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  • THE FETICH OF THE BIRTH-RATE

    THE FETICH OF THE BIRTH-RATE

    To the student of the progress of the human race the consideration of the state of public opinion regarding the Birth-rate of nations is of great interest. To the careful observer there is evident the gradual evolution of intelligent public opinion on this subject even in the comparatively short space of time in which the present generation has played its part on the great stage of human development.

    Public opinion on this subject during the period named may be said to have passed through three general stages. These stages are, of course, more clearly defined among the peoples of the most prosperous and intelligent countries, as for instance, in Western Europe and America, and particularly in England, France, and the United States. While the peoples of certain of these countries have passed through these stages somewhat more rapidly than have others, still it is perceived that each of these peoples have in the main followed the same general course.

    The first stage of this evolution of popular opinion may be said to have been begun about 1850, and to have ended about 1880. In this stage the ideal of a large and rapidly increasing birth-rate became a popular fetich before which all men and women were supposed to fall down and render worship. In this period public opinion manifested great satisfaction and joy in the evidences of a high and rapidly increasing birth-rate. It was held that this increasing birth-rate tended toward the success and glory of the particular nation, and incidentally to the race as a whole. The idea of Quantity was elevated to the throne of public favor, and the question of Quality was ignored or overlooked.

    This period was one of an unusual expansion of industry, and the rising birth-rate was regarded as a token that the world was destined to be exploited and eventually governed by the people of those nations who were able to demonstrate the greatest efficiency in industrial pursuits, and who at the same time were wise enough to increase their respective populations by an increasing birth-rate. The populace were excited by the idea of the dominance and prosperity of their own countrymen, while the leaders of industry were delighted with the idea of an increasing supply of laborers which would tend to keep down the rate of wages which otherwise would have reached proportions which would have interfered with competition with other countries. At the same time, the militarists were secretly delighted by the signs of an increasing supply of military material with which to build up gigantic armies.

    A writer on the state of public opinion on this subject during this period has well said: “It seemed to the more exuberant spirits that a vast British Empire, or a mighty Pan-German, might be expected to cover the whole world. France, with its low and falling birth-rate, was looked down at with a contempt as a decadent country inhabited with a degenerate population. No attempt to analyze the birth-rate, to ascertain what are really the biological, social, and economic accompaniments of a high birth-rate, made any impression on the popular mind. They were drowned in a general shout of exultation.”

    But this period of uncritical optimism was followed by a natural reaction. The pendulum stopped in its course, and soon began to swing in the opposite direction. Here, about 1880, the second stage may be said to have begun. Public opinion began to manifest a subtle change, and this mental attitude was accompanied by a physical manifestation in the form of a decreasing birth-rate. The rate of births began to fall rapidly, and has continued to fall steadily since that time.

    The writer above quoted from says of this second period: “In France the birth-rate fell slowly, in Italy more rapidly, and in England and Prussia still more rapidly. As, however, the fall began earliest in France, the birth-rate was lower there than in the other countries named. For the same reason it was lower in England than in Prussia, although England stands in this respect at almost exactly the same distance from Prussia today (1917) as thirty years ago, the fall having occurred at the same rate in both countries. It is quite possible that in the future it may become more rapid in Prussia than in England, for the birth-rate of Berlin is lower than the birth-rate of London, and urbanization is proceeding at a more rapid rate in Germany than in England.”

    It is not difficult to arrive at the psychological reason underlying this great change in public opinion, as manifested in this second stage. In the first place, the wonderful era of world-expansion was arrested, by natural causes well understood by students of sociology. The ambitious dreams of world-empires were rudely interrupted. Moreover, public opinion was being affected by a quiet education along the lines of sociology and economics.

    The working classes began to perceive, on the one hand, the tendency of overpopulation to hold down, or even decrease, the scale of wages. The evils of over-production, and of under-consumption were dimly perceived. And, on the other hand, the capitalists began to perceive that another factor was at work—one which they had failed to include in their optimistic calculations. Instead of the cheaper wage rate which they had expected by reason of the over-abundance of human material, they found that the growth of popular education in the democratic countries had caused the working classes to demand greater comforts of life, and to oppose the cheapening of human labor. And at the same time, the masses began to revolt against the idea of raising children to become “cannon fodder” for ambitious autocratic rulers. The masses began to protest against selling their labor and their lives so cheaply.

    These changed viewpoints of the working classes began to result in attempts on their part to form associations to resist the tendency on the part of capitalists to force down the scale of wages to fit the increased population. Trade unions flourished and became powerful, and the same impulse carried many into the ranks of socialism, and still beyond into the fold of anarchism and syndicalism. And, here note this significant fact, with these new perceptions and these new movements among the masses, the birth-rate began to fall rapidly.

    The writer above quoted from says of this period: “The pessimists were faced by horrors on both sides. On the one hand, they saw that the ever-increasing rate of human production which seemed to them the essential condition of national, social, even moral progress, had not only stopped but was steadily diminishing. On the other hand, they saw that, even so far as it was maintained, it involved, under modern conditions, nothing but social commotion and economic disturbance. There are still many pessimists of this class alive among us even today, alike in England and Germany, but a new generation is growing up, and this question is now entering another phase.”

    It would seem that the race is now well started in the third period, phase, or stage of this conception of the birth-rate. Even the Great War is not likely to seriouslyinterrupt its ultimate progress, though conditions in all civilized countries will unquestionably be disturbed by the unusual conditions now prevailing and caused by the great conflict. The spirit of this third stage seems to be that the Truth is to be found between the two extremes, viz.: (1) the extreme of passive optimism of the first stage; and (2) the extreme of passive pessimism of the second stage. It realizes that there is excellent ground for hope in better things; but it equally realizes that hope alone is vain, and will accomplish nothing unless it is accompanied with and directed by a clear intellectual vision manifested in individual and social action based on that clear intellectual vision.

    The writer above quoted from says of this developing period: “It is today beginning to be seen that the old notion of progress by means of reckless multiplication is vain. It can only be effected at a ruinous cost of death, disease, poverty, and misery. We see this in the past history of Western Europe, as we still see it in the history of Russia. Any progress effected along that line—if ‘progress’ it can be called—is now barred, for it is utterly opposed to those democratic conceptions which are ever gaining greater influence among us. Moreover, we are now better able to analyze demographic phenomena, and are no longer satisfied with any crude statements regarding the birth-rate. We realize that they need interpretation. They have to be considered in relation to the sex-constitution and the age-constitution of the population, and above all, they must be viewed in relation to the infant mortality rate.

    “The bad aspect of the French birth-rate is not so much its lowness as that it is accompanied by a high infantile mortality. The fact that the German birth-rate is higher than the English ceases to be a matter of satisfaction when it is realized that German infantile mortality is vastly greater than English. A high birth-rate is no sign of a high civilization. But we are beginning to feel that a high infantile death-rate is a sign of a very inferior civilization. A low birth-rate with a low infant death-rate not only produces the same increase in population as a high birth-rate with a high death-rate, which always accompanies it (for there are no examples of a high birth-rate with a low death-rate), but it produces it in a way which is far more worthy of our admiration in this matter than the way of Russia and China where opposite conditions prevail.”

    The evolutionary process which all students of sociology clearly perceive to have been underway in the matter of the attitude of public opinion toward the birth-rate, and which is now underway with increased impetus, is perceived to be a natural process. It is a natural process which has been underway from the beginning of the living world. For a long time it operated and manifested along unconscious and instinctive lines of activity, but now it has emerged into the light of human consciousness and manifests along the lines of conscious, voluntary, and deliberate human action.

    In its present state of evolutionary progress human thought along these lines has found expression in what is generally known as “Birth Control.” The process which has been working slowly through the ages, attaining every new forward step with waste and pain, is henceforth destined to be carried out voluntarily, in the light of human reason, foresight, and self-restraint. The rise of Birth Control may be said to correspond with the rise of social and sanitary science in the first half of the nineteenth century, and to be indeed an essential part of that movement.

    The new doctrine of Birth Control is now firmly established in all the most progressive and enlightened countries of Europe, notably in France and England; in Germany, where formerly the birth-rate was very high, Birth Control has developed with extraordinary rapidity during the present century. In Holland its principles and practice are freely taught by physicians and nurses to the mothers of the people, with the result that there is in Holland no longer any necessity for unwanted babies, and this small country possesses the proud privilege of the lowest death-rate in Europe.

    In the free and enlightened Democratic communities on the other side of the globe, in Australia and New Zealand, the same principles and practice are generally accepted, with the same beneficent results. On the other hand, in the more backward and ignorant countries of Europe, Birth Control is still little known, and death and disease flourish. This is the case in those eight European countries which come at the bottom of the list of the Birth Control scale, and in which the birth-rate is the highest and the death-rate the heaviest—the two rates maintaining such a constant correspondence as to lead to the inevitable conclusion that they are associated as cause and effect.

    But even in the more progressive countries Birth Control has not been established without a struggle, which has frequently ended in a hypocritical compromise, its principles being publicly ignored or denied and its practice privately accepted. For, at the great and vitally important point in human progress which Birth-Control represents, we see really the conflict of two moralities. The morality of the ancient world is here confronted by the morality of the new world.

    The old morality, knowing nothing of science and the process of Nature as worked out in the evolution of life, contented itself with assuming as a basis the early chapters of Genesis in which the children of Noah are represented as entering an empty earth which it is their business to populate diligently. So it came about that for this morality, still innocent of eugenics, recklessness was almost a virtue. Children were held to be given by God; if they died or were afflicted by congenital disease, it was the dispensation of God, and, whatever imprudence the parents might commit, the pathetic faith still ruled that “God will provide.”

    But in the new morality it is realized that in these matters Divine action can only be made manifest in human action, that is to say through the operation of our own enlightened reason and resolved will. Prudence, foresight, self-restraint—virtues which old morality looked down upon with benevolent contempt—assume a position of first importance. In the eyes of the new morality the ideal woman is no longer the meek drudge condemned to endless and often ineffectual child-bearing, but the free and instructed woman, able to look before and after, trained in a sense of responsibility alike to herself and to the race, and determined to have no children but the best.

    Such were the two moralities which came into conflict during the nineteenth century. They are irreconcilable and each firmly rooted, one in ancient religion and tradition, the other in progressive science and reason. Nothing was possible in such a clash of opposing ideas but a feeble and confused compromise such as we find still prevailing in various countries of Old Europe. This is not a satisfactory solution, however inevitable, and is especially unsatisfactory by the consequent obscurantism which placed difficulties in the way of spreading a knowledge of the methods of Birth Control among the masses of the population. For the result has been that while the more enlightened and educated have exercised a control over the size of their families, the poorer and more ignorant—those who should have been offered every facility and encouragement to follow in the same path—have been left, through a conspiracy of silence, to carry on helplessly the bad customs of their forefathers. This social neglect has had the result that the superior family stocks have been tampered by the recklessness of the inferior stocks.

    In America, we find the two moralities in active conflict today. Until recently America has meekly accepted at the hand of Old Europe the traditional prescription. On the surface, the ancient morality had been complacently, almost unquestionably, accepted in America, even to the extent of tacitly permitting the existence of a vast extension of abortion, under the surface of society— a criminal practice which ever flourishes where Birth Control is neglected.

    But today, a new movement is perceptible in America. It would seem that, almost in a flash, America has awakened to the true significance of the issue. With that direct vision of hers, that swift practicality of action, and above all, that sense of the democratic nature of all social progress, we see her resolutely beginning to face this great problem. In her vigorous tongue she is demanding “What is all this secrecy about, anyway? Let us turn on the Light!” And the best authorities agree that America’s answer to the demand will be of the greatest importance, and of immense significance to the whole world.

    In concluding this portion of our discussion, I ask my readers to consider the following quotations from writers who have touched upon the question of the stimulation of the birth-rate by the State, for the purpose of military policy. These quotations speak for themselves, and need but little comment.

    The first authority, a German, whose name has escaped me for the moment, laments the falling birth-rate in his country, and urges his own nation to stimulate it by offering bounties; he says: “Woe to us if we follow the example of the wicked and degenerate people of other nations. Our nation needs men. We have to populate the earth, and to carry the blessings of our Kultur all over the world. In executing that high mission we cannot have too much human material in defending ourselves against the aggression of other nations who are jealous of us and our achievements and progress. Let us promote parentage by law; let us repress by law every influence which may encourage a falling birth-rate; otherwise there is nothing left us but speedy national disaster, complete and irremediable.”

