Chapter VIII: Section IV: Medicine and Eugenics (3)

+Number of children and child mortality+: Bluhm adds:--"Figure 1 shows in Curve A the +influence of the duration of breast feeding+; in Curve B +influence of numerical position of birth on the mortality of the infant+. The very divergent course of the two curves expresses the very different influence of both these factors on mortality; the latter is almost exclusively dependent upon the length of suckling, and shows corresponding with its increase a continuous and steep decline down to 1.46% from a maximum number of 35%. The very slight increase of the mortality of children suckled for six weeks compared with those who have not been breast fed at all is immaterial (35.55% against 35.28%). These figures prove only that breast feeding up to six weeks does not give the child any protection against fatal diseases. The influence of the birth number hardly makes itself felt up to the seventh child, only from the eighth onwards the power of resistance decreases continuously but not nearly to the same degree in which it grows with the length of breast-feeding (greatest difference only 21%). Curve B shows a materially different course from that of similar curves by other authors, for instance--from Geissler's well-known curve, dealing with Saxon miners, in which not only the first born show up less favourably than the second and third born, but in which, from the fourth child on, the mortality increases rapidly. The economical condition of both groups being similar (85% of Baum's families had a maximum yearly income of £75), it is highly probable that the difference in the curves arises from different methods of infant feeding. In the Rhine provinces, as is also proved by Baum's figures, the feeding is good; in Saxony, however, it is notoriously bad. The co-relation of infant mortality with infant feeding is very clearly illustrated in Figures 2 and 3, the former shows the +influence of the length of suckling on the mortality of the children classed in order of birth+, the latter +the influence of the order of birth in connection with different lengthed periods of suckling+. The extraordinarily regular course of all the nine curves in Figure 2 and the extremely irregular course of the six top curves in Figure 3 are very striking. From these figures it is shown that the first, second and third born if breast-fed for a short time only, or not at all, are subjected to much greater risks than the eighth, ninth, tenth or later children, suckled for a sufficient length of time (maximum difference 1 to 42). In the curve showing the children who were breast fed for 39 weeks (Figure 3), the influence of the high birth number shows only to a very small degree."

[Sidenote: C 61]

+Number of children and capacity for breast-feeding.+ Concerning this it is remarked: "The upper curve shows what percentage of children had to do without breast feeding, and the lower one how many enjoyed the sufficient period of 39 weeks of breast-feeding. Though Baum's figures are only intended to deal with the number of cases of breast feeding and not with its duration, and though no difference is made between exclusive and partial breast feeding, yet some conclusions may be drawn with regard to suckling capacity. In a district where breast feeding is as general as it is in the one examined into here, the number of women who voluntarily renounce every attempt at suckling must necessarily be small. The curve dealing with the children who had no breast feeding at all is therefore likely to give a fairly correct picture of the absolute or primary incapacity for suckling on the mother's part; absolute incapacity does not of course mean that the mother could not produce a single drop of milk, but that she does not produce enough to satisfy the child, and therefore must resort to artificial feeding. As a period of 39 weeks' feeding, even if only partial, points to a good capacity, the lower curve may also be taken as an expression of feeding ability. A comparison of both figures illustrates that the milk production after the first birth is smaller than after the following ones, and that beyond the eighth birth, it decreases materially and continuously, probably in consequence of the exhaustion of the maternal organism."

[Sidenote: C 62]

+The habit of breast-feeding as running in families and infant mortality.+ With this goes the following explanation: "The two figures illustrate the proportion of mortality of the infants in 143 bottle-feeding families and 376 breast-feeding families of the first order. As the line could not be drawn very sharply, and as in the bottle-feeding families there had to be included those in which as an exception one or other child was suckled for a few days or perhaps for a week, one can see in these groups only the expression of the habit, but not the power of suckling. Both figures illustrate the largely avoidable sacrifice in young lives which still goes on through a want of knowledge and of feeling of responsibility towards the coming race. With the absence of breast-feeding the unfavourable influence of a very large number of children becomes much more apparent; whereas in breast-feeding families the difference in the mortality between medium-sized families (four to six children) and very large families (above ten children) amounts to only 1.39%, it reaches 12.90% with the non-suckling families. Here, if the number of children surpasses ten, nearly every second child dies in the suckling age, and amongst thirteen families there is not a single one which has not lost a child in that period, whereas in breast-feeding families of the first order, with the same large number of children, only every thirteenth child died in infancy, and of sixteen families seven (= 43.75%) lost no infant." The same material is treated in a different way by Dr. Marie Baum, of Dusseldorf, in Figures C 63-66.

[Sidenote: C 63]

+As the length of the period of suckling of the preceding child
increases, there is a constant and rapid decrease in the number of
children who are born at intervals of less than one year.+ If the
preceding child was not breast-fed a new birth occurred before the
expiration of one year in 9.6 cases out of 100. With a suckling period
of one-half to three-quarters of a year of the preceding child, this
figure is reduced to 1.8 per cent., and after a still longer suckling
period to 1 per cent. Out of one hundred mothers who have only partly
or not at all suckled the preceding child, seventy must count on a
fresh birth within a period of 1-3/4 years. If the preceding child
was suckled for at least 39 weeks, only thirty-eight, and with a
suckling period of more than a year only twenty mothers have to reckon
on a fresh birth within 1-3/4 years.

Dependence of Infant Mortality on the Duration of Breast-Feeding and the Length of Time Intervening Between Successive Births.

