Tag: large

  • A large chunk of Mercury may have been blown away by the sun

    A large chunk of Mercury may have been blown away by the sun

    Mercury is much denser than the other rocky planets in the solar system, and that may be because a collision vaporised its surface and the debris was blown away by the sun
    A large chunk of Mercury may have been blown away by the sun
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  • Indonesia firmly committed to eliminating lymphatic filariasis as a public health problem

    Indonesia firmly committed to eliminating lymphatic filariasis as a public health problem

    Indonesia recently completed the last of its annual large-scale treatment for lymphatic filariasis (also known as elephantiasis or Penyakit Kaki Gajah) in Malaka District located in its southernmost province, East Nusa Tenggara. Unprecedented
    progress by the National Lymphatic Filariasis Elimination Programme has strongly placed the country on the path to achieving the elimination of lymphatic filariasis as a public health problem.

    “We reached an estimated number of 40.7 million people living in the 118 high-risk districts during this month-long treatment campaign in October 2019” said Dr Anung Sugihantono, who recently retired as Director General of Diseases
    Prevention and Control, Ministry of Health Indonesia. “
    Single doses of diethylcarbamazine citrate and albendazole facilitated by WHO were delivered to all eligible populations.”

    In 2010, an estimated 125 million Indonesians were still at risk of the disease and required treatment.

    But things changed considerably in 2015 when Indonesia mounted an annual national campaign to resolutely address transmission of the disease and to tackle the morbidity and disability associated with it. The results were apparent as early as 2017, with
    remarkable progress.

    In Indonesia, LF is considered a significant public health concern. In 2009, risk mapping identified a population of 124.5 million people needing treatment for LF. The country initiated a national level LF elimination campaign in 2015, addressing both
    disease prevention and management. 

    “In 2017 and in just two years we managed to achieve 100% geographical coverage of all people requiring treatment” said Dr Sugihantono. “It meant achieving more than 78% epidemiological coverage – much higher than the generally recommended 65% to stop transmission.”

    Transmission of lymphatic filariasis can be stopped through large-scale treatment (or mass drug administration – MDA) of entire at- risk communities with recommended medicines once a year. These medicines kill the microfilariae in an infected patient’s
    blood preventing mosquitoes to transmit1 the disease to others. Through mass treatment, the aim is to reduce the reservoir of microfilariae in the blood to a level insufficient to maintain transmission by the mosquito vector.

    This strategy to interrupt transmission is the corner-stone of the World Health Organization’s (WHO) Global Program to Eliminate Lymphatic Filariasis (GPELF). Indonesia has been using the GPELF’s strategy since 2002 using a district or city
    as its implementation unit.

    In 2005, it listed the elimination of LF as a national priority for controlling infectious diseases and the medicines it has been using in large-scale treatment programmes are diethylcarbamazine citrate (DEC) and albendazole2 which are
    largely distributed by volunteer community health workers3.

    “Community health volunteers are themselves members of the community and know how to reach people effectively to improve compliance” said Dr. Stefanus Bria Seran, the Regent of Malaka District, one of LF endemic district in Indonesia. “Besides ensuring every single person ingests the medicine given to them, these community workers help in disseminating information well before a large-scale treatment campaign and also assist in reporting activities related to each treatment campaign”. 

    Indonesia’s efforts to eliminate lymphatic filariasis began in the 1970s but faced numerous challenges including programme coordination in the many inhabited islands, conducting information, education and awareness programmes, lack of capacity and
    insufficient medicines.

    Furthermore, the situation in Indonesia is unusual than in many other countries endemic for lymphatic filariasis as the country is endemic for all three species of thread-like filarial worms – Brugia malayi, Brugia timori, and Wuchereria bancrofti –
    that cause the disease. Most of the infections in Indonesia, however, are caused by B. malayi.

    In the past, some of the factors that prevented access to the medicines (DEC and albendazole) were social stigmatization linked to the disease, the vast geography of the territory and challenges in reaching remote populations.

    With an estimated population of 242 million, Indonesia is the world’s largest island nation and consists of approximately 17,000 islands, of which 5,000–6,000 are inhabited. It is the fourth most populated nation behind China, India, and the United
    States.

    Indonesia is endemic for many other neglected tropical diseases and an estimated 110 million Indonesians are believed to suffer from at least one neglected tropical disease (NTD), including lymphatic filariasis and soil-transmitted helminth infections.
    Leptospirosis (not classified as NTD) is also widespread.

    Indonesia is the only country of WHO’s South East Asia Region with endemic schistosomiasis. Like many other countries of the Region, it also faces recurrent threats of dengue outbreaks.

    Global progress

    The world has made significant progress towards the elimination of lymphatic filariasis as a public health problem.

    Sixteen countries4 and one territory are now acknowledged by WHO to have achieved elimination of lymphatic filariasis as a public health problem.  

    Seven additional countries have successfully implemented recommended strategies, stopped large-scale treatment and are under surveillance to demonstrate that elimination has been achieved.

    The disease

    Lymphatic filariasis is caused by infection with parasitic worms living in the lymphatic system. The larval stages of the parasite (microfilaria) circulate in the blood and are transmitted from person to person by mosquitoes.

    Infection involves asymptomatic, acute, and chronic conditions. Most infections are asymptomatic, showing no external signs while contributing to transmission of the parasite. Although asymptomatic, these infections still cause damage to the lymphatic
    system and the kidneys and alter the body’s immune system.

    When lymphatic filariasis develops into chronic conditions it leads to lymphoedema (tissue swelling) or elephantiasis (skin/tissue thickening) of limbs and hydrocele (scrotal swelling). Involvement of breasts and genital organs are common.

    Manifestation of the disease after infection takes time and can result in an altered lymphatic system, causing abnormal enlargement of body parts, and leading to severe disability and social stigmatization of those affected.

     


    1Lymphatic filariasis is transmitted by different types of mosquitoes – e.g the Culex mosquito which widespread across urban and semi-urban areas; Anopheles, mainly found in rural areas; and, Aedes, mainly
    in endemic islands in the Pacific.

    2In 2017, WHO recommended an alternative three drug treatment to accelerate the global elimination of lymphatic filariasis. The treatment, known as IDA, involves a combination of ivermectin, diethylcarbamazine citrate and albendazole.
    It is recommended annually in settings where its use is expected to have the greatest impact.

    3Community health workers, also called ‘cadres’, are volunteers who form part of the communities they serve and work with local
    communities to educate families. Their contribution in promoting health has been significant in the country.

    4Cambodia, The Cook Islands, Egypt, Kiribati, Maldives, Marshall Islands, Niue, Palau, Sri Lanka, Thailand, Togo, Tonga, Vanuatu, Viet Nam, Wallis and Futuna, and Yemen

    Indonesia firmly committed to eliminating lymphatic filariasis as a public health problem
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  • New estimates highlight need to step up the response to hepatitis D

    Lyon, France, 29 April 2020 – In a study published in the Journal of Hepatology, 1 Professor Anna Maria Geretti and Dr Alexander Stockdale from the University of Liverpool (United Kingdom), in collaboration with researchers
    from the World Health Organization (WHO) and the International Agency for Research on Cancer (IARC), estimate that worldwide, hepatitis D virus (HDV) affects nearly 5% of people who have a chronic infection with hepatitis B virus (HBV) and that HDV
    co-infection could explain about 1 in 5 cases of liver disease and liver cancer in people with HBV infection..

    To map the epidemiology of HDV infection in the world, Professor Geretti and Dr Stockdale joined forces with the WHO Global Hepatitis Programme and IARC, alongside investigators in Germany, Malawi, and the United Kingdom. “Infection with HDV occurs
    in about 1 in 22 cases of chronic HBV infection in the world,” Dr Stockdale says. “More high-quality data are needed, but we have identified several geographical hotspots of high prevalence of HDV infection: in Mongolia, the Republic of
    Moldova, and countries in Western and Middle Africa.”

    “Although it is less common than hepatitis B, hepatitis D is a serious disease that often affects underprivileged and vulnerable populations,” says Dr Meg Doherty, Director of the WHO Global Hepatitis Programme. Those who are more likely to
    have HBV and HDV co-infection include people who inject drugs and people with hepatitis C virus or HIV infection. The risk of co-infection also appears to be higher in recipients of haemodialysis, men who have sex with men, and commercial sex workers.
    Dr Doherty points out, “This information helps in identifying the groups with HBV among whom we should be looking for HDV.”

    HDV (formerly known as the Delta agent) is a small virus – one of the smallest that is known to cause disease in humans – and can replicate only in the presence of HBV, from which HDV borrows some of its structures. Compared with people with
    HBV infection alone, those who have a chronic infection with both HBV and HDV have a much higher risk of developing disease in the form of cirrhosis and liver cancer. “HDV is a significant contributor to severe liver disease and liver cancer,”
    says IARC scientist Dr Catherine de Martel. “The findings from this study inform our work on the association between viral infections and cancer, which is focused on developing improved prevention strategies.”

    Professor Geretti concludes, “HDV has long been neglected, because for decades the prevalence of infection remained uncertain and effective treatment was lacking. Mapping the epidemiology of the infection is just the first step. More efforts are
    needed to reduce the global burden of chronic hepatitis B and develop medicines that are safe and effective against hepatitis D and are affordable enough to be deployed on a large scale to those who are most in need.”

