CORNELL 
 
 UNIVERSITY 
 
 LIBRARY 
 
 Gift in memory of 
 
 MARY STEPHENS SHERMAN, '13 
 
 from 
 
 JOHN H. SHERMAN, '11 
 
Copcegtion control, and its effects on t 
 
 3 1924 012 179 085 
 
Cornell University 
 Library 
 
 The original of tliis book is in 
 tine Cornell University Library. 
 
 There are no known copyright restrictions in 
 the United States on the use of the text. 
 
 http://www.archive.org/details/cu31924012179085 
 
CONCEPTION CONTROL 
 
CONCEPTION CONTROL 
 
 AND ITS EFFECTS ON THE 
 INDIVIDUAL AND THE NATION 
 
 BY 
 FLORENCE E. BARRETT 
 
 C.B.E., M.D., M.C B.Sc. 
 Consulting Obstetric and Gynscological Surgeon to the Royal 
 Free Hospital. President of the Federation of Medical Women. 
 
 WrrH A FOREWORD BY 
 
 THE ARCHBISHOP OF CANTERBURY 
 
 NEW YORK 
 P. DUTTON & COMPANY 
 681 Fifth Avenue 
 
Copyright, 1922, 
 By E. P. Dutton & Company 
 
 All Rights Reserved 
 
 ////<fr(3 
 
 PRINTED IN THE UNITED 
 STATES OF AMERICA 
 
PREFACE 
 
 This small book has been written in response 
 to many requests for some statement regard- 
 ing the individual and national effects of the 
 widespread practice of conception control. 
 
 It is not intended to give medical advice on 
 the subject for, in my judgment, that is best 
 given to the individual by his or her medical 
 adviser, and will vary in different circum- 
 stances. 
 
 The question as to whether control of con- 
 ception shall or shall not be practised is a 
 decision ethical and not medical in charac- 
 ter when husband and wife are healthy, and 
 in the last resort will be decided by the indi- 
 vidual pair for themselves; but they will be 
 wise to discuss the question with their med- 
 ical attendant in order to realise all that is 
 involved in their decision. 
 
 Space forbids anything like a full discus- 
 
 5 
 
6 PREFACE 
 
 sion of the national issues, but that aspect of 
 the subject demands quite as careful study as 
 personal needs or desires. 
 
 F. E. B. 
 
 31, Devonshire Place, London, fV. 1. 
 September, 1922. 
 
CONTENTS 
 CHAPTER I 
 
 PAGE 
 
 The Problem of To-day 13 
 
 CHAPTER II 
 
 The Demand for Knowledge and from whom 
 to obtain it 29 
 
 CHAPTER III 
 Methods 38 
 
 CHAPTER IV 
 
 The Effect of widespread Conception Control 
 ON National Efficiency 43 
 
 SUMMARY OF CONCLUSIONS .... 51 
 
FOREWORD 
 
 The Archbishop of Canterbury allows me to 
 use the following letter as a Foreword to this 
 little book. 
 
 'Dear Lady Barrett, 
 
 I have read with great interest the manu- 
 script of your pamphlet. Very many of us 
 'fwho have daily to do with the problems and 
 perplexities of our social life and to give 
 counsel to the anxious or the penitent or the 
 perturbed will thank you for these clear and 
 cogent chapters. To arguments based on 
 rmoral and religious principle you add the 
 ruj/eight of ripe experience and of technical 
 scientific knowledge. Your words ;will gain 
 access to the commonsense of many who 
 would perhaps regard the opinions of clergy 
 as likely to be prejudiced or uninformed. I 
 am of course not qualified to express an inde- 
 pendent judgment upon the medical or phys- 
 iological aspects of this delicate problem, but 
 
10 FOREWORD 
 
 / desire on moral and religious as well as oil 
 social and national grounds to support your 
 general conclusions, and to express the hope 
 that your paper may have wide circulation 
 among those who are giving attention to what 
 is becoming an urgent question in thousands 
 of English homes. 
 
 I am. 
 
 Yours very truly, 
 
 Randall Cantuar. 
 
 Lambert Palace, 
 
 3rd August, 1922. 
 
CONCEPTION CONTROL 
 
CONCEPTION CONTROL 
 
 AND ITS EFFECTS ON THE 
 INDIVIDUAL AND THE NATION 
 
 CHAPTER I 
 
 THE PROBLEM OF TO-DAY 
 
 In the late seventies of last century a pamphlet 
 entitled The Fruits of Philosophy was repub- 
 lisihed by Mrs. Annie Besant and Mr. Charles 
 Bradlaugh, in their desire to mitigate the suf- 
 fering of poor women who were overburdened 
 by work and further weakened by frequent 
 child-bearing. They resolved to face public 
 obloquy and even legal prosecution in order 
 to bring to these women knowledge of how to 
 prevent conception, which, in their opinion, 
 would give the relief they so sorely needed. 
 As is well known, the later pamphlet on the 
 same subject written by themselves was with- 
 drawn from publication by Mrs. Besant in 
 1886 on religious grounds. 
 During the last few years the idea of the 
 13 
 
14 CONCEPTION CONTROL 
 
 need for conception control has again become 
 prominent, partly as a revolt against the 
 bondage of women in child-bearing, partly 
 accentuated by the difficulties and uncertain- 
 ties of an adequate livelihood, and the desire 
 to have a few children well educated and 
 cared for rather than many who shift more 
 or less for themselves. 
 
