century, as Clappier notes, industrial corporations sometimes had regard to this matter, and would not allow women to work during pregnancy. In Iceland, where much of the primitive life of Scandinavian Europe is still preserved, great precautions are taken with pregnant women. They must lead a quiet life, avoid tight garments, be moderate in eating and drinking, take no alcohol, be safeguarded from all shocks, while their husbands and all others who surround them must treat them with consideration, save them from worry and always bear with them patiently.[7] It is necessary to emphasize this point because we have to realize that the modern movement for surrounding the pregnant woman with tenderness and care, so far from being the mere outcome of civilized softness and degeneracy, is, in all probability, the return on a higher plane to the sane practice of those races which laid the foundations of human greatness.
While rest is the cardinal virtue imposed on a woman during the later months of pregnancy, there are other points in her regimen that are far from unimportant in their bearing on the fate of the child. One of these is the question of the mother's use of alcohol. Undoubtedly alcohol has been a cause of much fanaticism. But the declamatory extravagance of anti-alcoholists must not blind us to the fact that the evils of alcohol are real. On the reproductive process especially, on the mammary glands, and on the child, alcohol has an arresting and degenerative influence without any compensatory advantages. It has been proved by experiments on animals and observations on the human subject that alcohol taken by the pregnant woman passes freely from the maternal circulation to the foetal circulation. Féré has further shown that, by injecting alcohol and aldehydes into hen's eggs during incubation, it is possible to cause arrest of development and malformation in the chick.[8] The woman who is bearing her child in her womb or suckling it at her breast would do well to remember that the alcohol which may be harmless to herself is little better than poison to the immature being who derives nourishment from her blood. She should confine herself to the very lightest of alcoholic beverages in very moderate amounts and would do better still to abandon these entirely and drink milk instead. She is now the sole source of the child's life and she cannot be too scrupulous in creating around it an atmosphere of purity and health. No after-influence can ever compensate for mistakes made at this time.[9] What is true of alcohol is equally true of other potent drugs and poisons, which should all be avoided so far as possible during pregnancy because of the harmful influence they may directly exert on the embryo. Hygiene is better than drugs, and care should be exercised in diet, which should by no means be excessive. It is a mistake to suppose that the pregnant woman needs considerably more food than usual, and there is much reason to believe not only that a rich meat diet tends to cause sterility but that it is also unfavorable to the development of the child in the womb.[10] How far, if at all, it is often asked, should sexual intercourse be continued after fecundation has been clearly ascertained? This has not always been found an easy question to answer, for in the human couple many considerations combine to complicate the answer. Even the Catholic theologians have not been entirely in agreement on this point. Clement of Alexandria said that when the seed had been sown the field must be left till harvest. But it may be concluded that, as a rule, the Church was inclined to regard intercourse during pregnancy as at most a venial sin, provided there was no danger of abortion. Augustine, Gregory the Great, Aquinas, Dens, for instance, seem to be of this mind; for a few, indeed, it is no sin at all.[11] Among animals the rule is simple and uniform; as soon as the female is impregnated at the period of oestrus she absolutely rejects all advance of the male until, after birth and lactation are over, another period of oestrus occurs. Among savages the tendency is less uniform, and sexual abstinence, when it occurs during pregnancy, tends to become less a natural instinct than a ritual observance, or a custom now chiefly supported by superstitions. Among many primitive peoples abstinence during the whole of pregnancy is enjoined because it is believed that the semen would kill the foetus.[12] The Talmud is unfavorable to coitus during pregnancy, and the Koran prohibits it during the whole of the period, as well as during suckling. Among the Hindus, on the other hand, intercourse is continued up to the last fortnight of pregnancy, and it is even believed that the injected semen helps to nourish the embryo (W.D. Sutherland, "Ueber das Alltagsleben und die Volksmedizin unter den Bauern Britischostindiens," _Münchener Medizinische Wochenschrift_, Nos. 12 and 13, 1906). The great Indian physician Susruta, however, was opposed to coitus during pregnancy, and the Chinese are emphatically on the same side.
