The frequency of premature birth is probably as great in England as in France. Ballantyne states (Manual of Antenatal Pathology; The Fœtus, p. 456) that for practical purposes the frequency of premature labors in maternity hospitals may be put at 20 per cent., but that if all infants weighing less than 3,000 grammes are to be regarded as premature, it rises to 41.5 per cent. That premature birth is increasing in England seems to be indicated by the fact that during the past twenty-five years there has been a steady rise in the mortality rate from premature birth. McCleary, who discusses this point and considers the increase real, concludes that "it would appear that there has been a diminution in the quality as well as in the quantity of our output of babies" (see also a discussion, introduced by Dawson Williams, on "Physical Deterioration," British Medical Journal, Oct. 14, 1905).
It need scarcely be pointed out that not only is immaturity a cause of deterioration in the infants that survive, but that it alone serves enormously to decrease the number of infants that are able to survive. Thus G. Newman states (loc. cit.) that in most large English urban districts immaturity is the chief cause of infant mortality, furnishing about 30 per cent. of the infant deaths; even in London (Islington) Alfred Harris (British Medical Journal, Dec. 14, 1907) finds that it is responsible for nearly 17 per cent. of the infantile deaths. It is estimated by Newman that about half of the mothers of infants dying of immaturity suffer from marked ill-health and poor physique; they are not, therefore, fitted to be mothers.
Rest during pregnancy is a very powerful agent in preventing premature birth. Thus Dr. Sarraute-Lourié has compared 1,550 pregnant women at the Asile Michelet who rested before confinement with 1,550 women confined at the Hôpital Lariboisière who had enjoyed no such period of rest. She found that the average duration of pregnancy was at least twenty days shorter in the latter group (Mme. Sarraute-Lourié, De l'Influence du Repos sur la Durée de la Gestation, Thèse de Paris, 1899).
Leyboff has insisted on the absolute necessity of rest during pregnancy, as well for the sake of the woman herself as the burden she carries, and shows the evil results which follow when rest is neglected. Railway traveling, horse-riding, bicycling, and sea-voyages are also, Leyboff believes, liable to be injurious to the course of pregnancy. Leyboff recognizes the difficulties which procreating women are placed under by present industrial conditions, and concludes that "it is urgently necessary to prevent women, by law, from working during the last three months of pregnancy; that in every district there should be a maternity fund; that during this enforced rest a woman should receive the same salary as during work." He adds that the children of unmarried mothers should be cared for by the State, that there should be an eight-hours' day for all workers, and that no children under sixteen should be allowed to work (E. Leyboff, L'Hygiène de la Grossesse, Thèse de Paris, 1905).
Perruc states that at least two months' rest before confinement should be made compulsory, and that during this period the woman should receive an indemnity regulated by the State. He is of opinion that it should take the form of compulsory assurance, to which the worker, the employer, and the State alike contributed (Perruc, Assistance aux Femmes Enceintes, Thèse de Paris, 1905).
It is probable that during the earlier months of pregnancy, work, if not excessively heavy and exhausting, has little or no bad effect; thus Bacchimont (Documents pour servir a l'Histoire de la Puériculture Intra-utérine, Thèse de Paris, 1898) found that, while there was a great gain in the weight of children of mothers who had rested for three months, there was no corresponding gain in the children of those mothers who had rested for longer periods. It is during the last three months that freedom, repose, the cessation of the obligatory routine of employment become necessary. This is the opinion of Pinard, the chief authority on this matter. Many, however, fearing that economic and industrial conditions render so long a period of rest too difficult of practical attainment, are, with Clappier and G. Newman, content to demand two months as a minimum; Salvat only asks for one month's rest before confinement, the woman, whether married or not, receiving a pecuniary indemnity during this period, with medical care and drugs free. Ballantyne (Manual of Antenatal Pathology: The Fœtus, p. 475), as well as Niven, also asks only for one month's compulsory rest during pregnancy, with indemnity. Arthur Helme, however, taking a more comprehensive view of all the factors involved, concludes in a valuable paper on "The Unborn Child: Its Care and Its Rights" (British Medical Journal, Aug. 24, 1907), "The important thing would be to prohibit pregnant women from going to work at all, and it is as important from the standpoint of the child that this prohibition should include the early as the late months of pregnancy."
In England little progress has yet been made as regards this question of rest during pregnancy, even as regards the education of public opinion. Sir William Sinclair, Professor of Obstetrics at the Victoria University of Manchester, has published (1907) A Plea for Establishing Municipal Maternity Homes. Ballantyne, a great British authority on the embryology of the child, has published a "Plea for a Pre-Maternity Hospital" (British Medical Journal, April 6, 1901), has since given an important lecture on the subject (British Medical Journal, Jan. 11, 1908), and has further discussed the matter in his Manual of Ante-Natal Pathology: The Fœtus (Ch. XXVII); he is, however, more interested in the establishment of hospitals for the diseases of pregnancy than in the wider and more fundamental question of rest for all pregnant women. In England there are, indeed, a few institutions which receive unmarried women, with a record of good conduct, who are pregnant for the first time, for, as Bouchacourt remarks, ancient British prejudices are opposed to any mercy being shown to women who are recidivists in committing the crime of conception.
