asset to the parents. There are people who approve this state of 
affairs, but no one can who really cares for the welfare of children. We fight 
this condition with Child Labor Laws. If the children stay out of industry, 
the fathers have more work and make more money in the end. But one of 
the strongest factors against getting laws passed or enforced after they are 
passed, is the families’ immediate need of the children’s pitiful earnings. If 
there were fewer children in these families, it would be possible to keep them 
in school and leave the mines and factories to the fathers. There is another 
aspect to the matter. Not only do these unfortunate children drag down the 
physique and mentality of the race, but they keep many children of more 
thoughtful parents from being born at all. Just as long as there are many 
families that are too large, there will be other families that are too small. Yet 
these small families are potentially the best families of all. Serious-minded 
laboring people whose trades are being captured by child laborers are reluctant 
to bring offspring into a world which cannot promise a life of the simplest 
comforts in reward for hard labor. Here is the real danger of that race sui- 
cide so vigorously condemned by Ex-President Roosevelt and others; for while 
the man of virtue and strength is deterred from propagating his kind because 
of the jeopardy in which his children would stand, the vicious and the ignor- 
ant, the physically unfit and the discouraged are not deterred by any such 
consideration, but, regardless of consequences, continue to propagate their 
kind and swell the proportion of those who will be from birth to death a 
heavy liability against society. We regard the family—one father, one mother, 
a group of children to be fed, clothed, and educated during the years that 
precede maturity—as the fundamental institution of our civilization and the 
glory, thus far, of all social evolution. One of the causes out of which the 
family grew has direct bearing upon this matter—that to which Professor Fisk 
called attention as his chief contribution to the evolutionary theory—the pro- 
longed period of infancy. The evolutionary trend has been to prolong in- 
fancy and adolescence, and thus to launch upon society better individuals. 
This is impossible where the older children in a family are crowded out of the 
home into the workshop. 
The Child Labor Bulletin, November, 1912, contains special articles on Other Transmissible Diseases 
239 
the child workers in New York tenement houses. Record after record 
shows a two-child income supporting- a six-child family. 
In connection with Mr. Lovejoy’s statement that a high birth rate en- 
courages child labor, it is significant to find from the Galton Laboratories of 
the University of London, the statement that drastic child labor laws directly 
lower the birth rate. In “The Report on the English Birth Rate,” from the 
Eugenics Laboratory, Memoir X.IX, Part 1, England, North of the Humber, 
Ethel M. Elderton, after touching on the influence of the raised standard of 
decency and comfort, lays the responsibility of the change chiefly upon the 
lessened economic value of the child to its parents. 
Miss Elderton says, “Between 1871 and 1901 the number of children em- 
ployed largely diminished. Neo-Malthusianism spread and the child ceased 
largely to be born, because it was no longer an economic asset. The Com- 
pulsory Education Act of 1876, the Factories and Workshops Act of 1878, 
and the Bradlaugh-Besant Trial of 1877 (concerning the lawfulness of pub- 
lishing pamphlets on contraception) are not unrelated movements; they are 
connected with the lowered economic value of the child, and with the corre- 
sponding desire to do without it.” The relation which Miss Elderton traced 
between the higher ideals of protection to childhood and the lowered birth rate 
is the more interesting because she is deeply, passionately alarmed at England’s 
falling birth rate. 
Mr. Lovejoy does not regard the falling birth rate as a wholly undesir- 
able phenomenon. He says: “Children should be born when the parents are 
in good health, at intervals that will allow the mother to recover her strength, 
and only as many should be born as the parents can care for. There is no 
deeper sorrow than to know that a child has died for causes that might have 
been prevented if the parents had had more wisdom and foresight. The 
ideals of care and education which we have for our own children should be 
our ideals for all children. I shall not consider it a calamity if the birth rate 
falls to a point where every child is so precious to the nation that not one will 
be allowed to work in a factory or workshop or mine or store under the age 
of sixteen, and up to that time every one will have proper food and clothes 
and education. Our race-suicide danger is a danger, nor of quantity, but of 
quality.” 
