It would be out of place, and would lead us too far, to discuss here these various practical outcomes of the foolish attempt to belittle the immense racial importance of motherhood. It is enough here to touch on the one point of the excess of infantile mortality.
In England—which is not from the social point of view in a very much worse condition than most countries, for in Austria and Russia the infant mortality is higher still, though in Australia and New Zealand much lower, but still excessive—more than one-fourth of the total number of deaths every year is of infants under one year of age. In the opinion of medical officers of health who are in the best position to form an opinion, about one-half of this mortality, roughly speaking, is absolutely preventable. Moreover, it is doubtful whether there is any real movement of decrease in this mortality; during the past half century it has sometimes slightly risen and sometimes slightly fallen, and though during the past few years the general movement of mortality for children under five in England and Wales has shown a tendency to decrease, in London (according to J. F. J. Sykes, although Sir Shirley Murphy has attempted to minimize the significance of these figures) the infantile mortality rate for the first three months of life actually rose from 69 per 1,000 in the period 1888-1892 to 75 per 1,000 in the period 1898-1901. (This refers, it must be remembered, to the period before the introduction of the Notification of Births Act.) In any case, although the general mortality shows a marked tendency to improvement there is certainly no adequately corresponding improvement in the infantile mortality. This is scarcely surprising, when we realize that there has been no change for the better, but rather for the worse, in the conditions under which our infants are born and reared. Thus William Hall, who has had an intimate knowledge extending over fifty-six years of the slums of Leeds, and has weighed and measured many thousands of slum children, besides examining over 120,000 boys and girls as to their fitness for factory labor, states (British Medical Journal, October 14, 1905) that "fifty years ago the slum mother was much more sober, cleanly, domestic, and motherly than she is to-day; she was herself better nourished and she almost always suckled her children, and after weaning they received more nutritious bone-making food, and she was able to prepare more wholesome food at home." The system of compulsory education has had an unfortunate influence in exerting a strain on the parents and worsening the conditions of the home. For, excellent as education is in itself, it is not the primary need of life, and has been made compulsory before the more essential things of life have been made equally compulsory. How absolutely unnecessary this great mortality is may be shown, without evoking the good example of Australia and New Zealand, by merely comparing small English towns; thus while in Guildford the infantile death rate is 65 per thousand, in Burslem it is 205 per thousand.
It is sometimes said that infantile mortality is an economic question, and that with improvement in wages it would cease. This is only true to a limited extent and under certain conditions. In Australia there is no grinding poverty, but the deaths of infants under one year of age are still between 80 and 90 per thousand, and one-third of this mortality, according to Hooper (British Medical Journal, 1908, vol. ii, p. 289), being due to the ignorance of mothers and the dislike to suckling, is easily preventable. The employment of married women greatly diminishes the poverty of a family, but nothing can be worse for the welfare of the woman as mother, or for the welfare of her child. Reid, the medical officer of health for Staffordshire, where there are two large centres of artisan population with identical health conditions, has shown that in the northern centre, where a very large number of women are engaged in factories, still-births are three times as frequent as in the southern centre, where there are practically no trade employments for women; the frequency of abnormalities is also in the same ratio. The superiority of Jewish over Christian children, again, and their lower infantile mortality, seem to be entirely due to the fact that Jewesses are better mothers. "The Jewish children in the slums," says William Hall (British Medical Journal, October 14, 1905), speaking from wide and accurate knowledge, "were superior in weight, in teeth, and in general bodily development, and they seemed less susceptible to infectious disease. Yet these Jews were overcrowded, they took little exercise, and their unsanitary environment was obvious. The fact was, their children were much better nourished. The pregnant Jewess was more cared for, and no doubt supplied better nutriment to the fœtus. After the children were born 90 per cent. received breast-milk, and during later childhood they were abundantly fed on bone-making material; eggs and oil, fish, fresh vegetables, and fruit entered largely into their diet." G. Newman, in his important and comprehensive book on Infant Mortality, emphasizes the conclusion that "first of all we need a higher standard of physical motherhood." The problem of infantile mortality, he declares (page 259), is not one of sanitation alone, or housing, or indeed of poverty as such, "but is mainly a question of motherhood."
The fundamental need of the pregnant woman is rest. Without a large degree of maternal rest there can be no puericulture.[[4]] The task of creating a man needs the whole of a woman's best energies, more especially during the three months before birth. It cannot be subordinated to the tax on strength involved by manual or mental labor, or even strenuous social duties and amusements. The numerous experiments and observations which have been made during recent years in Maternity Hospitals, more especially in France, have shown conclusively that not only the present and future well-being of the mother and the ease of her confinement, but the fate of the child, are immensely influenced by rest during the last month of pregnancy. "Every working woman is entitled to rest during the last three months of her pregnancy." This formula was adopted by the International Congress of Hygiene in 1900, but it cannot be practically carried out except by the coöperation of the whole community. For it is not enough to say that a woman ought to rest during pregnancy; it is the business of the community to ensure that that rest is duly secured. The woman herself, and her employer, we may be certain, will do their best to cheat the community, but it is the community which suffers, both economically and morally, when a woman casts her inferior children into the world, and in its own interests the community is forced to control both employer and employed. We can no longer allow it to be said, in Bouchacourt's words, that "to-day the dregs of the human species—the blind, the deaf-mute, the degenerate, the nervous, the vicious, the idiotic, the imbecile, the cretins and epileptics—are better protected than pregnant women."[[5]]
Pinard, who must always be honored as one of the founders of eugenics, has, together with his pupils, done much to prepare the way for the acceptance of this simple but important principle by making clear the grounds on which it is based. From prolonged observations on the pregnant women of all classes Pinard has shown conclusively that women who rest during pregnancy have finer children than women who do not rest. Apart from the more general evils of work during pregnancy, Pinard found that during the later months it had a tendency to press the uterus down into the pelvis, and so cause the premature birth of undeveloped children, while labor was rendered more difficult and dangerous (see, e.g., Pinard, Gazette des Hôpitaux, Nov. 28, 1895, Id., Annales de Gynécologie, Aug., 1898).
