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well-known curve, dealing with Saxon miners, in which not only the
first born show up less favourably than the second and third born, but
in which, from the fourth child on, the mortality increases rapidly.
The economical condition of both groups being similar (85% of Baum's
families had a maximum yearly income of £75), it is highly probable
that the difference in the curves arises from different methods of
infant feeding. In the Rhine provinces, as is also proved by Baum's
figures, the feeding is good; in Saxony, however, it is notoriously
bad. The co-relation of infant mortality with infant feeding is
very clearly illustrated in Figures 2 and 3, the former shows the
+influence of the length of suckling on the mortality of the
children classed in order of birth+, the latter +the influence
of the order of birth in connection with different lengthed periods
of suckling+. The extraordinarily regular course of all the nine
curves in Figure 2 and the extremely irregular course of the six top
curves in Figure 3 are very striking. From these figures it is shown
that the first, second and third born if breast-fed for a short time
only, or not at all, are subjected to much greater risks than the
eighth, ninth, tenth or later children, suckled for a sufficient length
of time (maximum difference 1 to 42). In the curve showing the children
who were breast fed for 39 weeks (Figure 3), the influence of the high
birth number shows only to a very small degree."

[Sidenote: C 61]

+Number of children and capacity for breast-feeding.+ Concerning
this it is remarked: "The upper curve shows what percentage of children
had to do without breast feeding, and the lower one how many enjoyed
the sufficient period of 39 weeks of breast-feeding. Though Baum's
figures are only intended to deal with the number of cases of breast
feeding and not with its duration, and though no difference is made
between exclusive and partial breast feeding, yet some conclusions
may be drawn with regard to suckling capacity. In a district where
breast feeding is as general as it is in the one examined into here,
the number of women who voluntarily renounce every attempt at suckling
must necessarily be small. The curve dealing with the children who
had no breast feeding at all is therefore likely to give a fairly
correct picture of the absolute or primary incapacity for suckling on
the mother's part; absolute incapacity does not of course mean that
the mother could not produce a single drop of milk, but that she does
not produce enough to satisfy the child, and therefore must resort to
artificial feeding. As a period of 39 weeks' feeding, even if only
partial, points to a good capacity, the lower curve may also be taken
as an expression of feeding ability. A comparison of both figures
illustrates that the milk production after the first birth is smaller
than after the following ones, and that beyond the eighth birth, it
decreases materially and continuously, probably in consequence of the
exhaustion of the maternal organism."

[Sidenote: C 62]

+The habit of breast-feeding as running in families and infant
mortality.+ With this goes the following explanation: "The two
figures illustrate the proportion of mortality of the infants in 143
bottle-feeding families and 376 breast-feeding families of the first
order. As the line could not be drawn very sharply, and as in the
bottle-feeding families there had to be included those in which as an
exception one or other child was suckled for a few days or perhaps for
a week, one can see in these groups only the expression of the habit,
but not the power of suckling. Both figures illustrate the largely
avoidable sacrifice in young lives which still goes on through a want
of knowledge and of feeling of responsibility towards the coming race.
With the absence of breast-feeding the unfavourable influence of a
very large number of children becomes much more apparent; whereas
in breast-feeding families the difference in the mortality between
medium-sized families (four to six children) and very large families
(above ten children) amounts to only 1.39%, it reaches 12.90% with
the non-suckling families. Here, if the number of children surpasses
ten, nearly every second child dies in the suckling age, and amongst
thirteen families there is not a single one which has not lost a child
in that period, whereas in breast-feeding families of the first order,
with the same large number of children, only every thirteenth child
died in infancy, and of sixteen families seven (= 43.75%) lost no
infant." The same material is treated in a different way by Dr. Marie
Baum, of Dusseldorf, in Figures C 63-66.

[Sidenote: C 63]

+As the length of the period of suckling of the preceding child
increases, there is a constant and rapid decrease in the number of
children who are born at intervals of less than one year.+ If the
preceding child was not breast-fed a new birth occurred before the
expiration of one year in 9.6 cases out of 100. With a suckling period
of one-half to three-quarters of a year of the preceding child, this
figure is reduced to 1.8 per cent., and after a still longer suckling
period to 1 per cent. Out of one hundred mothers who have only partly
or not at all suckled the preceding child, seventy must count on a
fresh birth within a period of 1-3/4 years. If the preceding child
was suckled for at least 39 weeks, only thirty-eight, and with a
suckling period of more than a year only twenty mothers have to reckon
on a fresh birth within 1-3/4 years.

