LIBRARY UNIVERSITY OF CALIFORNIA. Class ON The Diminishing Birth- Rate ^RESIDENTIAL ADDRESS DELIVERED BEFORE THE BRITISH GYNAECOLOGICAL SOCIETY, February 11, 1904 BY JOHN W. TAYLOR, M.Sc., F.R.C.S.ENG, Professor of Gynaecology Birmingham University ; Surgeon to the Birmingham and Midland Hospital for Women Xotfton : BAILLIERE, TINDALL & COX, 8, Henrietta Street, Covent Garden 1904 PRICE ONE SHILLING PRINTED BY JOHN SONS AND DANIELSSON, LIMITED, 1 TITCHFIELD STREET, OXFORD STREET, W. ON The Diminishing Birth-Rate PRESIDENTIAL ADDRESS DELIVERED BEFORE THE BRITISH GYNAECOLOGICAL SOCIETY, February 11, 1904 BY JOHN W. TAYLOR, M.Sc., F.R.C.S.ENG. Professor of Gynaecology Birmingham University ; Surgeon to the Birmingham and Midland Hospital for Women fcottdon BAILLIERE, TINDALL & COX, 8, Henrietta Street, Strand 1904 GENERAL The Diminishing Birth-Rate and what is Involved by it. I. IN one of the chapters of Mr. Ruskin's well-known book on Political Economy, " Unto This Last," he deals with an inquiry into what he calls the " veins of wealth." He exposes the fallacy that the wealth of a State lies solely or essentially in material possessions showing that apparent or nominal wealth which fails in its authority over men, fails in essence and ceases to be wealth at all that the true veins of wealth are, as he says, " purple not in rock but in flesh," and the " final outcome and consummation of all wealth is in the producing as many as possible full-breathed, bright-eyed, and happy-hearted human creatures." In his final chapter, " Ad Valorem," Mr. Ruskin writes : " There is no wealth but life. That country is the richest which nourishes the greatest number of noble and happy human beings " " the nobleness being not only con- sistent with the number, but essential to it. The maximum of life can only be reached by the maximum of virtue." The principles or truths contained in these passages passages which bear the strictest examination and criti- cism may be, and are, very generally accepted, theo- retically. But the history of the nation during the last twenty-five years shows that the principles which govern its real life are altogether different and directly contra- dictory. 182782 4 The Diminishing Birth-Rate To-day we are brought face to face with unanswerable statistics proving that our birth-rate is steadily diminish- ing. This has already attracted the serious considera- tion of statisticians and of some of our statesmen, but the inquiry into its causes has been confused and incomplete. Here, I hope, we can at least discuss these plainly and fearlessly, for some of the problems connected with causation are essentially gynaecological, and can, perhaps, only be rightly gauged by those who have special medical and gynaecological experience. The subject is a great one so great indeed, that if the nation could only see it in its true proportion, it would, I think, be found to dwarf all other questions of the day. I cannot hope in the time at my disposal to enter fully into all its phases. I do hope, however, to take the most salient and striking features of the statistical data at our command, to inquire what is meant and involved by these, and to consider how far the profession and the public may do anything to check the apparently relentless progress of an evil destiny. The best tables for our primary consideration are some of those which have been compiled by Mr. Holt Schooling, the statistician. In Table i we see the average yearly number of births to each thousand persons living in the United Kingdom during five successive periods of five years each. Table i. The average yearly number of births per 1,000 persons living in Great Britain and Ireland, during the five-yearly Periods. 18741878 34'3 1879-1883 32-6 1884 1888 31-2 1889189? 29-8 18941898 29-1 (Note the steady decrease, 34, 32, 31, nearly 30, 29, and in 1901 it had come down to 28.) And what is Involved by it 5 Now let us compare this with exactly similar statistics of other countries : Table 2. The average yearly number of births per 1,000 persons living during the five-yearly Austria. Germany. Italy. France ' 18741878 . 1879-188^ . 18841888 . 18891893 . 18941898 . 39*4 .. 38-4 .. 38-1 37'i . 37'3 ... 40-1 -. 37'5 ... 36-9 ... 36-3 ... 36-1 36-8 ... 38/2 ... 36-9 ... 34'9 ... 34-3 ... ... 32-6 ... ... 31-2 ... ... 29-8 ... ... 29-1 ... 25-8 24*8 23*9 22-5 22-3 If we compare the top line with the bottom we see that in each case there has been a fall, so that a diminish- ing birth-rate is not a feature of our own kingdom only, but is to some extent European in its scope or effect, and the lowest birth-rate is that of France. Of the other great powers and nations the United States, Russia, China, and Japan no certain statistics are available, but we have very good reason to believe that the birth-rate is seriously falling in the States, but notably rising in Russia and Japan. According to Russian statistics from 1892 to 1894, the birth-rate per 1,000 was 477, and from 1894 to 1897 the, birth-rate per 1,000 was' 49-5, so that there has been not only no loss or diminution in the birth-rate here, but the figures are also far above those already tabulated. So far, the data we have con- sidered show us that the birth-rate throughout the whole of the West is diminishing, while that of the East is rather expanding. We now want to consider the relative birth-loss of the various Western nations as compared with one another, and this brings us to the most important and startling of Mr. Schooling's tables. He takes the birth-rate statistics for 1874 to 1878 in each European nation as the standard for that nation, and places against this the statistics for 1894 to 1898, computing from this the loss of birth-force in the twenty years. The following is the result : 6 The Diminishing Birth- Rate The yearly The yearly The percentage birth-force during birth-force during of yearly loss during 1874-78 taken as 1894-98 was only 1894-98 was Norway ... ... 