It is the mother who is the child's supreme parent. At various points in zoölogical evolution it has seemed possible that the functions that we now know as those of maternity would be largely and even equally shared by the male parent. Nature has tried various experiments in this direction, among the fishes, for instance, and even among birds. But reasonable and excellent as these experiments were, and though they were sufficiently sound to secure their perpetuation unto this day, it remains true that it was not along these lines that Man was destined to emerge. Among all the mammal predecessors of Man, the male is an imposing and important figure in the early days of courtship, but after conception has once been secured the mother plays the chief part in the racial life. The male must be content to forage abroad and stand on guard when at home in the ante-chamber of the family. When she has once been impregnated the female animal angrily rejects the caresses she had welcomed so coquettishly before, and even in Man the place of the father at the birth of his child is not a notably dignified or comfortable one. Nature accords the male but a secondary and comparatively humble place in the home, the breeding-place of the race; he may compensate himself if he will, by seeking adventure and renown in the world outside. The mother is the child's supreme parent, and during the period from conception to birth the hygiene of the future man can only be affected by influences which work through her.
Fundamental and elementary as is the fact of the predominant position of the mother in relation to the life of the race, incontestable as it must seem to all those who have traversed the volumes of these _Studies_ up to the present point, it must be admitted that it has sometimes been forgotten or ignored. In the great ages of humanity it has indeed been accepted as a central and sacred fact. In classic Rome at one period the house of the pregnant woman was adorned with garlands, and in Athens it was an inviolable sanctuary where even the criminal might find shelter. Even amid the mixed influences of the exuberantly vital times which preceded the outburst of the Renaissance, the ideally beautiful woman, as pictures still show, was the pregnant woman. But it has not always been so. At the present time, for instance, there can be no doubt that we are but beginning to emerge from a period during which this fact was often disputed and denied, both in theory and in practice, even by women themselves. This was notably the case both in England and America, and it is probably owing in large part to the unfortunate infatuation which led women in these lands to follow after masculine ideals that at the present moment the inspirations of progress in women's movements come mainly to-day from the women of other lands. Motherhood and the future of the race were systematically belittled. Paternity is but a mere incident, it was argued, in man's life: why should maternity be more than a mere incident in woman's life? In England, by a curiously perverted form of sexual attraction, women were so fascinated by the glamour that surrounded men that they desired to suppress or forget all the facts of organic constitution which made them unlike men, counting their glory as their shame, and sought the same education as men, the same occupations as men, even the same sports. As we know, there was at the origin an element of rightness in this impulse.[2] It was absolutely right in so far as it was a claim for freedom from artificial restriction, and a demand for economic independence. But it became mischievous and absurd when it developed into a passion for doing, in all respects, the same things as men do; how mischievous and how absurd we may realize if we imagine men developing a passion to imitate the ways and avocations of women. Freedom is only good when it is a freedom to follow the laws of one's own nature; it ceases to be freedom when it becomes a slavish attempt to imitate others, and would be disastrous if it could be successful.[3] At the present day this movement on the theoretical side has ceased to possess any representatives who exert serious influence. Yet its practical results are still prominently exhibited in England and the other countries in which it has been felt. Infantile mortality is enormous, and in England at all events is only beginning to show a tendency to diminish; motherhood is without dignity, and the vitality of mothers is speedily crushed, so that often they cannot so much as suckle their infants; ignorant girl-mothers give their infants potatoes and gin; on every hand we are told of the evidence of degeneracy in the race, or if not in the race, at all events, in the young individuals of to-day.
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 foetus. 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).
The frequency of premature birth is probably as great in England as in France. Ballantyne states (_Manual of Antenatal Pathology; The Foetus_, 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 Foetus_, 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 Foetus_ (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