WITH COMPLIMENTS OF THE WRITER. The President's Address, ■ 1890: The Limiting of Childbearing Among the Married. BY JOHN P. REYNOLDS, M.D., BOSTON. REPRINT FROM VOL. XV. GYNECOLOGICAL TRANSACTIONS. 1890. THE LIMITING OF CHILDBEARING AMONG THE MARRIED: THE PRESIDENT'S ANNUAL ADDRESS. BY JOHN P. REYNOLDS, M.D., BOSTON. REPRINTED EROM THE TRANSACTIONS OF THE AMERICAN GYNECOLOGICAL SOCIETY, SEPTEMBER, 1890. PHILADELPHIA: WM. J. DORNAN, PRINTER. 1 890. THE PRESIDENT'S ANNUAL ADDRESS. By John P. Reynolds', M.D., Boston. The unchanging success of the Society gives all its friends ground for honest congratulation. In individual life fifteen years mean adolescence fairly begun; here they imply not only the strength of youth but all its glorious promise. The twelvemonth has not left us untouched. William H. Byford, a founder of this Association, and always an active and valued member, will no more share its work. A me- morial of Dr. Byford, recording for us and for others his honored career, has been prepared by one of our colleagues, and will be found among the Transactions of the year. Were it not for this sad loss our ranks would remain-praise be to God!-unbroken. Each and every other, younger and older, reports himself to-day ready for duty. The pleasure of greeting once more these trusty friends needs no words. With a deep impression of personal insufficiency I bring before you a topic somewhat foreign to the usual character of the annual address. The grave importance, public and pri- vate, of the subject on which it bears will, I hope, sufficiently excuse my choice. No one can more regret the fragmentary and necessarily unsatisfactory treatment which it must receive. Marriage, which is at this moment under eager and widely extended debate, too deeply concerns every human interest to permit indifference to that discussion : on the issues involved every man feels the need of clear teaching and of deliberate convictions. To attempt within the limits of the annual address 4 THE PRESIDENT'S ADDRESS. a general review of this question would be gross presumption ; but such attention as has been at my command has made the conviction every day stronger, that the crucial element in the inquiry, the one factor upon which every conclusion must in the eud hinge, is the ever-recurring matter of childbearing. Our subject is, then, " The Limiting of Childbearing Among the Married." We have, however, to-day no fresh lance to break at the well-known infamous practice of our time. On the contrary, did there exist contrivances for preventing im- pregnation, sure, accessible, and utterly harmless, what I have to present would come all the more sharply outlined. Honest inquirers ought to covet eagerly on these points the judgment of assemblies like this. Throughout your profes- sional lives you have watched at the closest quarters and under every varying condition marriage and childbearing as no other class can. We will shut wholly out of view the misleading issues drawn from the family of the drunkard, the improvident, the phthisical, or the insane, and will equally forget every case in which, for medical reasons, sound and well considered, pregnancy ought to be interdicted or seldom allowed. These form a wide field for the counsels of the sagacious practi- tioner ; but to our inquiry they hold no relation. We are to take up the following instance: A man and a woman have married, neither prematurely nor too late, in the fulness of health and strength ; each of them free from any inheritance of disease; trained well and wisely in body and mind; with adequate means of support; in a union just, equal, and loving; and in character too upright and worthy to palter with any known wrong or dishonor. To .these parents, as to others their like, belong sons and daughters eight or ten, or thereabout. The husband and wife just described will not interfere with that result or substantially change it. Separation, for periods longer or shorter, may perhaps be mutually accepted. In repeated instances this is honorably maintained ; but with the JOHN P. REYNOLDS. 5 great majority of young, strong, and well people, living together, it is impracticable, and where unwillingly enforced it becomes in all time the fruitful parent of every form of degradation and immorality. Such separation excepted, these people have no control. The statements of this paper refer exclusively to the parents thus before us, and to their family. No criticism will hold that sets aside this restriction. Does, then, any statute make all these children obligatory ? Surely not. The loftiest purity, the highest nobleness may well be set before men, though no penal legislation make them binding. Marriage, the marriage of this man and this woman, establishes a home where parents gladly train those placed in their care, paying back to others the love that was once lavished on them. The ten children may not always be found : " There is no fold, howe'er tended, but one dead lamb is there "; but the demand is, that there be hearts open for all that God will give, that their coming be welcomed, counted a blessing unspeakable-never be matter of dread. For long years there has rung in my ears the word of one of the noblest of women,then in the height of the mother's struggle of bearing, nursing, and rearing a family of many sons and daughters: " Oh ! if I must think that any other creature did this to me-that it was my husband that appointed it for me; if in it I did not see