introduction of the Notification of Births Act.) In any case,

although the general mortality shows a marked tendency to improvement there is certainly no adequately corresponding improvement in the infantile mortality. This is scarcely surprising, when we realize that there has been no change for the better, but rather for the worse, in the conditions under which our infants are born and reared. Thus William Hall, who has had an intimate knowledge extending over fifty-six years of the slums of Leeds, and has weighed and measured many thousands of slum children, besides examining over 120,000 boys and girls as to their fitness for factory labor, states (_British Medical Journal_, October 14, 1905) that "fifty years ago the slum mother was much more sober, cleanly, domestic, and motherly than she is to-day; she was herself better nourished and she almost always suckled her children, and after weaning they received more nutritious bone-making food, and she was able to prepare more wholesome food at home." The system of compulsory education has had an unfortunate influence in exerting a strain on the parents and worsening the conditions of the home. For, excellent as education is in itself, it is not the primary need of life, and has been made compulsory before the more essential things of life have been made equally compulsory. How absolutely unnecessary this great mortality is may be shown, without evoking the good example of Australia and New Zealand, by merely comparing small English towns; thus while in Guildford the infantile death rate is 65 per thousand, in Burslem it is 205 per thousand. It is sometimes said that infantile mortality is an economic question, and that with improvement in wages it would cease. This is only true to a limited extent and under certain conditions. In Australia there is no grinding poverty, but the deaths of infants under one year of age are still between 80 and 90 per thousand, and one-third of this mortality, according to Hooper (_British Medical Journal_, 1908, vol. ii, p. 289), being due to the ignorance of mothers and the dislike to suckling, is easily preventable. The employment of married women greatly diminishes the poverty of a family, but nothing can be worse for the welfare of the woman as mother, or for the welfare of her child. Reid, the medical officer of health for Staffordshire, where there are two large centres of artisan population with identical health conditions, has shown that in the northern centre, where a very large number of women are engaged in factories, still-births are three times as frequent as in the southern centre, where there are practically no trade employments for women; the frequency of abnormalities is also in the same ratio. The superiority of Jewish over Christian children, again, and their lower infantile mortality, seem to be entirely due to the fact that Jewesses are better mothers. "The Jewish children in the slums," says William Hall (_British Medical Journal_, October 14, 1905), speaking from wide and accurate knowledge, "were superior in weight, in teeth, and in general bodily development, and they seemed less susceptible to infectious disease. Yet these Jews were overcrowded, they took little exercise, and their unsanitary environment was obvious. The fact was, their children were much better nourished. The pregnant Jewess was more cared for, and no doubt supplied better nutriment to the foetus. After the children were born 90 per cent. received breast-milk, and during later childhood they were abundantly fed on bone-making material; eggs and oil, fish, fresh vegetables, and fruit entered largely into their diet." G. Newman, in his important and comprehensive book on _Infant Mortality_, emphasizes the conclusion that "first of all we need a higher standard of physical motherhood." The problem of infantile mortality, he declares (page 259), is not one of sanitation alone, or housing, or indeed of poverty as such, "_but is mainly a question of motherhood_." The fundamental need of the pregnant woman is _rest_. Without a large degree of maternal rest there can be no puericulture.[4] The task of creating a man needs the whole of a woman's best energies, more especially during the three months before birth. It cannot be subordinated to the tax on strength involved by manual or mental labor, or even strenuous social duties and amusements. The numerous experiments and observations which have been made during recent years in Maternity Hospitals, more especially in France, have shown conclusively that not only the present and future well-being of the mother and the ease of her confinement, but the fate of the child, are immensely influenced by rest during the last month of pregnancy. "Every working woman is entitled to rest during the last three months of her pregnancy." This formula was adopted by the International Congress of Hygiene in 1900, but it cannot be practically carried out except by the coöperation of the whole community. For it is not enough to say that a woman ought to rest during pregnancy; it is the business of the community to ensure that that rest is duly secured. The woman herself, and her employer, we may be certain, will do their best to cheat the community, but it is the community which suffers, both economically and morally, when a woman casts her inferior children into the world, and in its own interests the community is forced to control both employer and employed. We can no longer allow it to be said, in Bouchacourt's words, that "to-day the dregs of the human species--the blind, the deaf-mute, the degenerate, the nervous, the vicious, the idiotic, the imbecile, the cretins and epileptics--are better protected than pregnant women."[5] Pinard, who must always be honored as one of the founders of eugenics, has, together with his pupils, done much to prepare the way for the acceptance of this simple but important principle by making clear the grounds on which it is based. From prolonged observations on the pregnant women of all classes Pinard has shown conclusively that women who rest during pregnancy have finer children than women who do not rest. Apart from the more general evils of work during pregnancy, Pinard found that during the later months it had a tendency to press the uterus down into the pelvis, and so cause the premature birth of undeveloped children, while labor was rendered more difficult and dangerous (see, e.g., Pinard, _Gazette des Hôpitaux_, Nov. 28, 1895, Id., _Annales de Gynécologie_, Aug., 1898). Letourneux has studied the question whether repose during pregnancy is necessary for women whose professional work is only slightly fatiguing. He investigated 732 successive confinements at the Clinique Baudelocque in Paris. He found that 137 women engaged in fatiguing occupations (servants, cooks, etc.) and not resting during pregnancy, produced children with an average weight of 3,081 grammes; 115 women engaged in only slightly fatiguing occupations (dressmakers, milliners, etc.) and also not resting during pregnancy, had children with an average weight of 3,130 grammes, a slight but significant difference, in view of the fact that the women of the first group were large and robust, while those of the second group were of slight and