and this, in itself, always entails a slight risk. Otherwise I hardly
know a single case where any serious degree of trouble has arisen from
circumcising an infant. On the contrary, I have seen great relief
afforded by the operation. The number of cases is increasing yearly, and
facilities should be extended to all classes for obtaining this necessary
surgical treatment for their babies. Public opinion should be educated
as to the great necessity of this operation, and, just as vaccination
is compulsory, so should circumcision be looked on as necessary to the
physical welfare of the male child.
With the advent of women into public life it was realised that their
special profession of motherhood had not been adequately assisted or
safe-guarded. Even before the war broke out, Government help was offered
in the form of a grant to defray the expenses of local health work. As a
result, England is now saving 50,000 babies a year, who would formerly
have died. In other words, we are losing one in eight instead of one in
seven, and the death-rate is proportionately lower.
During the great war England lost, every hour on the battle-fields
abroad, ten men. At home every hour twelve babies under one year of age
die. We could not save the men abroad, but we may well save as many of
the infants at home. And it is the patriotic duty of every woman to help
preserve the babies—the nation’s greatest asset.
V
PREMATURES
“There is no true potency, but that of help; nor true ambition,
but ambition to save.”—RUSKIN.
There existed long ago in Paris, in the Boulevard des Capucines, an
institution called “La Couveuse,” where, on payment of a franc, one could
see an exhibition of babies, domiciled in incubators for the period of
time requisite for their complete development. I do not know if the
same place is still in existence, but when I saw it, it was a long room
divided by a corridor with half a dozen incubators on either side.
Each of these was tenanted by a wee premature baby, which had made its
appearance at least two or three months before it was expected. More
than half of these infants (they were mostly boys) had enjoyed an embryo
existence of just six months. They had, as Shakespeare puts it,
“come into the world
Full fourteen weeks before the course of time.”
These babies were fed by three or four “nourrices,” who lived on the
premises and supplied each little incubated person with a drop or two of
human milk administered in a teaspoon, as none could suckle until the end
of the seventh month.
Among these infants a little pair of red-haired twins, born at twenty-six
weeks, were especially attractive. Their name was Smith, and they
certainly had a familiar John Bull-like expression of countenance. Their
native vigour proved itself in their obstinate battle for life. Two
years later I was able to see those same twins in the best of health and
spirits, and to all appearance as bonny specimens of humanity as any
parent might desire.
Hitherto incubators had been regarded solely as a means for hatching
chickens. It was in France that Dr. Tarnier for the first time applied
the system to the rearing of weakly babies. At the Maternity Hospital
in Paris, and in various other places in France, “couveuses” have now
been employed, for over twenty-five years, with the greatest success.
It seems a pity that in Great Britain the incubator is not more widely
used. Perhaps on account of the antipathy shown in that country to the
wet-nurse system, artificial feeding is a stumbling block. It certainly
is almost impossible to rear an infant born at six months on anything but
human milk. Wonderful results have been obtained, thanks to the incubator
and human milk combined, while many thousands of invaluable boy-lives
have been sacrificed for the lack of combined artificial warmth and
proper feeding.
Personally I know of no less than eleven little six-month prematures who
could have lived and thrived, had an incubator been available. One case
in particular was heart-rending, as the tiny creature cried pitifully
for nearly twenty-four hours on end, as if begging to be saved. Born at
six months from the last day of period, he was well made, with a voice
as strong as any full-time infant’s. Unfortunately it was bitter January
weather, and no amount of hot water bottles could keep the cold air
from his little lungs. He died the following day, literally perishing
with the cold, and worn out with his struggle for life. Here was a case
where an incubator would have solved the problem of rearing successfully
a perfectly healthy atom of humanity, thrown into the world before its
time, owing to the fact of its mother being elderly and not of a very
robust nature.