[Sidenote: C 64]

Figure C 64 shows the +parallelism between+ the +average length of breast-feeding and the average time between births+ within the families. A half to three-quarters of the mothers who suckled either long enough or very long show an interval between births of from 1-1/4 to 3 years, whereas of those who did not suckle at all, or only did so insufficiently, only one-third belong to this group, and figure largely in the column of lower birth intervals.

Dependence of Infant Mortality on the Average Duration of Breast-Feeding and the Average Length of Time Intervening between the Successive Births of the Children in a Family.

[Sidenote: C 65]

Figure C 65 enables us to examine into the +influence exercised by
a longer or shorter interval after the preceding birth on the vitality
of a child+, according as to whether the child was not breast-fed
at all or only moderately or amply so. The black oblongs demonstrate
that the average infant mortality falls regularly and decisively
according to the length of time between the birth of the children
considered and their predecessors. The average mortality of infants
who are born in rapid succession--under one year, one to one and a
quarter years, amounts to over 25 and to 22 per cent. respectively,
whereas the average mortality of children with at least two years'
interval amounts only to 11 per cent. "At the same time, however, it
is observed that the influence of the length of suckling is still
greater than that of the length of time elapsing between births. Even
with an interval of three or more years, the mortality of children who
were insufficiently or not at all breast-fed was above 20 per cent.
The children who had been suckled for at least three-quarters of a
year were only very slightly influenced by this factor in all groups,
except that with a birth interval of less than one year, where the
influence of short birth intervals is not counterbalanced even by long
extended breast-feeding."

[Sidenote: C 66]

Figure C 66. "The +infant mortality within the families+ dealt
with +falls materially and evenly as the average birth intervals
lengthen+. With an average birth interval of less than one year,
one-third of the children die in the first year, but only 7 per cent.
where the average birth interval was over three years; but here also
the influence is strongly modified by the mode of feeding. With the
non-suckling families the mortality is almost 25 per cent., even
with a birth interval of more than two years. On the other hand,
when the duration of suckling is sufficient, short birth intervals
almost disappear (see Table 2), and with an average birth interval of
1-1/4 to 2 years and a suckling duration of at least half a year the
mortality remains on an extremely small scale."

[Sidenote: C 67-73]

Groth and Hahn have exhibited two large tables C 67 and C 68 and a similar one C 69, the results of their important investigations about +breast-feeding and mortality in the administrative districts of Bavaria+. Groth shows in Table C 70 "+mortality of sucklings in Bavaria+," and in Table C 71 "+breast-feeding and cancer+." In Tables C 72 and C 73 the Groth and Hahn statistics are treated by Dr. A. Bluhm from the point of view of the +influence of the habit of breast-feeding on the frequency of births+. In connection with Figure C 73 she remarks: "This diagram shows the number of bottle-fed babies in the various Bavarian districts counted at the time of vaccination. To give as correct a picture as possible of the probable influence which the habit of breast-feeding has on the birth-rate (annual number of births per 1,000 of the whole population) there are represented on this figure by green and yellow columns the average birth-rate for the five years, 1875 to 1879, because in that period a record birth-rate was established, so that it may be assumed that there was then no intentional restriction of births. We see within the four 'old Bavarian' districts, where on the average 64.1% of the babies were not breast-fed at all, the number of births is about 4 per 1,000 of the population higher than in the Palatinate and the three 'Frankish' districts, which together only show 18% of non-breast-fed children."

[Sidenote: C 72 & 73]

"These two figures deal with the +influence of the length of suckling on the birth-rate+, the longer the duration of the suckling period, _i.e._, the higher the number of children breast-fed for six months or more, the lower the birth-rate. This only holds good for the country (Curve B) not for towns (Curve A). This circumstance is explained by the fact that the voluntary restriction of births is much more frequent in towns than in the country, where consequently the influence of the length of the period of suckling on the birth frequency can find much stronger expression than in towns, where, as Curve A shows, it is entirely extinguished by artificial birth preventatives. From both tables it results that, to prevent the senseless waste of human life, the interval between every two births must be more than two years; further, that it is possible to increase it by breast-feeding; the number of births in a district is based in the main on the larger or smaller intervals at which the women of reproductive age have children, and it may, therefore, at the same time, be taken as an expression of these intervals. Keeping these two facts in view, and considering the influence of the mode of infant feeding on infant mortality, it appears to be in the interest of the race that by means of the long duration of breast-feeding, the birth intervals should be extended to at least two years. The facts established in these two tables have a considerable bearing on race-hygiene, especially in reference to the Neomalthusian contentions of the necessary inferiority of the later born, and as a confirmation of the utility of breast-feeding for the reduction of birth frequency. Extremely great appears the influence of breast-feeding on infant mortality."

[Sidenote: C 74-78]

This importance of breast-feeding is further illustrated by Figure C 74--+duration of breast-feeding and infant mortality+, after Dietrich; by Figure C 75--+average number of carious teeth+, after Bunge; and by the three figures, C 76, 77, and 78--"+average duration of breast-feeding and physical development, duration of breast-feeding and average school reports+, and +duration of breast-feeding and frequency of rachitic disturbances of development+," after the extensive and valuable researches by Röse.

It must be pointed out that a far more direct connection exists between breast-feeding, duration of suckling, infant mortality and physical development than through the mere provision of suitable nourishment for the child. A good suckling capacity is a symptom of a strong constitution which is transmitted from mother to child. Examination of Röse's table offers this suggestion.