100 ... 96 ... 4 Denmark 100 ... 95 ... 5 Austria ... ... 100 ... 95 ... 5 Italy loo ... 94 ... 6 Hungary ... ... 100 ... 91 ... 9 Germany ... ... ico ... 90 ... 10 Switzerland ... ... 100 ... 90 ... 10 Belgium 100 ... 89 ... n Holland 100 ... 89 ... 11 Sweden ... ... 100 ... ... 12 France ... ... 100 ... 86 ... 14 United Kingdom ... 100 ... 85 ... 15 England and Wales ... 100 ... 83 ... 17 In other words, while Norway, Denmark and Austria very nearly keep up their birth-force of twenty years ago, the other nations in their order show an increasing loss, and England and Wales stand at the very bottom of the list. None of the other nations have sustained so great a loss as we have in this definite period of time. During the same period of time the marriage-rate in the United Kingdom has not altered much, but during the last ten years or so has been slowly rising. The figures in the returns of the Registrar-General are as follows (Table 44, 1900) : t Persons married to ico living. 18761880 I4-2 18811885 I4-I 18861890 13-8 18911895 14-3 1896 1900 ... ... ... ... ... ... 15*2 So that we may take the birth-loss in the United Kingdom as due to causes operating in the married life of its inhabitants. It is not simply due to celibacy. The fertility of marriages appears to have so much diminished that the decrease in London alone is said to " equal 26,000 births yearly, or about 500 weekly." (Mr. T. A. Welton, at a meeting of the Royal Statistical Society, June 17, 1902.) But some may say, England and Wales are only a small part of the Empire, and the statistics of Great Britain, where there is but little room for expansion and increase, And what is Involved by it 7 form no criterion of the birth-rate in our Colonies. Un- fortunately, what statistics are available on this point, and notably those of Australia, offer no encouragement to the hope that the Colonies are much better than our- selves. In Australia the birth-rate has fallen with an even still greater rapidity than in England. In 1861 to 1865 the rate was 41-9 per 1,000, but had diminished in 1871 to 1875 to 37-3 ; in 1881 to 1885 to 35-2 ; and in 1891 to 1895 to 31-5 ; while in 1896 to 1899 the rate was only 27*35, or actually below the rate of increase at home. If we work out these figures in harmony with Table 3, we find Australia a long way below all the European nations, with a birth-force down to 70-3 and a percentage of yearly loss amounting to nearly 30. Regarding this, Mr. H. W. Wilson writes : " The decline in Australia is great in every position of life, among the poorest and the richest alike, and it is the more ex- traordinary because the greatest want of Australia is a teeming population." But any statistical inquiry, to be of value, must be considered in all its bearings. It has been said, and with considerable reason, that there is nothing so unreliable as statistics, and this may be the case when these are im- perfectly considered. In the present instance, if we are desirous of estimating the true wealth or value of the popu- lation we possess, there may be a fallacy in mere numbers. It may well be that twenty children better clothed, better fed, better educated, better trained, may develop into men higher socially and morally, stronger and better able to hold their own than 100 children less advanta- geously brought up. Can we hope that the type of man is improving ? that the generation of Englishmen to-day, though falling short in birth-force, is yet greater than the generation preceding it ? Again, unfortunately, we must sorrowfully admit that we have not sufficient ground for believing this. The OF 8 The Diminishing Birth- Rate criminal statistics, though showing a general and steady reduction in the whole criminal population of the United Kingdom, during the last twenty years (a fact which is very encouraging), do not show a corresponding diminution in juvenile criminality, and it is necessarily the youth of our country to which any estimate of the last twenty- five years would more particularly apply. According to August Brahms, in his work on " The Criminal " (p. 272), " Juvenile criminalism is on the increase. Forty per cent, of the convictions in England every year are against young persons under 21 years of age." And on p. 281 he appends a table which shows a higher percentage of criminals under 20 years of age in England than in any of the other European countries there tabulated. The Lunacy statistics of England and Wales show a steady proportionate increase of lunatics and idiots, especially during the last few years. In 1869 there were 23-93 lunatics, idiots and persons of unsound mind to 10,000 of population. 10,000 of population. 1879 27-54 c f 1889 29-65 ve j rs 1894 30-58 ending " l8 *> - 3^6 g 1 1903 34'H (From the 57th Report of the Commissioners in Lunacy, 1903. Parliamentary Blue Book.) Or in other words, the increase of lunatics and idiots in England and Wales has, during the last fifteen to twenty years, been very nearly double the old rate. The natural deduction from these figures that insanity and idiocy are increasing seems also to be proved by the recent statistics of the new admissions to asylums and licensed houses. The ratio of first admissions to 10,000 of population has been as follows : In 1899 4'94 1900 5'02 ,, 1901 ... ... ... .. ... ... ... 