As men have emerged from barbarism in the direction of civilization, the animal instinct of refusal after impregnation has been completely lost in women, while at the same time both sexes tend to become indifferent to those ritual restraints which at an earlier period were almost as binding as instinct. Sexual intercourse thus came to be practiced after impregnation, much the same as before, as part of ordinary "marital rights," though sometimes there has remained a faint suspicion, reflected in the hesitating attitude of the Catholic Church already alluded to, that such intercourse may be a sinful indulgence. Morality is, however, called in to fortify this indulgence. If the husband is shut out from marital intercourse at this time, it is argued, he will seek extra-marital intercourse, as indeed in some parts of the world it is recognized that he legitimately may; therefore the interests of the wife, anxious to retain her husband's fidelity, and the interests of Christian morality, anxious to uphold the institution of monogamy, combine to permit the continuation of coitus during pregnancy. The custom has been furthered by the fact that, in civilized women at all events, coitus during pregnancy is usually not less agreeable than at other times and by some women is felt indeed to be even more agreeable.[13] There is also the further consideration, for those couples who have sought to prevent conception, that now intercourse may be enjoyed with impunity. From a higher point of view such intercourse may also be justified, for if, as all the finer moralists of the sexual impulse now believe, love has its value not only in so far as it induces procreation but also in so far as it aids individual development and the mutual good and harmony of the united couple, it becomes morally right during pregnancy.
From an early period, however, great authorities have declared themselves in opposition to the custom of practicing coitus during pregnancy. At the end of the first century, Soranus, the first of great gynæcologists, stated, in his treatise on the diseases of women, that sexual intercourse is injurious throughout pregnancy, because of the movement imparted to the uterus, and especially injurious during the latter months. For more than sixteen hundred years the question, having fallen into the hands of the theologians, seems to have been neglected on the medical side until in 1721 a distinguished French obstetrician, Mauriceau, stated that no pregnant woman should have intercourse during the last two months and that no woman subject to miscarriage should have intercourse at all during pregnancy. For more than a century, however, Mauriceau remained a pioneer with few or no followers. It would be inconvenient, the opinion went, even if it were necessary, to forbid intercourse during pregnancy.[14] During recent years, nevertheless, there has been an increasingly strong tendency among obstetricians to speak decisively concerning intercourse during pregnancy, either by condemning it altogether or by enjoining great prudence. It is highly probable that, in accordance with the classical experiments of Dareste on chicken embryos, shocks and disturbances to the human embryo may also produce injurious effects on growth. The disturbance due to coitus in the early stages of pregnancy may thus tend to produce malformation. When such conditions are found in the children of perfectly healthy, vigorous, and generally temperate parents who have indulged recklessly in coitus during the early stages of pregnancy it is possible that such coitus has acted on the embryo in the same way as shocks and intoxications are known to act on the embryo of lower organisms. However this may be, it is quite certain that in predisposed women, coitus during pregnancy causes premature birth; it sometimes happens that labor pains begin a few minutes after the act.[15] The natural instinct of animals refuses to allow intercourse during pregnancy; the ritual observance of primitive peoples very frequently points in the same direction; the voice of medical science, so far as it speaks at all, is beginning to utter the same warning, and before long will probably be in a position to do so on the basis of more solid and coherent evidence.
Pinard, the greatest of authorities on puericulture, asserts that there must be complete cessation of sexual intercourse during the whole of pregnancy, and in his consulting room at the Clinique Baudelocque he has placed a large placard with an "Important Notice" to this effect. Féré was strongly of opinion that sexual relations during pregnancy, especially when recklessly carried out, play an important part in the causation of nervous troubles in children who are of sound heredity and otherwise free from all morbid infection during gestation and development; he recorded in detail a case which he considered conclusive ("L'Influence de l'Incontinence Sexuelle pendant la Gestation sur la Descendance," _Archives de Neurologie_, April, 1905). Bouchacourt discusses the subject fully (_La Grossesse_, pp. 177-214), and thinks that sexual intercourse during pregnancy should be avoided as much as possible. Fürbringer (Senator and Kaminer, _Health and Disease in Relation to Marriage_, vol. i, p. 226) recommends abstinence from the sixth or seventh month, and throughout the whole of pregnancy where there is any tendency to miscarriage, while in all cases much care and gentleness should be exercised.
The whole subject has been investigated in a Paris Thesis by H. Brénot (_De L'Influence de la Copulation pendant la Grossesse_, 1903); he concludes that sexual relations are dangerous throughout pregnancy, frequently provoking premature confinement or abortion, and that they are more dangerous in primiparæ than in multiparæ.