elegant build. Again, comparing groups of women who rested during pregnancy, it was found that the women accustomed to fatiguing work had children with an average weight of 3,319 grammes, while those accustomed to less fatiguing work had children with an average weight of 3,318 grammes. The difference between repose and non-repose is thus considerable, while it also enables robust women exercising a fatiguing occupation to catch up, though not to surpass, the frailer women exercising a less fatiguing occupation. We see, too, that even in the comparatively unfatiguing occupations of milliners, etc., rest during pregnancy still remains important, and cannot safely be dispensed with. "Society," Letourneux concludes, "must guarantee rest to women not well off during a part of pregnancy. It will be repaid the cost of doing so by the increased vigor of the children thus produced" (Letourneux, _De l'Influence de la Profession de la Mère sur le Poids de l'Enfant_, Thèse de Paris, 1897). Dr. Dweira-Bernson (_Revue Pratique d'Obstétrique et de Pédiatrie_, 1903, p. 370), compared four groups of pregnant women (servants with light work, servants with heavy work, farm girls, dressmakers) who rested for three months before confinement with four groups similarly composed who took no rest before confinement. In every group he found that the difference in the average weight of the child was markedly in favor of the women who rested, and it was notable that the greatest difference was found in the case of the farm girls who were probably the most robust and also the hardest worked. The usual time of gestation ranges between 274 and 280 days (or 280 to 290 days from the last menstrual period), and occasionally a few days longer, though there is dispute as to the length of the extreme limit, which some authorities would extend to 300 days, or even to 320 days (Pinard, in Richet's _Dictionnaire de Physiologie_, vol. vii, pp. 150-162; Taylor, _Medical Jurisprudence_, fifth edition, pp. 44, 98 et seq.; L.M. Allen, "Prolonged Gestation," _American Journal Obstetrics_, April, 1907). It is possible, as Müller suggested in 1898 in a Thèse de Nancy, that civilization tends to shorten the period of gestation, and that in earlier ages it was longer than it is now. Such a tendency to premature birth under the exciting nervous influences of civilization would thus correspond, as Bouchacourt has pointed out (_La Grossesse_, p. 113), to the similar effect of domestication in animals. The robust countrywoman becomes transformed into the more graceful, but also more fragile, town woman who needs a degree of care and hygiene which the countrywoman with her more resistant nervous system can to some extent dispense with, although even she, as we see, suffers in the person of her child, and probably in her own person, from the effects of work during pregnancy. The serious nature of this civilized tendency to premature birth--of which lack of rest in pregnancy is, however, only one of several important causes--is shown by the fact that Séropian (_Fréquence Comparée des Causes de l'Accouchement Prémature_, Thèse de Paris, 1907) found that about one-third of French births (32.28 per cent.) are to a greater or less extent premature. Pregnancy is not a morbid condition; on the contrary, a pregnant woman is at the climax of her most normal physiological life, but owing to the tension thus involved she is specially liable to suffer from any slight shock or strain. It must be remarked that the increased tendency to premature birth, while in part it may be due to general tendencies of civilization, is also in part due to very definite and preventable causes. Syphilis, alcoholism, and attempts to produce abortion are among the not uncommon causes of premature birth (see, e.g., G.F. McCleary, "The Influence of Antenatal Conditions on Infantile Mortality," _British Medical Journal_, Aug. 13, 1904). Premature birth ought to be avoided, because the child born too early is insufficiently equipped for the task before him. Astengo, dealing with nearly 19,000 cases at the Lariboisière Hospital in Paris and the Maternité, found, that reckoning from the date of the last menstruation, there is a direct relation between the weight of the infant at birth and the length of the pregnancy. The longer the pregnancy, the finer the child (Astengo, _Rapport du Poids des Enfants à la Durée de la Grossesse_, Thèse de Paris, 1905). The frequency of premature birth is probably as great in England as in France. Ballantyne states (_Manual of Antenatal Pathology; The Foetus_, p. 456) that for practical purposes the frequency of premature labors in maternity hospitals may be put at 20 per cent., but that if all infants weighing less than 3,000 grammes are to be regarded as premature, it rises to 41.5 per cent. That premature birth is increasing in England seems to be indicated by the fact that during the past twenty-five years there has been a steady rise in the mortality rate from premature birth. McCleary, who discusses this point and considers the increase real, concludes that "it would appear that there has been a diminution in the quality as well as in the quantity of our output of babies" (see also a discussion, introduced by Dawson Williams, on "Physical Deterioration," _British Medical Journal_, Oct. 14, 1905). It need scarcely be pointed out that not only is immaturity a cause of deterioration in the infants that survive, but that it alone serves enormously to decrease the number of infants that are able to survive. Thus G. Newman states (loc. cit.) that in most large English urban districts immaturity is the chief cause of infant mortality, furnishing about 30 per cent. of the infant deaths; even in London (Islington) Alfred Harris (_British Medical Journal_, Dec. 14, 1907) finds that it is responsible for nearly 17 per cent. of the infantile deaths. It is estimated by Newman that about half of the mothers of infants dying of immaturity suffer from marked ill-health and poor physique; they are not, therefore, fitted to be mothers. Rest during pregnancy is a very powerful agent in preventing premature birth. Thus Dr. Sarraute-Lourié has compared 1,550 pregnant women at the Asile Michelet who rested before confinement with 1,550 women confined at the Hôpital Lariboisière who had enjoyed no such period of rest. She found that the average duration of pregnancy was at least twenty days shorter in the latter group (Mme. Sarraute-Lourié, _De l'Influence du Repos sur la Durée de la Gestation_, Thèse de Paris, 1899). Leyboff has insisted on the absolute necessity of rest during pregnancy, as well for the sake of the woman herself as the burden she carries, and shows the evil results which follow when rest is neglected. Railway traveling, horse-riding, bicycling, and sea-voyages are also, Leyboff believes, liable to be injurious to the course of pregnancy. Leyboff recognizes the difficulties which procreating women are placed under by present industrial conditions, and concludes that "it is urgently necessary to prevent women, by law, from working during the last three months of pregnancy; that in every district there should be a maternity fund; that during this enforced rest a woman should receive the same salary as