When sterility is due to a defect in the husband's spermatozoa, and is not discovered, as it usually might be, before marriage, the question of impregnating the wife by other methods has occasionally arisen. Divorce on the ground of sterility is not possible, and, even if it were, the couple, although they wish to have a child, have not usually any wish to separate. Under these circumstances, in order to secure the desired end, without departing from widely accepted rules of morality, the attempt is occasionally made to effect artificial fecundation by injecting the semen from a healthy male. Attempts have been made to effect artificial fecundation by various distinguished men, from John Hunter to Schwalbe, but it is nearly always very difficult to effect, and often impossible. This is easy to account for, if we recall what has already been pointed out (ante p. 577) concerning the influence of erotic excitement in the woman in securing conception; it is obviously a serious task for even the most susceptible woman to evoke erotic enthusiasm à propos of a medical syringe. Schwalbe, for instance, records a case (Deutsche Medizinisches Wochenschrift, Aug., 1908, p. 510) in which,—in consequence of the husband's sterility and the wife's anxiety, with her husband's consent, to be impregnated by the semen of another man,—he made repeated careful attempts to effect artificial fecundation; these attempts were, however, fruitless, and the three parties concerned finally resigned themselves to the natural method of intercourse, which was successful. In another case, recorded by Schwalbe, in which the husband was impotent but not sterile, six attempts were made to effect artificial fecundation, and further efforts abandoned on account of the disgust of all concerned.
Opinion, on the whole, has been opposed to the practice of artificial fecundation, even apart from the question of the probabilities of success. Thus, in France, where there is a considerable literature on the subject, the Paris Medical Faculty, in 1885, after some hesitation, refused Gérard's thesis on the history of artificial fecundation, afterwards published independently. In 1883, the Bordeaux legal tribunal declared that artificial fecundation was illegitimate, and a social danger. In 1897, the Holy See also pronounced that the practice is unlawful ("Artificial Fecundation before the Inquisition," British Medical Journal, March 5, 1898). Apart, altogether, from this attitude of medicine, law, and Church, it would certainly seem that those who desire offspring would do well, as a rule, to adopt the natural method, which is also the best, or else to abandon to others the task of procreation, for which they are not adequately equipped.
When we have ascertained that two individuals both belong to sound and healthy stocks, and, further, that they are themselves both apt for procreation, it still remains to consider the conditions under which they may best effect procreation.[[462]] There arises, for instance, the question, often asked, What is the best age for procreation?
The considerations which weigh in answering this question are of two different orders, physiological, and social or moral. That is to say, that it is necessary, on the one hand, that physical maturity should have been fully attained, and the sexual cells completely developed; while, on the other hand, it is necessary that the man shall have become able to support a family, and that both partners shall have received a training in life adequate to undertake the responsibilities and anxieties involved in the rearing of children. While there have been variations at different times, it scarcely appears that, on the whole, the general opinion as to the best age for procreation has greatly varied in Europe during many centuries. Hesiod indeed said that a woman should marry about fifteen and a man about thirty,[[463]] but obstetricians have usually concluded that, in the interests alike of the parents and their offspring, the procreative life should not begin in women before twenty and in men before twenty-five.[[464]] After thirty in women and after thirty-five or forty in men it seems probable that the best conditions for procreation begin to decline.[[465]] At the present time, in England and several other civilized countries, the tendency has been for the age of marriage to fall at an increasingly late age, on the average some years later than that usually fixed as the most favorable age for the commencement of the procreative life. But, on the whole, the average seldom departs widely from the accepted standard, and there seems no good reason why we should desire to modify this general tendency.
At the same time, it by no means follows that wide variations, under special circumstances, may not only be permissible, but desirable. The male is capable of procreating, in some cases, from about the age of thirteen until far beyond eighty, and at this advanced age, the offspring, even if not notable for great physical robustness, may possess high intellectual qualities. (See e.g., Havelock Ellis, A Study of British Genius, pp. 120 et seq.) The range of the procreative age in women begins earlier (sometimes at eight), though it usually ceases by fifty, or earlier, in only rare cases continuing to sixty or beyond. Cases have been reported of pregnancy, or childbirth, at the age of fifty-nine (e.g., Lancet, Aug. 5, 1905, p. 419). Lepage (Comptes-rendus Société d'Obstétrique de Paris, Oct., 1903) reports a case of a primipara of fifty-seven; the child was stillborn. Kisch (Sexual Life of Woman, Part II) refers to cases of pregnancy in elderly women, and various references are given in British Medical Journal, Aug. 8, 1903, p. 325.
Of more importance is the question of early pregnancy. Several investigators have devoted their attention to this question. Thus, Spitta (in a Marburg Inaugural Dissertation, 1895) reviewed the clinical history of 260 labors in primiparæ of 18 and under, as observed at the Marburg Maternity. He found that the general health during pregnancy was not below the average of pregnant women, while the mortality of the child at birth and during the following weeks was not high, and the mortality of the mother was by no means high. Picard (in a Paris thesis, 1903) has studied childbirth in thirty-eight mothers below the age of sixteen. He found that, although the pelvis is certainly not yet fully developed in very young girls, the joints and bones are much more yielding than in the adult, so that parturition, far from being more difficult, is usually rapid and easy. The process of labor itself, is essentially normal in these cases, and, even when abnormalities occur (low insertion of the placenta is a common anomaly) it is remarkable that the patients do not suffer from them in the way common among older women. The average weight of the child was three kilogrammes, or about 6 pounds, 9 ounces; it sometimes required special care during the first few days after birth, perhaps because labor in these cases is sometimes slow. The recovery of the mother was, in every case, absolutely normal, and the fact that these young mothers become pregnant again more readily than primiparæ of a more mature age, further contributes to show that childbirth below the age of sixteen is in no way injurious to the mother. Gache (Annales de Gynécologie et d'Obstétrique, Dec., 1904) has attended ninety-one labors of mothers under seventeen, in the Rawson Hospital, Buenos Ayres; they were of so-called Latin race, mostly Spanish or Italian. Gache found that these young mothers were by no means more exposed than others to abortion or to other complications of pregnancy. Except in four cases of slightly contracted pelvis, delivery was normal, though rather longer than in older primiparæ. Damage to the soft parts was, however, rare, and, when it occurred, in every case rapidly healed. The average weight of the child was 3,039 grammes, or nearly 6¾ pounds. It may be noted that most observers find that very early pregnancies occur in women who begin to menstruate at an unusually early age, that is, some years before the early pregnancy occurs.