 But also the claim is made that jnarri^ge 
 exisSIaFleast as' mucTi foF^e jfulfihnwiJLof 
 happiness in union with the beloyed^aS-JEor 
 the procreation of chil dxen ; and that it should 
 be possible for a married pair to have the full- 
 est gratification without fear of children unless 
 they desire them. 
 
 Others, but these are extremists, go so far 
 as to claim that apart altogether from mar- 
 riage vows, sexual intercourse should be the 
 experience of all, and that knowledge of how 
 to avoid the birth of illegitimate children 
 should be given to all. 
 
 The discussion of this subject has taken 
 place under the title of Birth Control, but the 
 control or regulation of births is not really 
 the point under discussion. A very big fac- 
 tor in the diminution of births, comes under 
 
THE PROBLEM OF TO-DAY 15 
 
 the heading of abortions, whether voluntary 
 or through conditions which might be reme- 
 died. That subject is not touched upon in this 
 paper, but only methods which avoid concep- 
 tion, which is, of course, a very different sub- 
 ject from the larger one of avoiding births. 
 
 At first sight it might seem a comparatively 
 simple thing, in view of the knowledge whicK 
 already exists of the physiological processes 
 involved in conception, to advise a method 
 which shall prevent conception at will with- 
 out harmful effect upon man or woman and 
 yet leave intercourse unimpaired. But even 
 at first sight it is obviqus that whatever knowl- 
 edge may be available, and whatever meth- 
 ods may be devised, it would not be easy to 
 convey this knowledge rightly to the indi- 
 vidual it is hoped to benefit without doing 
 harm to others. Further thought shows that 
 the national problems involved are so impor- 
 tant and far reaching in effects that they might 
 well arrest the attention of the most careless 
 advocate of indiscriminate conception control. 
 
 This is a subject, therefore, which requires 
 careful consideration from the point of view 
 of the individual, of public morality, and of 
 
16 CONCEPTION CONTROL 
 
 national welfare — and the more closely it is 
 studied the more apparent are the far reach- 
 ing issues involved. It is improbable that the 
 practice of using contraceptives will continue 
 if or even a generation without revealing the 
 harmful eflects which must to some extent 
 ensue. 
 
 In the whole discussion of this subject it is 
 important to keep in mind that the physical 
 is only one aspect of the sex relation. 
 
 In the evolution which sex has shared with 
 all else, the psychic side appears even in the 
 higher animals. In them the desire is not for 
 mere indiscriminate physical satisfaction, but 
 the element of choice comes in, a factor which 
 sometimes upsets the plans of breeders. In 
 man this aspect of the relation is all impor- 
 tant. The higher side of sex, or what we may 
 call the psychical secondary sex characters, 
 seem to extend through the whole range of 
 mental and spiritual activities. Because of 
 this there is freshness of contact in mental and 
 spiritual intercourse between men and women 
 which differs somewhat from that between in- 
 dividuals of the same sex, and very much of 
 the joy of life springs from the impact of these 
 
THE PROBLEM OF TO-DAY 17. 
 
 differing yet completing selves the one upon 
 the other. 
 
 Where the whole being enters into the union 
 of the sexes the complete joy of marriage is 
 realised, the characteristic of which is that it 
 does not fade, but becomes ever deeper and 
 more fully realised, a sure indication that the 
 highest pleasure of sex union is only attained 
 when it consummates a love which involves 
 mutual sympathy and consideration. Physical 
 union alone produces dissatisfaction the more 
 quickly in proportion as it is physical only; on 
 the other hand, when all parts of the nature 
 find their counterpart in another, the joy of 
 such intercourse pervades the whole life, and 
 frequent repetition of physical intercourse is 
 not essential to its highest development. 
 
 This is well known to all true lovers who 
 have for varied reasons exercised some volun- 
 tary self-control in regard to the physical side 
 of sex in marriage, either in deference of the 
 one to the desire of the other, or to avoid too 
 frequent child-bearing, or in special seasons 
 such as Lent. 
 
 On the other hand it has been observed by 
 most people that many marriages which seem 
 
18 CONCEPTION CONTROL 
 
 to promise well, quickly lose even to the eye 
 of the outsider all the romance of the days of 
 courtship. Is not too frequent physical indul- 
 gence sometimes the cause? 
 
 Even the time of courtship is spoiled by un- 
 restrained demonstration of affection, and the 
 beauty of the higher side of love is apt to lose 
 its delicate bloom by over accentuation of the 
 physical in marriage ; husband and wife sadly 
 admit to themselves that disillusionment has 
 come — the real truth being that in seeking 
 only physical satisfaction in each other, their 
 eyes have become blinded to those higher 
 qualities which each glimpsed in the other 
 during the happier days of courtship, and the 
 "road of the loving hearts," which they hoped 
 to tread through life, has been missed because 
 they have forgotten that "man is a spfrit and 
 doth not live by bread alone." 
 