during work." He adds that the children of unmarried mothers should be cared for by the State, that there should be an eight-hours' day for all workers, and that no children under sixteen should be allowed to work (E. Leyboff, _L'Hygiène de la Grossesse_, Thèse de Paris, 1905). Perruc states that at least two months' rest before confinement should be made compulsory, and that during this period the woman should receive an indemnity regulated by the State. He is of opinion that it should take the form of compulsory assurance, to which the worker, the employer, and the State alike contributed (Perruc, _Assistance aux Femmes Enceintes_, Thèse de Paris, 1905). It is probable that during the earlier months of pregnancy, work, if not excessively heavy and exhausting, has little or no bad effect; thus Bacchimont (_Documents pour servir a l'Histoire de la Puériculture Intra-utérine_, Thèse de Paris, 1898) found that, while there was a great gain in the weight of children of mothers who had rested for three months, there was no corresponding gain in the children of those mothers who had rested for longer periods. It is during the last three months that freedom, repose, the cessation of the obligatory routine of employment become necessary. This is the opinion of Pinard, the chief authority on this matter. Many, however, fearing that economic and industrial conditions render so long a period of rest too difficult of practical attainment, are, with Clappier and G. Newman, content to demand two months as a minimum; Salvat only asks for one month's rest before confinement, the woman, whether married or not, receiving a pecuniary indemnity during this period, with medical care and drugs free. Ballantyne (_Manual of Antenatal Pathology: The Foetus_, p. 475), as well as Niven, also asks only for one month's compulsory rest during pregnancy, with indemnity. Arthur Helme, however, taking a more comprehensive view of all the factors involved, concludes in a valuable paper on "The Unborn Child: Its Care and Its Rights" (_British Medical Journal_, Aug. 24, 1907), "The important thing would be to prohibit pregnant women from going to work at all, and it is as important from the standpoint of the child that this prohibition should include the early as the late months of pregnancy." In England little progress has yet been made as regards this question of rest during pregnancy, even as regards the education of public opinion. Sir William Sinclair, Professor of Obstetrics at the Victoria University of Manchester, has published (1907) _A Plea for Establishing Municipal Maternity Homes_. Ballantyne, a great British authority on the embryology of the child, has published a "Plea for a Pre-Maternity Hospital" (_British Medical Journal_, April 6, 1901), has since given an important lecture on the subject (_British Medical Journal_, Jan. 11, 1908), and has further discussed the matter in his _Manual of Ante-Natal Pathology: The Foetus_ (Ch. XXVII); he is, however, more interested in the establishment of hospitals for the diseases of pregnancy than in the wider and more fundamental question of rest for all pregnant women. In England there are, indeed, a few institutions which receive unmarried women, with a record of good conduct, who are pregnant for the first time, for, as Bouchacourt remarks, ancient British prejudices are opposed to any mercy being shown to women who are recidivists in committing the crime of conception. At present, indeed, it is only in France that the urgent need of rest during the latter months of pregnancy has been clearly realized, and any serious and official attempts made to provide for it. In an interesting Paris thesis (_De la Puériculture avant le Naissance_, 1907) Clappier has brought together much information bearing on the efforts now being made to deal practically with this question. There are many _Asiles_ in Paris for pregnant women. One of the best is the Asile Michelet, founded in 1893 by the Assistance Publique de Paris. This is a sanatorium for pregnant women who have reached a period of seven and a half months. It is nominally restricted to the admission of French women who have been domiciled for a year in Paris, but, in practice, it appears that women from all parts of France are received. They are employed in light and occasional work for the institution, being paid for this work, and are also occupied in making clothes for the expected baby. Married and unmarried women are admitted alike, all women being equal from the point of view of motherhood, and indeed the majority of the women who come to the Asile Michelet are unmarried, some being girls who have even trudged on foot from Brittany and other remote parts of France, to seek concealment from their friends in the hospitable seclusion of these refuges in the great city. It is not the least advantage of these institutions that they shield unmarried mothers and their offspring from the manifold evils to which they are exposed, and thus tend to decrease crime and suffering. In addition to the maternity refuges, there are institutions in France for assisting with help and advice those pregnant women who prefer to remain at home, but are thus enabled to avoid the necessity for undue domestic labor. There ought to be no manner of doubt that when, as is the case to-day in our own and some other supposedly civilized countries, motherhood outside marriage is accounted as almost a crime, there is the very greatest need for adequate provision for unmarried women who are about to become mothers, enabling them to receive shelter and care in secrecy, and to preserve their self-respect and social position. This is necessary not only in the interests of humanity and public economy, but also, as is too often forgotten, in the interests of morality, for it is certain that by the neglect to furnish adequate provision of this nature women are driven to infanticide and prostitution. In earlier, more humane days, the general provision for the secret reception and care of illegitimate infants was undoubtedly most beneficial. The suppression of the mediæval method, which in France took place gradually between 1833 and 1862, led to a great increase in infanticide and abortion, and was a direct encouragement to crime and immorality. In 1887 the Conseil Général of the Seine sought to replace the prevailing neglect of this matter by the adoption of more enlightened ideas and founded a _bureau secret d'admission_ for pregnant women. Since then both the abandonment of infants and infanticide have greatly diminished, though they are increasing in those parts of France which possess no facilities of this kind. It is widely held that the State should unify the arrangements for assuring secret maternity, and should, in its own interests, undertake the expense. In 1904 French law ensured the protection of unmarried mothers by guaranteeing their secret, but it failed to organize the general establishment of secret maternities, and has left to doctors the pioneering part in this great and humane public work (A. Maillard-Brune, _Refuges, Maternités, Bureaux d'Admission Secrets, comme Moyens Préservatives des Infanticide_, Thèse de Paris, 1908). It is not among the least benefits of the falling birth rate that it