It is clear, however, that young mothers do remarkably well, while there is no doubt whatever that they bear unusually fine infants. Kleinwächter, indeed, found that the younger the mother, the bigger the child. It is not only physically that the children of young mothers are superior. Marro has found (Pubertà, p. 257) that the children of mothers under 21 are superior to those of older mothers both in conduct and intelligence, provided the fathers are not too old or too young. The detailed records of individual cases confirm these results, both as regards mother and child. Thus, Milner (Lancet, June 7, 1902) records a case of pregnancy in a girl of fourteen; the labor pains were very mild, and delivery was easy. E. B. Wales, of New Jersey, has recorded the history (reproduced in Medical Reprints, Sept. 15, 1890) of a colored girl who became pregnant at the age of eleven. She was of medium size, rather tall and slender, but well developed, and began to menstruate at the age of ten. She was in good health and spirits during pregnancy, and able to work. Delivery was easy and natural, not notably prolonged, and apparently not unduly painful, for there were no moans or agitation. The child was a fine, healthy boy, weighing not less than eleven pounds. Mother and child both did well, and there was a great flow of milk. Whiteside Robertson (British Medical Journal, Jan. 18, 1902) has recorded a case of pregnancy at the age of thirteen, in a Colonial girl of British origin in Cape Colony, which is notable from other points of view. During pregnancy, she was anæmic, and appeared to be of poor development and doubtfully normal pelvic conformation. Yet delivery took place naturally, at full term, without difficulty or injury, and the lying-in period was in every way satisfactory. The baby was well-proportioned, and weighed 7½ pounds. "I have rarely seen a primipara enjoy easier labor," concluded Robertson, "and I have never seen one look forward to the happy realization of motherhood with greater satisfaction."
The facts brought forward by obstetricians concerning the good results of early pregnancy, as regards both mother and child, have not yet received the attention they deserve. They are, however, confirmed by many general tendencies which are now fairly well recognized. The significant fact is known, for instance, that in mothers over thirty, the proportion of abortions and miscarriages is twice as great as in mothers between the ages of fifteen and twenty, who also are superior in this respect to mothers between the ages of twenty and thirty (Statistischer Jahrbuch, Budapest, 1905). It was, again, proved by Matthews Duncan, in his Goulstonian lecture, that the chances of sterility in a woman increase with increase of age. It has, further, been shown (Kisch, Sexual Life of Woman, Part II) that the older a woman at marriage, the greater the average interval before the first delivery, a tendency which seems to indicate that it is the very young woman who is in the condition most apt for procreation; Kisch is not, indeed, inclined to think that this applies to women below twenty, but the fact, observed by other obstetricians, that mothers under eighteen tend to become pregnant again at an unusually short interval, goes far to neutralize the exception made by Kisch. It may also be pointed out that, among children of very young mothers, the sexes are more nearly equal in number than is the case with older mothers. This would seem to indicate that we are here in presence of a normal equilibrium which will decrease as the age of the mother is progressively disturbed in an abnormal direction.
The facility of parturition at an early age, it may be noted, corresponds to an equal facility in physical sexual intercourse, a fact that is often overlooked. In Russia, where marriage still takes place early, it was formerly common when the woman was only twelve or thirteen, and Guttceit (Dreissig Jahre Praxis, vol. i, p. 324) says that he was assured by women who married at this age that the first coitus presented no especial difficulties.
There is undoubtedly, at the present time, a considerable amount of prejudice against early motherhood. In part, this is due to a failure to realize that women are sexually much more precocious than men, physically as well as psychically (see ante p. 35). The difference is about five years. This difference has been virtually recognized for thousands of years, in the ancient belief that the age of election for procreation is about twenty, or less, for women, but about twenty-five for men; and it has more lately been affirmed by the discovery that, while the male is never capable of generation before thirteen, the female may, in occasional instances, become pregnant at eight. (Some of the recorded examples are quoted by Kisch.) In part, also, there is an objection to the assumption of responsibilities so serious as those of motherhood by a young girl, and there is the very reasonable feeling that the obligations of a permanent marriage tie ought not to be undertaken at an early age. On the other hand, apart from the physical advantages, as regards both mother and infant, on the side of early pregnancies, it is an advantage for the child to have a young mother, who can devote herself sympathetically and unreservedly to its interests, instead of presenting the pathetic spectacle we so often witness in the middle-aged woman who turns to motherhood when her youth and mental flexibility are gone, and her habits and tastes have settled into other grooves; it has sometimes been a great blessing even to the very greatest men, like Goethe, to have had a youthful mother. It would also, in many cases, be a great advantage for the woman herself if she could bring her procreative life to an end well before the age of twenty-five, so that she could then, unhampered by child-bearing and mature in experience, be free to enter on such wider activities in the world as she might be fitted for.