although certainly the latter occasion has hitherto been considered as much the more serious."
The certificate, as usually advocated, would be a private but necessary legitimation of the marriage in the eyes of the civil and religious authorities. Such a step, being required for the protection alike of the conjugal partner and of posterity, would involve a new legal organization of the matrimonial contract. That such demands are so frequently made, is a significant sign of the growth of moral consciousness in the community, and it is good that the public should be made acquainted with the urgent need for them. But it is highly undesirable that they should, at present, or, perhaps, ever, be embodied in legal codes. What is needed is the cultivation of the feeling of individual responsibility, and the development of social antagonism towards those individuals who fail to recognize their responsibility. It is the reality of marriage, and not its mere legal forms, that it is necessary to act upon.
The voluntary method is the only sound way of approach in this matter. Duclaux considered that the candidate for marriage should possess a certificate of health in much the same way as the candidate for life assurance, the question of professional secrecy, as well as that of compulsion, no more coming into one question than into the other. There is no reason why such certificates, of an entirely voluntary character, should not become customary among those persons who are sufficiently enlightened to realize all the grave personal, family, and social issues involved in marriage. The system of eugenic certification, as originated and developed by Galton, will constitute a valuable instrument for raising the moral consciousness in this matter. Galton's eugenic certificates would deal mainly with the natural virtues of superior hereditary breed--"the public recognition of a natural nobility"--but they would include the question of personal health and personal aptitude.[457] To demand compulsory certificates of health at marriage is indeed to begin at the wrong end. It would not only lead to evasions and antagonisms but would probably call forth a reaction. It is first necessary to create an enthusiasm for health, a moral conscience in matters of procreation, together with, on the scientific side, a general habit of registering the anthropological, psychological, and pathological data concerning the individual, from birth onwards, altogether apart from marriage. The earlier demands of Diday and Bertillon were thus not only on a sounder but also a more practicable basis. If such records were kept from birth for every child, there would be no need for special examination at marriage, and many incidental ends would be gained. There is difficulty at present in obtaining such records from the moment of birth, and, so far as I am aware, no attempts have yet been made to establish their systematic registration. But it is quite possible to begin at the beginning of school life, and this is now done at many schools and colleges in England, America, and elsewhere, more especially as regards anthropological, physiological, and psychological data, each child being submitted to a thorough and searching anthropometric examination, and thus furnished with a systematic statement of his physical condition.[458] This examination needs to be standardized and generalized, and repeated at fixed intervals.
"Every individual child," as is truly stated by Dr. Dukes, the Physician to Rugby School, "on his entrance to a public school should be as carefully and as thoroughly examined as if it were for life insurance." If this procedure were general from an early age, there would be no hardship in the production of the record at marriage, and no opportunity for fraud. The _dossier_ of each person might well be registered by the State, as wills already are, and, as in the case of wills, become freely open to students when a century had elapsed. Until this has been done during several centuries our knowledge of eugenics will remain rudimentary.
There can be little doubt that the eugenic attitude towards marriage, and the responsibility of the individual for the future of the race, is becoming more recognized. It is constantly happening that persons, about to marry, approach the physician in a state of serious anxiety on this point. Urquhart, indeed (_Journal of Mental Science_, April, 1907, p. 277), believes that marriages are seldom broken off on this ground; this seems, however, too pessimistic a view, and even when the marriage is not broken off the resolve is often made to avoid procreation. Clouston, who emphasizes (_Hygiene of the Mind_, p. 74) the importance of "inquiries by each of the parties to the life-contract, by their parents and their doctors, as to heredity, temperament, and health," is more hopeful of the results than Urquhart. "I have been very much impressed, of late years," he writes (_Journal of Mental Science_, Oct., 1907, p. 710), "with the way in which this subject is taking possession of intelligent people, by the number of times one is consulted by young men and young women, proposing to marry, or by their fathers or mothers. I used to have the feeling in the back of my mind, when I was consulted, that it did not matter what I said, it would not make any difference. But it is making a difference; and I, and others, could tell of scores of marriages which were put off in consequence of psychiatric medical advice."
