THE SMALL FAMILY SYSTEM Neo-Malthusianism is an ethical doctrine based on the principle of Malthus that poverty, disease and premature death can only be eliminated by control of reproduction, and on a recognition of the evils inseparable from prolonged abstention from marriage. It therefore advocates early marriage, combined with a selective limitation of offspring to those children to whom the parents can give a satisfactory heredity and environment so that they may become desirable members of the community. It further maintains that a universal knowledge of hygienic contraceptive devices among adult men and women would in all probability automatically lead to such a selection through an enlightened self-interest, and thus to the elimina- tion of destitution and all the more serious social evils, and to the elevation of the race. — C. V. Drysdale. THE SMALL FAMILY SYSTEM IS IT INJURIOUS OR IMMORAL? BY C. V. DRYSDALE, D.Sc. (Lond.) ti* REVISED AND ENLARGED EDITION With thirteen diagrams of population movements, etc., at home and abroad, and Prefatory Notes by Dr. B. DUNLOP AND Dr. WILLIAM J. ROBINSON NEW YORK B. W. HUEBSCH MCMXVII COPYRIGHT, 1917, BY B. W. HUEBSCH Printed in U. S. A. First printing, November, 1917 Second printing, April, 1918 PREFACE Having with pleasure written a prefatory note to the first edition of The Small Family System in 1913, I am still more pleased to do the same for this second one. A sufficient reason will be found in the new chapters that Dr. Drysdale has added in which he shows the astonishing progress the birth-control movement has made in England and the United States of America these last three years, and in which he gives a brief history of the whole movement that will now be greatly appreci- ated. Otherwise the book remains very little altered. The Small Family System happened to be writ- ten at an opportune moment. Just as it was being published, the newspapers announced that the British National Council of Public Morals had formed a highly influential Commission to inquire fully into the whole subject of the falling birth- rate. Dr. Drysdale was the first witness before the Commission and he sent to each member a copy of the book along with his statement of evi- dence. Hundreds of doctors and clergymen also obtained copies of it as the result of letters I con- tributed to medical and Church papers, and many of them wrote to express their hearty agreement with it. Even more confidently than before, there- fore, can I commend The Small Family System to all who are interested in the subject. B. Dunlop, M.B. 24, Alexandra Court, London, S.W.7. AUTHOR’S NOTE TO SECOND PRINTING In the two diagrams on pp. 73 and 75 (Australia and New Zealand) two strips are given on the right hand side for comparison, the former being Japan and the latter Russia. Japan was put adjacent to Australia because of the supposed fear of Japanese incursion, and showing that the rate of natural increase of Japan is less than that of Australia. Russia was put by the side of New Zealand as a contrast between the highest birth and death rates and the lowest, the natural increase being nearly the same in both cases. PREFACE TO THE AMERICAN EDITION When the history of the Birth-Control Move- ment throughout the world comes to be written, as it shortly will, the name of Dr. C. V. Drysdale will occupy an honored and honorable place. No man in the world has done more for the cause of Neo-Malthusianism, or, as we are used to call it in this country, limitation of offspring or birth- control, than has this noble son of noble parents, Dr. Alice Drysdale Vickery and the late Dr. C. R. Drysdale. Steadily, persistently, indefatigably, he has been preparing the ground, and presenting facts and figures which cannot be contradicted. To bring about a revolution in a deeply-rooted institution, two avenues of appeal are open to us — the emotions and reason. Dr. Drysdale has always preferred to appeal to reason. His argu- ments have always the precision of mathematical problems. For this reason perhaps they do not make the same appeal to the average man and woman that is made by some other propagandists of the Birth-Control Movement. But the earnest students of birth-control always go to him for ammunition, and the little volume before us has done an immense amount of good, not only in Eng- land, but in this country as well; in fact wherever English is spoken. It is not only because of my feeling of warm friendship and deep respect for the author, but Preface to American Edition because I know that this volume is needed by the human race, that I welcome the second edition to the American public, and wish it even greater suc- cess in the future than it has had in the past. William J. Robinson, M.D. 12 Mount Morris Park West, New York. CONTENTS PAGE Prefatory Note by Binnie Dunlop, M.B., Ch.B. . . v Prefatory Note by Dr. W. J. Robinson vii Introduction 1 chapter I Opinions of Medical Authorities 8 II Opinions of Clerical Authorities 37 III Conduct of Authorities 51 IV The Public Health: Birth, Death, and Infantile Mortality Tables, England, Germany, France, Holland, Australia, and New Zealand; Sum- mary 58 V Do Preventive Methods Cause Cancer? .... 84 VI Morality; Crime; Alcoholism; Pauperism; Sex Morality; Divorce; Illegitimacy; Disease . . 98 VII General Conclusions 125 VIII Family Limitation and Social Reform . . . .129 IX The Single Child System 141 X Progress Since 1913 148 XI The War and the Birth Rate Commission . . . 174 LIST OF DIAGRAMS PAGE Fig. i. Variations in Birth Rate, Death Rate, and Infan- tile Mortality in England and Wales . . . 59 Fig. 2. German Empire: Growth of Population, Birth and Death Rates 64 Fig. 3. France: Birth and Death Rates 66 Fig. 4. The Netherlands: Birth, Death, and Infantile Mortality Rates 70 Fig. 5. Australia: Birth, Death, and Infantile Mortality Rates 73 Contents PAGE Fig. 6. New Zealand: Birth, Death, and Infantile Mor- tality Rates 75 Fig. 7. Birth Rate and Death Rate in Berlin .... 80 Fig. 8. Cancer in England and Wales: Corrected Death Rates at all Ages, 1861-1910 87 Fig. 9. Variation of Cancer in Persons at Different Ages — Men 90 Fig. 10. Variation of Cancer in Persons at Different Ages — Women 90 Fig. 11. Cancer in Various Parts of the Body — Mortality at all Ages, 1897-1910: Women 92 Fig. 12. Various Countries: Fertility and Cancer, 1901-5 93 Fig. 13. Fertility and Illegitimacy: England and Wales, 1876-1909 118 THE SMALL FAMILY SYSTEM Is it Injurious or Immoral? INTRODUCTION BY far the most important question of our time, to those who take more than a super- ficial or transitory interest in social matters, is the question of limitation of families.1 Since the year 1876 when Mr. Charles Bradlaugh and Mrs. Annie Besant were prosecuted for publishing The Fruits of Philosophy, in which practical informa- tion concerning the means of limitation was given, the birth-rate in practically all civilized countries has rapidly declined, although it was rising before that date. This fact, combined with the inquiry made by the Fabian Society in 1905, and the tes- timony of many medical men, renders it beyond doubt that this fall of the birth-rate is not only due to the voluntary restriction of families within marriage, but also to the employment of means of preventing conception which do not otherwise in- terfere with the sexual life of the parents. That the fall of the birth-rate is due to restriction of 1 Note.—Throughout this book the terms artificial restriction or limitation are used in the popular sense of restriction of families without cessation of sexual life. The appropriateness of the term “ artificial ” may well be questioned. 2 The Small Family System families is practically proved by the record of the fertility of married women, which has fallen from 292.5 births per thousand married women in 1870-72 to 209.4 per thousand in 1909 1 in Eng- land and Wales, and similarly in other countries. Another strong piece of evidence against this being due to what is sometimes termed “ moral restraint ” from intercourse by married people is that it did not occur before 1876, although the necessity for restriction of families and the ad- vice of “ moral restraint ” had been most strongly before the public ever since the commencement of last century. The inquiry made by the Fabian Society in 1906 showed that 242 out of 316 mar- ried couples admitted having deliberately limited jtheir families.2 Moreover a well-known English gynaecologist has put the matter in the following strong terms, in 1904:—3 “ Artificial prevention is an evil and a disgrace. The immorality 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 1 Reg.-GeneraPs Report, 1909, p. xxx. 2 A further examination of the figures led to the conclusion that during the decade 1890-99 “ only seven or possibly eight unlimited fertile marriages are reported out of a total of 120.” See Fabian Tract No. 131. 3 Dr. F. W. Taylor, late President of the Gynaecological So- ciety, quoted in The Falling Birth-rate, by Lieut.-Col. H. Ev- eritt, Hon. Secretary of the White Cross League, 7, Dean’s Yard, S.W. Footnote to 2nd Ed. I have since learned that Dr. Taylor was a very earnest Christian and the author of several sacred hymns and of a pious work, The Coming of the Saints, Introduction 3 that must assuredly follow the parents of decadence who started it; all of this needs to be brought home to the minds of those who have thoughtlessly or ignorantly ac- cepted it, for it is to this undoubtedly that we have to attribute not only the diminishing birth-rate, but the diminishing value of our population. “ It would be strange indeed if so unnatural a practice, one so destructive of the best life of the nation, should bring no danger or disease in its wake, and I am con- vinced, after many years of observation, that both sudden danger and chronic disease may be produced by the meth- ods of prevention very generally employed . . . The natural deduction is that the artificial production of mod- ern 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. “ Since I delivered my Presidential address I have found such widespread agreement and approval of all that I said among my own professional brethren every- where, that I have no hesitation in bringing the whole body of professional opinion in evidence, at least of prac- tical unanimity, in the tracing of the decline of the birth- rate to the use of artificial checks or preventives; and this body of skilled opinion is not founded on any theory, but on the ascertained facts of daily experience. . . . The cause of the stationary population of France has been threshed out and acknowledged for years and the Report of the Royal Commission on the similar decline in New South Wales not only traces the cause directly to arti- ficial prevention, but stigmatizes the married state of those who practice it as one of * monogamous prostitution.’ “ It is no good trifling with facts:— “(i) Our birth-rate is steadily declining. “(2) This is due to artificial prevention. “(3) This is slowly bringing grievous physical, moral, and social evils on the whole community.” 4 The Small Family System There is no hesitation here as to the cause of the fall in the birth-rate, nor as to the writer’s opinion concerning it. Leaving the latter for consideration below, we must regard it as accepted by all educated people who not only study the ex- ternal evidence, but have their own experience to go upon, that “ artificial ” restriction is practically the sole means by which limitation of families is brought about, and that the “ moral restraint ” preached by the Bishop of London and other Church dignitaries is responsible for a negligible fraction of it. It is most important to realize this fact, for many people who are practicing arti- ficial restriction themselves have the impression that “ moral restraint ” is the ideal which they ought to follow, and which others are perhaps fol- lowing; and they are therefore ashamed of their conduct and maintain secrecy concerning it. This is a serious matter. For if artificial restriction is an evil we ought to know the extent of it, and how to fight it; while if it is good for the educated classes, it is evidently far more necessary on all grounds for the poor, and the former ought hon- estly to declare their actions and join in extending to the poor the knowledge which they have applied for themselves. All the evidence goes to show that artificial restriction is now well nigh universal among people of education and refinement, so no one has any reason for feeling shame as being below the general level at all events in having adopted it. Introduction The only question really before us, therefore, is whether this artificial restriction is or is not in- jurious to health and morality; and this question has been brought forward with special prominence lately by Mr. Commissioner Beale’s work on Racial Decay 1 and by the evidence before the Select Committee on Patent Medicines now sitting. Those who wish to hear the case against artifi- cial restriction of births put with the strongest pos- sible force and completeness may be recommended to read Commissioner Beale’s extensive work on Racial Decay. Indeed, the existence of this book will absolve the present writer from doing more than quoting the strongest and most official pro- nouncements against the practice. A brief though emphatic indictment against it is also given in The Falling Birth-rate, a pamphlet compiled by Lieut.- Col. H. Everitt, and issued by the White Cross League in 1909. At the time of writing, the evi- dence given before the Select Committee on Patent Medicines on this subject has not been very re- markable, but those who may like to know of it will find reports of the proceedings in the columns of the Chemist and Druggist and the Pharmaceu- tical Journal notably for June and July, 1912. It will be noticed that many of the writers quoted in this book speak of artificial restriction of families as Neo-Malthusianism. This is so far true that the advocacy of such methods and the 1 London: A. C. Fifield, 5s, net. 6 The Small Family System invention of many of them originated with the neo-Malthusians. But neo-Malthusianism is a doctrine which teaches that the control of births is necessary for the improvement both of the eco- nomic conditions and the quality of the human race, and at the same time recognizes that delayed marriage or celibacy inevitably leads to serious sexual irregularities and diseases. It therefore advocates general early marriage, combined with the voluntary limitation of families to those chil- dren which the economic conditions or health of the parents will permit them to bring up as efficient citizens, and it approves of the employment of all devices for this purpose which are not injurious to health. But mere indiscriminate prevention of concep- tion by artificial means is no more neo-Malthus- ianism than is the indiscriminate dabbling in drugs or patent medicines, by ignorant people, the science of medicine. No one in his senses would condemn the medical profession or the use of drugs because ignorant people made bad use of them, nor should neo-Malthusianism be necessarily blamed for any possible evil results of preventive devices. Abuses non tollit usum, and we do not condemn explosives or firearms because serious results occa- sionally arise from their unskillful use. There are three methods of coming to a conclu- sion on this all-important question; (a) by ascer- taining the opinions of medical authorities and moralists, (b) by considering the conduct in this Introduction 7 respect of these authorities themselves, and (c) by studying the course of the health and morality of the community as limitation of families has become more general. This we shall now pro- ceed to do. CHAPTER I OPINIONS OF MEDICAL AUTHORITIES THE opinion of Dr. F. W. Taylor, above cited, is that of an acknowledged gynaeco- logical authority in this country. Although we have not come across any other example of such wholesale and unsparing medical condemnation, we believe that many of his statements would have been endorsed by other medical men at the time. But it is unnecessary to investigate this in detail as the consensus of medical opinion in this country was supposed to be expressed in the following Resolution passed in 1905 by the South Western Branch of the British Medical Association, and afterwards endorsed by the Devonport Branch of the Association: — “ That the growing use of contraceptives [means to prevent conception] and ecbolics [substances to empty a pregnant womb~\ is fraught with grave danger both to the Individual and the Race; and that the advertisement and sale of such appliances and substances, as well as the pub- lication and dissemination of literature relating thereto, should be made a penal offense It is perhaps unnecessary to go further for ex- amples of strong condemnation. Those who are accustomed to put their faith in official authority Opinions of Medical Authorities 9 will feel that the matter is thereby settled. But there are others who will remember that authority in all departments has frequently been used to bar progress. For these the following facts may lead to a reconsideration of the matter. Dealing first with the resolution just quoted, we may observe that two things are coupled together for censure — preventives and ecbolics. The latter term implies abortifacients, which are drugs or other devices for producing abortion; that is, for destroying-the embryo after conception has taken place. This is not only a destruction of life already commenced (albeit unconscious life), and a criminal offence; but, when attempted or carried out by drugs or unskilled interference, is generally attended by serious injury to the health of the mother. It is therefore most strongly to be dis- countenanced.1 The prevention of conception, on the other hand, is not a destruction of life (relig- ious fanatics notwithstanding). So far as any kind of destruction is concerned it does not differ in any way from strict continence. It is not ille- gal, and its effects on the health, which are now in question, are at any rate of a quite different order to those of the taking of poisonous abortifacients. To anyone having medical or physiological knowledge, the mere fact of these two methods 1 It will be remembered, however, that the majority of papers, even of the most respectable kind, have freely opened their columns (until quite recently) to advertisements of means for the “correction of irregularities,” which refer to drugs of this kind. The Small Family System 10 being coupled together in the same sentence, as if deserving of equal condemnation, affords a strong ground for suspicion of the whole Resolution. If any body of people were to pass a resolution stat- ing that the growing prevalence of murder and of sport in the United States is fraught with grave danger to the individual and the State, and that therefore the sale of revolvers and sporting ap- pliances as well as the publication and dissemina- tion of the literature relating thereto should be made a penal offense, the public would imme- diately regard them as some puritanical fanatics who were endeavoring to obtain legislation against practices which might be either hurtful or bene- ficial, by coupling them with a great and unques- tioned evil. Whether prevention is harmful or not, it is on an absolutely different plane from abortion. The inclusion of the two in the same category can only be regarded as an evidence of ignorance or of prejudice. This is perhaps a strong statement, so it will be well to examine the evidence in detail. We shall commence by seeing what medical authorities in other countries have to say concerning preventive methods. Dr. Hector Treub, Professor of Gynaecology at the University of Amsterdam, in his widely adopted Handbook of Gynecology, 4th Edition, 19°3, PP- 656 et seq., describes several of the methods of preventing conception as perfectly innocuous, and says: — Opinions of Medical Authorities 11 “ And the fact in itself that pregnancy is prevented cannot be said to be a source of danger. In the numerous sterile marriages nothing is to be seen of such dangers, and when you look around you at the present time, you observe that voluntary sterility is just as harmless.” The same eminent authority in his Verspreide Opstellen Haarlem, p. 8, says: — “ So my conclusion is, that in society as it ib now, neo- Malthusianism, carried out in all respects in as satisfac- tory a manner as possible, is only deserving of praise.” Dr. J. Rutgers, of The Hague, in his book on Race Improvement (Rasverhetering), p. 50, says:— “ There is but one method of saving women from the risk of Gynaecological diseases depending on infection, and that is cleanliness. Now cleanliness is the most essential feature in the application of preventive means. Prevent- ing infection and preventing fecundation are in principle parallel problems.” Dr. Aletta H. Jacobs, the first lady doctor in Holland, has for more than twelve years given a gratuitous gynaecological and neo-Malthusian con- sultation twice a week for poor women. Between 1880 and 1898 she instructed more than 2,200 women in the use of mechanical preventives, and testifies that she never observed any injury to health arising from it. Dr. H. Rohleder, of Leipzig, an eminent spe- cialist on sex questions, has recently written a brochure, entitled Neo-Malthusianism and the The Small Family System 12 Physician, in which he speaks of the great impor- tance of preventing parenthood in cases of diseases of the heart, kidneys and lungs; and in cases of feeblemindedness, and of chronic alcoholism and poverty; and he says: — “ Indeed I believe that in such cases the recommenda- tion of neo-Malthusian methods by the doctor is not only a duty from which there is no escape, but that his failure to do so is a crime against our present and future genera- tions and the community.” Dr. August Forel, M.D., Ph.D., LL.D., late Professor of Psychiatry at the University of Zur- ich, and a well-known authority on sex questions, says in his Sexual Ethics (New Age Press), p. 61: — “ Moreover, we must no longer be content to remain indifferent and idle witnesses of the senseless and unthink- ing procreation of countless wretched children, whose parents are diseased and vicious, and whose lives are for the most part destined to be a curse to themselves and their fellow men.” “ We must therefore recommend to all persons who are sickly or infirm in body or mind, and especially to all suffering from hereditary ailments, the use of means for the prevention and regulation of conception, so that they may not, out of pure stupidity and ignorance, bring into tbe world creatures doomed to misery and misfortune, and predisposed to disease, insanity and crime.” And in a footnote he says: “We refer, of course, to such pre- ventive methods as are completely harmless to the per- sons making use of them. Methods for the prevention of conception in general fulfill this condition.” Opinions of Medical Authorities 13 These citations are amply sufficient to show that many Continental medical men of high repu- tation take a diametrically opposite view to that expressed by the Resolution of the South Western Branch of the British Medical Association in 1905. Here is another unhesitating utterance from a well-known American, Dr. W. J. Robin- son of New York, editor of a medical paper, The Critic and Guide. In the issue of the paper for March, 1912, he wrote the following:'—? THE THREE MOST IMPORTANT MEASURES FOR THE IMPROVEMENT OF THE HUMAN RACE “ The three most important measures for the improve- ment of the human race from a eugenic standpoint? What are they? I suppose everybody who has given the subject any thought has his remedies. I have studied the subject for years, and my answer is: (i) Teaching the people the proper means of the prevention of conception, so that people may only have as many children as they can afford to have, and have them when they want to have them; (2) Demanding a certificate of freedom from venereal and other transmissible disease from all candi- dates for a marriage license. This is bound to come, and come soon; (3) The sterilization by vasectomy and oophorectomy of all degenerates, imbeciles, and vicious criminals. This measure has already been adopted by some States, and it is but a question of time when it will become universal. “ Of the three measures the first one is the most im- portant, and still it will be the last to come, because our prudes think it will lead to immorality. And neverthe- less, I will repeat what I said several times before, that there is no single measure that would so positively, so 14 The Small Family System immediately contribute towards the happiness and prog- ress of the human race as teaching the people the proper means of regulating reproduction. This has been my sincerest and deepest conviction since I have learned to think rationally. It is the conviction of thousands of others, but they are too careful of their standing to ex- press it in public.1 I am happy, however, to be able to state that my teachings have converted thousands; many of our readers who were at first shocked by our plain talk on this important subject are now expressing their full agreement with our ideas. And Congress may pass Dra- conian laws, the discussion of this subject cannot, must not be stopped.” In the February issue of this paper, Dr. Robin- son also had a short note on “ The Maternal In- stinct,” in which he relates the case of a woman who had lost five children in succession, but who was so anxious to have a living child as to undergo Caesarean section twice; and he concludes: — “ Incidentally this again shows that the fear of our prudes that knowledge of the means of the prevention of conception would depopulate the earth is unfounded. The maternal instinct is still strong enough in the breasts of a sufficiently large number of women to keep the race satisfactorily replenished; the only difference being, as we have said so many times before, that the people would 1 It is worthy of note, in confirmation of this statement, that a few months ago a banquet was given in honor of Dr. Robin- son by two hundred of his fellow medical practitioners, pre- sided over by Dr. Jacobi, the President of the American Medical Association. The occasion was the tenth anniversary of Dr. Robinson’s paper, the Critic and Guide, in which he has so strongly and continually advocated teaching all adult persons the methods of prevention. Opinions of Medical Authorities 15 have their children when they wanted them and only as many as they wanted.” And the following quotation from Dr. Robin- son’s book on Sexual Problems of the Day leaves not the slightest doubt as to the importance he attaches to the question: — “ And one of the central thoughts of my discourse to- night, one of the thoughts I would like you to carry away with you and ponder at your leisure, is this: Let the district physicians and district nurses who visit the poor be not only permitted, but instructed to teach the poor mothers how to avoid having more children than they can properly support and care for. And let us also insti- tute a propaganda which will work a change in public opinion, so that it may not be considered a matter of pride, but a matter of shame, to give birth to children for which the parents must invoke public aid.”—“ The Limi- tation of Offspring: The Most Important Immediate Step for the Betterment of the Human Race, from an Economic and Eugenic Standpoint.” A discourse read by Dr. W. J. Robinson before the American Society of Medical Sociology (of which he is now the President), March 4th, 1911. One other quotation which may be given is from an English medical man, Dr. C. Killick Millard, M.D., D.Sc., Medical Officer of Health for Lei- cester. Writing in the Church paper, The Guar- dian, of 3rd Nov., 1911, in answer to one of the Bishop of London’s characteristic attacks, and referring to the resolution of the Lambeth Con- ference of Bishops in 1908, to be dealt with later, he says:— 16 The Small Family System “ In order to justify it [the condemnation on moral grounds] and increase the conviction of this very sweep- ing indictment, the Committee next proceed to give an apparently scientific endorsement for their ban, and state that ‘ there is good reason to believe that the use of artificial methods of prevention is associated with serious local ailments.’ Nervous enfeeblement, loss of mental and moral vigour, neurasthenia, ovarian disease, cancer, and even insanity are all hinted at as possible results, on the authority of * many eminent physiologists,’ the two principal names invoked being the late Professor Taylor and Professor Bergeret. Now I venture to submit that in its scientific aspect the Report is open to serious criti- cism. Having appealed to science, the Committee ought in fairness to have been at some pains to have obtained the true verdict of science, and not have been satisfied with a loose citation of a few selected opinions all on one side. Nothing is easier than to bolster up a cause in this way. It would have been better had the Com- mittee stated frankly that scientific opinion was very far from being unanimous as to the alleged physical ill- effects of preventives. They might truly have said also that there was little if any evidence of these alleged ill- effects, and they might have quoted on the other side the opinions of authorities such as Professor P. Fiibringer, in his article on ‘ Sexual Hygiene in Married Life,’ in Sen- ator and Kaminer’s Marriage and Disease — an exhaus- tive and standard work — to the effect that while certain methods might possibly be injurious, others were harm- less.” These opinions, to which many more could be added, are sufficient to show that doctors have dis- agreed most strongly on this subject, so it may be asked, Who then is to decide? The only answer is that people must decide for themselves. The Opinions of Medical Authorities 17 following considerations may assist them to do so. We have already called attention to the fact that the South Western Branch of the British Medical Association has coupled together preven- tives with abortifacients in its resolution, which the Continental writers never do. This can only be due to great ignorance, or to a desire to cloak the real issue. Dr. Taylor’s strong remarks do not in any way inform us as to whether attempts at prevention or at abortion 1 were the cause of the evils he mentions; and everyone will agree as to the terrible results of unskilled attempts at abor- tion. There can be no doubt that a large number of medical men in this country are lamentably ignorant of the general scope of contraceptive means (although they employ particular ones themselves), and are quite prepared to confuse them with abortifacients. In conversation with a medical graduate from one of our premier col- leges, and of considerable experience, we gathered from him that he had no general knowledge what- ever of contraceptive methods, and that the ma- jority of medical practitioners had no opportunity of gaining scientific knowledge concerning them. An eminent Medical Officer of Health informed us, that although he and such of his colleagues as he had privately inquired of considered contra- ceptive methods quite harmless, the ignorance of 1 It is, of course, quite open to any one to include abortion under the term prevention, in the more general sense of pre- vention of .child-birth instead of prevention of conception. 18 The Small Family System the subject among them was astonishing. When we hear such statements, we can quite understand that the confusion between prevention and abor- tion, combined with theological prejudice and self- interest, could easily lead to statements such as those of Dr. Taylor, or to resolutions such as that of the South Western Branch of the British Medi- cal Association. On the latter point, the following quotation from the British Medical Journal of the 9th Sep- tember, 1911, throws a light of some impor- tance : — “ The prospects of private practice are inferior to what they used to be. Complaints of lessened incomes and increased expenses began, indeed, to come in a few years ago in such numbers that the subject was specially investi- gated by this Journal, and the results recorded in two articles on ‘ The Financial Prospects of Medicine.’ . . . The net outcome of these articles was to prove that not only was the possible number of patients less, but each one of those that remained needed less medical attendance than formerly, especially for the zymotic diseases, which used to furnish so much work. In this connection must be mentioned the decline in the birth-rate, which not only affects the medical men of this generation, but must seri- ously influence the prospects of those who may succeed them.” It is indeed unpleasant to have to suggest that medical prejudices on this matter may not be en- tirely unconnected, albeit unconsciously, with ques- tions of self-interest; and I should not have done so but for having seen this possibility referred to Opinions of Medical Authorities 19 elsewhere.1 Apart from this the foregoing quo- tation is of importance; it contains no indication of any injury to health from the restricted birth- rate. On the contrary, we are told that less medi- cal attendance is now necessary, and that there is every prospect of this continuing as the birth-rate falls. How is this compatible with the remarks of Dr. Taylor? It must further be noted that in the past five years the opinions of British medical men appear to have been undergoing a very rapid change on this subject. No legislation has occurred since the above resolution was passed, and the birth-rate has been falling even more rapidly. It would only have been natural if, when the matter came up before the British Medical Association in 1910, the resolution of 1905 had been reaffirmed with a 1 See “Is There a Medical Conspiracy?” John Bull, October 8th, 1910. See also The Vote, September 24th, 1910, which, referring to a discussion on the question of medicine as a profession which had just appeared in The British Medical Journal, says: “ Amongst the causes quoted for the present bad condition and the worse prospects of the medical profession is the decline in the birth-rate. The cause deserves to be quoted in full. The article says the decline of medicine as a profession is due to ‘ the lowered birth-rate, which has fallen to 26.3 per thousand. This has had a dual effect. There are not only fewer confine- ments, but fewer babies for medical men to attend.’ We are quite willing to admit this, and further, to admit the bearing of this factor on the doctor’s income; but we are not willing to admit that this gives the doctor any right to preach the doctrine of large families. We go further, and say that it does not justify the medical profession in encouraging the coming of unfit children into the world, and in failing to warn women unfit for motherhood.” 20 The Small Family System note of increasing urgency. Instead of this, all that happened was a very mild discussion,1 in which perhaps the strongest adverse point was made by Dr. J. W. Ballantyne, in the following remarks: — “ There is first, the dissemination of the knowledge of the possibility of limiting the number of pregnancies by other means than the dangerous induction of abortion, and in ways that do not include continence; this informa- tion has been industriously propagated by the supporters of neo-Malthusianism, and is being quietly handed on from one married man or woman to another all over the country. Time will tell whether the use of ‘ checks ’ is indeed harmless, but there is already some evidence that a perfectly healthy state of the reproductive organs cannot be looked for when these organs are constantly being stimulated to a certain point, and as constantly being prevented from experiencing the natural conse- quences of the stimulation. It will be strange if bodily and mental well-being in women are found to be com- patible with the frequent production of the sexual orgasm unaccompanied by its reproductive consequences, namely, pregnancy, child-birth, and lactation.” This is indeed an anti-climax to the thunders of Dr. Taylor and the resolution of the South West- ern Branch. The distinction between abortion and prevention is clearly brought out, and all we have is simply a vague suggestion of possible harm from the use of preventive checks. And even this suggestion is not allowed to pass unchallenged. In the Editorial article on “ The Medical Profes- 1 Dr. Binnie Dunlop took part in this and advocated a fall of the birth-rate among the poor and unfit. Opinions of Medical Authorities 21 sion and the Falling Birth-rate ” in the British Medical Journal of 3rd September, 1910, the fol- lowing remarks appeared: — “ Of such unproved assumptions — possibly correct, possibly wrong — as were made by any speaker, it is pro- posed to mention only one. This is that an ordinarily active sexual life in which pregnancy is intentionally pre- vented is directly inimical to the physical well-being of women. It is a statement constantly made, and on the strength of it medical men are told that it is their duty to preach the same doctrines on the subject as those of the Roman Catholic Church, which, however, are based on a totally different order of ideas. As already indi- cated, the assumption may be perfectly true, but the proof has yet to be furnished.1 The question merits considera- tion, if only because the point is so constantly brought up; but many difficulties surround its thorough examina- tion. If the idea can be shown to be well founded, medi- cal men will then have truly medical — and indeed im- perative — grounds for joining hands with those who express themselves as seriously disturbed by the fall in the birth-rate, and for co-operating with them as far as this particular factor is concerned. “ Meantime emphasis should be laid on the circum- stance that the factors at work are numerous, and that the action of most of them can probably be negatived rapidly, if at all, neither by individuals nor the State, and that in any case most of them are of such a kind as little to concern medical men as a profession. It is hardly pos- sible to sum up these factors in a single sentence, but they are covered in a measure by the statement that while most people would admit that a childless family was one of the bitterest of ironies, and while love of children is no less characteristic of normal adults than formerly, 1 Italics mine.— C. V. D. 22 The Small Family System many men and women feel that they can best develop their capabilities by remaining unmarried, and many mar- ried couples esteem it a duty alike to themselves and to unborn possible progeny to limit their families to a num- ber which they feel able to educate and place out in life in thoroughly satisfactory fashion. “ It would indeed be somewhat paradoxical if in an age when the need for endowment, life, sickness, and other insurances is constantly being put before the public, doctrines such as ‘Take no thought for the morrow, what ye shall eat or what ye shall drink,’ and ‘ Happy is the man who hath his quiver full ’ were felt to have their original force.” “ It is quite possible that these new scruples and such part of the fall in the birth-rate as results from their exercise is an inevitable incident in the evolution of civi- lized humanity, and is the answer which Nature makes when it finds modern man departing so essentially in respect of environment and mode of life from those for which she first designed his ancestors. “ It does not follow, however, that medical men have nothing to do with the subject. If a distinction is drawn, as it should be, between conception-rates and birth-rates, this becomes more obvious. With the former it is no concern of medical men to interfere,1 but the latter they can influence materially in respect of height, and benefi- cially in point of effectiveness. . . . The effectiveness of the birth-rate can also be influenced by continuing the study of heredity, which has already been in progress so long, and by pressing on the notice of the public such facts as have been definitely ascertained. They may be few, but they offer the strongest ground for holding that a check should be placed on the fertility of certain classes of individuals whose offspring, if not defective from the 1 Italics mine.— C. V. D. Opinions of Medical Authorities 23 beginning, almost inevitably grow up into citizens of a very undesirable type.1 In both these directions there is plenty of work for the medical profession to do.” So that we actually find the official organ of the British Medical Association stating that there is no proof yet forthcoming of any evil results of ar- tificial prevention, that this restriction of families is the result of praiseworthy prudence, and that doctors ought to help in checking the fertility of the obviously unfit — a doctrine which has always been part of the program of the neo-Malthus- ians. But the change of opinion still progresses. Since the above was written the British Medical Association has met again twice, and the subject has been referred to on both occasions. Here are some extracts from the Presidential Address of Sir James Barr to the British Medical Associa- tion at Liverpool on July 23rd, 1912. “We have successfully interfered with the selective death-rate which Nature employed in eliminating the un- fit, but, on the other hand, we have made no serious at- tempt to establish a selective birth-rate so as to prevent the race being carried on by the least worthy citizens. The same maudlin sentimentality which often pervades the public not infrequently infects the medical profes- sion. We have often joined forces with self-constituted moralists in denouncing the falling birth-rate, and have called out for quantity regardless of quality. . . . We readily forget that utility, as long ago pointed out “ Over-population is one of the problems of the age. The old blessing of ‘ increase and multiply,’ suitable for a sparsely peopled land, has become the great curse of our crowded centres. ... You may say children are from God. I reply, so is the cholera. I suppose you are here among other things to determine when and how God’s laws shall operate. . . . Some of the happiest couples I have known have been childless. Mutual society, help and comfort count for something, aye, sometimes take the place of everything.” The Rev. Leonard Dawson said, in a lecture which was reported in the Alnwick and County Gazette of February nth, 1888: — “ How rapidly conjugal prudence might lift a nation out of pauperism was seen in France. . . . Let them therefore hold the maxim that the production of offspring with forethought and providence was rational nature. It was immoral to bring children into the world whom they could not reasonably hope to feed, clothe and edu- cate. . . . Let them rest assured that he considered his views truly Christian, and likely to promote the cause of temporal happiness and religion in this land and all over the world.” Coming to modern times, the Rev. Dr. Horton, writing in The Problem of Motherhood/ al- though deploring the declining birth-rate in gen- eral, says: —■ 1 Cassell & Co., 1911, p. ao. 40 The Small Family System “ But there is one thing that I feel bound to mention out of my own personal experience and that is this, I have seen instances of married people exercising the strong- est self-control for the very noblest of reasons; sometimes because their means do not enable them to face the re- sponsibilities of a family; sometimes because the health of one or other of them would make a family dangerous; and sometimes because of hereditary tendencies which might possibly be transmitted to the children, if there were any children. And I have learned to regard such self-control with so profound a reverence that it makes me very fearful of passing a general judgment upon the phenomenon causing our present anxiety. “ Many a man remains single, or, having married, re- mains childless, from motives as high and as praiseworthy as the motives that induce a Catholic to renounce the world and lead a cloistered life; and although the birth- rate may fall to an appalling degree, it is difficult to see how one should point an accusing finger at such a man.” Let us not be understood for one moment to claim the remarks of the last writer as implying approval of “ artificial ” prevention. We have little doubt that the “ self-control ” referred to implies simply the old “ moral restraint ” which Malthus preached — though with practically no success. But the motives which Dr. Horton ex- tols are surely not confined to those extremely few who exercise moral restraint.” They are the motives which have been steadily in the minds of the neo-Malthusians throughout their propaganda. In the latter part of last year the Bishop of Lon- don in his Congress Sermon at Stoke, referred to Opinions of Clerical Authorities 41 the “ sin ” of family limitation. The result was a flood of protest from both clergy and laity, and the feeling ran so high that at a mass meeting held shortly after at the Queen’s Hall to protest against the Ne Temere decree, the mention of his name was received with hisses. In fact he was obliged to write to the Guardian of 27th October, stating that he had been misunderstood as regards limitation in general: — “ I was by no means denouncing the limitation of families by self-control. My point is that there is no check allowed by the Church except the check of self- control.” This letter was immediately followed by a long reply from the Medical Officer of Health for Leicester, C. Killick Millard, M.D., D.Sc., writ- ing as a churchman, in which he pointed out that the practice of family limitation was admittedly practiced by the “ ablest and most intelligent part of the working-class population,” who most cer- tainly regarded it as an act of prudence and decid- edly the reverse of immoral. “ The Bishop of London, we know, deplores the breach between the Church and the People, but it is scarcely to be expected that intelligent persons will feel drawn to a Church which denounces them as guilty of ‘ immorality ’ for doing that which their own conscience and better judgment approve. Of course if the practice be really immoral it is the Church’s duty to denounce it at any cost; but is it quite certain that the practice is immoral? Is it immoral under any circumstances and irrespective of motive? ” 42 The Small Family System Dr. Millard then went on to state, as already mentioned, that the Bishops in their resolution had only accepted a few statements from medical authorities all on one side, and that authorities were very far from agreed in condemning them. And he proceeds: — “The Bishop of London, in a letter in The Guardian for October 27th, replies to ‘ Married Priest,1 and ex- plains that he does not object to limitation of the family provided it be accomplished by self-control. Surely the Bishop, even though himself unmarried, must realize that ‘ self-control ’ within the bonds of matrimony, however commendable in other respects, is practically useless as a preventive measure. The most abstemious and self-con- trolled of husbands may have the largest families — wit- ness many of the clergy themselves! To recommend the poor to employ an unreliable method in a case like this is merely to mock them. On the other hand, the em- ployment of artificial means, whilst far more effectual, undoubtedly involves a certain amount of self-control and self-denial, and this is one chief reason why they are not resorted to by the more reckless, selfish, and depraved sections of the community.” The whole of Dr. Millard’s letter is a strong plea for the decided morality of limitation from a man of undoubted authority — and the Bishop of London has not deigned to reply. The latest clerical pronouncement on the ques- tion has come from Dr. Inge, the Dean of St. Paul’s, who in presiding at a meeting of the Socio- logical Society on 13th February, 1912, spoke strongly on the over-population difficulty.1 1 Daily Telegraph (London), February 14th, 1912. Opinions of Clerical Authorities 43 “ With regard to the reduced birth-rate among the middle and upper classes, some people had used very strong language about the selfishness of persons who de- liberately had small families. It was only fair to say that, though in some cases small families were due to selfishness, in many cases they were due to unselfishness, and involved a great deal of self-denial, for the benefit of the children: ... At present, happily, there was room for eugenic children, however, many were born, in the waste places of the earth. This would not be the case very long, and he repeated that this question of over- crowding was a thing which must not be shirked. After all, quality was better than quantity, and the great menace to our civilization was not so much the stationary birth- rate of the upper classes as the great increase among the poor and ill-fed population of our great towns.” And on May 20th, Dr. Inge wrote:—1 “ But I must add that in my opinion the main cause of tension is the excessive increase in the population of an overcrowded country (the figures for 1909 are: births, 1,146,118; deaths 687,765), and the unfortunate fact that we are breeding chiefly from inferior stocks. As long as our social reformers and agitators shirk these problems I find it difficult to have much confidence in their intelligence or honesty.” Within the last month a discussion under the heading of “ One-child Homes ” has appeared in the Standard in which a number of writers ap- proved of small families. Several, however, while agreeing with the necessity of limiting the family, strongly protested against preventive 1 Daily Mail (London) symposium on Labor Unrest (May 2oth, 1912). 44 The Small Family System methods. Immediately after these letters, ap- peared the following, on September 4th, from a well known clergyman: — To the Editor of The Standard. Sir,— There is no greater act of selfishness than to bring a large number of children into the world without the wherewithal to provide for them. We have Scriptu- ral authority in certain cases for the limitation of family. — I am, Sir, yours truly, Crowhurst Rectory. J. P. Bacon-Phillips. I do not profess to have studied the Scriptures sufficiently to give chapter and verse for this state- ment, but it should be abundantly clear to those who will study the words of Christ, Matt, xix, 10-12; and of St. Paul, I Corinthians vii, i, 2, and 5, as well as of the Church marriage service under the heading “ Secondly,” that if restriction of births within the marriage tie is permissible under any circumstances “ moral restraint ” is cer- tainly not to be advocated. Marriage is definitely instituted for those who “ have not the gift of continency,” and St. Paul expressly warns against the results of attempting it within the marriage state. When the Bishop of London stated that the only check that the Church could recognize was the check of continence he was both unclerical and unscriptural. Thus we find, as with doctors’ utterances, that clerical ones against artificial limitation are becom- ing less vehement, if nothing more. But the most astonishing development is now to be recorded. Opinions of Clerical Authorities 45 In 1910 a “ National Council of Public Morals ” was formed, of distinguished clerical dignitaries aided by a quota of scientific men, in order to com- bat all undesirable social tendencies, and taking as its motto the words of our present King: — “ The foundations of National Glory are in the homes of the people. They will only remain unshaken while the family life of our race and nation is strong, simple and pure.” The most public action of this highly responsi- ble Council has been to issue a series of sixpenny booklets entitled “ New Tracts for the Times.” 1 The first of them, The Problem of Race Regener- ation, issued in 1911, is by Dr. Havelock Ellis. The passages in it approving of a reduced birth- rate are far too long and too numerous to be quoted in full; but the following will give some idea of their tenor: “The new sense of responsibility — of responsibility not only for the human lives that now are, but the new human lives that are to come — is a social instinct of this fundamental nature. Therein lies its vitality and its promise. “It is only of recent years that it has been rendered possible. Until lately the methods of propagating the race continued to be the same as those of savages thou- sands of years ago. Children ‘ came,’ and their parents disclaimed any responsibility for their coming; the chil- dren were sent by God, and if they all turned out to be idiots the responsibility was God’s. That is all changed now. We have learnt that in this, as in other matters, 1 Cassell & Co. 46 The Small Family System the Divine force works through us, and that we are not entitled to cast the burden of our evil actions on to any Higher Power. It is we who are, more immediately, the creators of men. We generate the race; we alone can regenerate the race. “ The voluntary control of the number of offspring, which is now becoming the rule in all civilized countries in every part of the world, has been a matter of concern to some people, who have realized that, however desirable under the conditions, it may be abused. But there are two points about it which we should do well always to bear in mind. In the first place it is the inevitable result of advance in civilization. Reckless abandonment to the impulse of the moment and careless indifference to the morrow, the selfish gratification of individual desire at the expense of probable suffering to lives that will come after — this may seem beautiful to some persons, but it is not civilization. All civilization involves an ever increasing forethought for others, even for others who are yet unborn. “ In the second place, it is not only inevitable, but it furnishes us with the only available lever for raising the level of our race. In classic days, as in the East, it was possible to consider infanticide as a permissible method for attaining this end, or for terminating at the outset any life that for any reason it might seem desirable to termi- nate. That is no longer possible for us. We must go further back. We must control the beginnings of life. And that is a better method, even a more civilized method, for it involves greater forethought and a finer sense of the value of life. “ To-day all classes; in the community, save the lowest and the most unfit, exercise some degree of forethought in regulating the size of their families. That it should be precisely the unfit who procreate in the most reckless manner is a lamentable iact, hut it is pot a hopeless fact, Opinions of Clerical Authorities 47 and there is no need of the desperate remedy of urging the fit to reduce themselves in this matter to the level of the unfit. That would merely be a backward move- ment in civilization. . . . “ It used to be feared that a falling birth-rate was a national danger. We now know that this is not the case, for not only does a falling birth-rate lead to a falling death-rate, but in these matters no nation moves by itself. Civilization is international, though one nation may be a little before or behind another. Here France has been ahead, but all other nations have followed; in Germany, for instance, which is sometimes regarded as a rival of England, the birth-rate is falling just as in England. Russia, indeed, is an exception, but Russia is not only behind England but behind Germany in the march of civilization; its birth-rate is high, its death-rate is high; a large proportion of its population live on the verge of famine. We are not likely to take Russia as our guide in this matter; we have gone through that stage long ago.” The second book of the series is by Dr. C. W. Saleeby, entitled The Methods of Race Regener- ation, in which he deals with the various methods by which the principles of Eugenics or heredity may be directed towards race improvement. In it he says (p. 24) : — “ There are cases, however, not merely imaginable, but actual, as a record of my private correspondence alone would abundantly show, of persons who certainly should not have children, and whom many would therefore seek to keep asunder, yet who are married and live happier and better lives therefor, whilst faithfully regarding their duty towards negative eugenics. We must recognize that, as human beings become more responsible, the num- 48 The Small Family System ber of such cases will increase; and in the name of many of the best men and women, in whose blood, perhaps, there may run some insane taint or what not, I protest against the notion that marriage and parenthood are to be regarded as identical because marriage is primarily for parenthood, or because it is convenient to assume that they are so in public discussion. “ What can conceivably be the explanation of such arguments as those of the Bishop of London and others, who, in the face of our monstrous infant and child mor- tality, the awful pressure of population and overcrowding in our great cities, where every year a larger and larger proportion of the population lives, and is born and dies — plead for a higher birth-rate on moral grounds, of all amazing grounds conceivable; and those also who, from the military or so-called Imperial point of view, regard- ing men primarily as * food for powder,’ in Shakespeare’s phrase, read and quote statistics of population in order to promulgate the same advice? “To the moralist we need make no reply except simply to name the infant mortality, which is at last coming to be recognized everywhere as, perhaps, the most abomi- nable of all our scandals.” Elsewhere 1 Dr. Saleeby has said: — “ Professors of divinity and other distinguished theolo- gians and popular preachers have lent their names to eu- genics. The time has come when we cannot possibly descend from aspiration to practice without the innocent and, in point of fact, indispensable aid of neo-Malthusi- anism. . . . Only by the aid of neo-Malthusianism can we attain the ideal which I have defined in my outline study of Eugenics, that every child who comes into the world shall be desired and loved in anticipation.” 1 The Malthusian, May 15th, 1910, p. 35. Opinions of Clerical Authorities 49 It would be hard to imagine a more absolute anti-climax to the accusations of immorality in connection with limitation of families, even when effected by “ artificial ” means. In the third book of the series, by Dr. A. Newsholme, M.R.C.S., on The Declining Birth- rate, we find a statement of some of the facts con- cerning it with some carefully guarded expressions. While, on the whole, expressing regret at the phe- nomenon, he tells us on p. 42 that: — “ It would not be fair to omit from consideration what is probably one of the chief factors tending to restrict families. This is the desire of parents with small in- comes to educate their children more satisfactorily than they themselves were educated, and to give their children the means for rising in the social scale. “ The motive here is far removed from that of the well-to-do who love ease and luxury and pursue it; and however much the supposed need for this regulated family may be deprecated in these instances, a harsh judgment in regard to it cannot be maintained.” In the face of such statements emanating from the first three books of the series, it can hardly be said that the National Council of Public Morals with its distinguished clerical representation has even attempted to make out a strong case against the limitation of families. All the ideals concern- ing the glory of limited maternity and the welcom- ing of desired children, with the responsibilities of race improvement, were realized and taught by the neo-Malthusians thirty-five years ago, and we 50 The Small Family System may close this section with the oft-quoted remark of John Stuart Mill, who was described by Mr. Gladstone, in spite of his religious prejudices, as the “ Saint of Rationalism,” but who appears when a young man to have taken part in the actual dis- tribution of leaflets giving practical information on “ artificial limitation.” “ Little advance can be expected in morality 1 until the producing of large families is looked upon in the same light as drunkenness or any other physical excess.” 2 1 Italics mine.