5-28 1902 576 (Ibid., p. 95.) And what is Involved by it 9 It is very difficult to obtain trustworthy statistics regarding alcoholism, but those given in the " Temperance Problem," by Messrs. Rowntree and Sherwell, are probably the best. According to these the consumption of wine per head of the population has varied but little during the twelve years from 1885 to 1897, but during the same time, the consumption of beer has gone up from 27-5 gallons to 313 gallons, and of spirits from '93 gallons to 1-02 gallons ; and the " National Drink Bill " (p. 437), which was estimated at 3 73. zod. per head in 1885, came to 3 i6s. iojd. in 1898. In London (Metropolitan Police Area) there were, from 1885 to 1889, 4-33 arrests for drunken- ness to 1,000 of the population. In 1897 the proportion had risen to 7*35 (p. 499). V So, in juvenile criminalism, in mental disease and brain weakness, and even in alcoholism, the restricted population of the present day compares unfavourably with that of a former generation. If we try to go on and trace this comparison further, and compare the general culture of the more intellectual classes of the two generations over a limited field for no general statistics are available still the investiga- tion (though necessarily imperfect and tentative) seems to point to an unfavourable conclusion. In my own city of Birmingham, a critical survey of its chief semi-public literary and artistic institutions has been recently made by Mr. Howard S. Pearson, and he publishes a tabulated statement showing the support given to these twenty years ago, ten years ago, and to-day. (Central Literary Magazine, November, 1903.) His figures show as a net result that in the course of twenty years there has been a loss of 366 subscribers, or about one in fourteen. " This would be discouraging, but it is by no means all. The population of the city and district has vastly increased, while this care for intellec- tual and artistic culture has materially diminished. In brief, the population has increased by more than one- io The Diminishing Birth- Rate fourth, while the interest in the institutions named has decreased by one-fourteenth." Later on, Mr. Pearson writes : " These institutions are not some among many ; they have actually no rivals at all. Neither in the city nor in the neighbourhood is there anything which even pretends to touch their special work. They stand, each in its own way, for the general and intellectual culture of the educated classes. The very aim and intent of all our strenuous efforts in the cause of education is to increase the proportion of the educated classes and to lead to a life-long interest in culture. And as the population rises, as education becomes . more far-reaching, as art is more and more talked about, even so must grow the discourage- ment of all who might have hoped to gather from the changed conditions a larger sympathy in their work." It must be confessed that the more deeply and thoroughly one goes into this matter the more serious does it appear. Prof. Karl Pearson (Huxley Memorial Lecture, 1903, and British Medical Journal, October 24, 1903), who has approached it from an altogether different standpoint from a careful study of the inheritance by children of the mental and moral, as well as the physical characters of their progenitors comes to much the same conclusions. He notes that there appears to be a want of intelligence in the British merchant, workman and professional man of to-day, and sees but little hope in the usually proposed remedies of foreign methods of in- struction and the spread of technical education. " The reason for the deficiency," he states, " is that the mentally better stock in the nation is not reproducing itself at the same rate as of old the less able and the less energetic are the more fertile. Education cannot bring up hereditary weakness to the level of hereditary strength, and the only remedy is to alter the relative fertility of the good and bad stocks of the community. The psychical characters which are the backbone of a State in the modern struggle of nations are not so much manufactured by home and And what is Involved by it 1 1 school and college ; they are bred in the bone, and for the last forty years the intellectual classes of the nation, enervated by wealth or by love of pleasure, or following an erroneous standard of life, have ceased to give in due proportion the men wanted to carry on the ever-growing work of the Empire." All this tends to show that the marriages of to-day are not only relatively infertile, but, also, either (i) : " That the children born of such marriages are weak, neurotic, specially liable to alcoholism, criminality and insanity, and so far unfit for the battle of life, or (2) that marriages of the middle and better classes are now so sterile that quite an undue and dangerous proportion of the rising generation is recruited from the lower, the more ignorant, the more vicious and semi-criminal population. In any case the conclusion is one of the utmost gravity, and almost paralysing in the seriousness of its import. It is indeed a "handwriting on the wall" which claims the fullest and wisest interpretation to be found throughout the Kingdom. II. We now pass on to the consideration of the cause and life-history of these, relatively sterile marriages. Some, and notably M. Arsene Dumont in his work on the age of marriage, profess to consider the elevation of the age when marriage is entered into as mainly responsible for the deficit in the birth-rate. It does undoubtedly account for some of the loss. Obviously, if marriage be deferred until 35 or 40 years of age, there must be less expectation of progeny than in a marriage contracted some ten years earlier. It is, however, idle to suppose that this touches more than the fringe of the nation's loss. The main cause and we who are in gynaecological practice must know it, is the deliberate prevention of conception. This, which was first encouraged and taught in England some thirty- 12 The Diminishing Birth-Rait five years ago, has gradually spread like a blight over the middle-class population of the land, and the true wealth of the nation, the " full-breathed, bright-eyed, and happy-hearted children " of Ruskin, have more or less gone down before it. It is this which has so altered the family life of our country that the most superficial observer of middle or advancing age must be struck by the difference. Instead of the families of six or twelve to eighteen children, we see more often the so-called family of three or two or one, and that which used to be and still should be the highest and