    1 Stockdale AJ, Kreuels B, Henrion MYR, Giorgi E, Kyomuhangi I, de Martel C, Hutin Y, Geretti AM (2020). The global prevalence of hepatitis D virus infection: systematic review and meta-analysis. J Hepatol. Published online 23 April 2020;
    https://doi.org/10.1016/j.jhep.2020.04.008

    For more information, please contact

    Véronique Terrasse, Communications Group, at +33 (0)6 45 28 49 52 or terrassev@iarc.fr or IARC Communications, at com@iarc.fr

    The International Agency for Research on Cancer (IARC) is part of the World Health Organization. Its mission is to coordinate and conduct research on the causes of human cancer, the mechanisms of carcinogenesis, and to develop scientific strategies for
    cancer control. The Agency is involved in both epidemiological and laboratory research and disseminates scientific information through publications, meetings, courses, and fellowships. If you wish your name to be removed from our press release emailing
    list, please write to com@iarc.fr. 

    About University of Liverpool

    Founded in 1881 as the original ‘red brick’, the University of Liverpool is one of the UK’s leading research-intensive higher education institutions. Consistently ranked in the top 200 universities worldwide, we are a member of the prestigious
    Russell Group and have a global reach and influence that reflects our academic heritage as one of the country’s largest civic institutions. For more information please visit us at www.liverpool.ac.uk

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  • WHO calls for healthy, safe and decent working conditions for all health workers, amidst COVID-19 pandemic

    WHO calls for healthy, safe and decent working conditions for all health workers, amidst COVID-19 pandemic

    On World Day for Safety and Health at Work, the World Health Organization calls upon all governments, employers and workers organizations and the global community to take urgent measures for strengthen countries’ capacities to protect occupational health and safety of health workers and emergency responders respect their rights to decent working conditions, and develop national programmes for occupational health of health workers and to provide them with occupational health services. Amidst the COVID-19 pandemic, ILO has dedicated World Day for Safety and Health at Work 2020 in addressing the outbreak of infectious diseases at work, in particular, on the COVID-19 pandemic.

    Health workers are at the front line of the COVID-19 outbreak response and as such are exposed to hazards that put them at risk of infection. Hazards include pathogen exposure, long working hours, psychological distress, fatigue, occupational burnout, stigma, and physical and psychological violence.

    Infections with COVID-19, insufficient measures for infection prevention and control, occupational safety and health, mental health and psychosocial support for health workers result in high rates of absenteeism and deplete the health workforce – the most precision resources for stopping the COVID outbreak. 

    Key Messages and Facts

    COVID-19 infections among health workers:

    • As of 21 April 2020 countries reported to WHO that over 35, 000 health workers were infected with COVID19. This number is significantly higher because of underreporting.
    • The major occupational risks for COVID19 infection among health workers are: late recognition or suspicion of COVID-19 in patients, working in a higher-risk department, longer duty hours, sub-optimal adherence to infection prevention and control measures, such as hand hygiene practices, and lack of or improper use of personal protective equipment (PPE). Other factors have also been documented, such as inadequate or insufficient IPC training for respiratory pathogens, including the COVID-19 virus, as well as long exposure in areas in healthcare facilities where large numbers of COVID-19 patients were being cared for.
    • The prevention of infections requires the use of appropriate infection prevention and control measures by all health workers, with a special focus on the adherence to hand hygiene and personal protective equipment when caring for COVID-19 patients, as well as a combination of environmental and administrative controls
    • Health workers infected with COVID-19 following exposure in the workplace should have the right to employment injury benefits for occupational disease, including compensation, rehabilitation, and curative services.

    Violence and stigma against health workers:

    • Health workers are at high risk of violence all over the world. Between 8% and 38% of health workers suffer physical violence at some point in their careers. Many more are threatened or exposed to verbal aggression and social stigma because of their work.
    • In the COVID19 crisis, shortage of staff and resources and increasing social tensions result in increased level of violence against health workers and even attacks against health care facilities. Doctors, nurses, security personnel and those who are assisting in testing, tracing contacts and enforcing physical distancing measures to stop COVID-19 experience threats and aggression.
    • WHO calls upon governments, employers and workers organizations to institute measures for zero-tolerance to violence against health workers at the workplace and at the way to and from their workplace, and for intensifying social support and respect for health workers and their families.

    Long working hours and psychosocial hazards for health workers:

    • Many health workers have to work longer or irregular hours because of the increasing demand for health services. In addition, many countries experience shortage of health workers, or junior staff are working in demanding new roles.
    • Health workers face psychosocial hazards, which are exacerbated during emergencies where demands increase and they have to experience risk of infection witness higher suffering or mortality.
    • Long working hours, shift work, high workload and other psychosocial hazards can lead to fatigue, occupational burnout, increased psychological distress or declining mental health – affecting the health of health workers, and the quality and safety of care delivered.
    • WHO calls for adequate staffing levels and clinical rotation in healthcare facilities, measures to minimize psychosocial hazards, and provision of access to mental health and psychosocial support for health workers.

    The annual World Day for Safety and Health at Work on 28 April promotes the prevention of occupational accidents and diseases globally. It is an awareness-raising campaign intended to focus international attention on the magnitude of the problem and on how promoting and creating a safety and health culture can help reduce the number of work-related deaths and injuries.

     

    WHO calls for healthy, safe and decent working conditions for all health workers, amidst COVID-19 pandemic
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  • Maternal infections in health facilities

    Maternal infections in health facilities

    A clearer picture of the global impact 

    New research from the Global Maternal Sepsis Study (GLOSS), a major WHO/HRP initiative, shows that infection has a much larger impact on global maternal mortality and morbidity than previously thought.

    Logo of the Lancet Global HealthThe
    results from GLOSS, published in The Lancet Global Health, are the first to provide data on frequency of maternal infections and
    sepsis across the pregnancy and post-pregnancy period, in a large number of health facilities around the world. 

    Around 11 women per 1000 live births had an infection which resulted in or contributed to what is known as a severe maternal outcome – either they died or nearly died – during their hospitalization. 

    Urgent improvement is needed to manage this life-threatening risk faced by all pregnant and recently pregnant women, wherever they are in the world. 

    What is maternal sepsis and how does it lead to maternal death?

    Maternal sepsis is a life-threatening condition that arises when the body’s response to infection causes injury to its own tissues and organs during pregnancy, child-birth, post-abortion or the postpartum period.

    The latest global estimates place sepsis due to obstetric infections as the third most common cause of maternal mortality. However, this only includes infections as a direct result of pregnancy, such as endometritis or post-caesarean wound infections.

    Few
    previous studies include post-abortion infections. Neither do they address indirect infections such as respiratory and meningitis, which are aggravated by pregnancy but not directly caused by it.

    A better understanding of maternal infection

    GLOSS was a massive facility-based data collection effort led by WHO, accompanied by a ‘STOP SEPSIS!’ campaign to increase awareness among healthcare providers.

    The study gathered data on women who were admitted with suspected or confirmed infection during pregnancy or post-pregnancy over a one-week period in 2017. More than 2800 women participated in the study in 52 countries.

    GLOSS included healthcare facilities that care for women during pregnancy, childbirth or at the end of pregnancy, as well as facilities without maternity service but where women could be hospitalized during or after pregnancy, and data on infections
    which are not usually recorded as maternal sepsis, including post-abortion and indirect infections. 

    The result is a more complete understanding of the frequency and impact of maternal infections in health facilities. 

    GLOSS calls attention not only to the wider range of risks faced by pregnant women but also to the long period of time during which they are at risk. 

    Putting global numbers on maternal infection and sepsis

    Overall, around 70 pregnant or recently-pregnant women per 1000 live births were found to have a maternal infection needing hospital management. 

    Across the study, 11 women with either direct or indirect infection per 1000 live births developed a severe maternal outcome, but in low- and middle-income countries up to 15 women per 1000 births were affected.

    Infections were the underlying cause of most of the deaths recorded during the study, primarily post-abortion infection and indirect infections. Infections were also present in about a third of deaths attributed to other causes, such as postpartum
    haemorrhage.

    This suggests that the contribution of infection to global maternal mortality and morbidity may be larger than current reports of maternal sepsis mortality suggest.

    Preventing, identifying and treating maternal infection and sepsis

    Some of the most common maternal infections found in the study, such as urinary tract infections, post-caesarean and post-abortion infections, are largely preventable and treatable.

    GLOSS results suggest that current levels of monitoring and clinical care across health facilities are not enough to prevent, identify and treat levels of maternal infection effectively. 

    For instance, a complete set of vital signs was not reported for a third of the women in the study, on the day their infection was suspected or diagnosed. Delays in antimicrobial therapy were frequent.

    GLOSS also shows marked differences across countries, with the highest burden in low- and middle-income countries, compared with high-income countries.

    This may reflect the impact of broader health determinants in different country contexts. Challenges of overcrowding, limited access to water and sanitation and constraints to safe births by skilled birth attendants can reduce the ability of healthcare
    providers to manage the frequency and outcome of maternal infections.

    An opportunity to implement evidence-based practice

    GLOSS gives healthcare providers, policy-makers, and the public at large an opportunity: to mobilise around these data improve evidence-based practice, and save lives. 

    WHO has produced a number of resources which can support timely action to prevent, diagnose and treat maternal infection, as well as activities such as the upcoming SAVE LIVES: Clean Your Hands campaign
    on 5 May which celebrates the central role played by nurses and midwives in clean health care. 

    In addition, WHO will publish a global sepsis epidemiology report around the 73rd World Health Assembly (WHA) in May, as requested in the
    2017
    WHA Resolution on Improving the prevention, diagnosis and clinical managementof sepsis.