has helped to stimulate this beneficent movement. The development of an industrial system which subordinates the human body and the human soul to the thirst for gold, has, for a time, dismissed from social consideration the interests of the race and even of the individual, but it must be remembered that this has not been always and everywhere so. Although in some parts of the world the women of savage peoples work up to the time of confinement, it must be remarked that the conditions of work in savage life do not resemble the strenuous and continuous labor of modern factories. In many parts of the world, however, women are not allowed to work hard during pregnancy and every consideration is shown to them. This is so, for instance, among the Pueblo Indians, and among the Indians of Mexico. Similar care is taken in the Carolines and the Gilbert Islands and in many other regions all over the world. In some places, women are secluded during pregnancy, and in others are compelled to observe many more or less excellent rules. It is true that the assigned cause for these rules is frequently the fear of evil spirits, but they nevertheless often preserve a hygienic value. In many parts of the world the discovery of pregnancy is the sign for a festival of more or less ritual character, and much good advice is given to the expectant mother. The modern Musselmans are careful to guard the health of their women when pregnant, and so are the Chinese.[6] Even in Europe, in the thirteenth century, as Clappier notes, industrial corporations sometimes had regard to this matter, and would not allow women to work during pregnancy. In Iceland, where much of the primitive life of Scandinavian Europe is still preserved, great precautions are taken with pregnant women. They must lead a quiet life, avoid tight garments, be moderate in eating and drinking, take no alcohol, be safeguarded from all shocks, while their husbands and all others who surround them must treat them with consideration, save them from worry and always bear with them patiently.[7] It is necessary to emphasize this point because we have to realize that the modern movement for surrounding the pregnant woman with tenderness and care, so far from being the mere outcome of civilized softness and degeneracy, is, in all probability, the return on a higher plane to the sane practice of those races which laid the foundations of human greatness. While rest is the cardinal virtue imposed on a woman during the later months of pregnancy, there are other points in her regimen that are far from unimportant in their bearing on the fate of the child. One of these is the question of the mother's use of alcohol. Undoubtedly alcohol has been a cause of much fanaticism. But the declamatory extravagance of anti-alcoholists must not blind us to the fact that the evils of alcohol are real. On the reproductive process especially, on the mammary glands, and on the child, alcohol has an arresting and degenerative influence without any compensatory advantages. It has been proved by experiments on animals and observations on the human subject that alcohol taken by the pregnant woman passes freely from the maternal circulation to the foetal circulation. Féré has further shown that, by injecting alcohol and aldehydes into hen's eggs during incubation, it is possible to cause arrest of development and malformation in the chick.[8] The woman who is bearing her child in her womb or suckling it at her breast would do well to remember that the alcohol which may be harmless to herself is little better than poison to the immature being who derives nourishment from her blood. She should confine herself to the very lightest of alcoholic beverages in very moderate amounts and would do better still to abandon these entirely and drink milk instead. She is now the sole source of the child's life and she cannot be too scrupulous in creating around it an atmosphere of purity and health. No after-influence can ever compensate for mistakes made at this time.[9] What is true of alcohol is equally true of other potent drugs and poisons, which should all be avoided so far as possible during pregnancy because of the harmful influence they may directly exert on the embryo. Hygiene is better than drugs, and care should be exercised in diet, which should by no means be excessive. It is a mistake to suppose that the pregnant woman needs considerably more food than usual, and there is much reason to believe not only that a rich meat diet tends to cause sterility but that it is also unfavorable to the development of the child in the womb.[10] How far, if at all, it is often asked, should sexual intercourse be continued after fecundation has been clearly ascertained? This has not always been found an easy question to answer, for in the human couple many considerations combine to complicate the answer. Even the Catholic theologians have not been entirely in agreement on this point. Clement of Alexandria said that when the seed had been sown the field must be left till harvest. But it may be concluded that, as a rule, the Church was inclined to regard intercourse during pregnancy as at most a venial sin, provided there was no danger of abortion. Augustine, Gregory the Great, Aquinas, Dens, for instance, seem to be of this mind; for a few, indeed, it is no sin at all.[11] Among animals the rule is simple and uniform; as soon as the female is impregnated at the period of oestrus she absolutely rejects all advance of the male until, after birth and lactation are over, another period of oestrus occurs. Among savages the tendency is less uniform, and sexual abstinence, when it occurs during pregnancy, tends to become less a natural instinct than a ritual observance, or a custom now chiefly supported by superstitions. Among many primitive peoples abstinence during the whole of pregnancy is enjoined because it is believed that the semen would kill the foetus.[12] The Talmud is unfavorable to coitus during pregnancy, and the Koran prohibits it during the whole of the period, as well as during suckling. Among the Hindus, on the other hand, intercourse is continued up to the last fortnight of pregnancy, and it is even believed that the injected semen helps to nourish the embryo (W.D. Sutherland, "Ueber das Alltagsleben und die Volksmedizin unter den Bauern Britischostindiens," _Münchener Medizinische Wochenschrift_, Nos. 12 and 13, 1906). The great Indian physician Susruta, however, was opposed to coitus during pregnancy, and the Chinese are emphatically on the same side. As men have emerged from barbarism in the direction of civilization, the animal instinct of refusal after impregnation has been completely lost in women, while at the same time both sexes tend to become indifferent to those ritual restraints which at an earlier period were almost as binding as instinct. Sexual intercourse thus came to be practiced after impregnation, much the same as before, as part of ordinary "marital rights," though sometimes there has remained a faint suspicion, reflected in the hesitating attitude of the Catholic Church already alluded to, that such intercourse may be a sinful indulgence. Morality is, however, called in to fortify this indulgence. If the husband is shut out from marital intercourse at this time, it is argued, he will seek extra-marital intercourse, as indeed in some parts of the world it is recognized that he legitimately may; therefore the interests of the wife, anxious to retain her husband's fidelity, and the interests of Christian morality, anxious to uphold the institution of monogamy, combine to permit the continuation of coitus during pregnancy. The custom has been furthered by the fact that, in civilized women at all events, coitus during pregnancy is usually not less agreeable than at other times and by some women is felt indeed to be even more agreeable.