C 48
The Increasing Frequency of Obstetrical Operations and their Significanceto the Race.(Based on the official statistics of Baden by Dr. Agnes Bluhm.)
Figure C 48.
Dr. Agnes Bluhm contributes to the question of the deterioration of the race by therapeutic measures in dealing inFigure C 48with "The increasing frequency of surgical operations in connection with childbirth and its significance for the race." She writes in explanation "The number of doctors having increased relatively much more than the number of the population, it follows that for a growing number of women medical assistance at childbirth is available. To this must be added that progress in surgical technique, above all the diminished danger of infection, allows of amuch more frequent operative interference with good results for mother and child. Both these facts find expression in the reduction of the number of stillbirths. The purpose of these operations being to assist a diminished birth capacity in women, and this diminished capacity arising partly from constitutional and consequently hereditary factors, this question suggests itself: Is the average birth capacity of women progressively diminished by the fact that an increasing number of women, more or less unfit for childbirth, are artificially assisted in bringing forth living children who inherit this weakness from the mother?"
"Our table attempts to answer this question on the basis of official Midwifery Statistics compiled in the Grand Duchy of Baden reaching back to 1871, that is the beginning of the antiseptic era.
"To avoid the errors, which small figures might lead to, each calculation has been based on the average figures of a lengthy period. The material dealt with comprises over two million births."
C 48-1
"Figure 1shows theincreasing frequency of all childbirth operations taken together. The period 1871 to 1879 shows an average of 4.38 operations to every 100 births, the period 1900 to 1907 up to 8.12 operations to every 100 births."
C 48-2
"Figure 2shows thefrequency of each class of operation in every 1,000 births. Each class of operation shows an increase in number, but the increase has not been uniform throughout the various classes."
C 48-3
"Figure A and B, shows theshare of each class of operation in the total number for the various periods. A more leading part is taken by aftermath operations, by artificially induced premature birth, by perforation of the head and by Caesarean section on the living. Aftermath operations depend (like the use of the forceps) to such a degree on the teachings of the various schools for midwifery (and on the time at the doctor's disposal) that they can hardly serve as a standard of birth capacity. The Caesarean section, too, can hardly be taken as a guide, as a much wider view is taken now of the indications for this operation. But the equally increasing numbers of perforations of the head and artificially induced premature birth are well worthy of attention. For these two operations exclude one another. With the existing tendency to avoid perforation of the head by artificially inducing premature birth, a rise in the curve of premature births should correspond with a sinking of the perforation curve. 1871 to 1879 a maximum of the former actually coincides with a minimum of the latter; butfrom there on both curves rise, though not in the same degree. Premature births have become since then (seeFig. 2) more than eight times as frequent; perforations of the head have trebled; and dismemberments of the child have doubled. This fact must be considered as a sign of lessened birth capacity."
C 48-4
"Figure 4shows thedecrease of the total number of stillbirths."
C 48-5
"Figure 5gives theshare which abnormal position of the child has in this total, and a comparison of the two shows that whilst the total has decreased by 1.42% the decrease (1880 to 1889) has been 2.35% in the case of stillbirth through abnormal position. The conclusion is, that there is now more opportunity for hereditary transmission of the tendency to faulty position of the child than three to four decades ago."
C 48-6
"ButFigure 6proves that up to now anincreased inheritance of this tendency has not taken place. The curves of these positions not only show irregularities but (with the exception of cross births) a tendency to sink."
"Recapitulation. The growing frequency of surgically assisted births cannot be taken as evidence of a diminished birth capacity, but is closely connected with the growing number of doctors. Against the indications of a diminished birth capacity stand at the moment those which previously could be taken as pointing in the opposite direction. It would, therefore, appear that medical interference at birth has brought to the race advantages as to quantity and no drawbacks as to quality. But it is probable that the picture will change during the coming decades, because only then will the daughters of mothers who could not have brought forth living children without surgical assistance become themselves mothers. The renunciation of motherhood on the part of the women least suited for this function and the war against rickets might act as preventatives."