    Understanding why and how infection affects women is essential for equipping healthcare providers with life-saving knowledge and enabling health care systems to bring down global maternal mortality and morbidity.

    Related publications

    WHO recommendations for prevention and treatment of maternal peripartum infections

    WHO Clinical practice handbook for safe abortion

    Global guidelines on the prevention of surgical site infection

    WHO statement on maternal sepsis

    World Health Assembly resolution on Improving the prevention, diagnosis and clinical management of sepsis

    Health Topics

    Antimicrobial resistance

    Infection Prevention and Control

    Water Sanitation Hygiene

    Other links

    Global Maternal Sepsis Study

    SAVE LIVES: Clean Your Hands 5 May 2020

     

     

    Maternal infections in health facilities
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  • WHO reports fivefold increase in cyber attacks, urges vigilance

    WHO reports fivefold increase in cyber attacks, urges vigilance

    Since the start of the COVID-19 pandemic, WHO has seen a dramatic increase in the number of cyber attacks directed at its staff, and email scams targeting the public at large. 

    This week, some 450 active WHO email addresses and passwords were leaked online along with thousands belonging to others working on the novel coronavirus response. 

    The leaked credentials did not put WHO systems at risk because the data was not recent. However, the attack did impact an older extranet system, used by current and retired staff as well as partners. 

    WHO is now migrating affected systems to a more secure authentication system. 

    Scammers impersonating WHO in emails have also increasingly targeted the general public in order to channel donations to a fictitious fund and not the authentic COVID-19 Solidary Response Fund. The number of cyber attacks is now more than five times the number directed at the Organization in the same period last year. 

    “Ensuring the security of health information for Member States and the privacy of users interacting with us a priority for WHO at all times, but also particularly during the COVID-19 pandemic. We are grateful for the alerts we receive from Member States and the private sector. We are all in this fight together,” said Bernardo Mariano, WHO’s Chief Information Officer. 

    WHO is working with the private sector to establish more robust internal systems and to strengthen security measures and is educating staff on cybersecurity risks. 

    WHO asks the public to remain vigilant against fraudulent emails and recommends the use of reliable sources to obtain factual information about COVID-19 and other health issues. 

    For more information, please visit: www.who.int/covid-19.

     

    WHO reports fivefold increase in cyber attacks, urges vigilance
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  • RACE SUICIDE

    RACE SUICIDE

    A favorite argument of certain opponents of scientific Birth Control is that such teachings and modes of conduct tend toward Race Suicide, and the consequent weakening and final destruction of the human race by means of “bleeding it white” by draining from it its normal supply of children. Those who hold this view argue that if Birth Control methods become popular, and sanctioned by the law and public opinion, then the race will eventually die out and disappear from the face of the earth. Some vary the argument by insisting that those nations favoring Birth Control would suffer decline and gradual extinction at the hands of other nations opposed to scientific methods of regulating the number and frequency of offspring. This is a serious charge against Birth Control, which if proved would probably serve to array all right-thinking persons against it.

    But the advocates of Birth Control seriously and positively controvert and deny the validity and truth of this argument. On the contrary they claim that scientific Birth Control would not only keep up the population of all countries, or any country, to a normal standard proportionate to its ability to sustain properly such population, but will also act to render that population stronger and better, physically, mentally and morally, and far more efficient in every way owing to improved quality of the stock. The first requisite is met by the reduction of the death rate to meet the decreasing birth-rate; and the second requisite is met by the improvement of the stock by proper rearing and training made possible by the decreased size of the average family. Birth control serves to eliminate the waste caused by excessive infant mortality, and to thus fully counterbalance the decreased birth rate.

    The advocates of Birth Control assert that the natural instinct of parenthood, the love of children, and the desire for offspring and the perpetuation of the family name and stock, are too firmly rooted and grounded in human nature to be seriously affected by such knowledge and practice on the part of the race. They point to the fact that in many families in which intelligent modes of Birth Control are favored, and in which the size of the family has been limited to a few children, the children are, as a rule, better cared for and provided for, better reared and better educated, than in the case of families in which children are brought into the world without thought or reason, and without the possibility of proper care and rearing. Birth Control, say its advocates, will not do away with children, but will merely regulate their number to rational limits, and at appropriate intervals between births. Moreover, it is claimed, that while the birth-rate in such families may be smaller, the death-rate is also smaller. And, at the last, it is the number of children that survive that counts with the race, not those who merely are born.

    The fact that many persons consult physicians for a cure for sterility, and go to great trouble and expense to further the bearing of children, and the fact many childless couples adopt children rather than to have a childless home, are evidence of the fact that there is no danger of the parental instinct dying out. It is the experience of physicians generally that the patients who desire information regarding scientific contraceptive methods are usually those who already have as many children as they can well take care of, and not those who wish to escape parenthood in toto.

    We are constantly reminded that the size of the average family is much smaller than it was a hundred years ago—but still the race is rapidly increasing, owing to the decreased death-rate resulting from a better knowledge of hygiene and medicine. Moreover, it is positively asserted that the “old time large family” frequently had one father but several mothers—the husband marrying several times in order to replace with a new life the old wife who had broken down and died from overwork and excessive childbearing.

    It is claimed that in Holland, in which Birth Control is recognized by law, and where it is legally sanctioned and even encouraged among those who are not able to support large families, statistics show that the population is increasing more rapidly than before, owing to the decreased mortality of infants and young children arising from the better care of those who are born.

    Dr. Robinson says on this point: “Here we have a whole country, Holland, in which the prevention of conception is legally sanctioned, in which the use of preventives is practically universal—and is this country dying out? On the contrary, it is increasing more rapidly than before, because we have this remarkable and gratifying phenomenon to bear in mind, that wherever the birth-rate goes down, the death rate goes down pari passu, or even to a still greater degree. This can be proven by statistics from almost every country in the world. For instance, in 1910 the birth-rate in Holland was 32, and the mortality 18; in 1912 the birth-rate fell to 28, but then the mortality rate fell still lower, namely to 12, so we see an actual gain in population, instead of a loss. And the physical constitution of the people has been improving * * *. And in New Zealand, where the sale of contraceptives is practically free, the birth rate is now 20, and the mortality rate is 10. Does that look like race suicide? On the contrary, there is a steady increase at the rate of ten per cent, while sickness and death of children, with their attendant economic and emotional waste, are reduced to a minimum.”

    Not only are the children of small families as a rule better cared for, from economic reasons easy to discern, but it is also a fact that the health of the mothers is far better, and consequently the health of the children when born is better than the average. One has but to look around him upon the families who boast of having had eight, ten, and twelve children born to them, to see what a frightful average percentage of deaths of infants and young children is present, and which brings down the number of the survivors.

    Dr. Alice Hamilton, in “The Bulletin of the American Academy of Medicine,” for May, 1910, reports that she has investigated the families of 1,600 wage workers, and found the following death rate per 1,000 birth among them, viz.:

    Families of 4 children and less 118 deaths per 1,000 births
    Families of 6 children 267 deaths per 1,000 births
    Families of 7 children 280 deaths per 1,000 births
    Families of 8 children 291 deaths per 1,000 births
    Families of 9 children or more 303 deaths per 1,000 births

    Dr. Hamilton sums up her investigation as follows:

    “Our study of the poorer working class shows that child mortality increases proportionately as the number of children increase, until we have a death rate in families of 8 children and over which is two and a half times as great as that in families of 4 children and over.”

    The facts above mentioned, and other facts of the same nature which will be disclosed in the progress of our consideration of the matter in the present book, have evidently been overlooked, deliberately or otherwise, by the fanatics in this country and in Europe who have been preaching to the people that a falling birth-rate means a decaying nation. Careful students of sociology now dismiss altogether the statement so often made that a falling birth-rate means “an old and decaying community.” The Germans for years have contemptuously been making this remark about France, but today they have been forced to recognize an unexpected vitality in the French, while, in fact, their own birth-rate has been falling more rapidly than that of France.

    Nor is it true that a falling birth-rate means a falling population. The French birth-rate has been steadily falling for a number of years, yet the French population has been steadily increasing all the time, though less rapidly than it would had not the death-rate been abnormally high. It is not the number of babies born that counts, but the net result in surviving children. An enormous number of babies are born in China; but an enormous number die while still babies. So that it is better to have a few babies of good quality than a large number of indifferent quality, for the falling birth-rate is more than compensated by the falling death-rate. In England, as the statistics show, while the birth-rate is steadily falling, the population has been steadily growing.

    Small families and a falling death-rate are not merely no evil—they are a positive good. They are a gain for humanity. They represent an evolutionary rise in Nature and a higher stage in civilization. We are here in the presence of a great fundamental principle of progress which has been working through life from the beginning.

    At the beginning of life on the earth, reproduction ran riot. Of one minute organism it is estimated that, if its reproduction were not checked by death or destruction, in thirty days it would form a mass a million times larger than the sun. The conger-eel lays fifteen million eggs, and if they all grew up, and reproduced themselves on the same scale, in two years the whole sea would become a wriggling mass of eels. As we approach the higher forms of life, reproduction gradually dies down. The animals nearest to man produce few offspring, but they surround them with parental care, until they are able to lead independent lives with a fair chance of surviving. The whole process may be regarded as a mechanism for slowly subordinating quantity to quality, and to promoting the evolution of life to even higher stages.

    This process, which is plain to see on the largest scale throughout living nature, may be more minutely studied, as it acts within a narrower range, in the human species. Here we statistically formulate it in the terms of birth-rate and death-rate; by the mutual relationship of the two courses of the birth-rate and death-rate we are able to estimate the evolutionary rank of a nation, and the degree in which it has succeeded in subordinating the primitive standard of quantity to the higher and later standard of quality.