[13] There is also the further consideration, for those couples who have sought to prevent conception, that now intercourse may be enjoyed with impunity. From a higher point of view such intercourse may also be justified, for if, as all the finer moralists of the sexual impulse now believe, love has its value not only in so far as it induces procreation but also in so far as it aids individual development and the mutual good and harmony of the united couple, it becomes morally right during pregnancy. From an early period, however, great authorities have declared themselves in opposition to the custom of practicing coitus during pregnancy. At the end of the first century, Soranus, the first of great gynæcologists, stated, in his treatise on the diseases of women, that sexual intercourse is injurious throughout pregnancy, because of the movement imparted to the uterus, and especially injurious during the latter months. For more than sixteen hundred years the question, having fallen into the hands of the theologians, seems to have been neglected on the medical side until in 1721 a distinguished French obstetrician, Mauriceau, stated that no pregnant woman should have intercourse during the last two months and that no woman subject to miscarriage should have intercourse at all during pregnancy. For more than a century, however, Mauriceau remained a pioneer with few or no followers. It would be inconvenient, the opinion went, even if it were necessary, to forbid intercourse during pregnancy.[14] During recent years, nevertheless, there has been an increasingly strong tendency among obstetricians to speak decisively concerning intercourse during pregnancy, either by condemning it altogether or by enjoining great prudence. It is highly probable that, in accordance with the classical experiments of Dareste on chicken embryos, shocks and disturbances to the human embryo may also produce injurious effects on growth. The disturbance due to coitus in the early stages of pregnancy may thus tend to produce malformation. When such conditions are found in the children of perfectly healthy, vigorous, and generally temperate parents who have indulged recklessly in coitus during the early stages of pregnancy it is possible that such coitus has acted on the embryo in the same way as shocks and intoxications are known to act on the embryo of lower organisms. However this may be, it is quite certain that in predisposed women, coitus during pregnancy causes premature birth; it sometimes happens that labor pains begin a few minutes after the act.[15] The natural instinct of animals refuses to allow intercourse during pregnancy; the ritual observance of primitive peoples very frequently points in the same direction; the voice of medical science, so far as it speaks at all, is beginning to utter the same warning, and before long will probably be in a position to do so on the basis of more solid and coherent evidence. Pinard, the greatest of authorities on puericulture, asserts that there must be complete cessation of sexual intercourse during the whole of pregnancy, and in his consulting room at the Clinique Baudelocque he has placed a large placard with an "Important Notice" to this effect. Féré was strongly of opinion that sexual relations during pregnancy, especially when recklessly carried out, play an important part in the causation of nervous troubles in children who are of sound heredity and otherwise free from all morbid infection during gestation and development; he recorded in detail a case which he considered conclusive ("L'Influence de l'Incontinence Sexuelle pendant la Gestation sur la Descendance," _Archives de Neurologie_, April, 1905). Bouchacourt discusses the subject fully (_La Grossesse_, pp. 177-214), and thinks that sexual intercourse during pregnancy should be avoided as much as possible. Fürbringer (Senator and Kaminer, _Health and Disease in Relation to Marriage_, vol. i, p. 226) recommends abstinence from the sixth or seventh month, and throughout the whole of pregnancy where there is any tendency to miscarriage, while in all cases much care and gentleness should be exercised. The whole subject has been investigated in a Paris Thesis by H. Brénot (_De L'Influence de la Copulation pendant la Grossesse_, 1903); he concludes that sexual relations are dangerous throughout pregnancy, frequently provoking premature confinement or abortion, and that they are more dangerous in primiparæ than in multiparæ. Nearly everything that has been said of the hygiene of pregnancy, and the need for rest, applies also to the period immediately following the birth of the child. Rest and hygiene on the mother's part continue to be necessary alike in her own interests and in the child's. This need has indeed been more generally and more practically recognized than the need for rest during pregnancy. The laws of several countries make compulsory a period of rest from employment after confinement, and in some countries they seek to provide for the remuneration of the mother during this enforced rest. In no country, indeed, is the principle carried out so thoroughly and for so long a period as is desirable. But it is the right principle, and embodies the germ which, in the future, will be developed. There can be little doubt that whatever are the matters, and they are certainly many, which may be safely left to the discretion of the individual, the care of the mother and her child is not among them. That is a matter which, more than any other, concerns the community as a whole, and the community cannot afford to be slack in asserting its authority over it. The State needs healthy men and women, and by any negligence in attending to this need it inflicts serious charges of all sorts upon itself, and at the same time dangerously impairs its efficiency in the world. Nations have begun to recognize the desirability of education, but they have scarcely yet begun to realize that the nationalization of health is even more important than the nationalization of education. If it were necessary to choose between the task of getting children educated and the task of getting them well-born and healthy it would be better to abandon education. There have been many great peoples who never dreamed of national systems of education; there has been no great people without the art of producing healthy and vigorous children. This matter becomes of peculiar importance in great industrial states like England, the United States, and Germany, because in such states a tacit conspiracy tends to grow up to subordinate national ends to individual ends, and practically to work for the deterioration