Ellen Key, also, refers to the growing tendency among both men and women, to be influenced by eugenic consideration in forming partnerships for life (_Century of the Child_, Ch. I). The recognition of the eugenic attitude towards marriage, the quickening of the social and individual conscience in matters of heredity, as also the systematic introduction of certification and registration, will be furthered by the growing tendency to the socialization of medicine, and, indeed, in its absence would be impossible. (See e.g., Havelock Ellis, _The Nationalization of Health_.) The growth of the State Medical Organization of Health is steady and continuous, and is constantly covering a larger field. The day of the private practitioner of medicine--who was treated, as Duclaux (_L'Hygiène Sociale_, p. 263) put it, "like a grocer, whose shop the customer may enter and leave as he pleases, and when he pleases"--will, doubtless, soon be over. It is now beginning to be felt that health is far too serious a matter, not only from the individual but also from the social point of view, to be left to private caprice. There is, indeed, a tendency, in some quarters, to fear that some day society may rush to the opposite extreme, and bow before medicine with the same unreasoning deference that it once bowed before theology. That danger is still very remote, nor is it likely, indeed, that medicine will ever claim any authority of this kind. The spirit of medicine has, notoriously, been rather towards the assertion of scepticism than of dogma, and the fanatics in this field will always be in a hopelessly small minority.
The general introduction of authentic personal records covering all essential data--hereditary, anthropometric and pathological--cannot fail to be a force on the side of positive as well as of negative eugenics, for it would tend to promote the procreation of the fit as well as restrict that of the unfit, without any legislative compulsion. With the growth of education a regard for such records as a preliminary to marriage would become as much a matter of course as once was the regard to the restrictions imposed by Canon law, and as still is a regard to money or to caste. A woman can usually refrain from marrying a man with no money and no prospects; a man may be passionately in love with a woman of lower class than himself but he seldom marries her. It needs but a clear general perception of all that is involved in heredity and health to make eugenic considerations equally influential.
A discriminating regard to the quality of offspring will act beneficially on the side of positive eugenics by substituting the pernicious tendency to put a premium on excess of childbirth by the more rational method of putting a premium on the quality of the child. It has been one of the most unfortunate results of the mania for protesting against that decline of the birthrate which is always and everywhere the result of civilization, that there has been a tendency to offer special social or pecuniary advantages to the parents of large families. Since large families tend to be degenerate, and to become a tax on the community, since rapid pregnancies in succession are not only a serious drain on the strength of the mother but are now known to depreciate seriously the quality of the offspring, and since, moreover, it is in large families that disease and mortality chiefly prevail, all the interests of the community are against the placing of any premium on large families, even in the case of parents of good stock. The interests of the State are bound up not with the quantity but with the quality of its citizens, and the premium should be placed not on the families that reach a certain size but on the individual children that reach a certain standard; the attainment of this standard could well be based on observations made from birth to the fifth year. A premium on this basis would be as beneficial to a State as that on the merely numerical basis is pernicious.
This consideration applies with still greater force to the proposals for the "systematic endowment of motherhood" of which we hear more and more. So moderate and judicious a social reformer as Mr. Sidney Webb writes: "We shall have to face the problem of the systematic endowment of motherhood, and place this most indispensable of all professions upon an honorable economic basis. At present it is ignored as an occupation, unremunerated, and in no way honored by the State."[459] True as this statement is, it must always be remembered that an indispensable preliminary to any proposal for the endowment of motherhood by the State is a clear conception of the kind of motherhood which the State requires. To endow the reckless and indiscriminate motherhood which we see around us, to encourage, that is, by State aid, the production of citizens a large proportion of whom the State, if it dared, would like to destroy as unfit, is too ridiculous a proposal to deserve discussion.[460] The only sound reason, indeed, for the endowment of motherhood is that it would enable the State, in its own interests, to further the natural selection of the fit.