LATEST OFFICIAL FIGURES ON CHILD LABOR. From United 
States Census of Occupations, 1910. New York State. 
Age 
10 to 13 
14 to 15 
years 
years 
Manufacturing and mechanical 
518 
18,502 
Extraction of Minerals 
3 
47 
Agriculture 
1,566 
5,034 
All other occupations 
2,765 
36,659 
Total in all gainful occupations New York State 
4,852 
60,242 
Total in all gainful occupations United States of America 
895,976 
1,094,249 
Total child laborers in the United States of America.... 
1.990.225 240 
The Case eor Birth Control 
WAGES AND THE COST OF LIVING. Together with its relation to 
Prevention of Conception. Compiled by C. V. Drysdale, D.Sc. 
Apart from the special problems of experts, the great economic question 
of the day is that of the remuneration of labor and its relation to the cost of 
living. In Parliament and the press the questions of a minimum or living 
wage and of the purchasing power of existing wages are continually debated; 
and it is perfectly evident from the tone of these debates that we are con- 
fronted with a most serious difficulty, for which none of the political parties 
or economic authorities has any satisfactory solution. The recognition of 
this difficulty is due not to the fact that any new phenomena are present, or 
that the workers are worse off than at many periods in the past; but to the 
fact that the compilation of more accurate and official statistics during recent 
years has brought to light facts which were formerly only surmised, and has 
made two important conclusions practically indisputable. These are as fol- 
lows : 
A. That the wages of a large fraction of the working classes are in- 
sufficient, even when most skilfully employed, for the adequate support of a 
normal family. 
B. That during the last ten or fifteen years of social legislation and of 
strenuous effort on the part of the working classes and social reformers, the 
purchasing power of average wages has declined instead of increasing, and 
this decline shows no definite sign of being arrested. 
In order to improve the efficiency of production, it is important that the 
efficiency of the race should be improved. Hence the reduction of births 
should be especially encouraged among the poor and those suffering from 
physical or mental defect or disease, who, it may be noted, should have the 
strongest personal motives for voluntary restriction. 
The restriction of births in proportion to economic or physiological de- 
ficiency would steadily improve economic conditions in the following ways: 
(a) It would immediately reduce the burden upon the poor with their 
existing wages. 
(b) It would immediately check increased demand, and therefore a fur- 
ther rise in price of food. 
(c) It would reduce the burden of charity and taxation. 
(d) It would permit the workers to be better nourished and educated. 
(e) It would permit the children to be better educated and technically 
trained. 
(f) In course of time it would reduce the number of workers competing 
and further raise wages. Other Transmissible Diseases 
241 
(g) The evils of overcrowding, with its serious hygienic and moral dan- 
gers, would be rapidly diminished, and the housing problem made easier of 
solution. A three bedroom house only provides decency for a family not ex- 
ceeding four children. 
(h) It would give better opportunities for thrift among the workers and 
for their emancipation from the position of “wage slaves.” It would then 
give them an opportunity of co-operating and owning their own instruments 
of production. 
In support of these statements it may be recalled that in Prof. Thorold 
Rogers’s Six Centuries of Work and Wages a striking example is given of the 
continued rise of wages after the Black Death of 1349, despite all efforts of 
Parliament to fix them. 
“It is certain that the immediate consequence of the plague was a dearth 
of labor, an excessive enhancement of wages, and a serious difficulty in collect- 
ing the harvests of those landowners who depended on a supply of hired labor 
for the purpose of getting in their crops. . . . The plague, in short, had almost 
emancipated the surviving serfs. 