Dependence of Infant Mortality on the Duration of Breast-Feeding and
the Length of Time Intervening Between Successive Births.

[Illustration: Figure C 63.]

[Sidenote: C 64]

Figure C 64 shows the +parallelism between+ the +average
length of breast-feeding and the average time between births+
within the families. A half to three-quarters of the mothers who
suckled either long enough or very long show an interval between births
of from 1-1/4 to 3 years, whereas of those who did not suckle at all,
or only did so insufficiently, only one-third belong to this group, and
figure largely in the column of lower birth intervals.

Dependence of Infant Mortality on the Average Duration of
Breast-Feeding and the Average Length of Time Intervening between the
Successive Births of the Children in a Family.

[Illustration: Figure C 64.]

[Sidenote: C 65]

Figure C 65 enables us to examine into the +influence exercised by
a longer or shorter interval after the preceding birth on the vitality
of a child+, according as to whether the child was not breast-fed
at all or only moderately or amply so. The black oblongs demonstrate
that the average infant mortality falls regularly and decisively
according to the length of time between the birth of the children
considered and their predecessors. The average mortality of infants
who are born in rapid succession - under one year, one to one and a
quarter years, amounts to over 25 and to 22 per cent. respectively,
whereas the average mortality of children with at least two years'
interval amounts only to 11 per cent. "At the same time, however, it
is observed that the influence of the length of suckling is still
greater than that of the length of time elapsing between births. Even
with an interval of three or more years, the mortality of children who
were insufficiently or not at all breast-fed was above 20 per cent.
The children who had been suckled for at least three-quarters of a
year were only very slightly influenced by this factor in all groups,
except that with a birth interval of less than one year, where the
influence of short birth intervals is not counterbalanced even by long
extended breast-feeding."

[Sidenote: C 66]

Figure C 66. "The +infant mortality within the families+ dealt
with +falls materially and evenly as the average birth intervals
lengthen+. With an average birth interval of less than one year,
one-third of the children die in the first year, but only 7 per cent.
where the average birth interval was over three years; but here also
the influence is strongly modified by the mode of feeding. With the
non-suckling families the mortality is almost 25 per cent., even
with a birth interval of more than two years. On the other hand,
when the duration of suckling is sufficient, short birth intervals
almost disappear (see Table 2), and with an average birth interval of
1-1/4 to 2 years and a suckling duration of at least half a year the
mortality remains on an extremely small scale."

[Sidenote: C 67-73]

Groth and Hahn have exhibited two large tables C 67 and C 68 and a
similar one C 69, the results of their important investigations about
+breast-feeding and mortality in the administrative districts of
Bavaria+. Groth shows in Table C 70 "+mortality of sucklings in
Bavaria+," and in Table C 71 "+breast-feeding and cancer+."
In Tables C 72 and C 73 the Groth and Hahn statistics are treated by
Dr. A. Bluhm from the point of view of the +influence of the habit
of breast-feeding on the frequency of births+. In connection with
Figure C 73 she remarks: "This diagram shows the number of bottle-fed
babies in the various Bavarian districts counted at the time of
vaccination. To give as correct a picture as possible of the probable
influence which the habit of breast-feeding has on the birth-rate
(annual number of births per 1,000 of the whole population) there are
represented on this figure by green and yellow columns the average
birth-rate for the five years, 1875 to 1879, because in that period a
record birth-rate was established, so that it may be assumed that there
was then no intentional restriction of births. We see within the four
'old Bavarian' districts, where on the average 64.1% of the babies were
not breast-fed at all, the number of births is about 4 per 1,000 of
the population higher than in the Palatinate and the three 'Frankish'
districts, which together only show 18% of non-breast-fed children."

