iCKET SERIES NO. 209 E. Haldeman-Julius
ts of Birth ontrol
.phus Knopf
HALDEMAN-JULIUS COMPANY GIRARD, KANSAS
TEN CENT ROCKET SERIES NO. 209 Edited by E. Haldeman-Julius
Aspects of Birth Control
Adolphus Knopf
HALDEiMAN-JULIUS COMPANY GIRARD, KANSAS
^t(^^^!>0
SRLF
MORAL ASPECTS OF BIRTH CONTROL.
When at this very moment across the sea in Europe the best blood of the nations which were heretofore considered the most enlight- ened, cultured, and civilized, is daily being shed and hundreds of thousands of young men in the prime of life sacrificed to the Moloch of war, it must seem a hazardous undertak- ing to talk of birth control, which means ar- tificial birth limitation and by some super- ficial observers is designated as race suicide. I trust, however, that before I arrive at the end of my paper, I will have convinced you that the object of my appeal is not a plea for reducing the population but for increasing its vigor by reducing the number of the physi- cally, mentally and morally unfit and adding to the number of physically strong, mentally sound, and higher morally developed men and women.
In accordance with the program outlined, I will deal first with the medical and san- itary aspects of the subject. No one will deny that we occasionally come across a family, well- co-do and intelligent, where the parents by reason of unusual vigor, and particularly by reason of the physical strength of the mother, have been able to rear a large num-
4 ASPECTS OF BIRTH CONTROL
ber of children. In some instances all have survived and have grown up to be healthy and vigorous, but these instances are rare and are becoming more and more so every day. On the other hand, large families, that is to say, numerous children as the issue of one couple, among the ignorant, the poor, the un- derfed and badly housed, the tuberculous, the degenerate, the alcoholic, the vicious, and even the mentally defective, is an everyday spec- tacle. It is well known to every general prac- titioner whose field of activity lies among the poor and the above mentioned classes, that the infant mortality among these is very great. The same holds true of the mortality of school children coming from large families among these classes of the population.
Concerning tuberculosis, with which, by reason of many years' experience, I am per- haps more familiar than with other medical and social diseases, let me relate the interest- ing fact that a carefully taken history of many, many cases has revealed to me that with surprising regularity the tuberculous in- dividual, when he or she comes from a large family, is one of the later born children — the fifth, sixth, seventh, eighth, ninth, etc. The explanation for this phenomenon is obvious When parents are older, and particularly when the mother is worn out by frequent pregnancies and often weakened because •bliged to work in mill, factory, or workshop «p to the very day of confinement, the child win eome into the world with lessened vital-
ASPECTS OF BIRTH CONTROL 8
ity, its main inheritance being a physological poverty. This systemic poverty will leave it less resistant, not only to tuberculosis but to all other diseases of infancy and childhood as well.
The morbidity and mortality among these children is greatest when the children are most numerous in one family. Miss Emma Duke, in the third of the Infant Mortality Series, gives the result of a field study in Johnstown, Pa., based on the births of one calendar year (1911.) The inspection was made in 1913, of the 1911 babies, so that even the last born baby included had reached its first birthday — or rather had had a chance to reach its first birthday; many of them were dead long before that day. The following is Miss Duke's table showing the infant mor- tality rate for all children born by married mothers in Johnstown during that year;
Deaths per 1,000 births in —
Families of 1 and 2 children 108.6
Families of 3 and 4 children 126.0
Families of 5 and « children 162.8
Families of 7 and 8 children 176.4
Families of 9 and more children 191.9
Dr. Alice Hamilton of the Memorial Insti- tute for Infectious Diseases, Hull House, Chicago, made a study of 1,600 families in the neighborhood of the settlement. The fol- lowing is the table of the child mortality rate of the 1,600 families as published by Doctor
6 ASPECTS OF BIRTH CONTROL
Hamilton :
Deaths per 1,000 births in —
Families of 4 children and less 118
Families of 6 children 287
Families of 7 children 280
Families of 8 children 291
Families of 9 children and more 808
Many families were found of thirteen, fourteen, and even sixteen members. The largest of all was that of an Italian woman who had born twenty-two and raised two The small family of every nationality had a lower mortality rate than the large families of the same nationality. The Jewish families of four and less had the astonishingly low mortality rate of 81 per 1,000, while in families of eight and less, the rate rose to 260 pei 1,000.
The larger the family, the more congested will be the quarters they live in and the more unsanitary will be the environment. Last, but not least, with the increase of the family there is by no means a corresponding increase of the earning capacity of the father or mother, and as a result malnutrition and in- sufficient clothing enter as factors to predis- pose to tuberculosis or cause an already ex- isting latent tuberculosis to become active.
What is the result of this condition in re- lation to tuberculosis — one single disease? Out of the 200,000 individuals who die an- nually of tuberculosis in the United States. 50,000 are children. Of the economic loss re- sulting from these early deaths I will speak
ASPECTS OF BIRTH CONTROL 1
later on, but in continuing along the medical and sanitary lines of my subjejct, I must call your attention to the fact that according to some authors 65 per cent of women afflicted with tuberculosis, even when afflicted only in the relatively early and curable stages, die as a result of pregnancy which could have been avoided and their lives been saved had they but known the means of prevention. Some times we succeed in saving such a mother by a timely and careful emptying of the uterus. But an abortion even scientifically carried out and only resorted to with a view of saving the life of the mother, is never desirable, either for the consultant to advise, nor for the gynecologist or obstetrician to perform; and who will dare to say that even under the best conditions this operation is devoid of danger.
What is the explanation and what are the consequences from the point of view of sanita- tion, of the death of 50,000 tuberculous chil- dren? They have mostly become infected from tuberculous parents or tuberculous board- ers who had to be taken into the family to help pay the rent. In the crowded homes of the poor there was neither sunlight, air, nor food enough to cure the sufferers and before they died they became disseminators of the disease. Nearly all of the infectious and communicable diseases are more prevalent in the congested, overcrowded homes of the poor and particularly in those of large families. The propagation of syphilis and gonorrhoea by
8 ASPECTS OF BIRTH CONTROL
contact infection, other than sexual, can sometimes be avoided in the homes of the well- to-do, by enlightenment and the conscientious- ness of the afflicted. They are almost in- variably communicated to the innocent in the homes of the ignorant and poor. Gonorrhoe- al infection from parent to child or from one infected member of the family to the other, is responsible more than anything else for the 57,272 blind persons in the United States.*
The great syphilographer Foumier left U8 the following irrefutable statistical evidences of the seriousness of syphilitic transmission. As a result of parental transmission there is a morbidity of 37.0 per cent, and a mortality of 28.0 per cent; maternal transmission re- sults in 84.0 per cent morbidity and 60.0 per cent mortality; and the combined transmis- sions are no less than 90.0 per cent of mor- bidity and 68.5 per cent of mortality.!
I venture to say right here that would or could a syphilitic or gonorrhoeic parent be taught how to prevent conception during the acute and infectious stages of his or her dis- ease, there would certainly be less inherited syphilis, less blindness from gonorrhoeal in- fection; in other words, less unfortunate chil- dren in this world handicapped for life and a burden to the community.
That insanity, idiocy, epilepsy, and alco
•United States Census, 1910.
IBerkowitE! "Late Congenital Syphilis." N. Y. Medi eal Journal, June 17, 1916.
ASPECTS OF BIRTH CONTROL «
holic predisposition are often transmitted from parent to child is now universally ad- mitted, and corroborated by every day ex- perience and by an abundance of statistics. Countless are the millions of dollars expended for the maintenance of these mentally unfit. The state of New York alone spends ^2,000,- 000 annually for the care of its insane. Whether sterilization of these individuals would be the best remedy is a question still open for discussion. The constitutionality of the procedure is doubted by some of our legal authorities. Segregation is resorted to in the meantime with more or less rigor, according to the state laws. Every year, however, many of the individuals who had been committed to institutions for the treatment of mental dis- orders are discharged as cured. They are al- lowed to procreate their kind. Would it not be an economic saving if at least the individ- uals whose intelligence has been restored were instructed in the prevention of bringing into the world children who are most likely to be mentally tainted and to become a burden to the community?
The economic loss to our commonwealth from bringing into this world thousands of children mentally and psysically crippled for life is beyond calculation. But considering tuberculosis we have been able to calculate at least approximately what it costs. I stated above that 50,000 children die an- nually from tuberculosis in the United States. Figuring the average length of life of these
10 ASPECTS OF BIRTH CONTROL
children to be seven and one half years and their cost to the community as only $200 per annum, represents a loss of $75,000,000. Such children have died without having been able to give any return to their parents or to the community. Who will dare to calculate in dollars and cents the loss which has accrued to the community because so many mothers died of tuberculosis when an avoidable preg- aancy was added to a slight tuberculous ail- ment in a curable stage? Who will dare to estimate the cost of the loss of an equally large or perhaps larger number of mothers afflicted with serious cardiac or renal diseases, or frail or ill from other causes, whose lives could have been prolonged had an additional pregnancy not aggravated their condition?
Of the many mothers married and unmar- ried, who have become chronic invalids and even lost their lives as a result of having re- sorted to abortive measures in order to rid themselves of an unwelcome child, no statis- tics are available. If there were, they would be an appalling evidence of the great danger of such criminal procedures and would cer- tainly show the advantage of a more enlight- ened attitude regarding the means of contra- ception, at least for the married women who are enfeebled or diseased.
The many diseases I have mentioned whereby children in large families and moth- ers because of too frequent pregnancies are carried off to an early grave, are not limited to the poor. In regard to economics, the
ASPECTS OF BIRTH CONTROL 11
middle class suffers also. Thus, if even a relatively well-to-do family begins to increase out of all proportion to the earnings of the father, the family will soon be in want and approaching poverty. Less and less food, less sanitary housing, less care of the children, and more sickness will almost inevitably re- sult. Every sickness or death of child ot adult has increased the expenses of the fam- ily. There is the doctor's bill, the druggist's bill, and last but not least, that of the under- taker. A grave had to be purchased. If there have been savings, they are gradually swallowed up and debts are often contracted for the sake of a decent funeral.