Nearly everything that has been said of the hygiene of pregnancy, and the need for rest, applies also to the period immediately following the birth of the child. Rest and hygiene on the mother's part continue to be necessary alike in her own interests and in the child's. This need has indeed been more generally and more practically recognized than the need for rest during pregnancy. The laws of several countries make compulsory a period of rest from employment after confinement, and in some countries they seek to provide for the remuneration of the mother during this enforced rest. In no country, indeed, is the principle carried out so thoroughly and for so long a period as is desirable. But it is the right principle, and embodies the germ which, in the future, will be developed. There can be little doubt that whatever are the matters, and they are certainly many, which may be safely left to the discretion of the individual, the care of the mother and her child is not among them. That is a matter which, more than any other, concerns the community as a whole, and the community cannot afford to be slack in asserting its authority over it. The State needs healthy men and women, and by any negligence in attending to this need it inflicts serious charges of all sorts upon itself, and at the same time dangerously impairs its efficiency in the world. Nations have begun to recognize the desirability of education, but they have scarcely yet begun to realize that the nationalization of health is even more important than the nationalization of education. If it were necessary to choose between the task of getting children educated and the task of getting them well-born and healthy it would be better to abandon education. There have been many great peoples who never dreamed of national systems of education; there has been no great people without the art of producing healthy and vigorous children.
This matter becomes of peculiar importance in great industrial states like England, the United States, and Germany, because in such states a tacit conspiracy tends to grow up to subordinate national ends to individual ends, and practically to work for the deterioration of the race. In England, for instance, this tendency has become peculiarly well marked with disastrous results. The interest of the employed woman tends to become one with that of her employer; between them they combine to crush the interests of the child who represents the race, and to defeat the laws made in the interests of the race which are those of the community as a whole. The employed woman wishes to earn as much wages as she can and with as little interruption as she can; in gratifying that wish she is, at the same time, acting in the interests of the employer, who carefully avoids thwarting her.
This impulse on the employed woman's part is by no means always and entirely the result of poverty, and would not, therefore, be removed by raising her wages. Long before marriage, when little more than a child, she has usually gone out to work, and work has become a second nature. She has mastered her work, she enjoys a certain position and what to her are high wages; she is among her friends and companions; the noise and bustle and excitement of the work-room or the factory have become an agreeable stimulant which she can no longer do without. On the other hand, her home means nothing to her; she only returns there to sleep, leaving it next morning at day-break or earlier; she is ignorant even of the simplest domestic arts; she moves about in her own home like a strange and awkward child. The mere act of marriage cannot change this state of things; however willing she may be at marriage to become a domesticated wife, she is destitute alike of the inclination or the skill for domesticity. Even in spite of herself she is driven back to the work-shop, to the one place where she feels really at home.
In Germany women are not allowed to work for four weeks after confinement, nor during the following two weeks except by medical certificate. The obligatory insurance against disease which covers women at confinement assures them an indemnity at this time equivalent to a large part of their wages. Married and unmarried mothers benefit alike. The Austrian law is founded on the same model. This measure has led to a very great decrease in infantile mortality, and, therefore, a great increase in health among those who survive. It is, however, regarded as very inadequate, and there is a movement in Germany for extending the time, for applying the system to a larger number of women, and for making it still more definitely compulsory.
In Switzerland it has been illegal since 1877 for any woman to be received into a factory after confinement, unless she has rested in all for eight weeks, six weeks at least of this period being after confinement. Since 1898 Swiss working women have been protected by law from exercising hard work during pregnancy, and from various other influences likely to be injurious. But this law is evaded in practice, because it provides no compensatory indemnity for the woman. An attempt, in 1899, to amend the law by providing for such indemnity was rejected by the people.
In Belgium and Holland there are laws against women working immediately after confinement, but no indemnity is provided, so that employers and employed combine to evade the law. In France there is no such law, although its necessity has often been emphatically asserted (see, e.g., Salvat, _La Dépopulation de la France_, Thèse de Lyon, 1903).