A medical friend of mine told me recently that, had he been able to
procure an incubator, he was sure his own seven-month baby girl could
have been reared. Twenty-five years ago an attempt was made to introduce
them in England, and I know personally of two mothers who made use of
them with success. In one case a very tiny seven-month girl was put in
an incubator for two months, and has grown up to be a fine healthy young
woman. The other did equally well, and is, I believe, still a woman of
strong constitution.
Why the use of incubators did not become more general was evidently
because they were difficult to procure and expensive to hire. Then the
question of food without the wet-nurse system renders them very difficult
to use privately. But there seems to be no reason why these difficulties
should not be overcome in hospitals and private “Homes” where so many
premature, or difficult, lying-in cases are to be found. Wet-nurses
doubtless could be obtained, and, if this were not possible or desirable,
humanised milk or some patent food administered, with effective, if not
equally excellent results.
As a rule I do not hold with the wet-nurse system; it has been tried
for generations and found wanting. The moral question is at the bottom
of the failure. Perhaps also the eugenic point of view had something to
say about the transmission of hereditary taints through the milk of a
foster-mother, quite frequently drawn from the lowest stratum of society.
In the last generation, of course, the use of wet-nurses was an habitual
occurrence with the well-to-do. But then it was a common question whether
the child did not often become similar in ways and even looks to its
foster-mother.
My own mother, who had ten children, of whom four had wet-nurses, used to
remark in her latter days how much these children partook of the robust
health and nature, and even looks, of those who had nurtured them. In the
case of one of my brothers this was especially marked, and it was also
certainly noticeable in one of the girls.
In France, where many children are put out to nurse, the disadvantages
outweigh the beneficial results of human lactation. The nurses hold
such a sway over the mothers, and in many cases abuse the power they
control to such an extent, that the mother’s care is discounted; her
maternal instincts are blunted, and the child, once weaned, becomes the
defenceless victim of ignorant incompetence and wrong feeding. Meanwhile,
the nourrice returns to her native village to find the child she left as
often as not a puny weakling, suffering all the evils of maternal neglect.
Nevertheless, if a wet-nurse were immediately available, she would
accompany the promptly forthcoming incubator when required, and many
thousands of premature male lives could be saved. I say male advisedly,
for the reason that a six-month baby is nearly always a boy, whereas
the rare five-month miscarriage is generally a girl. In April, 1915, at
Sunderland, England, a Mrs. Pallion, the wife of a soldier, gave birth to
premature boy-triplets. They were immediately conveyed to the Children’s
Hospital and placed in incubators. They have all survived and done well,
and were duly christened Kitchener, Jellicoe and French. The public can
hardly realise the enormous number of children lost to the nation as a
result of still or premature birth.
As a rule no fœtus is born viable before twenty-six weeks, though
according to Scotch law, an infant may be viable at six lunar months or
168 days. A Mr. Tait reports a case in which the mother gave birth to
a girl at five months and twenty-seven days. It lived four months. Dr.
Keiller recorded particulars of a case in which a child of about four
months intra-uterine life lived for about an hour. It weighed 9½ ozs.[7]
Under ordinary conditions it is almost hopeless to try and save these
mites; but, if the greatest care is exercised, it is nevertheless
possible to rear a goodly proportion, in spite of the many difficulties.
Here is a case in point from my own experience: A Scotch woman, over
forty and very stout, gave birth to a seven-month girl, her first-born.
She reared it with trouble owing to her inability to nurse it. Nine
months later she became pregnant of a boy, which was born barely over the
six months. A day after its birth, when weighed, it turned the scale at 1
lb. 10 ozs. The doctor present did not think it would survive. It seemed
impossible to keep the infant warm, as it had no powers of suction.
When asked to take over the baby, my first care was to wrap him in
cotton-wool and flannel, discarding the cotton shirt in which Highlanders
invariably swathe their shivering offspring. I next secured a rubber
hot water bottle, filled it with warm water, and baby and bottle were
rolled up together in a blanket. The next problem was how to feed it. The
mother, happily, had plenty of milk this time, and by means of a teaspoon
I drew off a few drops at a time and fed the baby every half-hour. He
stopped crying and slept for hours on end. The bathing difficulties were
great, as he was so tiny as to fit into my hand, and his little legs
were about as long and fat as my finger.