Next to the medical and sanitary come? the physiological aspect of birth control which can be summarized in a very few sentences. The average mother with two, three or four children, not having arrived in too rapid suc- cession, say with two or three years interven- ing, is physiologically, that is to say, physi- cally and mentally, stronger and better equip- ped to cope with life's problems than the worn out and w^eakened mother whose life is shortened by frequent and numerous preg- nancies.
What is the physiological effect of volun- tary artificial restriction of the birth-rate ? In Holland, where the medical and legal pro- fessions have openly approved and helped to extend artificial restriction of the birth-rate, the health of the people at large, as shown by its general death-rate, has improved faster
12 ASPECTS OF BIRTH CONTROL
than in any other country in the world. At the recent Eugenics Congress it was stated that the stature of the Dutch people was in- creasing more rapidly than that of any other country — the increase being no less than four inches within the last fifty years. According to the Official Statistical Year Book of the Netherlands, the proportion of young men drawn for the army over 5 feet 7 inches in height has increased from 24 1-2 to 47 1-2 per cent since 1865, while the proportion below 5 feet 2 1-2 inches in height has fallen from 25 per cent to under 8 per cent.*
In that enlightened country, the teaching by the medical profession of the most hygienic methods of birth control limitation has en- abled the poor to have small families which they could raise to be physically and morally better equipped than formerly. What is most interesting to observe, however, is that, wheth- er as a result of this or for some other reason, the families among the well-to-do are not nearly as small as in other countries.
In Australia and New Zealand, the means of artificial restriction are in free circulation and the restriction of families is almost uni- versal. Yet these two English colonies have furnished to their mother country in these hours of struggle the most efficient, and phys- ically and mentally best equipped regiments.
•"The Small Family System ; Is It Injurious or Im- moral T' By Dr. C. V. Drysdale ; Published by B. W. finebech, New York.
ASPECTS OF BIRTH CONTROL It
The soldiers of Australia and New Zealand have shown themselves brave and fearless fighters and certainly equal, if not superior as far as physical endurance is concerned, to their English brethren. In the latter country it is well known that birth control is frowned upon by the legal and nearly all the ecclesias- tical authorities.
And what of France? Before the present war Drysdale, in his "Small Family System," very aptly says: "It has become the fashion to speak of the depravity of France, of hei alcoholism, of her disregard for law and order, and of her terrible 'crimes passionels,' and to ascribe to them the falling birth rate. If this were the case it is obvious that these evils would be most intense where the process had gone furthest, i. e., in the cantons of the low- er birth- rate (The French islands of Re and Oleron.)" The passions of the inhabitants of these islands are very innocent. "They are reading and dancing. The dancing, al- ways decent, is the preparation for mar- riage; illegitimate births are very rare. One could not imagine manners more pleasant or more honorable. Nevertheless the birth rate in these islands is among the lowest. It is because everyone there is more or less of a proprietor. Each person has some property to protect; each is ambitious for his children." But we have the authority of Doctor Bertil- lon, the great French statistician, that it is just in the cantons of these islands in which the greatest moral improvement has taken
U ASPECTS OF BIRTH CONTROL
place, and that where the French have obeyed the command to increase and multiply, there alcoholism and crime abound.
Let me quote briefly from an editorial on contraception which appeared in the Medical Times of April, 1916: "France today is pre- senting her splendid spectacle of utter effic- iency to the world because only the fittest of her people have survived, and the chief factor there has admittedly been contraception. Surely we have heard the last of the croakers about decadent France. Holland would give an equally good account of herself if the need should arise and for the same reason."
We have already touched in part on the economic cost growing into the millions which accrues annually to the nation because of a high birth-rate concomitant with a high infant and child mortality rate. Well may we ask the question whether disease and the deaths of thousands of women and children can not be prevented by an enlightened attitude to- ward the question of birth control. Why is it not done? If the millions of dollars ex- pended uselessly reverted to the nation's wealth, would they not add immeasurably to the health and economic happiness of the nation at large?
And now we come to the social or sociolog- ical aspect of our topic, so closely interwoven with economics. That the social and moral life of a smaller family, where the father earns enough to support wife and children, where the mother can devote her time to the
ASPECTS OF BIRTH CONTROL IB
care of them, and where neither she nor the children must go out and help in the support of the family, is superior to that of a family with a large number of children where the mother and often the older children must slave, does not permit discussion. The larger the family of the poor the more child labor, the more there is disruption and irregularity, and the more frequent one finds a lower stan- dard of life and morals in general.
The records of our charities and benevo- lent societies amply prove that as a rule the larger the families are that apply for relief the greater is their distress.
In answer to a letter from Doctor Foote. containing suggestions on this topic, the pres- ident of the New York Association for Im- proving the Conditions of the Poor very per- tinently said:
"The race suicide theory which has been so much exploited of late, is an immense en- couragement to the large family idea and the illiterate are hardly to be blamed if they are misled upon this question. The subject that you discuss is one that is worthy of serious consideration and that has in the past been treated with an excess of sentiment."
That judicious birth control does not mean race suicide, but on the contrary race preser- vation, may best be shown from the reports from Holland. The average birth-rate in the three principal cities of Holland was 37.7 per 1,000 in 1881^ when birth control clinics were started. In 1912 it had fallen to 25.3 per
16 ASPECTS OF BIRTH CONTROL
1,000. The general death-rate, however, had dropped in the same period from 24.2 to 11.1 per 1,000, or to less than half, while the two- thirds reduction in the mortality of children under one year of age — from 209 to 70 per 1,000 living births — is even more significant. As a final evidence of the social and eco- nomic value of imparting information con- cerning family limitation, permit me to quote from a personal letter to me from the great pioneer of this humanitarian movement, Dr. J. Rutgers, the Honorable Secretary of the Neo-Malthusian League of The Hague. The league has been in existence since 1888 and received its legal sanction by a royal decree January 30, 1895. It has 6,000 contributing members; all information is given gratuitous- ly. As a result of this league in Holland one does not see any children dressed in rags as in former years prior to the starting of this movement. To use the venerable secretary's own words: "All children you now see are suitably dressed, they look now as neat as formerly only the children of the village cler- gyman did. In the families of the laborers there is now a better personal and general hy- giene, a finer moral and intellectual develop- ment. All this has become possible by limita- tion in the number of children in these fami- lies. It may be that now and then this preven- tive teaching has caused illicit intercourse, but on the whole morality is now on a much higher level and mercenary prostitution with its de- moralizing consequences and propagation of
ASPECTS OF BIRTH CONTROL 17
contagious disease is on the decline. The best test (the only possible mathematical test) of our moral physiological -and financial progress is the constant increase in longevity of our population. In 1890 to 1899 it was 46.20; in 1900 to 1909 it was 51 years. Such rise cannot be equalled in any other country except in Scandinavia where birth limitation was preach- ed long before it was in Holland. None of the dreadful ,consequences anticipated by the ad- vocates of clericalism, militarism, and con- servatism have occurred. In spite of our low birth-rate the population in our country is rising faster than ever before, simply because it is concomitant with a greater economic im- provement and better child hygiene."
To verify these figures statistically, Doc- tor Rutgers refers to Drysdale's diagrams.* The good doctor closes his splendid letter by saying: "One must have been a family phy- sician for twenty-five years like myself in a large city (Rotterdam) to appreciate the blessings of conscious motherhood resulting in the better care of children, the higher mor- al standard. And all these blessings are tak- en away from you by your government's pe- culiar laws, made to please the Puritans."
To these latter well-meaning people and those similarly minded who fear race suicide,
•"Diagrams of International Vital Statistics With De- scription in Enprlish and Esperanto, together with a Table of Coirelation Coefficients Between Birth and Death-rates, etc." Bv C. V. Drysdale. D. Sc. ; London : Wm. Bell, 162 Drury Lane, W. C. 1912.
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particularly a decline of the American stock, I strongly recommend the reading of that splendid address by ^Professor Charles A. S. Reed, A. M., M. D.,* former president of the American Medical Association, entitled, "The American Family." In the chapter on "The Outlook of the American Family," he very pertinently says: "We see in a declining birth-rate only a natural and evolutional ad- justment of race to environment — an adjust- ment that insures rather than menaces the perpetuation of our kind under favoring con- ditions." And concerning under-population in general, this distinguished writer says in the same address: "It seems, indeed, to the care- ful student that the danger to the American family today and still more in the future lies in the direction of over-population rather than under-population."
According to Mulhall and Reed, the in- crease in the density of population from 1820 to 1890 was 650 per cent in the United States (only 25 per cent in the United King- dom and less than 100 per cent in France and Belgium.) The rate of increase in this coun- try has been vastly accelerated in the twenty- five years that have since elapsed. Our pop- ulation today of over 100,000,000 has beeni doubline itself on an average of once in less than twenty-five years since 1790, and it will probably continue to do so in the future. May I say in passing, that in the state of New York we have observed the alarming phen- omenon that the proportional increase among
ASPECTS OF BIRTH CONTROL 19
the insane is double that among the sane pop- ulation ?
And now I approach the last and most important phase of my subject, namely the moral, which to me means no less than the religious phase of this great problem. Let me say to you, my colleagues, that I approach it with awe and reverence, for I believe 1 fully understand the import of it.