noblest function of the married woman, the rearing of sons and daughters to the family, the nation and the Empire, is very largely handed over to the lower classes of our own population and to the Hebrew and the alien. For a long time it appears to have been assumed that whatever might be the loss to the nation and the race by such a practice, the individual must gain. The avoid- ance of the troubles of pregnancy, the dangers incidental to parturition, the confinement of the lying-in, the worries of lactation, the expense of another child, and the extra work which this entails all of this avoided seems at first to be an undoubted gain to the struggling husband and over-anxious wife, and it would ill become me, with the knowledge I possess, if I failed to appreciate the difficulties of the position or to under-estimate the power of that current advice which seems only to be dictated by common prudence. But the question arises whether this immunity from pain and trouble may not be too dearly purchased, even by the persons themselves who are primarily concerned. It would be strange indeed if so unnatural a practice one so destructive to the best life of the nation should bring no danger or disease in its wake, and I am convinced, after many years of observation, that both sudden danger and chronic disease may be produced by the methods of prevention very generally employed. And what is Involved by it 13 In one or two instances I have known acute periton- itis to immediately follow the use of an injection after sexual intercourse. The cervical canal appears to be often unusually patent at this time, and the danger is neither an unimportant nor isolated one. In another instance I was consulted for an acute purulent vaginitis directly following the use of a mechanical shield, and as both parties were free from any disease previously, there could be no doubt that the infection or cause of irritation arose from this. These are casual instances of sudden danger or acute illness that have come under my own notice, but none the less real and far more common is that chronic impair- ment of the nervous system which frequently follows the long-continued use of any preventive measures, whether open to hostile criticism or not as immediately dangerous. This chronic impairment of nervous energy of which I am now speaking, often referred to under the name of neurasthenia, and still more recently under that of " brain-fag," has many causes, and may be produced whenever there has been too great a tax or drain upon the nervous system, and too short a time for real recupera- tion ; but it is especially marked in many of these cases of sexual onanism. The inability to fix attention, the unreasonable fears, the loss of memory, the loss of emotional control, the mental depression and abject misery often felt by the sufferer himself or herself and shown more or less in countenance, word and act, these are symptoms well known to all of us, and symptoms that may be studied exceptionally well perhaps in the school-boy addicted to the habit or vice of self- abuse. With the. reform of this habit in the boy, all of these symptoms quickly dis- appear. It is difficult, therefore, to escape from the con- clusion that the storing-up of semen in the male is of value in the economy. It is undoubtedly a source of strength both in man and in the lower animals, and it appears 14 The Diminishing Birth-Rate as if the seminal fluid must therefore have some function beyond and in addition to its power in the reproduction of species. Its loss is often followed immediately by loss of strength and staying power, and this loss of strength or vitality after the process of reproduction is noticeable throughout all the animal creation, man being no exception to the general rule. Further, the artificial injection of " testicular juice " in senility, though a means of treatment by no means free from objection, and one of which I have no personal knowledge, is stated by many competent observers (from Brown-Sequard to Boy Teissier in the "Twentieth Century Practice of Medicine") to be attended by very marked results, and this, I believe, quite irrespective of the sex of the patient submitted to the treatment. 1 Do we understand the whole of the physiology of the act which often ends in conception ? Is it limited as most have too readily assumed, to the carrying of sper- matozoa for the fecundation of the ovum, or is some portion of the fluid retained by the uterus and absorbed ? Modern investigation shows that traces of the seminal fluid may be found quite high in the female genital tract, beyond the confines of the uterus, and the ever-varying mucous surface of the body of the uterus can, as we know, under certain conditions easily absorb septic poisons and mercurial salts. Beyond this, it is by no means certain that the endo- metrium and so-called uterine glands are inactive. Except during menstruation there is no visible discharge from the body of the normal uterus, and if the theory of Arthur Johnstone be accepted, that the cavity of the corporeal 1 Dr. Boy Teissier writes : " I have employed injections of testicular juice in certain cases of irregular and sometimes very advanced senility, and the very favourable results thereby obtained are of such a nature as to make me regard this substance as an agent of real power, the employment of which is rarely contra- indicated." And what is Involved by it 15 endometrium is essentially an open lymph-gland, the channel of absorption may be immediate and direct. It is quite possible, then, that in one or both of these suggested ways some tonic constituent of the seminal fluid may be taken up by the uterus, and thus affect the general organism ; and there is nothing unreasonable in the suggestion that such absorption may allay the exhaustion which, without it, is liable to follow the act of connection. It is very noticeable that exactly the same train of neurasthenic symptoms are nearly always to be