of the race. In England, for instance, this tendency has become peculiarly well marked with disastrous results. The interest of the employed woman tends to become one with that of her employer; between them they combine to crush the interests of the child who represents the race, and to defeat the laws made in the interests of the race which are those of the community as a whole. The employed woman wishes to earn as much wages as she can and with as little interruption as she can; in gratifying that wish she is, at the same time, acting in the interests of the employer, who carefully avoids thwarting her. This impulse on the employed woman's part is by no means always and entirely the result of poverty, and would not, therefore, be removed by raising her wages. Long before marriage, when little more than a child, she has usually gone out to work, and work has become a second nature. She has mastered her work, she enjoys a certain position and what to her are high wages; she is among her friends and companions; the noise and bustle and excitement of the work-room or the factory have become an agreeable stimulant which she can no longer do without. On the other hand, her home means nothing to her; she only returns there to sleep, leaving it next morning at day-break or earlier; she is ignorant even of the simplest domestic arts; she moves about in her own home like a strange and awkward child. The mere act of marriage cannot change this state of things; however willing she may be at marriage to become a domesticated wife, she is destitute alike of the inclination or the skill for domesticity. Even in spite of herself she is driven back to the work-shop, to the one place where she feels really at home. In Germany women are not allowed to work for four weeks after confinement, nor during the following two weeks except by medical certificate. The obligatory insurance against disease which covers women at confinement assures them an indemnity at this time equivalent to a large part of their wages. Married and unmarried mothers benefit alike. The Austrian law is founded on the same model. This measure has led to a very great decrease in infantile mortality, and, therefore, a great increase in health among those who survive. It is, however, regarded as very inadequate, and there is a movement in Germany for extending the time, for applying the system to a larger number of women, and for making it still more definitely compulsory. In Switzerland it has been illegal since 1877 for any woman to be received into a factory after confinement, unless she has rested in all for eight weeks, six weeks at least of this period being after confinement. Since 1898 Swiss working women have been protected by law from exercising hard work during pregnancy, and from various other influences likely to be injurious. But this law is evaded in practice, because it provides no compensatory indemnity for the woman. An attempt, in 1899, to amend the law by providing for such indemnity was rejected by the people. In Belgium and Holland there are laws against women working immediately after confinement, but no indemnity is provided, so that employers and employed combine to evade the law. In France there is no such law, although its necessity has often been emphatically asserted (see, e.g., Salvat, _La Dépopulation de la France_, Thèse de Lyon, 1903). In England it is illegal to employ a woman "knowingly" in a work-shop within four weeks of the birth of her child, but no provision is made by the law for the compensation of the woman who is thus required to sacrifice herself to the interests of the State. The woman evades the law in tacit collusion with her employers, who can always avoid "knowing" that a birth has taken place, and so escape all responsibility for the mother's employment. Thus the factory inspectors are unable to take action, and the law becomes a dead letter; in 1906 only one prosecution for this offense could be brought into court. By the insertion of this "knowingly" a premium is placed on ignorance. The unwisdom of thus beforehand placing a premium on ignorance has always been more or less clearly recognized by the framers of legal codes even as far back as the days of the Ten Commandments and the laws of Hamurabi. It is the business of the Court, of those who administer the law, to make allowance for ignorance where such allowance is fairly called for; it is not for the law-maker to make smooth the path of the law-breaker. There are evidently law-makers nowadays so scrupulous, or so simple-minded, that they would be prepared to exact that no pickpocket should be prosecuted if he was able to declare on oath that he had no "knowledge" that the purse he had taken belonged to the person he extracted it from. The annual reports of the English factory inspectors serve to bring ridicule on this law, which looks so wisely humane and yet means nothing, but have so far been powerless to effect any change. These reports show, moreover, that the difficulty is increasing in magnitude. Thus Miss Martindale, a factory inspector, states that in all the towns she visits, from a quiet cathedral city to a large manufacturing town, the employment of married women is rapidly increasing; they have worked in mills or factories all their lives and are quite unaccustomed to cooking, housework and the rearing of children, so that after marriage, even when not compelled by poverty, they prefer to go on working as before. Miss Vines, another factory inspector, repeats the remark of a woman worker in a factory. "I do not need to work, but I do not like staying at home," while another woman said, "I would rather be at work a hundred times than at home. I get lost at home" (_Annual Report Chief Inspector of Factories and Workshops for 1906_, pp. 325, etc.). It may be added that not only is the English law enjoining four weeks' rest on the mother after childbirth practically inoperative, but the period itself is absurdly inadequate. As a rest for the mother it is indeed sufficient, but the State is still more interested in the child than in its mother, and the child needs the mother's chief care for a much longer period than four weeks. Helme advocates the State prohibition of women's work for at least six months after confinement. Where nurseries are attached to factories, enabling the mother to suckle her infant in intervals of work, the period may doubtless be shortened. It is important to remember that it is by no means only the women in factories who are induced to work as usual during the whole period of pregnancy, and to return to work immediately after the brief rest of confinement. The Research Committee of the Christian Social Union (London Branch) undertook, in 1905, an inquiry into the employment of women after childbirth. Women in factories and workshops were excluded from the inquiry which only had reference to women engaged in household duties, in home industries, and in casual work. It was found that the majority carry on their employment right up to the time of confinement and resume it from ten to fourteen days later. The infantile death rate for the children of women engaged only in household duties was greatly lower than that for the children of the other