Later children may be spaced to suit the desires of the parents, a recovery period of two years or more always being allowed the mother. But will there be any later children? Dr. Ellsworth Huntington in his contribution to this volume has told us that most of us who are not shiftless and incompetent, on one hand, or wealthy and well-established, on the other, belong to a group in which the average number of children, including those who die young, is fewer than three. Dr. Huntington rightly deplores this "rapid fall of the birthrate, especially among intelligent, far sighted, industrious, progressive people whose ideals of family life are high." The trouble with a family of fewer than three is that it cannot be counted on to project very far into the future those sound souls, that good biological inheritance, which the parents flatter themselves are so definitely worth preserving. A family of two or even three children will not, on the average, produce two who, by becoming parents, may be thought of as replacing their father and mother. Thus a family of fewer than four children may be said to be dying out. This is a sorry state of things for those parents who, as I said above, like to think of themselves as affecting the destinies of the race by transmitting their best characteristics from generation to generation.
When intelligent people are forced to limit their families to one or two children by lack of money, it is a great pity. There is a great abundance of good things in America, but we do not seem to be able to get these things distributed in such a way as to do the most good. We are all working for a better world, but are we working hard enough? I sometimes think that we are not working so hard as we might, because our stake in that better scheme of things is not large enough. If we dared to have three or four children, with all the sacrifices implied, I wonder whether this fact would not sharpen our scent on the trail of the better America.
Lord Bacon said that those who have children have given hostages to fortune. But I am inclined to think that those who have made large and important bargains with chance are just those who will move heaven and earth to guard against mischance. One aspect of the better America, proposed by the American Eugenic Society, will perhaps be the adoption of a sliding-wage scale, characterized by a rise in pay upon marriage and with the arrival of each successive child.
That thoughtful people of our time, whether rich or not, will soon return to having families as large as our grandparents' is extremely unlikely. To bear ten or fifteen children would probably kill most modern women or so completely wear them out that the remnant of their lives would not be worth living. And families of this size would similarly exhaust even unusually large pocket-books, leaving most fathers insolvent. Though it is probably true, as economists say, that our land and its resources, if more equitably distributed and scientifically exploited, are capable of supporting many more millions of Americans than at present, there seems to be no good reason for stepping up the modern middle-class family beyond four or five children.
The reader will notice that I have been going on the assumption that people can have children, and fine specimens at that, to order—when and as they please. This is to a large extent true. The key to the mystery is the doctor. Modern medical schools and modern law have entrusted into his hands not only the physical but the mental well-being of his patients. The tight interlocking of the body and spirit has been everywhere recognized, and the impossibility, in many illnesses, of healing one without treating the other. Positive well-being in the body, so important for the begetting of strong children, is practically inconceivable apart from positive happiness in the mind.
Thus it has become a prime tenet of eugenics that babies must not be conceived under conditions of excessive mental worry or strain. Children begotten in deprivation or the fear that they are going to lower the whole family's standard of living to a painful pinch are not going to have much chance, even while in the womb, to turn out fit and strong. Judicious limitation of birth for reasons of health, the whole health of the parents, in behalf of the best possible grade of offspring has therefore become a routine part of the physician's service to his patients. Every married couple should put themselves in the hands of a physician whom they respect and admire, making him an indispensable third partner to their family planning. This crucial role of the doctor in eugenics is one of the few really deeply encouraging signs of our times.
The Woman Asks the Doctor, by Dr. Emil Novak of Johns Hopkins, gives some idea of the role the modern physician may play in helping parents plan the vigorous citizenry of the future. When the married lovers are ready to have their children, it is naturally with the woman that the doctor is most concerned, correcting structural or functional deviations or mild organic disease before the pregnancy has advanced too far, seeing to it that the glandular mechanisms do their important work, that nutritional intake is sufficient, that digestion is kept successfully functioning, that metabolic processes are raised to more than ordinary efficiency, and that the body is kept free from all toxins and infections. After the birth of the child the doctor will not only look after the child but also see to it that the mother suffers no adverse after-effects and is restored to her maximal health and efficiency as soon as possible, ready to bear her next healthy baby when the time shall come.
Should a baby be conceived unexpectedly, the doctor is often the best person to help the parents handle the untoward situation. He can give the mother's physical condition that special attention which it will probably need if she has borne another child quite recently. If the objection to the child arises from economic or psychologic unpreparedness, there is no one better fitted, possibly, than the modern physician for changing negative fear to positive desire. By the force of his own enthusiasm for new life, by his vision of the modern family, by a skillful combination of his common sense and psychiatric training, and by his ability to arrange fees within the range of his worried clients, he can usually turn the unplanned conception into a happy accident.
It is often to the physician, too, that the father must look for practical guidance and encouragement in those unforeseeable cases when the mother perishes in connection with childbirth. It is he who is in the best position to prevent the father from unconsciously attaching blame to the unoffending child and harboring an undefined resentment which may adversely affect both lives. The doctor can help the bereaved father to cling to his dream of family life, can assist him in building a happy home for his motherless child or children, or can advise him on problems which may arise out of finding a new mother for them.
Another important function of the physician is to give aid to couples who have difficulty in begetting children. The question of sterility comes up frequently in our time, especially among cultivated and intellectual people. Persistent failure to conceive we term absolute sterility; persistent failure to carry pregnancy to a successful end, we call relative sterility. The latter is an obstetric problem and can usually be dealt with successfully. So can the former in about forty percent of the cases. We must remember the rule formulated by Matthews Duncan, that the marriage of persons between twenty and thirty cannot be regarded as sterile until at least four years of normal, happy sexual intercourse have elapsed. I have known half a dozen instances in which a child was born after five, six, ten, and, in one case, fifteen years of complete failure to conceive. In these cases no special efforts were made by the couple to bring about conception.