[Sidenote: C 79-82]

+The importance of the hereditary constitution+ (which he considers is dependent on soil and climate) +as regards infant mortality+ v. Vogel expresses in four maps of Bavaria (Figures 79-82), so which he has furnished the following comments (contained in the pamphlet, "Der Örtliche Stand der Säuglingsterblichkeit in Bayern," Munich, Piloty and Loehle, 1911): "The district of the highest infant mortality in Bavaria is inhabited by a population of small height, small fitness for military service, and high tuberculous mortality. The reverse holds good on the whole for the district with a low mortality.

Infant mortality in 1901.

Figure C 79.]

I cannot suppress another objection to the usual way of proving the--to my mind undoubted--influence of breast-feeding on the duration of life in infancy. Why is the mortality of those children who have not been suckled for a week so large? Is it because they have not been suckled, or because they have only lived altogether for less than a week? Or, again, to be able to be suckled for 40 or 50 weeks, one must have lived for 40 or 50 weeks, but a child who has lived for 40 or 50 weeks, whether it has been suckled or not, has passed over the worst period. It is well-known that the mortality in the first days of life is the highest in the second week, much higher than in the third week, and so on. In short, the mortality changes in such an extremely high degree in the course of the first year of life that this period is much too long for the comparison between mortality of suckled and non-suckled children. One ought to calculate how many of those who have been suckled for 0 weeks, one week, two weeks, one month, three months, six months, and so on, have survived the first week, the second week, the first month, and so on. Only in this manner can be established what is the share of the absence of breast-feeding and what is the share of the innate weakness and tendency to disease in the degree of infant mortality."

Percentage of under-sized Bavarian recruits (below 1.62 metres in height) in 1875.

After Professor Ranke.

Figure C 80.]

Exhibit C 81-82.

Fitness for Military Service in Bavaria, 1902.

Figure C 81.]

Mortality from Pulmonary Consumption in 1901.

Figure C 82.]

[Sidenote: C 83]

A striking peculiarity of cities, especially large cities, is, as pointed out before, the high mortality amongst men; for this general observation Figure C 83, +male and female mortality in town and country+, offers an example. Whereas the female mortality in Berlin, in the higher age groups, is even lower than in Mecklenburg with its preponderantly country population--which is evidence that in town life there are no inherent circumstances adversely affecting all persons in a high degree--the male mortality in all the age groups is higher, and in some much higher. The special adverse influence on men of town life is also apparent in the upper part of the figure (+comparison of male and female mortality)+. In Mecklenburg the mortality among men is at most 25% higher than among women, and during the period of most intense child production, as well as in the highest age group, it is even smaller, whereas in Berlin the differences are much more accentuated. It may be remarked that the higher male death-rate in Mecklenburg between the ages of 40 to 75 years can only to a small degree be explained by physiological reasons. This is shown for example by the fact that in the provinces of Schleswig-Holstein, Pomerania, Hanover, Hessen-Nassau, and the Rhein Provinces in the country, the expectation of life for men aged 25 years is about equal to that of women.

[Sidenote: C 84 & 85]

The higher male mortality in cities is only partially explained by the specific harmfulness peculiar to men's town occupations, though the mortality of peasants and agricultural labourers ranks amongst the lowest. A very important part in this connection may be played by syphilis. How terribly syphilis injures the body, though it is seldom directly fatal, is shown by the experiences of life insurance companies, of which examples are given in Tables C 84 and C 85. With the Gotha Life Insurance Bank, for instance, +the mortality of the syphilitic at the ages of 36 to 50 years+ was found to be nearly double as high (186%) as that of the non-syphilitic.

[Sidenote: C 85]

Table C 85 shows to what a high degree +the heart and vessels especially are harmed by syphilis+. At this point it is to be noted that it may now be considered as proved that the statement that general paralysis causes death in 2.9% cases among the non-syphilitic is erroneous, because general paralysis only occurs among persons who have been affected with syphilis. There is no doubt that the poison of syphilis is also most injurious to the germs and the progeny; the foetus is sometimes infected in the mother's womb, and sometimes suffers by the general debility of the maternal body. A large proportion also of those children who attain a higher age are either enfeebled or damaged in many ways, and this inferiority is often passed down to the grandchildren. The most recent Serum investigations (the Wasserman reaction) are the first to throw full light on this. In Germany syphilis occurs much more frequently in town than in the country; this no doubt dependent on prostitution and on a much greater degree of promiscuity of sexual intercourse in cities. In the country couples keep together with greater constancy, even in the case of cohabitation without marriage.

[Sidenote: C 86-88]

+The frequency of syphilis and other venereal diseases in town and country+ is illustrated in Table C 86, which gives the result of the enquiries of the Prussian Government on the 30th April, 1900, and Table C 87 after Schwiening, on +the frequency of sexual diseases among military recruits+. Also Table C 88 which gives the +frequency of delirium tremens, epilepsy, and general paralysis+ in the +Prussian lunatic asylums+, points in the same direction by the great differences shown in the frequency of general paralysis in the different institutions. This table, at the same time, indicates what is also supported by other observations, that the +frequency and intensity of harmful influences through alcohol+ are much +greater in towns than in the country+; this may be partly because in cities there is a greater and more regular abuse of alcoholic beverages than in the country, partly because town-life induces a greater susceptibility to alcoholic poisoning than country life (less intense metabolism with sedentary occupations).