 To many the introduction of this aspect of 
 the question may seem beside the mark. For 
 them the practical question in a world of sense 
 is how to avoid having children when for any 
 reason they are not wanted, and yet leave un- 
 impaired facilities for married life. It is true 
 the problem is not always stated so bluntly. 
 
THE PROBLEM OF TO-DAY 19 
 
 The uses of contraceptives are explained, to- 
 gether with a recommendation for moderation 
 in physical intercourse; but as will be shewn 
 below, if such moderation is really practised, 
 it is possible to live a natural married life such 
 as renders unnecessary the use of artificial con- 
 traceptives with all their attendant evils and 
 yet limit the size of the family. 
 
 But it is necessary to consider more care- 
 fully the claim made to-day that contracep- 
 tives are both necessary and harmless, and that 
 public propaganda on the subject is desirable. 
 
 There are several different groups for 
 W'hom relief is claimed: — 
 
 1. Women who are suffering from chronic 
 or from temporary ill-health are frequently 
 not in a condition to bear the strain of child- 
 bearing, and indeed it may become a real dan- 
 ger to their future health, either mental or 
 physical, 
 
 2. There are cases of inherited disease, 
 mental or physical, which ought to prohibit 
 child-bearing. 
 
 3. There are over-worked women whose 
 daily work, added to child-bearing, destroys 
 their health and vitality. These people are 
 
20 CONCEPTION CONTROL 
 
 found not only among the so-called working 
 classes; the same conditions with somewhat 
 different types of strain are found in wives of 
 professional men with very slender incomes. 
 
 4. Some parents wish to "space" their child- 
 ren, that greater attention may be given to 
 each, or they wish to limit the number of their 
 family on account of financial and other dif- 
 ficulties. 
 
 With these and other considerations in view, 
 the widespread teaching of methods of pre- 
 venting conception is advocated because it is 
 claimed : — 
 
 (a) That except for general propaganda, 
 the greatest sufferers, viz., poor women with 
 constantly recurring pregnancies, would other- 
 wise never learn of any method of reliel. 
 
 (b) That many young people who for 
 various reasons, such as housing or financial 
 difficulties or inherited disease, feel themselves 
 unable to have a family, would if such know- 
 ledge were available marry much earlier, and 
 their natural desires would be satisfied, while 
 apart from marriage they might resort to 
 promiscuous intercourse. 
 
 (c) That homes where the growing diffi- 
 
THE PROBLEM OF TO-DAY 21 
 
 culties and strain of a continually increasing 
 family are leading to estrangement between 
 husband and wife, are restored to happiness 
 when saved from the difficult choice between 
 continence, which they have never trained 
 themselves to practice, or many children with 
 which they cannot cope. 
 
 There are, however, serious fallacies in 
 these contentions. 
 
 The propagandists of conception control 
 appear to take it 'for granted that after pre- 
 ventive measures in early youth, children may 
 be conceived at will whenever they are de- 
 sired ; and, moreover, it is 'assumed that apart 
 from such precautions every woman will con- 
 ceive annually and will continue to do so until 
 ten to twelve children have been born. 
 
 Neither of these suppositions is supported 
 by facts. On the contrary, there are large 
 numbers of married couples who would give 
 anything to have children, but have postponed 
 it until circumstances should seem quite de- 
 sirable, and then, to their grief, no children are 
 given to them. It is very unfair to teachpeople 
 that they may safely postpone the natural ten- 
 dency to bear children in youth and rely upon 
 
22 CONCEPTION CONTROL 
 
 having them later in life. Probably gynaecolo- 
 gists are consulted more often by women who 
 desire children but do not have them, than by 
 those who wish to avoid having them — the 
 truth being that the tendency among people In 
 comfortable surroundings is towards relative 
 sterility rather than towards excessive f ertilfty. 
 
 Those who are interested in this aspect of 
 the question will find the facts admirably set 
 forth in Mr. Pell's book on The Law of births 
 and Deaths, being a study of the variation in 
 the degree of animal fertility under the influ- 
 ence of environment. 
 
 He finds that the all-important factor which 
 determines fertility is the amount of nervous 
 energy of the organism, and that nervous en- 
 ergy is produced or modified by three specially 
 influential factors, viz., Food, both quantity 
 and quality; Climate, hot or cold — ^moist or 
 dry; and, lastly, all those varied conditions 
 which make for greater or lesser mental and 
 physical activity. 
 
 Fertility, broadly speaking, varies in inverse 
 proportion to the degree of nervous energy or 
 what we may call vitality. 
 
 Conditions, therefore, which lower the gen- 
 
THE PROBLEM OF TO-DAY 23 
 
 eral vitality below the normal produce ab- 
 normal fertility. This excessive child-bearing 
 under present conditions still further lowers 
 the standard of life and the health of the 
 mother, hence a vicious circle is set up, the 
 only escape from which will come by such 
 consideration of the laws of health relating to 
 work, housing, food and recreation as shall 
 ensure the maximum of vitality to the workers. 
 This is the true method of conception control. 
 There comes a point in the development of 
 nervous energy which is productive of steril- 
 ity. It is true that principles based on so many 
 varying factors will necessarily appear to fail 
 in individual cases. Environment with its in- 
 fluence on the nervous energy of the individual 
 will 'be modified by the inherited tendency of 
 that individual towards fertility or the reverse. 
 We fiiid, therefore, isolated cases of large 
 families among the well-to-do and small famil- 
 ies among those whose vitality is below the 
 normal, but if the general principle is true we 
 should expect to find a larger number of sterile 
 marriages among the well-to-do than among 
 those whose lives are more full of hardship, 
 and this undoubtedly is the case. 
 