God's hand, I could never endure it." Pardon me if I tell the rest; I was the physician. The births were hard, even to see; labors of a strong, mighty mother. There was never any miscarriage. And I have watched that family. Not one failed. There came no great sorrow. The children were noble men and women; love between them was never wanting. The mother lived through it all, it seemed to me, in that spirit which has been the inheritance of the ages : " Behold the handmaid of the Lord; be it unto me according to thy word." The varying interpretations of the original motive and 6 THE PRESIDENT'S ADDRESS. purpose of marriage must iu passing receive some considera- tion. They will appear closely related to our special theme. It is hardly possible to distinguish too sharply the concep- tion of marriage from the mere relations of passion.1 Over- whelmingly powerful as is the sexual impulse, it is idle to build upon an instinct so quickly and easily gratified the entire framework of social order. Thus primeval man, in his struggle for existence, had other needs more permanent and far more pressing. We know no stronger distiuction between animal and human existence than the use of fire. That alone means for man better nourishment, makes him a flesh-eating animal. The ensuing preparation of food creates a division of labor that the animal never knew. Woman must get ready the prey which man now regularly provides. She becomes to him indispensable, not on account of an impulse suddenly aroused and as quickly gone, but from a necessity that lasts as long as life itself: his hunger. The union thus formed is monogamous; there exists no motive for plurality. It is also enduring. Did marriage rest only on sexual impulse, perma- nency could not be expected ; but admit the need of establish- ing a household, add the birth of a child, require from the mother care for that and its training, and all is changed. Primitive marriage cannot have been largely tender. It was as hard and dry as primitive life. Compensations primeval man no doubt had; but how bitter was the desolation ! Famine and cold were ever at hand. His cave and his hut were but little better than those of the neighbor lions and bears. Pride of ancestry he could not know. Yet in him lay even then the striving for all that has made his posterity brave, loving, and wise; powers destined to bring under stern control his animal nature, and to lead on the individual and the race to a future of glory and greatness of which the end is not yet. 1 Starcke: The Primitive Family. From this excellent book the thoughts, and in a few sentences the words, of this paragraph are largely borrowed. JOHN P. REYNOLDS. 7 In that life the old and his infirmities found no place. Remorselessly killed, left alone to die, at times praying to be destroyed, that he might not longer bear his need, he was a companion in wretchedness of all the feeble and deformed, and of that child who is never other than helpless and weak. In these ages, and hardly less among savages to-day, child- murder is everywhere common. At birth relatives decide whether the infant die or live. In one tribe every child of a mother not yet thirty is killed ; in another only the first two live; here nearly every girl child dies ; there the first-born is sacrificed to some dead relative's shade, or in honor of a deified ancestor. Polynesians, only a century since, though no Malthus had lived, anticipated his teaching. " Their islands were so small that unless children were early made away, famine would surely comeand the child, kept alive, like a calf or a kid, till old enough, as a rule till it could walk, was then killed by its parents, cooked and eaten, often in the very hut that had seen its childish play. Civilization, bearing witness to the ever-growing light, undoes all this, cares for and cherishes the sick, the infirm and the old, trains the feeble in mind, watches for each littlest child, will have it that nothing be lost, prizes those infants that the savage would kill and eat, seeing in them the very image of God, and glories in that prolific exuberance of crea- tion which alone makes possible the wonders of natural selec- tion. Those on every side who seek the abolition of marriage, or such alterations in its form as will make it virtually cease, have no patience with what they call sentimental pleading in its defence. Such a family as I have described they would condemn with scorn. Their thronging abettors and asso- ciates, the outspoken worshippers of Venus and Bacchus, are troubled by no scruples for man's asserted need of permanent monogamous union, and find in the mother of a large family something beneath contempt-a mere figure of fun. The marriage love of these writers, under whatever more 8 THE PRESIDENT'S ADDRESS. acceptable terms disguised, is nothing if not in a high degree passionate and sensuous. Sexual appetite is for them the groundwork of the union, and its gratification a purpose never forgotten. Accept this, and the folly of marrying becomes transparent. Desire, transitory in nature and soon appeased, cannot call for a prolonged and indissoluble union. If to gratify that instinct be the only end, satiety soon ensues. Love, or what bears its name, must next seek freedom, and divorce must pave the way for fresh, joyous excitement. Moreover, man's " fatal sense of power and possession " in marriage is matter of bitter complaint. Could woman be only free to take herself away, there would