[Sidenote: C 89-90]

+Injury to the reproductive function through alcohol+. It has been known for a long time that drunkards are frequently sterile. This must be attributed to the fact that the testicles of drunkards become to a great extent atrophied. The condition is shown in Figure C 89 by R. Weichselbaum,[B] representing a section through the testicle of a drunkard. Figure C 90 which shows a section through a normal testicle, enables even the layman to observe the atrophy of the characteristic glandular tissue of the testicle. Weichselbaum has up to now found that in fifty-four cases, without exception, in which alcoholism had been proved, this atrophy could be demonstrated to a greater or less degree. In thirty of these cases the subject was so young that senile atrophy was out of the question. The abuse of alcohol is not the only harmful influence which is able to induce such atrophy of the testicles, but chronic alcoholism acts with special intensity. Very similar results to those of Weichselbaum have been obtained by Bertholet (Zentralbl. f. allg. Pathologie 20 Bd. 1909) in 37 out of 39 habitual drunkards. They agree with observations on the vesiculae seminales of drunkards by Simmonds, who found that in 61% of the cases examined the spermatozoa were absent or dead. It is a permissible assumption that a poison which can cause the total atrophy of the sexual glands may, in an earlier stage, have adversely influenced in respect to quality the function of those organs.

[Footnote B: Verhandlungen der Deutschen Patholog: Gesellschaft, 14th day, Jena, Fischer, 1910, page 234.]

[Sidenote: C 91]

[Sidenote: C 92]

+Alcohol and Degeneration+, from the tables on the alcohol question by Gruber and Kraepelin, Munich; Lehmann; contains the well-known statistics of Demme, Bunge, and Arrivée. Table C 92 adds to the summary of the statistical observations of Demme, further details of the +kind of abnormalities+ which were +observed in children of drunkards+. Representing, as they do, exceptionally bad cases with a high degree of degeneration, one may doubt whether and in how far congenital hereditary inferiority of the parents may have had its influence.

[Sidenote: C 93]

Figure C 93 contains the well-known result of v. Bunge's investigations on the +influence of paternal alcoholism on the suckling capacity of the daughters+. The varying frequency of the habitual consumption of alcohol and of drunkenness proper of the father in the two groups of families is most striking. Official investigations of this question on a large scale are urgently called for.

[Sidenote: C 94]

Figure C 94 dealing with the +interconnection of tuberculosis, nervous diseases and psychoses of the progeny and the alcohol consumption of the father+, is derived from Bunge's investigations. It is worthy of notice that he endeavoured to eliminate from his statistics all families in whom hereditary diseases could be traced previously.

[Sidenote: C 95]

Table C 95 contains a summary of T. Laitinen's +experiments on animals with small quantities of alcohol+. The degree of injury to the progeny supposed to be produced by even a minimum quantity of alcohol (corresponding to about one-third of pint of beer for a man) is astounding. Repetition of these experiments on a large scale and with the strictest care would be most desirable here also.

[Sidenote: C 96]

Table C 96 also refers to reports by T. Laitinen.[C] +It deals with the effect of alcohol on the progeny in man+. Unfortunately Laitinen's paper is so confused and inexact that it is impossible for the reader safely to draw conclusions from it. His personal observations are mixed up with those gathered by means of inquiry sheets circulated by him in such a way that one cannot make out how he has arrived at his weights at birth and mortality. Information is lacking with regard to the nutrition of the children, their age at the conclusion of the investigations, the length of marriage, the rapidity of birth sequence and so on. It is, therefore, indispensable to await the more detailed report before Laitinen's information can be made use of.

[Footnote C: Internat. Monatschrift z. Erforschung des Alkoholismus, Juli, 1910.]

[Sidenote: C 97]

Bezzola has sent in in a modified form the data which he presented to the Eighth International Congress against Alcoholism in Vienna in 1901, on the +effect of acute intoxication on the origin of feeble-mindedness+. With their help the curve on Figure C 97 has been constructed, showing the distribution of illegitimate births in Switzerland during the different months of the year from Bezzola's data and the corresponding curve of the births of mentally eminent individuals (taken from Brockhaus' encyclopædia.) The author supplies the following comments:--

"+Comparison between the general birth curve and the corresponding one for the birth of feeble-minded children+."

The casual observation at the registration of the personal history
of feeble-minded individuals that 50 per cent. of the birth dates
fall within only fourteen weeks of the year (New Year, carnival,
and wine harvest) has aroused the desire to deal with the seasonal
incidence of the begetting of the feeble-minded on the basis of as
much material as possible. For this purpose the author's census of
feeble-minded school children, which took place in the year 1897, and
referred to the years 1886-90 inclusive, seemed specially suited.
Originally (in 1901) a curve was plotted in which all the 8,186
feeble-minded and idiotic children were included whose exact birthdays
were known, and this curve was compared with the total curve for that
period. (Schweiz. Statistik 112 Liefg.) The latter was constructed
in the following manner from the whole number of births (934,619)
which occurred in these eleven years:--The general daily average was
taken as 100, and the daily average for each month was expressed
proportionately. Thus numbers above 100 show a daily birth frequency
above the average, while for numbers below 100 the reverse is the
case. The curve for the 8,136 feeble-minded persons was constructed
in a similar way, and thus a comparison with the general population
producing them was made possible. Subsequently (1910-11), in order to
secure homogeneous material, the first and last years were left out,
since by including them, owing to the non-agreement of the school
year and the astronomical year, the earlier months (January-April)
were much weighted. By this restriction of the material dealt with
the number of feeble-minded is reduced to 7,759, but the material for
each separate year is more homogeneous. Distributed between 2,922 days
(eight years), the daily production of the feeble-minded is 2.648,
the corresponding total number of births of the years 1882-89 ls
677,083, or 231.7 per day. 1.14 per cent. of all births are included
in the figure for the feeble-minded. If one treats the total number of
births for each month as well as the number of births of feeble-minded
according to the method described above, and used by the Federal
Statistical Bureau, two curves are produced which diverge considerably
from each other in particular months. On the whole the curve for the
feeble-minded (thick line) is flatter than the curve for the total.
Especially striking are the drop in May and June (corresponding to
the procreation period from the 25th July to the 23rd September) and
two peaks rising above the "total" curve. One of these is slight,
yet distinct. It refers to the months of birth, July and August,
corresponding with the procreation period from the 24th September to
the 24th November. More conspicuous is the second peak of the curve
for the feeble-minded from October to December, otherwise a time poor
in births. The centre of the corresponding period of procreation
(25th December to 26th March) is in February (carnival). This seems
to confirm the suspicion that during the wine harvest and carnival
an increased procreation of feeble-minded occurs (procreation during
drunkenness?).