24 CONCEPTION CONTROL 
 
 This aspect of the problem is deserving of 
 careful study. The desire for children in so 
 many homes where every advantage could be 
 given, may be gratified when more knowledge 
 of how wisely to modify the environment of 
 the rich is within our grasp. 
 
 It may be that the more simple life among 
 those who have much will give to them the 
 prize of children which they covet more than 
 things which wealth can buy. 
 
 But let us return for a moment to the false 
 expectation that children will come to all un- 
 less prevented. 
 
 The results of this assumption are really 
 serious. They involve the training of large 
 numbers of people in unnatural practices, 
 which in many cases are unnecessary, even if 
 they were desirable. They rob many families 
 of the children who would have been the de- 
 light of their parents through middle and later 
 life. 
 
 Moreover, it is obvious that advice which 
 may be quite necessary in cases of ill-health 
 or special conditions, may be fundamentally 
 wrong to give broadcast to all indmduals, for 
 apart from the fact that when given to all it is 
 
THE PROBLEM OF TO-DAY 25 
 
 largely unnecessary, there are other serious 
 objections, as follows: — 
 
 1. A public opinion at the present time is 
 being gradually produced which takes it for 
 granted that as a matter of good form young 
 people should not have children for a few 
 year^ after marriage, and it is becoming a 
 common practice to start married life with 
 sordid and unnatural preparations for a nat- 
 ural act; yet many of these young people, men 
 and women alike, are most anxious to have 
 children, and only seek to know how to pre- 
 vent them because they believe it to be "the 
 thing to do." 
 
 One or two illustrations which have come to 
 my personal knowledge will peAaps show the 
 kind of idea which is conveyed to the mind of 
 young people by books and speeches on this 
 subject, though such results may not have been 
 desired by the authors or speakers. 
 
 A young bride came to her mother on 
 returning from her honeymoon and said, 
 "Mother, how long must we wait before hav- 
 ing children — is it really necessary to prevent 
 them for a year or two? We are both dying 
 to have babies." 
 
26 CONCEPTION CONTROL 
 
 A young couple on the eve of the marriage 
 consulted a gynjecologist regarding the ques- 
 tion of using the cap pessary to prevent the 
 possibility of having children for a few years. 
 
 The bride, who was greatly distressed, pro- 
 duced the pessary which she had purchased, 
 and said she could not possibly use it; her 
 fiance, however, had been advised that she 
 could, and ought to do so, hence the first seri- 
 ous dispute had arisen between them, clouding 
 the future. 
 
 She was told by her doctor that it was quite 
 impossible for her, and this fully satisfied the 
 future husband. 
 
 The next point was if this method were im- 
 possible what should be used. 
 
 They were a splendid young couple, with 
 ample means to support a family, and the 
 doctor naturally asked — "But for what pur- 
 pose do you need any methods to prevent 
 children at all?" They hesitated and looked 
 at each other, and then said — "I don't know, 
 but we thought it was the thing to do." 
 
 They left with the whole nightmare put 
 aside, determined not to spoil the perfect con- 
 summation of their happiness. 
 
THE PROBLEM OF TO-DAY 27 
 
 Many similar cases might be quoted where 
 young people, without any considered motive, 
 are acting in accordance with the vogue of the 
 moment. 
 
 2. The use of contraceptives does not en- 
 courage self-control, yet the cultivation of self- 
 control is a far higher gain to the individual 
 and the nation than any apparent advantages 
 obtained by its abandonment. 
 
 By no means unimportant is the influence 
 that wide diffusion of the knowledge of how 
 to prevent conception would have in causing 
 more irregular unions and greater promiscuity 
 in sex relations. The effect of this would not 
 only loosen, rather than strengthen, the mar- 
 riage tie, but would inevitably lead to an 
 extension of venereal disease. Many people 
 seem to think that contraceptives prevent ven- 
 ereal disease at the same time that they prevent 
 conception. But this is not so. The use of 
 methods of prevention by women is no pro- 
 tection to them from infection. 
 
 3. We have, moreover, to take a wider view, 
 and consider who will receive and act upon the 
 advice given, and hence what the result will be 
 on the differential birth-rate of the community. 
 
28 CONCEPTION CONTROL 
 
 It is quite obvious that the educated classes 
 can most easily follow instructions which re- 
 sult in protection from conception, and since 
 such knowledge most easily circulates among 
 the more highly endowed classes, it has been 
 claimed that it is important to make efforts to 
 let the knowledge be so widespread that it may 
 reach all. The result, however, could only be 
 that the practice of conception control would 
 spread throughout the upper, middle and 
 more intelligent of the working classes, and 
 this would involve a very serious reduction in 
 the births of those who furnish the leaders and 
 efficient workers in all branches of life, and in 
 those only. 
 