As to the positive qualities which the State is entitled to endow in its encouragement of motherhood, it is still too early to speak with complete assurance. Negative eugenics tends to be ahead of positive eugenics; it is easier to detect bad stocks than to be quite sure of good stocks. Both on the scientific side and on the social side, however, we are beginning to attain a clearer realization of the end to be attained and a more precise knowledge of the methods of attaining it.[461] Even when we have gained a fairly clear conception of the stocks and the individuals which we are justified in encouraging to undertake the task of producing fit citizens for the State, the problems of procreation are by no means at an end. Before we can so much as inquire what are the conditions under which selected individuals may best procreate, there is still the initial question to be decided whether those individuals are both fertile and potent, for this is not guaranteed by the fact that they belong to good stocks, nor is even the fact that a man and a woman are fertile with other persons any positive proof that they will be fertile with each other. Among the large masses of the population who do not seek to make their unions legal until those unions have proved fertile, this difficulty is settled in a simple and practical manner. The question is, however, a serious and hazardous one, in the present state of the marriage law in most countries, for those classes which are accustomed to bind themselves in legal marriage without any knowledge of their potency and fertility with each other. The matter is mostly left to chance, and as legal marriage cannot usually be dissolved on the ground that there are no offspring, even although procreation is commonly declared to be the chief end of marriage, the question assumes much gravity. The ordinary range of sterility is from seven to fifteen per cent. of all marriages, and in a very large proportion of these it is a source of great concern. This could be avoided, in some measure, by examination before marriage, and almost altogether by ordaining that, as it is only through offspring that a marriage has any concern for the State, a legal marriage could be dissolved, after a certain period, at the will of either of the parties, in the absence of such offspring.
It was formerly supposed that when a union proved infertile, it was the wife who was at fault. That belief is long since exploded, but, even yet, a man is generally far more concerned about his potency, that is, his ability to perform the mechanical act of coitus, than about his fertility, that is, his ability to produce living spermatozoa, though the latter condition is a much more common source of sterility. "Any man," says Arthur Cooper (_British Medical Journal_, May 11, 1907), "who has any sexual defect or malformation, or who has suffered from any disease or injury of the genito-urinary organs, even though comparatively trivial or one-sided, and although his copulative power may be unimpaired, should be looked upon as possibly sterile, until some sort of evidence to the contrary has been obtained." In case of a sterile marriage, the possible cause should first be investigated in the husband, for it is comparatively easy to examine the semen, and to ascertain if it contains active spermatozoa. Prinzing, in a comprehensive study of sterile marriages ("Die Sterilen Ehen," _Zeitschrift für Sozialwissenschaft_, 1904, Heft 1 and 2), states that in two-fifths of sterile marriages the man is at fault; one-third of such marriages are the result of venereal diseases in the husband himself, or transmitted to the wife. Gonorrhoea is not now considered so important a cause of sterility as it was a few years ago; Schenk makes it responsible for only about thirteen per cent. sterile marriages (cf. Kisch, _The Sexual Life of Woman_). Pinkus (_Archiv für Gynäkologie_, 1907) found that of nearly five hundred cases in which he examined both partners, in 24.4 per cent. cases, the sterility was directly due to the husband, and in 15.8 per cent. cases, indirectly due, because caused by gonorrhoea with which he had infected his wife.
When sterility is due to a defect in the husband's spermatozoa, and is not discovered, as it usually might be, before marriage, the question of impregnating the wife by other methods has occasionally arisen. Divorce on the ground of sterility is not possible, and, even if it were, the couple, although they wish to have a child, have not usually any wish to separate. Under these circumstances, in order to secure the desired end, without departing from widely accepted rules of morality, the attempt is occasionally made to effect artificial fecundation by injecting the semen from a healthy male. Attempts have been made to effect artificial fecundation by various distinguished men, from John Hunter to Schwalbe, but it is nearly always very difficult to effect, and often impossible. This is easy to account for, if we recall what has already been pointed out (_ante_ p. 577) concerning the influence of erotic excitement in the woman in securing conception; it is obviously a serious task for even the most susceptible woman to evoke erotic enthusiasm _à propos_ of a medical syringe. Schwalbe, for instance, records a case (_Deutsche Medizinisches Wochenschrift_, Aug., 1908, p. 510) in which,--in consequence of the husband's sterility and the wife's anxiety, with her husband's consent, to be impregnated by the semen of another man,--he made repeated careful attempts to effect artificial fecundation; these attempts were, however, fruitless, and the three parties concerned finally resigned themselves to the natural method of intercourse, which was successful. In another case, recorded by Schwalbe, in which the husband was impotent but not sterile, six attempts were made to effect artificial fecundation, and further efforts abandoned on account of the disgust of all concerned.