— C. V. D. 2 Political Economy, bk. ii, ch. xiii. CHAPTER III CONDUCT OF AUTHORITIES WE now come to the second point. How far do the medical and clerical opponents of family limitation carry out the principle they pro- fess? It is surely common knowledge that now- adays the majority of medical men and clergy, like other educated people, have decidedly small families. But those who do not remember the large families of thirty-five years ago may suppose that this is an automatic result of their higher culture, etc. Unfortunately, however, apart from records in fiction such as given by George Eliot and many others, we have in the inquiry made on behalf of the National Life Assurance Society by Mr. C. Ansell in 1874, just before the Knowlton Trial, a definite statement which gives the follow- ing table of average families in various profes- sions : — Profession. Total Results including Born Alive. Clergymen Still-born. 5.36 5.25 Legal Profession 5-32 5.18 Medical Profession 4.96 4.82 General (Aristocracy, Merchants, Bankers, Manufacturers, etc.) .. SS° 5-39 About the same time, according to the Regis- 52 The Small Family System trar-General’s Report for 1877 (p. vi), the aver- age number of births to marriages was 4.63 for the whole of England. The result of this inquiry is therefore to show that the families of both medical men and clergy- men were then, on an average, just as high as those of the remainder of the community; or, in other words, that their fertility was in no way lower, despite their greater culture, than that of the poorer classes. But although no such exhaustive inquiry appears to have been made recently,1 no one who observes can have the slightest doubt as to what has happened since. In Paris an inquiry made by Dr. Lutaud showed that 1,200 medical families had only 2,700 children between them, or an average of only 1.5. We have recently asked some friends to ascertain the number of children in medical and clerical families in their districts, with the result of finding very few families of more than three children in either case. An interesting sidelight on this question was given by a friend quite recently. She had been staying in the country at the house of a young married couple who had felt that their means did not permit them to undertake a family. The wife of the local medical man was so distressed at this as to take the young woman to task. On the retort being made that she had only one child her- self, she said that the cost of educating him made 1 Possibly the detailed figures of the 1911 Census may give us the information, when they appear. Conduct of Authorities 53 it impossible to have more, but that there was no excuse for the poor who had so much done for them. When the middle classes realize that they are heavily taxed for the large families of the poor, and that they have to limit their own fam- ilies the more in consequence, they will be in a condition to fully appreciate this anecdote. It is hardly worth discussing a matter which is so obvious to all, and we can only come to one of the following conclusions, so far as doctors are concerned: either: — (a) they do not believe in the hygienic evils of artificial restriction, or (b) they have methods which they consider sat- isfactory for themselves, but which are unknown to the public, or (c) that the evils, whatever they may be, are less than those of large families. The only one of these alternatives which really concerns us is the third. Personally, I have every reason to believe that the majority of English medical men have no better knowledge on the sub- ject than the most enlightened section of the pub- lic. But if they have, is it honest to condemn limi- tation because the public are ignorant of the best means? Is it not rather their duty to help the poor, who suffer so much from the burden of their large families, to a knowledge of the means which they use with so much success themselves? Now we come to the clergy. Again the facts speak for themselves. Where among the married 54 The Small Family System clergy do we find the large families of thirty-five years ago? Instead of an average family of five, as found by Ansell, this number is much more like the maximum, and two or three children is decid- edly the usual order of things. It may of course be that this limitation is simply due to the “ moral restraint ” or “ self-control ” of the Bishop of London. But how is it that, just as with the rest of the community, it has only taken place since the Knowlton Trial? In a controversy which I had a few years ago with the Secretary of a certain cleri- cal purity organization, I became so disgusted at his methods of attack as to challenge him to insti- tute an enquiry among the members of his Society, on similar lines to that carried out in the Fabian Society, by asking them to make a solemn declara- tion in each case as to whether they had lived lives of complete “ self-control.” In making this chal- lenge I pointed out that if he really believed in his mission and his supporters he would welcome the suggestion as affording the most effective means of showing the good example of the clergy, and the practicability of “ moral restraint.” The only re- sult was a letter marked “ private,” abusing me for the suggestion. A month or two later, I read in a provincial paper that this gentleman had at- tempted to recruit members for his Society at a local meeting. When he apparently found some hesitation among his audience, he stated that many might feel unworthy to join such a movement as they had not previously been able to live up to its Conduct of Authorities 55 high ideals, but that by joining in the good work their past sins would be forgiven them. Are the sins, I would ask, which lead to the communication of loathsome contagious diseases to innocent women and to their helpless children to be wiped away by turning puritan in later life? Are those who have run the gamut of dissipation themselves and have treated women as mere ministers to their pleasure to turn round and condemn those who are undertaking married life in a responsible spirit, refusing to burden their wives with the pain and anxiety of unlimited child-bearing and to bring children into the world regardless of their prob- able future prospects? And are the lives of countless young men and women to be ruined by the hypocrisy that sets up a standard of life which violates all the needs of their physiological organ- ization, and which inevitably leads a large number to have recourse to really injurious practices, in- stead of the pretended one of artificial limitation? No wonder my challenge was evaded. Among the chief weapons which the clerical party has employed against family restriction are the appeals to women that such restriction is de- grading to them, that it results in premature old age, and that it may dispose to cancer and other diseases. The opinion of women as to whether they are more degraded and prematurely aged by restriction or by unlimited child-bearing may be to some extent gauged by the experience of New Zealand, where women have been voters since 56 The Small Family System 1893. Towards the end of 1910 a Conference on Public Morality, consisting apparently of six clergymen with Bishop Julius as chairman, for- warded the following resolution to the Govern- ment of New Zealand: — “Preventives: — We, ministers of the Gospel, assem- bled in conference, hold, that, except in special cases, which can only be pronounced upon by medical authority, the use of preventives is absolutely immoral; But in view of their unrestricted sale, which encourages immorality, and is tending, in our opinion, to an alarming decrease of the birth-rate of the Colony, we recommend: (1) That the sale of preventives be restricted to qualified chemists; (2) That the sale of preventives to any person under twenty-one years of age be subject to penalty; (3) That the hawking of preventives be made a criminal offence; (4) That the wholesale dealers in preventives, whether such preventives are imported or manufactured within the Colony, be required to keep a register of their sales; (5) That any advertisement of notification of preventa- tives, except in trade catalogues, be made illegal.” At that time it appeared that the hawking of such devices was quite common all over New Zea- land. The birth-rate was at its lowest, 25 to 26 per 1,000. There can be no doubt that restriction was almost universal. But the feeling of the women as well as of the men of New Zealand on the question was shown by the fact that when a Bill was introduced by Mr. Seddon in the Parlia- ment of 1901, under the title of “The Sale of Preventives Prohibition Act,” proposing penalties of fines or imprisonment upon those found guilty Conduct of Authorities 57 of selling “ any contrivance for hindering, or pre- venting, conception,” it was thrown out after a brief discussion. It is said that women took a prominent part in the agitation against this Bill; and in any case, as Women’s Suffrage had been granted eight years previously, women had every opportunity of getting their wishes attended to. The death-rate and infantile mortality in New Zealand have continued to be the lowest in the world, and the rate of increase of its population nearly the highest, owing to the excellent health of its people. (See Fig. 6.) CHAPTER IV THE best approximate guide to the progress of the general health of the community is the variation of the death-rate. In the Annual Report of the Registrar-General of Births, Deaths and Marriages for England and Wales, tables are given showing how both the birth- and death-rates and the infantile mortality have progressed in no less than 29 countries. The figures, when put into the form of diagrams, are most striking, and enable us to come to a very definite conclusion as to the effect of family limitation. If “ artificial ” limitation of births were pro- ductive of either direct physical, or even moral, injury to the community, the result should have been a rise of the death-rates — either by the in- crease of disease, or of crimes or accidents. The reader will have noticed, however, that, although the announcement has been made with monotonous regularity in recent years that each successive birth-rate was the lowest on record, it has been accompanied, no less monotonously, by the state- ment that the death-rate was also the lowest yet recorded. When we add to this the lament of the British Medical Journal that the prospects of the medical profession are declining, owing to the THE PUBLIC HEALTH The Public Health 59 WtMT/OMS m BIRTH-RATE &€.,{.» ENGLAND Ts WALES. Fig. i fewer births and the consequently improved health of the children, we may suspect that there is not much wrong with the world, 60 The Small Family System Let us now turn to the facts concerning the death-rate, remembering that these are more accu- rately known than any other social phenomena. The annexed diagram, Fig. i, shows the variation of the birth-rate, the death-rate, and the infantile mortality in England and Wales. The birth-rate for each year (the number of births for each thou- sand of the population) is represented by a white strip; the death-rate (the number of deaths for each thousand of the population) by a shaded strip, partly covering the white strip; and the in- fantile mortality (the number of infants out of each hundred born who die before the age of one year) by a black strip. Such a diagram enables us to see at a glance both how the birth-rate and the health of the community are varying, and how the population is naturally increasing. For ex- ample, if we take the year 1861 we see that the birth-rate in that year was 34y2 per 1,000, the death-rate and the infantile mortality a little over 15 per cent. Also, that since there were 34F2 births for each thousand people, and 21J/2 deaths, there was an excess of 13 births over deaths per 1,000, or that 1,000 people increased to 1,013 people in the year. This is represented by the amount of the white strip visible above the shaded strip, enabling one to see at a glance, by watching the length of the white portion, what effect the change of the birth-rate has had upon the rate at which the population increases. We see that from the year 1853 (when accu- The Public Health rate statistics began to be kept) up to 1876, the birth-rate rose fairly steadily from a little over 33 to more than 36 per 1,000. In 1876, how- ever, commenced the famous trial of Mr. Brad- laugh and Mrs. Besant for publishing the Knowl- ton Pamphlet. It attracted enormous attention to the question and means of family limitation, and the result was the instant setting in of that rapid and steady decline of the birth-rate which we now hear so much about. In 1910 the birth- rate had fallen to as low as 25 per 1,000, and it has since gone lower still. Let us now examine the variation of the death- rate. If family limitation is so terrible from the medical and moral point of view as the South Western Medical Association or as Dr. Taylor made out, we ought to have seen a rise in the death-rate from 1876 onwards. But the facts are all the other way. Before this date the death- rate was rising and falling, but was certainly show- ing no definite sign of a tendency to decline; while from a date somewhere about that time a rapid and steady fall has set in. So great has been this fall in the death-rate that it has almost made up for the loss of births, and the population of this country is now increasing almost as fast as it did before the fall of the birth-rate set in, although something like 400,000 fewer births now take place every year than if the birth-rate of 1876 had been maintained. It would be hard to imagine a more absolute contradiction to the impression 62 ,The Small Family System given by the resolutions of the doctors and bishops. The only possible justification for these resolu- tions in the face of this fact would be a belief that the improvement is due to the strenuous fight of the medical profession and of modern sanitation to counteract the evil effects of this terrible inno- vation. If there were any grounds for this be- lief we should certainly have to congratulate them on having most successfully dealt with these evils by turning them into blessings. In this connec- tion it should be mentioned that the Public Health Act was passed in 1875, and most hygienists at- tribute the decline of the death-rate to the era which it inaugurated. Even if we granted it, we are forced at least to the conclusion that modern hygiene is fully competent to rectify all the evils supposed to arise from artificial prevention — a result which is at all events reassuring. Turning to infantile mortality, we find that it oscillated at a figure of about 15 per cent, up to somewhere about 1875 or 6, after which there was an improvement for a few years. It then rose to about its former level, or a little higher in 1900. Since then it has plunged down very rap- idly, so that it is now only about 10 instead of 15 per cent. Again, although one could wish it much lower, there is no sign of any evil result to infantile life either from disease engendered by artificial restriction or from the supposed degeneration of maternal feeling and care which is claimed to fol- The Public Health 63 low such “ unnatural ” practices, or from the higher education of women. There is no getting away from these facts. Even if the whole medical profession were unani- mous in condemnation of artificial restriction, it could not weigh one iota in the balance against evidence which is so incontestable as that of the death-rates — uijless it could be shown that there has been an increasing struggle amongst the medi- cal profession to preserve the health of the middle classes, who practice this limitation, a contention which is hardly maintained by the claims of the profession itself. The one objection which is oc- casionally urged against the death-rate criterion is that it ought to be “ corrected ” to allow for alterations in the proportions of young and old people, etc., in the country; but “corrected” fig- ures (whenever they are available) always show that the differences from the “ crude ” death-rates are very small in comparison with the great im- provement which has followed the fall of the birth- rate. In order to come to a just conclusion upon this all-important point, it will be well to obtain evi- dence from other countries. As before stated, the Registrar-General gives particulars in his annual Reports of twenty-nine countries, but as it wrould over-load the present small volume to deal with them all, we shall only take a few of the most notable examples. 64 The Small Family System Germany.— The German Empire, having only been formed after the war of 1871, does not give us a long period to deal with. But it will be seen from Fig. 2 that the birth-rate was rising very GERMAN EMPIRE. Fig. 3 The Public Health 65 rapidly before the year 1876, and that it has since declined nearly as rapidly as our own. As its highest value was about 41 per 1,000, or nearly 5 per 1,000 higher than the highest figure for England and Wales, the German birth-rate has always been in excess of our own, although de- clining similarly. In this case we find that the death-rate fell rapidly over the whole period, and indeed to a greater extent than the birth-rate, so that the excess of births over deaths got larger and larger as the birth-rate declined. Surely again this hardly bears out the contention that the limitation of births has been attended with dis- astrous results either from the point of view of health or of the vitality of the people. It will be noticed also that although the German birth-rate is higher than our own, its death-rate is decidedly higher (instead of being lower) and its infantile mortality very much higher. Instead, therefore, of Germany having an advantage over us in conse- quence of its lesser restriction of births, it appears that the health both of its general public and of its infants is much behind ours, despite the praises of the German hausfrau as compared with her more emancipated and less prolific English sister. France.— We now turn to one of the most in- teresting countries in connection with this ques- tion. France 1 is continually held up to us as the 1 France is not a neo-Malthusian country for the poor and unfit have not been encouraged and helped to limit their fami- lies according to means and health. 66 The Small Family System FRANCE. Fig. 3 example of an effete and “ dying ” nation, owing to the fact that it has the lowest birth-rate known, and that it occasionally has fewer births than deaths in a year. It is also of special interest be- The Public Health 67 cause it is one of the very few countries in which “ artificial restriction,” as distinguished from ce- libacy or late marriage, had been systematically practiced long before the Knowlton Trial of 1876. In fact it started almost immediately after the Revolution. In Fig. 3 we see the course of the birth and death-rates in France from 1781 on- wards, taken from the official Annuaire. In 1781-84 the birth-rate of France was 38.9 per 1,000, higher than any value recorded for our own country, and nearly as high as the highest recorded in Germany. It has since fallen to 21.1 in the period 1901-06, or by the large amount of 17.8 per 1,000. But now observe what has happened to the death-rate. In the period 1781-84, before the Revolution, the death-rate was no less than 37.0 per 1,000, and it has since fallen to 19.6 per 1,000. In other words a fall in the birth-rate of 17.8 per 1,000 has been accompanied by a fall in the death-rate of 17.4 per 1,000, or of a practi- cally equal amount, so the rate of increase of the French population is hardly any lower now, with a birth-rate of 21 per 1,000, than it was with one of 39 per ijooo.1 During the period of the de- clining birth-rate the average duration of life in France has doubled, and the progress of its popu- lation has not been checked. The explanation of 1 Since this was written the figures for 1906-10 have come to hand, and are shown on the diagram. The increase has been rather smaller during that quinquennium, but it is not a decline as has been so often stated. 68 The Small Family System the very slow rate of increase of population in France both at the end of the 18th century and to-day is probably that France was the most civil- ized and densely populated country in the Middle Ages, and had already come nearly to the limit of its agricultural productivity. At the same time it has apparently no store of minerals which would enable it to compete successfully with the indus- tries of England and Germany. After the Revo- lution the feudal system was destroyed and the land became better distributed among the people. This somewhat increased the output of food, so the death-rate fell faster than the birth-rate and the population increased more rapidly. After 1830, however, this advantage began to be used up by the increased population, and the country has returned to the position of very slowly increas- ing its production and population. There is no doubt that the health of the French people has enormously improved during the whole period of the falling birth-rate, and that its population has not been checked thereby — although the bulk of the limitation in France has admittedly been car- ried out by a method which has been specially de- nounced by both theologians and doctors. If any one contends that artificial limitation of families is injurious and degrading to women, the example of the French women (of the middle classes and provinces as distinguished from the gay set of Paris) ought to prove a corrective. There are few countries in which women exercise so much The Public Health 69 authority, in which they are so strong and free from nervous disorders, and in which maternal affection and love of home are so strong. Holland.— The only other example we need give of a European country with a falling birth- rate is that of Holland. This country is chosen, not because it shows an exceptionally great decline in the birth-rate, but because, wonderful to relate, the Neo-Malthusian League which has sought to instruct the poorer classes as to the means of re- striction (through the agency of medical men and midwives) has had the countenance of ministers of State and has been registered since 1895 as a Society of Public Utility. The essential point in this connection is that Holland is the only country in which artificial restriction has been extended to the poor, instead of, as in other countries, being adopted by the rich and educated classes only. As Fig. 4 shows, the birth-rate rose as usual to the year 1876, when it was about 37 per 1,000, and has since fallen steadily to about 28. But it will be observed that the death-rate and infantile mortality have fallen more rapidly and satisfac- torily than in any other country — so much so, in- deed, that the excess of births over deaths has in- creased astonishingly. At the same time there seems to be little or none of the physical deteriora- tion which we hear so much of in England and Germany and many other countries. Holland is the one and only country where some members at least of the medical profession have openly ap- 70 The Small Family System NETHERLANDS. Fig. 4 The Public Health 71 proved and helped to extend artificial restriction; and not only has its health, as shown by its death- rate and infantile mortality, improved faster than in any other country in the world, but it was stated at the recent Eugenics Congress that the stature of the Dutch people was increasing more rapidly than that of any other country — by no less than four inches within the last fifty years. According to the Official Statistical Year Book of the Nether- lands the proportion of young men drawn for the army over 5 ft. 7 in. in height has increased from 243/2 to 473/2 per cent, since 1865, while the pro- portion below £ ft. 234 in. in height has fallen from 25 per cent, to under 8 per cent. The ex- planation is, without much doubt, that the medical cooperation in Holland enables the Dutch people to employ hygienic methods of limitation; and in the second place that the knowledge of such meth- ods by the very poor enables them to have smaller families which they can look after better, and also prevents that recruiting of the race mainly from the poorest and most reckless classes which is so often deplored in England. One of the factors in this admittedly unfortunate circumstance is that the educated classes tend to limit their families unduly on account of the heavy taxation for the education and support of the large families of the poor. There is no doubt that in Holland, where the poor are taught to restrict, the families are not so much reduced among the wealthier people. Australia and New Zealand.— These two coun- 72 The Small Family System tries form a remarkable culmination to the exam- ples of declining birth-rates (see Figs. 5 and 6). In both of them the means of artificial restriction are in free circulation, and the restriction of fami- lies is almost universal. Mr. Octavius Beale in his Racial Decay waxes especially eloquent over the terrible 'degeneracy of these countries. In 1888, however, when Mrs. Annie Besant’s Law of Population was prosecuted in Australia, Mr. Jus- tice Windeyer, in a judgment delivered in the Su- preme Court of New South Wales, most strongly upheld the book as necessary and valuable.1 The following extract from this judgment forms a sharp contrast to the views we are gen- erally accustomed to hear expressed: — “ A court of law has now to decide for the first time whether it is lawful to argue in a decent way with earnest- ness of thought and sobriety of language the right of married men and women to limit the number of children to be begotten by them by such means as medical science says are possible and not injurious to health. Of the enormous importance of this question, not only to persons of limited means in every society and country, but to nations, the populations of which have a tendency to increase more rapidly than the means of subsistence, there cannot be the slightest doubt. Since the days when Malthus first announced his views on the subject to be 1 Mrs. Besant repudiated this book after her conversion to Theosophy. But she has recently written that “ if the premises of Materialism be true, there is no answer to the neo-Malthusian conclusions. . . . Not until I felt obliged to admit that neo- Malthusian teaching was anti-Theosophical would I take this step.”—Theosophy and the Law of Population. The Public Health 73 AUSTRALIA (Commonwealth). Fig. s misrepresented and vilified, as originators of new ideas usually are by the ignorant and unthinking, the question has not only been pressing itself with increasing intensity 74 The Small Family System of force upon thinkers and social reformers dealing with it in the abstract, but the necessity of practically dealing with the difficulty of over-population has become a topic publicly discussed by statesmen and politicians. It is no longer a question whether it is expedient to prevent the growth of a pauper population, with all its attendant miseries following upon semi-starvation, overcrowding, disease, and an enfeebled national stamina of constitution; but how countries suffering from all these causes of na- tional decay shall avert national disaster by checking the production of children, whose lives must be too often a misery to themselves, a burden to society, and a danger to the State. Public opinion has so far advanced in the consideration of a question that has become of burning importance in the mother country by reason of its notori- ously increasing over-population, that invectives are no longer hurled against those who, like John Stuart Mill and others, discuss in the abstract the necessity of limiting the growth of population; but they are reserved for those who attempt practically to follow up their teaching and show how such abstract reasoning should be acted upon. It seems to be conceded by public opinion, and has indeed been admitted in argument before us, that the abstract discussion of the necessity of limiting the number of chil- dren brought into the world is a subject fitting for the philosopher and student of sociology. The thinkers of the world have so far succeeded in educating it upon the subject, and public attention is so thoroughly aroused as to its importance, that every reader of our English peri- odical literature knows it to be constantly discussed in magazines and reviews. Statesmen, reviewers, and eccles- iastics join in a common chorus of exhortation against improvident marriages to the working classes, and preach to them the necessity of deferring the ceremony till they have saved the competency necessary to support the truly British family of ten or twelve children. Those, how- The Public Health 75 NEW ZEALAND. Fig. 6 ever, who take a practical view of life, will inevitably ask whether the masses, for whose benefit this exhortation 76 The Small Family System is given, can be expected to exercise all the powers of self- denial which compliance with it would involve. To what period of life is marriage to be postponed by the sweater in the East End of London, earning his three or four shillings a day, without any hope of ever being able to educate, decently house, and bring up, eight or ten chil- dren? The Protestant world rejects the idea of a celi- bate clergy as incompatible with purity and the safety of female virtue, though the ecclesiastic is strengthened by all the moral helps of a calling devoted to the noblest of objects, and by every inducement to a holy life. With strange inconsistency, the same disbelievers in the power of male human nature to resist the most powerful in- stincts, expect men and women, animated by no such exalted motives, with their moral nature more or less stunted, huddled together in dens where the bare condi- tions of living preclude even elementary ideas of modesty, with none of the pleasures of life, save those enjoyed in common with the animals — expect these victims of a social state, for which the educated are responsible if they do not use their superior wisdom and knowledge for its redress, to exercise all the self-control of which the celibate ecclesiastic is supposed to be incapable. If it is right to declaim against over-population as a danger to society, as involving conditions of life not only destructive to morals but conducive to crime and national degenera- tion, the question immediately arises, can it be wrong to discuss the possibility of limiting births by methods which do not involve in their application the existence of an impossible state of society in the world as it is, and which do not ignore the natural sexual instincts in man. “ Why is the philosopher who describes the nature of the diseases from which we are suffering, who detects the causes which induce it and the general character of the remedies to be applied, to be regarded as a sage and a benefactor, but his necessary complement in the evolution The Public Health 77 of a great idea, the man who works out in practice the theories of the abstract thinker, to be denounced as a criminal? ” We have already referred to the Conference on Public Morality instituted by distinguished cleri- cal representatives in New Zealand in 1901 and to the fate of the attempt to restrict the circulation of preventive devices, although Bishop Julius had said in an interview with a representative of the Christchurch Truth: “ Recent enquiry has proved a very large sale of preventives in this city, also that they are manufactured in Christchurch, and that they are being hawked about from door to door.” Mr. Beale has spoken of Australia as being in a very similar state. As such freedom is certainly much greater than exists in this and most other countries, Australia and New Zealand ought to be the most awful examples of physical and moral decadence. But are they? The fall of the birth-rate, of course, is most striking. In Australia it has fallen from 43.4 per 1,000 in 1862 to 25.5 in 1904, and it has since remained a little over 26 per 1,000. In New Zealand the decline did not defi- nitely commence till 1878, but it has since been phenomenal, dropping to 25.2 in 1899, or by about 17 per 1,000 in 20 years. Since then it has revived somewhat, but this is due simply to a higher marriage rate, as the fertility rate (or num- ber of births per thousand married women) has steadily continued to decline as follows: — 78 The Small Family System Year .., 1878 1881 1886 1891 1896 1901 1906 .Fertility .•337-2 313.3 295-5 276.3 252.1 2413.8 227.6 But when we come to consider the death-rate, we are immediately confronted with the fact that Australia and New Zealand are the healthiest countries in the world, whether regarded from the standpoint of general or of infantile mortal- ity. Not only so, but even here the fall in the birth-rate has been followed by a small but de- cided improvement in the death-rate. How is it that, despite the lamentations of the prophets, the facts will persist in absolutely repudiating their contentions? According to the statements of these moralists, Australia and New Zealand should compare with Sodom and Gomorrah in their resolute determination to pursue a course of iniquity. Yet we find them the most healthy and prosperous countries of the world, certainly among the most virile. Ex-President Roosevelt in his review 1 of Mr. Beale’s book has told us that “ the rate of natural increase in New Zealand is actually lower than in Great Britain, and has tended stead- ily to decrease.” The truth is that the rate of natural increase (excess of birth-rate over death- rate) in New Zealand is nearly double that of Great Britain, and has also been growing steadily of late years. Mr. Roosevelt also informs us that in Australia, “ even if the present rate were maintained, the population would not double itself 1 Reproduced at the commencement of Mr. Beale’s Racial Decay. The Public Llealth 79 in the next century.” With the present excess of births over deaths of 16 per 1,000, the Australian population will double itself in 44 years, and in- crease 4.8-fold in a century. Such glaring mis- statements will give our readers an idea of the way in which people are misled by those whom they are accustomed to look upon as authorities on such questions. Since this was written the Bishop of London has been on a visit to Australia and has given forth similar views to Mr. Roosevelt at the Annual Meeting of the North-West Australia Diocesan Association. This repeated attack has at last been too much for the Australian Government, and the High Commissioner for Australia com- municated a protest to the press. He pointed out that there were two sides to a birth-rate, the other being the number of infants who survive their first year of life. “ If he [the Bishop of London] will look at the statistics he will find that while the crude birth-rate of Australia is comparatively low in the list, nevertheless, on account of the equally comparatively low death-rate, Australia stands at the very top of the list in effective natural in- crease.” Summary.— It is quite a fascinating as well as an extremely profitable study to deal with all the countries in extenso, but that will be done in a later volume. We can, however, call atten- tion to the chief points in the following sum- mary. 80 The Small Family System BERLIN, 1841-1906. Fig. 7 Of the twenty-nine countries given in the Re- port of the Registrar-General: — 1. There are eighteen in which the birth-rate has fallen. In fifteen of these the death-rate has fallen by an amount nearly corresponding to the fall in the birth-rate; in two — New Zealand and Australia — the death-rate has only fallen slightly, but theirs is the lowest in the world. The Public Health 2. There are four in which the birth-rate has remained approximately stationary (Russia, Rou- mania, Jamaica and Ireland). In these four countries the death-rates and infantile mortality have remained practically stationary (except that there may be a small fall of the death-rate in Russia). Russia with the highest birth-rate in Europe (nearly 50 per 1,000) has the highest death-rate, about 36 per 1,000, and the highest infantile mortality, 26 per cent. In the other three countries the general and infantile mortali- ties are lower, the lower their birth-rates. 3. There are four countries only in which the birth-rate has risen (Bulgaria, Ceylon, Japan and Ontario [Canada]). In every one of the four the death-rate and infantile mortality rose when the birth-rate rose, and in close correspondence with the rise of the birth-rate. 4. When we compare different countries or towns, or different parts of the same country or town, we find as a whole that high birth-rates are accompanied by high rates of general and infantile mortality, while low birth-rates are accompanied by lower mortality rates. 