In England it is illegal to employ a woman "knowingly" in a work-shop within four weeks of the birth of her child, but no provision is made by the law for the compensation of the woman who is thus required to sacrifice herself to the interests of the State. The woman evades the law in tacit collusion with her employers, who can always avoid "knowing" that a birth has taken place, and so escape all responsibility for the mother's employment. Thus the factory inspectors are unable to take action, and the law becomes a dead letter; in 1906 only one prosecution for this offense could be brought into court. By the insertion of this "knowingly" a premium is placed on ignorance. The unwisdom of thus beforehand placing a premium on ignorance has always been more or less clearly recognized by the framers of legal codes even as far back as the days of the Ten Commandments and the laws of Hamurabi. It is the business of the Court, of those who administer the law, to make allowance for ignorance where such allowance is fairly called for; it is not for the law-maker to make smooth the path of the law-breaker. There are evidently law-makers nowadays so scrupulous, or so simple-minded, that they would be prepared to exact that no pickpocket should be prosecuted if he was able to declare on oath that he had no "knowledge" that the purse he had taken belonged to the person he extracted it from.
The annual reports of the English factory inspectors serve to bring ridicule on this law, which looks so wisely humane and yet means nothing, but have so far been powerless to effect any change. These reports show, moreover, that the difficulty is increasing in magnitude. Thus Miss Martindale, a factory inspector, states that in all the towns she visits, from a quiet cathedral city to a large manufacturing town, the employment of married women is rapidly increasing; they have worked in mills or factories all their lives and are quite unaccustomed to cooking, housework and the rearing of children, so that after marriage, even when not compelled by poverty, they prefer to go on working as before. Miss Vines, another factory inspector, repeats the remark of a woman worker in a factory. "I do not need to work, but I do not like staying at home," while another woman said, "I would rather be at work a hundred times than at home. I get lost at home" (_Annual Report Chief Inspector of Factories and Workshops for 1906_, pp. 325, etc.).
It may be added that not only is the English law enjoining four weeks' rest on the mother after childbirth practically inoperative, but the period itself is absurdly inadequate. As a rest for the mother it is indeed sufficient, but the State is still more interested in the child than in its mother, and the child needs the mother's chief care for a much longer period than four weeks. Helme advocates the State prohibition of women's work for at least six months after confinement. Where nurseries are attached to factories, enabling the mother to suckle her infant in intervals of work, the period may doubtless be shortened.
It is important to remember that it is by no means only the women in factories who are induced to work as usual during the whole period of pregnancy, and to return to work immediately after the brief rest of confinement. The Research Committee of the Christian Social Union (London Branch) undertook, in 1905, an inquiry into the employment of women after childbirth. Women in factories and workshops were excluded from the inquiry which only had reference to women engaged in household duties, in home industries, and in casual work. It was found that the majority carry on their employment right up to the time of confinement and resume it from ten to fourteen days later. The infantile death rate for the children of women engaged only in household duties was greatly lower than that for the children of the other women, while, as ever, the hand-fed infants had a vastly higher death rate than the breast-fed infants (_British Medical Journal_, Oct. 24, 1908, p. 1297).
In the great French gun and armour-plate works at Creuzot (Saône et Loire) the salaries of expectant mothers among the employees are raised; arrangements are made for giving them proper advice and medical attendance; they are not allowed to work after the middle of pregnancy or to return to work after confinement without a medical certificate of fitness. The results are said to be excellent, not only on the health of the mothers, but in the diminution of premature births, the decrease of infantile deaths, and the general prevalence of breast-feeding. It would probably be hopeless to expect many employers in Anglo-Saxon lands to adopt this policy. They are too "practical," they know how small is the money-value of human lives. With us it is necessary for the State to intervene.
There can be no doubt that, on the whole, modern civilized communities are beginning to realize that under the social and economic conditions now tending more and more to prevail, they must in their own interests insure that the mother's best energy and vitality are devoted to the child, both before and after its birth. They are also realizing that they cannot carry out their duty in this respect unless they make adequate provision for the mothers who are thus compelled to renounce their employment in order to devote themselves to their children. We here reach a point at which Individualism is at one with Socialism. The individualist cannot fail to see that it is at all cost necessary to remove social conditions which crush out all individuality; the Socialist cannot fail to see that a society which neglects to introduce order at this central and vital point, the production of the individual, must speedily perish.