be joy in keeping her; she would not lose her charm. Marriage must by no means bring children that might keep the mother tied; above all, not many children. Unless she decide for children, they are not to be born; being born, they are not treasures jointly owned, but belong exclusively to the mother. " Unwilling motherhood"-that the mere fact of marriage should imply childbearing-is of all marriage cruelties the last and worst. When marriage reform has come, woman will yield herself to man merely when she choses and exactly to the extent that she elects; he may expect children only in case she so decides, and then just the few that she permits; and this principle, pure and simple, is declared to be that last ditch from which marriage reformers will never fall back. In all these affairs man's choice will apparently not count.1 1 Fairness perhaps requires that we contrast with these last sentences the fol- lowing parallel words. They with others in the immediate context are thought to warrant fully the paraphrase above introduced : " It need scarcely be said that there must be a full understanding and ac- knowledgment of the obvious right of every '' [married] " woman to give or to withhold herself body and soul exactly as she wills. The moral right is here so palpable, and its denial implies ideas so low and offensive to human dignity, that no fear of consequences ought to deter us " [agitators] " from making this liberty an element of our ideal-in fact, its fundamental principle." " Mar- riage," Mrs. Mona Caird; The Westminster, August, 1888. Readers of that paper; of " The Morality of Marriage," Fortnightly, March, 1890; and of articles upon this question in the North American for June and JOHN P. REYNOLDS. 9 In Emerson's words : " The lover seeks in marriage " her " [his] private felicitation and perfection, with no prospective end; and Nature hides in " her " [his] happiness her own end, namely, progeny, or the perpetuity of the race." But not such the wife of days to come; for her, Nature will at least do no hiding; in woman Nature will have found more than a match. It is even hoped, we are told, that " overwrought mater- nity," the joy that sees in each latest offspring only something dearer and better than all before, will, on a more free devel- opment of woman's other attributes, be stifled or held in check ; this instinct being a product of man's tyranny, culti- vated by him to the dwarfing and stunting of woman's nobler powers. But against childbearing there are fresh indictments. Is the more equal marriage of the future to free woman from every legal and social subjection of man's devising? The bearing, nursing, and rearing of his and her children will involve a subjection, just and equitable, it may be, but none the less real. Is woman's economic independence to be made good, that in this respect she may stand with man on an exactly equal footing ? The bearing of children during the best years of her life hopelessly handicaps her in all compe- tition with him, mechanic, literary, or commercial. Will woman stimulate and develop to the utmost artistic or intel- lectual powers; will she become man's open rival in art, in scholarship, in public life? Any free bearing of children must first be put out of the way. And accordingly great and varied interests demand that childbearing cease, or that it be restricted within limits that virtually end it. It requires some hardihood, in the face of all this, to main- tain, as I assuredly do, that the exact opposite is true; that the happiness and peace of the parents of whom I speak, the July of the present year, the work of the same spirited pen, will perceive in the address frequent reference to these writings and occasional quotations from them. 10 THE PRESIDENT'S ADDRESS. welfare of the family, the glory and strength of the State, alike require all such women and men to permit no other restriction of childbearing than that which belongs to rational self-restraint, to mutual forbearance and tenderness in all the exigencies of married life; admitting always that the inmost soul and spirit of their union condemns every act of marriage which does not find its warrant in love. Who has not seen in families the growing apart of hus- band and wife when the avoidance of pregnancy begins? There are noble hearts that under such trial grow only more tender, but how often does that prohibition lead the way for the uew lover or for the wife of whom no one hears. Sorrow and suffering lovingly shared, the straitening of resources, the widening of care; these are privileges under which hearts ripen. In the new and daily-varying interests of the great group of daughters and sons, ever opening out, are found for man and woman the deepening of character, the loss of self-consideration, the joy and the content of living for others and in others. Nor need we, in the midst of this all, undervalue for elders the homely peace and blessing of Thackeray's " kindly nuptial bed." Old Etruscan couples in the infancy of civilization could carve in stone no dearer image of long-enduring rest. Time and again you have known the heartrending agony of parents that through wilfulness, or folly, or thrift, had fore- gone recurring childbearing, aud when bereavement came, forever refused to be comforted. In great families how gently and mercifully do loving hearts that remain draw only closer that they may fill the gap I Deep as may be the needs of the Soudanese or the Ugan- das, better missionary work can hardly be done than that of the woman who among us faces obloquy and scorn, and takes joyfully her burden of training for noble service a troop of daughters and sons. The demand for divorce is a vexation alike to the nation and the church. Its all-potent cause is the restriction of JOHN P. REYNOLDS. 