We cannot suppress the remark that the fluctuations of the curve for the feeble-minded are much too small to admit of the drawing of an ætiological conclusion, but the fluctuations of the intelligence curve and the illegitimate curve partly exceed the limits of probable error. The peaks of both birth curves in February, correspond to a peak in the procreation curve in May. Perhaps one may attribute them to the existence of a remnant of a period of "heat" (or a rutting season) in man.

[Sidenote: C 98]

+Lead.+ Whereas the +germ cells+ are well protected against many harmful influences from without which affect the soma of the mother, they +and the foetus produced from them suffer considerably from+ some. Amongst their deadliest enemies are +certain poisons+, and +notorious in this respect is lead+. Table C 98 gives two sets of statistics on this point, they justify the law in Germany, and in other States, forbidding female labour to deal with lead and lead-containing materials. Paul's figures, showing that lead poisoning of the father is also extremely adverse to the production of a healthy progeny, are remarkable.

[Sidenote: C 99]

+Female Labour.+ A baneful influence on reproduction is brought to bear by the growing quantity of professional female labour away from home and by the economic emancipation of women. Evidence of this is given in Table C 99--"+female labour and child mortality+"--the data of which are taken from Prinzing's work. Infant mortality is higher the larger the percentage of females employed in factories during the child-bearing period. This is partly due to interference with breast-feeding and partly to the unfavourable influence on pregnancy.

[Sidenote: C 100]

Dr. Agnes Bluhm has given in Figure C 100 "+Female Labour and Reproductive Activity+," the statistics of Roger and Thiraux, as well as the results of the investigation of the Imperial Statistical Office on the "Relationship of illness and deaths in the Local Invalidity Fund for Leipzig and surroundings." Dr. Bluhm gives the following explanation: "The top figure on the left is based on material of the Local Invalidity Fund for Leipzig and surroundings, dealing with over a quarter of a million of women of child-bearing age. The distinction between obligatory and voluntary members makes possible the estimate of the +influence of work continued up to the time of confinement+, because the voluntary members receive the same weekly payments during confinement as the obligatory ones, and, consequently, a woman has no object in joining the voluntary insurance scheme except in order to secure rest before confinement, which they procure for themselves at their own expense and with the loss of their wages. (At that time the compulsory support during time of pregnancy did not exist.) It is to be noted that the voluntary members show ten times as many confinements as the obligatory ones."

"The left hand figure at the top shows that the women who work up to the time of confinement fall ill during their pregnancy twice as often, and have six or seven times as many miscarriages and premature births and 1.28 times as many cases of death in child-bed, as those who stop work for a more or less extended period previous to their delivery."

"The frequency of illness after childbirth is in both categories of women almost the same; but the duration of the illness beyond the period for which the legal subvention provides (13, 26, or 34 weeks respectively) is much greater in the case of the obligatory members who do not spare themselves before their delivery."

"Left hand figure at the bottom--the researches were made by Roger and Thiraux in a maternity home. A comparison is made between the women who entered the home only at the beginning of childbirth and those who entered during the last month of pregnancy or sooner. Premature birth occurs in nearly one-third of the cases among the former, but among the latter only one-eighth.

"Right hand figure at the bottom--dealing with the same material as the left hand figure below compares the weight at birth of the first, second and later born. The average weight of the former is 300 g. and that of the latter 341 g. higher with mothers who cease work two or three months before delivery, than with those who worked up to the last. Possibly this expresses in the main the different duration of pregnancy. The importance of the birth weight of a child for its further development is not to be underrated."

"The top figure on the right shows that the importance of the adverse influence of female labour on the race, shown in the above figures, is growing, because there is an increase of employment amongst married women. Simon's figures show that the manufacturing industries, which in 1907 employed by themselves two million female hands, the number of married women has increased by almost 200,000 during the last twelve years. In agriculture, in which four and a half million females find their main occupation, the share of the married women is much greater still."

"The increase of married female labour being intimately connected with the development of our economic life, which cannot be deliberately influenced, the demand for a Motherhood Insurance for all female labourers of any kind, and for the extension of the legal time of stoppage of work before childbirth to at least four weeks, follows as a practical result of the facts stated above."

Dr. Bluhm's repeated assertion, which is regarded by many as a dogma, that economic conditions cannot be deliberately influenced (+i.e.+, that they are of the character of a law of nature) must not remain uncontradicted as a principal. It is absolutely unproved, though the difficulty of influencing our economic life cannot be denied; the economic order has been created by man and +must+ be altered if it proves harmful for the race.