[Sidenote: C 72 & 73]

"These two figures deal with the +influence of the length of
suckling on the birth-rate+, the longer the duration of the
suckling period, _i.e._, the higher the number of children breast-fed
for six months or more, the lower the birth-rate. This only holds good
for the country (Curve B) not for towns (Curve A). This circumstance
is explained by the fact that the voluntary restriction of births is
much more frequent in towns than in the country, where consequently
the influence of the length of the period of suckling on the birth
frequency can find much stronger expression than in towns, where,
as Curve A shows, it is entirely extinguished by artificial birth
preventatives. From both tables it results that, to prevent the
senseless waste of human life, the interval between every two births
must be more than two years; further, that it is possible to increase
it by breast-feeding; the number of births in a district is based in
the main on the larger or smaller intervals at which the women of
reproductive age have children, and it may, therefore, at the same
time, be taken as an expression of these intervals. Keeping these
two facts in view, and considering the influence of the mode of
infant feeding on infant mortality, it appears to be in the interest
of the race that by means of the long duration of breast-feeding,
the birth intervals should be extended to at least two years. The
facts established in these two tables have a considerable bearing on
race-hygiene, especially in reference to the Neomalthusian contentions
of the necessary inferiority of the later born, and as a confirmation
of the utility of breast-feeding for the reduction of birth frequency.
Extremely great appears the influence of breast-feeding on infant
mortality."

[Sidenote: C 74-78]

This importance of breast-feeding is further illustrated by Figure C
74 - +duration of breast-feeding and infant mortality+, after
Dietrich; by Figure C 75 - +average number of carious teeth+,
after Bunge; and by the three figures, C 76, 77, and 78 - "+average
duration of breast-feeding and physical development, duration of
breast-feeding and average school reports+, and +duration
of breast-feeding and frequency of rachitic disturbances of
development+," after the extensive and valuable researches by Röse.

It must be pointed out that a far more direct connection exists between
breast-feeding, duration of suckling, infant mortality and physical
development than through the mere provision of suitable nourishment
for the child. A good suckling capacity is a symptom of a strong
constitution which is transmitted from mother to child. Examination of
Röse's table offers this suggestion.

[Sidenote: C 79-82]

+The importance of the hereditary constitution+ (which he
considers is dependent on soil and climate) +as regards infant
mortality+ v. Vogel expresses in four maps of Bavaria (Figures
79-82), so which he has furnished the following comments (contained in
the pamphlet, "Der Örtliche Stand der Säuglingsterblichkeit in Bayern,"
Munich, Piloty and Loehle, 1911): "The district of the highest infant
mortality in Bavaria is inhabited by a population of small height,
small fitness for military service, and high tuberculous mortality. The
reverse holds good on the whole for the district with a low mortality.

[Illustration: Map of Bavaria

Infant mortality in 1901.

Figure C 79.]

I cannot suppress another objection to the usual way of proving the - to
my mind undoubted - influence of breast-feeding on the duration of life
in infancy. Why is the mortality of those children who have not been
suckled for a week so large? Is it because they have not been suckled,
or because they have only lived altogether for less than a week? Or,
again, to be able to be suckled for 40 or 50 weeks, one must have lived
for 40 or 50 weeks, but a child who has lived for 40 or 50 weeks,
whether it has been suckled or not, has passed over the worst period.
It is well-known that the mortality in the first days of life is the
highest in the second week, much higher than in the third week, and so
on. In short, the mortality changes in such an extremely high degree
in the course of the first year of life that this period is much too
long for the comparison between mortality of suckled and non-suckled
children. One ought to calculate how many of those who have been
suckled for 0 weeks, one week, two weeks, one month, three months, six
months, and so on, have survived the first week, the second week, the
first month, and so on. Only in this manner can be established what is
the share of the absence of breast-feeding and what is the share of
the innate weakness and tendency to disease in the degree of infant
mortality."

[Illustration: Map of Bavaria

Percentage of under-sized Bavarian recruits (below 1.62 metres in
height) in 1875.

After Professor Ranke.

Figure C 80.]

Exhibit C 81-82.

[Illustration: Map of Bavaria.

Fitness for Military Service in Bavaria, 1902.

Figure C 81.]


[Illustration: Map of Bavaria

Mortality from Pulmonary Consumption in 1901.