 For the birth-rate amongst the least intelli- 
 gent, least efficient and the mentally deficient 
 will be unaffected. It must be apparent that 
 after a very few generations of such weeding 
 out of the best, with the continuous multipli- 
 cation of the worst type of citizen, the general 
 standard of efficiency, enterprFse and executive 
 skill of the nation would be seriously impaired. 
 Such, briefly stated, is the problem before the 
 public at the present timfe. 
 
CHAPTER II 
 
 THE DEMAND FOR KNOWLEDGE 
 AND FROM WHOM TO OBTAIN IT 
 
 Even the brief survey given in the first chap- 
 ter will have suggested to the reader that the 
 people who ask for knowledge seek it for 
 various reasons. Indeed, the first thing that 
 strikes anyone who gives consideration to the 
 subject is the difference in type and cir- 
 cumstance of the people for whom relief is 
 claimed. We begin to realise at once that the 
 subject of conception control is an intimate 
 and individual one, and can really be dealt 
 with by advice which is given to the indivrd- 
 ual and not to the public at large. 
 
 This is perhaps most obvious in the first 
 group mentioned on page 19, where the woman 
 is suffering from chronic or acute disease, and 
 the necessity for preventing conception is clear 
 to her medical adviser. If disease renders 
 child-bearing a danger to the life and health 
 of the mother, it becomes a positive duty of her 
 doctor to prevent such a catastrophe — but the 
 
 29 
 
30 CONCEPTION CONTROL 
 
 method' advised will differ according to the 
 special nature of the case. 
 
 Again, where in the case of husband or wife 
 there is a serious inheritance of mental or phy- 
 sical disease, and especially when the same 
 weakness exists in both families, it is justly 
 regarded as a duty by the married pair not 
 to bring children into the world. It may be 
 contended that men and women with such an 
 inheritance should not marry, but that is a 
 matter for the decision of the individuals con- 
 cerned. It not infrequently happens that mar- 
 riage has taken place before they know of the 
 inherited tendency. In such cases clearly the 
 advice of the family doctor should be given as 
 to the best course to pursue in order to avoid 
 conception. 
 
 The case of the overworked and burdened 
 mother with a large and increasing family fs 
 nearly allied to that of a woman with disease, 
 though in her case the causes for ill-health are 
 more complicated. 
 
 While it is true that ill-health and prema- 
 ture ageing in working women are the result 
 of many causes, yet where child-bearing still 
 further injures health it is essential that she 
 
THE DEMAND FOR KNOWLEDGE 31 
 
 should consult her medical adviser on this 
 point, for she not only needs treatment to re- 
 store her health, but also advice specially suit- 
 able to her own case, as to the best method to 
 avoid conception for the time being, and such 
 advice will vary according as the disability is 
 temporary or permanent. 
 
 It is, happily, as possible for the poor 
 woman to obtain advice in all matters of 
 health as it is for the rich. The mothers of 
 the country are in touch everywhere with 
 maternity clinics, where doctors advise them 
 on all questions of health relating to preg- 
 nancy, and treat each woman as a separate 
 individual. 
 
 But the case of the poor working woman 
 overburdened with worlc which she cannot ac- 
 complish — ^yet with the added burden of bear- 
 ing more children than her more fortunate 
 sisters, deserves some further consideration. 
 
 What is it that prematurely ages so many of 
 these women of the slums — is it child-bearing 
 alone? 
 
 The answer to that is immediately in the 
 negative, for women in comfortable circum- 
 stances may have large families, with no sign 
 
32 CONCEPTION CONTROL 
 
 of weariness and dejection. No, the causes 
 of ill-health and debility are diverse, and to 
 pretend to solve the question by conception 
 control is a mockery, for it salves the con- 
 science of the community without really deal- 
 ing with the question of the disabilities of the 
 working woman, or the true cause of her ex- 
 cessive fertility. 
 
 Ill-health in working-class mothers often 
 has its origin in inherited weakness and lack 
 of care in childhood. It is further accentuated 
 by overwork, with no labour-saving devices; 
 lack of suitable food; too few, if any, hours 
 of recreation, and hence very little out-door 
 exercise. Badly ventilated homes deprive the 
 mother of necessary supplies of oxygen, and 
 insufficient sleep is often the last straw which 
 breaks down the patient burden bearer. A 
 true and haunting picture is given in a recently 
 published book called The Woman in the 
 Little House (which first appeared in a series 
 of articles in the journal "Time and Tide'^), 
 describing the anxiety of a working woman at 
 night to keep her baby quiet that the husban"d 
 may sleep. 
 
 Now it is quite true that a small family in- 
 
THE DEMAND FOR KNOWLEDGE 33 
 
 Stead of a large one will diminish the work and 
 anxieties of such a mother, but it will not give 
 her the remedies which she needs, nor will it 
 diminish the excessive sexual demands made 
 upon her. , 
 
 Everyone who knows these women inti- 
 mately realises what an exhausting feature is 
 this habit of excess due to lack of knowledge 
 or self-restraint on the part of the husband. 
 