observed in the worst cases of cervicitis, where the cervical canal is effectively plugged by thick mucus, and the patient, though married, is temporarily but necessarily sterile. In both cases the resulting imperfect acts of sexual con- gress appear to be directly harmful. But apart from this, is the prevention of pregnancy the gain to the woman that so many imagine ? It may well be questioned whether in the study of pregnancy sufficient attention has been paid to the period of ovarian rest which appears to accompany the growth of the preg- nancy. The raising of the ovaries out of the pelvis into the abdomen, the diversion of the main blood stream for nine months directly to the uterus, and the absence of menstruation, through pregnancy and lactation, argue a time of rest and comparative inactivity for the ovaries which cannot but have an important value in the life of the woman who is married, and at the same time physio- logically ready for conception and for pregnancy. During this time of uterine activity, but of ovarian rest, there is ample opportunity for the nervous supply of the ovary to recover from any undue stimulus, and it is perhaps worthy of notice that this period is usually attended by improvement in general nutrition and increase of fat. This comparative suspension of ovarian activity also coincides with the time when the uterus is filled and unable to retain the secretion of the male. 1 6 The Diminishing Birth- Rate When this period is fully over it is only reasonable to suppose that the ovaries have gained by this alterna- tion in the sexual apparatus, and that the maturation of the follicle may proceed more healthily, and even the ovum itself may be more perfectly formed, than in the case of a woman in whom this natural cycle has been arti- ficially prevented. In this case the ovaries suffer and the woman suffers with them far more, as a rule, than she would by repeated child-bearing. Widely as the practice of prevention has spread, you will still have to go to the mothers of large families if you want to point to the finest and healthiest examples of advanced British matronhood. The natural deduction from this reasoning is, that the artificial production of modern times the relatively sterile marriage is an evil thing even to the individuals primarily concerned, injurious not only to the race, but to those who accept it. Much that I have said regarding the married life of the mothers of our race has a very similar bearing on that of the fathers also. The incomplete act of sexual congress is but slightly removed from that of self-abuse and is open to much the same criticism and strictures. The lower passions are usually stronger in man than in woman, and demand a firmer control. This is encouraged by the natural progress of the healthy married life. The recur- ring periods of abstinence and restraint induced by each pregnancy, at the confinement and lying-in, not only tend to raise the man himself, but the power obtained by this we may expect (as Prof. Pearson has demonstrated regarding other moral faculties) to be mathematically transmitted to his children. The increased work and self-sacrifice also necessitated by the growth of the family, the simpler and plainer standard of life corresponding to this, all have their en- nobling effect on parents and children. But when the opposite of this obtains then, indeed, there follows not only a moral deterioration of the individual, but a step And what is Involved by it 17 has been taken reversing the great order of progress from the brute. For then the higher powers of the race, know- ledge and the intellectual application of it shown in " prevision " and " precaution " have become systematically subservient to the lower and the animal. And when this is the case decadence has begun. There is no method of prevention, whether by with- drawal or by the use of injections, or shields, or medicated suppositories, that can be regarded as innocuous. The health, and especially tne mental and moral stamina of those who use these " checks " is slowly under- mined. The very life of the nations, as we have seen, is seriously imperilled, and there is increasing reason to believe that such isolated children as are " arranged for " and produced under these conditions may themselves suffer and be degraded by their antecedents. To the evils of disease, race-limitation, or destruction and hereditary weakness which appear to inevitably follow the artificially sterile marriage, we have to add the accompanying evil of a debased and stunted education for the children. In the most plastic period of the child's life, in its earliest years, the more or less solitary child brought up in a land of solitary children is necessarily isolated and self-centred. Reared in greater comfort or comparative luxury, with no brothers or sisters of similar age to rub off its angles and selfishness, it is ill-prepared for every step of the succeeding battle of life, and it is very generally the child of the larger family and poorer parents, and very often the child of a lower class, who pushes his way in front of him and elbows him to the wall. I have no time to dwell on this, which opens out an important field for further observation and study, but you, gentlemen, who have necessarily been students of human nature all your lives, will know how much there is to bear out every word that I have said. 1 8 The Diminishing Birth- Rate III. What will be the outcome for England in the future if nothing be done to check this and allied abuses of so-called modern civilisation ? If I shall not weary you with statistics I would ask you to turn your attention for a short time to our sister nation, France, where (as in a magic mirror) one can apparently see the future of those countries in which the birth-rate tends to fall until the population becomes stationary, or even less than stationary, as it is in France to-day. 1 In a remarkable paper written by M. Alfred Fouillee, of the