Letourneux has studied the question whether repose during pregnancy is necessary for women whose professional work is only slightly fatiguing. He investigated 732 successive confinements at the Clinique Baudelocque in Paris. He found that 137 women engaged in fatiguing occupations (servants, cooks, etc.) and not resting during pregnancy, produced children with an average weight of 3,081 grammes; 115 women engaged in only slightly fatiguing occupations (dressmakers, milliners, etc.) and also not resting during pregnancy, had children with an average weight of 3,130 grammes, a slight but significant difference, in view of the fact that the women of the first group were large and robust, while those of the second group were of slight and elegant build. Again, comparing groups of women who rested during pregnancy, it was found that the women accustomed to fatiguing work had children with an average weight of 3,319 grammes, while those accustomed to less fatiguing work had children with an average weight of 3,318 grammes. The difference between repose and non-repose is thus considerable, while it also enables robust women exercising a fatiguing occupation to catch up, though not to surpass, the frailer women exercising a less fatiguing occupation. We see, too, that even in the comparatively unfatiguing occupations of milliners, etc., rest during pregnancy still remains important, and cannot safely be dispensed with. "Society," Letourneux concludes, "must guarantee rest to women not well off during a part of pregnancy. It will be repaid the cost of doing so by the increased vigor of the children thus produced" (Letourneux, De l'Influence de la Profession de la Mère sur le Poids de l'Enfant, Thèse de Paris, 1897).
Dr. Dweira-Bernson (Revue Pratique d'Obstétrique et de Pédiatrie, 1903, p. 370), compared four groups of pregnant women (servants with light work, servants with heavy work, farm girls, dressmakers) who rested for three months before confinement with four groups similarly composed who took no rest before confinement. In every group he found that the difference in the average weight of the child was markedly in favor of the women who rested, and it was notable that the greatest difference was found in the case of the farm girls who were probably the most robust and also the hardest worked.
The usual time of gestation ranges between 274 and 280 days (or 280 to 290 days from the last menstrual period), and occasionally a few days longer, though there is dispute as to the length of the extreme limit, which some authorities would extend to 300 days, or even to 320 days (Pinard, in Richet's Dictionnaire de Physiologie, vol. vii, pp. 150-162; Taylor, Medical Jurisprudence, fifth edition, pp. 44, 98 et seq.; L. M. Allen, "Prolonged Gestation," American Journal Obstetrics, April, 1907). It is possible, as Müller suggested in 1898 in a Thèse de Nancy, that civilization tends to shorten the period of gestation, and that in earlier ages it was longer than it is now. Such a tendency to premature birth under the exciting nervous influences of civilization would thus correspond, as Bouchacourt has pointed out (La Grossesse, p. 113), to the similar effect of domestication in animals. The robust countrywoman becomes transformed into the more graceful, but also more fragile, town woman who needs a degree of care and hygiene which the countrywoman with her more resistant nervous system can to some extent dispense with, although even she, as we see, suffers in the person of her child, and probably in her own person, from the effects of work during pregnancy. The serious nature of this civilized tendency to premature birth—of which lack of rest in pregnancy is, however, only one of several important causes—is shown by the fact that Séropian (Fréquence Comparée des Causes de l'Accouchement Prémature, Thèse de Paris, 1907) found that about one-third of French births (32.28 per cent.) are to a greater or less extent premature. Pregnancy is not a morbid condition; on the contrary, a pregnant woman is at the climax of her most normal physiological life, but owing to the tension thus involved she is specially liable to suffer from any slight shock or strain.
It must be remarked that the increased tendency to premature birth, while in part it may be due to general tendencies of civilization, is also in part due to very definite and preventable causes. Syphilis, alcoholism, and attempts to produce abortion are among the not uncommon causes of premature birth (see, e.g., G. F. McCleary, "The Influence of Antenatal Conditions on Infantile Mortality," British Medical Journal, Aug. 13, 1904).
Premature birth ought to be avoided, because the child born too early is insufficiently equipped for the task before him. Astengo, dealing with nearly 19,000 cases at the Lariboisière Hospital in Paris and the Maternité, found, that reckoning from the date of the last menstruation, there is a direct relation between the weight of the infant at birth and the length of the pregnancy. The longer the pregnancy, the finer the child (Astengo, Rapport du Poids des Enfants à la Durée de la Grossesse, Thèse de Paris, 1905).