    Especially in Europe we can investigate this relationship by the help of statistics which in some cases extend back for nearly a century. We can trace the various phases through which each nation passes, the effects of prosperity, the influence of education and sanitary improvement, the general complex development of civilization, in each case moving forward, though not regularly and steadily, to higher stages by means of a falling birth-rate, which is to some extent compensated by a falling death-rate, the two rates nearly always running parallel, so that a temporary rise in the birth-rate is usually accompanied by a rise in the death-rate, by a return, that is to say, towards the conditions which we find at the beginning of animal life, and a steady fall in the birth-rate is always accompanied by a fall in the death-rate.

    It is thus clear that the birth-rate combined with the death-rate constitutes a delicate instrument for the measurement of civilization, and that the record of their combined curves registers the upward or downward course of every nation. The curves, as we know, tend to be parallel, and when they are not parallel we are in the presence of a rare and abnormal state of things which is usually temporary or transitional.

    A study of the statistics of European countries furnishes us with evidence of the facts above stated. It is instructive to perceive how closely the birth-rate and the death-rate of the several European countries agree. It is perceived that the eight countries of Europe which register the highest birth-rate are the identical countries registering the highest death-rate. This is as might be expected, for a very high birth-rate seems fatally to involve a very high death-rate. The study of the following table may prove interesting—it certainly is instructive. In the following table the European countries having the highest birth-rate are stated in the order of rank according to size of such rate; and the countries having the heaviest death-rate are stated in the order of their rank in size of such rate:

    Highest European Birth-Rate.  Highest European Death-Rate.
    Russia. Russia.
    Roumania. Roumania.
    Bulgaria. Hungary.
    Serbia. Bulgaria.
    Hungary. Spain.
    Italy. Serbia.
    Austria. Austria.
    Spain. Italy.

    Moreover, Japan, with a rather high birth-rate, has the same death-rate as Spain; and Chile, with a still higher birth-rate, has a higher death rate than Russia. So, we see, that among human peoples we find the same laws prevailing as among animals, and the higher nations of the world differ from those which are less highly evolved precisely as the elephant differs from the herring, though within a narrower range, that is to say, by producing fewer offspring and taking better care of them.

    So, when we get to the root of the matter, the whole question of “Does Birth Control tend toward Race Suicide?” becomes clear, and we are able to answer, positively, “It certainly does not; on the contrary it tends toward Race Progress and Race Betterment.” We see that there is really no standing ground in any country for the panic-monger who bemoans the fall of the birth-rate, and storms against small families. The falling birth-rate is a world-wide phenomenon in all countries that are striving toward a higher civilization along lines which Nature laid down from the beginning. We cannot stop it if we would, and if we could we should be merely impeding civilization. It is a movement which rights itself and tends to reach a just balance.

    Instead of trying to raise the birth-rate by offering a bonus on babies as has been proposed in some quarters, it would be saner and better calculated for the betterment of the race to offer a bonus upon young men and women who attained maturity with a definite high standard of physical and mental development. As a writer on the subject has well said: “But we need not therefore fold our hands and do nothing. There is much still to be effected for the protection of motherhood and the better care of children. We cannot, and should not, attempt to increase the number of children born; there is still far more misery in having too many babies than in having too few; a bonus on babies would be a misfortune, alike for the parents and the State. But we may well work for the better quality of babies. There we should be on very safe ground. More knowledge is necessary so that all would-be parents may know how they may best become parents, and how they may, if necessary, best avoid it. Procreation by the unfit should be, if not prohibited by law, at all events so discouraged by public opinion that to attempt it would be considered disgraceful. Much greater public provision is necessary for the care of mothers during the months before, as well as in the period after, the child’s birth. Along such lines as these we may hope to increase the happiness of the people and the strength of the State. We need not worry about the falling birth-rate.”

    The more that one intelligently examines the argument against Birth Control based upon fear of Race Suicide, the more one becomes convinced that not only is there “nothing to it,” but that every fact brought to light in the inquiry reveals itself in the nature of proof of the desirability of Birth Control as a factor of Race Evolution, rather than evidence to the contrary. Therefore, the more inquiry and investigation that such argument brings forth, the stronger is the case disclosed for Birth Control, and the greater the amount of public opinion created in its favor.

    In all considerations of the general question of Race Suicide, one must take note of the general question of Eugenics or Human Breeding. This because the sound breeding of the race operates in a direction diametrically opposed to Race Suicide, while unsound breeding operates directly in favor thereof.

    When we consider the general subject of Eugenics we touch upon the highest ground, and are concerned with our best hopes for the future of the world. There can be no doubt that Birth Control, considered as a phase of Eugenics, is not only a precious but also an indispensable instrument in moulding the coming man to the measure of our developing ideals. Without Birth Control we are powerless in the face of the awful evils which flow from random and reckless reproduction. With it we possess a power so great that some persons have professed to see in it a menace to the propagation of the race, amusing themselves with the idea that if people possess the meansto prevent the conception of children they will never have children at all. It is not necessary to discuss such a grotesque notion seriously.

    The desire for children is far too deeply implanted in mankind and womankind alike ever to be rooted out. If there are today many parents whose lives are rendered wretched by large families and the miseries of excessive child-bearing, there are an equal number whose lives are wretched because they have no children at all, and who snatch eagerly at any straw which offers the smallest promise of relief to the craving. Certainly there are people who desire marriage, but—some for very sound and estimable reasons and other for reasons which may less well bear examination—do not desire children at all.

    For the class of married people who do not desire children at all, contraceptive methods, far from being a social evil, are a social blessing. For nothing is as certain as that it is an unmixed evil for a community to possess unwilling, undesirable parents. Birth Control would be an unmixed blessing if it merely enabled us to exclude such persons from the ranks of parenthood. We desire no parents who are not competent and willing parents. Only such parents are fit to father and to mother a future race worthy to rule the world.

    It is sometimes said that the control of conception, since it is frequently carried out immediately upon marriage, will tend to delay parenthood until an unduly late age. Birth Control has, however, no necessary result of this kind, and might even act in the reverse direction. A chief cause of delay in marriage is the prospect of the burden and expense of an unrestricted flow of children into the family; and it is said that in Great Britain, since 1911, with the extension of the use of contraceptives, there has been a slight but regular increase not only in the general marriage rate but also in the proposition of early marriage. The ability to control the number of children not only enables marriage to take place at an early age, but also makes it possible for the couple to have at least one child soon after marriage. The total number of children are thus spaced out, instead of following in rapid succession.

    It is only of late years that the eugenic importance of a considerable interval between births has been fully recognized, as regards not only the mother—this has long been recognized—but also the children. The very high mortality of large families has long been known, and their association with degenerate conditions and with criminality. However, of recent years, evidence has been obtained that families in which the children are separated from each other by intervals of more than two years are both mentally and physically superior to those in which the interval is shorter. Investigators have found that children born at only a short interval after the birth of a previous child are notably defective, even at the age of six, in a large percentage of cases; and when compared with children born at a longer interval, or with first children, they are, on the average, three inches shorter and three pounds lighter. These are facts of the most vital significance.

    Thus when we calmly survey, in however summary a manner, the great field of life affected by the establishment of voluntary human control over the production of the race, we can not see a cause for anything but hope. It is satisfactory that it should be so, for there can be no doubt that we are here facing a great and permanent fact in civilized life. With every rise in civilization, indeed with all evolutionary progress whatever, there is what seems to be an automatic fall in the birth-rate. That fall is always normally accompanied by a fall in the death-rate, so that a low birth-rate frequently means a high rate of natural increase, since most of the children born survive.

    Thus in the civilized world of today, notwithstanding the low birth-rate which prevails as compared with earlier times, the rate of increase in the population is still appalling—nearly half a million a year in Great Britain, over a million in Austro-Hungary, and three-quarters of a million in Germany. When we examine this excess of births in detail we find among them a large proportion of undesired and undesirable children. There are two alternative methods working to diminish this proportion: the method of regulating conception under the methods of scientific Birth Control, or the bungling substitutes for the same, on the one hand, and the method of preventing live births after conception by means of the abominable practice of abortion.

    There can be no doubt about the enormous extension of the practice of abortion in all civilized countries, even although some of the extravagant estimates of its frequency in countries, the United States for example, be discarded as unwarranted. The burden of bearing excessive children on the overworked and underfed mothers of the working classes becomes at last so intolerable that almost anything seems better than another child. As a woman in Yorkshire once said to an English investigator of this evil: “I’d rather swallow the druggist’s shop and the man in it, than have another kid.”

    A community which takes upon itself the responsibility of encouraging abortion lays itself open to severe criticism. And it must be admitted that just as all those who work for Birth Control are really diminishing the frequency of abortion, so every attempt to discourage Birth Control promotes abortion. We have to approach this problem calmly, in the light of Nature and reason. We have each of us to decide on which side to range ourselves. For it is a vital problem concerning which we cannot afford to be indifferent.

    There is no desire here to exaggerate the importance of Birth Control. It is not a royal road to the millennium of the race; and like all other measures which the course of progress forces us to adopt, it has its disadvantages. But fairness and honest thought should admit freely that so far as is concerned the question of its being a factor toward Race Suicide, we must pronounce a verdict of “Not Guilty” upon Birth Control. On the contrary, the contrary course of teaching and practice, if carried to their full logical conclusion, would inevitably bring the race to such a stage of degeneracy, and retrogression to primitive type, that a fate far worse than suicide would befall the human race. For the race, as well as the individual, may commit “suicide” and an end to its career, not only by a will-not-to-live but also by a will-to-degenerate.