    Havelock Ellis, an Englishman, says: “In Germany for years past it has been difficult to take up a serious periodical without finding some anxiously statistical article about the falling birth-rate, and some wild recommendations for its arrest. For it is the militaristic German who of all Europeans is most worried by this fall; indeed Germans often even refuse to recognize it. Thus today we find Professor Gruber declaring that if the population of the German Empire continues to grow at the rate of the first five years of the present century, it will have reached 250,000,000 at the end of the century. By such a vast increase in population, the Professor complacently concludes, ‘Germany will be rendered invulnerable.’ But Gruber’s estimate is entirely fallacious. German births have fallen, roughly speaking, about 1 per 1,000 of the population, every year since the beginning of the century, and it would be equally reasonable to estimate that if they continue to fall at the present rate (which we cannot, of course, anticipate) births will altogether have ceased in Germany before the end of the century. The German birth-rate reached its climax forty years ago (1871-1880) with 40.7 per 1,000; in 1906 it was 34 per 1,000; in 1909 it was 31 per 1,000; in 1912 it was 28 per 1,000; in an almost measurable period of time, in all probability before the end of the century, it will have reached the same low level as that of France, when there will be but little difference between the ‘invulnerability’ of France and of Germany, a consummation which, for the world’s sake, is far more devoutly to be wished than that anticipated by Gruber.”

    Writers of Teutonic sympathies have asserted that the aggressive attitude of Germany at the beginning of the Great War was to be legitimately explained and apologized for on the ground that the War was the inevitable expansive outcome of the abnormally high birth-rate of Germany in recent times. Dr. Dernburg, the German statesman, said not very long ago: “The expansion of the German nation has been so extraordinary during the past twenty-five years that the conditions existing before the war had become insupportable.” Another writer has said: “Of later years there has arisen a movement among German women for bringing abortion into honor and repute, so that it may be carried out openly and with the aid of the best physicians. This movement has been supported by lawyers and social reformers of high position.”

    Thus, it would seem that a birth-rate stimulated by unusual circumstances or by deliberate State encouragement, seemingly draws upon it the operation of natural laws which tend to increase its death-rate by War, as well as by an increased number of abortions, and an increased death-rate. It would seem as natural laws operate to bring down the population to normal by war if the other factors do not operate sufficiently rapidly and efficiently.

    Havelock Ellis makes the following interesting statement: “If we survey the belligerent nations in the war we may say that those who took the initiative in drawing it on, or at all events were most prepared to welcome it, were Germany, Austria, Serbia, and Russia—all nations with a high birth-rate, and in which the fall of the birth-rate has not yet had time to permeate. On the other hand, of the belligerent peoples of today, all indications point to the French as the people most intolerant, silently but deeply, of the war they are so ably and heroically waging. Yet the France of the present, with the lowest birth-rate, was a century ago the France of a birth-rate higher than that of Germany today, and at that time the most militarist and aggressive of nations, a perpetual menace to Europe.”

    Finally, let us quote Havelock Ellis once more; he says: “When we realize these facts we are also enabled to realize how futile, how misplaced and how mischievous it is to raise the cry of ‘Race Suicide.’ It is futile because no outcry can affect a world-wide movement of civilization. It is misplaced because the rise and fall of the population is not a matter of birth-rate alone, but of the birth-rate combined with the death-rate, and while we cannot expect to touch the former we can influence the latter. It is mischievous because by fighting against a tendency which is not only inevitable but altogether beneficial, we blind ourselves to the advance of civilization and risk the misdirection of our energies. How far this blindness may be carried we see in the false patriotism of those who in the decline of the birth-rate, fancy they see the ruin of their own particular country, oblivious of the fact that we are concerned with a phenomenon of world-wide extension. The whole tendency of civilization is to reduce the birth-rate. We may go further, and assert with the distinguished German economist, Roscher, that the chief cause of the superiority of a highly civilized state over lower stages of civilization is precisely a greater degree of forethought and self-control in marriage and child-bearing. Instead of talking about Race Suicide, we should do well to observe at what an appalling rate, even yet, the population is increasing; and we should note that it is everywhere the poorest and most primitive countries, and in every country (as in Germany) the poorest regions, which show the highest birth-rate.”

    The same authority says: “One last resort the would-be patriotic alarmist seeks when all others fail. He is good enough to admit that a general decline in the birth-rate might be beneficial. But, he points out, it affects social classes unequally. It is initiated, not by the degenerate and unfit, with whom we could well dispense, but by the very best classes in the community, the well-to-do and the educated. One is inclined to remark, at once, that a social change initiated by its best social class is scarcely likely to be pernicious. Where, it may be asked, if not among the most educated classes, is any process of amelioration to be initiated? We cannot make the world topsy-turvy to suit the convenience of topsy-turvy minds. All social movements tend to begin at the top and to permeate downwards. This has been the case with the decline of the birth-rate, but it is already well marked among the working classes, and has only failed to touch the lowest stratum of all, too weak-minded and too reckless to be amenable to ordinary social motives. The rational method of meeting this situation is not a propaganda in favor of procreation—a truly imbecile propaganda, since it is only carried out and only likely to be carried out, by the very class which we wish to sterilize—but rather by a wise policy of regulative eugenics. We have to create the motives, and it is not an impossible task, which will act even upon the weak-minded and reckless lowest social stratum.”

    PRIVATE Sex Advice to Women By R. B. Armitage, M. D.

    For Young Wives and those who Expect to be Married.

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  • WHAT BIRTH CONTROL IS, AND IS NOT

    WHAT BIRTH CONTROL IS, AND IS NOT

    The student of the progress of human affairs, or even the average person whose knowledge of the doings of mankind is derived from a hasty and casual reading of the daily newspapers and the popular magazines, cannot plead ignorance of the growing interest in the general subject which is embraced within the content of the term “Birth Control.”

    But while the general meaning of the term is at least vaguely grasped by the average member of the human crowd—the individual to whom we refer as “the man on the street”—we find a startling condition of mental confusion and often positive misconception concerning the essence and spirit of the general idea expressed by the term in question.

    While the fact is a reflection upon the average intelligence of the general public, it must be admitted that to the average person, or “the man on the street,” Birth Control means simply the teaching and practice of certain methods whereby men and women may indulge their sexual appetites, in or out of marriage, without incurring the liability or risk of conception and child-bearing. The average person does not stop to consider that such teachings and practices do not constitute “Birth Control” at all, but are, rather, merely the theory and practice of Birth Prevention, desirable only to those who seek sexual indulgences without being called upon to shoulder the responsibilities attached by Nature to the physical sexual union of men and women.

    The term “control” does not mean “prohibition,” or “prevention”; but, on the contrary, means “governing, regulating, or managing influence.” Birth Control, in the true meaning of the term, does not mean the prevention or prohibition of the birth of children, but rather the encouragement of the birth of children under the best possible conditions and the discouragement of the birth of children under improper or unfavorable conditions.

    Birth Control, in the true meaning of the term, does not mean theories and practices which would tend to reduce the population of the civilized countries of the world, but rather theories and practice which would inevitably result in the production of an adequate ratio of increase in the population of such countries, not only by reason of a normal birth-rate, but also by reason of a diminishing death-rate among infants—by the production of healthier children, accompanied by the raising of the standard of the average child born in such countries.

    Birth Control, in the true meaning of the term, therefore, is seen to consist not of the prohibition or prevention of human offspring, but rather of the governing, regulating, and managing of the production of human offspring, under the inspiration of the highest ideals and under the direction of the highest reason, for the purpose of the advancement and welfare of the race and that of the individuals composing the race. Instead of being an anti-social and anti-moral propaganda, Birth Control when rightly understood is perceived to be in accordance with the highest social aims and aspirations, and in accordance with the highest and purest morality of the race.

    Much of the opposition toward the general movement of Birth Control which has been manifested by many well-meaning, though misinformed, persons, has arisen by reason of the erroneous conception and understanding of the term itself, and of misleading information concerning the true nature of the best teachings on the subject. This prejudice has been heightened by certain zealous but ill-balanced advocates of the general movement who have overemphasized the incidental feature of the limitation of offspring under certain conditions, and who have appealed to the attention and interest merely of those who wished to escape the responsibilities of parenthood. This has caused much sorrow and distress to the many persons who have the highest ideals and results in view, and who deplore this unbalanced propaganda under the name, and apparently under the cloak of the general movement. Such persons have felt inclined to cry aloud “Good Lord, deliver us from our so-called friends!”

    One of the most distressing features of the popular prejudice against Birth Control, arising from a total misconception of the subject, has been the widely spread and popularly accepted notion that Birth Control is practically analogous to abortion—or, at the best, but a more refined and less repulsive and less dangerous form of abortion. In view of the fact that one of the important results sought to be obtained by a scientific knowledge of Birth Control actually is the prevention and avoidance of the crime of abortion which has wrought such terrible havoc among the women of civilized countries, it is most distressing and discouraging to the conscientious and high-minded advocates of Birth Control to have it said and believed that their teachings encourage and justify abortion.

    A reference to any standard dictionary or textbook will reveal the fact that “Abortion” means: “the premature expulsion of the human embryo or foetus; miscarriage voluntarily induced or produced,” etc. It is seen at a glance that the essence and meaning of abortion consists in the destruction of the human embryo which has resulted from conception. The embryo human child must already exist in its elemental form, before it can be destroyed by abortion. Therefore, if no such embryo form exists, it cannot be destroyed, and therefore there can be no abortion in such a case. And, it may positively be stated, no true advocate of Birth Control can possibly justify, much less advocate, the destruction of the human embryo or foetus, which act constitutes abortion. The difference between true Birth Control teachings and methods, and that of the advocates of abortion, is as great as the difference between the two poles. Instead of the two being identical or similar, they are diametrically opposed one to the other—they are logical “opposites,” each the antithesis of the other.

    Even in those forms or phases of the Birth Control propaganda in which the use of “contraceptives,” or “preventatives” is considered justified in certain cases—and these forms and phases are far from being the most important, as all students of the subject know—even in these exceptional forms and phases of the general subject the idea of abortion is combatted, and never justified or encouraged. A “contraceptive” agency merely tends to prevent or obviate undesirable conception; it never acts to destroy the result of previous and accomplished conception. A “contraceptive” merely prevents the union of the male and female elements of reproduction, and consequently the process from which evolves the foetus or embryo. A leading medical authority has said regarding this distinction: “In inducing abortion, one destroys something already formed—a foetus or an embryo, a fertilized ovum, a potential human being. In prevention, however, one merely prevents chemically or mechanically the spermatozoa from coming in contact with the ovum. There is no greater sin or crime in this than there is in simple abstinence, in refraining from sexual intercourse.”

    What then must we say when we consider the higher and more advanced forms and phases of Birth Control, those phases and forms which may be said to be mental or emotional “contraceptives,” rather than physical? Surely these cannot be considered as identical with or similar to abortion. And when we consider those phases and forms of Birth Control which are concerned with Pre-Natal Culture—the culture of the child before its birth—can one, even though he be intensely prejudiced against Birth Control, assert that there is to be found here anything which in any way whatsoever can be considered as relating to the theory or practice of abortion? And what must we say of the still higher phases in which the teachings are concerned with the mental and physical preparation of the parents prior to the conception of the child, to the end that the child may have the best possible physiological and psychological basis for its future well-being? Is not this the very antithesis and opposite of all that concerns abortion or abortive methods?

    The trouble about all great movements designed for the benefit of the human race is that at the beginning there is attracted to the movement, by reason of its novelty and “newness,” certain elements which seize upon certain incidental features of the general idea, make them their own while excluding or ignoring the more important things, and then exploit these incidental features in a sensational way, thereby attracting public attention and gaining much undesirable notoriety, and as a consequence bringing discredit and disfavor, prejudice and misunderstanding, to the general movement.

    Birth Control has passed through this apparently inevitable experience, and has suffered greatly thereby. But the Light is being thrown on the Dark Places, and the more intelligent portion of the public is beginning to realize that there is another side to the shield of Birth Control. And, as a consequence, much of the original prejudice is disappearing, and a new understanding of the subject is arising in the minds of many of the best individuals of the race. It is the purpose of this book to help to dispel the ignorance and misconception concerning this great subject of Birth Control, and to aid in presenting the higher and nobler aspects of the general movement to the attention of those who are concerned with the advance and progress of the race as a whole, and of the individual members thereof.