Opinion, on the whole, has been opposed to the practice of artificial fecundation, even apart from the question of the probabilities of success. Thus, in France, where there is a considerable literature on the subject, the Paris Medical Faculty, in 1885, after some hesitation, refused Gérard's thesis on the history of artificial fecundation, afterwards published independently. In 1883, the Bordeaux legal tribunal declared that artificial fecundation was illegitimate, and a social danger. In 1897, the Holy See also pronounced that the practice is unlawful ("Artificial Fecundation before the Inquisition," _British Medical Journal_, March 5, 1898). Apart, altogether, from this attitude of medicine, law, and Church, it would certainly seem that those who desire offspring would do well, as a rule, to adopt the natural method, which is also the best, or else to abandon to others the task of procreation, for which they are not adequately equipped.
When we have ascertained that two individuals both belong to sound and healthy stocks, and, further, that they are themselves both apt for procreation, it still remains to consider the conditions under which they may best effect procreation.[462] There arises, for instance, the question, often asked, What is the best age for procreation?
The considerations which weigh in answering this question are of two different orders, physiological, and social or moral. That is to say, that it is necessary, on the one hand, that physical maturity should have been fully attained, and the sexual cells completely developed; while, on the other hand, it is necessary that the man shall have become able to support a family, and that both partners shall have received a training in life adequate to undertake the responsibilities and anxieties involved in the rearing of children. While there have been variations at different times, it scarcely appears that, on the whole, the general opinion as to the best age for procreation has greatly varied in Europe during many centuries. Hesiod indeed said that a woman should marry about fifteen and a man about thirty,[463] but obstetricians have usually concluded that, in the interests alike of the parents and their offspring, the procreative life should not begin in women before twenty and in men before twenty-five.[464] After thirty in women and after thirty-five or forty in men it seems probable that the best conditions for procreation begin to decline.[465] At the present time, in England and several other civilized countries, the tendency has been for the age of marriage to fall at an increasingly late age, on the average some years later than that usually fixed as the most favorable age for the commencement of the procreative life. But, on the whole, the average seldom departs widely from the accepted standard, and there seems no good reason why we should desire to modify this general tendency.
At the same time, it by no means follows that wide variations, under special circumstances, may not only be permissible, but desirable. The male is capable of procreating, in some cases, from about the age of thirteen until far beyond eighty, and at this advanced age, the offspring, even if not notable for great physical robustness, may possess high intellectual qualities. (See e.g., Havelock Ellis, _A Study of British Genius_, pp. 120 et seq.) The range of the procreative age in women begins earlier (sometimes at eight), though it usually ceases by fifty, or earlier, in only rare cases continuing to sixty or beyond. Cases have been reported of pregnancy, or childbirth, at the age of fifty-nine (e.g., _Lancet_, Aug. 5, 1905, p. 419). Lepage (_Comptes-rendus Société d'Obstétrique de Paris_, Oct., 1903) reports a case of a primipara of fifty-seven; the child was stillborn. Kisch (_Sexual Life of Woman_, Part II) refers to cases of pregnancy in elderly women, and various references are given in _British Medical Journal_, Aug. 8, 1903, p. 325.
Of more importance is the question of early pregnancy. Several investigators have devoted their attention to this question. Thus, Spitta (in a Marburg Inaugural Dissertation, 1895) reviewed the clinical history of 260 labors in primiparæ of 18 and under, as observed at the Marburg Maternity. He found that the general health during pregnancy was not below the average of pregnant women, while the mortality of the child at birth and during the following weeks was not high, and the mortality of the mother was by no means high. Picard (in a Paris thesis, 1903) has studied childbirth in thirty-eight mothers below the age of sixteen. He found that, although the pelvis is certainly not yet fully developed in very young girls, the joints and bones are much more yielding than in the adult, so that parturition, far from being more difficult, is usually rapid and easy. The process of labor itself, is essentially normal in these cases, and, even when abnormalities occur (low insertion of the placenta is a common anomaly) it is remarkable that the patients do not suffer from them in the way common among older women. The average weight of the child was three kilogrammes, or about 6 pounds, 9 ounces; it sometimes required special care during the first few days after birth, perhaps because labor in these cases is sometimes slow. The recovery of the mother was, in every case, absolutely normal, and the fact that these young mothers become pregnant again more readily than primiparæ of a more mature age, further contributes to show that childbirth below the age of sixteen is in no way injurious to the mother. Gache (_Annales de Gynécologie et d'Obstétrique_, Dec., 1904) has attended ninety-one labors of mothers under seventeen, in the Rawson Hospital, Buenos Ayres; they were of so-called Latin race, mostly Spanish or Italian. Gache found that these young mothers were by no means more exposed than others to abortion or to other complications of pregnancy. Except in four cases of slightly contracted pelvis, delivery was normal, though rather longer than in older primiparæ. Damage to the soft parts was, however, rare, and, when it occurred, in every case rapidly healed. The average weight of the child was 3,039 grammes, or nearly 6¾ pounds. It may be noted that most observers find that very early pregnancies occur in women who begin to menstruate at an unusually early age, that is, some years before the early pregnancy occurs.