A quarter of a century of practice among the tuberculous, the rich and the poor, in pa- latial homes, humble cottages, dark and dreary tenements, and in over-crowded hospitals, has shown me enough to bring to my mind the utter immorality of thoughtless procreation, and my experience has been limited to this one disease of the masses. The tears and suf- fering I have witnessed when I have had to decline help because it was too late to prevent the despair of the poor, frail mother at the prospect of another inevitable confinement, and later the sight of a puny babe destined to disease, poverty, and misery, has made me take the stand I am taking today. I am do- ing it after profound reflection, and I am fully aware of the opposition I am bound to meet. But in my early career as an anti-tuberculosis crusader, I became accustomed to the fate of those who venture on new and heretofore untrodden paths of progress.
What would the moral outcome of birth control, or let us rather say, rational family limitation be, if taught judiciously to those seeking and needing the advice? Millions of
20 ASPECTS OF BIRTH CONTROL
unborn children would be saved by contracep- tion from the curse of handicapped existence as members of a family struggling with pov- erty or disease.
There are hundreds of young men and women, physically and morally strong, who gladly would enter wedlock if they knew that they could restrict their family to such an ex- tent to raise few children well. But their fear of a large family retards, if it does not prevent, their happiness and ipso facto the procreation of a better and stronger manhood and womanhood. The woman withers away in sorrowful maidenhood and the man whose sexual instincts are often so strong that he cannot refrain, seeks relief in association with the unfortunate and often diseased sisters, called prostitutes. The result is a propaga- tion of venereal diseases with all its dire con- sequences. To an audience composed of phy- sicians and sanitarians I need not say what these consequences are. They involve sterility physical and mental suffering in the man, or sterility in both man and woman; and accord- ing to the severity of the infection, pelvic dis- orders, abortion, premature labor, a dead child or one lastingly tainted with disease.
At times disease does not enter as a factor in the tragedy, but the result is a girl mother, a blasted life, for our double standard of mor- ality recognizes only the "sin" in our sisters, not in ourselves. Of her, compassionate ton- gues only say she loved not wisely but too well; of him, nothing is said at all. He is
ASPECTS OF BIRTH CONTROL 21
spotless and virtuous in the eyes of the world and can go through life as if he had never sinned and been responsible for a blasted life or two.
Even our moralists must acknowledge that by an early marriage with a man of her choice, enabled by understanding to limit the number of children, many a girl would be sav- ed from so-called dishonor and in many in- stances from pr(/stitution. One of the strong- est arguments of our moralists and purists is that the knowledge of contraception would lead the young to enter forbidden sexual re- lations and degrade them morally. Granted that this may happen in a number of instances the benefit derived from a diminution of ven- ereal diseases, from a greater number of happy and successful marriages among the younger people, fewer but better and healthier off- spring instead of an unrestricted procreation of the underfed, the tuberculous, the alcohol- ics, the degenerate, the feeble-minded and in- sane, would more than outweigh the isolated Instances of sexual intercourse prior to mar- riage.
I absolutely agree with our moral teach- ers when they say that self-control is possible — I believe it to be the cleanest, purest and best preventive measure for family limitation — but while it may be easy for many it is not easy for all. Sociologically speaking, it is even more difficult when you deal with a married couple belonging to the poorer classes who cannot have separate bedrooms. Salf-
22 ASPECTS OF BIRTH CONTROL
control can be more easily exercised prior to marriage than afterwards.
The critics of birth control maintain that with the knowledge of birth limitation many women, whether poor or rich, who should and can bear children, will shirk the duties of motherhood. This I do not believe to be true. You can no more prevent the desire for motherhood in the normal, healthy woman than you can stem the tide of the ocean. It is inherent in every woman's heart. With more marriages of young people and a ration- al birth control, I do believe there will not be fewer children but the same number of better ones. There will be, of course, instances — and there are too many in certain classes of so- ciety now — where for purely selfish reasons ihe marriage remains barren, but it is a ques- tion in my mind whether it would be really 'lesirable for society to have such women be mothers.
It has been asserted by the same critics that the enfeebled, diseased, ignorant, and poverty stricken woman in whose case birth control might be justified, will never know about the existence of birth control clinics. In Holland, however, there must have been some such ignorant women, yet they seem to have learned to avail themselves of the service of such clinics. Besides, these classes will sooner or later come under the observa- tion of some physician, either privately or in a hospital. Some opponents to the birth con- trol propaganda say that the measure advo-
ASPECTS OF BIRTH CONTROL 2«
cated would not reach the feeble-minded, the idiotic, half insane, chronic alcoholics and chronic criminals. This, I will grant, and sterilization of those totally unfit for parent- hood will some day have to become a state measure, unless segregation is resorted to more universally and more rigorously. Birth control is only one measure toward a saner and happier manhood, womanhood, and child- hood.
Finally, I must mention the almost pa- thetic criticisms of some of my colleagues who wrote me in answer to my request for an expression of opinion, that the matter of birth control was a question not for the medical profession, but for the laity. To such I can only express my regret at their attitude. The physician of the twentieth cen- tury who deals only with the purely medical and curative part of his profession, who is indifferent to measures to prevent disease, and cannot feel with the social sufferings of the masses, is lacking in the highest ideals of his calling and misses the greatest opportun- ity of benefitting suffering mankind.
After all is said, I feel impelled to plead with great earnestness for the abolishment of the state and federal laws which make the imparting of knowledge for contraception a criminal offense. I plead for the re-establish- ment of gratuitous clinics, directed by regular physicians of high repute, remunerated by city or state, who are competent to give in- formation as to birth limitation in cases where
24 ASPECTS OP BIRTH CONTROL
t^ey deem the giving of such instructions ad- rUable.
Concerning the urgency and the wisdona of efforts to change these laws* I am sure that you will be willing to listen to the worda of two of our greatest American physicians; first, to those of our venerable nestor of the medical profession, Professor A. Jacobi, of New York, the ex-president of the American Medical Association; secondly, to Professor Hermann M. Biggs of New York, my beloved
♦United States Criminal Code, Section 211 (Act ot March 4, 1909, Chapter 321, Section 211, U. S. Statute* at Large. Vol, 35, part 1, page 1088 et seq.) New York Statute Book, (Section 1142 of the Penal Law). The federal law prescribes a fine of $5,000 or imprisonment of not more than five years, or both, for any one using the mails to give advice for producing abortion or pre- venting conception. The New York State law, above mentioned, makes the giving of a recipe, drug or medi- cine for the prevention of conception or for causing un- lawful abortion a misdemeanor punishable with no less than ten days nor more than one year imprisonment or a fine of not less than $50 nor more than $1,000, or both, fine and imprisonment for each offense. It will be noticed that both laws make the giving of advice for the prevention of conception as great an offense as produc- ing abortion. According to the New York State law, b "lawful" abortion is permitted and not punishable, but to prevent such abortion, always more or less dangerous to life, is not permitted and punishable by law. In all medical colleges careful instruction is given how to per- form the "lawful" abortion. All good textbooks on gynecology describe the operation as carefully as an amputation of the cervix or a hysterectomy ; but con- cerning the advice to give, for example, to the poor tuberculous mother who has had her uterus emptied once, so that she may not be obliged to submit to such a "lawful" operation again, our teachers of grynecology and amr textbooks dare not Bay a word.
ASPECTS OF BIRTH CONTROL 29
teacher, the distinguished sanitarian and pio- neer in the modern warfare against tuberculo- sis. In his preface to Dr. William J, Robin- son's book "The Limitation of Offspring," Dr. Jacobi says: "Our federal and state laws on the subject of prevention of conception are grievously wrong and unjust. It is important that these laws be repealed at the earliest pos- sible moment; it is important that useful teaching be not crippled, that personal free- dom be not interfered ^vith, that the inde- pendence of married couples be protected, that families be safe-guarded in regard to health and comfort, and that the future children of the nation be prepared for competent and comfortable citizenship."
Dr. Hermann M. Briggs, prior to the recent dismissal of the case by Judge Dayton of the federal court, against Mrs. Sanger for send- ing information about birth control through the mails, gave to the press the following statement: "I am strongly of the opinion that the present laws in regard to the giving out of information in relation to the govern- ing of infant control are unwise and should be revised. There can be no question in the mind of any one. familiar with the facts that the unrestricted propagation of the mentally and physically unfit as legally encouraged at the present time is coming to be a serious menace to civilization and constitutes a great drain on our economic resources. This is my personal view."
To the foregoing expressions of opinions
26 ASPECTS OF BIRTH CONTROL
let me add what one of our most distinguished jurists, the Hon. Judge William H. Wadhams, of the Court of General Sessions, wrote me concerning these laws: "In order to save the state from the burden of large families, where there is no possibility of their being support- ed and where the neglect which follows often results in their becoming state charges not only because they are mentally but often phys- ically unfit to bear the burdens of life, I am of the opinion that there should be some proper birth regulation after a certain num- ber of children have been born, and that there- fore, there should also be some modification of the laws with respect to the giving of in- formation upon this subject. I think the sani- tary, medical, social, economic, and moral status of the population would be improved by proper and more general information upon this subject."