Figure C 82.]

[Sidenote: C 83]

A striking peculiarity of cities, especially large cities, is, as
pointed out before, the high mortality amongst men; for this general
observation Figure C 83, +male and female mortality in town and
country+, offers an example. Whereas the female mortality in
Berlin, in the higher age groups, is even lower than in Mecklenburg
with its preponderantly country population - which is evidence that in
town life there are no inherent circumstances adversely affecting all
persons in a high degree - the male mortality in all the age groups
is higher, and in some much higher. The special adverse influence on
men of town life is also apparent in the upper part of the figure
(+comparison of male and female mortality)+. In Mecklenburg the
mortality among men is at most 25% higher than among women, and during
the period of most intense child production, as well as in the highest
age group, it is even smaller, whereas in Berlin the differences
are much more accentuated. It may be remarked that the higher male
death-rate in Mecklenburg between the ages of 40 to 75 years can only
to a small degree be explained by physiological reasons. This is shown
for example by the fact that in the provinces of Schleswig-Holstein,
Pomerania, Hanover, Hessen-Nassau, and the Rhein Provinces in the
country, the expectation of life for men aged 25 years is about equal
to that of women.

[Sidenote: C 84 & 85]

The higher male mortality in cities is only partially explained by
the specific harmfulness peculiar to men's town occupations, though
the mortality of peasants and agricultural labourers ranks amongst
the lowest. A very important part in this connection may be played
by syphilis. How terribly syphilis injures the body, though it is
seldom directly fatal, is shown by the experiences of life insurance
companies, of which examples are given in Tables C 84 and C 85. With
the Gotha Life Insurance Bank, for instance, +the mortality of the
syphilitic at the ages of 36 to 50 years+ was found to be nearly
double as high (186%) as that of the non-syphilitic.

[Sidenote: C 85]

Table C 85 shows to what a high degree +the heart and vessels
especially are harmed by syphilis+. At this point it is to be
noted that it may now be considered as proved that the statement that
general paralysis causes death in 2.9% cases among the non-syphilitic
is erroneous, because general paralysis only occurs among persons who
have been affected with syphilis. There is no doubt that the poison
of syphilis is also most injurious to the germs and the progeny; the
foetus is sometimes infected in the mother's womb, and sometimes
suffers by the general debility of the maternal body. A large
proportion also of those children who attain a higher age are either
enfeebled or damaged in many ways, and this inferiority is often
passed down to the grandchildren. The most recent Serum investigations
(the Wasserman reaction) are the first to throw full light on this.
In Germany syphilis occurs much more frequently in town than in the
country; this no doubt dependent on prostitution and on a much greater
degree of promiscuity of sexual intercourse in cities. In the country
couples keep together with greater constancy, even in the case of
cohabitation without marriage.

[Sidenote: C 86-88]

+The frequency of syphilis and other venereal diseases in town and
country+ is illustrated in Table C 86, which gives the result of
the enquiries of the Prussian Government on the 30th April, 1900,
and Table C 87 after Schwiening, on +the frequency of sexual
diseases among military recruits+. Also Table C 88 which gives the
+frequency of delirium tremens, epilepsy, and general paralysis+
in the +Prussian lunatic asylums+, points in the same direction
by the great differences shown in the frequency of general paralysis
in the different institutions. This table, at the same time, indicates
what is also supported by other observations, that the +frequency
and intensity of harmful influences through alcohol+ are much
+greater in towns than in the country+; this may be partly
because in cities there is a greater and more regular abuse of
alcoholic beverages than in the country, partly because town-life
induces a greater susceptibility to alcoholic poisoning than country
life (less intense metabolism with sedentary occupations).