women, while, as ever, the hand-fed infants had a vastly higher death rate than the breast-fed infants (_British Medical Journal_, Oct. 24, 1908, p. 1297). In the great French gun and armour-plate works at Creuzot (Saône et Loire) the salaries of expectant mothers among the employees are raised; arrangements are made for giving them proper advice and medical attendance; they are not allowed to work after the middle of pregnancy or to return to work after confinement without a medical certificate of fitness. The results are said to be excellent, not only on the health of the mothers, but in the diminution of premature births, the decrease of infantile deaths, and the general prevalence of breast-feeding. It would probably be hopeless to expect many employers in Anglo-Saxon lands to adopt this policy. They are too "practical," they know how small is the money-value of human lives. With us it is necessary for the State to intervene. There can be no doubt that, on the whole, modern civilized communities are beginning to realize that under the social and economic conditions now tending more and more to prevail, they must in their own interests insure that the mother's best energy and vitality are devoted to the child, both before and after its birth. They are also realizing that they cannot carry out their duty in this respect unless they make adequate provision for the mothers who are thus compelled to renounce their employment in order to devote themselves to their children. We here reach a point at which Individualism is at one with Socialism. The individualist cannot fail to see that it is at all cost necessary to remove social conditions which crush out all individuality; the Socialist cannot fail to see that a society which neglects to introduce order at this central and vital point, the production of the individual, must speedily perish. It is involved in the proper fulfilment of a mother's relationship to her infant child that, provided she is healthy, she should suckle it. Of recent years this question has become a matter of serious gravity. In the middle of the eighteenth century, when the upper-class women of France had grown disinclined to suckle their own children, Rousseau raised so loud and eloquent a protest that it became once more the fashion for a woman to fulfil her natural duties. At the present time, when the same evil is found once more, and in a far more serious form, for now it is not the small upper-class but the great lower-class that is concerned, the eloquence of a Rousseau would be powerless, for it is not fashion so much as convenience, and especially an intractable economic factor, that is chiefly concerned. Not the least urgent reason for putting women, and especially mothers, upon a sounder economic basis, is the necessity of enabling them to suckle their children. No woman is sound, healthy, and complete unless she possesses breasts that are beautiful enough to hold the promise of being functional when the time for their exercise arrives, and nipples that can give suck. The gravity of this question to-day is shown by the frequency with which women are lacking in this essential element of womanhood, and the young man of to-day, it has been said, often in taking a wife, "actually marries but part of a woman, the other part being exhibited in the chemist's shop window, in the shape of a glass feeding-bottle." Blacker found among a thousand patients from the maternity department of University College Hospital that thirty-nine had never suckled at all, seven hundred and forty-seven had suckled all their children, and two hundred and fourteen had suckled only some. The chief reason given for not suckling was absence or insufficiency of milk; other reasons being inability or disinclination to suckle, and refusal of the child to take the breast (Blacker, _Medical Chronicle_, Feb., 1900). These results among the London poor are certainly very much better than could be found in many manufacturing towns where women work after marriage. In the other large countries of Europe equally unsatisfactory results are found. In Paris Madame Dluska has shown that of 209 women who came for their confinement to the Clinique Baudelocque, only 74 suckled their children; of the 135 who did not suckle, 35 were prevented by pathological causes or absence of milk, 100 by the necessities of their work. Even those who suckled could seldom continue more than seven months on account of the physiological strain of work (Dluska, _Contribution à l'Etude de l'Allaitement Maternel_, Thèse de Paris, 1894). Many statistics have been gathered in the German countries. Thus Wiedow (_Centralblatt für Gynäkologie_, No. 29, 1895) found that of 525 women at the Freiburg Maternity only half could suckle thoroughly during the first two weeks; imperfect nipples were noted in 49 cases, and it was found that the development of the nipple bore a direct relation to the value of the breast as a secretory organ. At Munich Escherich and Büller found that nearly 60 per cent. of women of the lower class were unable to suckle their children, and at Stuttgart three-quarters of the child-bearing women were in this condition. The reasons why children should be suckled at their mothers' breasts are larger than some may be inclined to believe. In the first place the psychological reason is one of no mean importance. The breast with its exquisitely sensitive nipple, vibrating in harmony with the sexual organs, furnishes the normal mechanism by which maternal love is developed. No doubt the woman who never suckles her child may love it, but such love is liable to remain defective on the fundamental and instinctive side. In some women, indeed, whom we may hesitate to call abnormal, maternal love fails to awaken at all until brought into action through this mechanism by the act of suckling. A more generally recognized and certainly fundamental reason for suckling the child is that the milk of the mother, provided she is reasonably healthy, is the infant's only ideally fit food. There are some people whose confidence in science leads them to believe that it is possible to manufacture foods that are as good or better than mother's milk; they fancy that the milk which is best for the calf is equally best for so different an animal as the baby. These are delusions. The infant's best food is that elaborated in his own mother's body. All other foods are more or less possible substitutes, which require trouble to prepare properly and are, moreover, exposed to various risks from which the mother's milk is free. A further reason, especially among the poor, against the use of any artificial foods is that it accustoms those around the child to try experiments with its feeding and to fancy that any kind of food they eat themselves may be good for the infant. It thus happens that bread and potatoes, brandy and gin, are thrust into infants' mouths. With the infant that is given the breast it is easier to make plain that, except by the doctor's orders, nothing else must be given. An additional reason why the mother should suckle her child is the close and frequent association with the child thus involved. Not only is the child better cared for in all respects, but the mother is not deprived of the