5. The two most extreme variations of the birth-rate which have been shown among the great towns, are in the case of Berlin (see Fig. 7), where it has risen from 32 to 45 per 1,000 be- tween 1841 and 1876, and has since fallen to 21 per 1,000. The death-rate and infantile mortal- ity have risen with the rising birth-rate and have 82 The Small Family System fallen with its fall in almost exact correspondence, except for occasional irregularities due to war and epidemics. Toronto, on the other hand, is the only exam- ple of a town in which the counsels of the moralists appear to have been taken seriously to heart, and which has returned to a high birth-rate after join- ing in the general fall. The death-rate fell step by step as the birth-rate declined — and to prac- tically the same extent, but rose again immediately the birth-rate began to go up, and in 1909 was higher than in 1880-85. What do we learn from these incontrovertible facts? Not only that medical science has suc- ceeded in bringing down the death-rate when fam- ily restriction has been practiced, but that it has utterly failed to do so when the birth-rate has been maintained. Worse still, in every case where the command to increase and multiply has been obeyed by more rapid reproduction, the whole power of medical science has failed to prevent the death-rate from rising, And in Toronto, where for some reason the people have stopped in their downward path and have restored their birth-rate to its former high value, they have been rewarded not by greater health, but by a steady increase of the death-rate. In face of this it is difficult to find words adequate to deal with the attempt of the medical profession to stem the tide of the de- clining birth-rate. If the aim of the medical pro- fession is to allay suffering and to prolong life, the The Public Plealth 83 facts show that the whole profession is practi- cally incompetent to effect this for the community as a whole, unless helped by family restriction. There are those who will attempt to escape from this conclusion by appealing to “ corrected ” statistics, so it may be well to repeat that although the question is rendered more complicated by such modifications, the general conclusion is unaffected, or indeed strengthened, that family limitation is a decided advantage for the health of the com- munity. France, for example, which is always held up as such a dreadful object lesson, comes out much better when its corrected death-rate is given. CHAPTER V DO PREVENTIVE METHODS CAUSE CANCER? SPECIAL reference must be made to this terri- ble disease as it appears to be increasing, and as opponents of family limitation, Mr. Beale espe- cially, have sought to ascribe this increase to the practice of family limitation. Although he has brought together several instances of serious evils arising from abortion (probably mixed up with venereal disease) and of medical opinion connect- ing it with cancer, he does not seem to have been able to cite a single authoritative medical utter- ance associating cancer with preventive, as dis- tinguished from abortifacient, practices. No sug- gestion of such a consequence appears in the addresses of Sir James Barr or of the President of the American Medical Association in their re- marks upon the declining birth-rate, while with regard to the contention that mechanical devices 1 and the employment of antiseptic fluids2 are provocative of irritation to the mucous mem- 1 Is this contention ever advanced against the very similar mechanical devices which many women have, under medical advice, to Wear constantly over long periods of displacements — the result of excessive child-bearing? 2 For as Dr. Rutgers has said, preventive methods and per- sonal hygiene are almost equivalent. Preventive Methods and Cancer 85 branes, the same might be said of artificial teeth, and of antiseptic mouth washes. If wrongly fitted, artificial teeth will cause serious irritation; and an impure or too concentrated dentifrice may do the same. But that does not alter the fact that properly fitted artificial teeth, and suitable, regularly used mouth washes are powerful aids to health, and that they are safeguards against both irritation and disease. A very large number of refined persons are wearing mechanical devices in their mouths sixteen hours or more out of the twenty-four, and are daily, or even more fre- quently, scrubbing the mucous membrane of their mouths with fluids that are sometimes identical with, and even more concentrated than, those em- ployed for family limitation. The very antisep- tic precautions recommended by medical men them- selves for women after childbirth and at other times are practically identical with the best means for preventing conception. So far from conced- ing that anti-conceptional means are an evil, or a lesser evil than excessive and burdensome ma- ternity, those who have studied the subject know that many of them are most beneficial and that they should be employed even when prevention is not desired, the only difference being the time at which they are used. This may seem a startling contention after the diatribes of Mr. Beale and his coadjutors, but when it is remembered that the majority of the public have no opportunity given them to differentiate between the good and 86 The Small Family System the bad, and that every effort has been made to confuse harmless preventives with noxious aborti- facients, it is not surprising that a strong case can be made out against prevention in general from the records of unfortunate ignorance. Indeed it is wonderful that such good results have followed, and they enable us to realize what splendid results should arise from a humane and intelligent exten- sion of the knowledge. A quotation from a gynae- cologist of the eminence of Professor Hector Treub, such as given on p. 11 of this book, is suffi- cient to show that no harm need follow preventive means. So the duty of the medical profession is not to denounce them indiscriminately, but to in- struct the public in employing the harmless and beneficial methods. One more opinion on the subject of cancer may be given. In the fourth scientific report issued by the Imperial Cancer Research Fund, Dr. E. F. Bashford, the Director, says: — “ For the first time it is fully demonstrated that it is erroneous to make statements of a disquieting nature about the increase of cancer in general,” and he points out, as has been frequently pointed out by neo-Malthusians, that an increase of cancer is naturally to be expected, since cancer is a dis- ease of later life, and since the average duration of life is increasing. As the present writer has often argued, the reduction one by one of various diseases by prevention or cure must inevitably lead to an increase of the diseases that we have not yet Preventive Methods and Cancer 87 ENGLAND $, WALES. CAA/CEN. CONNECTED DEATN-NATES AT AU ACES /t6/-io/o* troTt >- Tttt ootrrro* snAoeo vetrncAii r fr/AAeSCAT rj r/tt Aio/rrAi/rr Ascs/oeo rc CA/vce* or r#t gcmmati** aa/o AtAMMA/tr srsrwAs ovA/Afa r/ft re a as tg6t •/ Fig. 8 learned how to prevent. Those who to-day live long enough to be attacked by cancer would, in 88 The Small Family System the majority of cases, had they lived in years gone by, have succumbed earlier to small-pox, consump- tion and other scourges which have since been so greatly reduced in frequency. As all who are born must die sooner or later, the conquest of one disease after another means that more people will die of old age and of the unconquered diseases. As cancer is the most important of the latter, it is not at all surprising that it has increased. In fact, paradoxical as it may seem, the increase of cancer might actually be regarded as a sign of im- provement rather than of deterioration of the health of the community, until the day comes, as we hope it soon will, when its prevention or easy and certain cure are arrived at. So much for theory; now for facts. In Fig. 8 is reproduced the diagrams given for the vari- ation of cancer by the Registrar-General in his Report for 1910, the figures being “corrected” for the age and sex distribution of the population in 1901. The rapidity of the increase is unques- tionable, but there are certain features to be no- ticed about it. Firstly, the increase of cancer, both in men and women, was taking place just as rapidly before the commencement of the decline of the birth-rate in 1876 as it has done since. The comparison be- tween this period and that of the last fifteen years, 1894-1910, during which the decline of the fer- tility rate has been most rapid, is clearly shown in the following table: — Preventive Methods and Cancer 89 Males .... Cancer Mortalities. Cancer Mortalities. 1861. 1876. 1894. 1901. Per cent. Per cent. Increase. Increase. 220 320 44.5 560 855 34.9 Females .. 5i7 645 24.8 875 1,070 22.3 Birth-rate 36.4 36.3 5 29.5 24.8 —15.9 According to this, therefore, cancer among males increased by 45 per cent, when the birth- rate actually increased by 5 per cent.,1 and has only increased by 35 per cent, during the last 15 years during which the birth-rate has fallen 16 per cent. For females, the rise of cancer mor- tality has been reduced from 24.8 to 22.3 per cent, with this change of the birth-rate. There is noth- ing whatever on the curves of cancer mortality to show the slightest influence of the sudden reversal in 1876 from a rising to a falling birth-rate, and there is no evidence here to show that the rise of cancer mortality would not have been the same if the falling birth-rate had never set in. But the diagrams indicate more than this. They give us — unfortunately only for the past fourteen years — the mortality from cancer of the generative and mammary systems, which are, of course, the really important factors in the ques- tion. As regards males, the position is obvious; cancer of the generative organs is extremely small, and shows no perceptible tendency to increase. On the other hand, as regards females, cancer of 1 Probably because premature deaths from violence and epi- demics were decreasing. 90 The Small Family System VARIATION OF CANCER IN PERSONS AT DIFFERENT AGES. WOMEN (Fig. 10). MEN (Fig 9). Preventive Methods and Cancer 91 the generative and mammary system forms a most serious proportion of the total, and it is perhaps increasing a little faster than the general female cancer mortality. When we come to study the matter a little further, however, we find two inter- esting facts. In the first place, the increase of cancer among women, instead of being greatest at the ordinary years of motherhood (as would have been ex- pected if artificial prevention were responsible for it), is actually less and shows signs of being ar- rested. Figs. 9 and io are diagrams given by the Registrar-General for the increase of cancer mor- tality in men and women at different ages. From these we see at once that while among men (where cancer of the generative system is unimportant) the increase has been very rapid at all ages, among women (where cancer of the generative organs is important) there is actually an arrest of the in- crease up to the age of 45 (the end of the child- bearing period) and signs of a decline. It is only above the age of 65, long after any preventive methods have become unnecessary, that the in- crease of cancer among women is unaffected. It thus appears that, relatively to men and older women, the women at the child-bearing periods are positively benefiting rather than suffering by the new custom. When we remember that frequently repeated pregnancy and childbirth are themselves 92 The Small Family System ENGLAND AND WALES. Cancer in various parts of the body. Mortality at all Ages, 1897-1910 WOMEN (Fig. i t). a serious source of irritation and of disorders, this result is by no means unintelligible.1 1 It is worth noticing that the women above 65 years of age among whom cancer has been principally increasing, probably never used preventives, as their child-bearing period must have ceased before the practice of prevention became at all general. This goes to confirm the statement just made. Preventive Methods and Cancer 93 In the second place, the surmise just made is de- cidedly confirmed by the fact that the very organ which is the most concerned in the matter, is the only one in which can- cer has not increased (at any rate during the last thirteen years), and in which it actually shows signs of a decrease. The Registrar - General’s Report1 contains dia- grams showing the variation of cancer in various organs of the body in males and fe- males since 1897. A glance at one of these (Fig. 11) will con- vince any one that the case for connecting the increase of cancer with the employment of preventive devices breaks down at the most critical point. Before leaving this subject, reference must be briefly made to other countries. VARIOUS COUNTRIES. Fertility and Cancer. 1901-1905. Fig 12. 1 Annual Report for 1909, p. Ixxx. 94 The Small Family System It may be said as a general rule that the increase of cancer has been noted in all countries — even in Ireland, for instance, where the birth-rate has remained practically constant for the past twenty- five years. In Holland, where, as has been said, artificial restriction has been largely taught to the poor, cancer has actually diminished during the past five years. France, with a birth-rate of 21 per 1,000 in 1901-5, had a cancer mortality of only .76 per 1,000 as against .95 in England and Wales, and 1.3 in Switzerland. Both of these countries had birth-rates of 28 per 1,000 at that time. The most satisfactory comparison, how- ever, is that between the cancer mortality and the fertility rate, i. e., the birth-rate compared with the number of married women. In Fig. 12 we have a diagram exhibiting this comparison for all the countries in which these particulars are given in the period 1901-5. This appears to show that there is practically no relation between the average amount of child-bearing and cancer. Those who have read Mr. Beale’s book will very probably feel, however, that all these sta- tistics and reasoning do not affect the terrible ex- amples he cites of disease following upon what he calls “ conjugal frauds.” To this it may immedi- ately be replied that Mr. Beale in his zeal has omitted to tell us two things: firstly whether the “ conjugal frauds,” which he alleges to have given rise to terrible consequences, were prevention or abortion; and secondly what was the real nature of Preventive Methods and Cancer 95 these consequences. No one would be surprised to hear that terrible effects had followed from re- peated induction of abortion, either by drugs or unskilled interference; and the Hungarian Na- tional Senate has warned us that such evils are due to ignorance of, and not to knowledge of, preven- tive methods. Again Mr. Beale ought to know that an immense amount of sterility and suffering are caused by horrible diseases which are the direct results of the fear of early marriage on account of the large families which naturally follow from it, and that the want of knowledge of preventive devices is thus directly responsible for such evils. When we add that the effects of such diseases are often hardly to be distinguished from those of can- cer, even by experienced medical practitioners, it is easy to see that a strong case can be made out for the apparent production of cancer by preventive methods. Such evidence, therefore, appears to have very little weight in comparison with the posi- tive evidence of the falling death-rate, and of the arrested increase of cancer in women at the period of motherhood, and in the generative organs, etc. It is also of very little weight in comparison with such negative evidence as the absence of any warn- ing from the eminent medical authorities who have recently dealt with the birth-rate question. When we consider the anguish caused to millions of poor women by their eternal burden of bearing children one after another into wretched conditions and by seeing half of them die from want and unnecessary 96 The Small Family System disease, some of us may have our own opinions of Mr. Beale’s attempt to hound these poor mothers away from hope of relief by scaring them with the threat of cancer. Doubtless he would heartily subscribe to the words of Luther: “ If a woman becomes weary, or at last dead, from bearing, that matters not; let her only die from bearing. She is there to do it.” Prevention and Sterility.—Another favorite device of the opponents of artificial limitation is to claim that it leads to sterility, so that when couples who have employed preventive methods for some time wish to have another child they find them- selves incapable of having one. How absurd this statement is is well known to those who have had experience of the subject. On the contrary there is some evidence that the fertile period is even pro- longed by preventive methods, as cases have occurred when couples have abandoned preventive methods only after passing the end of normal fer- tile life, and have immediately had another child. This statement is confirmed by Dr. W. J. Robin- son, the President of the American Society of Medical Sociology, in his Practical Eugenics, chap. III. “ Another argument is that the use of the means of prevention renders a woman sterile, so that when she afterwards wants to have children she cannot do so. This is absolutely and unqualifiedly untrue. Here is again confusion between prevention and abortion. It is true that repeatedly performed abortions may render a Preventive Methods and Cancer 97 woman sterile on account of the inflammations and infec- tions that abortions often set up. But properly used means of contraception have no such effect. Thousands and thousands of women use these means as long as they do not want to have any children; when they want a child they discontinue their use and very soon afterwards become impregnated.” CHAPTER VI MORALITY WE now come to the evidence concerning the actual moral effects of family restriction, and for this purpose we can appeal both to opinion and to facts. As regards opinion, it is hardly necessary to mention that several eminent persons who consider themselves entitled to speak with au- thority, unhesitatingly declare that we are under- going a terrible moral decline, comparable with that which brought about the decline and fall of the Roman Empire. The words of Horace, Vitio parentum, rara juventus, are thought by them to apply equally to the present day. Among the chief expositors of this view are Father Bernard Vaughan and the Bishop of London in this coun- try, Dr. J. Bertillon in France, and ex-President Roosevelt in the United States. The following quotations are the strongest denunciations we have read, emanating from each of these gentlemen in turn. “ With a sigh I look back to the early days of my boyhood, when the birth-rate, instead of being what it is now, was 37 or 38 per thousand. For my experience goes to show that, quite apart from the vaster questions in- volved, the larger the family the healthier and merrier Morality 99 the children. But the parents of to-day ridicule the notion of having big families. Instead of being proud, Society is becoming ashamed to own a nursery full of children. And motherhood, instead of being looked upon as a blessing, is regarded as a curse, and disregarded as a duty. . . . There is no wealth like human life — no health like that of an increasing population; and the outlook for any country whose birth-rate is on a decreas- ing scale is black indeed. I wish I did not find in the story of our own times so many chapters that recall Gibbon’s Decline and Fall of the Roman Empire; but the points of resemblance are so striking that no student of history can avoid comparing them.” (Father Bernard Vaughan. “A Doctrine of Destruction,” in The Prob- lem of Motherhood. “ In his charge to the clergy of the diocese of London at his annual visitation at St. Paul’s to-day, the Bishop of London again referred to the question of the birth-rate. “ His lordship remarked that the birth-rate in 1905 was 27.2 per 1,000; in 1906, 27.1; 1907, 26.3; 1908, 2.65; 1909, 25.6; 1910, 24.8. “ In 1876 the birth-rate attained its highest point on record, namely 36.3 per 1,000, and since then it had fallen year by year. “ In Australia they found a similar fall for the last six years, but not quite so great. “ He could only repeat his words of six years ago: ‘ It is as completely proved as anything can be that the cause of all this is the deliberate prevention of conception.’ ” To use the eloquent words of Professor Taylor, “ This which was first encouraged in England some thirty-five years ago has gradually spread like wildfire among the middle-class population of the land, and the true wealth of the nation, ‘ the full-healthed, bright-eyed, and happy- hearted children,’ have more or less gone down before it.” 100 The Small Family System “ Now it is to stem this gigantic evil,” said the Bishop, “ that I summon the forces of the Church to-day. “ Let teaching be given in suitable ways and at suitable times on the responsibility which married life entails, on the glory of motherhood, and the growing selfishness which thinks first of creature comforts, of social pleasures, and then of the ordinary duties and joys of life. “ It is all part of this miserable gospel of comfort which is the curse of the present day, and we must live ourselves and teach others to live the simpler, harder life our fore- fathers lived when they made Britain what it is to-day, and handed down a glorious heritage, which unless we amend our ways, must surely slip from our nerveless fingers.” (Evening News, I2th October, 1911). Now we come to Mr. Roosevelt: — “ Even more important than ability to work, even more important than ability to fight at need, is it to remember that the chief of blessings for any nations is that it shall leave its seed to inherit the land. The greatest of all curses is the curse of sterility, and the severest of all condemnations should be that visited upon wilful sterility. The first essential in any civilization is that the man and the woman shall be the father and mother of healthy children, so that the race shall increase and not decrease.” (Lecture at the Sorbonne, April, 1910, quoted by the [London] Daily Chronicle of April 25th, 1910.) As a matter of fact, however, few people seem to have committed themselves to a definite asser- tion that the morals of the nation are really deter- iorating, although it is frequently insinuated that the limitation of births must certainly be causing them to do so. Here, for example, is a recent ut- Morality 101 terance from Canon J. W. Horsley’s just published work, How Criminals are Made and Pre- vented: — “ Infecundity is the symptom and the cause of a decom- posing Society. The violation of Nature’s laws and the prostration of Nature’s ends must always create their own Nemesis, and that not merely in the region of economics, but in that of general morality; for as Professor Nitz says, ‘ when pleasure is desired and sought for its own sake, without the responsibility and consequence of having children, matrimony loses its entire purpose, and becomes nothing else than a form of monogamic prostitution.’ “ Honor be to fecund marriages, honor to virtuous celi- bacy, but dishonor to all else. Not a word is to be said against child restriction, when necessary, by conjugal prudence, moral restraint, and self-denial in things law- ful, as advocated by Malthus; but nothing is more dis- honest than the claim of his authority by neo-Malthusi- anism or the Malthusian League.1 As Professor Flint says, ‘ Malthus would have disowned with horror the Malthusian League,’ which has advocated and promoted with appalling success child restriction by genetic frauds, family suicide leading to racial decay. Marriages in the upper and middle classes are now made ito be so sterile that an undue and dangerous proportion of the rising generation is formed of the lower and more ignorant population. Three crimes are common and increasing — the destruction of the seed, of the unborn, and of the body. They only vary in accident; the criminal motive is the same. The disastrous effects to the race, to mor- ality, and commonly to the health of the woman are the same. Nor can any one pretend that in teaching the 1 Neo-Malthusianism is based on Malthus’s principle of popu- lation, and the Malthusian League alone has appreciated its fundamental and abiding importance. 102 The Small Family System way of child-prevention he or she is not also making seduction easy by depriving it of the salutary fear of consequences.” And yet, after showing what a moral decline these practices must “ inevitably ” lead to, Canon Horsley has a chapter, in the same book, entitled “Are We Improving?” in which he confesses himself an optimist, and goes on as follows: — “ An improvement in general morality as regards its outward manifestation seems to me obvious. It must have been some twenty years ago when I heard a vener- able man, Mr. Scott, the City Chamberlain, contrast the sights and the language of the streets at that time with what he remembered when younger, and he found reason to thank God for the great improvement. After twenty years I take up that parable again. Vice is to be found in the streets, if you search for it and know where to search; but it is not flaunted in our main thoroughfares and outside our railway stations as it used to be. Music halls are improved out of all knowledge, partly through the pressure of public opinion exercised through the Lon- don County Council, and while the humor of most comic songs is such as to make the lover of literature, or even of sanity, to groan, it is no longer demonstrative or sug- gestive of foulness. . . . “ And certainly the common language of the street is another tongue compared with that of thirty years ago. Oaths and obscenity are now the effervescence of drunken quarrels rather than the Homeric epithets of normal speech. “ I can well remember too, when houses of ill-fame were thick in some streets in all boroughs, and the most persistent energy on the part of the Vigilance Society or of individuals (like my friend Canon Jephson in Lam- Morality 103 beth) was necessary to induce Borough Councils to take reluctant action. Now, however, neither police nor civil bodies require urging from outside, and other boroughs besides my own are insistent in pressing magistrates to imprison brothel-keepers instead of giving an ineffective fine, which used, at any rate, to be paid by an associa- tion of such folk.” Meanwhile the birth-rate goes on declining, and the middle classes, who are foremost in the matter of family limitation, are also foremost in the efforts to bring about these reforms! It would, of course, be easy to call up a fairly strong array of opinion in favor of an advance in public morality, but it is not now proposed to do so, as we prefer to deal with facts. The above quotations have only been given in order to do full justice to the opponents of family limita- tion. But we cannot resist giving a few quota- tions from another part of the work of Dr. Ber- tillon, who appears to be alone among the oppo- nents of family limitation in showing any capacity for collecting and assimilating real evidence. He gives us some particulars of a few cantons in France with high and low birth-rates. At Foues- nant in Brittany, where the birth-rate is extremely high, he informs us that the children are brought up in mud huts with the pigs, and that the people can hardly write their own names. At Lillebonne on the Seine, an industrial canton, where the birth- rate has risen to 37 or 38 per 1,000 (higher than in almost any part of Great Britain, and equal to 104 The Small Family System that figure which Father Bernard Vaughan so extols), the death-rate has not only increased to an equal extent and the infantile mortality enor- mously, but Dr. Bertillon mentions that while in the days of the low birth-rate they were careful and honest they are now careless concerning the future, live on credit, and that: — “ Several of them consume daily at the cabaret, or more frequently at home with their wives and families, enor- mous quantities of alcohol. It may sometimes happen that, retiring in a state of intense drunkenness, they en- gender nothing except for the cemetery. But what is certainly frequent is that semi-intoxication combined with fatigue, inspires them with a profound indifference con- cerning the responsibilities of the family which they pro- duce, or rather renders them totally incapable of caring for it.” So that, according to such a denunciator of the falling birth-rate as Dr. Bertillon, the moral evils which are ascribed to France as a consequence of family limitation are shown to the most extreme degree among those who do not practice it. Now let us hear him concerning an industrial canton of low birth-rate, Conde sur Noireau. The people are “ clean, honest, polite, economical, and peace- able,” they save and they read a great deal. “ Cases of drunkenness are not very rare, but chronic alcoholism is.” . . . “ They do not kill, they do not steal, they do not commit adultery — at least to the extent of being certain that there shall be no consequences — they do not squander Morality 105 their money, they do not resist the authorities, they insult no one, they never have revolts or noc- turnal brawls, but they also very rarely have ille- gitimate children, they marry late or remain celi- bate, and only have too few legitimate children.” He also speaks of their simple and healthy food in contradistinction to the unwholesome food of the inhabitants of Lillebonne. Elsewhere in the same volume Dr. Bertillon quotes from the well-known writer, M. Arsene Dumont, concerning the inhabitants of the French islands of Re and Oleron. “ Their only passions are very innocent; they are read- ing and dancing. The dancing, always decent, is the preparation for marriage; illegitimate births are very rare. One could not imagine manners more pleasant or more honorable. Nevertheless the birth-rate in these islands is among the lowest. It is because every one there is more or less of a proprietor. Each person has some property to protect; each is ambitious for his children.” It must not be supposed that these passages have been abstracted from Dr. Bertillon’s book to show one side of the case. They are perfectly repre- sentative of the evidence he gives. That he him- self would admit this, is shown by the fact that he deplores all these evidences of prudence, and ex- presses great pleasure at the reckless disregard of the future which leads to the “ admirable ” high birth-rates. It has become the fashion to speak of the de- pravity of France, of her alcoholism, of her dis- 106 The Small Family System regard for law and order, and of her terrible crimes passionels, and to ascribe them to the fall- ing birth-rate. If this were the case it is obvious that these evils would be most intense where the process had gone furthest, i.e., in the cantons of lowest birth-rate. But we have the authority of Dr. Bertillon himself to show us that it is just these cantons in which the greatest moral improvement has taken place; and that where the French have obeyed the Church’s command to increase and mul- tiply, there alcoholism and crime abound. If we can judge from Dr. Bertillon’s own evidence, France might escape from all these evils not by avoiding the sin of family limitation, but by adopt- ing it more universally. The pictures given by Dr. Bertillon himself of the results of family limitation appear to be in striking contrast to those we would have expected from his comparisons with the decline of Rome. Are the hardworking, self-reliant, prudent and temperate peasants of those cantons of France where family limitation is most practiced, com- parable with the lazy, sullen, pauperized prole- tariat of Rome, dependent for their living on the bounty given them by their masters and wrested from others by war, and kept from rebellion by the panem et circenses distributed by their rulers? So convinced indeed is Dr. Bertillon that pru- dence, sobriety and education go with a low birth- rate, that he actually proposes legislation calcu- lated to encourage irresponsibility, such as com- Morality 107 plete liberty of disinheriting some children for the benefit of others, so that large families would not involve the division of property as they do at pres- ent. This will hardly commend his advocacy of large families to lovers of justice. We may now leave the realm of assertion and come to those of fact. The term “ morality ” is, unfortunately, very loosely employed, some people using it in its larger sense of the general conduct in relation to the welfare of the community, while others restrict it to the very narrow sense of the relationship of the sexes. We must, of course, take the larger view here, although, as the ques- tion of family limitation is so intimately connected with marriage and sex relationship in general, we shall lay stress on sex morality. The most im- portant items concerning general morality are those of crime, alcoholism and pauperism; while as regards sex morality we have to consider divorce, prostitution, illegitimacy, and venereal disease. Crime.