    The student of the subject of Birth Control will fall into grievous error if he begins his consideration of the subject under the impression that the questions concerned therein are new to the world of living things. If the process of Birth Control were something which had suddenly sprung into existence in the consciousness of man, without having an antecedent activity in the history of the race, and of living creatures in general, we might well hesitate to go further in the matter without the most serious and prolonged consideration of the entire principle by the careful thought of the wisest of the race. But while such consideration is advisable, as in the case of any and all important problems presenting themselves for solution and judgment, it is found that those so considering the subject have a sound and firm foundation upon which to base their thought and to test their conclusions.

    As many thoughtful students of the subject have pointed out to us, the question of Birth Control has been with the race practically since the beginning of human history; and it has its correspondences in the instinctive actions of the lower forms of life. The chief difference is that we are now seeking to deal with these problems consciously, voluntarily, and deliberately, whereas in the past the race has dealt with them more or less unconsciously, by methods of trial and error, through perpetual experiment which has often proved costly but which has all the more clearly brought out the real course of natural processes.

    We cannot hope to solve problems so ancient and so deeply rooted as these by merely the rational methods of yesterday and today. To be of value our rational methods must be the revelation in deliberate consciousness of unconscious methods which go far back into the remote past. Our deliberate methods will not be sound except in so far as they are a continuation of those methods which, in the slow evolution of life, have been found sound and progressive on the plane of instinct. This is particularly true in the case of those among us who desire their own line of conduct in the matter to be so closely in accord with natural law, or the law of creation, that to question it would be impious.

    It may be accepted without an extended argument or presentation of evidence that at the outset the prime object of Nature seems to have been that of Reproduction. There is evident, without doubt, an effort on the part of Nature to secure economy of method in the attainment of ever greater perfection in the process of reproduction, but we cannot deny that the primary motive seems to be that of reproduction pure and simple. The tendency toward reproduction is indeed so fundamental in Nature that it is impressed with the greatest emphasis upon every living thing. And, as careful thinkers have told us “the course of evolution seems to have been more of an effort to slow down reproduction than to furnish it with new facilities.”

    Reproduction appears in the history of life even before sex manifests itself. The lower forms of animal and plant life oftener produce themselves without the aid of sex, and some authorities have argued that the presence of sex differentiation serves rather to check active propagation rather than to increase it. If quantity, without regard to quality or variation, be the object of Nature, then that purpose would have been better served by withholding sex-differentiation than by evolving it. As Professor Coulter, a leading American botanist, has well said: “The impression one gains of sexuality is that it represents reproduction under peculiar difficulties.”

    To those who find it difficult to assimilate this somewhat startling idea, we now present a brief statement of the infinitely greater facility toward reproduction manifested by living creatures lacking in sex-differentiation as compared with those possessing it. It is seen that bacteria among primitive plants, and protozoa among primitive animals, are patterns of very rapid and prolific reproduction, though sex begins to appear in a rudimentary form in very lowly forms of life. A single infusorian becomes in a week the ancestor of millions, that is to say, of far more individuals than could proceed under the most favorable conditions from a pair of elephants in five centuries; and Huxley has calculated that the progeny of a single parthenogenetic aphis, under favorable circumstances, would in a few months outweigh the whole population of China. It must be noted, however, that this proviso “under favorable circumstances” reveals the weak point of Nature’s early method of reproduction by enormously rapid multiplication. Creatures so easily produced are easily destroyed; and Nature, apparently in consequence, wastes no time in imparting to them the qualities needed for a high form of life and living.

    And, even after sex differentiation had attained a considerable degree of development, Nature seemed slow to abandon her original plan of rapid multiplication of individuals. Among insects so far advanced as the white ants, the queen lays eggs at the enormous rate of 80,000 a day during her period of active life. Higher in the scale, we find the female herring laying 70,000 eggs at one period of delivery. But in both of these cases we find the manifestation of that apparently invariable rule of Nature, viz., that a high birth-rate is accompanied by a heavy death-rate, whether that high death-rate be caused by natural enemies, wars, or disease.

    At a certain stage of the evolutionary process, Nature seems to have awakened to a realization of the fact that it was better, from every point of view, to produce a fewsuperior beings rather than a vast number of inferior ones. Here, at last, Nature discloses a heretofore hidden aim, namely, the production of quality rather than quantity; and once she has started on this new path, she has pursued it with even greater eagerness than that of reproduction pure and simple. And here we pause to note a principle laid down by the students of Evolution, viz., that advancing evolution is accompanied by declining fertility.

    This new stage of Nature’s processes is marked by a constant and invariable manifestation of diminished number of offspring, accompanied by an increased amount of time and care in the creation and breeding of each of the young creatures. Accompanying this, we find that the reproductive life of the creature is shortened, and confined to more or less special periods; these periods beginning much later, and ending much earlier, and even during their continuance tending to operate in cycles of activity. Here, we see, Nature, grown wiser by experience, herself began to exercise her power in the direction of Birth Control—the use of preventive checks on reproduction.

    A writer has said along these lines: “As reproduction slackened, evolution was greatly accelerated. A highly important and essential aspect of this greater individuation is a higher survival value. The more complex and better equipped creature can meet and subdue difficulties and dangers to which the more lowly organized creature that came before—produced wholesale in a way which Nature seems to look back on as cheap and nasty—succumbed helplessly without an effort. The idea of economy began to assert itself in the world. It became clear in the course of evolution that it is better to produce really good and highly efficient organisms, at whatever cost, than to be content with cheap production on a wholesale scale. They allowed greater developmental progress to be made, and they lasted better. Even before man began it was proved in the animal world that the death-rate falls as the birth-rate falls.”

    Let us compare the lowly herring with the highly evolved elephant. The herring multiplies with enormous rapidity and on a vast scale, and it possesses a very small brain, and is almost totally unequipped to grapple with the special difficulties of its life, to which it succumbs on a wholesale scale. A single elephant is carried for about two years in its mother’s womb, and is carefully guarded by her for many years after birth; it possesses a large brain, and its muscular system is as remarkable for its delicacy as for its power, and is guided by the most sensitive perceptions. It is fully equipped for all the dangers of life, save for those which have been introduced by the subtle ingenuity of modern man. Though a single pair of elephants produces so few offspring, yet their high cost is justified, for each of them has a reasonable chance of surviving to old age. This contrast, from the point of view of reproduction, of the herring and the elephant, well illustrates the principle of evolution previously referred to. It brings clearly into view the difference between Nature’s earlier and her later methods—the ever increasing preference for quality over quantity. Unless we grasp this underlying principle of Nature in its wider aspects we may fail to perceive its operations in the case of man, which latter we may now consider.

    It is, of course, impossible to speak positively regarding the birth-rate and death-rate of the pre-historic primitive races of mankind, for there is not data upon which to base such a report. But reasoning upon the basis of conditions existing among the primitive tribes of the present time we are justified in holding that in the early stages of the evolution of the race there was manifested a high birth-rate and a correspondingly high death-rate. Upon the basis of conditions now existing among savage tribes it would appear that primitive man has a higher birth-rate than the average of mankind today, and likewise a higher death-rate. The rapidly increasing number of children born to the tribe was counteracted by deaths among children caused by neglect, poverty, and disease. In some cases the population was prevented from becoming larger than the means of subsistence justified by the practice of infanticide.

    As to the condition of the race in the early stages of “modern” civilization, we have modern Russia as a surviving instance of this stage. In modern Russia we find, side by side with the progress in neighboring nations, conditions which a few centuries ago existed all over Europe. Here we have an enormous birth-rate, and a terrible death-rate caused by ignorance, superstition, insanitation, filth, bad food, impure water, plagues, famines, and other accompaniments of overcrowding and misery. We find a mortality among young children which sometimes destroys more than half of the children born before they have attained the age of five years. As high as is the Russian birth-rate, it is a matter of record that at times the death-rate has actually exceeded it. And among the survivors there is found a startlingly large percentage of chronic and incurable diseases, with a large number of cases of blindness and other defects.

    Similar results follow in China, where the birth-rate is exceptionally high, and the death-rate correspondingly large; and where there is a large percentage of inferior physical development and pathological defects, the evil conditions which produce death also tending to produce deterioration in the survivors. In both of these countries we have an example of the result of unrestricted reproduction, and unrestricted destruction—as among herrings, so among men. And yet this condition of unrestricted reproduction is the logical goal of certain persons who, inspired by the best possible intentions, in their ignorance and criminal rashness would dare to arrest that fall in the birth-rate which is now beginning to spread its influence in every civilized land.

    In Western Europe before the nineteenth century the population increased very slowly. The enormous birth-rate was nearly equalled by the exceedingly heavy death-rate caused by plagues, pestilences, and famine, and by the frequent wars large and small. The mortality among young children was particularly heavy. Writers have pointed out that the old family records show frequently two or three children of the same Christian name, the first child having died and its name given to a successor.

    During the last quarter of the eighteenth century, when machinery was introduced and a new industrial era opened, the birth-rate rose rapidly. Factories springing up gave increased support to many, and as children were employed as “hands” in the mills at an early age, the richest family was the one with most children. The population began to increase rapidly. But soon disease, misery, and poverty arose from filth and insanitation, immorality and crime, overcrowding and child-labor, drink and lack of sane courses of conduct.

    In time, however, progress set in, and social reformers began the great movement for the betterment of the environment, sanitation, shorter hours of labor, and restriction of child-labor, factory regulation, etc. And when the environment is bettered, the death-rate drops, and the birth-rate accompanies it on its downward progress. As Leroy-Beaulieu says: “The first degree of prosperity in a rude population with few needs tends toward prolificness of reproduction; a later degree of prosperity, accompanied by all the feelings and ideas stimulated by the reduction of such prolificness.”

    The law of the reduction of reproduction in response to the improvement of environment is a natural law, arising from fixed biological principles. This is because when we improve the environment we improve the individual situated in that environment; and the improvement of the individual has always resulted in a check upon reproduction. We must remember, however, that this change is not the result of conscious or voluntary action; instead it is the result of unconscious activities and instinctive urge. As Sir Shirley Murphy has said: “Birth Control is a natural process, and though in civilized men, endowed with high intelligence, it necessarily works in some measure voluntarily and deliberately, it is probable that it also works, as in the evolution of the lower animals, to some extent automatically.”

    Science shows us that even among the most primitive micro-organisms; when placed under unfavorable conditions as to food and environment, they tend to pass into a reproductive phase and by sporulation or otherwise begin to produce new individuals rapidly. This, of course, because of the fact that their death-rate is increased, and an increased birth-rate must be manifested in order to maintain a balance. If the environment be improved, the death-rate decreases, and this is followed by a fall in the birth-rate, according to the constant laws of Nature manifesting in such cases.

    The same law is seen to be manifested in the case of Man. Improve his environment, and his death-rate drops, which is accompanied by a falling birth-rate. Here, once more we see the application of the scientific axiom “Improve the environment and reproduction is checked.” As Leroy-Beaulieu has said: “The tendency of civilization is to reduce the birth-rate.” And as Professor Benjamin Moore has said: “Decreased reproduction is the simple biological reply to good economic conditions.” And as Havelock Ellis has said: “Those who desire a higher birth-rate are desiring, whether they know it or not, the increase of poverty, ignorance, and wretchedness.”

    Among men, Birth Control has now evolved from the unconscious and instinctive phase, and is now unfolding and manifesting on the plane of conscious and voluntary activity. The influence of deliberate intention and conscious design is now one of the important factors in the process. Here at this point we reach a totally new aspect of reproduction. In the past stages of evolution the original impetus toward reproduction has been checked and directed by Nature, working along instinctive and unconscious lines; and the result has been an extreme diminution of the number of off-spring; a prolongation of the time devoted to the breeding and care of each new member of the family, in harmony with its greatly prolonged life; a spacing out of the intervals between the offspring; and, as a result, a vastly greater development of each individual, and an ever better equipment for the task of living. All this was slowly attained automatically, without any conscious volition on the part of the individuals, even when they were human beings, who were the agents.

    Now, however, we are confronted with a change which we may regard as, in some respects, the most momentous sudden advance in the whole history of reproduction, namely, the process of reproductive progress now become conscious and deliberately volitional. Birth control, no longer automatic, is now being directed by human mind and will precisely to the attainment of ends which Nature has been struggling after for millions of years; and, being consciously and deliberately directed, it is now enabled to avoid many of the pitfalls into which the unconscious method fell.