11 childbearing. He and she who have many children can spare no time for disagreement and divorce. With every fresh child a new guarantee against separation is born. In child- less communities divorce finds a congenial home. To children themselves the crowded family is an even greater gain. What training that elders can give matches the rough-and-tumble of a houseful of boys and girls? Will staid parents, a generation older, ever set on foot the merry pranks that are themselves an education? How does the love of many brothers and sisters supplement and round out the kindness of elders ! How do prospering children lend helping hands to those who struggle ! Nay, how great a blessing is that struggle! Remember Abraham Lincoln's words : " The Lord must love the common people; He made so many of them ! " When but two children are born, the parents' place is not made good. Four barely restore in adult life the father and mother. Such rates of birth mean for the community, the State, the race, narrow resources, penury of power. Only with the prolific home does strength to face the enemy at the gate begin. We delude ourselves with phrases about race deterioration and the infertility that cannot help following high civilization ; the causes lie deeper. Fifty years ago the development of well-to-do Frenchmen, Germans, and Eng- lish was not unlike; yet the family of Napoleon the Third and that of the reigning British sovereign not unfairly repre- sent habits and traditions of two peoples. " Mais, die ponde comme une poule!" I heard my French obstetrical teacher say, after one of the later royal births. In what land has the hive been so full that swarming could never cease? What nation has beeu compelled to found in Australia, in India and on this continent fresh empires? " That famous man, the greatest sailor since the world began," was tenth English child in a family of eleven. "Poor Richard" was one of seventeen, himself the fifteenth; during five generations his ancestors had been youngest sons of youngest sons, no doubt 12 THE PRESIDENT'S ADDRESS. in ample households. These and many another priceless in public worth had their training in great families and polished away oddities and angles in the elbowing and pushing of thronging sisters and brothers. The wealth of countries is not in money or in mines, but in their women and in their men. Every added hand is a fresh producing power. " Away," breaks in the objector, " with your ideal of mar- riage and your childbearing: picturing first to yourselves as you do, what the world will never by any chance see; and then making of this fancy a Procrustean bed to which all families must be shortened or stretched, whether they choose or not." " The real," says a late able article,1 " is but the ideal not yet completely developed; and the ideal is not merely the goal toward which the real is tending, but its actual ground- work." From a writer on the marriage question, an English- woman, whose short paper in last April's Fortnightly2 seems to me pure gold, I quote the following words : " Of the new marriage, as of the old, it assuredly will remain true, that the improvement of the pattern will not greatly avail if the material be bad. Worthy relationships can only subsist between worthy human beings. Too many men and women in our so-called civilized life are not civil- ized at all. They are not controlled by any sense of equal rights on the part of their neighbors; they have no reasoned principles, and are in effect led by the impulse of the moment. People of this sort-there are quite as many such women as men-and no small proportion of them belong to the middle and upper social classes-are incapable of the sort of com- panionship which seems to me the only marriage worth hav- ing. They are also incapable of any worthy friendship, and they are eminently unfitted to have the charge of children. 1 Lux Mundi: The Church. Walter Lock. 2 On Marriage: a Criticism. By Clementina Black. JOHN P. REYNOLDS. 13 For persons in this stage of social development, equal freedom in intimate relations is not possible. They will inevitably be more or less tyrants or slaves; and they will be happiest, it appears to me, when they are kept under control by a not unkindly tyrant. On the other hand a certain degree of freedom is necessary to the development of the partially civ- ilized. Responsibility educates and fits for responsibility." And again: " In the lowest stratum of our population marriage virtually does not at all exist. The essential elements -fidelity and a sense of mutual duty-are absent. Moral chaos reigns as to the relations between man and woman. At the other end of the scale we find a highly-civilized class of self-controlled men and women imbued with respect for one another's freedom of action, and so educated that their prin- ciples of conduct, intellectual interests, and general outlook on life are pretty much the same. . . . But then in the majority of these cases1 the wives are highly-cultivated women, in the truest sense the equals of their husbands." In the development of marriage woman's purity was early seen to be indispensable. But the