[Sidenote: C 101]

The adverse influence of female labour on the progeny is shown from a somewhat different point of view in Table C 101--"+premature births and abortions in different callings+." The most serious fact shown here is that a low birth rate may frequently be found in conjunction with a high rate for miscarriage and premature birth; as the compiler of these statistics points out, this conjunction is most apparent in those callings which demand frequent intercourse with the public, such as domestic service, that is to say in cases where pregnancy is particularly inconvenient. Probably in these cases artificial prevention of pregnancy goes hand in hand with the procuring of abortion!

Race-hygiene does not aim at an indiscriminate motherhood insurance of married and unmarried mothers, but it aims at the economic subvention and encouragement of legitimate fertility of healthy and able parents, connected with, and rendered possible by, a reduction of female labour away from the home. Marriage is one of the most important hygienic institutions for the individual as well as for the race, and it is folly to allow its decay and to replace it by substitutes.

[Sidenote: C 102]

+The importance of marriage for the health to married persons+ is shown by figure C 102--"+condition with regard to marriage and mortality in Prussia, 1894-97+," as given in Prinzing's book. That we have to deal here with an actual favourable influence of marriage, and not with a selection of the healthy at the time of marriage, is proved by the fact that the low death rate of the married is maintained through all age classes and that the widowed and divorced show throughout the highest death rate.

[Sidenote: C 103]

"+Condition with regard to marriage and mortality, cases of death from tuberculosis+," after Weinberg, also confirms with regard to tuberculosis the favourable influence of marriage on the health of men. With women the mortality from tuberculosis up to the age of 60 is lowest among the unmarried. Pregnancy and suckling act here adversely, but by far the worst position is also held here by widows and divorced women.

[Sidenote: C 104-105]

The advantage of marriage for the progeny is made evident in Figure C 104--"+mortality of illegitimate children in different European states+", and in Figure C 105 dealing with the "+survival of the legitimate and illegitimate children in Berlin in 1885+." After five years there are still alive more than 60% of the legitimate, but only 40% of the illegitimate children. The higher mortality of the latter is by no means a purifying process of weeding, but the expression of greater sickliness which permanently harms the surviving also. The division of labour between man and wife, with reference to the care of the offspring, is one of Nature's institutions which is of the greatest advantage for parents as well as children.

[Sidenote: C 106-107]

+Inbreeding and the Crossing of Races.+ On the whole with mankind inbreeding is viewed with fear, and justly so, in view of our customary carelessness with regard to the physical and mental conditions of those who contract marriage. +If blood relations have similar pathological conditions or pre-dispositions to illness or degeneracy, the progeny which results from their union is endangered to a particularly high degree.+ Our collection brings as an example of this in Table C 106--the pedigree of the celebrated Don Carlos. The bad inheritance of Johanna the Mad asserts itself to a lesser degree yet quite perceptibly also in the children of Max. II. Table C 107--the children of Maximilian and his cousin Maria of Spain; undoubtedly the Emperor Rudolf II. was mentally diseased. Also Charles V. and his son Philip II. were abnormal characters.

[Sidenote: C 108]

+Blood relationship of the parents and health of the children+, which v. d. Velden has prepared from Riffel's family tables, also speaks for the harmfulness of inbreeding. The offspring of blood relations are emphatically weaker and sicklier than those of persons related distantly or not at all.

[Sidenote: C 109]

The harm of inbreeding amongst the pathological is also illustrated by the large Table 222 (exhibited by Schüle). Pedigrees from wine-growing districts in the centre of Baden; against this it may be taken as proved that inbreeding in itself between the healthy and fit is not harmful. Animal breeders (as well as plant cultivators) make an extensive use of it with the view to the cultivation of certain hereditary characteristics.

[Sidenote: C 110]

We show in Table C 110, after de Chapeaurouge, the +pedigree of Belvidere+, an animal which, in spite of close inbreeding, was distinguished by excellent qualities, and by whom, out of his own daughter, another sire of the highest rank was produced.

[Sidenote: C 111]

After long-continued and very close inbreeding, even with a faultless condition of the germ plasm, the decrease of vitality and fertility of the progeny asserts itself. Important evidence for this is given by Georg. H. Shull in his exhibition of +cross-fertilized, self-fertilized and hybridized maize+ (Exhibit No. C 111). Shull makes the following comments: "Results of inbreeding with maize--crossing between different races or genotypes, if not too distantly related, results in a progeny which excels its parents in vitality, whereas crosses between individuals belonging to the same genotype engender no increase of vitality as compared with the parents."

In maize, and presumably in most other plants and animals in which cross-fertilization is the rule, all individuals are usually complicated hybrids between different varieties of genotype. They owe their vigorous constitution to this hybrid nature.

"The result of self-fertilization or of close inbreeding is that the hybrid nature diminishes in degree. The stock is reduced to a homozygotic condition, and is thus deprived of the stimulus which lies in the hybrid condition."

"When two given genotypes are crossed, the first hybrid generation is possessed of the greatest vigour. Even the second generation shows much less vitality, and this decrease continues with the third and later generations. But each succeeding generation differs less from its predecessor than the latter differed from its own parents. As soon as the stock has become a pure line, inbreeding produces no further weakening."

"The top row of the exhibited collection of maize cobs (large cobs with many grains) is derived from a family in which for five generations self-fertilization has been prevented by using mixed pollen. These conditions approach those prevailing in an ordinary field."