School of Moral Sciences, in the Revue des deux Mondes of January 15, 1897, we find the following account of the criminal statistics of France : " Since 1881 that is, from 1881 to 1896 the number of prisoners before the Correctional tribunals has risen from 210,000 to 240,000. Since 1889 or in seven years manslaughter has risen from 156 to 189, murder from 195 to 218, and sexual crime from 539 to 651. " In addition to the general increase in criminality of all kinds, a sort of specialisation of crime, especially for acts of violence, is to be noticed. These belong more and more to a certain class, that of the old offenders. The number of these, which was 30 per cent, in 1850, is now 65 per cent. In short, during the last fifty years crimi- nality has trebled itself in France, although the population has hardly increased at all. " The saddest side of the criminal statistics is that regarding children and young people. From 1876 to 1880, 1 " In France during the past year, according to the returns of the Bureau of Vital Statistics, there were 25,998 more deaths than births, and 20,000 fewer births than during the previous year. The record shows only 827,297 births for a population of 39,000,000, though there was a slight increase in the number of marriages, and a slight decrease in the number of divorces." Montreal Medical Journal, December, 1903. And what is Involved by it 19 while the misdemeanours of common law had trebled among the adults, the criminality of youths (from 16 to 24) had quadrupled, that of young girls had nearly trebled, and the number of children prosecuted had doubled. In the period 1880 to 1893 criminality has increased still more rapidly. To-day child-criminality is nearly double that of adults, notwithstanding that minors from 7 to 16 years only represent 7,000,000, while adults amount to more than 20,000,000. In Paris more than half of the individuals arrested are under 21, and nearly all have committed the more serious offences." According to M. Adolphe Guillot, the acts of the young prisoners are marked by an exaggerated ferocity, a special refinement of lust, and a bragging of vice that are never met with to the same degree at a more advanced age. " Child prostitution is growing, and in ten years the number of children charged with prostitution was esti- mated at 40,000. In 1830 the number of suicides was 5 in 100,000 ; in 1892 there were 24 to the same number. By 1887 the suicides of children under 16 years (formerly extremely rare) amounted to the number of 55. In 1896 we had 375 suicides of young people between the ages of 16 and 21, and the suicides of children under 16 were 87." These are facts written by a Frenchman for French readers in the best known French magazine of the day. 1 If we like to extend our inquiry we find that these figures are taken from the national statistics, and are in harmony with other observations. " Since 1880 that is, during the last twenty years the consumption of alcoholic drink in France has trebled, and France has passed from the seventh place in order of consumption of alcohol to the first." (Mr. Yoxall, M.P.) The figures in Mulhall's " Dictionary of Statistics," 1 A very similar or parallel article on the Increase of Crime in the United States (where " prevention " is exceedingly common) is written by Dr. Buckley in the Century Magazine for November, 1903. 2O The Diminishing Birth- Rate though varying to some extent, are in rough accordance with these. According to this authority, we find that insanity is steadily increasing in France, and that the ratio of suicides has risen from 112 per million in 1880 to 205 (or nearly double) in 1885. I do not want to press these figures beyond their bare legitimate application. In particular, with regard to alcoholism, this depends on many factors, and is very much governed -by the legislation of the country regarding its sale. In England, for instance, there was a marked diminution in national expenditure after the Early Closing Act of 1872, and in France there has been a great increase since 1880, when, as I understand, the facilities for obtain- ing it were much increased. But this does not alter the fact that after half a century of trial with an increasingly limited population France shows more and more a lowered and still falling moral average, a lessening virtue and strength, and an increasing national neurasthenia, which seems to crave and to need the help of constant stimulation in order to face the ordinary routine of life. Here we see a great nation, a people and a land which, next to my own, I think I understand, appreciate and love better perhaps than any other, and to which I wish nothing but good ; but a nation so bound by the fetters she has forged for herself that nothing but the life she has deliberately cast aside could apparently save her from her slow decay. And is not this refusal of life by the French at the root of the deep anti-Semite feeling which otherwise would be so contrary to the frank spirit of the French ? The Hebrew race, to their lasting honour, with very few excep- tions, have not only kept themselves free from the vice of which I have been speaking, but, by reason of their laws and customs, are the most systematically temperate in their sexual relations of any nation or people I know. Consequently, among them, the natural breeding ^of And what is Involved by it 21 the better stock has never been interfered with, and in a country like France, the Hebrew seems to rise not only individually, but racially, among the people with whom he has his dwelling, until what appears to be an unfair proportion of responsibility and power and wealth rests in' the hands of an alien race. When this is discovered, and the cause of it but dimly recognised, there cannot but be bitter feelings of jealousy and even hatred in the great mass of the nation among whom the Hebrew dwells, and it is not surprising that the power of combina- tion and of number is sometimes unjustly