marriage of the future will equally exact the strictest purity from man. "Women," says one of their sex,2 "if dependent upon men, must, almost of necessity, condone men's vices, and, as a result, gradually approximate to their standards. The fact that we are morally upon a higher level than men repels us from the close relations of marriage, in which we now believe that we have a right to a return for all that we give. If, while we are offered intellectual companionship and provision for our bodily needs, the higher demands of our spiritual nature are ignored or set aside, we hesitate. Our moral life, the life of our aspirations, is upon a plane which the average man has not reached. We stand ready to welcome him when- 1 Reference had been made to marriages at Cambridge, during late years, of younger Fellows of Colleges. 2 " The Mission of Educated Women." By Mrs. M. F. Armstrong. Popular Science Monthly, March, 1890. 14 THE PRESIDENT'S ADDRESS. ever lie can bridge the chasm." . . . " Women require of the fathers of the next generation just what Mr. Grant Allen demands for the mothers : that they be as strong, as wise, as pure, as sane, as healthy, as earnest, and as efficient as they can be made." When Mr. Grant Allen, in his widely-known paper,1 urges for women the importance of motherhood, one watches with interest his intelligent critics of the fair sex, as they shine in the retort courteous and, throwing back his very thoughts, reply: " The customs which render it difficult for a young man to marry, which send him hither and thither to gain a fortune, succeed in a profession, or dissipate his strength, when he should be choosing his sweetheart, are harmful and divert the attention of men from the true problem of their sex, to fix it on side issues of comparative unimportance."2 The trenchant condemnation of men to which a moment ago your attention was drawn may possibly find some warrant in fact, but one can hardly pass by without indignant challenge certain gross overstatements of universal male impurity, which, recklessly spread abroad, have done great wrong, and created among pure women no little unhappiness and terror. May the demoralized life of certain districts of Europe, which alone gives color to these reports, never find here its counterpart! We hear it urged that much sexual evil is due to ignorance, and it is gravely proposed to make the world more pure by explaining the structure and use of the reproductive organs to children at school. Obviously, two very diverse matters are here hopelessly confused-pregnancy and childbearing and a knowledge of sexual relations. In fairly large families the birth of children, the coming of nieces and nephews, the unavoidable incidents of daily life, give to the young under 1 " Plain Words on the Woman Question." Grant Allen. Fortnightly, December, 1889. 2 " Is Education Opposed to Motherhood ? " By Alice B. Tweedy. Popular Science Monthly, April, 1890. JOHN P. REYNOLDS. 15 the gentlest and kindest teaching ample acquaintance with reproduction. It is far otherwise with the relation of the sexes. Curious interest in that subject will only be set at rest by the sexual relation itself, that relation which nothing but marriage must warrant; and without which instruction, how- ever communicated, does but whet the appetite for farther knowledge. The greater information acquired by boys is no unimportant factor in that low moral standard of their sex of which these crazy reformers so loudly complain. For the young of either sex, it will at least never do harm to be simple concerning evil, and above all, to be wise unto that which is good. All of us have perhaps now and then seen unhappy girls immature in character and unbalanced, whose stormy and threatening youth presaged ruin, but whom marriage, multi- plied childbearing, and the tumult and care of a great house- hold, developed into strong and useful women, as nothing else could-not, as lookers-on thoughtlessly say, thanks to the worry and toil, but far rather from the fact that strong desire having been early relegated to its properly subordinate place, the nobler instincts found room, and in tender love and care for others the beauty of motherhood slowly made itself felt; as breaking sunlight drives before it foul mist and lingering cloud till at last stream and hilltop stand out in all their remembered charm. Without children, marriage would have probably brought to these unfortunates nothing but evil. The denunciation of improvident marriage has its limits. Strictly provident marriages, the unions of a few persons of great wealth, or in royal and imperial families, are too infre- quent to count. For the early wedded, marrying with an ample income is, even financially, the very poorest pledge of success. To call that marriage improvident to which young people bring sound bodies and minds, and the man both capacity for labor and steady employment, is an outrage; mercifully, the weight of family burdens comes only little by little, as years roll on. The marriage, early in life, of per- 16 THE PRESIDENT'S ADDRESS. sons like these demands every encouragement, alike in the interest of private and public morals, for individual happiness, and for the safety of all. Men may well echo Bacon's words : " He that hath a wife and children hath given hostages to fortune." For one and another all-absorbing service, noble and attractive women have in every age laid aside marriage, many a time with a loving appreciation