    Havelock Ellis says: “The control and limitation of reproductive activity by conscious and volitional effort is an attempt by open-eyed intelligence and foresight to attain those ends which Nature through untold generations has been painfully yet tirelessly struggling for. The deliberate co-operation of Man in the natural task of Birth Control represents an identification of the human will with what we may, if we choose, regard as the divinely appointed law of the world. We can well believe that the great pioneers, who, a century ago, acted in the spirit of this faith may have echoed the thought of Kepler when, on discovering his great planetary law, he exclaimed in rapture: ‘O God! I think Thy thoughts after Thee!’”

    The following brief general history of the modern Birth Control movement is quoted from Havelock Ellis, and will be of interest to students of the subject: “The pioneers of modern Birth Control were English. Among them Malthus occupies the first place. That distinguished man, in his great and influential work, ‘The Principles of Population,’ in 1798, emphasized the immense importance of foresight and self-control in procreation, and the profound significance of birth limitation for human welfare. Malthus, however, relied on ascetic self-restraint, a method which could only appeal to the few; he had nothing to say for the regulation of conception in intercourse. That was suggested twenty years later, very cautiously by James Mill, the father of John Stuart Mill, in the ‘Encyclopaedia Britannica.’ Four years afterwards, Mill’s friend, the Radical reformer, Francis Place, advocated this method more clearly. Finally, in 1831, Robert Dale Owen, the son of the great Robert Owen, published his ‘Moral Physiology,’ in which he set forth the ways of preventing conception; while a little later the Drysdale brothers, ardent and unwearying philanthropists, devoted their energies to a propaganda which has been spreading ever since and has now conquered the whole civilized world.

    “It was not, however, in England but in France, so often at the head of an advance in civilization, that Birth Control first firmly became established, and that the extravagantly high birth rate of earlier times began to fall; this happened in the first half of the nineteenth century, whether or not it was mainly due to voluntary control. In England the movement came later, and the steady decline in the English birth-rate, which is still proceeding, began in 1877. In the previous year there had been a famous prosecution of Bradlaugh and Mrs. Besant for disseminating pamphlets describing the methods of preventing conception; the charge was described by the Lord Chief Justice, who tried the case, as one of the most ill-advised and injudicious ever made in a court of justice. But it served an undesigned end by giving enormous publicity to the subject and advertising the methods it sought to suppress. There can be no doubt, however, that even apart from this trial the movement would have proceeded on the same lines. The times were ripe, the great industrial expansion had passed its first feverish phase, social conditions were improving, education was spreading. The inevitable character of the movement is indicated by the fact that at the very same time it began to be manifested all over Europe, indeed in every civilized country of the world.

    “At the present time the birth-rate (as well as usually the death-rate) is falling in every country of the world sufficiently civilized to possess statistics of its own vital movement. The fall varies in rapidity. It has been considerable in the more progressive countries; it has lingered in the more backward countries. If we examine the latest statistics for Europe, we find that every country, without exception, with a progressive and educated population, and a fairly high state of social well-being, presents a birth-rate below 30 per 1,000. We also find that every country in Europe in which the mass of the people are primitive, ignorant, or in a socially unsatisfactory condition (even although the governing classes may be progressive or ambitious) shows a birth-rate of above 30 per 1,000. France, Great Britain, Belgium, Holland, the Scandinavian countries, and Switzerland are in the first group. Russia, Austro-Hungary, Italy, Spain, and the Balkan countries are in the second group. The German Empire was formerly in the second group, but now comes within the first group, and has carried on the movement so energetically that the birth-rate of Berlin is already below that of London, and that at the present rate of decline the birth-rate of the German Empire will before long sink to that of France. Outside Europe, in the United States just as much as in Australia and New Zealand, the same progressive movement is proceeding with equal activity.”

    The same authority sums up the present attitude of the advocates of scientific and rational Birth Control, as follows: “The wide survey of the question of birth limitation has settled the question of the desirability of the adoption of preventing conception, and finally settled those who would waste out time with their fears that it is not right to control conception. We know now on whose side are the laws of God and Nature. We realize that in exercising control over the entrance gate of life we are not fully performing, consciously and deliberately, a great human duty, but carrying on rationally a beneficial process which has, more blindly and wastefully, been carried on since the beginning of the world. There are still a few persons ignorant enough or foolish enough to fight against the advance of civilization in this matter; we can well afford to leave them severely alone, knowing that in a few years all of them will have passed away. It is not our business to defend the control of birth, but simply discuss how we may most wisely exercise that control.”

    PRIVATE Sex Advice to Women By R. B. Armitage, M. D.

    For Young Wives and those who Expect to be Married.

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  • GENERAL ADVICE TO WOMEN ON SEX SUBJECTS

    GENERAL ADVICE TO WOMEN ON SEX SUBJECTS

    In this lesson the writer seeks to direct the attention of his women readers to certain subjects upon which the average woman is not well informed, and upon which she usually requires sound, sane, clean, frank information. In many cases women hesitate to ask even their family physicians for such information, and, although there is no rational reason for it, they even shrink from consulting better informed and capable women concerning these subjects.

    Sexual Feeling. Owing to erroneous teachings, and irrational prejudices arising from ancient distorted and perverted ideals of sex, many women have grown to maturity under the erroneous belief that it is a sign of immorality, or at least low ideals and depraved nature, for a woman to experience sexual emotions or feelings, wishes or desires. So true is this that even many married women seek to withhold from their husbands the knowledge that any sexual feeling is experienced by the wife.

    Such a belief is of course absurd. It is as natural for a woman to experience normal sexual feeling as it is for her to experience any other feeling aroused by natural instincts and organism. Without such instinct and the feelings arising therefrom, there would be no mating or marriage, and no perpetuation of the race. The woman experiencing such feelings should not allow herself to imagine that she is depraved or perverted, or immoral in thought and feeling. Incredible as it may appear to a normal, healthy-minded man, it is true that thousands of young women have lost self-respect, and have lapsed into a morbid state of mind, because of the occasional manifestation of their normal sexual feeling.

    This does not, of course, mean that the woman must necessarily manifest into action the feeling experienced by her. On the contrary, she must acquire self-mastery and self-control, just as she must in other phases of her life. It may help some women of this kind to realize that the sex feeling and impulses, arising unbidden (and often unwelcomed) from the depths of their subconscious mentality, are essentially creative impulses. If the woman be unmarried, or if married and placed under conditions in which the marital relation with the husband is impossible or undesirable, then she can transmute this creative energy in some form of creative work—in work which leads to the creation, manufacture, building-up, or composing something. There is a hint here which will prove a great blessing to the woman who will understand and apply the principle suggested—for many other women have found it so.

    As for the married woman, there is no reason whatsoever why she should seek to withhold from her husband the knowledge that she is possessed of normal, natural, healthy sexual feeling. In fact, the withholding of such information, and the concealment and deception arising therefrom, has often done much to bring marital inharmony between husband and wife. If there is any deception to be practiced in the marital association of husband and wife, it should rather be in the opposite direction, i. e., in the direction of pretending the emotional feeling when it exists only partially or is absent. The last matter, however, is one for the exercise of the judgment and conviction of each individual woman; but the first mentioned admonition is one which should be observed, as it is based on honesty, truth, and good judgment as well.

    Alcohol and Sexuality. It needs no extended argument to convince the average person that an individual will do things when under the influence of drink that he or she would not do when perfectly sober. It is an old saying that “When the wine is in, the wits are out.” But there is a deeper connection and relation between alcoholic drink and sexual indiscretions than is usually realized by the average person. Besides the commonly known weakening of will-power and self-control arising from the influence of strong drink, there are certain influences concerning the sexual nature and arising from the presence of alcohol in the system, which are not known to most persons. So true is this that the writer has thought it well to utter a few words of warning to his women readers concerning these things.

    In the first place, there is an exhilarating effect arising from certain kinds of liquor, wines, and other forms of alcoholic drinks, which manifests directly in an excitement of the sexual centers and organism. In many cases a strong sexual excitement, absent at other times, is aroused, and the person is carried away with the force of passion unknown under other circumstances. Added to this the weakened will-power arising from too much drink, and we have an explanation of many cases of “mistakes” of women. It would appear that women are even more susceptible than are men to unusual sexual excitement arising from alcoholic drinks; and that, therefore, they should be especially cautious in the indulgence in such drinks, particularly when in the company of strange men, or men careless in regard to sexual morality and respect for women in their company.

    But there is still a deeper reason, based upon the latest discoveries in psychology, why caution in this respect should be observed by women. We allude to the discovery that alcohol first affects the mental and emotional tendencies of more recent racial acquirement, acting so as to paralyze and inhibit the activities thereof, and to thus release the activity of the more primitive emotions and motive activities. Thus, the woman under the influence of alcohol finds that the more recent racial traits, such as sexual control, restraint, sexual morality, conventional observations, etc., are practically temporarily paralyzed in inhibitual—or to use the current slang phrase, are “put out of commission” for the time being; and, at the same time, the old elemental, savage, barbaric, “cave man” instincts, habits, and methods of action, are brought to the surface, and proceed to manifest their activity if opportunity be granted for the same—and the opportunity is usually granted. This being seen to be true, it is seen that the woman so under the influence of liquor is, for the time being, little more than a “cave woman,” or barbarian, with all the lax sex morality of the latter, and with all the tendencies to manifest into activity the primitive impulses arising in her nature and demanding expression. Added to this the weakening of will-power always accompanying the alcoholic influence, it is seen that the woman under the influence of strong drink is an easy prey to designing men, and a willing victim to her own lower passions.

    An authority of sex subjects says: “That Bacchus, the god of wine, is the strongest ally of Venus, the goddess of love, using the term Love in its physical sense, as the French use the word ‘amour,’ has been well known to the ancient Greeks and Romans, as it is well known today to every saloon-keeper and every keeper of a disreputable house. And all measures to combat venereal diseases and to prevent girls from making a false step will only be partially successful if we do not at the same time carry on a strong educational campaign against alcoholic indulgence. * * * Of what use are warnings to a girl, when under the influence of a heavy dinner and a bottle of champagne, to which she is unaccustomed, her passion is aroused to a degree she has never experienced before, her will is paralyzed and she yields, though deep down in her consciousness something tells her she shouldn’t? She yields, becomes pregnant, and is in the deepest agony for several months, and has a wound which will probably never heal for the rest of her life. Of what use have all the lectures, books, and maternal injunctions been to her? * * * I believe that the sex instinct can be stimulated artificially beyond the natural needs, and among the artificial stimulants of the sex instinct alcohol occupies the first place. And bear in mind that alcohol produces even a stronger effect upon women, in exciting the sexual passion, than it does on men. Women are more easily upset by stimulants and narcotics, and that is the reason why it is more dangerous for women to drink than it is for men. It is impossible to give statistics and exact or even approximate figures. But there is no question in my mind, in the mind of any careful investigator, that if alcoholic beverages could be eliminated, the number of cases of venereal infection would be diminished by about one-half. And what is true of venereal disease is also true of the seduction of young girls. Alcohol is the most efficient weapon that either the refined Don Juan or the vulgar pimp has in his possession.”

    Our advice to the woman who is asked to drink liquor when in the company of a man outside of her immediate family circle is emphatically this: DON’T DO IT!

    The Menstrual Period. As strange as it may appear to those women who have had the advantage of intelligent maternal advice, it is a fact known to all physicians that many mothers permit their young daughters to enter into the stage of puberty, with the accompanying menstrual flow, without having first instructed the daughter as to the meaning and character of this phenomenon of her nature, and without having given her advice concerning the proper care of herself during this period.

    Physicians constantly experience cases in which the young girl to whom the first menstrual flow having come, without previous knowledge on her part, has supposed it to be the result of a wound, or of a diseased condition, and has attempted to stop the flow by the application of cold water. Even where a partial knowledge has been attained by the girl, she is found to lack the knowledge of the proper hygienic care of herself during the period. The mothers in such cases are criminally negligent, and have alluded a false modesty or prudery to interfere with a natural and necessary maternal duty.