Besides the letter from this eminent ju- Icial authority and the strong expressions of opinion of A. Jacobi, M. D., and Hermann M. Biggs, M. D., I have been the recipient of communications from many leading physic- ians, divines, political economists, and sociol- ogists, all agreeing with me that judicious birth control, under the highest ethical and medical guidance, is a national necessity and that our present laws on the subject need urgent revision. For want of space I will mention only the following: Dr. John N. Hurty, secretary, Indiana State Board of Health; Dr. Godfrey R. Pisek, professor of
ASPECTS OF BIRTH CONTROL 27
diseases of children, New York Post-Graduate Medical School and Hospital; Dr. J. W. Trask, of Washington, D. C; Dr. Lydia Allen de Vilbiss, formerly of the New York State De- partment of Health, now in charge of the division of Child Hygiene of the State Board of Kansas; Dr. Ira S. Wile, editor of American Medicine, New York; Dr. John A. Wyeth, pro- fessor of surgery and president of the New York Polyclinic Medical School and Hospital, ex-president of the American Medical Asso- ciation and New York Academy of Medicine; Frank Crane, D. D., formerly pastor of the Union Congregational Church of Worcester. Mass., now well known writer of leading edi- torial articles; Percy S. Grant, D. D., rector. Protestant Episcopal Church of the Ascension of New York City; Frank Oliver Hall, D. D.. minister of the Church of the Divine Patern- ity, New York City; John Haynes Holmes, M. A., Minister, Unitarian Church of the Mes- siah, New York City; Stephen S. Wise, D. D.. Rabbi of the Free Synagogue, New York City; James A. Field, Ph. D., Professor of Economics, University of Chicago; Irving Fisher, Ph. D., professor of political economy of Yale University and chairman of the Hy- giene Reference Board of the Life Extension Institute; Franklin H. Giddings, Ph. D., pro- fessor of political science, Columbia Univers- ity; William H. Allen, Ph. D., director of the Institute for Public Service of New York City; Hon. Homer Folks, former commissioner of charities of New York, now secretary of the
28 ASPECTS OF BIRTH CONTROL
State Charities Aid Association of New York; Lillian D. Wald, founder of the Henry Street Settlement and originator of the work of the School Nurse in New York; Prof. Melvil Dew- ey, LL. D., educator and president of the National Society for Efficiency.
I leave it to this distinguished body of phy- sicians and sanitarians either to send a mem- orandum to the federal and state governments setting forth the reason for a change of these laws, or, if it is thought wiser, to form a com- mittee to study the best and most practical suggestions for federal or state legislatures to act upon.
Dr. William L. Holt, writing on birth con- trol as a social necessity and duty, says: "Conscious and limited procreation is dic- tated by love and intelligence; it improves the race. Unconscious, irresponsible procreation produces domestic misery, and half-starved children. Conscious procreation of human lives elevates man to the gods. Unconscious procreation degrades man to the level of brutes."
May I be permitted to close with what I am free to confess is my innermost conviction ? I believe in birth control, that is to say, birth limitation, based on medical, sanitary, high- est ethical, moral, and economic reasons. I believe in it because with the aid of it man and woman can decide when to have a child, work and prepare for its arrival, welcome it as the fulfillment of their heart's desire, watch over it, tenderly care for and educate it, and
ASPECTS OF BIRTH CONTROL 29
raise it to be what every child should be des- tined to be — a being happy, healthy, strong in mind, body, and soul. If we but use our God-given sense to regulate the affairs of government and family wisely and economi- cally, this great world of ours will be one of plenty and beauty where the good will pre- dominate over the evil and the children bom in it will becojne men and women only a little lower than the angels — images of their Creator.
DISCUSSION.
Dr. Ira S. Wile, New York City: In read- ing the thoughtful paper of Doctor Knopf, a number of thoughts suggested themselves. Birth control is recognized today as a factor in eugenic control. Some states take cogni- zance of the advantages of limiting the num- ber of offspring insofar as defectives and criminals are concerned. The laws of numer- ous states permitting sterilization or asexual- ization place the seal of governmental ap- proval upon the prevention of procreation in the interests of the public weal. Numerous regulations providing for the segregation of defectives represent crystallizations into law of the principle that the state has a vital in- terest in controlling the birth of certain tjrpe* of citizens. States requiring a certificate of health previous to marriage point out a deep
30 ASPECTS OF BIRTH CONTROL
interest in the character of health of those who are to become parents. The underlying principle is the protection of the state from the development of undesirable children.
The law recognizes the interruption of pregnancy as legal and justifiable in order to save the lives of women suffering from tu- berculosis, nephritis, cardiac diseases, or from conditions, whose fatal progress would be hastened through continued pregnancy, but the law holds it to be illegal to teach these same women how to avoid conception. It is manifestly contrary to every principle of mod- ern preventive medicine that there should be such interference with the judgment and ac- tion of physicians where it seems most ration- al and medically sound to give advice as to the methods of preventing a condition con- taining a hazard to life.
Despite the existing laws, contraception is practiced and undoubtedly taught by mem- bers of the medical and nursing profession, as well as by piidwives. What is equally im- portant is the fact that contraceptives are sold in drug stores throughout the country without any interference, providing conscience is stretched and the instrumentalities are dis- pensed on the plea that they are agents for the prevention of disease.
It is known that in 1900 there were only three-quarters as many living children to each 1,000 potential mothers in the United States as in 1860. The reason for this decreased birth-rate is undoubtedly in a large part due
ASPECTS OF BIRTH CONTROL 81
to "the deliberate and voluntary avoidance or prevention of child bearing on the part of a steadily increasing number of married people, who not only prefer to have but few children, but who know how to obtain their wish" to quote the words of Dr. John Shaw Billings. At the present time, the practice of birth con- trol is more or less limited to the more intel- ligent part of the population and indeed to those whose means would most warrant the • levelopment of large families.
Public health sees in poverty its great en- emy and realizes that education is its most capable ally. The education of potential par- ents, as to the methods of preventing concep- tion may be regarded distinctly as a public health measure. From the standpoint of the welfare of the race, those interested in public hea'th measures are more vitally interested in the vigor and quality of children born than in their absolute numbers. The birth of the most vigorous children, those least susceptible to disease, and possessing the greatest chance of living are the particular types of infancy in which health officers should be interested. The reduction of dysgenic types of offspring and the decrease of infants variously handi- capped, whose care-needing existence lessens family vitality represent a considerable part of the public health problem.
The tremendous wastage of human life re- sulting from stillbirths, congenital diseases, malformations, puerperal injuries and infec- tions, and economic pressures may be partial-
32 ASPECTS OF BIRTH CONTROL
ly offset by a properly controlled systen A dissemination of information concerning the limitation of offspring. The old doctrine of the survival of the fittest has been superseded by our more artificial and humanitarian pro- gram which permits the survival of even many of the weakest of the infantile populaltion.
It is well known that the rate of infant mortality, as pointed out in the paper of Doc- tor Knopf, increases with the size of the fam- ily. To quote from Doctor Hibbs, in his dis- cussion of Infant Mortality: Its Relations to Social and Industrial Conditions, "However dangerous 'race suicide* and the declining birth-rate may be, there can be little doubt that excessively large families is no remedy and however desirable a high rate of births may be, it is a mere waste to bring children into the world faster than the laws of nature decree to be desirable." Race suicide is not due to limiting the number of births, but is determined by the ratio between births and deaths. From the standpoint of public health, it is a greater degree of race suicide to bring six children into the world and lose two or three than to have two bom and reared. The social consequences of large families with the accompanying loss in lives and vitality have been sufficiently described, so that further comment is unnecessary.
From the standpoint of public health, it is important that a very sharp line of demarca- tion should be established between abortions and the prevention of conception. The interrup-
ASPECTS OF BIRTH CONTROL 38
tion of pregnancy to destroy a developing ovum entails physical hazards to the woman which often adds to the mortality rate. At the same time this is equally the destruction of life as foeticide and, literally speaking, in- fanticide. According to DeLee, while abor- tion occurs oftener among the lower classes, criminal abortion is more frequent among the more educated classes.
Howard Kelly (Medical Gynecology, page 449), comments "to what extent the medical profession is responsible for the murder of the unborn" is shown by the methods that women employ to induce abortions upon them- selves making use of antiseptic technic in which they obviously had been instructed.
The Report of the Special Committee on Criminal Abortions quoted in Textbook of Legal Medicine and Toxicology (Peterson and Haines, Volume H, page 92) "estimated that one-third of all pregnancies throughout the country end in abortions. This is estimated at not less than 100,000 yearly. A large number of these are criminal abortions from which the committee estimated that 6,000 women die yearly." A fact of this character merits care- ful consideration by a public health associa- tion with a view to pointing out to the intelli- crent laity and legislators the importance of differentiating between the prevention of con- ception, which carries practically no morbidity and certainly no mortality and abortion, which may cause destruction of two lives.
Howard Kelly in discussing syphilis (Med-
^
34 ASPECTS OF BIRTH CONTROL
ical Gynecology, page 423), states "It is the recognized duty of all physicians in the pres- ence of any contagious disease to protect others from the risk of infection. In the case of syphilis, where there is a question of its introduction into marriage, the physicians' protective duty embraces not only the pro- spective wife, but the children she may bring into the world and through them the interests of society." (Page 424.) After marriage has occurred "when a married man has syph- ilis the first indication is to prevent the con- tamination of the wife, the second is to guard against pregnancy." The interpretation of the term "guarding against pregnancy" open? up the question as to how this is to be ac- complished without violating existing laws.
It is urged that the frank discussion of methods of contraception by physicians will lead to an increase of clandestine relations among unmarried girls by virtue of the new knowledge. Clandestine prostitution ex- ists today and fear of pregnancy is not an im- passable barrier. The development of a con- scious morality, which is the greatest pro- tective force, should not be based upon fear. Admitting for the sake of argument that the same degree of immortality .might exist, there would be at least a decreased destruction of life for the women now illegitimately preg- nant and the foetus to be destroyed. Fewer homes would suffer disgrace, foundlings would decrease in number, while an accursed bas- tardy Would be greatly diminished.
ASPECTS OF BIRTH CONTROL 36
I do not advocate, however, that know- ledge concerning the prevention of conception should be given to the young, but merely to adults and only to those who are wedded. It cannot be denied that a law of this character would undoubtedly be broken just as is the present law today. The transmission of some facts with reference to contraception is con- stantly going on, but they emanate from pol- luted sources and reflect folk lore rather than intelligent medical opinion.