The great anxiety about the elimination of the severest struggle for existence is based on the undoubtedly erroneous fundamental conception that the organism is a sorry product of necessity which can barely manage to maintain a laborious existence by the constant straining of all its faculties, and that it requires the continuous use of the whip of necessity to prevent an organism from giving way to its inherent tendency to degeneration. In fact, however, no organism is conceivable which has not the "Tendency" to maintain itself and to react accordingly. There are many facts which prove that a wealth of capacities and tendencies is dormant inorganisms which for innumerable generations have not been active, or, perhaps, have, never functioned in every possible way, and that, therefore, if the occasion arises replacements or accommodations of an unprecedented character may occur. In an unprejudiced system of race-hygiene these facts must not be overlooked. The exhibition in this section gives two specially striking instances; the one from animal the other from plant life.
C 49
To begin with Figure C 49 gives a diagrammatic representation of thedevelopment of the eye of a vertebrate—after K. Kraepelin (taken from "Experimentelle Biologie II., T. v. Curt Thesing, Leipzig, Teubner, 1911")—which shows that the lens is formed out of an invagination of the cornea and the retina by an extension of the brain. In the lower part of the plate the various phases of thereconstruction of the lens out of the irisare shown, after it had been removed by a cataract operation from the eye of a Triton larva. (This experiment was carried out by Gustav Wolff.)[A]Thus an organ which normally is not concerned with the formation of the lens takes charge of its regeneration.
[A]Studies in the Physiology of Development II. Archiv. für Entwicklungs mechanic der Organismen, XII. Vol., 3 Part, 1901.
[A]Studies in the Physiology of Development II. Archiv. für Entwicklungs mechanic der Organismen, XII. Vol., 3 Part, 1901.
A large number of tables deal with the influence of the numerical position in the progeny, with the number of births and the interval between births, on the health of the children, partly acting alone, partly in combination with the influence of the manner of nourishment during infancy.
C 50
Numerical position in family and infantile mortality, after Geissler. According to these statistics, the fifth child of a mother has materially less vitality than the first four, the second and third children have the most; but this does not agree with other statistics.
C 51
According to Riffel's investigations—influence of the numerical position of the child and the age of the parents at the time of marriage on infant mortality, after v.d. Velden, a material difference between the mortality of the three earliest born children and the three next born is only shown if both parents at the time of marriage have attained a certain age (man over 28, woman over 25); only the seventh to ninth show under all circumstances a materially greater mortality than the earlier children. The children of more aged parents show a materially greater mortality than those of younger parents. The number of children in a family up to the eleventh has no material influence on infant mortality, only in families with twelve children or more a materially greater number of children perish before the fifth year.
Relation of Number of Births to Infant Mortality.Percentage of Deaths to 100 Births.
Died during the first year of life.
The mortality of the 1st, 2nd, 3rd and 4th child is below the average. Greatest vitality shown by 2nd and 3rd child.
Geissler.
26,429 births to 5,236 marriages of members of Saxon coalminers' funds. (Some still-born infants, and children of marriages to which there were only one or two births, are not included).
Died before reaching the age of 0.09 of a year,i.e., a little more than a month.
The mortality of the 2nd, 3rd, 4th and 5th child is below the average. Greatest vitality shown by 2nd, 3rd, and 4th child.
Figure C 50.
Influence of the Number of Births and the Age of the Parents at the Time of Marriage on Infant Mortality.
(From Riffel's Tables, after v. d. Velden).
Influence of the Number of Children Born to a Family on Infant Mortality.
Figure C 51.
C 52
Number of conceptions and conception losses, by Dr. Agnes Bluhm; the exhibitor gives the following explanation—
Hamburger's material deals with 1,042 marriages of the labouring classes in Berlin, with a total of 7,261 conceptions (an average of 6.97 conceptions for each woman); the material of Bluhm comprises 856 marriages of the wealthier and educated German middle and higher classes with a total of 3,856 conceptions (averaging 4.50 conceptions to each woman). Hamburger has counted as conception losses only miscarriages, premature births, stillbirths, or deaths from illness before the completion of the sixteenth year. Bluhm has included all those up to the twentieth year. Both have only included marriages which have been contracted at least twenty years back. As the births in these marriages apparently date back to twenty years, all living children are reckoned as survivors or conception results, even if they have not attained the sixteenth or twentieth year respectively. This has influenced the result optimistically, but as it has done so with both authors alike, the comparison of their results is admissible.