    The approach of the first menstruation is often accompanied by unusual physical, mental and emotional changes in the young girl. Her nervous system is affected, and she is apt to become irritable or morbid, or even somewhat “flighty.” Her appetite may become irregular, and there is often present a craving for indigestible food. A physical languor is often experienced, and there may be pains in the back and legs, chilliness and headaches, and a general upsetting of the usual physical condition, accompanied by a manifestation of peevishness and irritability. These unpleasant symptoms usually disappear when the periodical menstrual flow is permanently established. In fact, they are frequently superseded by the awakened energy and heightened spirits of healthy, normal adolescence.

    The time of the beginning of the menstrual period varies according to climate, race, condition of health, and temperament. In the tropical countries, menstruation begins from the tenth to the fourteenth year; in temperate countries, from the thirteenth to the sixteenth; in cold countries, from the fifteenth to the twentieth year. The Italian, Hebrew, Spanish, or French girl is apt to menstruate earlier than the English, German, or Swedish girl. The Negro girl menstruates early, as a rule. The full-blooded girl usually menstruates earlier than the anemic one.

    Normally, menstruation should proceed naturally and without pain or suffering. When pain or suffering is experienced in connection with menstruation, it is simply because of some lack of health in the general system; and when such general health is restored, the trouble ceases. Painful menstruation is called “dysmenorrhea,” and arises from several causes, principal among which are the following: Errors in diet, errors in dress, undue exposure, constipation, lack of proper exercise, or to a contracted or congested condition of the Uterus or the Fallopian Tubes. The pain, however, cannot be considered as a feature of normal menstruation, for the latter is no more painful than a normal movement of the bowels—the painful condition results from abnormal conditions, the removal of these conditions resulting in the cure of the complaint.

    Dysmenorrhea should be treated by the discarding of all unhygienic clothing, tight shoes, etc., and their replacement by rational clothing; the dietary should be carefully scanned, and improper articles replaced by nourishing elements of food—discard the pastries, pickles, confections, and stimulants, and substitute sensible articles of diet; if constipation is present, remove it by eating articles of food which promote free movements of the bowels, and drink more water each day; take a proper amount of exercise—housework is as good a form of exercise as any; many authorities advocate the free drinking of water prior to and during the menstrual period—some going so far as to say that where there is painful menstruation there is always a lack of a proper amount of water taken into the system. In some cases Dysmenorrhea is due to disorders of the general nervous system, and treatment therefore should be sought at the hands of a capable physician.

    Amenorrhea, another disorder arising in connection with the menstrual process, consists of the retention or suppression of the menses, or of “scanty” menses, or occasional “skipping” of the periods. This condition is apt to be manifest in cases of extreme obesity or “fatness;” the nervous system being burdened with superfluous flesh, its menstrual rhythm is often affected. Suppression of the menses also sometimes results from exposure and disturbing mental emotions. The most approved treatment is that of remedying the abnormal general physical condition, proper diet, and the use of hot drinks, hot sitz baths, and hot enemas about the time of the beginning of the normal period.

    Menorrhagia, another menstrual-period disorder, consists of very profuse flowing—it is, in fact, a mild form of hemorrhage. It usually arises from general debility, shocks, too violent exercise or labor, and also in many cases from undue and too frequent sexual intercourse. Sometimes the excessive flow occurs during the regular menstrual period, while in other cases it may manifest itself out of season—sometimes as often as two or three times a month. The duration of the normal period of menstrual flow, however, varies greatly among different women; the normal period may be said to last from two to six days, so what might be an excessive flow for one woman would be only normal for another—temperament plays a large part in determining the quantity of the menses.

    Some of the accompanying symptoms of Menorrhagia, or profuse flow, are lassitude, shortness of breath, faintness, dizziness, headache, irritability and nervousness, and often also leucorrhea between periods. The general treatment consists in measures calculated to bring the general health of the woman back to the normal. The building up of the general system, by means of nourishing food, proper exercise, etc., will almost always result in curing this disorder.

    A well-known authority has well said: “The hygiene of menstruation can be expressed in two words: Cleanliness and Rest.”

    So far as Rest is concerned, the woman need not be urged to take it at this period—that is, if she is able to do so. Care should be taken not to exercise unduly at this time, and under the head of exercise may be included dancing, horseback riding, and automobiling, as well as the more common forms of athletic work.

    It would seem that common sense and the general desire for cleanliness and daintiness would cause all women to observe the plain hygienic laws of Cleanliness at the time of the menstrual period. And, indeed, it is probable that such would be the case were it not for the fact that some ancient superstitions still exert their power over the mind of many women, in regard to the use of water during the menstrual period. While it is true that cold baths, or cold-water bathing, are not advisable for the average woman during the menstrual period (although some especially robust women bathe and swim as usual during this period), this prohibition does not apply to the use of warm water during the period. Lukewarm baths are permissible at this time; and the woman should wash the external genital parts with warm water, with soap if desired, every morning and evening of the period. A vaginal douche of lukewarm water is an excellent adjunct to the bathing of the parts.

    It is astonishing to meet with the superstitious prejudice existing in the minds of some women concerning the use of the vaginal douche; these good creatures seem tothink that it is either unnatural and unhealthy, or else is something “not respectable,” and fit only for the use of immoral women. These women should get in touch with modern hygienic methods, and learn to use the douche at least during their menstrual periods. At this time, if the plain rules of cleanliness are not observed, there often occurs a decomposition of the blood which has gathered in or about the genitals, and an offensive odor is manifested. Some women, while feeling distressed about this odor, are afraid to use lukewarm water in washing themselves, owing to some old unexplored superstition handed down from the great-grandmother’s time.

    The napkins should be changed at least every morning and evening. Unclean napkins may lead to infection, and it is probable that many cases of leucorrhea have their origin in lack of cleanliness concerning the napkins, cloths, or rags, used during menstruation. It may seem almost incredible to the average woman reader, but physicians know of cases (usually among the poorer and more ignorant foreign classes) in which the girl is instructed by her mother, grandmother, or aunts, that she must wear the original cloth or rag during the entire period, as she will “catch cold” by a change to a clean, fresh cloth while the flow continued. Imagine the result of such a practice! This last is an extreme instance, of course, but it will serve to show the absurd and harmful notions prevalent concerning this important natural function, and its incidents.

    Leucorrhea. A very common disorder among women is that known as Leucorrhea, or “the whites.” It consists of a discharge from the Vagina, or the Uterus through the Vagina. It is, in fact, of a catarrhal nature, and results from an over-secretion of the mucus fluids which, in proper quantity, keep the mucus membrane of the said organs in good condition. The discharge manifests in various shades and degrees of consistency. From the character of the discharge, physicians are able to determine whether it comes from the Vagina or the Uterus. The discharge from the Vagina usually is a light creamy fluid; that from the neck of the Uterus is a sticky, thick fluid flowing rather freely; that from the lining of the Uterus is alkaline, and generally precedes and follows menstruation; and that accompanying ulceration of the womb is semi-purulent and offensive in odor.

    Leucorrhea has many causes, among which may be mentioned the following: getting chilled feet or body, particularly during the menstrual period; over exertion and overwork standing on one’s feet; chills following dancing in overheated rooms; excessive worry or emotional strain, etc. It is a quite common complaint, and some assert that fully twenty-five per cent (perhaps more) of all women suffer from it to at least some extent.

    The general treatment of Leucorrhea consists of the building up of the entire system by the proper hygienic methods. Constipation should be removed, and the system is built up by the proper articles of food, exercise, etc. The use of the proper douches are also advised by the best practitioners. Physicians also treat inflamed areas by local treatments consisting of painting the Vagina or neck of the Uterus with certain medicinal solutions. Certain suppositories and douches are also employed in some cases. It is always better to consult a good physician in these cases, particularly where the trouble is aggravated or of long standing.

    A popular writer on the subject gives the following prescription for a vaginal injection: White Fluid Hydrastics, 2 ounces; Borax, 1/2 ounce; Distilled Witch Hazel Extract, 1 pint. Use of this preparation one ounce, diluted in a pint of lukewarm water, as a vaginal injection, taken twice each day.

    A well-known authority gives the following advice concerning treatment of Leucorrhea: “One of the simplest things is an alum tampon. You take a piece of absorbent cotton, about the size of a fist, spread it out, put about a tablespoonful of powdered alum on it, fold it up, tie a string around the center, insert it in the vagina as far as it will go, and leave it in twenty-four hours. Then pull it gently by the string and syringe yourself with a quart or two of warm water. Such a tampon may be inserted every other day or every third day, and I have known where this simple treatment alone produced a cure. In some cases, however, douches work better, and the two best things for douching are: tincture of iodine and lactic acid. Buy, say, four ounces of tincture of iodine, and use two teaspoonsful in two quarts of hot water in a douche bag. This injection should be used twice a day, morning and night. Of the lactic acid you buy, say, a pint, and use two tablespoonsful to two quarts of water. The lactic acid has the advantage over the tincture of iodine that it is colorless, while the iodine is dark and stains whatever it comes in contact with. Sometimes I order the use of the tincture of iodine and the lactic acid alternately: for one douche the tincture of iodine, for the next the lactic acid, and so on. When the condition improves, it is sufficient to use one teaspoonful of the tincture of iodine and one tablespoonful of the lactic acid to two quarts of water. These injections are quite efficient and have the advantage of being perfectly harmless. One point about the injections: they should be taken not in the standing or squatting position (in which position the fluid comes right out), but while laying down, over a douche pan. The douche bag should be only about a foot above the bed, so that the irrigating fluid may come out slowly; the patient, after each injection taken in the daytime, should remain at least half an hour in bed (in the nighttime she stays all night in bed.) This gives the injection a better chance to come in contact with all the parts of the vagina, and a portion of it comes in contact with the cervix, where it exerts a healing effect. Avoid the use of patent medicines.”

    Uterine Displacement. The woman suffering from Uterine Displacement should, of course, consult a competent physician and be governed by his advice. The following suggestions, however, will be found to be of service in many cases:

    In the case of Prolapsus, or falling of the womb, many women have found great relief, and in many cases permanent improvement, by taking occasional rests in bed for an hour or so, with the feet and lower part of the legs raised at least eight inches above the level of the head. In this plan, the Uterus is replaced by gravitation. Some authorities advise practicing waist-breathing while lying in this position, thus exercising the abdominal muscles. Dr. Taylor says: “Increase the pump-like action of the chest, and it will be found that the displaced viscera will return to their normal position.” Some have also found relief from the use of alum-water vaginal injections once or twice each day. The alum-water is prepared by dissolving one heaping teaspoonful of powdered alum in a pint of lukewarm water. This last treatment often strengthens the vaginal muscles whose yielding has at least partially been the cause of the falling womb.

    In cases of Retroversion, in which the Uterus is turned or bent backward, the “knee and chest” position will often aid in causing the organ to regain its normal position. In this position the woman kneels, and rests her chest upon the bed, thus causing the hips to be elevated.

    In cases of Antroversion, in which the Uterus is turned or bent forward, relief is often obtained by the woman resting upon the back, using a pillow to elevate her hips.

    Intercourse During Menstruation. It would seem that the natural esthetic repulsion to the exercise of the marital relations during the menstrual period should be sufficient to deter men and women from indulgence at this time; but many seem to have overcome this instinctive repulsion, and to these a stronger reason must be given—and the reason is at hand. The reasons in question are as follows: first, that congestion of the Uterus and Ovaries sometimes results from this unnatural practice; second, that the man may possibly contract an inflammation of the urethra by infection from the degenerated membrane, tissue, blood, etc., of the menstrual flow; and third, that such practices may result in the aggravation of discharges from the woman, such as leucorrhea, etc.

    Intercourse During Pregnancy. The best authorities advise total abstinence from sexual intercourse during the period of pregnancy; but in view of the fact that such abstinence is very difficult for most men, and that few will persist in it, it is thought well to point out the fact that at least an extreme moderation is desirable in such cases. A leading authority says on this point: “During the first four months of pregnancy, no change need be made in the usual sex relations; their intensity should be moderated, their frequency need not. During the fifth, sixth, and seventh months, intercourse should be indulged in at rarer intervals—once in two or three weeks—the act should be performed without any violence or intensity. During the eighth and ninth months relations had best be given up altogether. And this abstinence should last until about six weeks after the birth of the child. During this period the uterus undergoes what we call involution; that is, it goes back to the size and shape it had before pregnancy, and it is best not to disturb this process by sexual excitement, which causes engorgement and congestion.”