I do not favor the abolition of federal or state laws which deal with abortions, though owing to the weight of public opinion convic- tions for violations of these laws are remark- ably limited in view of the large number of violations occurring annually. I believe and would urge that the federal and state laws be amended so that in effect the procuring of an abortion and the preventing of conception will be dissociated as acts not synonymous in character and meriting entirely different treatment. The procuring of an abortion should still be penalized. The prevention of conception should be permitted. The New York state law links prevention of conception and unlawful abortion, thus indicating the legality of certain types of abortion.
Because the state already recognizes its right to limit procreation among certain groups of the population, because the decrease in the birth rate will result in improved public health and the social economic improvement of the masses of this country, because prevention oi
86 ASPECTS OF BIRTH CONTROL
conception would add to the health and racial betterment of the nation, I believe that the American Public Health Association should take a stand upon the subject •£ limitation of offspring. To this end, I urge that resolu- tions be passed favoring the amendment of federal and state laws, so that the words pre- venting or prevention of conception be elim- inated therefrom.
Dr. J. H. Landis, Health officer, Cincinnati, Ohio: It goes without saying that we are all in favor of reducing the number of those who are physically, mentally and morally unfit and adding to the number of those who are physi- cally fit, mentally sound and more highly de- veloped morally.
The paper brings to our attention a num- ber of facts that have long been recognized as true. No one will deny that the offspring of a tuberculous mother has a poorer chance of living than one from a mother without a wasting disease or that the healthy mother has a better chance of surviving pregnancy than has her diseased sister.
No one doubts that infant mortality is greatest among the offspring of the ignor- ant, the poor, the underfed and badly housed, the tuberculous, the degenerate, the alcoholic, the vicious and the mentally defective.
Congestion and lack of air and sunshine have long been recognized as powerful predis- posing factors in the dissemination of disease and death among those exposed.
The remedy suggested for all of these con-
ASPECTS OF BIRTH CONTROL 81
ditions is birth control. The remedy is direct- ed towards the effects produced instead of be- ing directed at the causes producing them.
I am unable to see how birth control is to solve the problems created by vice, poverty, ignorance and alcoholism while these condi- tions go on unchecked, and am unwilling to be- lieve that the size of the family has anything to do with any of them with the possible ex- ception of poverty.
The pride and glory of the medical profes- sion is bound up in the word "prevention." Humanity owes us a far greater debt for sick- ness prevented than for sickness cured.
A multitude of causes are responsible for the high tuberculosis rates that prevail. The disease is one of the most contagious with which we have to deal. Nature's favorite method of removing the unfit, from any cause, is by the tuberculosis route.
The control of tuberculosis involves all of the factors active in producing individuals who are rendered susceptible by these factors, the quarantining of those who are spreading the disease and the care of those other members of the family rendered dependent. Birth con- trol can play only a minor role in the control of this disease.
Birth control will not enlighten the ignor- ant, render the poverty-stricken affluent, transform the alcoholic into a total abstainer, make the vicious virtuous, or remove the cloud from the brain of the mentally defective.
Definite causes are combining to produce
38 ASPECTS OF BIRTH CONTROL
these results and the logical point of attack is the combination of causes.
The ignorant can be educated; the poor made more thrifty; the vicious forcibly re- strained; and the mentally defective rendered incapable of reproducing their kind.
The prevalence of typhoid fever is an in- dex to the purity of a community's v^^ater and milk supply. Filtration of water and pas- teurization of milk have solved the typhoid fever problem in those communities in which they have been efficiently carried on.
Vice, crime, tuberculosis, poverty, degen- eracy, alcoholism, ignorance and feeble-mind- edness are as distinctly due to particular pre- ventive causes as typhoid fever is to impure water and milk, and it appears to me that birth control would be as impotent to control the first set of conditions as it would be to control typhoid fever.
Dissemination of the knowledge of birth control would, in my humble judgment, de- crease the number of fit and increase the number of unfit for the reason that the know- ledge wouM be applied by those capable of producing normal children and ignored by those unfit individuals who are under the guidance and control of the most powerful primal instinct.
Dr. J. N. Hurty, Indianapolis, Ind.: We. the people, are suffering from many delu- sions. Nearly everyone entertains the de- lusion, that they can violate the laws of na- ture, abuse their bodies, bring on disease and
ASPECTS OF BIRTH CONTROL 39
tlegeneracy, and then find repair in a medi- cine. It is a fool idea, yet it is very general. There are other delusions. There is only one way to improve the human race, and that is the natural way. The first high point of in- terest in the paper is when Doctor Knopf >ays — "My appeal is not a plea for reducing the population but for increasing its vigor by reducing the number of the physically, men- tally and morally unfit and adding to the number of physically strong, mentally sound and higher morally developed men and wom- en," Certainly no one on any score can ob- ject to this. The idea is practical, pure and lofty. If general birth control will help it onward, even a little bit, then I am for gener- al birth control. I suppose no one would ad- vocate the raising of idiots or physically de- formed people, yet when it is proposed not to raise them, through the practical application of sterilization or segregation, up goes a howl from the prudes which is of character likely to provoke emesis. It is important and inter- esting to learn that when tuberculosis appears in a large family, it is generally numbers 5. 6, 7, 8 or 9 of the children that are stricken. This is indeed significant, and I believe it to be true. When I read this in Doctor Knopf's paper I made some inquiries of two men who have done a great deal of tuberculosis work, and they confirmed it and said they believed it was true. Again, Miss Duke's Johnstown figures speak loudly against families of above four children. For a pair to have more is
40 ASPECTS OF BIRTH CONTROL
generally to invite sickness, invalidism and death, and if we will stop to think and look around among the prosperous, great and strong people as a rule (of course there are exceptions) they do not have families of more than four and generally about two. I do not believe that this condition has been brought about by continence. Surely pregnancy is contra-indicated in a tuberculous woman un- less it is desirable to kill her and add to the number of pitiful motherless babies. A hus- band who cannot be continent with a tubercu- lous wife is a sorry specimen of manhood and truly such specimens are many. And here 1 think it proper to say that birth control will not likely ever be a resultant of voluntary continence. Like education and monogamy, it must be forced upon most of the animals we call men. An important point made by Doc- tor Knopf is, "would or could a syphilitic or gonorrhoeic parent know how to prevent con- ception during the acute and infectious stages of his or her disease, there would certainly be less of congenital syphilis, less blindness from gonorrhoeal infection." If these ends can be gained, even in slight degree, by birth con- trol, I'm for it strong. I remember the doc- tor in "Damaged Goods" says — "It is better to have fifty sound and whole men than to have a hundred, sixty or seventy of whom are more or less rotten."
That is an important interrogatory in the paper which reads — "What is the physiological effect of voluntary artificial restriction of the
ASPECTS OF BIRTH CONTROL 41
birth-rate of the offspring?" The answer is satisfactory, for the reports from Holland, where the medical profession have openly approved and helped to extend artificial re- striction, are to the effect that the morbidity and mortality rates have improved more rap- idly than in other countries. Holland also supplies data to prove that rational birth control does not mean race suicide, but on the contrary, race preservation and strengthen- ing. Doctor Holt, as quoted by Doctor Knopf, talks wisely when he says — ^'Conscious and limited procreation is dictated by love and intelligence; it improves the race. Uncon- scious, irresponsible procreation produces do- mestic misery and half-starved children. Con- scious procreation of human lives elevates man to the gods; unconscious procreation de- grades man to the level of brutes." It is plain that Doctor Knopf has contended and written well. Conscientiousness in his con- tention is apparent. I am sure good will fol- low his effort.
Dr. W. L. Holt: I should like to call your attention to the fact that we as a nation, like all the ci\ilized nations, are already practic- ing birth control; but in a very stupid and mistaken way. Namely, just that part of the population which is called the "upper class," which is undoubtedly superior physi- cally and mentally as well as financially and accordingly produces the most desirable chil- dren and ought to produce at least its share of the future generation, is practicing birth
42 ASPECTS OF BIRTH CONTROL
control to such an extent that the old families are dying out; whereas the inferior part of our population, which is also financially least able to raise four children, is raising four and more. What could be more stupid?
Dr. Louis I. Dublin, New York City: The other day I contributed a paper in another section on the commoner errors in statistical work. I wish I had had Doctor Knopf's paper at my disposal for I could have used it very profitably for my text. I do not recall any paper that I have read for some time that is more subject to criticism on the score of method than the paper we have just heard. I believe it is fundamentally erroneous be- cause of the emotional attitude of the writer which has caused him to draw general con- clusions from an examination of only a very limited part of his subject.. His emphasis is entirely in the wrong place. There is alto- gether too much birth control now and what the community needs is emphasis on birth re- lease by the healthy, capable and self-respect- mg elements of the community.
There is time only for one word and I want to limit that to the story of France. In France, we have today a sorry spectacle of the results of birth control. The lesson is obvious. France is today crying for men; for men who were either not born or died at an alarming rate in infancy or later of tubercu- losis. The attitude of mind which is engen- dered by a nation-wide policy of birth control ultimately brings about more infant mortality
ASPECTS OF BIRTH CONTROL 48
and more tuberculosis because of the general weakening of the stock which directly results therefrom.
A Member: It strikes me that the whole question resolves itself into who should marry and who should not marry. Unless we have some laws regulating marriage, to teach young men and young women the nature of the social disease and the conditions necessary for a good physical body, why, we will have tuber- culosis, we will have degenerates, we will have idiots and imbeciles and our penitentiaries and almshouses and every other penal insti- tution will be filled. The whole question is prevention; I believe strictly in the doctrine of heredity. Heredity, environment and educa- tion is the triangle that leads to greatness. If we do not hover around those three points, we will never succeed. We know that if two degenerates marry, they beget degenerate children, beget imbeciles. If an imbecile mar- ries a normal person, half of the children will be imbeciles or degenerates, and we have the records of criminality and all those deficien- cies and the penalty is the result of improper marriage. Teach the laws of nature and our mothers will demand that their daughters don't marry a man who has in his veins the virus of a venereal disease circulating through his body.