 I believe if facilities were provided where- 
 by the woman could do her laundry with 
 modern appliances outside her own home, if 
 family meals were arranged in service rooms 
 equivalent to the arrangements in service flats, 
 and if there were creche rooms when chil- 
 dren might be left for an hour or two in safety 
 while necessary work was done — ^we should 
 find a greatly increased standard of comfort 
 even in existing homes, and a great improve- 
 ment in dietary for the whole family. Such 
 relief, added to teaching both to husband and 
 wife as to the times of conception, would rev- 
 olutionise the life of women more than any 
 teaching of artificial birth control, and would 
 lift it up to a higher level instead of degrad- 
 ing it to the grossly physical. 
 
34 CONCEPTION CONTROL 
 
 We come to very different considerations in 
 group 4, page 20, where choice rather than ne- 
 cessity impels the parents to limitation of the 
 family. The teaching now being advocated 
 by certain books and pamphlets advises delib- 
 erate delay in child-bearing for a perfod after 
 marriage, and the spacing of certain periods 
 between the births of such children as are al- 
 lowed to come into the world, with limitation 
 of the number in each family. 
 
 Teaching on these lines, if followed, would 
 involve an artificial mode of sex iFfe always 
 — natural spontaneous union would find no 
 place. Already young wives are seeking ad- 
 vice for some relief from methods of prepara- 
 tion which they say have destroyed in them all 
 spontaneous desire. The tragedy of it all is 
 that even to attain the end in view — ^modera- 
 tion in the size of families — such methods are 
 to a large extent unnecessary. Not to every 
 young married couple does a child arrive at 
 the end of a year. Some, using no artificial 
 checks, wait two or three years before the first 
 baby comes. Even if it does come, however, 
 at the end of a year, there are many advantages 
 to counterbalance the small means and per- 
 
THE DEMAND FOR KNOWLEDGE 35 
 
 haps hard living of the young pair. For when 
 people are young they can put up with small 
 means, because they are strong enough to worE 
 hard and help each other; indeed, the demand 
 for little work and many luxuries in youth is 
 not a healthy one, it is a sign of decadence in 
 the race. 
 
 Moreover, even though an early family in- 
 volves real hardship for awhile, it has the 
 great advantage that parents and children later 
 on are still young together, and that means far 
 more to the child in understanding friend- 
 ship and helpfulness during the most critical 
 period of life than extra comforts or pleasures 
 would have meant to the parents, and if young 
 parents realised this, would they not put the 
 child first? 
 
 The so-called advantages of a few years be- 
 tween one child and the next so that the par- 
 ents may give fuller care and attention to each, 
 are far outweighed from the child's point of 
 view by the advantages of playmates in the 
 nursery of nearly its own age, who are a source 
 of education in the give and take of life such 
 as no adult can supply. If parents wish to 
 have only three or four children, if is to the 
 
36 CONCEPTION CONTROL 
 
 advantage of the mother as well as pf the 
 children, to have the little family early in life 
 — they are then all in the nursery together, and 
 later all at school, and her life work is in this 
 way so arranged that she may give most 
 service to the world in addition to carrying on 
 the race. 
 
 Our conclusion is that for mothers and 
 children it is very desirable that no contra- 
 ceptives should be used in the early years of 
 married life. 
 
 In the vast majority of families where no 
 restrictions or unnatural means are used and 
 where mothers nurse their children for eight 
 or nine months, children only come every two 
 years. Even if a young couple decide that 
 they cannot afford to bring up more than four 
 children, they have first to prove that four 
 children will be given them — in many cases 
 they will not have so many, and as years go by 
 the fertility of the mother becomes progress- 
 ively less, so that if child-bearing is postponed 
 till after thirty, in a certain number of families 
 no children are born. There are many men 
 and women who bitterly regret having let the 
 
THE DEMAND FOR KNOWLEDGE 37 
 
 years go by in which children might have 
 been born to them, and it is only fair that 
 young couples of to-day should fully under- 
 stand this risk. 
 
CHAPTER III 
 
 METHODS 
 
 There are certain points in regard to meth- 
 ods of preventing conception which should be 
 made clear. 
 
 It is, of course, obvious that conception can 
 be voluntarily controlled by abstention from 
 intercourse except when children are desired. 
 This has been called a counsel of perfection. 
 It could only rightly be so described where 
 such a method of life was both desired and 
 approved by both husband and wife. It would 
 not be a fair thing for either to enforce a prac- 
 tically celibate life on the other without the 
 fullest understanding and consent before the 
 marriage vows were taken. 
 
 But conception can also be controlled by 
 avoidance of those parts of the monthly cycle 
 in which conception most commonly takes 
 place. That in the great majority of women 
 there is a time in the monthly cycle when no 
 conception occurs has been noted for a long 
 
 38 
 
METHODS 39 
 
 time. The rough-and-ready method of reck- 
 oning the date of birth in relation to the last 
 menstrual period is an example of the assump- 
 tion that conception will probably have taken 
 place a week later, and the frequency with 
 which such reckoning is justified shows that it 
 is not altogether unfounded. During the war 
 it was possible to make some more exact ob- 
 servations owing to the short leave granted to 
 soldiers to visit their homes. Seigel has pub- 
 lished a paper in the "Miinchener Medizin- 
 ische Wochenschrift," 1916, in which he gives 
 information regarding the conception of be- 
 tween two and three hundred children born 
 during the war. He finds that the likelihood 
 of fertilisation increases from the first day of 
 menstruation, reaching the highest point six 
 days later, the fertile period remains almost at 
 the same height till the 12th or 13th day, and 
 then declines gradually until- the 22nd day, 
 after which there is absolute sterility. 
 