[Sidenote: C 89-90]

+Injury to the reproductive function through alcohol+. It has
been known for a long time that drunkards are frequently sterile. This
must be attributed to the fact that the testicles of drunkards become
to a great extent atrophied. The condition is shown in Figure C 89 by
R. Weichselbaum,[B] representing a section through the testicle of a
drunkard. Figure C 90 which shows a section through a normal testicle,
enables even the layman to observe the atrophy of the characteristic
glandular tissue of the testicle. Weichselbaum has up to now found that
in fifty-four cases, without exception, in which alcoholism had been
proved, this atrophy could be demonstrated to a greater or less degree.
In thirty of these cases the subject was so young that senile atrophy
was out of the question. The abuse of alcohol is not the only harmful
influence which is able to induce such atrophy of the testicles, but
chronic alcoholism acts with special intensity. Very similar results
to those of Weichselbaum have been obtained by Bertholet (Zentralbl.
f. allg. Pathologie 20 Bd. 1909) in 37 out of 39 habitual drunkards.
They agree with observations on the vesiculae seminales of drunkards by
Simmonds, who found that in 61% of the cases examined the spermatozoa
were absent or dead. It is a permissible assumption that a poison which
can cause the total atrophy of the sexual glands may, in an earlier
stage, have adversely influenced in respect to quality the function of
those organs.

[Footnote B: Verhandlungen der Deutschen Patholog: Gesellschaft, 14th
day, Jena, Fischer, 1910, page 234.]

[Sidenote: C 91]

[Sidenote: C 92]

+Alcohol and Degeneration+, from the tables on the alcohol question
by Gruber and Kraepelin, Munich; Lehmann; contains the well-known
statistics of Demme, Bunge, and Arrivée. Table C 92 adds to the summary
of the statistical observations of Demme, further details of the +kind
of abnormalities+ which were +observed in children of drunkards+.
Representing, as they do, exceptionally bad cases with a high degree
of degeneration, one may doubt whether and in how far congenital
hereditary inferiority of the parents may have had its influence.

[Sidenote: C 93]

Figure C 93 contains the well-known result of v. Bunge's investigations
on the +influence of paternal alcoholism on the suckling capacity of
the daughters+. The varying frequency of the habitual consumption
of alcohol and of drunkenness proper of the father in the two groups of
families is most striking. Official investigations of this question on
a large scale are urgently called for.

[Sidenote: C 94]

Figure C 94 dealing with the +interconnection of tuberculosis,
nervous diseases and psychoses of the progeny and the alcohol
consumption of the father+, is derived from Bunge's investigations.
It is worthy of notice that he endeavoured to eliminate from his
statistics all families in whom hereditary diseases could be traced
previously.

[Sidenote: C 95]

Table C 95 contains a summary of T. Laitinen's +experiments on
animals with small quantities of alcohol+. The degree of injury
to the progeny supposed to be produced by even a minimum quantity of
alcohol (corresponding to about one-third of pint of beer for a man) is
astounding. Repetition of these experiments on a large scale and with
the strictest care would be most desirable here also.

[Sidenote: C 96]

Table C 96 also refers to reports by T. Laitinen.[C] +It deals
with the effect of alcohol on the progeny in man+. Unfortunately
Laitinen's paper is so confused and inexact that it is impossible
for the reader safely to draw conclusions from it. His personal
observations are mixed up with those gathered by means of inquiry
sheets circulated by him in such a way that one cannot make out how
he has arrived at his weights at birth and mortality. Information is
lacking with regard to the nutrition of the children, their age at the
conclusion of the investigations, the length of marriage, the rapidity
of birth sequence and so on. It is, therefore, indispensable to await
the more detailed report before Laitinen's information can be made use
of.

[Footnote C: Internat. Monatschrift z. Erforschung des Alkoholismus,
Juli, 1910.]

[Sidenote: C 97]

Bezzola has sent in in a modified form the data which he presented
to the Eighth International Congress against Alcoholism in Vienna
in 1901, on the +effect of acute intoxication on the origin of
feeble-mindedness+. With their help the curve on Figure C 97 has
been constructed, showing the distribution of illegitimate births in
Switzerland during the different months of the year from Bezzola's
data and the corresponding curve of the births of mentally eminent
individuals (taken from Brockhaus' encyclopædia.) The author supplies
the following comments: -

"+Comparison between the general birth curve and the corresponding
one for the birth of feeble-minded children+."

The casual observation at the registration of the personal history
of feeble-minded individuals that 50 per cent. of the birth dates
fall within only fourteen weeks of the year (New Year, carnival,


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Online LibraryVariousAbstracts of Papers Read at the First International Eugenics Congress → online text (page 9 of 15)