"The middle row of maize cobs (small cobs with few grains) comes from families of the same derivation as the first row; but for five generations they have been self-fertilized. Each one has characters which the others do not possess. They are almost pure bred, and continued self-fertilization produces no further adverse influence. The cob, quite to the right, without grains, has pistils so short that they do not project from the husks. This genotype must, therefore, be fertilized artificially."

"The lowest row (the largest cobs with the most grains) comes from families which have been created by the crossing of plants belonging to different genotypes, the relationship in which case is indicated by the lines which connect this row with the middle row."

"The following harvests of grain were made in the year 1910:--

Self-fertilization prevented (average of nine
families) 53.5 hi pro ha.
Self-fertilized (average of ten families) 25.3 " " "
F1 hybrid (average of six families) 59.2 " " "
F2 hybrid (average of seven families) 38.8 " " "

[Sidenote: C 112-114]

It is well-known to what degree +inbreeding+ is practised in +reigning families+. We show as an example for this, Chart C 112, the +pedigree of the Archduchess Maria de los Dolores of Tuscany+, exhibited by Dr. Stephan Kekule von Stradonitz, and Chart C 113 of the same exhibitor, +pedigree of Ptolemäus X+. Soter II. (Lathros), and Chart C 114, +pedigree of the celebrated Cleopatra+. Though with Ptolemäus X. the effect of sexual reproduction in bringing about new combinations of hereditary units was very limited, since the couple, Ptolemäus V. Epiphanes and Cleopatra Syra having produced all the germ cells from which he developed, he appears, nevertheless, to have been a perfectly normal being. In his granddaughter Cleopatra certainly much "extraneous blood" circulated.

[Sidenote: C 115]

Even where there is no high degree of inbreeding, the individuals of a people are much more closely related to each other than is generally assumed. Table C 115, "+theoretical number of ancestors+," shows that, assuming the duration of one generation to be 35 years, and that no marriages between relations have taken place, the number of the ancestors of a man living now would have been eighteen billions in the year 0 a.d. In reality the germanic race, wandering west, probably only numbered hundreds of thousands. This phenomenon of "+ancestral loss+," as Ottokar Lorenz calls it (that the number of real ancestors is much smaller than those theoretically possible), can be illustrated in the pedigrees of the reigning houses.

[Sidenote: C 116]

We have in Table C 116 an +analysis of pedigree of Emperor William II.+, after Ottokar Lorenz. Investigations show that twelve generations back the real number of his ancestors amounts to only one-eighth of the possible figure. Only 275 persons have actually been found because in the older lines, the bourgeois element, of which no record can be found, has had a very large share.

[Sidenote: C 117]

Very little knowledge exists concerning the effect of the crossing of races in man. On the whole it appears not to be favourable, if it is a question of crossing of races from far apart, even in purely physical respects. An example of harmful influence is given in v. d. Velden's Table C 117--"+Fertility and Health in relation to the crossings of races+."

NEOMALTHUSIANISM.

[Sidenote: C 118-122]

The next and the greatest concern of race-hygiene--much greater than the relative increase of inferiority--is, to-day, neomalthusianism, the intentional restriction of the number of births in varying degrees up to complete unproductiveness. Though conscious regulation of the production of children is absolutely necessary, it becomes fatal to a nation if under no control but the egotism of the individual. For its permanent prosperity a nation requires, in order merely to hold its own, a sufficient number of "hands" and a sufficient number of "heads" to guide those "hands." We referred to this when mention was made of sterility as a phenomenon of degeneration, but this cause of sterility during the last decades only takes a second place compared to deliberate intention. The wealthy and higher social classes were first attacked by neomalthusianism. Their progeny is becoming more and more utterly insufficient, so that under our present social conditions, particularly which give mind and talent better openings, and thereby more and more take out of the mass of the people the better elements, make the strongest demand for them and use them up, the danger of an increasing deterioration of the average quality of its progeny grows greater and greater. The baneful influence of wealth on fertility is shown by several tables. Figure C 118 "+Fertility and Wealth+," after Goldstein and Tallquist, gives the condition in the French Departments; Figure C 119, "+Number of Children and Wealth+," after Bertillon, for the Arrondissements of Paris; Figure C 120, "+Fertility and Wealth+," after Mombert, for Münich, 1901, Table C 121, "+The Number of Children in Families of Different Classes in Denmark+, 1901," after Westergaard; Table C 122, "+Fertility of Marriages, Occupation, and Wealth for Copenhagen, and Dutch Conditions+," after Rubin, Westergaard, and Verrijn Stuart.

[Sidenote: C 123]

The worst condition with regard to the fertility prevails among those with the highest mental endowment. Evidence of this is given in Figure C 123, "+Insufficient Fertility of the Highly Endowed in Holland+," after J. R. Steinmetz. It shows the rapidity with which the number of children decreases. In order to estimate the significance of these statistics, it must be noted that after taking into account the mortality among children and young persons, and the unfitness for parenthood of an appreciable fraction of the adults, a fully capable couple would have to produce at least four children to assure the necessary moderate increase in the population which is required to prevent a people from sinking into stagnation and deterioration.

[Sidenote: C 124]

The dying out of highly gifted families is shown to be more accentuated in Figure 255, after Bertillon, "+Progeny of the Highly Gifted in France+." Four hundred and forty-five of the best known Frenchmen, with their wives, have not even reproduced that number of individuals, and this in spite of the fact that repeated marriages of the same individuals have not been taken into account.