It is involved in the proper fulfilment of a mother's relationship to her infant child that, provided she is healthy, she should suckle it. Of recent years this question has become a matter of serious gravity. In the middle of the eighteenth century, when the upper-class women of France had grown disinclined to suckle their own children, Rousseau raised so loud and eloquent a protest that it became once more the fashion for a woman to fulfil her natural duties. At the present time, when the same evil is found once more, and in a far more serious form, for now it is not the small upper-class but the great lower-class that is concerned, the eloquence of a Rousseau would be powerless, for it is not fashion so much as convenience, and especially an intractable economic factor, that is chiefly concerned. Not the least urgent reason for putting women, and especially mothers, upon a sounder economic basis, is the necessity of enabling them to suckle their children.
No woman is sound, healthy, and complete unless she possesses breasts that are beautiful enough to hold the promise of being functional when the time for their exercise arrives, and nipples that can give suck. The gravity of this question to-day is shown by the frequency with which women are lacking in this essential element of womanhood, and the young man of to-day, it has been said, often in taking a wife, "actually marries but part of a woman, the other part being exhibited in the chemist's shop window, in the shape of a glass feeding-bottle." Blacker found among a thousand patients from the maternity department of University College Hospital that thirty-nine had never suckled at all, seven hundred and forty-seven had suckled all their children, and two hundred and fourteen had suckled only some. The chief reason given for not suckling was absence or insufficiency of milk; other reasons being inability or disinclination to suckle, and refusal of the child to take the breast (Blacker, _Medical Chronicle_, Feb., 1900). These results among the London poor are certainly very much better than could be found in many manufacturing towns where women work after marriage. In the other large countries of Europe equally unsatisfactory results are found. In Paris Madame Dluska has shown that of 209 women who came for their confinement to the Clinique Baudelocque, only 74 suckled their children; of the 135 who did not suckle, 35 were prevented by pathological causes or absence of milk, 100 by the necessities of their work. Even those who suckled could seldom continue more than seven months on account of the physiological strain of work (Dluska, _Contribution à l'Etude de l'Allaitement Maternel_, Thèse de Paris, 1894). Many statistics have been gathered in the German countries. Thus Wiedow (_Centralblatt für Gynäkologie_, No. 29, 1895) found that of 525 women at the Freiburg Maternity only half could suckle thoroughly during the first two weeks; imperfect nipples were noted in 49 cases, and it was found that the development of the nipple bore a direct relation to the value of the breast as a secretory organ. At Munich Escherich and Büller found that nearly 60 per cent. of women of the lower class were unable to suckle their children, and at Stuttgart three-quarters of the child-bearing women were in this condition.
The reasons why children should be suckled at their mothers' breasts are larger than some may be inclined to believe. In the first place the psychological reason is one of no mean importance. The breast with its exquisitely sensitive nipple, vibrating in harmony with the sexual organs, furnishes the normal mechanism by which maternal love is developed. No doubt the woman who never suckles her child may love it, but such love is liable to remain defective on the fundamental and instinctive side. In some women, indeed, whom we may hesitate to call abnormal, maternal love fails to awaken at all until brought into action through this mechanism by the act of suckling.
A more generally recognized and certainly fundamental reason for suckling the child is that the milk of the mother, provided she is reasonably healthy, is the infant's only ideally fit food. There are some people whose confidence in science leads them to believe that it is possible to manufacture foods that are as good or better than mother's milk; they fancy that the milk which is best for the calf is equally best for so different an animal as the baby. These are delusions. The infant's best food is that elaborated in his own mother's body. All other foods are more or less possible substitutes, which require trouble to prepare properly and are, moreover, exposed to various risks from which the mother's milk is free.
A further reason, especially among the poor, against the use of any artificial foods is that it accustoms those around the child to try experiments with its feeding and to fancy that any kind of food they eat themselves may be good for the infant. It thus happens that bread and potatoes, brandy and gin, are thrust into infants' mouths. With the infant that is given the breast it is easier to make plain that, except by the doctor's orders, nothing else must be given.
An additional reason why the mother should suckle her child is the close and frequent association with the child thus involved. Not only is the child better cared for in all respects, but the mother is not deprived of the discipline of such care, and is also enabled from the outset to learn and to understand the child's nature.