At present, indeed, it is only in France that the urgent need of rest during the latter months of pregnancy has been clearly realized, and any serious and official attempts made to provide for it. In an interesting Paris thesis (De la Puériculture avant le Naissance, 1907) Clappier has brought together much information bearing on the efforts now being made to deal practically with this question. There are many Asiles in Paris for pregnant women. One of the best is the Asile Michelet, founded in 1893 by the Assistance Publique de Paris. This is a sanatorium for pregnant women who have reached a period of seven and a half months. It is nominally restricted to the admission of French women who have been domiciled for a year in Paris, but, in practice, it appears that women from all parts of France are received. They are employed in light and occasional work for the institution, being paid for this work, and are also occupied in making clothes for the expected baby. Married and unmarried women are admitted alike, all women being equal from the point of view of motherhood, and indeed the majority of the women who come to the Asile Michelet are unmarried, some being girls who have even trudged on foot from Brittany and other remote parts of France, to seek concealment from their friends in the hospitable seclusion of these refuges in the great city. It is not the least advantage of these institutions that they shield unmarried mothers and their offspring from the manifold evils to which they are exposed, and thus tend to decrease crime and suffering. In addition to the maternity refuges, there are institutions in France for assisting with help and advice those pregnant women who prefer to remain at home, but are thus enabled to avoid the necessity for undue domestic labor.
There ought to be no manner of doubt that when, as is the case to-day in our own and some other supposedly civilized countries, motherhood outside marriage is accounted as almost a crime, there is the very greatest need for adequate provision for unmarried women who are about to become mothers, enabling them to receive shelter and care in secrecy, and to preserve their self-respect and social position. This is necessary not only in the interests of humanity and public economy, but also, as is too often forgotten, in the interests of morality, for it is certain that by the neglect to furnish adequate provision of this nature women are driven to infanticide and prostitution. In earlier, more humane days, the general provision for the secret reception and care of illegitimate infants was undoubtedly most beneficial. The suppression of the mediæval method, which in France took place gradually between 1833 and 1862, led to a great increase in infanticide and abortion, and was a direct encouragement to crime and immorality. In 1887 the Conseil Général of the Seine sought to replace the prevailing neglect of this matter by the adoption of more enlightened ideas and founded a bureau secret d'admission for pregnant women. Since then both the abandonment of infants and infanticide have greatly diminished, though they are increasing in those parts of France which possess no facilities of this kind. It is widely held that the State should unify the arrangements for assuring secret maternity, and should, in its own interests, undertake the expense. In 1904 French law ensured the protection of unmarried mothers by guaranteeing their secret, but it failed to organize the general establishment of secret maternities, and has left to doctors the pioneering part in this great and humane public work (A. Maillard-Brune, Refuges, Maternités, Bureaux d'Admission Secrets, comme Moyens Préservatives des Infanticide, Thèse de Paris, 1908). It is not among the least benefits of the falling birth rate that it has helped to stimulate this beneficent movement.
The development of an industrial system which subordinates the human body and the human soul to the thirst for gold, has, for a time, dismissed from social consideration the interests of the race and even of the individual, but it must be remembered that this has not been always and everywhere so. Although in some parts of the world the women of savage peoples work up to the time of confinement, it must be remarked that the conditions of work in savage life do not resemble the strenuous and continuous labor of modern factories. In many parts of the world, however, women are not allowed to work hard during pregnancy and every consideration is shown to them. This is so, for instance, among the Pueblo Indians, and among the Indians of Mexico. Similar care is taken in the Carolines and the Gilbert Islands and in many other regions all over the world. In some places, women are secluded during pregnancy, and in others are compelled to observe many more or less excellent rules. It is true that the assigned cause for these rules is frequently the fear of evil spirits, but they nevertheless often preserve a hygienic value. In many parts of the world the discovery of pregnancy is the sign for a festival of more or less ritual character, and much good advice is given to the expectant mother. The modern Musselmans are careful to guard the health of their women when pregnant, and so are the Chinese.[[6]] Even in Europe, in the thirteenth century, as Clappier notes, industrial corporations sometimes had regard to this matter, and would not allow women to work during pregnancy. In Iceland, where much of the primitive life of Scandinavian Europe is still preserved, great precautions are taken with pregnant women. They must lead a quiet life, avoid tight garments, be moderate in eating and drinking, take no alcohol, be safeguarded from all shocks, while their husbands and all others who surround them must treat them with consideration, save them from worry and always bear with them patiently.[[7]]