After seven days of this system, in which I was helped by the devoted
and painstaking mother, the infant had gained 6 ozs. and began to look
almost like a real baby. At the end of three weeks, during which time we
just managed to keep the mother’s milk-supply going, the child was able
to suckle all he required for the nourishment of his minute frame. By
that time he weighed 3 lbs., and had acquired a good hold on life. For
three months he lived and slept with the hot-bottle, and at the end of
that time he weighed 7 lbs. At one year he weighed 20 lbs.—well above the
average weight—and, as I write these words I recall that he has grown so
big as to need “breeching,” much to the satisfaction of his excellent
Highland mother.
The moral of this story is that if a hot-bottle and mother’s-milk could
save such a “puir wee loon” as that recorded above, thousands of babies
in similar plights could be saved yearly. The whole care consists in the
proper _warming_ and _feeding_ of these premature infants who need to be
literally coaxed into remaining with us in this cold and hungry world. In
New Zealand, state and voluntary efforts have united to provide what is,
judging by the results, the most perfect system for the care of maternity
and infant welfare that the world has ever seen. A voluntary society has
management and control of the whole work. No money grant is made, but
aid is given in skilled attendance, advice, and teaching. In five years
the infant death-rate has fallen from 80 to 35 per 1,000, whereas in
Australia it still stands at 71. It is significant that this marvellous
superiority in the numbers of children reared in New Zealand dates from
the time that women were given the vote.
In England in 1914 the death-rate was as high as 108 per 1,000 births. In
1924 it was only 69 per 1,000. In twenty-five years it had been reduced
from no less than 150 per 1,000 to 69. There are now 2,200 infant welfare
centres in the country, and 2,650 women employed on infant-welfare
work.[8] In Germany, France and Italy, the death-rate of infants is
terribly high, and in modern Greece only one child in three survives to
its first birthday. The reasons alleged for this state of affairs are the
sudden changes in the fickle winter weather, and the amount of soft fruit
with which babies are generally fed in summer-time.
As regards the death-rate from causes connected with maternity, there has
been a great improvement in England since the passing of the Midwives
Act. There are now 135 maternity hospitals and homes, and, whereas 20
years ago, five mothers died for every 1,000 children born, the rate has
now been reduced to less than four. With the advent of the new method
known as “Twilight Sleep” or painless childbirth, and the numerous other
means of ameliorating the condition during confinement, no woman need
dread the ordeal of childbirth, but can look forward with unmixed joy to
the advent of the child of her desire.
The excess of boy-births over girls has been recorded in Germany, France,
and England for more than 200 years as being at the rate of 106 boys to
100 girls; but against this we have to reckon with the greater mortality
of males already described, which, of course, does not include the
death-rate causes connected with men’s several callings, e.g., the army,
the navy, mines, colonial pioneering, etc. I have enumerated the many
ways in which we can help enormously to reduce male infant mortality,
and that surely is the first and most important step. In 1916, it was
calculated that in Australia, 72 babies died out of every 1,000 born
before reaching twelve months of age; in Norway 72, in Sweden the same
and in Holland 99, in the United Kingdom 109, in France 120, in Germany
170 and Austria 205. But in New Zealand, where women take an active part
in public life, only 35 babies die out of every 1,000 born. These figures
tell their own story. Where women have most power, the infants have the
best chance of living.
Where women do not count in politics, the babies have the worst chance.
And where all babies have little chance, the _boy_-babies have by far the
least.
It is true that we have made great strides in the direction of
infant-welfare. But very inadequate progress has been achieved with
regard to the saving of the thousands of premature boys, who die every
year, when they could, given the help of incubators and special feeders,
be fostered and reared with entire success. I have explained that
six-month prematures are almost invariably boys, just as the five-month
child is nearly always a girl, and though it may be impossible to save
the latter, I have endeavoured to prove that it is well within our
powers to accomplish apparent miracles in preserving those male atoms of
humanity. They need not die, but may grow up to become healthy and useful
citizens.