—In dealing with the question of crime, it must be remembered that this is a matter of law, and that the addition of new laws to the Statute Book or the repeal of old ones may make a con- siderable difference.1 The tendency of modern times is also certain to reduce the severity of pun- ishment. The best indication therefore appears 1 The amount of crime, in fact, in a progressive community represents the difference between the progress of its laws and that of its actions, 108 The Small Family System to be the number of convictions, apart from the punishment awarded. Tested by this the moral progress of our own country is most satisfactory. According to Mulhall’s Dictionary of Statistics, the number of convictions per million of the popu- lation has steadily fallen from 1,280 in the decade 1841-50 to 299 in 1896, and it seems to have dropped continuously since that time. The Re- port of the Commissioners of Prisons issued in 1911 says that the total number of offenses fell from 152,511 in 1900 to 141,555 in 1909, despite the increase of population, while “ in the year ending 31st March, 1912, the ratio of the prison population to the general public reached the lowest point within statistical record.” Here is an extract from the Commissioners’ Report: — “ It is a matter for satisfaction that, in a year marked by so much social unrest, and in some places by disorder, fewer persons should come to prison relatively to popula- tion than in any year on record. The low prison popu- lation was maintained throughout the year, the daily average in local prisons being over 1,000 less than for the preceding year.” 1 They also call attention to a considerable diminution in Juvenile Crime, the convictions of male offenders between 16 and 21 having dropped from 18,000 to 8,000 in the past 20 years, and those of females from 4,000 to less than 1,000 in the same period. 1 Daily News Year Book, London, 1913, p. 233. Morality 109 Beyond the statistical evidence there has also been a most remarkable increase of the number of occasions on which white gloves have been handed to the judges on circuit. And after occasions of public rejoicings, such as the Coronation Festivities or the Bank Holiday celebrations, the press have informed us that the number of police court cases has been surprisingly small. There seems to be no doubt that, on the whole, respect for law and order is increasing in England at a very rapid rate; and although this improvement certainly started long before the decline of the birthrate set in, all that concerns us is that it has been main- tained during the whole of the decline. Reference may also be made to Australia as having had the most rapid fall in the birth-rate of any country — from 35 to 26 per 1,000 between 1889 and 1908. According to the Official Hand- book for Australia, the convictions decreased from 69 to 26 per 10,000 for the population from 1881 to 1908, or to a little more than one-third of its previous value. In face of these two examples it is idle to pretend that family limitation predisposes to criminality, even if we admit (though there is strong reason to doubt it) that crime has increased in France in recent years. According to the French An- nuaire Stat'istique for 1910, the number of con- victions at the Assize Courts has steadily fallen from 3,900 per annum in the quinquennium 1873— 77 to 2,180 per annum in the year 1908-9, while 110 The Small Family System the population increased from 36.6 millions to 39.4 millions. The convictions per million of population have thus fallen from 106 to 55.5 per million, or to little more than half. Before the correctional tribunals they have increased from 5,050 per million in 1873-7 to 5>75° per million in 1893-7, but have fallen since to 5,150 in 1908-9. Of course we are always hearing of the extreme leniency of the French courts and juries. But there has been a decided tendency to greater severity of late years, and yet the convictions are decreasing. In any case, family restriction com- menced so long ago in France that it is no longer very rapidly extending; and apart from this, Dr. Bertillon’s examples show that crime and other evils are associated with large families rather than with small ones. On the whole it may be confi- dently decided that family restriction has not in any way tended to increase the criminality of the people. Alcoholism.— It hardly needs statistical evi- dence, as far as our own country is concerned, to show the improvement which has taken place in this matter. The immense strides which temper- ance and total abstinence have made of late years are surely patent to all. When we see half the guests at a public banquet to-day drinking mineral waters, while our grandfathers were proud of being “ three bottle men,” hardly any further evi- dence is needed. In fact statistics are of very lit- Morality tie use here, as cases of drunkenness are now severely dealt with which would have been looked upon’as amiable weaknesses a generation ago. Even so, the convictions for drunkenness seem to be steadily on the decrease. As regards the con- sumption of alcohol per head, the figures show a fall in the consumption of spirits from 1.23 gal- lons per head in 1876 to .8 gallon per head in 1909. The consumption of beer showed an in- crease from 27.6 gallons in 1881 to 33 gallons in 1898, the eve of the South African War, but it has since rapidly dropped to 26 gallons. On the other hand, deaths from alcoholism rapidly increased from 39 to hi per million from 1870 to 1900, but they have since fallen extremely rapidly to 43 per million in 1909. It is clear that there is little relation between this phenomenon and the decline of the birth-rate. Indeed it is a somewhat * curious reflection that the maximum consumption of spirits and beer, as well as the increased num- ber of deaths from alcoholism, seem to have been evoked, not by the falling birth-rate, but by the very wave of imperialism and patriotism called forth by the South African War. It has often been stated that the consumption of alcohol in France is increasing. It is certainly true that it is now higher than it was thirty-five years ago. But the official figures given in the Annuaire Statistique for 1910 show that the con- sumption of alcohol in drink has steadily fallen 4.2 litres per head in the quinquennium 1888-92 112 The Small Family System to 3.48 litres in 1908-9. The fall has recently been practically as rapid as in Great Britain. Ac- cording to Dr. Bertillon himself, alcoholism in France is specially great among the parents of numerous children; and he agrees that this is a most serious factor in infantile mortality and de- generation. It is somewhat remarkable that when we are told that family limitation is due to selfish- ness and love of luxury, we find that it is the fathers of large families who indulge in excess of alcohol, while the fathers of small families fre- quently live the simplest and most abstemious lives. As Dr. Bertillon says: — “ The alcoholic persons most often have very many children. I take this statement from a great number of doctors whom I have questioned on the birth-rate; those of the Orne, a department where the drunkards are numerous, have affirmed it strongly. This may be understood; it is through excess of prudence that the French do not have children; but the drunkards are the least prudent of men.” Of course there are those who will not regard the consumption of alcohol as having much to do with morality; and there are no doubt many who will consider that if drunkenness leads to the sub- lime imprevoyance (to use Zola’s phrase) of casting children on the world without consider- ation, it should be regarded as a virtue. But this view will hardly commend itself to the ma- jority; and quite apart from any ordinary views Morality 113 as to the morality or otherwise of drinking, it appears to be established that any great consump- tion of spirits has a most seriously deleterious effect upon the quality of offspring, by poisoning the parental germ plasm. Pauperism.— We need not dwell upon this question, as the amount of pauperism depends upon a large variety of circumstances. But it is satisfactory to note that pauperism in England and Wales, i.e., the number of persons relieved an- nually per thousand of the population, has fairly steadily fallen from 34.5 in 1875 t0 in i9ioj or by 23.5 per cent, during the period of the de- clining birth-rate. This is so far reassuring, in that it indicates that the easier circumstances en- gendered by smaller families do not lead to idle- ness, as is frequently contended. The industry and saving habits of the French peasantry are world-renowned, and it is worthy, of note that France is almost the only country which the real wages of the working classes have been increasing of late years, while they have dropped 15 per cent, in this country, and nearly 25 per cent, in prolific Germany. Sex Morality.— We now come to the great question of sex morality, and it is here that the de- nunciations are strongest, and here also that it is most difficult to obtain reliable evidence. The contention of the orthodox moralists is that the general knowledge of preventive methods tends to relax chastity in the unmarried, and that it lowers 114 The Small Family System the standard of married life into one of legalized prostitution — thus tending to a lower respect for the marriage tie and to increase of divorce; and also that the mistakes made from carelessness in prevention lead to a greater frequency of abor- tion. Such statements are very easily made, but not so easily either confirmed or disproved. Before taking such statistical evidence as is available, how- ever, we should like to ask those who make such assertions whether they have ever paused a mo- ment to compare (as Canon Horsley has done, see p. 102) the general standard of morals of to- day with that of thirty-five years or more ago? The present writer does not claim to have a great deal of worldly experience, but everything he has ever read or heard shows most strongly that the code of sexual ethics a generation or two ago, though more rigid in name, was far less so in fact than that of our own times. It is a common mis- take to suppose that because sex questions and evils are now openly recognized and discussed by both men and women there are more of these evils than in the days when such things were never mentioned. Persons who take his view forget the famous dictum of John Stuart Mill that “ the dis- eases of society can no more than corporeal mala- dies be cured without being discussed in plain lan- guage ”; and there are many who see in these discussions a much higher degree of purity than in the silence or innuendo of former times. Any- Morality 115 one who contrasts the after-dinner speech at a banquet to-day with that of even ten years ago will be forced to recognize that women are being held in increasing instead of decreasing respect, whatever Father Bernard Vaughan may say to the contrary. Where are women, and espe- cially mothers, held in such esteem as in France and New England, where the birth-rate is lowest? And when we see young men and women thrown into continual contact in all professions and in- dustries and observe their demeanor towards each other, will anyone seriously contend that there is really a greater degree of laxity in the relations of the sexes than in former times? If Father Vaughan, President Roosevelt, and other denun- ciators would turn their eyes from the “ smart set ” to the plain hard-working middle classes (where, be it noted, the fall of the birth-rate has been most marked) it would be impossible for them to talk as they have done. Family limita- tion may possibly have bred a love of ease and luxury, but it most certainly has not relaxed chas- tity in the unmarried or decreased respect for womanhood. Divorce.— It is here that the orthodox moral- ists have their strongest case, if not against family limitation in particular, at any rate against the ten- dencies of the times in general. Divorce is as- suredly increasing in this and most other coun- tries at a considerable rate. Between the period 1876-80, just after the decline of the birth-rate 116 The Small Family System set in, and the year 1909, divorces had increased from 22.1 to 41.5 per million of the population, or had practically doubled in frequency.1 But it remained practically stationary during the fifteen years from 1881 to 1895, although the birth-rate was falling rapidly during the whole of that time. Since then, however, divorce has rapidly become more common, and the same tendency is observ- able in practically all countries, even in Belgium, where the Roman Catholic Church still has a strong hold. Those, therefore, who cling to the indissolu- bility of marriage, are justified in regarding the tendencies of modern times as decidedly in the wrong direction, and they are probably so far cor- rect in coupling it with the spread of family limita- tion that both these phenomena are due to the modern inclination to look at social questions rather from the point of view of earthly happiness than from that of ecclesiastical dogma. This is clearly shown by the recent majority report of the Divorce Law Commission. There is a large and increasing body of men and women to-day who regard the spectacle of a refined and delicate woman tied to a brutal or unfaithful husband and condemned to bear weakly or diseased chil- dren, as infinitely more immoral than greater ease 1 Dr. Bertillon does not recognize any relation between di- vorce and the birth-rate, and points out that in Saxony, where the birth-rate is still extremely high (about 40 per 1,000), divorce is very frequent. Morality 117 of divorce. In New Zealand, for example, the electoral power of the women has led to the estab- lishment of the equality of divorce between the sexes, and a large increase of divorce has taken place as a consequence. But those who deplore this as immoral must have an extraordinary idea of the real interests of the human race. The matter may be left for settlement between the advocates and opponents of easy divorce. One other important matter, however, should be referred to here. In the Judicial Statistics for 1909, Sir John Donnell mentioned that the greatest proportion of divorces took place among couples with no children, and that they were less in proportion as the families grew larger. Many newspapers have seized upon this as indicating the demoralizing effects of family restriction. But childlessness is not only the result of restriction. It is frequently the result of the diseases caused by an irregular life before marriage. It would be surprising, therefore, if a large number of divorces did not take place among childless couples, for very few married people voluntarily remain with- out any children at all. Similarly, the restriction of families no doubt sometimes takes place on account of want of affection, or of later irregu- larities. And lastly, there is no doubt that a woman who has borne a numerous family is often bound, by want of means and by her maternal feelings, to endure a bondage which she would otherwise have broken for her own advantage and 118 The Small Family System that of her posterity. Those who delight in the picture thus indicated are welcome to their dis- approval of the modern tendencies. Illegitimacy.—As far as statistics are con- cerned, the most valuable evidence is that relat- ing to illegitimacy. The Registrar- General’s Reports contain a useful amount of infor- mation upon this point, and give us the number of ille- gitimate births per thousand unmar- ried women within the fertile period, between the ages of 15 and 45. This illegitimacy rate for England and Wales is rep- resented in Fig. 13, and it i s no- ticeable that the fall since the year 1876 has been ex- tremely rapid, much more so in fact than that of the fall in the gen- ENGLAND AND WALES. Fertility and Illegitimacy. Fig. 13. Morality 119 eral birth-rate or in the fertility rate of the married women. While the general birth-rate has fallen from 26.3 to 25.6 (or by 26.5 per cent), the illegitimate birth-rate has fallen from 14.6 to 7.9 per thousand unmarried women (or by nearly 50 per cent). This is most striking and satisfactory. An extreme instance is given in the county of Radnorshire, which in 1870—2 had a fertility rate of 308.6 births per 1,000 married women, which sank to 188.7 in 1909, or by 39 per cent. In the same interval the illegitimate birth- rate fell from 41.8 per 1,000 unmarried women to 7.2, or by no less than 83 per cent. In Holland a drop of legitimate fertility from 347 to 315 per 1,000 coincided with a fall of the illegitimate fer- tility from 9.7 to 6.8 per 1,000, i.e., at a much greater rate. It is true that France, with its low and decreasing fertility rate (from 196 to 158 per 1,000 between 1881 and 1901), has had a com- paratively high and increasing illegitimacy rate (from 17.6 to 19.1 per 1,000) ; and that Ireland, with a somewhat high and slightly increasing fer- tility (from 283 to 289 per 1,000), has the lowest and a falling illegitimacy rate (from 4.4 to 3.8 per 1,000). But this has been heavily out- weighed by Austria with an equally high and steady fertility (from 281 to 284 per 1,000) with the highest illegitimacy rate known (43.4 to 40.1 per 1,000), while Germany comes second with an illegitimacy rate of 27.4 per 1,000 in 1901. Though it cannot be said, therefore, that the low- 120 The Small Family System est birth-rate produces the lowest illegitimacy rate, it most certainly cannot be said that family limita- tion has had any evil effect in increasing illegiti- macy. The bulk of the evidence is quite decidedly the other way. In the case of the most notable exception — that of France — we have the au- thority of Dr. Bertillon for saying that the greatest decency and lowest illegitimacy are found where the birth-rate is lowest. We may also quote from our own Registrar-General, who said in his Annual Report for 1909: — “ Except in the cases of the German Empire, Sweden, France, Belgium, and the Australian Commonwealth, the falls shown in illegitimate fertility in Table LXXXIV are greater than the corresponding falls in legitimate fer- tility.” So far as the evidence of illegitimacy is con- cerned, therefore, it may be taken as definitely established that the adoption of family restriction has not led to greater laxity among the unmarried. But it would, of course, be quite unjustifiable to claim that this evidence is final. It may not mean that there is less lax conduct but only that there are fewer results of lax conduct. It is perfectly open for the orthodox moralist to claim that the greater knowledge of preventive methods has per- mitted an increase of laxity with a reduction of the ordinary effects. This must remain a matter of conjecture. When we find, however, that not only has illegitimacy decreased, but also deaths Morality 121 from abortion and from the diseases ordinarily associated with irregularity, there seems no justi- fication whatever for the contention that chastity has been relaxed. It must not be forgotten in this connection that the encouragement to early marriage afforded by the possibility of avoiding the economic burden of a too early or too large family affords the most likely of all methods for removing the temptations to unchastity and for conquering the hitherto untractable “ social evil.” Although the average age of marriage in this coun- try has been rising somewhat lately (probably on account of the increasing cost of living), it is in- teresting to note that it is lower and fairly steadily decreasing in France. For first marriages the average age at marriage of French men has fallen from 28.6 in 1856 to 27.88 in 1896-1900, and of French women from 24.25 to 23.5 in the same period.1 This cannot be regarded as otherwise than a very good sign. Disease.—We have just referred, in connec- tion with the question of illegitimacy, to the dis- eases associated with unchastity. This is not only an unpleasant subject to deal with but a most un- satisfactory one, as the evidence concerning it is of a most conflicting character. It appears neces- sary here to give a warning concerning some of the so-called evidence as to the prevalence of such diseases. The bulk of the statistics on this point are gathered from the Army, where inspections 1 Dr. J. Bertillon, Depopulation de la France. 122 The Small Family System are made from time to time, and where, by alter* ing the frequency of the inspections, the number of cases may be apparently increased or diminished at will. Those who have studied the question of the Contagious Diseases Acts well know that there has been a most determined and persistent attempt on the part of some Army authorities to revive these Acts. To show justification for this effort they have constantly attempted to represent these diseases as increasing, and it has been stated that this has been done by increasing the frequency of inspection. We cannot therefore rely upon evidence based on the number of cases of disease, but only on the number of deaths. Of course this is open to the objection in the other direction, that improved medical knowledge may have reduced death while the cause has remained unchecked. It may be questioned, however, whether during the last twenty years any striking improvement in the treatment occurred, except, perhaps, the introduc- tion of Salvarsan in 1911.1 But according to the Registrar-General’s Report for 1910 the death- rate for the principal venereal disease steadily fell from 71 per million in 1890 to 46 per million in 1910. If this is an indication of the frequency of the disease, it is a complete refutation of the charge of increased laxity; and it is a very decided 1 In Germany an immense reduction of these diseases has been effected by instruction in prophylactic methods, but such meth- ods are practically unknown in this country. Morality 123 rebuke to the assertions of Mr. Beale. At any rate the onus of proof most certainly lies with those who assert the increase of unchastity. Another thing of great importance in this con- nection is the frequency of abortion or miscarriage. It will be remembered that traducers of family limitation, such as Dr. J. W. Taylor, have sought to associate prevention with abortion and to imply that an increase of the one means an increase of the other. On the other hand, both economic considerations and medical evidence, such as that of the Hungarian Medical Senate, indicate that prevention and abortion are really alternatives; that women will seek to avoid the burden of ex- cessive families, and that an extension of preven- tive methods should therefore lead to a reduction of abortion. But we have no figures as to the actual extent of abortion, and our own authorities have only just begun to enumerate the still births, which would have given some clew. The Regis- trar-General, however, does give us the number of deaths from abortion and miscarriage. They have fallen from 9 per million in 1892 to only 2 per million in 1910. It seems hardly likely that medical treatment improved to such an extent in the interval, so the natural presumption again is that the frequency of abortion has diminished. It wTould be a difficult and wearisome task to pursue this investigation throughout other coun- tries, although it ought to be done by some com- petent authority. But enough has been said here The Small Family System 124 to show that the immense preponderance of evi- dence is against the detractors of family limita- tion, and that we have a right to expect more definite evidence from them before we need to investigate more deeply. Since this was written the author has come across a pamphlet entitled Preventive Hygiene, published by John Bale & Sons, in which it is clearly shown, by diagrams prepared from figures supplied by the Registrar-General and Army Medical reports, that the prevalence of venereal diseases in both the civil and military population has been rapidly decreasing from 1884 to 1910. [2nd Edition. The Royal Commission on Venereal Diseases which was appointed in 1913 reported in 1916. It had refused to hear evidence as to the importance of birth-control knowledge to promote early marriage and thus greatly reduce prostitution and disease, and to enable infected persons to avoid having children. The Commission was probably the outcome of two factors — (1) the growing desire to help in “counteracting” the falling birth-rate, and also in improving the race, by reduc- ing venereal disease which causes sterility, abortions, still- births, infant mortality and defective offspring, (2) the dis- covery of Salvarsan. Thus it seems to have been formed mainly to reveal the seriousness of venereal diseases, to remove the bar against mentioning them, and thus to encourage early and thorough treatment* The fact that Salvarsan only “ cures ” syphilis, and not gonorrhoea, was not emphasized. That the Commission maintained the old attitude that intercourse is only for procreation was shown by its refusal to hear evidence about prophylaxis and about neo-Malthusianism. Now, however, we have Sir H. B. Donkin, M.D., and others, urging instruction in prophylaxis, and Sir Malcolm Morris, M.D., (a leading mem- ber of the Commission, appealing to the clergy to encourage early marriages. As prophylaxis for the unmarried is so much more advanced a suggestion than birth-control for the married, neo-Malthusianism should soon be openly recognized and adopted.] CHAPTER VII GENERAL CONCLUSIONS OUR inquiry has now been carried out suffi- ciently, and it may be well to summarize briefly the conclusions we have arrived at. They are as follows: — I. Both opinion and statistics go to show that limitation of families is practically universal among educated married persons at the present day, and that this is due to “ artificial restriction ” rather than to “ moral restraint.” II. On collecting the evidence as to the hygiene and morality of such “ artificial restriction ” we find: — (a) As to opinion. Both medical and clerical opinion in this and other countries was most strongly condemnatory of such restrictions a few years ago, although there were isolated opinions to the contrary. Since that time, although the prevalence of artificial restriction has meanwhile enormously increased, the adverse opinions have diminished in number and intensity. Many emi- nent medical authorities have testified to the harm- lessness of such restriction, and the Official Judg- ment of the Hungarian National Senate for Social Hygiene, as well as the addresses of the Presidents 126 The Small Family System of the British and American Medical Associations, have shown a decided justification for it. Clerical opinion, though still hostile as a whole, is markedly less so than formerly. In fact we find a Council of Public Morals, comprising an Archbishop, ten Bishops, 26 Reverend Deans, Canons and other clerical gentlemen, and one Cardinal, publishing books in which the falling birth-rate is defended by men who have publicly endorsed neo-Mal- thusian methods. (b) As to conduct. The enquiry made for the National Life Assurance Society in 1874, just before the Knowlton Trial which led to the decline of the birth-rate, showed that both medical men and clergy had families which were as large as the average of the whole community. The small families of the medical profession to-day, as well as of many of the clergy, show that family restric- tion has been widely adopted by them. There is no question as regards medical men that this has been carried out by artificial means. As regards the clergy it is probable that a “ moral restraint ” has been adopted by a few; but there can be no doubt that a large number have also adopted arti- ficial restriction. (c) As to the Health and Morality of the Com- munity. The Vital Statistics of various countries show most conclusively that the national health has rapidly improved as the birth-rate has de- clined, and that in all probability the death-rate would not have declined without a diminution of General Conclusions 127 the birth-rate. Wherever the birth-rate has re- mained stationary or has risen, all the advances of medicine and hygiene have failed to diminish the death-rate or to keep it from rising. The most satisfactory improvement in the general death-rate, the infantile mortality and the stature of the peo- ple of any country in the world has been shown in Holland, where alone “ artificial restriction ” has been countenanced by the State, and taught to the poorer classes with medical cooperation and super- vision. With regard to specific diseases, there has been a satisfactory diminution in all important ones, except in cancer, which has increased. An analysis of the organs affected, however, fails to show any connection between this increase and the adoption of artificial restriction; while in women who have been threatened with such terrible con- sequences, cancer of the generative system actually appears to be on the decrease. Finally, the morality of the Community, so far as can be judged from crime, alcoholism, pau- perism, illegitimacy and venereal disease, appears to be most decidedly improving. Even in France, where we hear so much of moral decadence, the evidence by no means justifies this view, and the statements of the strongest opponents of restric- tion show that such evils exist most among those who do not limit their families, and very little among those who do. In view of all these investigations, it is impos- 128 The Small Family System sible to avoid the conclusion that the case against artificial restriction is certainly not made out. In fact the great bulk of the evidence is most remark- ably in favor of the hygiene of the practice, and of there being no moral objection to it. Such a con- clusion will doubtless be indignantly repelled by moralists of the old school. It is possible, of course, that there may be better evidence on their side than they have yet brought forward. Mean- while, having carefully read every hostile criti- cism of any importance, and having sought to do the fullest justice to it, we feel strongly that until this new and satisfactory evidence is forthcoming, every rational person must conclude, not only that “ the artificial sterilization of matrimony is the most revolutionary discovery of the nineteenth century,” as Mr. Bernard Shaw has said, but also that it is the most beneficial of modern discoveries for the well-being of the community. CHAPTER VIII FAMILY LIMITATION AND SOCIAL REFORM THE preceding chapter has terminated our enquiry as to the permissibility or otherwise of family restriction. But those who have any in- terest in social questions will hardly fail to see that this one has the most intimate relation to almost every other question of economic or racial im- provement. We may, therefore, indicate a few of the more important consequences of admitting the justification of artificial restriction. Few people have not heard at one time or an- other of the doctrine of Malthus — that un- checked human fertility causes population rapidly to catch up with food supply and then continually to press against it, thus leading to poverty, famine, disease, and war. Economists of the highest standing, such as John Stuart Mill, have accepted this doctrine as unanswerable. It is only of recent years — since the decline of the birth-rate has set in, since the improved means of transport have brought food from abroad, and since the Socialists have claimed that under their regime plenty could be produced for all — that it has suffered a tem- porary eclipse. Yet during this period the accu- mulating