“I shall point out below what were the actual effects of this great and 
sudden scarcity of labor. At present I merely continue the narrative. Par- 
liament was broken up when the plague was raging. The King, however, 
issued a proclamation, which he addressed to William, the Primate, and cir- 
culated among the sheriffs of the different counties, in which he directed all 
officials that no higher than customary wages should be paid, under the 
penalties of amercement. The King’s mandate, however, was universally 
disobeyed, for the farmers were compelled to leave their crops ungathered or 
to comply with the demands of the laborers. When the King found that his 
proclamation was unavailing, he laid, we are told, heavy penalties on abbots, 
priors, barons, crown tenants, and those who held lands under mesne lords, 
if they paid more than customary rates. But the laborers remained masters 
of the situation. ‘Many were said to have been thrown into prison for dis- 
obedience; many, to avoid punishment or restraint, fled into forests, where 
they were occasionally captured. The captives were fined, and obliged to> 
disavow under oath that they would take higher than customary wages for 
the future. But the expedients were vain; labor remained scarce and wages* 
according to all previous experience, excessive.” 
Mr. Thorold Rogers tells us of all the expedients employed by Parliament* 
in the Statute of Laborers, in order to check the rise of wages, and how they 
broke down and were evaded by the employers themselves. “The rise in 
agricultural labor is, all kinds of men’s work being taken together, about 50 
per cent., of of women’s work fully 100 per cent.” Artisans fare equally 
well. And, despite the rise in price of manufactured articles consequent upon 
this rise of wages, “there was no corresponding rise in the price of provisions. 
The free laborer, and, for the matter of that, the serf, was in his The Case for Birth Control 
242 
way still better off. Everything' he needed was as cheap as ever, and his 
labor was daily rising in value.” 
It would, of course, be absurd to apply the lesson of one period of history 
to another, without consideration of the changed circumstances. But it is 
equally absurd to pass over such a vivid object lesson as the above without 
giving it due consideration, especially when it has a sound theoretical basis. 
Prof. Thorold Rogers was not a disciple of the Malthusian school, and he 
takes Mill and others to task for the importance they ascribed to the popu- 
lation difficulty. Yet he tells us that the reign of prosperity lasted for some 
time after the reduction of population by the Black Death, and that a rapid 
growth of population followed. This is quite in accordance with the doctrine 
of Malthus, and justifies our belief that, if this increase had been prudentially 
restricted, prosperity would have been permanently maintained. 
A modern illustration of the same principle appears to be given in New 
Zealand, where the practice of family restriction seems to be almost universal. 
In the Standard of June 20th, 1912, appeared a note commenting upon the 
great and increasing prosperity of New Zealand; and it contains the follow- 
ing significant passage:— 
“The wages paid to employees and the output of the printing establish- 
ments in the country have pretty nearly doubled in the same ten years, rising 
respectively from £284,605 to £490,246 and £704,285 to £1,377,926. A curious 
point in connection with the grain mills is that while there were fewer estab- 
lishments and fewer hands employed in 1910 than in the previous years—al- 
though wages are higher—yet the value of the output has almost doubled, 
being £1,248,001 as against £682,884.” 
Some mention should be made of the question of emigration. Strange as 
it may seem, emigration does not, as a rule, greatly mitigate the population 
difficulty (though it may have done so to a certain extent in Ireland), and it 
may even enhance it. The reason for this apparent paradox is not far to seek, 
and it serves to explain a good many common fallacies as regards the popu- 
lation question. Human beings are not all of equal producing power. Each 
child born into the world is an immediate consumer, and he remains a con- 
sumer without being a producer until his education and training are com- 
pleted. After that time he becomes a producer, and, if of average talents, he 
may for a certain period produce enough to support himself and perhaps a 
wife. It is at the beginning of the effective period that emigration so fre- 
quently takes place, so that the old country is burdened with all the con- 
sumption of immature children, without any possible return. Emigration can 
only be a remedy for overpopulation when it is emigration of non-producers, 
i.e., children, aged people, tramps, paupers, or lunatics; and it need hardly be 
said that these are not the types which emigrate, or who are wanted by the 
colonies. It is quite possible for an already greatly over-populated country 
:to be in great need of further accessions of ready trained workers; but until Other Transmissible Diseases 
243 
someone discovers how our children may be born at this stage of develop- 
ment it is absolutely absurd to say that such a country is “calling out for 
population,” in the sense of needing a higher birth-rate. The fact that On- 
tario, in Canada, has experienced an increase of its death-rate following on 
an increase of its birth-rate is a vivid illustration of this absurdity. 