[Sidenote: C 125-126]

Even if one has been able, up to the present, to live in the hope that the number of persons of more than average ability produced by the mass of the people is always sufficient to replace those that are used up, at the present time anxiety about the "heads" is replaced by anxiety about the "hands." The knowledge of means of preventing fertilization spreads incessantly, and is recklessly promulgated by the neomalthusians and by a shameless industry. We point to Figure C 125, "+Want of Fertility in French Towns+," after Jayle, and to Figure C 126, "+Fertility in Prussia+." In Berlin fertility is decreasing most rapidly; at the end of the sixties it still amounted to 200 in every 1,000 women of child-bearing age. In the five years, 1905-1910, only to 84; in the year 1910 only to 74. This state of things is shown also in the relative increase in numbers of the first born.

[Sidenote: C 127, 128 & 129]

Figure C 127, "+Decrease of Legitimate Fertility in Berlin--the two-children system+." The other German towns follow the example of Berlin. Berlin to-day produces 20% less children than are required to maintain its own population without immigration, and the same conditions will soon prevail in other towns. Up to now the country districts in general maintain their fertility (West Prussia on Figure C 128), but there, too, modern practices begin to make themselves felt. The town and industrial population increases so rapidly that the conditions prevailing among them have an ever increasing effect on the people as a whole. Thus we see, even at the present time, a serious decline in fertility among an overwhelming majority of European States: Figure C 129, "+Decrease of Fertility in Some European States+."

[Sidenote: D]

Exhibited by David Fairchild Weeks, M.D.,

+Director of the New Jersey State Village for Epileptics at Skillman, U.S.A.+

Explanation of Symbols used in the Charts.

Male individuals are indicated by squares and females by circles. The members of each fraternity are connected by the same horizontal line. The fraternity line is connected by a vertical line to the line joining the symbols representing the father and mother. Illegal unions and illegitimate children are shown by dotted lines. As an aid in tracing the patient's immediate family, a green line is used to connect the direct ancestors on the paternal side, and a red line on the maternal side. The red squares and circles indicate epileptics, the green the insane, the black the feeble-minded, and purple the criminalistic. The figures directly above the fraternity line indicate the rank in birth, a figure inside a square or circle shows the number of individuals of that sex. A black dot suspended from the fraternity line stands for a miscarriage or a stillbirth. A line underneath a square or circle shows that institutional care has been received. The hand points out our patient.

The following letters indicate the different conditions: A, alcoholic; B, blind; C, criminalistic; D, deaf; E, epileptic; F, feeble-minded; I, insane; M, migrainous; N, normal; P, paralytic; S, syphilitic; T, tubercular; W, wanderer, tramp; d, died; b, born; inf, infancy; Sx, unchaste.

[Sidenote: D 1]

This chart shows very clearly the dangerous results of a marriage in which both of the +parents are epileptic+. Of the four children the first three were epileptic, and the fourth, a boy, who died at the age of nine, was feeble-minded. All four of these children were cared for at public expense, two are patients at the New Jersey State Village for Epileptics, and the other two were wards of the Children's Home Finding Society. The epileptic father is dead, and the mother married again to an alcoholic man. When last heard of she had another child.

[Sidenote: D 2]

An +epileptic+ woman, married to a +feeble-minded man+, is responsible for the large number of defectives shown on this chart. The principal mating is that of one of the epileptic daughters of this woman, who, like her mother, married a feeble-minded man. Eight children resulted from this marriage; one died before two years of age, the other seven were epileptic, the five who are living are patients at the New Jersey State Village. Two of the girls in this fraternity had illegitimate children before receiving proper care. This family is undoubtedly a branch of a family of defectives, most of whom live in an adjoining State.

[Sidenote: D 3]

This is a case of +incest+, and shows plainly that the "empty germ plasm can yield only emptiness." These people lived in a hut in the woods. The feeble-minded man had by his defective sister an epileptic daughter, then by this daughter he had four children, one an epileptic, one a feeble-minded woman of the streets, who spends much of her time in jail, one an anencephalic monster who died soon after birth, and one a feeble-minded boy, who did not grow to manhood. Since the hut in the woods burned down, the epileptic woman and feeble-minded daughter live in a cellar in town, though much of their time is spent in jail.

[Sidenote: D 4]

This chart shows a +feeble-minded+ man, who came from a feeble-minded family, married to an +epileptic+ woman, who descended from a tubercular epileptic father and a mother who is described as "flighty," "not too bright." This couple had six children, three feeble-minded, two epileptic, and one still-born. Since the death of the epileptic mother, the father has secured homes in institutions for all of his children except one, and then married again. As yet he has no children by the second wife.

[Sidenote: D 5]

The wife in the central mating in this case is a low grade +epileptic+, who can scarcely recognize her own children. The father is a +feeble-minded alcoholic+, who works hard, but who spends all his money for drink. There were six children; one died at the age of four, and all of the others except one six-year-old boy are epileptic. All are being cared for by the public. Before the mother and three of the epileptic children were brought to the State Village for Epileptics the family lived in a cellar, slept on rags, and depended on the neighbours for food.

[Sidenote: D 6]

This is a history which illustrates very well the source of a large number of the almshouse inmates. The central figure is an +epileptic+ woman, who spent most of her life in the poor house. No two of her seven children are by the same father. The epileptic daughter, whose father was feeble-minded, had started to lead the same kind of life as her mother; in the almshouse she gave birth to one illegitimate child before she was put under State care. The mother, when she last left the almshouse, went to live in a hut in the woods with a feeble-minded man, who had three feeble-minded sons; one of these sons married the feeble-minded sister of one of the epileptic patients at the New Jersey State Village.

[Sidenote: D 7a]

[Sidenote: D 7b]