vital statistics of various countries have 130 The Small Family System been proclaiming the truth of Malthus’ law, and that improvement in social conditions, as evi- denced by the death-rate, has only been rendered possible by the reduction of the birth-rate. Within the last few years, too, the rapidly increas- ing cost of living has made many people recognize that the temporary respite granted by a larger area of food supply has been checked by the great increase of population in the United States and elsewhere, and that the law of Malthus has again to be admitted and reckoned with. The very strong pronouncement of a churchman like the Dean of St. Paul’s shows that the question presents itself as a most serious one to some, at least, of our leaders of thought. It is not proposed to go into the evidence here which shows most conclu- sively that over-population (i.ethe pressure of too high a birth-rate against the necessities of life) does exist, and is the chief factor in the social evils of to-day. But it is sufficient for anyone to look at the progress of the birth and death-rates in Fig. i to see that by reducing the birth-rate to 20 per 1,000 we may reduce our death-rate to 10 per 1,000 — the value found in New Zealand and Australia, where poverty and misery as we know them hardly exist. Again, apart from questions of quantity, every- one knows that a most serious question to-day is the high birth-rate among the least desirable class of the community — the indigent, the unemploy- able, the reckless, the drunken, and the mentally Limitation and Social Reform 131 and physically deficient. On this account many Eugenists, especially in Germany, have been call- ing out for the educated and successful classes to redress the balance by having larger families, and thus to kill out the unfit by the struggle for exist- ence. To this, however, there are two objections. One is that the educated classes have not re- sponded, and will not respond to the call. They know too well the advantages they and their children gain by limitation. Indeed, the very peo- ple to call out for the larger families, whether in Germany, France, Hungary or England, are, as the Hungarian Medical Senate pointed out, the chief offenders against their own doctrine. The other objection is that, in these days of humani- tarianism, society has an objection to the killing out process. The victims, moreover, have a habit of protesting. Anyhow, society does everything possible to maintain them (usually at a minimum of vitality) and to allow them to propagate to the fullest extent. Is it wonderful then that we have overcrowding, disease, and physical and men- tal deterioration? Mephistopheles himself could not have devised a better system for ruining the race than the one we have at present — the full license to the unfit to breed at the expense of the fit, who limit their families more and more in order to maintain workhouses, hospitals and asy- lums for these poor creatures. There are only two alternatives for race improvement — either the fit must increase their own multiplication and 132 The Small Family System refuse all help to the unlit (with the specter of the French Revolution to cheer them), or they must see to it that the unfit do not reproduce. The combined wisdom of the age can find no escape from this dilemma — unlimited reproduction and brutality, or humanitarianism with restricted re- production of the unfit. The recent Mental Defi- ciency Bill is a first recognition of the latter prin- ciple. But why deal only with the extreme cases of mental deficiency? There are millions of poor physically and mentally unfit creatures who, if voluntary restriction were known to them, or they were not told it was unhealthy or immoral, would only be too glad to escape burdening themselves and the community with a numerous and weakly progeny. What is the use of deploring the in- crease of the unfit when the poor mothers among the working classes are only too anxious to avoid the misery of bearing child upon child in wretched surroundings, on miserably insufficient wages, and of seeing half of their children perish from semi- starvation before their eyes? What is the use, too, of simply segregating the mentally deficient when we have a huge factory of mental deficiency in our midst in the terrible amount of venereal disease caused by prostitution? If all young people were able to marry at a suit- able age, instead of having to wait till they can provide for a family, this great source of defect would be stopped, and it would do far more to check mental defect than any other measure which Limitation and Social Reform 133 could be devised. In fact, we should probably never have needed the recent Mental Deficiency measure if our educated classes had done their duty in extending the knowledge of hygienic means of family limitation to the poor when they them- selves adopted them. Let us now look at the matter from the point of view of present day politics. We have before us the question of housing and overcrowding, of a minimum wage, of the land, etc., and both politi- cal parties are endeavoring to show how they will solve them. We need not take up a position of hostility to either party, but simply point out a few simple facts. First as to the housing question. We are not concerned either to assert or to deny that much better accommodation should be available, or that rents should be lower. Even when we find that about 2 y2 millions of working men at the present time have a wage of six dollars a week, or less, we feel that, even as things are, a man and his wife and one or two children can have two rooms and live in some approach to decency. With a greater number of children the position is hopeless. More accommodation is needed with more chil- dren, though the margin for rent gets less. Hence we have the spectacle of whole families herding together, like beasts, in a single room. However much we may urge the necessity for bet- ter and cheaper accommodation, we cannot get over the fact that while this is being settled — and 134 The Small Family System it will only be settled slowly — the most acute phases of the housing problem would be solved in a year or two by the adoption of family limitation by the poor. Next take the question of the minimum wage. Opinions may vary as to the justification or pos- sibility of it. But there is one simple question which is never raised in the controversy, namely: What do you mean by a minimum wage? Is it a family wage? If so it must mean a minimum of subsistence for each member of the family. If no restriction is to be practiced, and the size of the family left to chance, it must include a certain sum for each child. Is Mr. Lloyd George or any other advocate of the minimum wage prepared to enact a scale of wages based on the size of fami- lies? Mr. Rowntree has clearly shown that in a provincial town a family of three can only with the utmost economy be maintained on 23s. 8d. per week, without the slightest margin for amuse- ments, luxuries, or contingencies. In London the wage would have to be higher. Whenever poli- ticians talk of a minimum wage of £1 or 25s. a week, they really imply that the family must not include more than one or two children, and it is dishonest not to say so. In the same way, when they talk of cottages with certain accommodation, it will always be found that they provide only suffi- cient for two or three children. Yet they never say that the workers are to restrict their offspring to this number, although they well know that Limitation and Social Reform 135 families of ten or twelve children are quite com- mon among the poor, and indeed make political capital of this very fact. So long as marriage implies unlimited parenthood, the principle of the minimum wage or of adequate housing implies provision in proportion to the number of children. Are the middle classes, who regulate their own families to their means and who provide the bulk of the taxation, prepared to assent to this propo- sition? Nothing has here been said about celibacy as opposed to marriage. Even were celibacy desir- able, it would be no solution of the above difficulty, so long as married people had very large families. Of course one may preach very late marriages, as advocated by Malthus. But this means the delay- ing of marriage in the case of women of the poorest classes till the age of 35 or over. Even then families of six or more children would still be common. But no one can contend that such an age would be an ideal one for commencing mar- riage or child-bearing. Nor would hardly any medical man or clergyman to-day advocate either celibacy or long delayed marriage, certainly not for the working classes. On the contrary, early marriage, apart from its more ideal character, is the one and only possibility of reducing or elim- inating the evils of prostitution, which evil has defied all other efforts to check it. The only rea- sonable possibility of securing general early mar- riage is by removing the burden of unlimited fami- 136 The Small Family System lies, and if limitation in itself were regarded as necessary and moral, and led to this result,1 it should do more for the promotion of a really moral state of society than any reform hitherto proposed. Nowadays one hardly ever finds a person who in private conversation does not fully admit the position. Any father or mother of a family will tell you more or less freely that they cannot prop- erly feed, clothe and educate their children as use- ful citizens and do justice to their own individual- ities with more than three or four children at the outside. They see in a moment that if their workmen or charwoman only had small families they would be much better off. They will often tell you how foolish these people are to have so many children. But they never seem to realize that the poor are largely ignorant on such mat- ters, or that they have been frightened off from limiting their families by statements of the kind we have been investigating. Nor do they seem to feel it their duty in the name of humanity and of patriotism to see that the necessary knowledge is extended to the poor. This is probably partly because of conventionality, and partly because there is some belief that the country will suffer from want of workers or of defenders if family limitation became general. A little study of the 1 The age of marriage is diminishing in Holland, and so is the illegitimate birth-rate, proportion of still-births, etc. Limitation and Social Reform 137 question would show anyone that this is a complete delusion. Will the country suffer by having a smaller number of the poorest and most ineffective workers or unemployables? Family limitation has now been adopted by nearly all the intelligent and efficient people in the country; and if that be an evil, it has done its worst work. All the more necessary is it to extend the knowledge now as rapidly as possible to those who are inefficient. As the Bishop of Ripon himself admitted at the Church Congress of 1910, “ If the diminution of the birth-rate could be shown to prevail among the unfit, we might view the phenomenon without apprehension, and we might even welcome the fact as evidence of the existence of noble and self- denying ideals.” It cannot be too strongly impressed upon every- one that family limitation within reasonable limits does not mean the slightest slackening of popula- tion. Not even in France, which is held up as such a terrible example, has it done so or is it even likely to do so. Increase of population is due to survivals, not to births, and the rate of survival may be greatly increased by diminishing the birth- rate in the right place. When the State of On- tario in Canada had a birth-rate of 19 per 1,000, the figure which France has now attained, it had a death-rate of only 10 per 1,000, and its rate of natural increase was therefore 9 per 1,000, or as high as many European countries to-day. Those who, like Dr. Bertillon, imagine that the slow in- 138 The Small Family System crease of France is due to its low birth-rate, must simply be asked to explain why its death-rate is 18 instead of only io per 1,000. We are all familiar with the motto, “ the more haste the worse speed.” The more haste we make to increase population by a too high birth-rate the worse confusion we get into, the more complex are our social evils, and the less rapidly does our population increase. The golden rule for population, as for everything else, is — Festina lente. While we have the example of Holland (the only country in which family limitation has been fairly tried on its merits, and been extended to the proper quarters by the cooperation of statemen and medical men — with such .splendid results in increasing the population, while reducing the gen- eral and infantile mortality and improving the physique) we must ask ourselves whether we should not do better to concentrate upon educat- ing our poorest people to limit their families in the best possible manner. It is greatly to be hoped that in view of the declarations of the Presidents of the British and the American Medical Associa- tions our medical men will now come forward to the task. An inspection of Fig i, representing the course of the birth and death-rates in our own country, reveals the fact that within the thirty-five years during which the birth-rate has fallen, the death- rate has fallen from 22 to 13.3 per 1,000. It also shows that at the present rate of progress the Limitation and Social Reform 139 death-rate will fall to io per 1,000 (the figure for New Zealand and Australia) by the year 1921, if the birth-rate falls to 20 per 1,000 as it appears likely to do. When that time is reached it will mean that there is practically no premature death from actual want of the necessities of life, or in other words, that poverty in its worst sense is abolished. It is quite certain that this result will be attained by 1921, even if no greater efforts are made than at present. It is equally certain that if the educated classes of the community realize their duty in this matter, and would help in bring- ing about restriction of families in the places where it is most required, the death-rate could be brought down to 10 per 1,000 within five years. Yet dur- ing these five years there would probably be a greater increase of population than at present} since we should be checking the supply of ineffec- tives rather than that of effectives. It sounds strange talk of doing away with indi- gence in such a short period of time, but those who make an unprejudiced study of vital statistics will quickly realize that the above statement is per- fectly warranted. It is for the medical profession and the educated classes to decide whether arti- ficial restriction is or is not healthy and moral, and, if they decide in the affirmative, to use their utmost endeavors to direct it wisely for the benefit of the race. Without their aid it has done wonders; with it, it will perform miracles. We may close by repeating the words of that ardent pioneer of 140 The Small Family System Eugenics, Dr. Saleeby: “ Only by the aid of neo- Malthusianism can we attain the ideal which I have defined in my outline study of Eugenics, that every child who comes into the world shall be desired and loved in anticipation.” CHAPTER IX Judgment of the Hungarian National Medi- cal Senate delivered 27th October, 1911, by Professor Dr. William Taufer, in reply to the Minister of the Interior concerning a Memo- randum presented by the National Agrarian League and referred to the Senate for its opinion. THE SINGLE CHILD SYSTEM [As this remarkable judgment does not appear to be known in this country, and is in such striking contrast to earlier medical pronouncements, I venture to include a literal translation from a German copy of the Judgment made for me by the late Dr. Gustav Dimer, Professor of Gynaecol- ogy at Budapest.] THE Agrarian League deals in its Memoran- dum with the Single Child System, and asks from the Ministry certain enactments which, in its opinion, will mitigate or arrest this serious social evil. It demands legislation, but only to a very small extent of a social hygienic character; and we observe that even it does not contend that the Single Child or Small Family System is in- jurious from the hygienic point of view. For the truth is, of course, that too many children — that is, more than the parents can feed properly — are not to be desired from the hygienic standpoint. 142 The Small Family System The Memorandum enumerate the measures which the Agrarian League considers necessary. Only the following paragraphs, however, are really concerned with the question of social hygiene. 1. Especially conducive to the Single Child System are inter alia the absurdly permitted marriage of 18 year old youths with 15-16 year old girls. What a danger for the race is implied in these early marriages! They simply ought not to be allowed by the laws. Such early sexual life results in “ female diseases,” premature old age, ster- ility — or, at least, in defective offspring. These contentions of the Agrarian League, re- garded from the hygienic point of view, are en- tirely unwarranted. Early marriage can bring with it many social evils — perhaps also ethical and economical disadvantages, which we will not consider — but never “ female diseases,” prema- ture old age, sterility or defective offspring. It cannot be supposed that the marriage of youthful persons (assuming they are physically fit, as should be medically ascertained) gives rise to hygienic evils. If the Agrarian League calls for legisla- tion against early marriages, it cannot do so on medical grounds. 2. The League states that the Ministerial decree Z. 50981 of 1901, which aims at the reduction of the circu- lation of preventive devices, has practically not been applied. This is quite true; and the Senate can only re- The Single Child System 143 peat what it recently decided when considering the proposition of the Komitate Somagy Borsod und Heves. No new Ministerial action is here neces- sary, but only the strict application of the above- mentioned decree. As the Single Child System is referred to as a “ social disease,” the Senate cannot abstain from calling your Excellency’s attention to the circum- stance — which weighs much more heavily in the balance than the dangers urged by the Agrarian League — that, in order to avoid the blessing of children, the practice of abortion prevails to a horrible extent not only in the capital and the great towns, but also in the country. This social disease devours the life force of the people, for it is a source of much injury and life-long invalidism. We must also point out that under any stringent restriction of the circulation of ordinary means of prevention this great evil would grow even greater. Its diminution — there can be no question of its extirpation — must be the highest aim of any civilized community. The splendid hygienic con- ditions in Germany have had astonishing results. The supervision of midwives — in combination, of course, with the improvement of economic con- ditions — has led to an increase of population so amazing as to cause France the greatest apprehen- sion. In Hungary, where social hygiene has always been the step-child of State administration, there is at present no possibility of great, costly, health-giving reforms such as the fundamental es- 144 The Small Family System tablishment and maintenance of hygiene adminis- tration on every side; nevertheless, we must in this connection be alive to the deep-rooted and far- reaching evil above mentioned. The second great danger which t>ur population has in its germ, so to speak, is the very serious infantile mortality. To a great extent this is also due to unorganized administration in hygienic mat- ters; but also to the poverty of the people, and to the want of education. We are convinced that the growth of population will best be promoted by intelligent organization of the administration and far-reaching regulation of midwives, and by State attention to the care and feeding of infants. The rational procedure would be: improvement of the standard of comfort and education, the building up of a hygienic administration, and State super- vision of midwives and of infant feeding. Social science has shown that a people repro- duce more rapidly the poorer and less educated they are; and, on the other hand, that with the extension of civilization, and the increase of edu- cation and improvement of economic conditions, the number of births falls off. This holds good not only for Europe, but for the whole world. Almost every legislative body has occupied itself with this question. The French Chamber has just issued a report which draws attention to the fact that the increase of population in 1909 was only 13,000, and that in 1907 there was actually a diminution of 20,000 souls. The Single Child System 145 The three items of proposed legislation are: — 1. Men who have not married up to their 29th year are again to be called to military service. 2. Whoever has not married before his 25th year cannot receive any appointment under State or municipality. 3. Whoever has at least three living children shall have higher salary and higher pension. But all these propositions must be rejected — not, however, on the grounds of hygiene, but on the grounds of political economy. The greater number of children desired by the Agrarians may serve the military and capitalistisc interests, but never the interests of hygiene. From the hygienic standpoint the increase of population is a food question, the answer to which is that the unre- stricted physiological reproductive power of hu- manity increases rapidly, while the food-producing power increases very slowly in the most favorable cases, and is in any case limited. So an unlimited number of children can even threaten the exist- ence of a family from the hygienic point of view. Inevitably then, human beings will guard against a number of children disproportionate to their social conditions. Equally readily can we under- stand that educated and thinking parents will wish to ensure their children the same amount of well- being which they possess. The result of this rational line of thought is apparent even among the best educated and most capable classes of the community — including our ground landlords, 146 The Small Family System who have sent up their cry for help through the Agrarian League. It would seem that in this cry a strong class interest finds expression, and that the League asks for State help against an evil of which the landlords are quite as guilty as the lower classes whom they accuse. Neo-Malthusianism (the international title of the Single Child System)1 is a natural consequence of civilized environment, and can only be uprooted by the destruction of civilization. Forel says on this point that “ hypocrisy lies in the fact that each class brands the limitation of births as immoral, and itself practices this immorality. It is well- known that the members of the propertied classes bring only a few children into the world, in order that the standard of life of the children should not fall below that of the parents. The whole neo-Malthusian practice owes its origin to the propertied classes. The very moment, however, that the working classes commence the adoption of this practice, the ruling classes proclaim all such conduct as immoral, which they, by their own con- duct, have recognized as moral.” The State possesses neither the power nor the means to prevent or diminish family limitation; for when the working classes have realized that excessive reproduction puts a burden on their progeny, and have learnt the means of restriction, there is no law or power which can bring them 1 Neo-Malthusianism is not a single-child system. The Single Child System 147 back to renewed over-production. Moreover, Social Hygiene can only benefit the working classes after improvement in their material existence — so even it will be thereby furthered, and not set back. The contentions of those who consider and decide upon this question on the grounds of reli- gion, moral philosophy, patriotic militarism or capitalism, and who discuss by what means the in- evitable might be postponed, cannot form a sub- ject for the deliberation of the National Senate for Public Health. END OF THE FIRST EDITION CHAPTER X PROGRESS SINCE 1913 SINCE the issue of the first edition of this book in 1913 the question of family limitation — or “ birth-control,” as it is now frequently called — has come rapidly into great prominence, and a large number of new and weighty pronouncements have been made concerning it. In order to see how far the more recent evidence supports or conflicts with the conclusions arrived at in the first edition, the previous chapters have been left substantially unaltered (except for the bringing of the diagrams up to date), and the recent events here chronicled can be compared with them. The most salient of these events were the formation of the British National Birth Rate Commission by the National Council of Public Morals referred to in Chapter II; a paper by Dr. Bond to the Leicester Ruri-Decanal Conference in 1914; the rapid growth of popular opinion in Germany in favor of family limitation; the outbreak of a mili- tant birth-control propaganda by Mrs. Margaret Sanger in the United States, after the long medi- cal campaign in its favor by Dr. W. J. Robinson; and the terrible European war which has brought the whole birth-rate question into strong relief. Progress Since 1913 149 But these are only milestones along a path of rapid progress. THE NEO-MALTHUSIAN MOVEMENT So before enlarging upon these recent develop- ments it seems desirable to say a few words about the organized Neo-Malthusian movement which has been carried on ever since the Knowlton, or Bradlaugh and Besant Trial, in 1876. This movement was not referred to before, as the book was merely intended to be an enquiry into the jus- tification or otherwise of family limitation. But it has now come into such prominence that its his- tory and scope should here be briefly outlined. Although the necessity for the restriction of births was appreciated by the greatest thinkers of antiquity, for example, Plato and Aristotle, who advocated limitation in a most drastic form, it was reserved for the Rev. T. R. Malthus in his famous Essay on the Principle of Population (1798) to establish it scientifically, and to inves- tigate the problem of overpopulation in various countries and civilizations. His conclusions were, briefly, that if mankind followed its natural im- pulse to marry at a reasonably early age and al- lowed children to come without any restraint, the births would be considerably in excess of the power to find means of support for them, and that, con- sequently, there would be great poverty and ex- cessive death-rates (as shown in Chapter IV). He therefore declared that the only way of pre- 150 The Small System venting an immense amount of poverty, disease, and early death, was by reducing the birth-rate, and he proposed that this should be effected by late marriage. The great thinkers who followed him,— James Mill, John Stuart Mill, the Owens, and others — were, however, keenly alive to the great social evils arising from late marriage, and they adopted the idea, already beginning to pre- vail in France after the Revolution, of early mar- riage combined with “ artificial ” restriction of births by contraceptive means. This was strongly upheld in his Elements of Social Science (1854) by the late Dr. George Drysdale, who interested Mr. Charles Bradlaugh and Mrs. Annie Besant in the question. Some information on these means had been given by Robert Dale Owen in the United States in his Moral Physiology (1831), in England by Francis Place in the Dia- bolical Handbill (about 1831), and again in the United States by Dr. Knowlton (Fruits of Philos- ophy, 1833). But these pamphlets were almost unknown until, in 1876, the trial of Mr. Brad- laugh and Mrs. Besant for republishing Dr. Knowlton’s pamphlet suddenly drew the attention of the whole civilized world to the question. Hundreds of thousands of the Knowlton pam- phlet, of the Elements of Social Science, and of Mrs. Besant’s Law of Population, were sold all over the world. The Malthusian League, the first society for popularizing the Malthusian doc- trine, was founded in London in 1877, with the Progress Since 1913 151 late Dr. C. R. Drysdale (brother of Dr. G. Drys- dale) as President, and with Mrs. Besant as its first Honorary Secretary. In 1878 it issued a monthly paper, The Malthusian, which has ap- peared uninterruptedly ever since. The English law has never declared contraceptives or their de- scription illegal, but it has rendered people liable to prosecution for indecency who publicly gave such information. On this account the Society felt itself unable to give instruction concerning preventive methods, though several of its mem- bers did so privately and at their own risk. In 1881 Dr. C. R. Drysdale was invited by Dr. S. van Houten, afterwards Minister of the Interior, and by other prominent Dutch citizens, to lecture at Amsterdam, and a Dutch Neo-Mal- thusian League was formed. The name Neo- Malthusian was proposed by Dr. van Houten to show (1) agreement with the Malthusian doctrine of overpopulation, (2) the new departure as re- gards the recommendation of early marriage and contraceptive methods, instead of late marriage as advocated by Malthus. This Society was soon able to commence issuing, with certain precau- tions, a carefully compiled leaflet describing the best known contraceptive methods and devices. In this practical work it was ably seconded by Dr. Aletta Jacobs, the first lady physician in Holland, who opened a clinic in Amsterdam for the gra- tuitous instruction of poor women. From that day to the present the Dutch League has made 152 The Small Family System steady and rapid progress, and now it has centers in all the large towns where either medical men or nurses trained by the League will give infor- mation. In addition it has sent out thousands of illustrated pamphlets describing in detail all the best preventive methods and devices as they be- came known. Holland is the only country where such knowledge has been disseminated freely on a large scale over a long period, and the results have been referred to in Chapter IV. It may be added here that figures have recently come to hand showing that Amsterdam and The Hague, the two chief centers of the League, have the low- est death-rate and infantile mortality in Europe, thus further exemplifying the value of the propa- ganda. Before long the movement began to spread to other countries — to Germany in 1889, France 1895, Austria 1901, Spain 1904, Belgium 1906, Sweden 1911, Italy 1913, United States 1913. The record of the United States in this ques- tion is of especial interest, as, on account of puri- tanical legislation, it has presented a unique ex- ample of intolerance. The Federal Law imposes a fine of $10,000 or two years’ imprisonment, or both, for the mailing of any practical information concerning preventives (which are coupled, as usual, with abortifacients), while most of the States have similar drastic laws against the giving of such information by word of mouth, even by a qualified physician. As a consequence, abortion Progress Since 1913 153 appears to be more rife in the United States than in any other civilized country. The modern campaign in favor of family limi- tation in the U. S. A. commenced with Moses Harman and his daughter, Lilian Harman, in Los Angeles, and although actual contraceptive direc- tions were not given, he was twice imprisoned. Dr. Elliot of Kansas has also been for many years in prison for having yielded to the entreaties of two women (police spies) who applied for advice. A strong champion of the right to control births by contraceptive methods then came into the field in the person of Dr. W. J. Robinson of New York, whose work has earned the admiration of all lovers of liberty and has brought large numbers of sympathizers into the movement, among them Dr. A. Jacobi, late President of the American Medical Association. In 1913 arose a fearless protagonist of birth-control, Mrs. Margaret Sanger, whose experience as a nurse and social worker had convinced her of the terrible need for this knowledge among the poor, and an ac- count of her remarkable action will be given later. With this brief survey of the earlier progress of the movement we may now turn to a consideration of recent events in the various countries. England.