It is interesting to note, as a confirmation of this theory, that consider- 
able changes in the rate of emigration appear to have had very little influence 
upon the death-rate. It may be, however, that emigration increases in times 
of dearth, and thus tends to prevent increased mortality. 
NBO-MALTHUSIANISM AND EUGENICS. C. V. Drysdale, D.Sc. 
The last few years has been a period of continual persecution of the neo- 
Malthusians whenever they try to instruct the poorer classes, and more strin- 
gent laws are being framed against them in many countries. 
I am glad to say that a recent attempt on the part of the dominant agra- 
rian party in Hungary in this direction has been foiled by a judgment of the 
Hungarian Medical Senate, which has strongly reported against any attempt 
to check the practice of family limitation, in the interests of the quality of the 
race. CHAPTER IX 
CONCLUSION: EMINENT OPINIONS 
THE PROGRESS OF HOLLAND 
WAGES AND THE COST OF LIVING. C. V. Drysdale, D.Sc. 
Unlike those of other countries, who, in Lord Morley’s words, have 
shirked the population question, the statesmen of Holland have been fully 
alive to it, and have made their country the only one where facilities have been 
given to the poorer classes to freely obtain knowledge as to the best means of 
restricting families. The following strong statement by Heer S. van Houten, 
late Minister of the Interior in the Netherlands (Staats Kundige Brieven, 
1899), leaves no doubt as to this difference of outlook:— 
“Wage-slavery exists as a consequence of the carelessness with which 
the former generation produced wage-slaves; and this slavery will continue 
so long as the adult children of these wage-slaves have nothing better to do 
than to reproduce wage-slaves. The fault lies in our poorer classes them- 
selves, and also in some clergymen and orthodox pedants who, in their preach- 
ing about mortality, only permit a choice between an unnaturally lengthened 
celibacy or an ever-increasing family with the bonds of marriage, and who 
prevent the acceptance of the higher morality, which finds such easy accept- 
ance among the better classes, of marriage and restriction of the family to 
the number which the parents can feed and comfortably rear.” 
And Heer N. G. Pierson, late Dutch Minister of Finance, has expressed 
himself equally strongly in his Political Economy, which has just been trans- 
lated into English:— 
“No improvement in the economic situation can be hoped for if the num- 
ber of births be not considerably diminished.” 
Under the segis of these gentlemen and of Heer Gerritsen, a prominent 
Councillor of Amsterdam, a Dutch Neo-Malthusianische Bond was formed in 
1881, and has carried on an active propaganda among the working classes, 
with the help of a number of qualified medical men and trained midwives. 
So great has its success been that it now numbers over 5,000 members, and it 
was recognised by Royal Decree in 1895 as a society of public utility. An 
enormous number of practical brochures describing methods of limitation are 
sent out gratis annually, and poor men and women can get gratuitous advice 
in every important centre in Holland. 246 
The Case eor Birth Control 
The result of this work, as indicated by the vital statistics, is clearly seen 
in Fig. 11. The birth-rate has fallen from 37 in 1876 to 28 in 1912, and with 
especial regularity and rapidity during the last few years. The death-rate has 
fallen more regularly and rapidly than in any other country in the world (from 
a value averaging about 25 per 1,000 to only just over 12 per 1,000 in 1912), 
and the infantile mortality has similarly shown the most rapid fall on record. 
It will be observed that, far from this decline in the birth-rate having checked 
the increase of population, the rate of “natural increase” is now higher than 
at any previous period, and the highest in Western Europe. This indicates 
not only that social conditions are rapidly improving, but that the productive 
efficiency of the population is increasing, instead of diminishing, as in our 
own country, where the “natural increase” has fallen from 12 to 10 per 1,000. 