    Sterility in Women. Sterility, or barrenness, i. e., the inability to bear children, is frequently met with among married people. It is usually blamed upon the woman, whereas in at least one-half of the cases the fault is with the man.

    The causes of sterility in women are usually one or more of the following: Inflammation of the Fallopian Tubes, which may have been caused by gonorrhea or ordinary inflammation—in some rare cases childbirth has been known to set up an inflammation in this region, which has prevented the woman from future childbearing—the inflammation causes the tubes to clog up or become closed, so that no more ova can pass through them from the ovaries to the womb; in some cases, also, severe cases of leucorrhea have caused sterility, as the discharge is sometimes fatal to the life of the spermatozoa and destroys them; in other cases misplacement of the womb causes sterility; also severe inflammation of the neck or mouth of the womb operates in the same way, in some cases. In cases of sterility, the woman should have an examination made by a competent physician, and it often will be found that the cure of the disorders above noted will work a cure of the sterility.

    But, in all cases of sterility, it will be found that the husband should be examined as well as the wife—in fact, many authorities insist that the husband should be examined first. Venereal diseases frequently produce sterility in the man, although he is loath to admit this and is apt to place the blame entirely upon the woman.

    Miscarriage and Abortions. The terms “miscarriage,” and “abortion,” respectively, mean the expulsion of the fetus from the womb before its natural time of delivery. In common usage, the term “miscarriage” is usually employed to indicate instances in which the premature delivery has occurred without any voluntary act on the partof the woman, or other persons acting with her permission; the term “abortion” being reserved for instances in which the miscarriage has been voluntarily produced.

    When the fetus dies within the womb of the mother, it is usually expelled spontaneously within a few days or even a few hours. Some women suffer from certain weakness which result in habitual miscarriage; such women seem unable to carry the child for the full natural term, and lose it at some time during the period of gestation. Like results often arise from certain diseases, principal among which is syphilis. In some cases the physician produces what is known as “therapeutic abortion,” for the purpose of saving the life of the woman—this is sanctioned by medical custom and by law. Other forms of abortion, performed for the purpose of preventing the progress of the gestation, and designed for the destruction of the embryo or fetus, are known as “criminal abortion,” and are punishable by several legal penalties.

    Abortions are frequently followed by severe illness, invalidism, or even death for the woman. Many women have had their entire lives ruined by this evil practice. It is one of the curses of modern civilization, and one which must be removed by means of rational instruction and education along the lines of sexual science if the race is to be prevented from deterioration. The subject will be further considered in the subsequent lessons in this book.

    The best advice to those who have contemplated the performance of abortion is simply this: Don’t; Don’t; DON’T!

    PRIVATE Sex Advice to Women By R. B. Armitage, M. D.

    For Young Wives and those who Expect to be Married.

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  • GESTATION OR PREGNANCY

    GESTATION OR PREGNANCY

    Gestation is “the act of carrying young in the Uterus, from the time of conception to that of parturition.” Conception occurs at the moment of the impregnation of the ovum; parturition is the act of delivery, or childbirth. Pregnancy is “the state of being with child.” The terms “period of gestation,” and “period of pregnancy,” respectively, are employed by medical authorities to designate the time during which the mother carries the young within her own body—from the moment of the impregnation of the ovum until the moment of the final delivery of the child into the outer world.

    The term of pregnancy in woman continues for over nine calendar months (or ten lunar months)—from about 275 to 280 days, though in exceptional cases it may be terminated in seven calendar months, or on the other hand may continue for ten calendar months. The usual method is to figure 280 days from the first day of the last menstruation. A simple method of calculating the probable date of delivery is as follows: Count back three months, and then add seven days, and you will have the date of probable delivery. Example: A woman’s first day of last menstruation is March 28. Counting back three months gives us December 28; and adding seven days to this gives us January 4, as the date of probable delivery. There will always be a possible margin of a few days before or after the ascertained probable date—but the delivery will very closely approximate said date. Ignore the shortage of days of February in this calculation, the same being covered by the general margin allowed.

    Development of the Impregnated Ovum. In the preceding lesson we terminated our consideration of the impregnated ovum at the point at which, after the process of segmentation, the “primitive trace” had appeared. This primitive trace appears as an opaque streak, or straight line, formed of an aggregation of cells of a distinctive quality. This delicate “trace” or “streak” is the first indication of the form of the coming child. It is the basis, pattern, or mould, in or around which the spinal column is to be formed, and around which the entire young body is to be developed by the wonderful and intricate processes of dividing and reduplication, and the folding and combination of cells. From one end of this “trace” develops the head; from the other end develops the lower end of the spine. At a later stage there appear tiny “buds” in the positions at which the arms and legs should be; these gradually develop, and their ends split into tiny fingers and toes, and finally are transformed into perfect little arms and legs, miniatures of those of the adult human being.

    The term “the embryo” is employed to designate the developing young creature in the earlier stages of its development, particularly before the end of the third month of its existence. After the end of the third month the embryo is called “the fetus.” In the short space of 280 days the young creature evolves and develops from a single simple cell into a complex organism—a perfect miniature human being. Nature works a wonderful miracle here, and yet so common is it that we take it all as a matter of course, and lose sight of the miracle. From the most simple forms are formed in the developing creature the most complex organs and parts. The heart is formed from a tiny straight line of cells, by enlargement and partition. The stomach and intestines, likewise, develop from a tiny straight line of cells arranged as a tiny tube—the stomach is formed by dilation of one part of the tube, while the large intestine experiences a similar though lesser distention and a greater growth in length; the smaller intestines being formed by growth in length and circumference. The other organs evolve from similar simple beginnings.

    The embryo is nourished during its earlier stages by means of the “yolk sack,” or “umbilical vesicle,” which is outside the body of the embryo, being joined to it by means of the umbilical duct. This yolk sack (originally formed by a “drawing together” in the ovum, which thus separates itself into two portions or areas) is an important feature of the life of the embryo, as it nourishes and sustains it in its earlier stages. Blood vessels form in this yolk sack, and after a time its fluid is absorbed, and after the third month the sack gradually disappears.

    After the passing away of the yolk sack, the embryo is nourished and sustained by the “allantois,” another peculiar sack which is formed. This sack readily becomes filled with blood-vessels, and serves to nourish the embryo by sustenance obtained from the body of the mother through the walls of the Uterus, a direct communication with the blood-vessels of the mother thus being secured. The blood in the embryo, and that in the mother, come into close contact, thus allowing the embryo to be nourished by the blood of the mother. After a time, in turn, the allantois diminishes and dwindles away, its offices being taken up and performed by the “placenta” or “afterbirth.”

    The Placenta or Afterbirth. The Placenta, or afterbirth, is a round, flat substance or organ, contained within the Uterus, by which communication and connection is established and maintained between the fetus and the mother, by means of the umbillical cord. It is a flat, circular mass, about seven inches in diameter, and weighing about sixteen ounces. It is attached to the sides of the Uterus of the mother during the period of gestation, and is expelled from the body of the mother, as “the afterbirth,” after the birth of the child.

    Let us pause a moment, and reconsider the several steps in Nature’s plan for nourishing the embryo and fetus. In the first place, as we have seen, there is the yolk sack or umbillical vesicle, filled with a fluid which nourishes the embryo. This gradually disappears in time, and is replaced by the “allantois” which by connection with the walls of the Uterus is enabled to nourish the fetus from and by the blood of the mother. For a short time, however, the embryo is nourished by both the yolk sack and the allantois. Then the allantois assumes the entire task, and the yolk sack passes away. Then, later, the placenta replaces the allantois, and the latter passes away as did its predecessor. The placenta works along the same general lines as the allantois, but is a far more complex way and with a much higher degree of efficiency, as we shall see presently.

    The placenta is connected with the body of the fetus by what is known as “the umbillical cord.” The “umbillicus” or “navel” in the human being marks the place at which the umbillical cord entered the body of the fetus, from which it was severed after the birth of the child. The purpose of the umbillical cord is to contain and support the umbillical arteries and veins through which the fetus obtains nourishment from the placental substance, and through which the return blood flows. The rich red arterial blood is carried from the placenta to the fetus, and is then distributed over the body of the fetus, nourishing and building it up; the dark venous blood, laden with the waste products of the body of the fetus, is carried back to the placenta, there to be repurified and rendered again rich and nourishing.

    The story of the circulation of the blood of the fetus is most interesting. Although the fetal blood is derived from that of the mother, as we have said, yet the maternal blood does not pass directly from the circulatory system of the mother into that of the fetus; nor does the blood of the fetus return directly into the circulatory system of the mother. In fact, the fetal blood never comes in direct contact with that of the mother, or vice versa. The fetus has an independent circulatory system of its own, and yet, at the same time, from the moment of the placental connection until the moment of childbirth, all its nourishment is derived from its mother.

    The secret of the above paradoxical statement is made apparent when we understand the meaning of the scientific term “osmosis.” Osmosis is “the passage of a fluid through a membrane”; it is a chemical process, caused by the chemical affinity between two liquids or gases separated one from the other by a porous diaphragm or substance. In the process of osmosis in the case before us, the fetal blood takes up nourishing substances and oxygen from the blood of the mother, and passes on to the latter the waste products of the fetal system, by means of passing these substances through the thin porous membranes which separate the two independent systems of blood vessels, i. e., the system of the fetus, and that of the mother. Before birth, in fact, the fetus has its blood nourished and oxygenated by means of the food partaken of by its mother, and the oxygen taken in by the mother in her breathing. After its birth, the infant eats and breathes for itself, and thus nourishes its blood supply directly, instead of receiving it indirectly from the mother.

    The Placenta begins to be formed about the third month of gestation, and continues to develop steadily from that time. At the time of the delivery of the child the Placenta covers nearly or quite one-third of the inner space of the distended Uterus of the mother. The total “afterbirth” consists of the Placenta, the umbillical cord, and the remaining membranes of the ovum, all of which are expelled after the birth of the child.

    The Amnion. An important appendage contained in the Uterus in connection with the developing fetus is that known as “The Amnion.” This is an inner sack which forms within the womb, and which serves to enclose the fetus, and also to sheath the umbillical cord. The Amnion encloses the embryo very snugly during the early stages of its development, but it gradually becomes distended with a pale watery fluid, known as “the amniotic fluid,” the purpose of which is to “float” the fetus and to give it mechanical support on all sides. This fluid is composed of water carrying in solution small quantities of albumin, urea, and salt.

    Sex in the Embryo and Fetus. It is impossible to determine the sex of the embryo during its early stages. During the fourth week the first traces of the sexual glands appear, but not until the fifth week can the sex be determined even by the microscope. If the embryo is to become a male, certain ducts are transformed into convoluted tubules, and each is attached to the testes which have been formed from the genital nucleus. If the embryo is to become a female, the ducts join to form the uterus and vagina, other portions being transformed into the fallopian tubes and connecting with the ovaries which have been formed otherwise. The outer genitals appear in the early stages of the embryo, but there is no apparent distinction between the sexes, the external organs being the same in all cases, and consisting of a small tubular organ with a small lateral fold of skin on either side. Later, in the male, a groove appears on the under side of this primitive organ, thus forming the urethra, the scrotum being formed from the folded skin at the side. In the female, the primitive organ ceases to develop as in the male, and thus becomes proportionately smaller, and evolves into the clitoris of the female; the two lateral folds, on each side, being transformed into the labia majora, or “outer lips” of the female external genitals.

    Position of the Fetus. During the period of gestation the fetus lies “curled up” in the bag of the amnion. The head is usually relaxed and inclined forward, the chin resting on the breast; the feet are bent up in front of the legs, the legs bent up on the thighs, the knees separated from each other, but the heels almost touching on the back of the thighs; the arms bent forward and the hands placed between them as though to receive the chin between them. The folded-up fetus forms an oval, the longest diameter of which is about eleven inches at its greatest stage of growth. Nature here shows a wonderful ability to pack the fetus into as little space as possible, and in such a position as to protect it from injury, and to discommode the mother as little as possible.