Dr. John W. Trask, United States Public Health Service, Washington, D. C: The sub- ject may be approached from a number of different angles. During the discussion a
44 ASPECTS OF BIRTH CONTROL
thought has occurred to me which may be worth presenting. What is the common rea- son for wanting the population to grow? What is at the bottom of the more or less prevalent idea that it is meritorious to be the parent of many children? It has occurred to me while sitting here that chambers of commerce and boards of trade want the pop- ulation of their respective cities to increase — the faster, the better — because it is to their interest to have more individuals to sell things to, more individuals to whom they can sell dry goods, clothing, and groceries, more in- dividuals to whom to sell houses and land. The greater the population the more business will be done and the greater the increase in the value of real estate. On the other hand, those interested in affairs of state may want the population of their counti-y to grow that there may be a larger group from which to draw an army for purposes of defense or perhaps offence. Birth control is opposed in a way to the interests of business and of the holders of real estate. Nor will it be the best national policy where a growing population and large armies are necessary as a protection against invasion or oppression by lawless peoples. However, it would seem at least worthy of consideration whether the best conditions would not be attained by families commen- surate in size with the household incomes and by nations commensurate in population with their areas, economic conditions and natural resources. Better people, living cleaner,
ASPECTS OF BIRTH CONTROL «
healthier and more rational lives, and not more people, would seem to be the logical objective.
Dr. Knopf:* My first duty is of course to thank all of you for the very kind attention you have given to my paper on a rather un- usual and, in some circles, rather unpopular subject. It shows that you have come here determined to listen and then to judge — to accept my ideas, to reject them, or to sus- pend judgment.
Dr. Ira S. Wile agrees with me so thor- oughly that I see very little reason to take up time in referring to his paper, except to thank him for his co-operation and particu- larly for the strong opinion he has expressed concerning the urgent need of recommending an amendment of the federal and state laws to the effect that the procuring of an abortion and the prevention of conception will be dis- associated, and considered as acts meriting entirely different treatment. We all agree that producing an abortion for no other rea- son than to rid a healthy mother of an un- welcome child is a crime and should continue to be considered as such.
Doctor Landis' paper is a little surprising to me. When the doctor says in today's dis- cussion that birth control will not do away with our social evils, will not render the pov- erty stricken affluent, transform the alcoholic
*This discussion has been revised and enlarged Binc« Its presentation.— EDITOR.
46 ASPECTS OF BIRTH CONTROL
into a total abstainer, nor remove the cloud from a mentally defective, he is but partially right. Birth control has enlightened the ig- norant in Holland and has rendered the pov- erty stricken not affluent but economically more comfortable; it has decreased crime, immorality, and illegitimacy. At the same time, I do not for a moment think that birth control alone will do away with the procreation of the feeble-minded, idiotic, half insane, chronic aleoholics, or chronic criminals. Birth control is not a panacea for all the ills of society, it is only one measure toward a saner and happier man-, woman-, and childhood. To minimize the harm to society and to future generations produced by the just mentioned class of unfortunates, the state should step in and demand medical examination of both the prospective father and mother, prior to grant- ing them a marriage license. Even with our present limited but growing knowledge of the laws of heredity we should be able to prevent many of the evidently unfit from becoming parents and save many a child of tomorrow from a handicapped existence — a burden to himself and others.
As already indicated in my paper, there is a certain class so mentally and physically diseased that sterilization, or at least segre- eration, must be resorted to. Doctor Landi? is absolutely right when he says that "A mul- titude of causes are responsible for the high tuberculosis rates that prevail." If I did not think that, would I have devoted twenty-five
ASPECTS OF BIRTH CONTROL 47
of the best years of my life to the combat of tuberculosis ? Bad housing conditions, bad factory hygiene, over-crowded and unhygienic schools, useless studies and not enough out- door play for the children, child labor, ignor- ance on the part of the laity, the late diagnosis of the disease on the part of the profession, failure of rational treatment and lack of in- stitutions, are some of the multiple causes responsible for the high tuberculosis morbid- ity and mortality rate.
Those of my colleagues who have honored me by their steadfast friendship and constant co-operation will bear me out when I say that I have done my best to help to remove these causes during years of conscientious labor.
I have approached the subject of birth control after deep reflection and with the same earnestness and zeal I am devoting to my tuberculosis work, and with due reverence for all that is sacred in man's physical, moral and religious life. I now believe in it with all the sincerity and earnestness I am capable of. I believe in it because by its aid there will rise a generation of men physically, men- tally, and morally fit, and children free from disease and prepared to take up the struggle for life.
I must revert once more to my friend Doctor Landis' discussion of the tuberculosis problem. I said he was absolutely right in the statement that a multitude of causes were responsible for the high tuberculosis death rates that prevail. But J say with equal em-
48 ASPECTS OF BIRTH CONTROL
phasis that he is absolutely wrong when he says in the following sentence that "the dis- ease is one of the most contagious with which we have to deal." It is not the most but the least contagious and should always be classed with communicable diseases. It should not be considered as most contagious like smallpox for example. On the contrary, strictly speak- ing, it is not contagious at all. The word con- tagious comes from the Latin contingere, "to touch," but the touch of the honest, con- scientious and clean consumptive is no more contagious than that of a healthy person. This can hardly be said of the smallpox patient, be he ever so clean. It is best for an unvac- cinated individual never to touch him, and still better to stay away from him as far as possible.
I would consider it a most regrettable thing if it should go out to the public that a distinguished member of the American Public Health Association has suddenly declared tu- berculosis to be the most contagious of dis- eases. We have already too much phthisio- phobia which makes the lot of the unfortunate consumptives hard enough.
For the kindly words said by my good friend, Doctor Hurty, I am deeply grateful. He is always progressive, fearless and out- spoken. He agrees with me so thoroughly that I feel he will do his share toward a bet- ter understanding of the problem under con- sideration and be an enthusiastic supporter of the all important movement for the better-
ASPECTS OF BIRTH CONTROL 49
ment of mankind, which he loves so much.
To the member whose name I could not catch and who maintained that the whole ques- tion resolves itself into who should marry and who should not marry, I wish to say that it was merely for lack of time that I did not touch on this subject in my paper. That I strongly advocate a medical examination of the man as well as the woman prior to grant- ing a marriage license, I have already said in my reply to Doctor Landis' criticisms. Much unhappiness and misery could be avoided by such obligatory examination and if we could add to our institutions of learning a school of parenthood with obligatory attendance for every one desiring to enter the matrimonial state, we would add still more to the happiness and prosperity of the individual and the com- munity at large.
Now a word to our Catholic friends and those of other faiths who are so strongly op- posed to contraception and limiting family increase. Let us have no word of bitterness or reproach because millions of devout Cath- olics hold these views. Let us not antagon- ize either Catholic priest or layman, who have a right to their convictions as much as we have to ours. This is a purely scientific meeting, composed of men who should not have, and I hope do not have, any hatred in their heart because of differences of opinion regarding religious views. Therefore, in re- ply to the somewhat passionate remarks of the* distrngpitshed statiaticiati of the M«tropoli-
jO ASPECTS OF BIRTH CONTROL
tan Life Insurance Company who questions the accuracy of my statistics and my state- ments, and says that it is all fundamentally erroneous, I wish to reply with less vehemence. I would calmly state that if we do not believe in official statistics of one kind, we cannot believe in official statistics of another kind. Mine were prepared by the government in Holland and by the United States government and officials of various cities. The gentle- man makes the statement that because of my emotional attitude toward the question of birth control, my conclusions are fundament- ally erroneous and drawn from an examina- tion of only a very limited part of my subject Mr. Dublin is not a physician; he is a Doctor of Philosophy, and this perhaps is an excuse for finding fault with my emotional attitude. My experience as a physician has brought me into contact not only with the happy and well- to-do but also with the poverty stricken and the mentally and morally diseased, and with the unfortunate girl-mother and our unfor- tunate sister, the so-called prostitute, and last, but not least, with the honest but poor and ignorant mother of a large family who is a slave by day and by night. It has been my earnest desire to lessen the misery caused by thoughtless procreation, and I may perhaps be forgiven if I have approached the subject with deep conviction and not without emotion. We physicians cannot, and God forbid that we ever shall, deal merely with cold figures and statistical facts. We k>ve science, y6i, and
ASPECTS OF BIRTH CONTROL 61
accuracy in science and statistics, but this does not prevent us from feeling with our patients in their sufferings of mind, body, or soul.
I do not at all disagree with the gentle- man when he speaks of birth release by the healthy and well-to-do. In my paper I have referred to this and also believe to have dis- tinctly shown that I do not plead for race suicide but most emphatically for race pres- ervation and multiplication of the best and noblest, physically, mentally and morally. What I think of France of today, I have al- ready said, and when the gentleman says that France is crying for more men, I might first say that the quality of the French soldiers has made up for the quantity. Russia has had and has the most men. It does not cry for more men, and still its achievements do not compare, at least up to this day, with the achievements of France.
Lastly, when Dr. Dublin says: "The at- titude of mind which is engendered by a na- tion-wide policy of birth control, brings about more infant mortality and more tuberculosis because of the general weakening of the stock which directly results therefrom," I most thoroughly disagree with this argument. My personal statistics regarding the frequency of tuberculosis among the later children born in large families have been, as you have heard, corroborated by Dr. Hurty's investigations; and all physicians know that women, particu- larly those of the working class when worn
eS ASPECTS OF BIRTH CONTROL
out by frequent pregnancies, are more subje&t to tuberculosis than almost any other class of people. How then can Dr. Dublin believe that birth limitation would cause more tuber- culosis? In Russia, where the word birth control is unknown, tuberculosis and infant mortality are the highest of all civilized coun- tries. On the other hand, in Holland, where we might speak of nation-wide birth control, as already stated in my paper, after forty years of this policy there is less infant mor- tality, an increase in population, a better physique, and a higher morality. Further- more, there has not been a general weakening but a general improvement in the strength of the stock which is shown by an increase in stature and increase in the longevity of the population at large.