This is explainable on the eugenic ground that in Holland family restriction 
has taken place among the poor, and has thus tended to eliminate unfitness; 
while in this and other countries the poor are almost entirely ignorant of re- 
strictive methods. And this view is strikingly confirmed by the paper read 
by Dr. Soren Hansen at the Eugenics Congress of 1912, in which he stated 
that the average stature of the Dutch people had increased by four inches 
within the last fifty years. An examination of the heights of the young men 
drawn for military service shows that since 1865 the proportion under 5 ft. 
2y2 in. in height has fallen from 25 per cent, to under 8 per cent., while that 
of those above 5 ft. 7 in. has increased from 24.5 per cent, to 47.5 per cent. 
This is a most decided evidence of increased wellbeing and elimination of 
unfitness. On the many occasions that I have been in Holland, I have never 
yet seen any cases of that terrible physical deterioration and economic misery 
which are so conspicuous in this country. Further, the emigration of the 
Dutch population is almost infinitesimal. 
As regards wages and cost of living, Dutch statistics do not give weighted 
index numbers to compare with the other figures. But the unweighted mean 
of money wages of workers in the different government services show the 
most rapid increase recorded, being about 25 per cent, in Holland between 
1894 and 1908, as against 18 per cent, in France and 10 per cent, in England 
and Wales. (Fig. 12). 
As to prices, it is not easy to come to a definite conclusion, as some articles 
have risen and some fallen in price; but there seems good ground for be- 
lieving that the cost of living has risen comparatively little in Holland, and 
that real wages have therefore risen very materially during the period when 
they have been declining in this and other countries. It is certainly difficult 
in any case to see how the undoubtedly great advance in health and physique 
experienced by the Dutch population could have taken place without a great 
increase in real wages. 
According to a diagram given in the Manchester Guardian of August 
16th last the cost of living in Holland had gone up by 23 per cent, in 1912. Conclusion: Eminent Opinions 
247 
An examination of detailed prices, however, showed a relatively small rise up 
to 1909. 
These facts, together with many others which could be adduced, make 
it clear that in Holland, the only country in which the population problem has 
been realised and facilities for family limitation been extended to the poor, 
the expectations of the Neo-Malthusians have been completely justified, and 
their doctrines have received the confirmation of experience. Amsterdam, in 
which the first lady doctor in Holland opened a gratuitous clinic for the in- 
struction of poor women in preventive methods, has now the lowest death- 
rate and infantile mortality of any European capital. And this is in no way 
attributable to any extension of State help either of a socialistic type, or of 
that familiar to us in this country, as Holland has been distinguished for its 
adherence to individualism, and has apparently adopted hardly any measure 
of State assistance. 
DR. S. ADOLPHUS KNOPF IN THE SURVEY, quoting Dr. J. Rutgers, 
Honorable Secretary to Neo-Mathusian League of Holland. 
“All children you now see are suitably dressed, they look now as neat as 
formerly only the children of the village clergyman did. In the families of 
the laborers there is now a better personal and general hygiene, a finer moral 
and intellectual development. All this has become possible by limitation in 
the number of children in these families. It may be that now and then this 
preventive teaching has caused illicit intercourse, but on the whole morality 
is now on a much higher level, and mercenary prostitution with its demoral- 
izing consequences and propagation of contagious diseases is on the decline. 
The best test (the only possible mathematical test) of our moral, physio- 
logical and financial progress is the constant increase in longevity of our popu- 
lation. In 1890 to 1899 it was 46.20; in 1900 to 1909 it was 51 years. Such 
rise cannot be equalled in any other country except in Scandinavia where birth 
limitation was preached long before it was in Holland. None of the dreadful 
consequences anticipated by the advocates of clericalism, militarism and con- 
servatism have occurred. In spite of our low birth-rate the population in our 
country is rising faster than ever before, simply because it is concomitant with 
a greater economic improvement and better child hygiene.” 