VI
THE SUPERFLUOUS FEMALE
“Life begins with the female organism and is carried on a long
distance by means of females alone.”—LESTER WARD.
The old saying that girls are easier to rear than boys has been already
referred to and commented on, and its truth has been established by
statistics. It is true also that girls are easier to carry through the
period of pregnancy.
One reason is that they are carried higher in the uterus than boys,
so that serious bearing-down feelings are rarely experienced in
girl-gestation. Doubtless, too, the greater pressure upwards against the
digestive organs accounts for the more frequent nausea experienced during
girl-pregnancy.
In most cases where hitherto hopeless sterility has been relieved it
has been through the birth of a daughter—“Nature’s weakest growths have
quickest spring.” In the far fewer cases where a boy has been born,
the former sterility has generally been due to some slight anatomical
disability rather than to any local delicacy or disease.
A powerful proof of the safe pregnancy of girls lies in the fact that
girl miscarriages are of very rare occurrence. Out of every hundred
babies who miscarry, as I have already noted, eighty are boys. Among
fifty letters received recently from women who wanted sons, no less
than eighteen spoke of mishaps of four-month male children, two
mentioned miscarriages with a female at five months, and in eight others
miscarriages during the first few weeks had occurred or were suspected.
Doubtless a vast number of male abortions occur at or about the third
month and at a time corresponding to the menstrual period.
Female abortions, on the other hand, generally occur at the end of
the fifth month, possibly as the result of shock or accident, but
more commonly owing to disease. They are often caused by a syphilitic
condition of the womb, or by a tainted father. In Aberdeen I noted a
woman who had given birth to two healthy boys, but with her first-born—a
girl—she had miscarried at five months; her husband suffered from
syphilis. In another case a woman produced a healthy boy, but the next
child—a girl—aborted at five months. I have collected numerous cases of
girl-miscarriages happening at the same length of fœtal existence, and
all due to severe accidents or abortive methods, when they were not the
result of a syphilitic condition.
There are innumerable cases to prove that a hereditary taint on the
father’s side is more likely to affect his daughters than his sons,
provided the mother is healthy. In the case of a Viennese family, I noted
that the two girls both showed the signs of a tainted father, whereas
the three boys were as strong and healthy as their mother.
A case in which I was much interested was spread over a number of
years. It was that of a poor country woman, who, when I first met her,
had a healthy family of four girls and a baby boy of ten months. After
that she gave birth to a girl who wasted away at two months with some
tubercular trouble; from that time on the mother had continuous pains in
her left side. However, at the end of a year, she was confined of another
tuberculous girl who lived only eighteen months, and ten months later
still she gave birth to yet another girl-child premature and still-born.
After this the poor mother became seriously ill. The pain in her left
groin was almost unbearable, and continuous discharge caused her at last
to seek surgical advice. At the end of some months of drastic treatment
for tubercular trouble in the left ovary, the patient was completely
cured, and two years later she gave birth to a little son. Though
apparently free from disease, he was rather small and weakly and, when a
year old, died of whooping-cough. But a year later the mother, having now
become a robust woman, produced a fine and lusty boy who is now nearly
four years old.
The explanation would, I think, be as follows. The father, a
consumptive-looking man with a tubercular family-history, transmitted the
trouble to his fifth little girl, who in her turn infected her mother’s
left ovary, and it was only after the birth of two more sickly infants
that the disease became acute. As a result of the surgical removal of the
diseased left ovary, the woman was left with a single normal right ovary,
which was brought into renewed activity by the extinction of its rival;
hence the birth of the two sons.
Here is another case which goes to prove that a son will readily inherit
a disease latent in his mother. An apparently healthy mother bore a
son who soon developed symptoms of the chronic asthma from which he
still suffers. Five years later the same woman bore a healthy girl,
and finally two years after that she again became pregnant, and showed
symptoms, for the first time in her life, of distressing attacks of
asthma. After giving birth to a healthy girl, she died of exhaustion
caused by one of these attacks. Here it will be observed that the boy
alone partook of the latent maternal disease whilst the baby-girl, like
her little sister, has grown up quite strong and healthy, and entirely
free from the complaint.