used to over- come (if possible) the disadvantage. So far, I have been dealing only with what is open to observation and experience. But may we not reason- ably go a step further ? What must be the future of such a society if degeneration goes on and the power of the democracy remains as at present or increases ? So long as the race progresses the people can be trusted with the powers of Government, but when decadence has been going on for years, or even ages, what can be the final outcome of such democracy but anarchy and confusion ? IV. In dealing, or attempting to deal, with the treatment of this grave national evil, it is necessary to take a broad and yet sympathetic view of the problem. It is one belonging essentially to the higher gynaecology, in which no false sympathy or lower obstetric platform must be permitted to interfere with what is really best for the individual and the race. And yet when we recog- nise that the whole force of modern civilisation, its honour paid to riches, its luxury, its frivolity, its impatience, its society, its manner of life, its very " neurasthenia," seems all more or less opposed to the cultivation of that true family life which is its best safeguard against decay, one needs indeed to temper judgment with a quick appre- 22 The Diminishing Birth- Rate elation of all the difficulties encountered by every modern wife and mother, and to recognise the almost insurmount- able obstacles for the Church, the State, and the Profession of Medicine to slowly overcome. For I think the help of all is needed. The Roman Catholic Church teaches that prevention is a sin, and though this is altogether beyond my province, I would submit that no lower standard of sexual morality should be allowed by those who belong to another communion, and that every effort should be made by the religious and the moralist to inculcate a higher ideal and a plainer and simpler standard of life. In the State it might be possible to encourage this higher ideal by regarding the well brought-up family as one of the attendant qualifications for high distinction and honour, and, in addition, by some wide scheme of old-age insurance or pension, by better facilities for the higher education of children, and by some special remis- sion of taxation to lighten the burdens of those who are bringing up large families to be a credit to themselves, and a lasting benefit to the nation. Again, where further education is demanded, and legitimately demanded, by any profession or calling as necessary to full qualification, I would have the State rather jealuously guard the earliest possible date at which productive work may begin. Part of the difficulties of our modern life seenis to be caused by the ever-receding age at which such work is possible. In my own student- days many of us qualified at 21, were earning our own living at 22, and yet managed to keep up study and hos- pital attendance until taking the higher degrees at 25 or 26. This may have been mistaken, but I am convinced it is a far greater mistake to keep a young man, with a man's vigour and ambition, from any real independent work through most of the years from 20 to 30. In the Medical Profession itself the evils of prevention, both immediate and remote, should be studied more And zv hat is Involved by it 23 closely, and explained to such patients as need direction and advice. No advice should be given in favour of it without special consideration of the subject in all its bearings and due consultation. My own opinion is that while occasional abstinence in married life is perfectly allowable and may have, as I have suggested, a high moral hereditary value, no arti- ficial prevention is advisable save that which is produced by operation, when deformity or grave disease imperatively demands it. Certainly in the present day when septic diseases, as we know, can be reduced to a minimum and should be almost entirely avoided, when surgery can so effectually and safely deal with nearly every kind of difficult or dangerous labour, it is not the time for the fairly healthy parents of one child to shelter themselves behind the terrors and troubles of a first confinement, and demand some easy but evil way of further immunity. But as civilisation increases, there can be little doubt that the susceptibility to pain increases also, and it may be that the mothers of to-day need a greater consideration and help, during the progress of pregnancy and lactation, than the mothers of former years. Very much more may be done during these periods by suitable advice, management, and diet than many imagine. In some cases, as I showed last year, repeatedly disastrous preg- nancies may be changed into ones of healthy type and character solely by what amounts to a special and more liberal dietary before and during pregnancy j 1 and much of the partial collapse and ill-health that is apt to follow parturition and accompany lactation may be modified or altogether avoided by due provision and direction for the hygienic requirements of mother and child, particu- larly as regards rest and food. In these ways, and especially by personal influence 1 British Medical Journal, April 11, 1903. 