C 52-1
Figure 1 shows theconception losses in marriages of varying conception numbers(Curve A, Hamburger's working-men's families; Curve B, Bluhm's well-to-do families); both curves confirm Hamburger's words that "the percentage of the survivors gets smaller in proportion as the conception number increases." The mounting of Curve B in the families with ten births is probably a delusion brought about by a very small number. In the marriages with eleven or more births there are lost with the well-to-do one quarter and with the working-classes nearly two-thirds of the conceptions up to the twentieth or sixteenth year respectively.
C 52-2
Figure 2 represents theshare which miscarriages and premature births have in the conception losses in marriages of different degrees of productiveness(Curve A, Hamburger; Curve B, Bluhm). Amongst the Berlin labouring classes on the average 17.89 per cent. of all conceptions are lost through miscarriage and premature birth; for the wealthier German families the figure is 7.59 per cent.
C 52-3
Figure 3 shows theshare which deaths and stillbirths have in conception losses. With the labouring classes it amounts on the average to 32.75 per cent. (Curve A), and in the wealthier families to 10.55 per cent. (Curve B).
C 52-4
Figure 4. To investigate whether the continuous decrease in the percentage of the survivors, going hand in hand with the increase of maternal conceptions, is caused by the constitutional inferiority of the offspring as the numerical position increases, Bluhm has established, in dealing with her material, the loss for each numerical position (first, second, third, etc., conceptions respectively). If this were the case, Curve A, which gives the loss according to the frequency of conception in each marriage, would have to be identical with Curve B, which gives the loss of first, second, and third, etc., conceptions, but this is by no means the case, for only at a very high numerical position of the conception the curves begin to be parallel. This proves that Hamburger's "the percentage of the survivors gets smaller in proportion as the conception number increases" is not a biological law but only expresses a social phenomenon. With the increasing number of children there is a decrease in the value of each individual childlife. The mother is less careful about avoiding miscarriages; she devotes, and must necessarily devote, less care to each child; and the risk of infectious diseases which are a frequent cause of death during infancy increases.
C 53
How little the increasing mortality of the later born children up to the tenth child is based on a biological law is shown in Figure C 53.Numerical position of birth and infant mortality up to the age of five in princely families, by Ploëtz; 463 seventh to ninth children show the same mortality as the 614 first born.
Pearson endeavored to prove a high degree of inferiority in the first born, physically and intellectually as well as morally. But his results are very open to attack, as Weinberg has recently shown; one is reminded of Pearson's results in Crzellitzer's Figure C 54—first and later born. Crzellitzer writes thus about this—"Ahigh degree of myopiaismore frequent amongst first bornthan among later children. The disadvantage of the first born in respect of myopia is based on a greater hereditary taint and on no other factor. Where there is no hereditary taint about one quarter to one-third are affected, no matter whether first, second, third, etc., born. Also in well-to-do families, where the age of fathers at the time of procreation is materially higher, the first born are more frequently myopic than their brothers or sisters."
First and Later-Born.Percentage of Frequency of Extreme Short-sightedness.
Figure C 54.
A large amount of material has been treated by W. Weinberg, in which tuberculous and non-tuberculous families are compared.
C 55 & 56
Figure C 55—influence of numerical position of birth on infant mortalityand Figure C 56—mortality of the first and later born. Weinberg writes concerning these: "The parallelograms in the first row indicate for each position in order of birth how many children out of every hundred die before the age of 20. On this, however, the difference in the mortality in families with different numbers of children has an influence. To counteract this, it has been calculated how many children in each position would die if within each family the number of children had no influence, and the actual number of deaths expressed as a percentage of the expectation calculated in this way gives parallelograms to the second row. After eliminating the influence exercised by the size of the family, the increase of the mortality with the higher birth number appears considerably smaller. Figure C 56, which compares the mortality of the first and last born children, is to a certain extent a test of this. This shows clearly a considerably higher death rate in the last born. Both figures indicate that children of the same numerical position of birth show a higher mortality, if from tuberculous families."
Mortality of Children According to Sequence of Birth3,129 Tuberculous and 1,830 Non-Tuberculous Families of Stuttgart, 1873-1889 (after Weinberg).
Figure C 55.
Relative Mortality of the First and Last-born.3,129 Tuberculous and 1,830 Non-Tuberculous Families of Stuttgart, 1873-1889 (after Weinberg)
Of each 100 living-born there died before reaching their 20th year:
Figure C 56.