    The face of Birth Control is set toward the rising sun of Race Betterment, not toward the setting sun of Racial Decline. Its ideas are those of Race Life, not of Race Death. It bids the race not to perish, but rather to live on in greater strength, happiness, and efficiency. Birth Control is in full accord with the Racial Will-to-Live, and not opposed to it. All humanity, all civilization, all human progress, call upon us to take our stand upon this vital question of Birth Control. And, as a writer has well said, in doing so we shall each of us be contributing, however humbly, to that “one far-off event, to which the whole creation moves.”

    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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  • THE ARGUMENT FOR BIRTH CONTROL

    THE ARGUMENT FOR BIRTH CONTROL

    Let us now consider the general and special arguments advanced in favor of rational and scientific Birth Control, as stated by the advocates thereof.

    General Argument. The general argument in favor of Birth Control may well be begun by the statement that rational and scientific Birth Control is not the fixing upon the race of a new and unfamiliar practice or policy, but is rather the scientific correction of a practice and policy which is now followed by the majority of married persons in civilized countries, though in a bungling, unscientific, and frequently a harmful manner. The modern advocates of scientific methods of Birth Control seek to replace these bungling, unscientific, and frequently harmful methods by sane, scientific, harmless methods, approved of by capable physicians and other experienced and capable authorities, and under the sanction of the law rather than contrary to it.

    The advocates of Birth Control seek to place upon a scientific basis, under cover and protection of the law, a subject which heretofore has been but imperfectly known, and more imperfectly practiced in some form by the majority of married couples, and which has heretofore been under condemnation of the law so far as concerned the actual dissemination of information concerning methods of contraception. They hold that it is the veriest hypocrisy to pretend ignorance of the fact that the great majority of married couples in civilized communities know and practice to some extent contraceptive methods—usually imperfectly and bunglingly, it must be added.

    One has but to consider the families of married couples, and to count their children, to become aware that at least some form of contraception has been known and practiced in many cases. This is particularly true of the more intelligent and cultured members of civilized society, among whom we find large families of children to be the exception, and small families to be the general rule. Among the less intelligent and uncultured classes the reverse of this condition is found.

    It is hypocritical folly to assert that these small families to be found among the more intelligent classes of society are due to the fact that the husbands and wives are physically incapable of procreating off-spring—the mere suggestion produces an incredulous smile from the reader. No one who is acquainted with the habits and customs of married people would in good faith offer such an explanation. Rather is it tacitly acknowledged by all thinking persons that such married couples practice some form of Birth Control, or else commit the crime of abortion. All physicians, particularly those who practice in the large cities, are fully informed as to the appalling facts concerning the prevalence of abortion among the women of the “respectable” classes, and are likewise fully informed as to the terrible consequences so frequently arising from this criminal course.

    The question, then, to many intelligent persons is not so much that of “Should contraception be employed in order to avoid excessively large families?” as that of “Should not contraception be employed to obviate the crime of abortion with its terrible train of consequences?” And the Birth Control propaganda which is so vigorously underway in all civilized countries may be stated to be designed for the following purposes: (1) to replace abortion, and other harmful methods of restricting the size of families, with rational and scientific methods of contraception; and (2) to supply to married persons the best scientific knowledge concerning the regulation of the size of families, and the methods of producing the best kind of children, under the best conditions, and at the times best adapted for their proper care and well-being. These advocates of the Betterment of the Race face the facts of human nature and married life fearlessly, instead of trying to cover them over with pretty words and sentimental generalities. They take “things as they are,” and not as certain persons insist that “they should be”—they live in a world of facts and try to better things as they find them, instead of trying to live in a fool’s paradise and contenting themselves with denying the existence of the facts which they consider “ugly.”

    Dr. William J. Robinson, one of the leading American workers in the field of Birth Control, ably presents the main contention of the Birth Control advocates as follows:

    “We believe that under any conditions, and particularly under our present economic conditions, human beings should be able to control the number of our offspring.They should be able to decide how many children they want to have, and when they want to have them. And to accomplish this result we demand that the knowledge of controlling the number of offspring, in other and plainer words, the knowledge of preventing undesirable conception, should not be considered criminal knowledge, that its dissemination should not be considered a criminal offense punishable by hard labor in Federal prisons, but that it should be considered knowledge useful and necessary to the welfare of the race and of the individual; and that its dissemination should be permissible and as respectable as is the dissemination of any hygienic, sanitary or eugenic knowledge.

    “There is no element of force in our teachings; that is, we would not force any family to limit the number of children against their will, though we would endeavor to create a public opinion which would consider it a disgrace for any family to have more children than they can bring up and educate properly. We would consider it a disgrace, an anti-social act, for any family to bring children into the world which they must send out at an early age into the mills, shops, and streets to earn a living, or must fall back upon public charity to save them from starvation.

    “Public opinion is stronger than any laws, and in time people would be as much ashamed of having children whom they could not bring up properly in every sense of the word, as they are now ashamed of having their children turn out criminals. Now, no disgrace can attach to any poor family, no matter how many children they have, because they have not got the knowledge, because society prevents them from having the knowledge of how to limit the number of children. But if that knowledge became easily accessible, and people still refused to avail themselves of it, then they would properly be considered as anti-social, as criminal members of society. As far as couples are concerned who are well-to-do, who love children, and who are well capable of taking care of a large number, we, that is, we American limitationists, would put no limit. On the contrary, we would say: ‘God bless you, have as many children as you want to; there is plenty of room yet for all of you.’”

    Another writer, a celebrated English thinker along these lines, has said of the general argument in favor of Birth Control:

    “It used to be thought that small families were immoral. We now begin to see that it was the large families of old which were immoral. The excessive birth-rate of the early industrial period was directly stimulated by selfishness. There were no laws against child-labor; children were produced that they might be sent out, when little more than babies, to the factories and the mines to increase their parents’ incomes. The diminished birth-rate has accomplished higher moral transformation. It has introduced a finer economy into life, diminished death, disease, and misery. It is indirectly, and even directly, improving the quality of the race. The very fact that children are born at longer intervals is not only beneficial to the mother’s health, and therefore to the children’s general welfare, but it has been proved to have a marked and prolonged influence on the physical development of children.

    “Social progress, and a higher civilization, we thus see, involve a reduced birth-rate and a reduced death-rate. The fewer the children born, the fewer the risks of death, disease, and misery to the children that are born. The fact that civilization involves small families is clearly shown by the tendency of the educated and upper social classes to have small families. As the proletariat class becomes educated and elevated, disciplined to refinement and to foresight—as it were aristocratised—it also has small families. Civilizational progress is here on a line with biological progress. The lower organisms spawn their progeny in thousands, the higher mammals produce but one or two at a time. The higher the race, the fewer the offspring.

    “Thus diminution in quantity is throughout associated with augmentation in quality. Quality rather than quantity is the racial ideal now set before us, and it is an ideal which, as we are beginning to learn, it is possible to cultivate, both individually and socially. That is why the new science of eugenics or racial hygiene is acquiring so immense an importance. In the past, racial selection has been carried out crudely by the destructive, wasteful, and expensive method of elimination, through death. In the future, it will be carried out far more effectively by conscious and deliberate selection, exercised not merely before birth, but before conception and even before mating. Galton, who recognized the futility of mere legislation to elevate the race, believed that the hope of the future lay in eugenics becoming a part of religion. The good of the race lies, not in the production of a super-man, but of a super-humanity. This can only be attained through personal individual development, the increase of knowledge, the sense of responsibility toward the race, enabling men to act in accordance with responsibility. The leadership in civilization belongs not to the nation with the highest birth-rate, but to the nation which has thus learnt to produce the finest men and women.”

    Let us now proceed to a consideration of the special arguments in favor of rational and scientific Birth Control as advanced by its leading advocates.

    The advocates of rational and scientific Birth Control have presented the strongest points of their case in their replies to those opposing the general idea, and without positively taking the stand that the burden of the proof in the argument concerning Birth Control rested upon those opposing the idea, have practically assumed that position. They claim that the right to Birth Control is so self-evident, and its application so generally recognized (though usually sought to be smothered with silence) that the case in favor of Birth Control is really quite apparent to anyone seriously considering the same without prejudice. The opposing side of the question is held by them to be represented principally by statements based on prejudice and disingenuous statements, which are capable of being turned against those advancing them.

    And, the present writer, likewise is of the opinion that the strongest possible case for Birth Control is presented in the answer to the arguments advanced by the opponents thereof. But, before proceeding to the latter phase of the argument, it may be well to examine briefly the several leading points of argument advanced by the advocates of rational and scientific Birth Control, in order to clear the way for the answers to the opposite side of the question. The reader is, therefore, invited to consider the said points, briefly presented in the following paragraphs:

    Birth Control Encourages Marriage. The advocates of Birth Control hold that a scientific knowledge of contraception would speedily result in a large increase of marriages, particularly among persons of limited incomes. Persons who have not been able to accumulate the “little nest egg” which prudent persons consider a requisite on the part of those contemplating marriage and the responsibilities of rearing a family of children, are in many cases caused to hesitate about contracting marriage, and often relinquish the idea altogether. Many of these persons are well adapted for marriage, being of the domestic temperament and having the home ideal prominent in their mental makeup.