of the beauty and sacred- ness of motherhood that has but deepened the sacrifice. Under the well-known sorrows and uncertainties of life others at last forego what they deeply prize, and in their accepted self-denial, tenderly borne, daily glorify womanhood in thousands of homes with an honor second only to that of the mother herself, if second at all. Woman may also de- cline marriage, and have her question of self-support to face. Show watchful and generous forethought! See to it, that an unwritten law so bind the conscience of every parent that no child of either sex, whether born in want or cradled in ease, grow up without acquiring beside the nurture of the mind some handicraft or other human pursuit that will yield maintenance. Reformers scout the thought that in marriage the general interest of a family may rightly hold in check woman's indi- vidual will; or worse, marriage give to even a wide circle of kinsfolk binding rights and claims. Fidelity in wedded life, which for them masquerades as " stern, inexorable duty " can- not be in keeping with honest freedom in love. 11 Virtue," if under any external control, or helped by any propping from without, they hold of small account; since all goodness that is not utterly spontaneous is worthless. Who of us may not hourly give thanks that loving hearts at home, and many a gracious help from honorable ambition and honest pride, stand near to reinforce our tottering spon- taneous good ! Between marriage and individual liberty there is no true conflict. The service which is perfect freedom finds there its like. JOHN P. REYNOLDS. 17 Very many of you know in a gay European capital a gigan- tic hospital in whose obstetric department from nine to ten thousand children are each year born-an average of one for every hour. Of the mothers, only four in a hundred are married; and so little is marriage good form, that the mar- ried often conceal that fact. A large part of these women are domestic servants, go to the hospital for delivery, frequently more than once, and yet, if otherwise of value, are gladly taken back by their employers. A friend, thoroughly con- versant with life in that city, said : " I do not see how a ser- vant could marry; I never knew one that did." I heard at a hospital morning visit the question, "Das wievielste Kind?" put to a thin, anxious-looking woman no longer young. "Das sechste, Herr Professor." "Das sechste, und dock noch ledig ! " Why is not this "the marriage of the future" already come? Here is no jealous "possession" by man. To these women " freedom in love " might be " as the very breath of their nostrils." Surely they are not prostitutes. Delivered, their power to support themselves is as great as before, and their social standing not in the least harmed. For the chil- dren they have no worry ; a paternal government long watches over the offspring. Dare any man or woman in this room call such a state of things progress? That degradation is due to the enforced celibacy of thousands of soldiers and priests, and equally to a law which, without a fixed income, forbids marrying. Such cruel laws may be done away; domestic service itself, with all its evils may, according to the promise of one of our clever countrywomen,1 speedily cease, changing into an out- side organized industry ; in time, drunken women and men may become temperate and self-controlled, fitted to be again parents: the improvident may learn thrift; under wisdom and skill diseases which now forbid childbearing may disap- 1 The Housekeeping of the Future. By Mrs. H. E. Starrett, of Chicago. 18 THE PRESIDENT'S ADDRESS. pear; but bring all this about, and much more like it, for the very end that troops of happy children may fill the homes of these now sorrowing neighbors, just as crowding sons and daughters are welcomed for those brighter unions of which so much has to-day been spoken. The mother for whom this heavy burden waits, needs from all about her not only honor but deep and abiding sympathy, comfort, and help. She asks it most of all from our profes- sion. Great changes in the bodily training of woman, in her attire, in the cultivation and equipment of her mind, are surely close at hand. Steady gymnastic work, the bicycle, and out- door games will not fail to tell. I know no reason why she may not show herself in her way as strong as hei' brother. The paw of an enraged lioness would hardly be less frightful than that of her mate. The desire to please may yet pre- serve woman's flowing dress, but undergarments like those of the gymnasium cannot be long delayed. That harming of the waist for which thousands of years have striven will be done away. The training of her mind may well make her the intellectual equal and companion of man ; true though it be, that the school-work of to-day too often scorns the remem- brance that she is the mother of all living, and in an aggra- vated sense unfits her to be that mother. You will perhaps echo the conviction, very firm in my own mind, that fine sons and daughters, with vigorous minds and tough bodies, oftener owe their excellence to their mothers than to their fathers; sure it is, that the gain of the race will never be truly admir- able till more earnest care is given to the bodily training of girls. It is a true appreciation of the greatness and honor of childbearing that asks for the mother of children the stately form, die hohe Gestalt, of Dorothea, as she is seen in the even- ing light first stepping over the threshold of Hermann's home. The mother of women and men must be spared every other toil, must be refused all strange and unfitting care. During JOHN P. REYNOLDS. 