 This suggests that conception control can be 
 attained without artificial methods if inter- 
 course is confined to one week in the month. 
 
 Such control of conception, though natural, 
 does not make it any more desirable to space 
 
40 CONCEPTION CONTROL 
 
 the births unduly so that the children are 
 brought up in separate units instead of in a 
 happy family group in which they can share 
 games and interests — but it does avoid the 
 risks which are associated with artificial meth- 
 ods of conception control. 
 
 It is not proposed to discuss in detail ar- 
 tificial methods in this pamphlet, because no 
 advice can be wisely given on this subject in 
 a general way. Those who after careful con- 
 sideration choose to use artificial means to 
 prevent child-bearing will be wise if they 
 consult their medical attendant as to those 
 methods which are least harmful for their 
 individual case, and ask for careful instruction 
 in their use. 
 
 Most of the methods so widely advertised 
 are productive of diseased conditions, whether 
 from the nature of the method itself or from 
 the way in which it is used, and all of those 
 recommended to women interfere with normal 
 physiological processes. The object aimed at 
 in methods recommended to women, is either 
 to produce, by drugs or otherwise, conditions 
 in the vagina inimical to the life of the male 
 cell, or to prevent by mechanical means the 
 
METHODS 41 
 
 reception of the semen into the uterus. Owing 
 to the uncertainty in the results of either of the 
 above methods of prevention, the later editions 
 of books which teach conception control now 
 advocate the use of both methods at the same 
 time in order to approximate more closely to 
 certainty of result. 
 
 All these artificial preparations for inter- 
 course demand from the woman an investiga- 
 tion of and interference with her own internal 
 organs, which is revolting to all decent women, 
 and such teaching is directly opposed to the 
 advocacy of cleanliness and non-interference 
 with the genital organs, which is the natural 
 habit of healthy-minded women. 
 
 The effects, however, go further than this. 
 Nature has provided in the healthy vaginal 
 secretions an antidote of infection which 
 quickly destroys harmful germs. If the natural 
 secretions are altered it is difficult to restore 
 them to their natural quality. 
 
 Professor Arthur Thomson, F.R.C.S., has 
 shewn ("British Medical Journal," January 
 7th, 1922) from observations of the lining of 
 the womb in animals and in women that "the 
 weight of evidence goes to prove that its 
 
42 CONCEPTION CONTROL 
 
 function is more likely to be absorbent than 
 excretive, and that as such it plays an import- 
 ant part in the animal economy." 
 
 After describing at length the evidence that 
 the male secretion consist largely of the secre- 
 tions from special glands as well as the sex 
 cells, he refers to the fact that these are all 
 largely received into and absorbed by the 
 glands of the womb, and he discusses the prob- 
 ability that such absorption profoundly and 
 beneficially affects the physiological reaction 
 in the woman. He points out that the use of 
 artificial checks "while preventing fertilFsa- 
 tion may also be the means of depriving the 
 female of certain secretions which may exer-" 
 cise a far reaching influence on her economy" ; 
 and he concludes, "As a rule we cannot inter- 
 fere with the normal course of nature without 
 some consequent evil result. May this not be 
 an instance in which for some apparent gain in 
 one direction, the woman pays the penalty?" 
 
CHAPTER IV 
 
 THE EFFECT OF WIDESPREAD CONCEPTION 
 CONTROL ON NATIONAL EFFICIENCY 
 
 In every nation individual capacity varies 
 within wide limits. We have men and women 
 of brilliant attainments, and of all grades of 
 intelligence ranging downwards to the men- 
 tally defective. There is no doubt that all 
 grades of intelligence can be improved by 
 education, but there appears to be a limit to 
 the capacity of development of each indivi- 
 dual. Lower intelligence, therefore, is not 
 only due to lack of opportunity, but to an 
 inborn constitutional defect. 
 
 Further study has shewn this defect to be 
 hereditary — the parents or grandparents of 
 such people shew defective intelligence, and 
 their offspring are likely to do the same; in- 
 deed, if two mentally defective people marry 
 it is fairly certain that their children will all 
 be mentally defective. 
 
 There are, however, no sharply defined 
 classes of intelligence; just as the mentally 
 defective are in many grades, so ordinary men 
 
 43 
 
44 CONCEPTION CONTROL 
 
 and women vary from low or average intel- 
 ligence up to outstanding cases of genius or 
 capacity. 
 
 By the newer methods of mental testing it 
 has been shewn that children of various classes 
 of the community, as well as men and women 
 of different races, can be grouped according to 
 their intellectual capacity, and that no educa- 
 tional facilities will develop that capacity 
 beyond a certain point. 
 
 Professor W. McDougall, F.R.S., in his 
 most useful and interesting book on 'National 
 Welfare and National Decay, reaches the im- 
 portant conclusion "that innate capacity for 
 intellectual growth is the predominant factor 
 in determining the distribution of intelligence 
 in adults, and that the amount and kind of 
 education is a factor of suUordinate import- 
 ance." He claims that the evidence Ts over- 
 whelming as to the validity of the results 
 obtained by mental testing. 
 