discipline of such care, and is also enabled from the outset to learn and to understand the child's nature. The inability to suckle acquires great significance if we realize that it is associated, probably in a large measure as a direct cause, with infantile mortality. The mortality of artificially-fed infants during the first year of life is seldom less than double that of the breast-fed, sometimes it is as much as three times that of the breast-fed, or even more; thus at Derby 51.7 per cent. of hand-fed infants die under the age of twelve months, but only 8.6 per cent. of breast-fed infants. Those who survive are by no means free from suffering. At the end of the first year they are found to weigh about 25 per cent. less than the breast-fed, and to be much shorter; they are more liable to tuberculosis and rickets, with all the evil results that flow from these diseases; and there is some reason to believe that the development of their teeth is injuriously affected. The degenerate character of the artificially-fed is well indicated by the fact that of 40,000 children who were brought for treatment to the Children's Hospital in Munich, 86 per cent. had been brought up by hand, and the few who had been suckled had usually only had the breast for a short time. The evil influence persists even up to adult life. In some parts of France where the wet-nurse industry flourishes so greatly that nearly all the children are brought up by hand, it has been found that the percentage of rejected conscripts is nearly double that for France generally. Corresponding results have been found by Friedjung in a large German athletic association. Among 155 members, 65 per cent. were found on inquiry to have been breast-fed as infants (for an average of six months); but among the best athletes the percentage of breast-fed rose to 72 per cent. (for an average period of nine or ten months), while for the group of 56 who stood lowest in athletic power the percentage of breast-fed fell to 57 (for an average of only three months). The advantages for an infant of being suckled by its mother are greater than can be accounted for by the mere fact of being suckled rather than hand-fed. This has been shown by Vitrey (_De la Mortalité Infantile_, Thèse de Lyon, 1907), who found from the statistics of the Hôtel-Dieu at Lyons, that infants suckled by their mothers have a mortality of only 12 per cent., but if suckled by strangers, the mortality rises to 33 per cent. It may be added that, while suckling is essential to the complete well-being of the child, it is highly desirable for the sake of the mother's health also. (Some important statistics are summarized in a paper on "Infantile Mortality" in _British Medical Journal_, Nov. 2, 1907), while the various aspects of suckling have been thoroughly discussed by Bollinger, "Ueber Säuglings-Sterblichkeit und die Erbliche functionelle Atrophie der menschlichen Milchdrüse" (_Correspondenzblatt Deutschen Gesellschaft Anthropologie_, Oct., 1899). It appears that in Sweden, in the middle of the eighteenth century, it was a punishable offense for a woman to give her baby the bottle when she was able to suckle it. In recent years Prof. Anton von Menger, of Vienna, has argued (in his _Burgerliche Recht und die Besitzlosen Klassen_) that the future generation has the right to make this claim, and he proposes that every mother shall be legally bound to suckle her child unless her inability to do so has been certified by a physician. E.A. Schroeder (_Das Recht in der Geschlechtlichen Ordnung_, 1893, p. 346) also argued that a mother should be legally bound to suckle her infant for at least nine months, unless solid grounds could be shown to the contrary, and this demand, which seems reasonable and natural, since it is a mother's privilege as well as her duty to suckle her infant when able to do so, has been insistently made by others also. It has been supported from the legal side by Weinberg (_Mutterschutz_, Sept., 1907). In France the Loi Roussel forbids a woman to act as a wet-nurse until her child is seven months old, and this has had an excellent effect in lowering infantile mortality (A. Allée, _Puériculture et la Loi Roussel_, Thèse de Paris, 1908). In some parts of Germany manufacturers are compelled to set up a suckling-room in the factory, where mothers can give the breast to the child in the intervals of work. The control and upkeep of these rooms, with provision of doctors and nurses, is undertaken by the municipality (_Sexual-Probleme_, Sept., 1908, p. 573). As things are to-day in modern industrial countries the righting of these wrongs cannot be left to Nature, that is, to the ignorant and untrained impulses of persons who live in a whirl of artificial life where the voice of instinct is drowned. The mother, we are accustomed to think, may be trusted to see to the welfare of her child, and it is unnecessary, or even "immoral," to come to her assistance. Yet there are few things, I think, more pathetic than the sight of a young Lancashire mother who works in the mills, when she has to stay at home to nurse her sick child. She is used to rise before day-break to go to the mill; she has scarcely seen her child by the light of the sun, she knows nothing of its necessities, the hands that are so skilful to catch the loom cannot soothe the child. The mother gazes down at it in vague, awkward, speechless misery. It is not a sight one can ever forget. It is France that is taking the lead in the initiation of the scientific and practical movements for the care of the young child before and after birth, and it is in France that we may find the germs of nearly all the methods now becoming adopted for arresting infantile mortality. The village system of Villiers-le-Duc, near Dijon in the Côte d'Or, has proved a germ of this fruitful kind. Here every pregnant woman not able to secure the right conditions for her own life and that of the child she is bearing, is able to claim the assistance of the village authorities; she is entitled, without payment, to the attendance of a doctor and midwife and to one franc a day during her confinement. The measures adopted in this village have practically abolished both maternal and infantile mortality. A few years ago Dr. Samson Moore, the medical officer of health for Huddersfield, heard of this village, and Mr. Benjamin Broadbent, the Mayor of Huddersfield, visited Villiers-le-Duc. It was resolved to initiate in Huddersfield a movement for combating infant mortality. Henceforth arose what is known as the Huddersfield scheme, a scheme which has been fruitful in splendid results. The points of the Huddersfield scheme are: (1) compulsory notification of births within forty-eight hours; (2) the appointment of lady assistant medical officers of help to visit the home, inquire, advise, and assist; (3) the organized aid of voluntary lady workers in subordination to the municipal part of the scheme; (4) appeal to the medical officer of help when the baby, not being under medical care, fails to thrive. The infantile mortality of Huddersfield has been very greatly reduced by this scheme.[16] The Huddersfield scheme may be said to be the origin of the English Notification of Births Act, which came into operation in