    The following interesting statement made by Helen Idleson, M. D., in a European medical journal several years ago, gives a very clear idea, expressed in popular terms, of the appearance and characteristics of the embryo or fetus in the various stages of its development:

    “The growth of the embryo after fecundation is very rapid. On the tenth day it has the appearance of a semi-transparent grayish flake. On the twelfth day it is nearly the size of a pea, filled with fluid, in the middle of which is an opaque spot, presenting the first appearance of an embryo, which may be clearly seen as an oblong or curved body, and is plainly visible to the naked eye on the fourteenth day. The twenty-first day the embryo resembles an ant or a lettuce seed. Many of its parts now begin to show themselves, especially the cartilaginous beginnings of the spinal column, the heart, etc. The thirtieth day the embryo is as large as a horse-fly, and resembles a worm, bent together. There are as yet no limbs, and the head is larger than the rest of the body. When stretched out it is nearly half an inch long. Toward the fifth week the heart increases greatly in proportion to the remainder of the body, and the rudimentary eyes are indicated by two black spots toward the sides, and the heart exhibits its external form, bearing a close resemblance to that in an adult. In the seventh week, bone begins to form in the lower jaw and clavicle. Narrow streaks on each side of the vertebral column show the beginning of the ribs. The heart is perfecting its form, the brain enlarging, and the eyes and ears growing more perfect, and the limbs sprouting from the body. The lungs are mere sacks, and the trachea is a delicate thread, but the liver is very large. In the seventh week are formed the renal capsules and kidneys.

    “At two months, the forearm and hand can be distinguished, but not the arm; the hand is larger than the forearm, but it is not supplied with fingers. The distinction of sex is yet difficult. The eyes are prominent. The nose forms an obtuse eminence. The nostrils are rounded and separated. The mouth is gaping, and the epidermis can be distinguished from the true skin. The embryo is from one-half to two inches long, the head forming more than one-third of the whole. At the end of three months, the eyelids are distinct but shut; the lips are drawn together; the forehead and nose are clearly traceable, and the organs of generation prominent. The heart beats with force; the larger vessels carry red blood; the fingers and toes are well defined, and the muscles begin to be developed.

    “At the fourth month, the embryo takes the name of ‘fetus.’ The body is six to eight inches in length. The skin has a rosy color, and the muscles produce a sensible motion. A fetus born at this time might live several hours. At five months the length of the body is from eight to ten inches. At six months, the length is twelve and one-half inches. The hair appears on the head, the eyes closed, the eyelids somewhat thicker, and their margins, as well as their eyebrows, are studded with very delicate hairs. At seven months, every part has been increased in volume and perfection; the bony system is nearly complete; length, twelve to fourteen inches. If born at this period, the fetus is able to breathe, cry and nurse, and may live if properly cared for.

    “At eight months, the fetus seems to grow rather in length than in thickness; it is only sixteen to eighteen inches long, and yet weighs from four to five pounds. The skin is very red, and covered with down and a considerable quantity of sebaceous matter. The lower jaw, which at first was very short, is now as long as the upper one. Finally, at term, nine months, the fetus is about nineteen to twenty-three inches long, and weighs from six to eight pounds. The red blood circulates in the capillaries, and the skin performs the functions of perspiration; the nails are fully developed.”

    Another writer says: “There is a superstition that a child born at eight months is not as liable to live as if born at seven months; indeed, many suppose that an eight months’ child never survives. Facts do not prove this idea to be correct. Personally, I have known several eight months’ babies to live and do well, and I believe that their chance of life is much greater than if born at seven months.”

    Children born in the seventh month of gestation are capable of living, though great care is required to rear them for the first few months after birth. The “incubators” now so common in large cities have greatly increased the chances of the “seven months’ child,” and, for that matter, of those born even earlier. There are a number of cases of record where children have been born after six months of gestation, and a few even before the six months, but these cases are rare and unusual, and such children usually die soon after birth.

    The following table, given by a good authority, shows the average length and weight of the human embryo and fetus:

    Age. Length in inches. Weight.
    2 weeks 0.1 Not given
    3 weeks 0.2 3 grains
    4 weeks 0.3 Not given
    5 weeks 0.5 Not given
    6 weeks 0.7 Not given
    7 weeks 0.9 Not given
    8 weeks 1.5 4 drachms
    3 months 3.0 2 ounces
    4 months 6.0 5 ounces
    5 months 9.0 10 ounces
    6 months 12.0 1 pound
    7 months 15.0 3 pounds
    8 months 17.0 5 pounds
    9 months 20.0 6 to 9 pounds

    Professor Clark holds that if at birth the infant weighs less than 5 pounds, it rarely thrives, though the records show that many infants weighing much less than this have lived and thrived. In very rare cases, infants have been known to weigh no more than one pound at birth, and to have still survived and thrived. And, on the other hand, many cases are known where infants were born, and thrived, who weighed more than twice the average weight. So, at the last, it is difficult to lay down hard and fast rules in the case.

    Delivery. At the termination of the period of gestation, the child is born into the world, and, instead of depending upon the blood of the mother for nourishment and oxygen, it begins to ingest its own food, to eliminate its own waste matter through the regular channels of the body, and to use its own lungs for the purpose of obtaining oxygen for its blood and to burn up the waste products in the lungs.

    The process of bringing a child into the world is called “parturition.” The fetus is expelled from the body of the mother by the contraction of the muscles of and around the Uterus, and also by the contraction of the abdominal walls. In the early stages of labor, the uterine muscles are brought into play; but when the fetus enters into the vaginal passage the abdominal muscles manifest their energy. The uterine and abdominal muscular movements are purely involuntary, although the mother may aid in the delivery by voluntary muscular movements. The involuntary muscular movements are due to the reflex action originating, probably, in a part of the spinal cord.

    The uterine contractions are rhythmical, and have been compared to the contraction of the muscles of the heart. Each “labor pain” begins with a minimum of contraction, the activity increasing until a maximum is reached, when it gradually decreases, only to be followed a little later by a new contraction. When the fetus is finally expelled from the Uterus (followed later by the placenta or “afterbirth”) that organ begins a gradual contraction to its normal size, shape, and condition, the restorative process usually lasting over several weeks.

    The Physical Signs of Pregnancy. The physical signs of pregnancy in the case of women of normal health are as follows:

    (1) Cessation of the menses, or menstruation. While it is true that a non-pregnant woman may occasionally pass over a menstrual period, yet as a general rule the complete cessation of a period by a married woman, particularly when the woman has previously been regular in this respect, may be considered a probable indication of pregnancy; and when the second period has been passed the probability merges almost into a certainty. An examination by a competent physician will set all doubts at rest.

    (2) Enlargement of the breasts. This indication usually manifests itself in about six or eight weeks after conception. This enlargement is usually preceded by a sensation of tingling and throbbing. The enlargement is manifested in the form of a rather hard and knotty increase, differing from the ordinary fatty increase; the lobules, arranged regularly around the nipple, are plainly distinguishable beneath the skin by means of the touch of the fingers.

    (3) Darkening of the areolar tissue surrounding the nipple. In the unimpregnated condition this tissue is of a pinkish shade; but after impregnation the shade grows darker and the circle increases in size. However, when the woman bears several children in somewhat rapid succession, this dark color may become permanent and accordingly ceases to be an indication.

    (4) Enlargement of the abdomen. This indication manifests itself about the second month, at which time the Uterus begins to elevate the intestines by rising up from the pelvis. In the fourth month the Uterus has risen so far out of the pelvis that it assumes the form and appearance of a hard round tumor. The entire abdomen then begins to enlarge. The Uterus causes an enlargement in the region of the navel at the sixth month, and the region of the diaphragm at the ninth month.

    (5) Quickening, or “signs of life.” This indication manifests first from the fourth month to the fifth—at about the exact half of the entire period of gestation. At this time, and afterward, the movements of the embryo are plainly discernable to the mother.

    The Disorders of Pregnancy. There are a number of physical disorders usually accompanying pregnancy, some of which are trifling, but some of which require the advice of a competent physician. The best plan is for the woman to consult a physician shortly after she discovers herself to be pregnant, and thereafter to visit him occasionally for advice during the period of gestation. The too common plan of postponing the call upon the physician until the eighth or ninth month is not a wise one, for in many cases the advice of a competent physician at an earlier stage of the pregnancy will obviate serious complications. The call upon the physician should usually be made not later than the third or fourth month, and positively not delayed longer than the fifth month. The physician should make an examination to ascertain whether the child is in the normal position in the Uterus, and should also examine the urine each month to ascertain whether the kidneys are functioning normally.

    What is called “morning sickness” is one of the most common of the disorders of pregnancy. It is marked by nausea or vomiting, or both, early in the morning, usually shortly after arising. Some women have at least faint symptoms of this disorder from the very beginning of conception, but usually it does not manifest until the third, fourth, or fifth week of pregnancy. It usually ceases at the end of the third or fourth month. Except in very severe cases, in which the physician should be consulted, the disorder is not serious, and requires but a little common-sense treatment, and rational habits of living. An authority says: “Eat of some fruit that best agrees with palate or stomach; drink hot water; eat nothing until a real hunger demands food. Where nausea occurs after eating, a tart apple or orange is good.” Another authority says: “Let women suffering from morning sickness try acid fruit—apples, oranges, or even lemons, if their sourness is not unpleasant. If a single orange or apple after each meal does not suffice, let them try two; let them eat ten if that number is necessary to conquer the distress. The principle is a correct one, and the relief certain. Let fruit be eaten at all hours of the day—before meals and after, on going to bed at night and at getting up in the morning. If berries are in season, let them be eaten in the natural state—that is, without sugar. If the sickness still continues, omit a meal now and then, and substitute fruit in its stead. By persistence in this course, not only will nausea be conquered, but an easy confinement guaranteed.”

    The pregnant woman often develops a capricious appetite. This disorder may manifest in one or more of several forms, as for instance: the woman may lose her appetite, and take but little food; or she may develop an abnormally large appetite, and eat much more than is necessary; or she may take a dislike to certain kinds of food—many women have an aversion toward meat during pregnancy; or she may have a “craving” for certain articles of food, sometimes for kinds of food not liked at other times, such as sour pickles, sour cabbage, etc. A little common sense, and the presence of attractive articles of fruits, etc., will do much to relieve these troubles; in extreme cases the physician’s advice will help.

    The pregnant woman should have her teeth put in good order as soon as possible, as troubles with teeth sometimes manifest themselves during pregnancy, and give much trouble and annoyance. Difficulty in urination, constipation, piles, irritation or itching of the genital organs, varicose veins, liver spots, and similar disorders, which are sometimes manifest during pregnancy, in some form or degree, should receive the attention and care of a competent physician.

    The following general advice from a competent authority is worthy of being followed: “If everything is satisfactory, if there is no severe vomiting, kidney trouble, etc., the usual mixed diet may continue. The only changes I would make are the following: Drink plenty of hot water during the entire time of pregnancy: a glass or two in the morning, two or three glasses in the afternoon, the same at night. From six to twelve glasses may be consumed. Also plenty of milk, buttermilk and fermented milk. Plenty of fruit and vegetables. Meat only once a day. For the tendency to constipation, whole wheat bread, rye bread, bread baked of bran, or bran with cream. As to exercise, either extreme must be avoided. Some women think that as soon as they become pregnant, they must not move a muscle; they are to be put in a glass case, and kept there until the date of delivery. Other women, on the other hand, of the ultra-modern type, indulge in strenuous exercise, and go out on long fatiguing walks up to the last day. Either extreme is injurious. The right way is moderate exercise, and short, non-fatiguing walks. Bathing may be kept up to the day of the delivery. But warm baths, particularly during the last two or three months, are preferable to cold baths.”

    Childbirth. The first indication of approaching delivery of the child is that of the descent of the child into the pelvis of the mother, from its former position up near the diaphragm. When this occurs, the mother usually experiences a feeling of relief, and a greater ease in breathing because of the relaxation of the former pressure on the diaphragm. Sometimes this occurs several days preceding delivery, while in other cases it occurs only a few hours before delivery. There usually occurs about the same time a slight discharge of mucus tinged with blood. The latter is called “the show,” and is caused by the unsealing of the mouth of the womb, and indicates that the Uterus is preparing to discharge its contents.

    Labor, in childbirth, consists of three stages. In the first stage, the Uterus alone contracts, and the mouth of the womb dilates; in the second stage, the abdominal muscles assist the Uterus in expelling the child; in the third stage, the Placenta (afterbirth) and membranes are expelled.