    The increasing number of bachelors and unmarried women past thirty years of age, who are in evidence in all large centers of population at the present time, is undoubtedly due to a great extent to the fear on the part of these men and women regarding the proper support of a family of children. Many men and women feel that the man is able to earn enough to support himself and wife comfortably, by the exercise of economy, but that the said earnings are not sufficient to provide properly for a family of children. Some would be willing to have one or two children, born after the couple have well established themselves, but are appalled at the thought of bringing into the world a practically unlimited number of little children for whom they would not be able to provide properly.

    These people shrink at the idea of abortion, and doubt the efficacy of the popular so-called contraceptive methods of which their friends tell them, and they either defer the marriage until later in life, or else give up the idea altogether as being impossible for them under the existing circumstances. A scientific knowledge of the subject would give to such persons—and there are many thousands of such—an assurance of their ability to safely and properly control and regulate the size of their families, and would lead to many a marriage which would otherwise be out of the question.

    If it is agreed that the marriage state is the one normal to the average man and woman, and that marriages are in the interests of society—and few would seek to dispute this—then it would seem that anything that would tend to encourage marriage among the right kind of persons should receive the encouragement of society and be fully protected by the laws of society; and that the old prejudice against the subject, and the laws which discourage the same, and place a penalty upon the dissemination of scientific methods leading to the said result, are unworthy of civilized society and modern thought.

    Earlier Marriages and Curb on Prostitution. It is generally conceded by students of sociology that earlier marriages tend to decrease the causes of the evil of prostitution, illicit sexual relations, and general sexual morality; and the consequent spread and existence of the venereal diseases which have followed in the trail of such relations. And it is likewise conceded that prostitution is an evil, and a cancer spot upon modern social life, and that venereal diseases constitute a frightful menace to the health and physical welfare of the race. Therefore, it would seem that anything which would promote early marriages among healthy, intelligent young men and women would be a blessing to the race and to society. And as these earlier marriages are unquestionably prevented in a great number of cases by reasons of the fear of inadequate financial support for large families of children, it would seem to follow that the best interests of society would be served by the encouragement by public opinion, under the protection of the law, of the teaching by competent authorities upon the subject of rational and scientific methods of Birth Control.

    Health of Wives. The advocates of Birth Control lay considerable stress upon the fact that a scientific knowledge of Birth Control would practically obviate the state of broken-down health so common among married women, particularly among those who have been compelled to bear large numbers of children during the first few years of married life. Many a young married woman is in bad health—often reaching the state of chronic invalidism—as the result of having had to bear too many children, and in too close succession.

    Not only is the above the case, but there is to be found on all sides many cases of invalidism and shattered health caused by the horrible practice of criminal abortion. It is doubted whether anyone outside of medical circles can even faintly begin to realize the frequency of this practice of abortion among the well-to-do, and those in “comfortable circumstances”—not to speak of the countless deaths which arise from the prevalence of this curse. Were a physician to even faintly indicate the number of cases coming under his personal professional attention, in which the patient is suffering from the effects of one or more abortions, he would be accused of gross exaggeration, and would be condemned as a sensationalist.

    Without going into detail concerning these things, the writer states that it is a matter of common knowledge among physicians that in every large city there are thousands of unscrupulous (including those who call themselves physicians) who are kept busy every week in the year performing criminal operations designed to produce abortions. Some of these practitioners have many regular patients—women who visit them regularly for the purpose of having abortions produced by criminal operations. It seems almost incredible, but it is a veritable fact, that there are to be found many women in the large cities who actually boast to their friends of the number of operations of this kind they have had performed on them.

    Surely, any instruction which would prevent the physical breakdown of so many women by reason of excessive child-bearing on the one hand, and abortion on the other hand, would seem to be worthy of the hearty support of society, and the encouragement of its laws, rather than the reverse. So true does this seem, that it is difficult to realize that there are any intelligent persons who would condemn such instruction as evil and harmful to society. That such persons do exist is a striking proof of the persistence of ancient superstitions and the survival and tenacity of old prejudices.

    Morality of Married Men. It is a matter of common knowledge among physicians, and students of sociology, that many married men, particularly those living in the large cities, indulge in extra-marital or illicit sexual relations, with prostitutes and other women of loose morals, and this not because these men are naturally vicious, depraved or licentious, but rather because they fear causing their wives to bear them more children—the wives either being in delicate or broken-down health, or else the family already too large to be reared properly in justice to the children.

    Many persons who would see only what “ought to be,” and who refuse to see “things as they are” in modern society, will be disposed to pooh-pooh the above statement, and to accuse those making it to be sensational or even morbid on the subject. But those who are brought in close contact with men and women, as are family physicians and specialists, as well as honest students of sociology, know only too well that the above is not an over-statement, but is rather a very conservative recital of certain unpleasant, but true, facts of human society.

    Justice to the Children. The advocates of scientific Birth Control hold that a scientific knowledge along the lines favored by them would prevent the gross injustice to children which is now only too obvious to anyone who candidly considers the matter without prejudice. The child brought into the world, unwanted, undesired, unprepared for, and unprovided for before and after birth, is handicapped from the very start of its existence upon earth. The present state of affairs works a terrible injustice upon countless children brought into the world in such conditions. Nothing that the present writer could put into words would state this fact more concisely and clearly than the following statement made by Dr. Wm. J. Robinson, a leading authority along these lines, who has said:

    “The responsibility of bringing a child into the world under our present social and economic conditions is a very great one. The primitive savage or the coarse ignorant man does not care. It does not bother him what becomes of his offspring; if they get an education, if they have enough to eat, if they learn a trade or a profession, well—if they don’t, also well; if they achieve a competence or a decent social position, he is satisfied—if not, he can’t help it. God willed it so. But, on the other hand, the cultured, refined man and woman look at the matter differently. The thought of bringing into the world a human being which may be physically handicapped, which may be mentally inferior, which may have a hard struggle through life, which may have to go through endless misery and suffering, fills them with anguish. * * * * *

    “We see about us millions of working men and women who go through life, from cradle to grave, without a ray of joy, without anything that makes life worth living. In the higher classes we see a constant, hard, infuriated struggle to make a living, to make a career, and the spectre of poverty is almost as unremittingly before the eyes of the middle and professional classes as it is before the eyes of the laborer. And all over we see ignorance, superstition, beliefs bordering on insanity, hardness, coarseness, rowdyism, brutality, crime and prostitution; prostitution of the body, and what is worse, prostitution of the mind, the hiding or selling of one’s convictions for a mess of pottage. And our prisons, asylums, and hospitals are not decreasing, but increasing in number and inmates.

    “It is my sincerest and deepest conviction that we could accomplish incomparably more if only a small part of the energy and money now spent on philanthropic efforts were expended in teaching the women, the married women of the poor, how to limit the number of their children; in other words, how to prevent conception. It would work a wonderful reform in the lives of the poor, and our slums would be metamorphosed in ten years. * * * It is we who are to blame now for the large families of the poor, and for this reason we are morally obligated to give them the financial and medical aid that they demand. But when effectual means are put into their hands for limiting the number of their offspring, then they, and not we, will be to blame if they do not make use of them. * * * *

    “The rich and the upper-middle classes, those to whom several children would be the least burden, are quite familiar with the various means of prevention. The poorer middle classes use preventives recommended by their friends; these preventives sometimes succeed, sometimes fail, and sometimes ruin the woman’s health. While the very poor, the wage-earners, those who can least afford to have unlimited progeny, knowing no means of prevention, go on breeding to their own and to the community’s detriment. The result, as you can plainly see, is a general lowering of the physical and mental stamina of the race. For if the cultured and the well-to-do do not breed, or have only a few children, while the poor and the ignorant go on having a numerous progeny for which they cannot well provide, and which they cannot afford to educate properly, it stands to reason that the percentage of the uneducated, the unfit and the criminal, must go on constantly increasing. And this is something that no lover of humanity can look upon with equanimity.”

    Surely the above recited special points of argument in favor of Birth Control seem to be statements of self-evident facts to the unprejudiced mind, do they not? And the person of this kind who considers them carefully for the first time usually finds himself wondering what rational argument can be fairly urged on the other side of this important question. And, when he acquaints himself with the arguments of “the other side” he usually finds himself even more established in the belief that scientific Birth Control is advisable, sane, and along the lines of the mental evolution of the race. At any rate, it is difficult to escape the conviction that the burden of proof needed to controvert a proposition so nearly self-evident as intelligent and scientific Birth Control, must be placed squarely upon the shoulders of those opposing the proposition.

    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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  • THE SCIENCE OF EUGENICS

    THE SCIENCE OF EUGENICS

    No one who keeps in even only fair touch with the affairs of the world of today can have failed to notice the frequent mention of the term “Eugenics” in the newspapers, magazine, and books of the hour. And yet, many persons seem to be in doubt as to the meaning and use of the term; some thinking that it refers to some new “ism” or “ology,” or perhaps to some new and strange doctrine concerning the relations of the sexes. In view of this fact, the writer has thought it well to give the readers of this book a brief, though somewhat comprehensive, view of the general subject of Eugenics.

    Eugenics, sometimes known as the Science of Parenthood, has well been styled “the New Science,” for it has forced itself into public notice within the past ten or fifteen years, whereas before that time it was practically unknown to the general public. At the present time some of the world’s greatest thinkers have spoken or written on the subject, and many regard it as one of the most vital branches of human research, endeavor, and study, for the future of the race is involved in the solution of its problems. In its general phase of race-betterment, Eugenics is receiving the attention of statesmen, sociologists and patriots; in its particular phases, the earnest attention, interest and study of men and women who wish offspring of the best quality obtainable.