24 The Diminishing Birth-Rate and example, the medical practitioner may do more perhaps than anyone else to reform the judgment and correct the practice of this and coming generations. But when all this is said and done, there still seems to be needed some general awakening of the national conscience if any thorough and lasting change is to be hoped for. Let us be careful that the awakening is in the right direction. One word of caution may be needed. Whatever may be the merits or demerits of celibacy as compared with marriage, statistics show, as I have already stated, that it has but very little practical bearing on the subject before us. " The birth-loss in the United Kingdom must be due to causes operating in the married life of its inhabi- tants." True celibacy, maintained, as it often is, for the sake of the better service of mankind, is worthy of the highest honour and may well be subject to a higher law than that of physiological increase. Many noted examples of this will occur to all as I speak, in every pro- fession and of both sexes. These are vicarious fathers and mothers whose children far out-number the limits of a physiological family, and the lives they protect or encourage or save make for that " maximum of life " which is associated with the " maximum of virtue." There is no reason to fear any high ideal of chastity or continence, and especially none when it is associated with the care of those forces which go for the defence of the nation and that child-life which is its future hope. On the other hand, there is every reason to fear that debased ideal of married life which is secretly and in- sidiously working for the ruin of the nation's power and for the destruction of its hope. Artificial prevention as an evil and disgrace the im- morality of it, the degradation of succeeding generations by it, their domination or subjection by strangers who are stronger because they have not given way to it, the curses that must assuredly follow the parents of decadence And ivhat is Involved by it 25 who started it all of this needs to be brought home to the minds of those who have thoughtlessly or ignorantly accepted it. For it is undoubtedly to this that we have to attribute not only the diminishing birth-rate, but the diminishing value of our population. No truer words were ever said than those by Ruskin : " The maximum of life can only be reached by the maxi- mum of virtue." Do they not carry with them another truth which has now become almost a demonstrable fact, that the prevention of life is always accompanied by moral deterioration ? And this evil harvest, for ourselves and for our chil- dren, is of our own sowing. Some, looking back on past history and bygone civilisations, have imagined that the rise and fall of empire follows some unalterable law, and that nations, like individuals, must necessarily suffer from senility and decay. But it is not so. National decay or degeneration is by no means the inevitable consequences of age. Our modern ally, Japan, is an evidence of this. After a long and chequered history, quite as long or longer than our own, she has emerged in all the activity and strength of a second youth. And it is interesting to note that this new-found power is directly associated in the mind of the Japanese with the knowledge of their own racial strength and power of increase ; indeed, it is this which gives them youth. This is well shown by some recent remarks of one of their more prominent men. He writes : " Japan is in no danger of race-suicide. . . . The mothers are not shirking maternity as in other lands, and the result is that we can spare half a million of men a year for an in- definite number of years and not miss them. " Barring Formosa and the Pescadores, we have less than 150,000 square miles of territory, of which eleven- twelfths is unproductive of food. Nevertheless we have close to 50,000,000 folk to feed. Do you wonder that 26 The Diminishing Birth- Rate we are land-hungry that we want elbow-room ? " (Re- ported by Stephen England in the Daily Mail of December 23, I93-) In a somewhat different way the Hebrew race, to whom I have already referred, may also be cited as an example of an ancient people, old in every sense, and still not dying out. Conquest and dispersion have left their ineffaceable impress on the race, but they are with us to-day, not in- frequently showing evident traces of centuries upon cen- turies of nervous training and development, of nervous wear and tear ; possessing, too, a history of great achievement in music, art, and literature, corresponding to that development, and yet showing, so far as I am able to ascertain, no sign of real decay or loss of reproductive energy. We have the same power with far better opportunities and a much brighter outlook. At no period in our history, perhaps, was there less reason for racial suicide, and, apart from this, for pessimism. All of us, both men and women, need a truer and braver conception of life. Life is entrusted to us life and the power of life and we should be ready to work, to suffer and to adventure greatly and cheer- fully, for the honourable and wise employment of the entrusted capital. " Then welcome each rebuff That turns Earth's smoothness rough. Each sting that bids, nor sit, nor stand, but go. Be our joys three parts pain ! Strive and hold cheap the strain ; Learn, nor account the pang ; dare, never grudge the three." I must confess when I hear of thoughtful men among the Boers in South Africa, military authorities in St. Petersburg, and Japanese in far Japan, noticing and counting on their own racial increase, and comparing this, kindly or unkindly, with our own comparative stag- nation, I would like, if I could, to sting my fellow country- men into some proportionate sense of shame and duty. And what is Involved by it 27 My voice is weak, but in the responsible position in which you have so generously placed me, as the tem- porary head of a great British Society, which may well claim to be the greatest British authority on such ques- tions, I am surely not overstepping my province if I ask for the grave interest of every Fellow in this important subject ; if I ask, not so much for any following of my leadership as for the fullest independent investigation into all the facts, figures and arguments I have brought before you. For with us lies a great responsibility, and ours will be to a very large extent the blame if, in after years, the lamp of the Anglo-Saxon is found to be burning dimly. ,. Tft THJE ON THE LAST DATE RETURN CIRCULATION DEPARTMENT 202 Main Library LOAN PERIOD 1 HOME USE 2 3 4 5 6 ALL BOOKS MAY BE RECALLED AFTER 7 DAYS Renewals and Recharges may be made 4 days prior to the due date. 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