It is clear, however, that young mothers do remarkably well, while there is no doubt whatever that they bear unusually fine infants. Kleinwächter, indeed, found that the younger the mother, the bigger the child. It is not only physically that the children of young mothers are superior. Marro has found (_Pubertà_, p. 257) that the children of mothers under 21 are superior to those of older mothers both in conduct and intelligence, provided the fathers are not too old or too young. The detailed records of individual cases confirm these results, both as regards mother and child. Thus, Milner (_Lancet_, June 7, 1902) records a case of pregnancy in a girl of fourteen; the labor pains were very mild, and delivery was easy. E.B. Wales, of New Jersey, has recorded the history (reproduced in _Medical Reprints_, Sept. 15, 1890) of a colored girl who became pregnant at the age of eleven. She was of medium size, rather tall and slender, but well developed, and began to menstruate at the age of ten. She was in good health and spirits during pregnancy, and able to work. Delivery was easy and natural, not notably prolonged, and apparently not unduly painful, for there were no moans or agitation. The child was a fine, healthy boy, weighing not less than eleven pounds. Mother and child both did well, and there was a great flow of milk. Whiteside Robertson (_British Medical Journal_, Jan. 18, 1902) has recorded a case of pregnancy at the age of thirteen, in a Colonial girl of British origin in Cape Colony, which is notable from other points of view. During pregnancy, she was anæmic, and appeared to be of poor development and doubtfully normal pelvic conformation. Yet delivery took place naturally, at full term, without difficulty or injury, and the lying-in period was in every way satisfactory. The baby was well-proportioned, and weighed 7½ pounds. "I have rarely seen a primipara enjoy easier labor," concluded Robertson, "and I have never seen one look forward to the happy realization of motherhood with greater satisfaction."
The facts brought forward by obstetricians concerning the good results of early pregnancy, as regards both mother and child, have not yet received the attention they deserve. They are, however, confirmed by many general tendencies which are now fairly well recognized. The significant fact is known, for instance, that in mothers over thirty, the proportion of abortions and miscarriages is twice as great as in mothers between the ages of fifteen and twenty, who also are superior in this respect to mothers between the ages of twenty and thirty (_Statistischer Jahrbuch_, Budapest, 1905). It was, again, proved by Matthews Duncan, in his Goulstonian lecture, that the chances of sterility in a woman increase with increase of age. It has, further, been shown (Kisch, _Sexual Life of Woman_, Part II) that the older a woman at marriage, the greater the average interval before the first delivery, a tendency which seems to indicate that it is the very young woman who is in the condition most apt for procreation; Kisch is not, indeed, inclined to think that this applies to women below twenty, but the fact, observed by other obstetricians, that mothers under eighteen tend to become pregnant again at an unusually short interval, goes far to neutralize the exception made by Kisch. It may also be pointed out that, among children of very young mothers, the sexes are more nearly equal in number than is the case with older mothers. This would seem to indicate that we are here in presence of a normal equilibrium which will decrease as the age of the mother is progressively disturbed in an abnormal direction.
The facility of parturition at an early age, it may be noted, corresponds to an equal facility in physical sexual intercourse, a fact that is often overlooked. In Russia, where marriage still takes place early, it was formerly common when the woman was only twelve or thirteen, and Guttceit (_Dreissig Jahre Praxis_, vol. i, p. 324) says that he was assured by women who married at this age that the first coitus presented no especial difficulties.