    The spirit of Eugenics may be expressed in the words of Dr. G. Stanley Hall, president of Clark University, who has said: “Our duty of all duties is to transmit the sacred torch of life undiminished, and, if possible, a little brightened, to our children.{66} This is the chief end of men and women. All posterity slumbers in our bodies, as we did in our ancestors. The basis of the new biological ethics of today, and of the future, is that everything is right that makes for the welfare of the yet unborn, and all is wrong that injures them, and to do so is the unpardonable sin—the only one nature knows.”

    That phase of Eugenics which has brought the new science more prominently before the public mind, and which has enrolled on its roster the names of some of the world’s most eminent scientists, sociologists, and writers—the phase of race-betterment from the standpoint of sociology—has led many to believe that Eugenics is confined to that phase, and is but a movement toward “the successful breeding of the human race” on a universal scale. To many, such a movement while deemed commendable and desirable nevertheless lacks the appeal of the heart and affections—it seems to be of the head alone. But when such persons are brought to their realization that Eugenics is also a movement to promote the bearing of children—to enable each mated couple to bring forth perfect offspring—then the heart is enlisted as a co-worker with the head.

    The sociological phase of Eugenics—the phase of Race Culture in general—is being vigorously advanced by societies and organizations in various parts of the world, the parent organization being the Eugenics Education Society, of London, England. Dr. C. W. Saleeby, one of those prominent in the work of the said Society, has the following to say concerning the work of that organization:

    “The Eugenics Education Society exists to uphold the ideal of Parenthood as the highest and most responsible of human powers; to proclaim that the racial instinct is therefore supremely sacred, and its exercise{67} through marriage, for the service of the future, the loftiest of all privileges. It stands for a transfigured sentiment of parenthood which regards with solicitude not child and grandchild only, but the generations to come hereafter—fathers of the future creating and providing for the remote children. That which too many schools of thought and practice have derided or defiled, it seeks to elevate and ennoble. Parenthood on the part of the diseased, the insane, the alcoholic—where these conditions promise to be transmitted—must be denounced as a crime against the future. In these directions the Society stands for active legislation, and for the formation of that public opinion which legislation, if it is to be effective, must express. Parenthood on the part of the worthy must be buttressed, guided, and extolled. The Society stands for the education of the young regarding the responsibility and holiness of the racial function of parenthood.”

    The Eugenists hold that in the near future our children, looking back upon the present and the past state of indifference and neglect concerning the important subject of bearing and rearing of children, will experience the same horror that we now feel when we look back upon the indifference to the horrors of human slavery, imprisonment for debt, cruelty toward prisoners, treatment of the insane, executions for trivial offences, etc., on the part of our ancestors. Our descendants will deem it almost inconceivable that we, their ancestors, could have been so blind and criminally negligent.

    But, as leading Eugenists have pointed out, the new science does not confine its attention to the subject of preventive measures, important as they are—it also directs its attention to the constructive phase of the subject, i. e., the production of better children. While Eugenics strives to prevent the unfit from flooding the race with unfit progeny, it at the same time strives to{68} educate the race so that the fit may bear and rear better offsprings. It is not sufficient merely to eliminate the unfit—we must also improve, and still further render fit, the fit members of the race. The fit must not be allowed to remain merely the fit—we must evolve a fitter—and ever move onward toward the realization of the ideal of the fittest. We must not only strive to eliminate the beast in the race of men—we must also aid the race to unfold in the direction of the super-man.

    The Eugenists know that much of the talk concerning Race Suicide is not only futile and uncalled for, but is also in a sense misleading and actually dangerous. The real danger of Race Suicide comes not from the decreasing birth-rate, but from the excessive, ignorant, and unscientific bearing and rearing of children by unfit parents. It is not so much a matter of how many children are born, as of how they are born, what kind of children they are, and how they are reared physically, mentally and morally, and how many survive. It is not so much that the lower death-rate be avoided, says the Eugenist, as it is that the higher death-rate be overcome. The intelligent stockbreeder grasps this scientific law of the Eugenists when he endeavors to produce the best young, and then to take care of them that they survive and reach a healthy maturity. To the Eugenist, it is not so much a question of “more,” but of “better”—not so much a question of quantity as of quality—not so much a question of production, but of conservation and preservation.

    Dr. Saleeby refers to the death-rate of London, which is but 16 to the 1000, as compared to that of Bombay, which is 79 to the 1000. He adds: “It is asserted that in many large Indian cities the infant mortality approaches one-half of all the children born. What it amounts to in such cities as Canton and Pekin we can only surmise with{69} horror. * * * * Unless it be supposed by bishops and others, then, that a peculiar value attaches to the production of a baby shortly to be buried, the suggestion evidently is the same as that to which every humanitarian and social and patriotic impulse guides us, namely, the reduction of the death-rate, and especially of infant mortality. * * * * Hence the Eugenists and the Episcopal Bench may join hands so far as the reduction of the death-rate is concerned, and the only persons with whom a practical quarrel remains are those who applaud the mother who boasts that she has buried twelve.”

    The Eugenists urge that if the principles applied to plant-life by that master of his science, Luther Burbank, were applied to the production and rearing of young human life, in a few generations we should have a race so far advanced beyond the present average as to be almost god-like by comparison. But this means a far different thing from the ideal of merely “more children”—it requires the manifestation of the ideal of “better children,” well born, carefully reared, well nourished, and scientifically educated. And this rearing, nourishing, and education must not be confined to the physical part of the child’s nature—it must proceed along the three-fold line of physical, mental, and moral culture.

    The Eugenists have been actively concerned with the question of the prevention of the transmission of undesirable qualities to offspring. They have held that while crime is more frequently rather the result of evil environment than of criminal heredity, nevertheless there is a large class of children who are “born criminals”—that is, born with such a decided tendency toward criminal acts that the slightest influence of environment may, and often does, serve to kindle into a blaze the undesirable and criminal characteristics.

    Dr. Saleeby says of this: “In the face of the work of{70} Lombroso and his school, exaggerated though some of their conclusions may be, we cannot dispute the existence of born criminals and the criminal type. There are undoubtedly many such persons in modern society. There is an abundance of crime which no education, practiced or imaginable, would eliminate. Present day psychology and medicine and, for the matter of that, ordinary common-sense, can readily distinguish cases at both extremes—the mattoid or semi-insane criminal at one end, and the decent citizen who yields to exceptional temptation at the other end.”

    The Eugenists quote as an instance of the above contention the celebrated case of Max Jukes, a notorious criminal and drunkard, who as the records show us was the ancestor of a foul brood of descendants which cost the State of New York over a million dollars in seventy-five years. Among these descendants were 200 thieves and murderers; 285 subject to idiocy, blindness or deafness; 90 prostitutes; and 300 children born prematurely. It is possible that a portion of this evil result was caused not alone by bad heredity but, at least in part, by the suggestion of the environment, and the influence of example of the parents; but even so, the primal cause was that Max Jukes, the notoriously unfit ancestor, was allowed to propagate this evil brood, destined to be born and reared under the most adverse conditions and environment.

    The Eugenists also place great importance upon the prevention of insane persons becoming parents. To those who consider that this is but an exceptional and rare occurrence, the Eugenists reply that a large percentage of insane patients in asylums have a family history showing insanity in one or both parents; that reports show that there are thousands of feeble-minded women in every large city allowed to (yes, often actually compelled to) bear children to their husbands or male companions.

    Ribot says: “Every work on insanity is a plea for heredity.” Maudsley says: “More than one-fourth and less than one-half of all insanity is heredity.” Riddell says: “Of the great causes of insanity, alcoholism is perhaps the greatest, while morbid heredity ranks next. Insanity is largely the result of degeneracy. Most persons who become mentally deranged are the offspring of neurotic, drunken, insane or feeble-minded parents.” While it by no means follows that one must manifest traits of insanity or mental disturbance simply because one of his parents suffered from a like trouble—and we believe that many a one has frightened himself into those conditions by pure auto-suggestion inspired by a one-sided belief in heredity—still it is unquestionably true that a fair mind must concede that wisdom and a proper sense of right and justice would require that parents of unsound mental tendencies should not be permitted to bring into the world children who might inherit a tendency toward a like, or worse, condition.

    The Eugenists also have called the attention of the thinking public to the danger of deaf-and-dumb persons transmitting their condition to their offspring. Of this Dr. Saleeby says: “The condition known as deaf-mutism is congenital or due to innate defect in about one-half of all the cases in Great Britain.” Dr. Love says: “In every institution, examples may be found of deaf-mute children who have had one or two deaf parents or grandparents, and of two or more deaf-mute children belonging to one family.” A case is noted in England where a deaf-and-dumb man having been killed by an accident, his relatives could not identify the body, as the wife and sister were blind, deaf-and-dumb, and the four children were deaf-and-dumb. The man and his wife were both deaf-and-dumb when they were married, the wife being also blind.

    Perhaps no subject has aroused the active Eugenists{72} to a greater pitch of indignation than the ascertained results of the effect upon offspring of parents addicted to the over-indulgence in alcohol. It is known by the records that a large number of cases of feeble-mindedness and actual insanity are due to inebriety of parents, and often of grandparents, or ancestors for several generations. Epilepsy, idiocy, and criminality are also traceable in many cases to drunkenness of parents. Dr. Saleeby, moved by indignation by the ascertained results of the investigations of the Eugenists, has said: “Parenthood must be forbidden to the dipsomaniac, the chronic inebriate, or the drunkard, whether male or female.”