19 pregnancy she may not edit a dictionary, sit up till the early hours to hear her husband's sermons or read his proof, help to tide over a bankruptcy, or herself keep a hotel. " But for the children" (six), the wife of a shopkeeper is made to say, I would take chloroform to-morrow." We are then told how, under great worry and distress this wife had built up the business and carried it on, while she bore the children; and it is thereupon laid down that there should have been no such childbearing. But the evil lies at the door, not of the childbearing, but of the shop. The woman with child cannot -nay, on every ground, must not-do the work of a man. A fitting acknowledgment of repeated childbearing as an honor and trust, than which earth knows no greater, and thd appropriate watchfulness that such a recognition brings, would make much less common that disaster which more than all others enfeebles childbearing women. What record ot eight or ten children does not include a list of miscarriages? Unless in the family of careful physicians one rarely finds the exception. For thousands of years our profession has visited with loathing and scorn him who helps the murder of the unborn, and hardly less the mother who permits it; but the honoring of childbirth demands, far beyond this, that the woman who is to bring forth, do duty for her child, as the outpost does for the sleeping army, that she bear ever in mind its feebleness and its risk, that she watch for it as the mother bird on the nest, and this over and over again, it that may be. What words of upbraiding and shame befit the physician? be he older or younger, whose counsels tempt instead of strengthening the mother of two or three children, before whom the prospect of other recurring pregnancies lies ! How hard is the struggle, no matter how favoring the conditions ! Not only is there heavy and scarcely remitting care, but to meet the claims of the nursery, many an innocent happiness that has been before enjoyed must be hopelessly postponed. The camping-out of earlier days, journeys on horseback or on 20 THE PRESIDENT'S ADDRESS. foot, many a pleasure of social life, are no longer possible. Yet in the glad acceptance of just these privations lies hidden for this woman joy to come that words cannot exhaust-her crowd of eager faces and loving hearts that will made glad her riper years ; and the opportunity for all that, if lost in this its day, will never return. What the devilish suggesting of a possible forgery, or of a cruel breach of trust, means to a man trembling at the verge of financial ruin ; what it would be for a patriot to skulk or fly at the extreme moment of the country's peril; just that the medical adviser prompts, when he whispers to this mother the expediency of a judi- cious curtailing of childbearing; when he puts iu her way 'my imagined safe method of prevention. We neglect the more important division of our care for this woman if we content ourselves with answering her summons when labor comes. If we be not watchful that during preg- nancy she sleep, if we do not our utmost to secure for her peace of body and peace of mind, if we be not on the alert in the more strictly medical supervision of this period, post-partum service, however assiduous, will never acquit us. To forestall danger and to prevent it are worth far more than the most superb self-reliance and courage when peril has come. The suffering of labor begins to find its place even in fiction. Impatience of pain, indignation that it must be met, demand that it be either prevented or avoided, may not be the spirit of the noble army of martyrs, but it is on all sides displayed. On many grounds it behooves male physicians to make to this temper all reasonable concessions. Exempt as we our- selves are from the agony of childbirth, we must not, without the gravest reasons, withhold from those who suffer it the opportunity of innocent relief. I find it hard to excuse our growing supineness in regard to anaesthesia in ordinary labor. There are few prejudices more utterly unfounded, than our timidity about this resource. Not only does> the careful and judicious administration of ether in confinement not augment JOHN P. REYNOLDS. 21 the liability to hemorrhage; it unquestionably lessens this risk by saving that nervous power which the unrelieved endur- ance of pain exhausts. In everyday childbirth, and still more under intolerance of suffering, or where pain is in fact extreme, anaesthesia is of priceless value. The one indication for it in average labor is intolerance of pain, whether the dis- tress be really excessive or not. Often those who urgently need ether in the wretchedness of the early stage, and then thankfully welcome it, can bear the expulsive efforts without it or at that time scarcely require it. Those practitioners who withhold an anaesthetic during the earlier suffering, amidst entreaties for relief, and then timidly permit a little in the later pains, have no right to expect help from it and may often look for uterine relaxation after its use. The moment the endurance of pain, in whatever stage, begins to tell upon the condition of the patient and to make demands upon her courage, the time for ether has come. It is then bad practice, and I think clearly wrong, to deny it. Thus, in my