— In the early part of 1913 the Brit- ish Malthusian League, which had previously con- fined its activities to teaching the population doc- trine, to agitating for freedom in obtaining contraceptive knowledge, and to supporting those 154 The Small Family System who were prosecuted for giving it, decided that the time was ripe for the issue of a gratuitous practical leaflet in simple language that would help the very poorest people. This decision was taken in consequence of open-air meetings which the Society had been holding in the poorer dis- tricts of London, and at which a deep interest and a touching anxiety for practical help had been shown by the poor men and women who attended. In order, however, to repel the accusation of cor- rupting young people, and also to insist upon the personal and national justification of birth-control, the leaflet was only issued to those who signed a form declaring that they were over 21 years of age, that they were either married or about to be, and that they considered artificial family limitation justifiable on individual and national grounds. The issue of these leaflets was begun in Septem- ber, 1913, just before the opening of the National Birth Rate Commission. The formalities necessary to obtain these leaf- lets have naturally restricted their distribution. On the other hand, they have enabled certain con- clusions to be arrived at which an indiscriminate distribution would not have done. Firstly, they have confirmed the opinion long held by the advo- cates of birth-control, that even the poorest and most ignorant people — at any rate the women — would be most eager to limit their families. This is of great importance, as the only plausible argu- ment against family limitation was that it would Progress Since 1913 155 be adopted mainly by the educated and intelligent classes, leaving the race to be reproduced almost entirely from the ignorant, reckless and improvi- dent. After about eighteen months, an enquiry circulated to the earlier applicants for the leaflet elicited that all but a small percentage had found the information intelligible and practicable, and that they had succeeded in limiting their families by the means described. Secondly, signatures to the form were received from clergymen and doc- tors, none of whom offered adverse criticism, though this was specially asked for from them. Thirdly, the leaflet and the form were submitted by request to the National Birth Rate Commis- sion, and the absence of comment and of any ac- tion against the League at least shows that no ground of condemnation could be found. These facts in themselves indicate that the case against artificial family limitation has entirely collapsed, and that there is at least an influential minority of public men, doctors and clergymen, who are prepared to advocate or to permit it. In October, 1913, the National Birth Rate Commission commenced its sittings, and the pres- ent writer gave evidence at its first three meetings. The Report, which will be dealt with in the next chapter, appeared in June, 1916. In the meantime a valuable contribution to the question came from another source. We have already referred in Chapter II to the Memoran- dum of the Lambeth Conference of Bishops con- 156 The Small Family System demning contraceptives, abortifacients, and fam- ily limitation in general. Notwithstanding this strong pronouncement, no action seems to have been taken by any section of the Church to carry its recommendations into effect, till in the early part of 1914 some members of the clergy in Leicester perhaps considered that something ought to be done in this direction, and asked a well known medical man, Mr. C. J. Bond, F.R.C.S., to introduce at the Ruri-Decanal Con- ference at Leicester in June, 1914, a “ Discussion on the Memorandum Issued by the Bishops on the Misuse of Marriage.” The result must have been a considerable surprise to any who were hoping for support for an anti-birth-control cam- paign. Dr. Bond, although in strong sympathy with the religious attitude, showed that there was another side to the question, and his paper in ef- fect endorsed all the principal claims of Neo- Malthusians. The following extracts will serve to indicate his attitude: — “ We are confronted with this anomalous state of things: that the educated and the thrifty portion of civi- lized mankind is pursuing a line of conduct which the Church condemns; while the uneducated, the thriftless, and the feebler citizens are in this particular matter acting with the Church’s approval. This fact should, I think, lead us carefully to consider the position, which is not without serious difficulty, for there would seem to be no escape from the conclusion either that the more success- ful and the more prosperous section of civilized mankind is acting immorally, or that the judgment which the Progress Since 1913 157 Church has given on this particular matter is mis- taken. . . . “ Such is the fundamental position which the sex in- stinct occupies in human nature, and so great is the power that sex attraction exercises over human life, that to-day, in spite of religious influence, moral training, and the growth of knowledge of the laws of health and right living — in spite of such claims as the welfare of society and the lives and happiness of innocent women and chil- dren, mankind finds itself, even to-day, bound hand and foot by the thralls of an almost universal prostitution — a prostitution of the noblest human emotions to sensu- ality and greed. “ Bearing this in mind, and in view of the records of history and the more than doubtful effect on the life and morals of the time of ecclesiastical celibacy in the Middle Ages, how can we reasonably hope that total abstinence — with its difficulties and its dangers to mental stability and the happiness of married life — will ever be practiced on a large scale by married persons in work- ing class homes in which facilities do not exist for sexual privacy? “ In such homes under such conditions of compulsory cohabitation, attempts to entirely suppress the sexual in- stinct may be found to lead to worse results and to be more prejudicial to health and happiness than its re- strained and moderate exercise in association with such voluntary restrictions, as to conception, as may be found to be not injurious. At any rate any judgment passed on the morality of a certain line of conduct which does not take into consideration the different conditions which surround such conduct, and the difficulties which have to be faced is, I think, an unequal judgment. “ Seeing then that total abstinence must be regarded for many people in many homes as an unworkable solu- tion of the problem, seeing also that under present indus- 158 The Small Family System trial conditions, inadequate wages, bad housing, and many other faulty circumstances, some restriction of the number of children and a more equable distribution of births over the reproductive life of the mother are both imperative, if life in such homes is to be tolerable or desirable, what kind of advice ought we to give under the circumstances? “ The motive which prompts the act must be taken into serious consideration if we are to form a sound or fair or even a consistent judgment on the ethical problem before us. “ As I have already said — if the motive is a selfish motive; if reasonable facilities exist for the upbringing of children in health and decency; if the object is to escape the rightful responsibilities and the burdens which every normal citizen ought to bear; if the aim be the undue gratification of individual desire at the expense of the interests of the next generation — then in that case the practice of voluntary restriction must be unhesitatingly condemned. “ If, on the other hand, the motive is a worthy one; if, after the exercise of reasonable self-control, concep- tion is prevented with the real object of avoiding ill health and suffering by the wife, or by children for whose support and decent upbringing no adequate means exist; if, in short, the conduct is prompted by a legitimate de- sire, while fulfilling such duties as can be fulfilled, to avoid such responsibilities as, under the circumstances, are impossible of fulfillment, then I think the Church would do wisely to refrain from condemnation. “ The urgent necessity at the present time is to revise our ideals of civic and domestic duty. The real require- ment is to elevate and enlarge our conception of the nature and true purpose of the married life so that that conception may include the influence of marriage on the welfare of the next generation. Progress Since 1913 159 “ I would respectfully suggest that the Church should add the words: “ And in so far as human responsibility extends—healthy”—before the word children in the passage in the Prayer Book which sets forth the reasons for which the state of matrimony was ordained. . . . “ Among the many disharmonies that advancing civi- lization has introduced between social man and his pres- ent day environment, one of the most serious and im- portant is that disharmony which arises from the fact that the capacity for reproduction and the emotions and in- stincts which are associated with the productive life arise and become fully developed in the individual at a much earlier period than the proper opportunity for their legiti- mate exercise under modern social conditions. The ten- dency under the pressure of economic necessity has con- stantly been, during recent years, to delay the age of marriage as the artificial standard of life fixed by tra- dition and fashion continues to rise. . . . “ Now one of the most hopeful methods of dealing with the terrible problem of prostitution, with its appalling accompaniment of venereal disease, is to bring about earlier marriage, and the only way to bring about earlier marriage is to make earlier marriage possible for self- respecting working people, and to make the married life more attractive to them. “ The freeing of early marriage from the weight of care and anxiety which a family out of all proportion to the means for its support entails, would assuredly help not only to promote earlier marriage but also to diminish prostitution with its terrible evils.” France.— Despite all the efforts of the repopu- lateurs, of the Ligue pour les Nombreuses Fam- ilies, and of the Commission sur la Depopulation, the birth-rate of France has continued to decline. When it fell to 20 per thousand, about ten years 160 The Small Family System ago, a great outcry arose that the era of real de- population was at hand, that the death-rate would cease to fall or would even commence to rise, and that France would have “ more coffins than cradles.” But when the figures for the whole decade 1901 to 1910 were collected, they revealed that the surplus of births over deaths was actually twice as great as in the preceding decade — the death-rate having fallen more than the birth-rate. This clearly shows that France is still some dis- tance from the actual depopulation level and that the birth-rate can yet decline another few units before the population will even become stationary. An interesting and significant commentary upon the attitude of the influential classes in France is given by the following quotation which we have translated from a Swiss author, Mr. H. Gachte, in his book, Ende der Armut: — “ In France a national committee has been formed which has as its object an agitation for the increase of the population. Upon this committee these sit, besides President Poincare, who, although married, has no chil- dren, twenty-four senators and litterateurs. These twenty-five persons, who preach to their fellow citizens by word and pen, have between them nineteen children, or not one child on the average per married couple. Sim- ilarly a Paris journal (Intransigeant, August and Septem- ber, 1908) had the good idea of publishing four hundred and forty-five names of the chief Parisian personalities who are never tired of lending their names in support of opposition to the artificial restriction of families. I give these figures briefly without the names, which have Progress Since 1913 161 no special interest for us. Any one interested in the names can consult the paper well known in upper circles. Among them: 176 married couples had o children = o children 106 “ “ 1 child = 106 “ 88 “ “ 2 children = 176 “ 40 “ “ 3 “ = 120 “ 19 “ “ 4 “ — 76 7 “ 5 “ = 35 4 “ 6 “ =: 24 3 “ “ 7 “ = 21 “ 1 “ “ 9 “ — 9 “ i “ “ 11 “ = 11 “ Total..445 “ “ with 578 “ “ That is an average one and a third children per couple, while each single one of these families could much more easily have supported twenty children than a work- ing class family a single child.” Comment on the above is superfluous. From the same book we find, on the authority of statis- tics given by Dr. Bertillon, that 866 children out of a thousand born from the richer classes reach their twenty-first year, and only 486 among the poor. As the birth-rate among the rich is just about half that of the poor, the contribution of the rich to the surviving adult population is pro- portionately just as large as that of the poor with their high birth-rate. Since the percentage of un- fitness among the latter is certainly great, it ap- pears that the small families of the richer classes have the advantage in every way — even from the military point of view. Germany.— To those who appreciate the sig- 162 The Small Family System nificance of the birth-rate question the recent rec- ord of Germany is of the most vital moment. The general course of the birth and death rates was shown in Figure 2 and demonstrates that the fall of the birth-rate which began in 1876 has lately been strikingly accelerated. But the best indication of the trend of modern Germany is given by her great towns, such as Berlin, Ham- burg, Cologne, Frankfort, Munich, Leipzig and Dresden, whose records are astonishing. Figure 7 shows the course of the birth and death rates and infantile mortality in Berlin from 1841, and indicates not only how the general and infantile death-rates rose with a rise of the birth-rate be- fore 1876, but how eager the people were to seize upon the lesson of the Knowlton Trial of 1876. The decline of the birth-rate of Berlin, and of the other large towns, has been the most remarkable in history. At the rate prevailing just before the war their birth-rates would have fallen in a few years below that of Paris. Although the German Government with its militarist associations was, of course, extremely hostile to birth-control, strong utterances in its favor came from medical men and others. In 1911, the directors of the great Hygiene Exhibi- tion at Dresden actually issued an official invita- tion to the International Neo-Malthusian Feder- ation to hold a Congress at the Exhibition. This Congress was well attended and its proceedings were reported in the press and caused wide-spread Progress Since 1913 163 interest. From the medical standpoint, the cause of birth-control was championed by Drs. Rohleder, Goldstein, Marcuse, and Bornstein, and by repre- sentatives from other countries. The economic and national necessity for it was upheld by Herr Hausmeister, a Stuttgart banker and founder of the German Neo-Malthusian movement, who showed how seriously the physique of the con- scripts of the German army was deteriorating by reason of the underfeeding and overcrowding caused by large families. A very interesting fea- ture of the Congress was the adhesion of the pro- gressive women. Frau Marie Stritt, now Presi- dent of the German Women’s Suffrage Move- ment, presided over the Congress and gave an address in favor of woman’s freedom of control over motherhood in the interests of herself, her children, and the race. Dr. Helene Stocker and Frau Adele Schreiber, the leaders of the two great Mutterschutz Associations (Societies for the Pro- tection of Mothers and Children), gave equally strong testimony. Among the masses of the people also, a deep feeling has been growing up as to the necessity for birth-control, despite the fact that the German Socialist leaders, like those of most other coun- tries, have set themselves against it. Dr. W. J. Robinson has given us a graphic account of a meeting “ gegen den Geburtstreik ” (against the birth strike) which was convened by the Socialist leaders in Berlin on August 29th, 1913, and in 164 The Small Family System which Rosa Luxemburg and Clara Zetkin in- veighed against family limitation. The meeting aroused intense interest, 5000 persons being pres- ent and many more being unable to find admit- tance. The result, however, was a complete sur- prise. The audience howled down the opponents of birth-control, and then speaker after speaker arose and championed family limitation as a means by which the masses could escape the worst of their evils as regards poverty, underfeeding and overcrowding — and the consequences of these, promiscuous living and prostitution. That the German people have fully determined in favor of birth-control may be judged by the significant though scanty details which have leaked out since the commencement of the war. Cer- tainly the very low birth-rates are to some extent due to the absence of the men at the front; but that artificial prevention is the chief cause is openly recognized by the German press. Legislative proposals are on foot for encouraging larger fam- ilies, but they are hardly tempting enough to in- duce married couples who have once tasted the advantages of family limitation to revert to the old regime. It may confidently be predicted that Germany will soon be a country of very low birth- rate, and that her militarist attitude will conse- quently wane. Belgium.— Two birth-control leagues, a French and a Flemish one, have existed in Bel- gium. Although strongly combated by the Ro- Progress Since 1913 165 man Catholic Church, which is powerful in Bel- gium, the determination of the people to limit their families in spite of all sacerdotal warnings has been such that the birth-rate has fallen nearly as low as that of France, while in 1913 that of Brussels had actually fallen to 16.2, or decidedly below that of Paris. This is of considerable in- terest, as it shows that even the Roman Catholic Church is powerless to check the progress of birth- control, as is also seen in Spain, Portugal and Italy. Spain.— In 1904 a Spanish League was started by Sehor Luis Bulffi of Barcelona, who, besides publishing a monthly paper, Salud y Fuerza, openly discussing the population and sex ques- tions, issued several illustrated booklets describ- ing contraceptive devices. Although prosecutions were instituted they finally collapsed, and the pam- phlets have lately appeared bearing a notice that they have been pronounced lawful by judgment of the courts. Italy.— Although several writers, like Prof. Mantegazza, had advocated birth-control for many years, and although the birth-rate had been falling fairly rapidly from 1887, it was not till 1913 that an organized movement was started by Dr. Luigi Berta (now fallen in the war) and two associates from Turin who took the bold step of issuing an illustrated descriptive pamphlet. This led to their prosecution, but a number of power- ful friends rallied to their side and they were ac- 166 The Small Family System quitted. Since then the giving of contraceptive information has proceeded freely, and the subject has been very fully discussed in the monthly peri- odical, L’Educazione Sessuale. Formerly the birth-rate averaged about 38 per thousand and the death-rate about 29, giving a natural increase of population of only 9 per thousand per annum. In 1914 the birth-rate-had fallen to 31.3, and the death-rate to 18, so that the rate of natural in- crease had become 13.3 — 50 per cent, greater than with the higher birth-rate. The infantile mortality has also fallen very rapidly. Holland.— The Dutch Neo-Malthusian League has continued to prosper during the war, and its membership now numbers over 6000 in a popu- lation of only five millions. The attitude of women to the question of birth-control is shown by the fact that Dr. Aletta Jacobs has been elected President of the Dutch Women’s Suffrage organ- ization. It may be mentioned also that in 1910 an International Neo-Malthusian Bureau of Cor- respondence and Defense was formed at The Hague with Dr. J. Rutgers (Secretary of the Dutch Neo-Malthusian League) as Secretary, and that it has given financial and propagandist sup- port to birth-control workers who have been pros- ecuted in various countries. The headquarters of the Bureau are at 9 Verhulststraat, The Hague. Hungary.— Although the above are the chief countries of organized Neo-Malthusian propa- ganda, there are also others where leagues or Progress Since 1913 167 groups have existed and in which effective work has been done. Hungary is almost unique as a country in which the authorities have shown some appreciation of the population question, as is seen by the Report of the Hungarian Medical Senate, a translation of which forms Chapter IX; also by an agitation which arose a few years ago among the teachers for increase of pay owing to the ris- ing cost of living, when the Government granted a new scale based on a certain amount for the man and wife and for each child up to a maximum of three, beyond which no grant was made. The right of women to control the number of their children was also warmly taken up by the Hun- garian Feminists under Mme. Rosika Schwimmer. As this was, as usual, opposed by the Bishops, the Feminist Union took the delightfully logical step of sending them, with letters of recommendation, all mothers of large families seeking help or em- ployment, pointing out how well they had followed the increase and multiply mandate. Switzerland.— A movement founded by M. V. Grandjean has been centered in Geneva for many years and has received medical and general sup- port. In the German cantons, however, the Ro- man Catholics have succeeded in putting restric- tions upon it. Nevertheless the Swiss birth-rate continues to fall fairly rapidly. Sweden.— The organized movement has only been in existence a few years, but the population question has been kept well to the fore by the 168 The Small Family System economic writings of Prof. Knut Wicksell, of Lund, and by the medical activities of Dr. Anton Nystrom of Stockholm. Denmark.— There is no organized movement here, but a considerable amount of quiet propa- ganda has been going on in feminist and even in clerical circles. All the Scandinavian countries have low birth- rates and very low general and infantile mortality rates. The only European countries which until a few years ago showed no signs of adopting family limitation were Russia and the Balkan States. Apparently any attempt at propaganda in Russia was ruthlessly suppressed by the authorities, al- though a few strong attempts were made by those who realized the terrible evils arising from its high birth-rate. From 1801 to 1896 the Russian birth-rate remained almost stationary at nearly 50 per thousand, while its death-rate was about 34 per thousand — which on a population of over 100 millions meant between two and one-half and three millions of unnecessary deaths each year. Its infantile mortality averaged 270 per thou- sand, so that of the five or six million children born annually about one and one-half millions per- ished before attaining their first birthday. The latest figures, however, seem to show that birth- control is at last penetrating into Russia, its birth- rate having fallen to about 44 in 1909, and the death-rate to 29. This is most encouraging for Progress Since 1913 169 European peace in the future. If all goes well with the Russian Revolution, which has just taken place as we revise these pages, we may be sure that birth-control will soon spread apace there as it has done in all democratic countries. Extent and Effect of Birth-Control in Eu- rope.— The birth-rate of Europe has fallen from about 39.5 in 1876 to about 34.5. On the pres- ent population of approximately 470 millions, this means that about two and one-half million fewer births now take place annually than would have occurred had the higher birth-rate been main- tained; while over the 40 years of the decline from 1876, fifty to sixty million fewer children have been born. This may be estimated as the result of the adoption of family limitation by fully thirty million married couples. Since this limitation has mostly taken place among the educated and re- sponsible sections of the population, it is clear that birth-control has become an enormous force which cannot be combatted by any precepts or protests, religious or moral, unless they can be supported by real evidence of evils resulting from the practice. The United States of America.— Following the splendid propaganda work so long and per- sistently carried on by Dr. W. J. Robinson, the American Society of Medical Sociology became affiliated in 1913 to the International Federation of Neo-Malthusian Leagues. Now public atten- tion has been aroused by the Sanger Trial to a 170 The Small Family System greater extent than by anything since the Brad- laugh and Besant Trial of forty years ago. After sending out 100,000 copies of her practical pam- phlet, “ Family Limitation,” Mrs. Margaret Sanger came to Europe in October, 1914, to ob- tain time and material for the preparation of her defense. She visited England, France, Spain, and Holland, and underwent the course of train- ing given by Dr. J. Rutgers, Secretary of the Dutch Neo-Malthusian League, to nurses who wish to be able to instruct poor women in pre- ventive methods. Thereupon she wrote further pamphlets describing the methods of birth-control in favor in different countries and sent them to the U. S. A., where they were distributed and re- printed in great numbers. Meanwhile, Anthony Comstock, Secretary of the New York Society for the Suppression of Vice and Post Office Censor, the originator of the dras- tic Post Office Federal Law of 1909, balked of securing Mrs. Sanger, bethought himself of aim- ing a blow at her through her husband, William Sanger, an artist in New York, who, although a sympathizer, had taken no part in his wife’s cam- paign. He engaged a police spy who called upon Mr. Sanger and represented himself as a friend of the movement, and induced him to search for and give him one of Mrs. Sanger’s original pam- phlets on family limitation. A few weeks later Comstock in person arrested Mr. Sanger and at- tempted to get him to betray his wife’s where- Progress Since 1913 171 abouts by promise of a suspended sentence. Mr. Sanger indignantly refused the bribe, and in the trial which followed made an impassioned address to the court bravely expressing his full sympathy with his wife’s action and his conviction that birth- control was an inalienable right of women. He was condemned to a fine of $150 or thirty days’ imprisonment, but he refused to pay the fine and underwent his sentence. Immediately after the trial, Comstock, who had been taken aback by the great public sympathy shown to Mr. Sanger, and by the obviously hostile feeling to his own action, fell ill and died. The prosecution of Mr. Sanger aroused intense interest and sympathy all over the States, and large numbers of prominent men and women joined the birth-control movement. So in No- vember, 1915, Mrs. Sanger returned to face her trial, but found the authorities by no means in haste to repeat the experience they had had with Mr. Sanger. At length, however, she was ar- raigned merely on the old charges arising out of her paper, The Woman Rebel. She then went on a lecture tour through the country and was almost everywhere enthusiastically received, in some places being asked to speak under the auspices of religious organizations. Mrs. Sanger’s latest achievement has been, in conjunction with her sister, Nurse Byrne, and Miss Fania Mindell, to open a clinic in New York for the instruction of poor women in preventive 172 The Small Family System methods, and this has led to the arrest of all three. The legal proceedings are probably the most in- teresting that have ever been brought before a court. Mr. J. J. Goldstein, who conducted the defense, not only brought forward the legal points and precedents in favor of his case, but boldly im- pugned the validity of the law itself as being un- constitutional and in flagrant violation of the lib- erty of the subject. He also collected a mass of authoritative opinion, medical and sociological, in favor of birth-control, and altogether his brief forms a very valuable contribution to the subject. During the case Mrs. Sanger was released on bail, and took immediate advantage of her freedom to reopen the clinic. She also started, in association with Dr. Frederick A. Blossom, formerly Director of Charities of Ohio, and Mrs. Elizabeth Stuy- vesant, a promising periodical, The Birth Control Review. Great interest has also been aroused by the propaganda and prosecution of Miss Emma Gold- man, who had advocated birth-control for many years in her paper, Mother Earth, and had lately held large meetings in which she gave birth-con- trol information in defiance of the law. It may also be recorded that Mr. V. K. Allison, a young social worker, was tried and sentenced to a month’s imprisonment for giving out birth-control pam- phlets in Boston. As a result of all these activities and persecu- tions, the birth-control movement in America has Progress Since 1913 173 already reached large dimensions. There are now Birth Control Leagues in Boston, Cleveland, New York, Pittsburgh, Portland, St. Paul, Seat- tle and Washington, as well as centers in Ann Arbor, Denver, Detroit, Indianapolis, Los An- geles, Minneapolis, Painesville, O., Paterson, N. J., Rochester, and Spokane, besides various sub-organizations in New York and Brooklyn. The situation in the United States is of excep- tional interest as this is the only democratic coun- try in which a law exists heavily penalizing the giving of contraceptive information. That indi- vidual persons may have differences of opinion as to the advisability of adopting birth-control for themselves is understandable; but that they should impose their views on the remainder of the com- munity by a vindictive and abominable law, such as the Federal Post Office Law, or Section 1142 of the New York Penal Code, is an outrage which no country worthy of inclusion in the ranks of modern civilized countries can tolerate for long. Until the United States expunges these laws from its statute books it must stand, not as the land of freedom, but as a land which has permitted itself to be dominated by a puritanical and pru- rient oligarchy, which, in view of the knowledge of the day, is more inhuman than the Spanish Inquisition. In the histories of the future An- thony Comstock will figure with Torquemada as an example of fanaticism and callous disregard of human suffering. CHAPTER XI THE WAR AND THE BIRTH RATE COMMISSION TWO great events remain to be dealt with — the National Birth Rate Commission insti- tuted by the National Council of Public Morals in 1913, and the great world war, which, as many have recognized, is closely related to the birth- control question. A few words, therefore, may first be devoted to the military aspect of the question, as it was not dealt with in the first edition. Napoleon, when asked whom he considered to be the greatest woman, replied: “She who has produced the greatest amount of food for powder (chair a canon)” and similarly other militarists have usually called for high birth-rates regardless of humanitarian considerations. The militarist and popular view of the subject has always been that as large numbers of men were needed for war, the highest possible birth-rate was desirable for national safety. But considerable doubt can be thrown upon the soundness of this view. In the first place, history shows that battles have not gen- erally been won by large numbers, but by smaller armies of more intelligent, better trained and bet- ter equipped troops. Secondly, the reins of em- War and Birth Rate Commission 175 pire have rarely been in the hands of large popu- lous nations; we do not find populous high birth- rate countries like China and India in the front rank, nor is the Russian Empire a conspicuous example of military power. Thirdly, the evi- dence of the close relation of death-rates