    Professor Grenier, writing on the subject of alcoholic degeneration, has said: “Alcohol is one of the most active agents in the degeneracy of the race. The indelible effects produced by heredity are not to be remedied. Alcoholic descendants are often inferior beings, a notable proportion coming under the categories of idiots, imbeciles, and the debilitated. The morbid influence of parents is maximum when conception has taken place at the time of drunkenness of one or both parties. Those with hereditary alcoholism show a tendency to excess; half of them become alcoholics; a large number of cases of neurosis have their principal cause in alcoholic antecedents. The larger portion of the sons of alcoholics have convulsions in early infancy. Epilepsy is almost characteristic of the alcoholism of parents, when it is not an index of a nervous disposition of the whole family. The alcoholic delirium is more frequent in the descendants of alcoholics than in their parents, which indicates their intellectual degeneration.”

    What has been said of alcoholism of course applies to the use of narcotics and other drugs. Galton cites a case in which “a man who had had two healthy children acquired the cocaine habit, and while suffering from the{73} symptoms of chronic poisoning engendered two idiots.” And yet had anyone publicly instructed the wife of this man regarding the use of contraceptives, such person would have been liable to imprisonment!

    Another subject engaging the active attention of the Eugenists, and which is discussed to considerable extent in the privacy of their meetings, but which must be voiced only very carefully in the public prints owing to the “murderous silence” which society prefers to maintain on the subject, is of the influence of venereal diseases as racial poisons transmissible to offspring. Dr. Saleeby has well said: “No other disease can rival syphilis in its hideous influence upon parenthood and the future. But it is no crime for a man to marry, infect his innocent bride and their children; no crime against the laws of our lawgivers, but a heinous outrage against nature’s decrees. When at last our laws are based on nature’s laws, criminal marriages of this kind may be put an end to.”

    The above stated facts are not pleasant reading for most persons, and many pass over them hurriedly, thereby hoping to escape the mental discomfort which the hearing and learning of unpleasant truths so often produce. But the subject will not down—it is forcing itself to the attention of the thinking members of society today in a manner which will admit of no escape. These facts must be faced, and steps must be taken by society to protect the race from degeneration and actual Race Suicide. And the Science of Eugenics is pointing the way.

    Dr. Saleeby says of this phase of Eugenics: “Negative Eugenics will seek to define the diseases and defects which are really hereditary; to name those the transmission of which is already known to occur, and to raise the average of the race by interfering as far as may be with the parenthood of persons suffering from these{74} transmissible disorders. Only thus can certain of the gravest evils of society, as, for instance, feeble-mindedness, insanity, and crime due to inherited degeneracy, be suppressed; and if Race-Culture were absolutely incapable of effecting anything whatever in the way of increasing the fertility of the worthiest classes and individuals, its services in the negative direction here briefly outlined would be of incalculable value. To this policy we shall most certainly come; but here, as in other cases, I trust far more to the influence of an educated public opinion than in legislation; though there are certain forms of transmissible disease, interfering in no way with the responsibility of the individual, the transmission of which should be visited with the utmost rigor of the law, and regarded as utterly criminal, no less than sheer murder.”

    But the Science of Eugenics is concerned not only with telling society what “not to do”—it is equally concerned with telling it “what to do.” It has its Positive as well as its Negative side. After pointing out the evils of procreation on the part of the unfit, it then proceeds to tell the fit how to best serve the interests of the unborn. Eugenics is not satisfied with merely plucking out the foul weeds which have encumbered the fair garden of life—it seeks also to furnish to the real flowers better soil, and improved conditions, and to give them the benefit of the best selection, breeding and conditions, that they may evolve and improve into still more glorious products of nature’s power.

    The Eugenists earnestly advocate laws and public opinion tending to protect mothers and expectant mothers. They recognize the supremacy of motherhood, and aim to encourage and protect it. They decry the common indifference toward this function which is all important in the preservation and evolution of the race, and which neglect is well expressed in the complaint of{75} Bouchacourt, who said: “The dregs of the human species—the blind, the deaf-mute, the degenerate, the imbecile, the epileptic—are better protected than are pregnant women.”

    The Eugenists believe in educating women for motherhood, and in protecting them from conditions which interfere with that important function of their life. They are not fully agreed upon the methods to be pursued in cases of expectant mothers whose lack of proper support prevents them from obtaining the proper nourishment, etc., but in a general way it may be said that they agree in holding that the expectant mother should be looked upon as the honored ward of the State, and should be properly provided for from the public funds.

    The Eugenists also believe in educating the father, or prospective father. They hold that every man should be made acquainted with the duties and responsibilities of fatherhood, and should so conduct and order his life that the production and rearing of a family should result as a consummation of a long cherished ideal. The man should be taught to prepare himself, physically, mentally, and morally, for his coming responsibility to the race. He should also be taught to respect and regard motherhood, and to make it his business to secure and preserve the best possible conditions for the mother of his own children, and the mothers of other men’s children, not as an act of mere sentiment, but as a public duty, a patriotic service, a racial obligation.

    The Eugenists believe in teaching young men and young women on the subject of sexual physiology and psychology. They hold that the race is now criminally negligent in such matters, and that young men and women, by the thousands, enter into the state of marriage and parenthood with no knowledge regarding the sacred functions which they are to bring into activity. They{76} believe that the first requisite of scientific parenthood is and must be a sane knowledge of the physiology of sex, and the psychology of sex. There must be sane education concerning the sexual organism, its laws, its functions, its normal and healthy condition, its anatomy, physiology and hygiene.

    The average physician of several years’ experience can tell tales of almost incredible ignorance on the part of persons who have recently entered into the relationship of marriage. In some cases the ignorance is more than a mere absence of knowledge, for it consists of an array of false-knowledge, untruthful ideas, of often serious importance. It is sad enough to think how the ignorance and false-knowledge may work results hurtful to the young couple themselves, but it is even sadder to realize that these same ignorant or wrongly-informed young persons must gain their real knowledge through sad experience which is to be paid for not only by themselves but also by their children. It is a hard saying, but true that “the knowledge of the majority of young parents is gained by experience paid for by their unborn children.”

    The Eugenists look forward to the coming of the day when it will be regarded as reprehensible to allow young persons to enter into the relationship of marriage without a sane, practical knowledge of their own reproductive organism and functions, and of their physiological duties to themselves, their companions in marriage, and to their children born or to be born. We may, in due time, see a practical realization of the ideal set forth by Dr. Newell Dwight Hillis, who said: “The State that makes a man study two years before a license as druggist is given; that makes a young lawyer or doctor study three years before being permitted to practice, ought to ask the young man or young woman to pass an equally rigid examination {77}before license is given to found an American home, and set up an American family.”

    This idea of the scientific preparation for parenthood is a new one for many, but the coming generations will recognize its importance to the individual and to the race. Many who recognize the influence of pre-natal culture in so far as is concerned the physical, mental, and moral condition of the mother during pregnancy, have failed to perceive that an equally important influence is exerted by the physical, mental and moral condition of both parents before the conception of the child. These conditions are reflected, often very markedly, in the child, and an avoidance of consideration in this respect is often almost criminal negligence.

    Eugenists deplore the haphazard way in which children are so often conceived. More care is often bestowed upon the conditions precedent to the conception of the domestic animals than is given by their owners to the conditions preceding the conception of their own offspring. Too often, while in the case of the domestic animals the utmost care is exercised regarding the arrangement for the breeding of valuable stock, the human offspring are mere “accidents,” conceived without intention, forethought, or preparation; and too often is such conception undesired, regretted and unwelcome.

    This state of affairs is utterly unworthy of civilized man with the knowledge of science at his command, and the intellect and will with which to carry out the plain dictates of reason and duty. Nature does her part unhindered in the case of the lower animals, and man should use her principles as a foundation upon which to build a structure which reason and intelligence should supply the materials. Instead of this, man too often discards Nature’s plain rules entirely, and also refuses to use his reason, and, instead, allows himself to be ruled by selfish{78} inclinations and desires, and ignoble motives.

    To those who may ask: “But why should we give all this time, care and trouble to the young of the race—what is their claim upon us that demands so much of us in return for so little on their part?” the answer is plain. We should do this not alone because of the natural feeling of love for our own offspring which is innate in all normal human beings, but we should also do this because we owe a duty to the race in and which we are units—a duty which demands that we supply to the race the best material, and only the best, for its preservation, continuance, and betterment.

    The spirit of the age is pointing out the direction indicated by Eugenics and scientific Birth Control. And it is a spirit in which the best mental and spiritual powers of man are called into action. A new consciousness—the “race consciousness”—is awakening within the best of the race, and accompanying it is a new conscience—a “race conscience”—is manifesting within us, and is giving the individual a sense of right and wrong toward future generations, just as his earlier-awakened social conscience has opened his eyes to his duties toward his neighbors.

    Man is beginning to feel that all men are his brothers, and that the future generations of men are in a sense his children. The new ideal of “Let us build posterity worthily” has begun to supplant the old narrow idea humorously expressed in the famous bull of Sir Boyce Roche, who said, “Why should we do anything for posterity—what has posterity ever done for us?”

    As Dr. Saleeby has well said: “If the struggle toward individual perfection be religious, so assuredly is the struggle, less egoistic indeed, toward racial perfection. * * * And they that shall be of us shall build up the old waste places; for we shall raise up the foundations of many generations.”

    And in all this, also, we find ever present the distinctive note of modern thought, viz., “Not more children, but better ones; not more births, but less deaths and more survivals; not numerical birth values, but qualitative birth values and numerical survival values.”

    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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