My good friend. Assistant Surgeon-General John W. Trask, has admirably answered the question as to what, aside of the war and its demands for more men, is the common reason for wanting the population to grow. It is a splendid answer and I could not possibly im- prove on it but wish to thank him most heart- ily for what he said. And here I cannot help saying one word which, however, I hope may not be misunderstood. I am an American to the core of my being, but my cradle stood in Germany whose people I love as warmly as ever; and yet I cannot help feeling that the over-population of Germany has been one of the vital causes of this disastrous war which has brought so much misery to all humanity.
ASPECTS OF BIRTH CONTROL K
Professor Robert J. Sprague, of the Massa- chusetts Agricultural College, expressed this veiw very strongly the other day at the meet- ing of the Genetic Association when he said: "The barbaric birth-rate of Germany hemmed in as she is by the other nations, made the great war inevitable and will, if it keeps up, make war forever in the future. Some be- lieve this will work eugenically for the sur- vival and predominance of the strongest and best race, but this is still a mooted question. The survival of the merely strong may result in the survival of the strong animal. Pres- sure of population on subsistence and area develops brutality, selfishness, and disregard of human life. It crushes leisure, generosity, and art and makes impossible some of the finest virtues of the race."
I have already said how anxious I am that we may treat this subject as a scientific one and that we should only have in view the highest ideal, namely, a normal increase of population concomitant with our resources and an improvement of the quality of our population; in other words, we should strive to render the lives of man, woman and child more healthy and more happy, and economic- ally secure. My personal belief is that we shall thereby become more highly developed spiritually and approach more rapidly toward the millennium. When at last an enlightened government will permit contraception to be taught where it is likely to be produc- tive of the most good, when in years
54 ASPECTS OF BIRTH CONTROL
to come we can show our Catholic brethren and all those who oppose us now that because of judicious birth control result- ing in a rational family limitation, we have decreased poverty, disease, and crime and have produced a better generation of men and women, better equipped for life's mission, in short, men worthy to be called true citizens of a great republic, then I am sure our Cath- olic friends and other opponents will see that after all we have not been so wrong and they may then be willing to follow along the same lines of teaching rational birth control.
I have been asked why I became interested in birth control so suddenly, which is appar- ently so foreign to my specialty, but I can assure you that while I have taken up the work only recently, my interest was not sud- den at all. As already stated it began many years ago in connection with my work in the tenements and over-crowded hospitals where I witnessed the suffering of many a tubercu- lous mother whom I could not help because it was too late to prevent. The despair of some poor, frail creature at the prospect of another inevitable confinement, the likelihood of her early decease as a result of this newly added pregnancy, the thought of her other children who would be deprived of a mother's care at ages when they need it most, and later the sight of a puny babe destined to disease, pov- erty, and misery, opened my eyes to the utter immorality of thoughtless procreation, not -jnly of the tuberculous, but of all other phys-
ASPECTS OF BIRTH CONTROL 56
ically and mentally diseased and impoverished.
Nature's forces are blind. She creates without thought of provision for the offspring. Think of bacterial life if it had remained un- checked by the genius of a Pasteur, a Koch, a Lister; of the insects, such as the yellow fev- er and malaria-spreading mosquitoes, if un- checked by a Reed and a Gorgas! I could continue the theme of man's triumph and con- trol over nature indefinitely if I were to enter into the field of agricultural and industrial science. I could tell you of battles of the Australian farmer with the rapidly multiply- ing rabbit. Here nature's blind tendency to procreate devastated the fields destined to nourish the population.
The excessive birth-rate of human beings in India and China is to my mind also largely responsible for the frequent famines and their sequellae of pestilence, plagues, etc. The idea that there is and always will be enough room and food for all mankind on this earth, no matter how great the increase in population, is, to say the least, erroneous. In my address I have already referred to the work of Doctor Reed who says, "It seems, indeed, to the care- ful student that the danger to the American family today and still more in the future lies in the direction of over-population rather than under-population."
Is there no danger at all in this country of ours of a possible famine due to over-pop- ulation and under-production of food sub- stances? In his forthcoming book on Food
56 ASPECTS OF BIRTH CONTROL
Problems (Goodhue & Co., Publ., New York), of which I had the privilege to see the proof, my friend, Dr. Henry Smith Williams, the well known physician and economist, makes the following statement:
"In the census period of 1900-1910, the population of the United States in- creased by 21 per cent, but the production of cereal grain increased by only 1.7 per cent. In the meantime there has been such a falling off in the animal industry that there would have been required 60,000,000 more meat an- imals (cattle and sheep) on the hoof in order that meat should have been as abundant per capita as it was in 1890."
This authoritative statement should give serious food for thought to statesmen and sociologists, as well as to us physicians. The difference between the increase in production and population is too great at this time for family limitation alone to prevent food prob- lems becoming intensified from year to year. There must be very soon a wiser distribution of wealth and population, that is to say, more social justice for all — man, woman and child — and a return to the field of some of the masses through making farming more profitable. Be- sides taxing unimproved property in and around cities or utilizing it for the public good or temporary cultivation, there should be an intensive cultivation of the vast areas as yet unused. A steady decrease in the food sup- ply will not only lead ultimately to famine but prio- to that will increase tuberculosis
ASPECTS OF BIRTH CONTROL 67
and other diseases of malnutrition to an alarm- ing degree, as is demonstrated at this time in the warring countries of Europe. In order to thrive physically, mentally, and morally, man must have room. Over-population and over-crowding is injurious to man, beast and plant. Professor Sprague, whom I have al- ready referred to, is right when he says: "Man has learned that corn and potatoes must be given proper spacing lest Mother Earth be crowded and they do not grow well, but he has often forgotten to place sufficient spacing between his human children that they might develop to the highest."
If non-interference with thoughtless na- ture comprises one of the tenets of the relig- ion of others, to me man's intellectual control over nature's blind forces and nature's thought- less procreation of undesirable bacterial, in- sect or animal life, and his powers to bring forth more useful products and make life for man, woman, and child not only more bearable but even more beautiful and glorious, are among the greatest proofs of the existence of God's power in man. But the greatest of all achievements, the most divine gift which God has bestowed upon man, is conscious pro- creation. To me, judicious birth control under the guidance of the beat and ablest among our own profession, among the clergy and sociol- ogists, based on the highest conception of sanitary, medical, moral, ethical, and econom- ic reasons, can well be considered a spiritual asset which will uplift the race.
I TEN CENT POCKET SERIES I
Other Titles in Pocket Series
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Drama |
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King Lear. |
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Venus and Adonis. |
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316 Prometheus Bound. |
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90 The Mikado. Gilbert. |
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295 Master Builder. Ibsen. |
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308 She Stoops to Conquer. |
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Julius Caesar. |
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Oliver Goldsmith. |
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46 Salome. Oscar Wilde. |
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54 Importance of Being |
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King John. |
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Earnest. 0. Wilde. |
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King Richard HI. |
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Fiction |
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James. |
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Poe. |
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246 Hamlet. |
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TEN CENT POCKET SERIES
318 Christ in Flanders and Other Stories. Balzac. 230 The Fleece of Gold.
Theophile Gautier. 178 One of Cleopatra's
^"iglits. Gautier.
314 Short Stories. Daudet.
58 Boccaccio's Stories.
45 Tolstoi's Short Stories.
12 Poe's Tales of Mvsterv.
290 The Go'd Bug. Edgar
Allan Poe. 145 Great Ghost Stories. 21 Carmen. Merimee. 23 Great Stories of the
Sea. jl9 Conitesse de Saint-
Gerane. Dumas. 38 Dr. Jekyll and Mr, Hvde. Stevenson. 279 Will o' the Mill;
Markheiin. Stevenson. 311 A Lodging for the Night. Stevenson. 27 Lust Days of a Con- demned Man. Hugo. 151 Man Who Would Be
King. Kipling. 148 Strength of the Strong. London. 41 Christmas Carol.
Dickens. 57 Rip ^ an Winkle. Irving. 100 Red Laugh. Andrevev. 105 Seven That Were
Hanged, Andreyev. 102 Sher!o(k Holmes Tales.
Conan Dovle. 161 Countrv of the Blind. H. G. Wells. 83 Attack on the Mill. Zola. 15G Andersen's Fairy Tales. 158 Alice in Wonderland.
II
198
215
24
2 85
Dream of John Ball. William Morris. House and the Brain Bulwer Lytton. Color of Life. E. Haldeman-.Julius. Majesty of Justice. Anatole France. The Miraculous Re- venge. Bernard Shaw. The Kiss and Other Stories. Chekhov. Euphorian in Te.xas. George Moore. The Human Tragedy. Anatole France. The Marquise. George Sand.
Twenty-Six Men and a Girl. Gorki. Dreams. Olive Schreiner.
The Three Strangers, Thomas Hardy. The Man Without a Countrv. E. E. Hale.
History, Biography
219 196
324 312
328
3 23
339
i2G
l-i", 149
Life of Lincoln. Bowers. Life and Works of Lau- rence Sterne. Gunn. Addison and His Timea. Finger.
The Life of Joan of Arc.
Thoreau — the Man Who Escaped from the Herd. Finger. Historv of Rome. A. F. "Giles. Julius Caesar: WTio He Was.
History of Printing. Historic Crimes and Criminals. Finger.
Ill
TEN CENT POCKET SERIES
llJ
175 Science of History.
Froude. 104 Battle of Waterloo.