to birth- rates immediately contradicts the airy assumption that high birth-rates mean a high rate of survival; and when to the loss by child mortality we add the terrible amount of unfitness produced by under- feeding, overcrowding and over-competition, and by the diseases intensified through economic in- ability to marry early, it is more than questionable whether a high birth-rate is not completely nulli- fied, and if the country is not actually weakened seriously thereby, even from a military standpoint. Lastly, we have the example of Holland, where the recruiting efficiency and numbers have risen enormously as birth-control has been taught, and where the number of fit recruits in proportion to the population is probably the highest in Europe. All these things have made many people, and even some militarists, very doubtful as to the ad- visability of advocating large families; and both in England and Holland, military and naval offi- cers are among the members of the Malthusian Leagues. On the Other hand, there is the extremely im- portant consideration that while high birth-rates may not be a source of military power they are certainly a serious factor in bringing about war 176 The Small Family System and in neutralizing all the efforts of those who are working for international amity and perpetual peace. Darwin has shown beyond the possibility of dispute that over-reproduction leads to a con- stant struggle for existence. Animal life is one perpetual conflict, and man too has been in a con- stant state of war — the impelling force being really, although not always ostensibly, the need for food. Modern civilization has been working towards the elimination of war, although, paradoxically, the wars which have taken place in recent times have surpassed all previous ones in extent and in the amount of suffering entailed. This, however, is perfectly intelligible to Malthusians. The evil effects of strife are so evident that human insti- tutions have been devised to prevent it — by laws which restrain the individual from violence and murder, by associations for mutual protection, by diplomacy in international relations, by the for- mation of alliances and ententes, by international law, and by propositions for international arbi- tration and federation. International trade and science have also done much to promote mutual understanding and to produce a bond of self-inter- est between countries. All these may be called the centripetal or fusing forces, and they have suc- ceeded in securing us considerable intervals be- tween wars, as compared with the eternal warfare of early times. But against this there is one constant and in- War and Birth Rate Commission 177 superable centrifugal or destructive force — the pressure of population. We have seen that high birth-rates mean high death-rates, the latter being evidence of poverty and underfeeding. If the people are resigned to misery, as in the case of some of the peoples of India and China, they may submit tamely; but in any high-spirited progressive community, efforts are made by the poor them- selves, and by others for them, to surmount the evils from which they suffer. Thus we have the claims for higher wages, reenforced by trade union agitation and government action, we have char- itable organizations and hospitals, which aim at preserving life, but which must be supported by the work of others, and so forth. All these things intensify competition. The manufacturer finds the cost of production increased and has to seek additional markets, and a ruthless trade compe- tition grows up between the manufacturing na- tions, which constantly leads to trouble and to straining of diplomatic relations. The condition in peace may be likened to that of a sealed boiler in which the steam pressure is continually increas- ing by the uncontrolled heat of the furnace (the rising pressure of increasing numbers). If no care be taken to avoid leakage, the pressure need not rise to a dangerous extent; but if the leaks are stopped up as they occur, nothing will avert an ultimate terrible explosion. Social legislation in late years has aimed-at closing the leakage of pop- ulation through hunger and disease, and although 178 The Small Family System the pressure has been considerably relieved by the falling birth-rate, it had not been sufficiently re- duced to prevent the present war. The pressure of population may possibly be sufficiently relieved in a few decades to avoid any further European cataclysms. This view of the cause of war has been recognized by most of the great authorities on the subject, including Napoleon, General Brial- mont (the famous master of fortifications), and by the German war lords — the Kaiser, von Buelow, and von Bernhardi. Had the German birth-rate after the Franco-German war taken the same course as the French birth-rate it may fairly be claimed that the present war would never have occurred. Again, no unbiased person will deny that the tendency towards pacificism has been strongest in the low birth-rate countries (e. g. Belgium, France, Holland, Scandinavia, United Kingdom, etc.), and weakest in the high birth-rate ones (Austria, Balkan States, Germany, Russia, and probably also Turkey). Even if it be contended that France has lost by her lower birth-rate (but see Chapter IV), it must be remembered that the re- sultant decline of expansionist tendencies has re- moved the rivalry which used to exist between her and Great Britain. The low birth-rates in these two countries have permitted the entente which has enabled them to fight side by side. The case for birth-control from the military standpoint may be summarized as follows: — War and Birth R.ate Commission 179 (a) It enables couples to have only the chil- dren whom they can bring up to be useful and fit for the protection of their country. In this way a greater number of efficient fighting men would result, as in Holland. (b) It largely does away with the expenditure of capital and energy upon fighting poverty and disease, and gives greater opportunity for pro- viding adequate and efficient defensive armaments. (c) It makes for a prosperous and contented population, giving people something worth fight- ing for if they should be attacked. When there is much destitution and discontent in a country, the national spirit tends to be poor. , (d) It removes the need for territorial ag- grandizement or very rapid commercial expan- sion, and leads to the promotion of harmony be- tween the nations of low birth-rates and to the formation of alliances and ententes, which not only strengthen the nations concerned, but are the first and indispensable step towards the interna- tional federation that alone can prevent future war. Any proposition for international leagues or federations which does not put in the forefront of its program the principle that each nation should proportion its birth-rate to its resources (i. e., to the point of reducing its death-rate to a minimum) is philosophically unsound and will be futile. (e) In short, birth-control makes a nation strong for defense, while removing the impulse 180 The Small Family System for offense — the two greatest factors for pre- serving peace. That this argument has considerable force may be gauged by the increased popularity of the Mal- thusian movement since the outbreak of the war. It forms practically the only hope of mankind, for the old reliance on treaties and international law has received a death-blow in this war. Mr. Norman Angell has shown that war benefits no one. But the pressure of population forces na- tions into positions where they must fight even if it ruin them, and the arguments of the “ Great Illusion ” will never surmount the great fact of the struggle for existence if the birth-rate of the world and of most nations continues above 20 per thousand. The Birth Rate Commission Report.— This is certainly the most authoritative pronouncement that has yet appeared in any country. The Com- mission included leading physicians, statisticians, economists and eugenists, and distinguished rep- resentatives of the Established, Roman Catholic, and Nonconformist Churches, and of the Salva- tion Army, and its personnel should be recorded here: — The Rt. Rev. Bishop Boyd Carpenter, K.C.V.O. (Chairman) ; The Very Rev. W. R. Inge, D.D. (Chairman) ; Rt. Hon. Sir J. Gorst, LL.D.; Dr. A. Newsholme, C.B. (Local Govt. Board) ; Dr. T. H. C. Stevenson (Superintendent of Statistics for the Registrar-General) ; The Duchess of Marlborough; The Lord Bishop of War and Birth Rate Commission 181 Birmingham; Lord and Lady Willoughby de Broke; Lady Aberconway; The Rt. Rev. the Bishop of Barking; The Rt. Rev. Monsignor Canon W. F. Brown; Prof. Sir J. Macdonnell, C. LL.D.; Rt. Hon. Sir T. P. Whittaker, M.P.; Sir J. Creighton-Browne, LL.D., D.Sc., F. ; Sir Malcolm Morris, K.C.V.O.; Sir H. B. Donkin, M.D.; Rev. Principal A. E. Garvie, M.A., D.D.; Rabbi Prof. H. Gollancz, M.A., D. ; Rev. J. M. Gibson, M.A., D.D.; Rev. R. F. Horton, M.A., D.D.; Rev. F. B. Meyer, B.A., D.D.; Rev. Thomas Phillips, B.A.; Prof. G. S. Woodhead, M.A., LL.D.; Prof. L. T. Hobhouse; Dr. Major Greenwood (Statistician to the Lister Institute) ; Dr. T. B. Hislop; Dr. J. W. Ballantyne; Dr. F. Fremantle; Dr. A. T. Schofield; Dr. C. W. Saleeby; Dr. Mary Schar- lieb; Dr. Florence Willey; Dr. Agnes Savill; Dr. Ettie Sayer; Mrs. “General” Booth; Mrs. George Morgan; J. A. Hobson, Esq., M.A.; A. G. Gardiner, Esq. (Editor of the Daily News) ; Walter Heappe, Esq., M.A., F.R.S.; H. B. Grylls, Esq.; The Rev. James Marchant, F.R.S., Edin. (Secretary). The Medical Evidence.— We here find that few scientific authorities feel able to speak on the subject with any degree of certainty, as we found in the earlier part of the book. But Sir Francis Champneys, M.D., Chairman of the Central Mid- wives Board, stated that there was an increasing fashion among medical practitioners to recom- 182 The Small Family System mend contraceptives. He thought the adoption of these was mainly due to economic consider- ations and to a desire of parents to do well by their children, and not to any extent to fear and distaste of maternity on the part of women. Al- though he considered voluntary sterility as a rule deleterious, he did not think certain contraceptives harmful, and had only seen a few cases of injury resulting from any preventive device. Dr. David Starr Jordan, of Leland Stanford University, was certain that the decline of the birth-rate was due to prevention and not to any loss of natural fer- tility, and he pointed out how much greater were the demands on educated men and women to-day than formerly. On the other hand, Dr. Brown- lee, Statistician to the Medical Research Commit- tee, believed that the fall of the birth-rate was to a considerable extent due to a periodic change in the fertility of the people comparable to the fluc- tuation in the extent and severity of certain infec- tious diseases. This view was strongly contro- verted by the remaining witnesses and was not taken seriously by the Commission. It is difficult to see how it could be taken seriously if diagrams for various countries like those in Chapter IV were examined. Prof. J. W. Ballantyne, whom we have already quoted as a temperate critic of family limitation, appears to have modified his views to the extent of seeing some justification for it. He says: — “ Even if the birth-rate fall another 5 per thou- War and Birth Rate Commission 183 sand or so, there are lives enough to be saved immediately after birth as well as before it, to make up the loss.” This remark is not quite con- sistent but it is of great interest. For when Dr. Ballantyne gave his evidence the birth-rate was about 24 per thousand; so the reduction of 5 per thousand, which he considers could be spared with- out loss, would reduce the birth-rate to 19 per thousand — practically the same figure we have already suggested as desirable for Great Britain. Dr. Ballantyne was not prepared to say that pre- ventive methods were in any way liable to cause sterility, and he also agreed to the suggestion that doctors were now very frequently advising that children should not be born oftener than once in two or three years. He also read the following letter he had received: — “ I read your address, and felt surprised that men are still to be found who want the world to be cursed with large families. I labored hard in the mission field for thirteen years thinking Jesus would save and that Drink was man’s curse, but I am convinced that the curse of man is large families. Could I begin life again with my present knowledge, I would never rest until a law was passed making it a crime for any man to have more than one child unless he could make proper provision for them, whether both girls or both boys. Neither God nor the nation makes any provision for a man with a large family. Hence it is a crime to bring it into the world. “ I knew a good man, the best I ever knew; at forty- two he was the father of eleven. In deep poverty, he cried to God for help for his wife and children. God 184 The Small Family System laughed at him, and said (by his inaction), “Fool; you should not have brought children into the world.” He died, starved to death; left eleven children. That is thirty-four years ago. His children said, “ We will never be such a fool as father was to have a lot of children.” Result, nearly all in business and doing well. The ten men and women have ten children amongst them.” Of course there is nothing very remarkable about this letter to those who have carried on birth-control propaganda among the poor, but it is remarkable that it should have been brought forward by a medical man to a Commission sit- ting in the Cloisters of Westminster Abbey, and that it should have been published in the Report. Dr. J. C. Dunlop, Superintendent of Scottish Statistics, gave evidence as to the decline of the birth-rate of Scotland, and pointed out that while the legitimate birth-rate had fallen 25 per cent., the illegitimate birth-rate had diminished by no less than 46 per cent. The fertility of marriages in different occupations was — physicians, an aver- age family of 3.91; lawyers, 3.92; schoolmasters, 4.25; and clergymen, 4.3; while the average for all Scotland was 4.82. He also considered that of the whole fall of 27 per cent, in the birth-rate, 20 per cent, is the amount due to “ causes that we do not talk about,” i. e., contraception, and 3 per cent, to the fall in the illegitimate birth-rate, leav- ing very little for other possible causes. This is in accord with the conclusions that we have al- ready given in this book. When cross-examined War and Birth Rate Commission 185 as to whether the decline of the illegitimate birth- rate might not be largely caused by the adoption of preventive methods by the unmarried, Dr. J. C. Dunlop gave it as his decided opinion that it was due to a real reduction of irregular intercourse. This was the only definite statement given before the Commission as to the moral results of the spread of preventive knowledge, and it supports the view we have tentatively expressed in a pre- vious chapter. Dr. Amand Routh, M.D., Consulting Obstetric Physician to Charing Cross Hospital, has long been known as a strong opponent of preventive methods, and he expressed the only definite medi- cal opinion against them: “ I have no doubt that prevention of maternity by artificial methods in- variably produces physical, mental, and, I think, moral harm to those who resort to it — to one, or probably to both.” When closely questioned on this point he adhered to his opinion, but ad- mitted that there were many cases where excessive childbearing was injurious, and some in which abstinence was harmful. In such cases he would permit certain preventives. Dr. Mary Scharlieb, the only lady doctor who gave evidence before the Commission, was of opinion that the bulk of the fall of the birth-rate was voluntary, although she thought there was some indication of decreased fertility. She also considered that the avoidance of having children in the early years of marriage led in some cases 186 The Small Family System to sterility, but she did not attribute the sterility to the use of preventives, which she thought pro- duced no physical injury. While believing that abstinence before marriage was proper and harm- less, she thought it was definitely deleterious after marriage. She appeared to hold that “ if every- thing is perfectly normal, the intervals between births go on increasing ” from two years to three or four years. This is an astonishing statement in view of the usual experience among the poor. Dr. Scharlieb, like Dr. Routh, evinced a strong objection to a falling birth-rate apart from purely medical considerations. Dr. George Reid and Sir Thomas Oliver gave evidence principally upon the extent to which lead was used as an abortifacient, and revealed the anxiety which women often show to avoid having more children, whatever suffering it might cost them. Practically all the medical witnesses admitted that they had very little scientific evidence as to the harmfulness or otherwise of preventive meth- ods, and their opinions were mainly general im- pressions derived from their patients. That death-rates have always fallen whenever birth-rates have steadily fallen would seem to indicate that there can be nothing injurious in birth-control. This important point was only brought up by the present writer, who also sug- gested when interrogated as to possible mental disturbances produced by contraception, that it War and Birth Rate Commission 187 would not be surprising if mental disturbances had resulted in view of all the medical, religious and patriotic warnings which had been directed against family limitation. He submitted that if a man were on a perfect diet, but were told by physicians that it was poisonous, by clergymen that it was against the Divine Command, and by statesmen that it was unpatriotic, it would hardly be surpris- ing if his physical and mental health began to suffer seriously. The Moral and Religious Evidence.— The in- terest here centers round the statements of four witnesses of different denominations. The Lord Bishop of Southwark appreciated the need of family limitation on economic and hygienic grounds, but was in agreement with the view of Bishops in general that preventive methods are wholly objectionable. He said that among the very poor such methods were little known, and that there was very frequent resort to abortion. He considered that marital relations should only be entered into with the express intention of hav- ing children, and that otherwise there should be abstention. When he was cross-examined on this attitude — notably by Mrs. Bramwell Booth, of the Salvation Army, who considered that it had no scriptural warrant — he admitted that he could not give Biblical authority for his opinion. The Rev. W. F. Lofthouse, Secretary of the Wesleyan Methodist Union for Social Service, gave a carefully considered statement. In his 188 The Small Family System opinion Christian and Pauline teaching recognized that marriage with its intimate relationships was the normal state for men and women, and that celibacy or continence was not possible for all. “ It may here be noted that the Church has, for the most part, in her official theology missed the New Testament standpoint through a mistaken asceticism, regarding the sexual act as itself more or less harmful. . . . “ For Religion the first question is, therefore, is the sexual act end or only means? In answer, pleasure is never in the New Testament regarded as an end of itself. The one end for the Chris- tian is the glory of God. But in so far as pleasure benefits him who enjoys it, and inspires his grati- tude to its source, it is hallowed. This surely may be said to hold good of sexual pleasure. The New Testament does not speak as if the end of marriage were simply the production of children.” Mr. Lofthouse thought that a true Christian will not approve of preventive checks even if cer- tain and harmless. But those who are chiefly in- fluenced by earthly considerations will naturally resort to preventive checks, and need not be con- demned. “ Unless continence can be attained, it must be remembered that the alternative of ‘ fornication and uncleanness ’— which is wider than profes- sional prostitution — is the subject of the most explicit condemnation in the New Testament.” The whole evidence of Mr. Lofthouse ex- War and Birth Rate Commission 189 presses, on Biblical grounds, the very contention of Neo-Malthusians, who claim that continence, whether desirable or not, will not be followed by the majority of adult people, and that unless pre- ventive checks are permitted there is only the choice between early marriage (with the terrible evils of unlimited families) and the continuance of prostitution. On being asked, “ Would you say that in all circumstances the use of mechanical or artificial means is immoral?” he replied, “I do not say that. It seems to me very difficult to assert it is immoral. I do not know on what grounds you can say that it is definitely immoral.” The evidence given by Monsignor W. F. Brown on the Roman Catholic attitude is extremely im- portant. Marriage is recognized as having three ends: (a) The procreation and bringing up of children, (b) mutual assistance in life, and (c) “ restraint of concupiscence.” Although the first is regarded as the primary end of marriage, he recognized that in some cases — either on account of the health of the mother or of the future child — it may be lawful for married people to avoid having more children, either by complete absti- nence or by restricting intercourse to times in which results are less liable to follow. The great power of the sex impulse being recognized, how- ever, the Catholic Church takes the attitude that no restraint should be put upon marriage even in the case of the hereditarily defective, and that couples who suffer from hereditary defects are jus- 190 The Small Family System tified, if they cannot abstain, in bringing diseased children into the world. Artificial preventive methods must not be employed; rather must chil- dren suffering from the most terrible hereditary diseases be born, it being sufficient salve to the con- science that the intention was to produce children, not to transmit disease.— Apparently the condem- nation of preventive devices rests entirely upon the story of Onan, and their use is termed Onanism by Roman Catholics. This evidence will disgust every decent person by its callous disregard of the suffering inflicted on the innocent, yet it contains a very important concession to the Neo-Malthusian position. The old attitude of the Roman Catholic Church was that “all interference with the primary end of mar- riage is grievously sinful,” and the idea of any abstinence within marriage was entirely discoun- tenanced. The mere fact of allowing limitation by the restriction of marital relations to periods when children are less likely to be engendered is a definite concession to the principle of gratification of sex impulses without the consequence of off- spring. Moreover, it will be impossible for the Church to stop at this point. The pronouncement is but another example of the way in which Roman Catholicism has been obliged to yield to progress. In 1841 the advance of family limitation in France had already become so great and so firmly estab- lished that interrogation on this point in the con- fessional simply resulted in the refusal of the men .War and Birth Rate Commission 191 to attend. Bishop Bouchavesnes appealed to Rome for guidance and received the reply that the father confessors need not interrogate on this sub- ject. We have no doubt that before many years a new revelation will fall upon the Church of Rome to the effect that some preventive devices are not “ Onanistic ” and may be employed by believers. As regards the Jews, Chief Rabbi, Dr. J. H. Hertz, (late of New York), intimated that limita- tion of families by preventive devices was discoun- tenanced. But although the largest families are still to be found among Jews, the decline of the birth-rate among them in most countries was even more marked than in the rest of the population. For example, in Russia, in 1901, the Jewish birth- rate was 36 per thousand as against 52 for the general population, i.e., 16 per thousand less. It may be remarked, however, that as the Jewish death-rate was 14.4 per thousand less also, we have here a striking example of the advantage of smaller families. Similar results on a smaller scale were shown for other countries, and the in- fant mortality among the Jews was only a half, or even a third, of that for the remainder of the population. The decline of their birth-rate was attributed to “ the spread of secularism and intel- lectual unrest among the Jewish proletariat, and the weakening of religious observance, with the resultant vanishing of all scruples against artifi- cial restriction.” It cannot but be regarded as re- 192 The Small Family System markable that the vanishing of these scruples should be rewarded with such a great benefit to the health of adults and children. The above is a fair summary of the medical and religious opinions expressed before the Commis- sion, and it is evident that from the medical stand- point no case whatever has been made out against preventive methods. Since the publication of this Report the National Council of Public Morals has attempted to obtain legislation only against abor- tifacients. At the present moment a Criminal Law Amendment Bill is before the British Parlia- ment in which there is a clause to prohibit the advertisement and sale of abortifacients; but neither in the Bill nor in the discussion on it has there been the slightest suggestion in any quarter that the advertisement or sale of contraceptives should be interfered with. The British press now occasionally allows discussion of the birth-rate question, and there are even editors who have defended family limitation. Still more significant is the fact that in view of the troubles which the war has brought about as regards venereal dis- ease, medical statements have been widely quoted in the press advocating the Neo-Malthusian doc- trine of early marriage instead of the puritanical doctrine of self restraint. Unfortunately the Commission appears to have very largely missed the significance of the striking connection between low birth-rates and low death- rates; otherwise not only would their pronounce- War and Birth Rate Commission 193 ment of the medical side have been clearer, but the religious arguments must have been affected. We have seen that of the four representatives of relig- ion, three definitely condemned preventive devices on Scriptural grounds and the fourth, while ad- mitting them, considered them anti-Christian. It would seem, therefore, that the Churches are still practically united against the use of contracep- tives. But now we have, in the Edinburgh Re- view for January, 1917, an article on “The Birth- Rate” by Dr. Inge, Dean of St. Paul’s, who was Chairman of the Birth-Rate Commission. As the following quotation from it will show, he regards the use of preventive methods as a matter of taste and individual judgment: — “ The next question to be considered is how this re- striction is to be brought about. The oldest methods are deliberate neglect and infanticide. In China, where authorities differ as to the extent to which female infants are exposed, the practice certainly prevails of feeding infants, whom their mothers are unable to suckle, on rice and water, which soon terminates their existence. Such methods would certainly find no advocates in Eu- rope. The very ancient art of procuring miscarriage is a criminal act in most civilized countries, but it is prac- ticed to an appalling extent. Hirsch . . . estimates that two million births are so prevented annually in the United States, four hundred thousand in Germany, fifty thousand in Paris, and nineteen thousand in Lyons. In our own country it is exceedingly common in the north- ern towns. ... Its great prevalence in the United States is to be attributed mainly to the drastic legisla- tion in that country against the sale and use of preven- 194 The Small Family System tives, to which many persons take objection on moral or aesthetic grounds, but which are surely on an entirely different level from the destruction of life that has al- ready begun. The ‘ Comstock’ legislation in America has done immense harm. It is worse than useless to try to put down by law a practice which a very large num- ber of people believe to be innocent, and which must be left to the taste and conscience of the individual. To the present writer it seems a pis alter [a makeshift] which high-minded married persons should avoid if they can practise self restraint. Whatever injures the feel- ings of ‘ santification and honour, with which St. Paul led us to regard these intimacies of life, whatever tends to profane or degrade the sacraments of wedded love, is so far an evil. But this is emphatically a matter in which every man and woman must judge for themselves, and must refrain from judging others. There is a con- siderable weight of moral authority against these prac- tices, and to disregard authority in the sphere of morals is always dangerous. Those who justify them do so on utilitarian grounds, and can make out a very strong case. But might not the same argument be used to cover other expedients which do not commend themselves to any decent-minded person ? And may not even those who do not believe in divine promptings and inhibitions attach some value to the deep-seated racial instinct which shrouds these functions in awe and mystery? These are questions which must be considered before a decision is taken in a very complex and difficult problem of con- duct. “ In every modern civilized country population is [births are] restricted partly by deliberate postponement of marriage. In many cases this does no harm whatsoever; but in many others it gravely diminishes the happiness of young people, and may even cause minor disturbances of health. Moreover, it would not be so widely adopted War and Birth Rate Commission 195 but for the tolerance, on the part of society, of the ‘ great social evil ’ [prostitution], the opprobrium of our civiliza- tion. ... I believe that this abomination will not long be tolerated . . and if I am right, early marriage will become the rule in all classes. This will render the population more acute, especially as these [venereal] dis- eases are the commonest cause both of sterility and infant mortality. JJnder this pressure we must expect to see preventive methods widely accepted as the least of avoid- able evils." (All the italics are ours.) As a commentary on Dean Inge’s pronounce- ment we might note that a recent investigation of the records of the Quakers (the Society of Friends) reveals the fact that family limitation has been adopted by them to a most astonishing extent. Their birth-rates stood at 20 per thou- sand in 1876, and has now actually fallen to about 8 per thousand. The longevity of Quakers is well known, and the returns of deaths given by their Society show that the great majority live to between seventy and ninety years. Infantile mor- tality is practically unknown among them, al- though none of the special steps so dear to most social reformers have been taken for the protec- tion of infant life. The Quakers are well known to be very earnest Christians and to give the best example of religious morality. Their probity in business and their self-sacrifice in humanitarian work of all kinds are renowned. Yet it would seem that they have adopted family restriction to a greater extent than any other body of people, and, since the decline of their birth-rate only 196 The Small Family System began in 1876, that it is due to adoption of pre- ventive methods. In conclusion it would seem to the present writer that the essential point for religious per- sons to consider is this: It has been shown in this book, and admitted in the evidence given to the Commission, that the general and infantile death-rates are lower, i.e.} that persons live longer and healthier lives and have healthier children, where family limitation prevails. How can it, therefore, be seriously contended that artificial family restriction is displeasing to any higher power? “The wages of sin is death,” but the wages of birth control is healthier and longer life. THE END