    After the delivery of the child, and after the pulsation in the umbillical cord has ceased (usually from ten to thirty minutes after delivery), the umbillical cord is severed and tied by the physician. In natural labor, the expulsion of the afterbirth occurs from within a few minutes to an hour after the delivery of the child. Nature is sometimes slow in expelling the afterbirth, but caution should be exercised in the matter of using force to assist Nature in this matter, for injury to the Uterus has often resulted from malpractice in such a case. The afterbirth is not firmly attached to the womb, but is like the peel of an orange which Nature sloughs off in due time.

    PRIVATE Sex Advice to Women By R. B. Armitage, M. D.

    For Young Wives and those who Expect to be Married.

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  • Monkeys made their way from Africa to South America at least twice

    Monkeys made their way from Africa to South America at least twice

    Two lineages of ancient monkey migrated from Africa to South America more than 30 million years ago. But we’re not sure which ones got there first
    Monkeys made their way from Africa to South America at least twice
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    https://www.newscientist.com/article/2240325-monkeys-made-their-way-from-africa-to-south-america-at-least-twice/?utm_campaign=RSS%7CNSNS&utm_source=NSNS&utm_medium=RSS&utm_content=home

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  • Driving ROI Once Your Email is Delivered

    Even with a superior deliverability rate, are your email marketing results everything they could be? Getting your email delivered is only the first step in marketing via email. Your emails must arrive in a manner that encourages action on the part of the recipient. This whitepaper addresses several components of email marketing that matter after you?re in the inbox, as well as aspects you can control to encourage more opens, more click-throughs and more conversions.

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    http://www.associationofmarketing.org/whitepapers/view.php?whitepaper_id=70

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  • Speed of Covid-19 deaths shock doctors and nurses

    Speed of Covid-19 deaths shock doctors and nurses

    Speed of Covid-19 deaths shock doctors and nurses 1

    NEW YORK: One medical worker called it “insane”, another said it induces paranoia – the speed with which patients are dying from the novel coronavirus is shocking even veteran doctors and nurses as they scramble to determine how to stop such sudden deterioration.

    Patients “look fine, feel fine, then you turn around and they’re unresponsive”, said Diana Torres, a nurse at Mount Sinai Hospital in New York, the epicentre of the pandemic in the US where the virus has infected nearly 430,000 people and caused more than 14,700 deaths.

    “I’m paranoid, scared to walk out of their rooms.”

    It isn’t just the elderly or patients with underlying health conditions, who can be fine one minute, and at death’s door the next.

    It can happen for the young and healthy, too, health professionals told Reuters.

    A young woman died unexpectedly while nurse Laurie Douglas was on duty at Our Lady of the Lake Hospital in Baton Rouge, Louisiana.

    After 34 years on the job, Douglas said she normally has “an intuition of who is going to fade and who may improve”.

    “But these people are throwing that out the window.

    “Last week, she was planning her wedding.

    “This week, her family is planning her funeral,“ she said, referring to the deceased patient.

    Patients might enter the hospital with strong oxygen levels and be engaged in happy conversation, said a resident emergency doctor at New York-Presbyterian Hospital, only to be “gasping for breath” and intubated a few hours later.

    “The scary thing is there are no rules to it,“ the resident said on condition of anonymity.

    These scenes are playing out everywhere as Covid-19 has infected more than 1.4 million worldwide and killed more than 85,000 as of Wednesday.

    The quick turns for the worse are likely products of an “overly exuberant” reaction by the immune system as it fights the virus, said Dr Otto Yang, an infectious disease specialist at the UCLA Medical Centre in Los Angeles.

    Called a cytokine storm, it occurs when the body overproduces immune cells and their activating compounds – cytokines – causing dangerously high blood pressure, lung damage and organ failure.

    Emily Muzyka, 25, a nurse in the New York suburbs, said she reached her breaking point last week, when a relatively healthy 44-year-old woman needed sudden intubation.

    “I had a meltdown that night,“ she said.

    “I cried to my boyfriend.”

    Intubation refers to inserting a tube into the mouth and through the airway of a Covid-19 patient struggling to breathe, so they can be hooked to a mechanical ventilator.

    Journalist Anick Jesdanun, who was in good health and had run 83 marathons, died last week from Covid-19, according to a post on Facebook by his cousin Prinda Mulpramook.

    Jesdanun, who was 51, at first didn’t need hospitalisation, according to the post.

    He had begun to recover and showed clear lungs and strong vital signs during a doctor’s visit in late March. But “a sudden setback” sent him to the emergency room on April 1, and “13 hours later we lost him”, Mulpramook wrote.

    A nurse at Mount Sinai’s intensive care unit recalled watching patients’ kidneys quickly shut down, adding that many require intravenous drips of the blood thinner Heparin.

    “It’s insane how sick they get, how quickly.

    “We’re really trying hard to figure out how to treat them.”

    Some of those hospitals are experimenting with unproven drugs in hopes of helping patients, including the anti-malaria medication hydroxychloroquine.

    “We’re essentially throwing the kitchen sink at these patients,“ a doctor said.

    Speed of Covid-19 deaths shock doctors and nurses
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    https://www.thesundaily.my/home/speed-of-covid-19-deaths-shock-doctors-and-nurses-AF2241516

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  • Will the MCO be extended? You’ll get the answer today

    Will the MCO be extended? You’ll get the answer today

    Will the MCO be extended? You’ll get the answer today 2

    KUALA LUMPUR: The question that is on everyone’s mind – whether the Movement Control Order (MCO) which ends on April 14 is extended – will be answered today.

    According to a statement by Health Director-General Datuk Dr Noor Hisham Abdullah in a press conference yesterday, Prime Minister Tan Sri Muhyiddin Yassin is expected to make an announcement today on further measures to curb the spread of the Covid-19 outbreak.

    He is also expected to make the much-awaited announcement on the status of the MCO which has been enforced since March 18.

    The first phase of the MCO which was introduced to break the chain of Covid-19 infections was from March 18 to 31, followed by the second phase from April 1 to 14.

    As of yesterday, the situation has been encouraging, with 121 patients cured, exceeding the number of 109 recorded positive cases which brings the total of positive cases to 4,228, with 67 deaths.

    Meanwhile, as of yesterday, the compliance rate of the MCO was 97%, and the Royal Malaysia Police has issued 95 compound notices of RM1,000 each to the errant individuals.

    Also, there are currently 24 red zone areas in the country which are the places where the number of Covid-19 positive cases exceeded 41.

    To date, the locations where the Enhanced Movement Control Order (EMCO) has been enforced are Simpang Renggam (Johor), Hulu Langat (Selangor), and three buildings in Kuala Lumpur, namely Menara City One, and the Selangor Mansion and Malayan Mansion buildings.

    Simpang Renggam was the first location where the EMCO was enforced on March 27 after 61 residents were found to be positive for Covid-19, and the order has now been extended to April 14.

    Up till yesterday (April 9), three states have recorded the highest number of positive Covid-19 cases, namely Selangor (1,118), Kuala Lumpur (699) and Johor (503).

    The responsibility now lies with the public to comply with the MCO in order to break the chain of Covid-19 infections. – Bernama

    Will the MCO be extended? You’ll get the answer today
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    https://www.thesundaily.my/local/will-the-mco-be-extended-you-ll-get-the-answer-today-IF2241129

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  • A meeting on digital innovations, TB and implementation research organised by WHO and the European Respiratory Society

    A meeting on digital innovations, TB and implementation research organised by WHO and the European Respiratory Society

    Group of people posing after a meeting on TB, in Geneva

    WHO’s Global Tuberculosis Programme (WHO/GTB) and the European Respiratory Society convened a technical meeting on digital innovations, TB and implementation research, in Geneva on 7 February 2020. This meeting brought together funders,
    partners, representatives of national TB programmes, civil society and scientists to discuss the challenges and opportunities when evaluating, integrating and scaling up digital technologies under programmatic settings.  Specifically, this meeting
    sought to receive input on the elements of a toolkit on implementation research that is currently being developed by WHO/GTB and the Special Programme for Research and Training in Tropical Diseases (TDR) to support evidence-informed use of
    digital technologies under programmatic settings. Th etoolkit will be launched in mid-2020. Considering that several countries are updating their national TB strategic plans and preparing funding proposals for submission to the Global Fund, this meeting
    also sought to create mutual understanding on the importance of resourcing implementation science to bridge the divide between research and practice.

    This present meeting, is the latest in a series of efforts by WHO/GTB to facilitate the meaningful use of digital technologies for TB prevention and care. It
    was preceded by a one-day workshop on 6 February held at the same venue for partner agencies of the ASCENT project. ASCENT is a UNITAID-funded project that started in 2019 with the aim of increasing demand and adoption of affordable digital technologies for TB medication adherence. The project is led by KNCV in partnership with Aurum Institute for Health
    Research, PATH and the London School of Hygiene and Tropical Medicine. Activities are running in Ethiopia, the Philippines, South Africa, Ukraine and Tanzania UR. This was the first in a series of annual meetings that will be coordinated by the WHO/GTB
    to assess progress in implementation of country activities and results from the interventions.

    A meeting on digital innovations, TB and implementation research organised by WHO and the European Respiratory Society
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    https://www.who.int/news-room/detail/26-04-2020-a-meeting-on-digital-innovations-tb-and-implementation-research-organised-by-who-and-the-european-respiratory-society

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  • Strengthening accountability to end TB

    WHO today released a Checklist to enable Member States and their partners to assess the status of work at the national level to strengthen accountability to End TB, principally: national commitments made, actions taken on those commitments, monitoring & reporting approaches, and the nature of any high-level review mechanisms. The Checklist has been developed in response to requests from Member States, regions, civil society and partners as a tool to support the adaptation and implementation of the WHO Multisectoral Accountability Framework (MAF-TB) released in 2019. It responds also to the UN General Assembly request to WHO to ensure implementation of the Framework.

    There are four components of the MAF-TB that form a cycle for strengthening accountability: Commitments, Actions, Monitoring and Reporting, and Review, that were released during the World Health Assembly in May, 2019. In the political declaration of the first UN high-level meeting on TB, world leaders called for WHO to finalize the framework and ensure its implementation in 2019.

    After its publication in May, 2019, WHO began work with pathfinding country counterparts who were seeking to move ahead on key elements including, among others: formal adoption of country-specific targets for 2022 for increased TB case detection and treatment in line with the global targets in the political declaration; updating or development of new national TB strategic plans based on 2022 and 2030 targets and other new commitments; coordination platforms across sectors and stakeholders; formalizing engagement with civil society across End TB efforts;  producing robust performance reports; and, using those reports to inform high-level review bodies that will assess and drive faster progress.  Based on the MAF-TB document, relevant country experiences, and specific requests from countries and partners, WHO developed the MAF-TB Checklist. The Checklist is especially relevant for high TB burden countries, but has content relevant to all countries.  The appropriateness of different approaches may vary, according to national constitutional, legal and/or regulatory frameworks or other relevant factors.

    The MAF-TB Checklist has three annexes on:

    1. engagement across government ministries and bodies;
    2. engagement of civil society and affected communities; and,
    3. adoption  and implementation of WHO TB guidance.

    In releasing this MAF-TB Checklist today, Dr Tereza Kasaeva, Director of the WHO Global TB Programme noted,  “At this enormously difficult time, all countries and partners are focused on the COVID-19 pandemic.  Lessons learnt from ongoing TB programmes are helping the response. Likewise, TB efforts will benefit from learning underway on collaboration, innovation and accountability in confronting the virus.”

    WHO will be helping Ministries of Health and partners to use the Checklist, hold related consultations and move forward with more effective collaboration and review mechanisms.  The WHO Civil Society Task Force on TB also will support countries and civil society partners, using the Checklist. Progress in strengthening accountability will be assessed in the 2020 Report of the UN Secretary-General on progress since the 2018 TB UN high-level meeting, as well as in the WHO Global TB Report 2020.

    The WHO TB Civil Society Task Force, National TB  Programme Managers and other country officials, WHO staff at all levels, consultants working with WHO and The Global Fund, and staff of partner agencies, contributed content to, and/or provided feedback on, the MAF-TB Checklist during its development.   Access the Checklist and 3 annexes.  

    An online form of the checklist will be available shortly here, along with additional information.  

    Translations of the Checklist and annexes, as soon as available in Arabic, Chinese, French, Russian and Spanish, will be posted at the above link as well.   Kindly contact gtbprogramme@who.int if you have questions regarding the MAF-TB Checklist or to request versions in MS Word format if needed.

     

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    https://www.who.int/news-room/detail/08-04-2020-strengthening-accountability-to-end-tb

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