C 57
Of a materially greater influence than the numerical position of birth or the number of children in each family is the length of interval between births. We point at first to Figure C 57—interval between births and child mortality, after Ansell and Westergaard, by Dr. A. Bluhm. She writes in reference to it: "Ansell has demonstrated, from the material of the National Life Assurance Society of London, that a child has an increasingly better chance to survive his first year, the greater the interval between his own birth and that of the child born before him. If this interval is less than a year, the infant mortality is double what it is when there is an interval of two years (15.75% against 7.33%). This influence makes itself feltbeyond the age of infancy up to five years but not in so striking a manner. The proportion becomes modified to 20% against 12%. As the influence of the birth interval on child mortality is still very perceptible after the tenth or later children, it may be assumed that it is not caused exclusively by the exhaustion of the maternal organism produced by the rapid sequence of births. The varying length of breast-feeding of the children has probably also its influence. Though these statistics give no data about the mode of infant feeding, it is nevertheless probable that in those families in which there are longer intervals between consecutive births each child is suckled for a longer period.
C 58
Birth interval and health of the offspring, after Riffel—v. d. Velden.
C 59
Influence of the length of the birth interval and the duration of breast-feeding on infant mortality, exhibited by Weinberg. The author writes regarding the latter table "in proportion to the length of the interval between two births, the mortality of the children following decreases materially, but this relation only becomes clearly apparent in families in which several of the children have been suckled for more than six months."
C 60, 61, 62
The intimate connection which exists between birth interval and suckling and the great importance which suckling has under the favourable influence of a long birth interval is shown in Dr. Agnes Bluhm's Figures C 60, C 61, and C 62—infant nutrition (breast feeding), number of children and infant mortality, after Dr. Marie Baum. "The material is taken from the towns of Gladbach, Rheydt, Odenkirchen and, Rheindalen, and comprises 1,495, mostly poor families, with 9,393 cases in which the mother survived childbirth and 9,487 children born alive. In this table only 7,983 children were counted, because the remainder had not reached the age of one year on the day of counting. Of these 7,983, there died before the completion of the first year 1,276, or 15.98%."
C 60
Number of children and child mortality: Bluhm adds:—"Figure 1 shows in Curve A theinfluence of the duration of breast feeding; in Curve Binfluence of numerical position of birth on the mortality of the infant. The very divergent course of the two curves expresses the very different influence of both these factors on mortality; the latter is almost exclusively dependent upon the length of suckling, and shows corresponding with its increase a continuous and steep decline down to 1.46% from a maximum number of 35%. The very slight increase of the mortality of children suckled for six weeks compared with those who have not been breastfed at all is immaterial (35.55% against 35.28%). These figures prove only that breast feeding up to six weeks does not give the child any protection against fatal diseases. The influence of the birth number hardly makes itself felt up to the seventh child, only from the eighth onwards the power of resistance decreases continuously but not nearly to the same degree in which it grows with the length of breast-feeding (greatest difference only 21%). Curve B shows a materially different course from that of similar curves by other authors, for instance—from Geissler's 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 theinfluence of the length of suckling on the mortality of the children classed in order of birth, the latterthe 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."
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 istherefore 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."
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.
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 13/4years.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 13/4years.
Dependence of Infant Mortality on the Duration of Breast-Feeding and the Length of Time Intervening Between Successive Births.
Figure C 63.
C 64
Figure C 64 shows theparallelism betweentheaverage length of breast-feeding and the average time between birthswithin 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 11/4to 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.
Figure C 64.
C 65
Figure C 65 enables us to examine into theinfluence 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."
C 66
Figure C 66. "Theinfant mortality within the familiesdealt withfalls 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 11/4to 2 years and a suckling duration of at least half a year the mortality remains on an extremely small scale."
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 aboutbreast-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 theinfluence 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."
C 72 & 73
"These two figures deal with theinfluence 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."
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, andduration 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.
C 79-82
The importance of the hereditary constitution(which he considers is dependent on soil and climate)as regards infant mortalityv. 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.
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 50weeks, 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."
Figure C 80.
Figure C 81.
Figure C 82.
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.
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 yearswas found to be nearly double as high (186%) as that of the non-syphilitic.
C 85
Table C 85 shows to what a high degreethe 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 fœtus 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 enfeebledor 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.