Then again the extreme rarity of the premature dislodging of a female
fœtus tends to prove that:
1. A more or less healthy womb will harbour a girl-child; whereas it
requires a very strong and vital uterus to carry a male to its full term
and viable. Thus a lady writer:
I have to lead a very quiet life and I am very anæmic; each
of my babies—I have three little girls—arrived two or three
weeks too soon. My period is very profuse, and always five days
“early”.... I wish I were stronger and could bear a son.
Another letter runs thus:
I am terribly anæmic, my periods always “early” and far too
profuse.... I have had four girls; none of their births were
normal.... I had an operation to my bowels after the first;
severe colitis after the second; and had to be curetted after
the third; and since the fourth confinement I have been very
ill and have had my appendix removed. My doctor told me I was
not the _type to have boys_, as I am very small and delicate
especially internally.
2. In very many cases, female children are born to any given selection of
couples who otherwise would not have parenthood. It is unfortunate, but
I can count on my fingers the cases of obstinate and apparently hopeless
sterility that have been relieved by the birth of a boy. In far the
majority a girl has been the result. Lady B. wrote as follows:
I have been married many years, and have never had a sign
of the child for which I long.... The doctors tell me I am
fearfully anæmic, and nothing I do seems to help....
She was a very nervous and excitable patient, and gave me much trouble
for many months. Finally she became pregnant immediately after the
period, and in time produced a fine healthy girl. I have not kept trace
of her history, but I do not think she has had further offspring.
3. Since so many women are inclined to produce one child only, and
since miscarriages are more common among male children, there is a
large predominance of girls as first or only children. I have collected
statistics of hundreds of such cases.
4. There are more sets of girl-twins born than boy-twins; since the
former, being easier to rear if premature, more easily survive their
birth. Similarly in twins of mixed sex (and these are of more frequent
occurrence than any) the boy is the more difficult to rear than the girl.
A usual form of in-breeding in human beings or animals is the
predominance of female progeny. This is especially noticeable with
toy-dogs of various descriptions; out of every litter there may be only
one male dog, frequently none. I have heard several complaints on
account of this anomaly. In pedigree “catteries” the same condition has
been freely observed.
In Turkey there is a vast predominance of girls born, and the death-rate
amongst boys is stupendous. Though all the women are married, it is rare
to find anything but small families among the well-to-do classes, and
where there are many wives, one child apiece is the usual result.
It is now becoming more generally recognised by students of this branch
of science that the first child is usually inferior to the second or
third, and accordingly, when a nation is largely composed of _enfants
d’essai_, as the French call them, race degeneracy and possibly even
depopulation are not far off. This explains why the one child system has
proved so calamitous to a country like France, which is vainly struggling
in the vice-like grip of the Malthusian theory.
Another evil closely concerning the birth-rate of females is that of
illegitimacy; many more girls than boys are born out of wedlock. In 1922,
60,000 illegitimate infants were born in Great Britain, and among these
there were 106 females for every 100 males, which is almost exactly
the reverse proportion of the legitimate birth-rate. For this state of
affairs there are several reasons:
1. Large numbers of them are _first children_, and of these 70
per cent. are girls.
2. In such confinements too little care is generally given both
to mother and child, and the male child, having a larger head
and being therefore more difficult to bring into the world,
is frequently still-born. That, moreover, half the still-born
children are not registered, may further help to account for
the disparity.
3. A _male abortion_ is fairly easily brought about, but female
issue is infinitely more difficult to get rid of.
4. Illegitimate children have obviously less chance of
surviving than those born in wedlock, since their upbringing
is necessarily rather irregular. Boys succumb more readily than
girls to the evils which attend upon their undesired presence
in an unfriendly world.