The good doctor closes his letter by saying: “One must have been a 
family physician for twenty-five years like myself in a large city (Rotterdam) 
to appreciate the blessings of conscious motherhood resulting in the better 
care of children, the higher moral standard. And all these blessings are taken 
away from you by your government’s peculiar laws, made to please the Puri- 
tans.” 
Dr. Jacobi, ex-President of the American Medical Association and the 
New York Academy of Medicine, said: 248 
The Case for Birth Control 
“The future of mankind is conditioned by its children. Unless they be 
healthy and fit to work physically and mentally, they can not perform any 
duty in the service of the family, the municipality or the state. Hereditary 
influences propagate epilepsy, idiocy, feeble-mindedness and cretinism. Such 
children should not have been permitted to be born. Yet the prohibition of 
unnecessary and not wanted accessions of human beings is considered crimi- 
nal.” 
Dr. Lydia Allen de Vilbis of the New York State Department of Health, 
said that among the 25,000 deaths of children under one year of age that 
occur annually in New York State, half were due to causes with which medi- 
cal boards could not hope to cope—the defective, the deformed, the crippled, 
the diseased. 
“What are we going to do about these babies who are born only to suffer 
and die?” she asked. “There are at least 12,000 a year, 1,000 for each month, 
more than thirty a day. What for? Because we are so stupid that we still 
believe a pound of cure is better than an ounce of prevention.” 
MARY ALDEN HOPKINS. Harper’s Weekly, 1915. 
“Last year more than ten thousand children were proposed to the Depart- 
ment of Charities of New York City for commitment to institutions,” writes 
John A. Kingsbury, Commissioner of Charities in the Department of Public 
Charities of New York City, in reply to my inquiry concerning his view of 
the limitation of families. “Poverty or sickness or unemployment has out- 
worn the welcome of more than ten thousand innocent little citizens in their 
own homes. These children are paying the penalty of the social error of too 
large families. It is frequently remarked that children are often found in the 
largest number in those homes which are least equipped to properly provide 
for them. I believe it is as serious a mistake for parents in adverse circum- 
stances to bring children into the world for whom they are not prepared, as 
for parents in affluent circumstances to decline to bear children because of the 
inconvenience or embarassment to their scheme of living. If contraception 
can benefit the born by limiting the unborn, without bringing about any physi- 
cal or moral deterioration in human lives, I am unqualifiedly in sympathy 
with it.” 
JUDGE WM. H. WADHAMS, Court of General Sessions, New York. “The 
Spreading Movement for Birth Control.” The Survey, Oct. 21, 1916 
In the Court of General Sessions, New York City, Judge Wadhams sus- 
pended sentence upon a woman, mother of six children, who had pleaded 
guilty to a charge of burglary, her second offense. His investigation showed, 
the judge declared, that the mother had made a hard, but unsuccessful attempt Conclusion: Eminent Opinions 
249 
to support her children since the father had been driven from his work in 
garment working five years ago. Meantime, two of the children had been 
born. Said Judge Wadhams:— 
“Her husband is not permitted by the authorities to work because of his 
being ill with tuberculosis. It would be dangerous for him to work on chil- 
dren’s garments. It might spread consumption to the innocents. There is a 
law against that. As a result of this law the husband has had no work for 
four years. Nevertheless, he goes on producing children who have very little 
chance under the conditions to be anything but tubercular, and, themselves 
growing up, repeat the process with society. There is no law against that. 
But we have not only no birth regulation in such cases, but if information is 
given with respect to birth regulation people are brought to the bar of justice 
for it. There is a law they violate. The question is whether we have the 
most intelligent law on this subject we might have. These matters are regu- 
lated better in some of the old countries, particularly in Holland, than they 
are in this country. I believe we are living in an age of ignorance, which at 
some future time will be looked on aghast.” 
LETTER ADDRESSED TO PRESIDENT WILSON BY A GROUP OF 
NOTABLE ENGLISH WRITERS AND SOCIOLOGISTS, Septem- 
ber, 1915. 
To the President of the United States, 
White House, Washington, D.C. 