Victor Hugo. 62 Voltaire. Victor Hugo. 126 War Speeches of
Woodrow Wilson. 22 Tolstoy: His Life and
Works. 142 Bismarck and the
German Empire.
286 When the Puritans Were in Power.
343 Life of Columbus. 66 Crimes of the Borgias. Dumas.
287 Whistler: The Man and His Work.
61 Bruno: His Life and
Martyrdom. 147 Cromwell and His
Times. 236 State and Heart
Affairs of Henry VHI. 50 Paine's Common Sense. 88 Vindication of Paine.
Ingersoll. 33 Brann: Smasher of
Shams. 163 Sex Life in Greece and
Rome. 214 Speeches of Lincoln. 276 Speeches and Letters
oi Geo. Washington. 144 Was Poe Immoral?
Whitman. 223 Essay on Swinburne. 227 KeatR. The Man and
His Work. 150 Lost Civilizations.
Finger. 170 Constantine and the ^ Beginnings of Christi- anity. 201 Satan and the Saints.
67 Church History. H. M. Tichenor. 109 Voices From the Past. 266 Life of Shakespeare and Analysis of Hie Plays. 123 Life of Madame Du
Barry. 139 Life of Dante. 69 Life of Mary, Queen of Scots. Dumas. 5 Life of Samuel Johnson. Macaulay. 174 Trial of William Penn.
Humor
291 Jumping Frog and
Other Humorous Tales.
Mark Twain. 18 Idle Thoughts of an
Idle Fellow. Jerome. 166 English as She Is
Spoke. Mark Twain. 231 Eight Humorous
"Sketches. Mark Twain. 205 Artemus Ward. Hi.;
Book. 187 Whistler's Humor. 216 Wit of Heinrich Heine.
George Eliot. 20 Let's Laugh. Nasby.
Literature
278 Friendship and OtLc".
Essays. Thoreau. 195 Thoughts o n Nature.
Thoreau. 194 Lord Chesterfield's
Letters.
63 A Defense of Poetry.
Shellev. 97 Love Letters of King
Henry VIH. 3 Eighteen Essays.
Voltaire.
IV
TEN CENT POCKET SERIES
IV
28 Toleration. Voltaire.
89 Love Letters of Men and Women of Genius. 18G How I wrote "The Raven". Poe.
87 Love, an Essay. Montaigne.
4 8 Bacon's Essays.
60 Emerson's Essays.
84 Love Letters of a Portuguese Nun.
26 On Going to Church. G. B. Shaw. 13.5 Socialism for Million- aires. G. B. Shaw.
'il To'stoi's Essays.
176 Four Essavs. Havel ock Ellis.
160 Lecture on Shakes- peare. Ingersoll.
75 Choice of Books. Carlyle.
288 Essays on Chesterfield and Rabelais. Sainte-Beuve.
76 The Prince of Peace. W. .J. Bryan.
86 On Reading. Brandes. 95 Confessions of An
Opium Eater. 213 Lecture on Lincoln.
Ingersoll.
177 Subjection of Women. .John Stuart Mill.
17 On Walking. Thoreau. 70 Charles Lamb's Essavs. 235 Essays. Gilbert K." Chesterton. 7 A Liberal Education. Thomas Ilu.xley. 233 Thoughts on Literature
and Art. Goethe. 225 Condescension in
Foreigners. Lowell. 221 Women, and Other Essays. Maeterlinck.
10 .Shelley. Francis
Thompson. 2 89 Pepys' Diary. 299 Prose Nature Notes.
Walt Whitman. 315 Pen, Pencil and Poison.
Oscar Wilde. 313 The Decay of Lying.
Oscar Wilde. 36 Soul of Man Under
Socialism. 0. Wilde. 293 Francois Villon:
Student, Poet and
Housebreaker. R. L.
Stevenson.
Maxims and Epigrams
179 Gems from Emerson. 77 What Great Men Have
Said About Women. 304 ^^'hat Great Women
Have Said About Men. 310 The Wisdom of
Thackeray. 193 Wit and Wisdom of
Charles Lamb. .'.r, Wisdom of IngersoU. 106 Aphorisms. George
Sand. 168 Epigrams. Oscar
Wilde. .'9 Epigrams of W^it nd
Wisdom. 35 Maxims.
Rochefoucauld. l.")4 Epigrams of Ibsen. 197 Witticisms and Re- flections. De Sevigne. ISO Epigrams of George
Bernard Shaw. l.'>") Maxims. Napoleon. 1>1 Epigrams. Thoreau. •2 2 8 .\phoiism>. Huxley. 113 Proverbs of England. I 114 Proverbs of France.
TKN CKNT I'UCKET SERIES
115 Proverbs of Japan.
116 Proverbs of China.
117 Proverbs of It;\'y.
118 Proverbs of H:issia.
119 Proverb: of |:e!;ind.
120 l'ro\erbs of Rpiin.
121 Proverbs of Arabia.
Philosophy, Religion
15J
Du-
ir)7
A Guide to Plato, rani. 322 The Buddliist Phi'.os --
phv of Life. 317 A Guid to Stoicism. 124 Theory of Reincarna- tion Explained. Plato's Republic. 62 Schopenhauer's Essays. 94 Trial and Death of
Socrates. 65 Meditations of Marcus Aurelius.
64 Rudolf Eucken: His Life and Philosophy.
I Age of Reason. Thomas Paine.
65 Herbert Spencer: His Life and Works.
4 4 Aesop's Fables.
165 Discovery of the Fu- ture. H, G. Wells. 96 DinlopTues of P^nto.
3 25 Esseni-c of Buddhism.
103 Pn^kot Theology. "^'oHnire.
132 Fnimdntions of Re- ligion,
138 StnrliVf; in Possimism. S'"hopcn1->i"»^r.
211 Idea of God in V' t'lrp. .John St'i •'•t
212 Tif" ^nd Ch^rrir+rr Ooo+>ie
200 Tenorant Philosopher.
VnltnirP
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Thoughts of Pascal. |
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The Stoic Philosophy, |
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God: Known and |
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Xiet/.sche: Who he |
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Stood For. |
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Sun Worship and |
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Tichcnor. |
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O'ympian Gods. |
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Primitive Beliefs. |
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Chinese Philosophy of |
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Life. |
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What Life Means to |
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Poetry |
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The Kasidah. Burton |
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L'ATegro and Othe: |
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Courtship of Miles |
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Rime of An ient Mar- |
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iner. Co'eridgc. |
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Poems. Robert |
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Dante's Inferno, |
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^'ol1lme 1 . |
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Dinte's ^-"ferno, |
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Yo'ume |
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A Shropshire Lad |
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TToiism'-n. |
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Poems of Robert |
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Burns. |
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Rubaiynt of Omar |
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Khnwnm |
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Poo's iPoems |
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VI
TEN CENT POCKET SERIES
VI
71 146
88 •Bl -73 '22 •^7
321
327
140
275
49
42
238
202
:91
133 92
Poems of Evolution. Snovv-Bounii. Pied Piper.
Great English Poeiiis. Enoch Arden. Tennyson.
Shakespeare's Son- nets.
Lays nf Ancient Rome. Marnuhiy.
Vision of Sir Launfal. Lowell.
The Vampire and Other Poems. Kipling. Prose Poems. Baudelaire.
Science
A History of Evohtion. Fenton.
The Ice Age. Finger. The Puzz e of Person- ality; a Study in Psvcho-Analysis. Fielding.
Psyrh o- A n a ' y ;^ i =;— Th e Key to Human Be- havior. Fie'fling. Biologv and Spiritual Philosophy. The Bui'ding of the Enrth. C. L. Fenton. Three Lectures on Evolution. Haec'kel. Origin of the Human Race.
Reflections on Mod- ern Science. Huxlev. Survival of the Fittest. FT. M. Tichenor. Evolution vs. Religion. B:i'mforth.
E'ectricity M:nle Plain. Hvpnotism Made Plain.
1 Insects and Men: Instinct and Reason,
9 Engl nics. Havelock Ellis.
Series of Debates
11
130
43
Debate on Religion. Did .Jesus Ever Live? Controversy on Chris- tianity. Ingersoll and Gladstone.
Marriage and Divorce. Horace Greeley and Robert Owen.
208 Debate on Birth Con- trol. Mrs. Sanger and "Winter Russell.
129 Rome or Reason.
Ingersoll and Manning.
122 Spiritualism. Conan Doyle and McCabe.
171 Has Life Any Mean- ing? Frank Harris and Percy Ward.
206 Capitalism vs. Social- ism. Seligman and Nearing.
Is Free Will a Fact or a Fallacy? McNeal-Sinclair De- bate on Socialism. Would Practice of Christ's Teachings Make for Social Progress? Nearing and Ward.
13
!34
141
Miscellaneous
326
19
Hints on Writing
Sliort Stories. Finger.
Book of Synonyms. 2.') Rhyming Dictionary. 7S How to Be an Orator. 82 Common Faults in
Writing English.
8ij33irtM tUi JTHMHaU .ilJAu HU MV
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TEN CENT POCKET SERIES
VII
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What Expectant |
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How to Love. |
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172 |
Evolution of Love. |
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Care of tlu- I3al>v. |
Ellen Key. |
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Child Training. |
203 |
Rights of Women. |
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Home Nursing. |
Havelock Ellis. |
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What Every Girl Should |
209 |
Aspects of Birth Con- |
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trol. Medical. Moral, |
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Case for Birth Control. |
Sociological. |
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Manhood: Facts of |
93 |
How to Live 100 |
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Life Presented to Men. 1 |
Years. |
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Marriage: Past, 1 |
167 |
Plutarch's Rules of |
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Present and Future. |
Health. |
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Besant. |
320 |
The Prince. |
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On Threshold of Sex. |
Macbiavelli. |
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