judg- ment, a consultant called to a case in which the constricting obstetric ring has developed, may well first ask, u Was anaes- thesia with this patient early established and afterward main- tained?" If not, it is my belief that the attendant has not done his best to ward off the accident. I protest most urgently against the neglect of anaesthetics in hospital and dispensary obstetrics. It is said that such patients can do without anaesthesia. For the increased safety in the con- ditions of labor which it brings, they might well demand it as their right. The attendant, be it understood, is not, in ordinary cases, to employ ether till the farther endurance of pain seems to him unwarranted; he should then give it only during the pain, never continuously; he is to use it only as a palliative, the patient's intelligence, or, at any rate, her power of speech, remaining, as a rule, undisturbed. Even within these limits it is of inestimable worth. What is here said of ether is no 22 THE PRESIDENT'S ADDRESS. doubt equally true of chloroform, but I cannot assert that from personal knowledge. We all recognize the unspeakable benefit of anaesthesia in operative obstetrics and in eclampsia. Carried during labor to the surgical degree, it probably always implies some risk : but this use of it is not to-day before us. The obligation to keep up medical supervision during the hour and a half following delivery is widely accepted by the best obstetric guides. Would that its extreme importance might be universally admitted I It is not proposed to recount here the safeguards that come from late wondrous improvements in our art. You well know how invaluable these are. Early in this century the late Austin Flint, the elder, was a young practitioner. The following memorable words are found in a letter written to him fifty years ago from Northampton, in Massachusetts, the town where once Jonathan Edwards lived and labored: at the time of the correspondence one of the leading places in the western part of that State. " A.," says the lady writing, " has lately died in giving birth to her first child. This is the fourth case of a similar kind which has occurred among my acquaintances since your little Austin was born. I do think the gentlemen of your profession cannot give too scru- pulous a degree of attention to this subject." Contrast this with the record of a thousand distressed, half-fed, deserted women, out-patients of the Boston Lying-in Hospital in the last two years; the one death taking place six days after birth from pulmonary disturbance, and possibly due to causes not connected with the labor, while among the remaining patients there was hardly a disturbance of convalescence. I need not hesitate to make this statement, since like success has been reported from many another point. Nothing that has been heard in our meetings more won my heart than the brave retractation of that noble veteran, our lamented Dr. Ellwood Wilson, when he reported six cases of children saved in his hands by axis-traction, every one of whom he felt sure JOHN P. REYNOLDS. 23 would have died but for the very instrument whose employ- ment he had two years before discredited. And who is there among us, that, as he recalls past professional life, has not the pain to remember children that increased presence of mind on his part, more thorough understanding of the mechanical powers at work, greater adroitness in manipula- tion, would have saved from death; the sad memory of them following us through all our years. Surely, " gentlemen of our profession cannot pay too scrupulous attention to this subject." If we enjoin upon the much-enduring mother ten- derest care that not one of the least be lost, we likewise clearly need to make that lesson our own. Our duty to this mother of many is not yet told. To the parent the reckless night-nursing of children is an unmeasured evil. I have known it to become in a twelvemonth the unquestioned and only cause of death to a mother of good inherited health, and of fine bodily and mental endowments. Year by year women are breaking down under it before your eyes and mine, without the least occasion. What weariness and distress of woman and man might be spared could we make it everywhere known that after the earliest weeks well- taught babies almost without exception sleep through the night as do their fathers and mothers ! You smile, perhaps, at my presuming to introduce here a matter so trivial. Trivial it may be called. It is my conviction, that a generation so trained in its early months would thereby gain inconceivably both in mind and in body. There cannot be question of the increased approval of childbearing among parents whose peace is thus secured. Cl Extirpate," cries the most ardent of marriage reformers, Ci extirpate the enchained ideas that marriage necessarily im- plies children, and motherhood the power of rearing and training them." It has been the design of this paper, it should be the hearty wish of us all, to enchain to the utmost the convictions that marriage does imply childbearing; that the marriage of upright people, strong in mind and body and 24 THE PRESIDENT'S ADDRESS. so remaining, involves always many children; that the true education of woman's body and woman's mind has, for its first aim, to give with motherhood the power nobly to rear and train offspring. " These are the gems my children gave," The stately dame replied; " The wise, the gentle, and the brave I nurtured at my side."