Sir,—We understand that Mrs. Margaret Sanger is in danger of criminal 
piosecution for circulating a pamphlet on birth-problems. We therefore beg 
to draw your attention to the fact that such work as that of Mrs. Sanger re- 
ceives appreciation and circulation in every civilised country except the United 
States of America, where it is still counted as a criminal offence. 
We, in England, passed a generation ago, through the phase of pro- 
hibiting the expressions of serious and disinterested opinion on a subject of 
such grave importance to humanity, and in our view to suppress any such 
treatment of vital subjects is detrimental to human progress. 
Hence, not only for the benefit of Mrs. Sanger, but of humanity, we re- 
spectfully beg you to exert your powerful influence in the interests of free 
speech and the betterment of the race. 
We beg to remain, Sir, 
Your humble Servants, 
(Signed) 
Lena Ashwell, 
Dr. Percy Ames, 
William Archer, 
Arnold Bennett, 
Edward Carpenter, 
Aylmer Maude, 
Prof. Gilbert Murray, 
M. C. Stopes, 
H. G. Wells. 250 
The; Case: for Birth Control 
GLOSSARY OF MEDICAL TERMS USED IN THIS VOLUME. 
Abortion: As soon as the male sperm has met and joined with the female 
ova any attempt at removing it or preventing its development or further growth 
is called Abortion. Abortion is not to be confused with the prevention of con- 
ception. The practice of Birth Control, founded on the prevention of concep- 
tion will eventually do away with the necessity of abortions. 
Abortion: the expulsion of the fetus before it is viable.—Dorland’s Medi- 
cal Dictionary. 
Abortion: the arrest of any action or process before its normal comple- 
tion, as the abortion of pneumonia.—Stedman’s Medical Dictionary. 
Birth: the delivery of a child—Gould’s Practitioner’s Medical Dictionary. 
Birth Control: a new social philosophy dedicated to conscious and vol- 
untary motherhood, and racial betterment. 
Conception: the act of becoming pregnant.—Stedman’s Medical Dic- 
tionary. 
Conception: the fecundation of the ovum by the spermatozoon.—Gould’s 
Practitioner’s Medical Dictionary. 
Contraception: the prevention of conception.—Stedman’s Medical Dic- 
tionary. 
Contraceptive: anything used to prevent conception.—Dorland’s Medical 
Dictionary. 
Contraceptive: an agent for the prevention of conception.—Stedman’s 
Medical Dictionary. 
Fecundation: impregnation or fertilization.—Dorland’s Medical Diction- 
ary. 
Fetus: the unborn offspring of any viviparous animal; the child in the 
womb after the end of the third month: before that time it is called the 
embryo. 
Malthusianism: (Thomas Robert Malthus, English political economist, 
1766-1834). The doctrine that population increases in geometrical progres- 
sion; and the teaching, founded on this doctrine, that over-population should 
be prevented.—Stedman’s Medical Dictionary. 
Doctrine of Malthus: the doctrine that the increase of population is pro- 
portionately greater than the increase of subsistence.—Gould’s Practitioner’s 
Medical Dictionary. 
Theory of Malthus: that small families will abolish poverty and disease; 
recommends continence and late marriage to bring about this result. Glossary 
251 
Theory of Neo-Malthusians: that small families will abolish poverty and 
disease; recommends early marriage and use of preventive checks to bring 
about this result. 
Pregnancy: gestation, fetation, gravidity.—Stedman’s Medical Dic- 
tionary. 
Pregnancy: results from the meeting and fusion of two living cells, the 
cell furnished by the male (spermatozoon) and that by the female {ovum). 
To avoid or to prevent conception or pregnancy, then, consists of stopping the 
male cell from uniting with the female cell. 
Prevention of Conception: to prevent the male sperm from meeting the 
female ova. 
Prevention of Conception: the only logical and practical means for elimi- 
nating abortions when a child cannot be carried to full term. 
Preventive: anything which arrests the threatened onset of disease.— 
Stedman’s Medical Dictionary. 
Modern Art Printing- Co., New York.