 A few examples of experimental work given 
 in Professor McDougall's book will suffice to 
 show the trend of these results. 
 
 Tests of intelligence were carried out on 
 recruits for the American Army, white and 
 
EFFECT OF CONCEPTION CONTROL 45 
 
 coloured, and they shewed marked superiority 
 of the white race. 
 
 A special test was carried out in Oxford 
 by Mr. H. B. English, who compared the 
 capacity of boys in a school attended by 
 children of the intellectual classes with that 
 of boys in a very good primary school, whose 
 fathers were shop-keepers, skilled artisans, 
 etc., coming froni homes which were good, 
 with no sort of privation. The result showecl 
 marked superiority of the sons of intellectual 
 parents. Mr. English concludes that the chil- 
 dren of the professional classes, between T2 
 and 14 years of age, exhibit very marked 
 intelligence, and he is convinced that the 
 hereditary factor plays an altogether pre^ 
 dominant part. 
 
 In another experiment, Miss Arlitt, of 
 
 Bryn Mawr College, tested 342 children from 
 
 primary schools in one district, who were 
 
 divided into four groups : — 
 
 Group 1. Professional. 
 
 Group 2. Semi-professional and higher 
 
 business. 
 Groups. Skilled labour. 
 Group 4. Semi- and unskilled labour. 
 
46 CONCEPTION CONTROL 
 
 Marked differences between the groups 
 were shewn. The intellectual capacity was 
 represented by figures as follows : — 
 
 Group 1 ... 125 I Groups ... 107 
 Group 2 ...118 ,1; Group4 ... 92 
 
 A further research of 548 children, grouped 
 according to the occupation of their father, 
 gave its results in terms of the percentage of 
 children in each group who scored a mark 
 higher than the median for the whole 548. 
 They are as follows : — 
 
 Professional group 85% 
 
 Executive group 65% 
 
 Artisan group 41% 
 
 Labour group 39% 
 
 In the "Journal of Educational Psychol-, 
 ogy," Vol. IX, 1916, Mr. A. W. Kornhauser 
 gives evidence from the examination of 1,000 
 children drawn from five schools in Pitts- 
 burgh. 
 
 Schools A and B were attended by children 
 of unskilled manual workers. 
 
 Schools C and D by children of skilled 
 artisans and small shopkeepers. 
 
EFFECT OF CONCEPTION CONTROL 47 
 
 School E by children of parents in very 
 comfortable circumstances. 
 The results are tabulated as — 
 
 Retarded, {. e.; below average. 
 Normal, i. e., average. 
 (Advanced, i. e., above average. 
 
 Retarded Normal Advanced 
 
 45.2 47.1 7.7 
 
 36.7 55.9 7.4 
 29.4 50.2 20.7 
 
 28.8 50.2 19.5 
 
 Manual workers 
 
 A? 
 
 Bl 
 
 C/ 
 
 j-j> Artisans, etc. 
 
 E Most comfortable . . . .' 12.7 62.7 24.6* 
 
 These experiments all shew the trend of 
 intelligence (and with it will power or power 
 of concentration, and what we may call 
 general capacity) to be more concentrated in 
 the so-called higher grades of society, and to 
 be less and less evident as we descend in the 
 scale from skilled to unskilled workers. It 
 would, of course, be clear to all that the chil- 
 dren of mentally deficient parents can only Be 
 a burden on the State or can rarely contribute 
 anything of value to the common weal. 
 
 Now the teaching and advocacy of methods 
 of conception control is most easily assimilated 
 
 *I am indebted to Professor McDougall's book for informa- 
 tion here given. 
 
48 CONCEPTION CONTROL 
 
 and practised by the intelligent classes ; indeed, 
 we may say with certainty that such methods 
 can only be used effectively by the intelligent 
 members of the community, such as leisured, 
 professional and mercantile classes, skilled 
 artisans and better class workers, whereas the 
 lowest type of casual labourers whose home 
 conditions render the use of preventive meth- 
 ods difficult or impossible, and the mentally 
 deficient and criminal classes, are unaffected 
 by such teaching. 
 
 The result in a few generations must be 
 a marked decrease in the numbers of the 
 intellectual and efficient workers, while the 
 hopelessly unfit continue to produce their kind 
 at the same rate as before. 
 
 The figures given do not suggest that 
 individuals with marked ability are to be 
 found in the upper classes only, but they do 
 indicate that there is a larger proportion of 
 boys and girls in the more comfortable classes 
 whose inherited ability is above the average, 
 though this may be partly "due to the more 
 intellectual atmosphere in which their early 
 childhood has been passed. 
 
 The provision of education for all, with 
 
EFFECT OF CONCEPTION CONTROL 49 
 
 facilities for children of every class to pass; 
 on to higher grades of work, is essential if 
 the latent powers in all, whatever they may 
 be, are to be developed to the utmost. 
 
 The point for our consideration at the 
 moment, however, is that if the production 
 of all capable workers, whether mental or 
 manual, is to be curtailed and the numbers of 
 the population maintained in greater propor- 
 tion from the mentally deficient or criminal 
 classes, the result must be national disaster. 
 For in a very short time there will not be 
 enough leaders of real capacity to occupy posi- 
 tions of initiative and responsibility in the 
 various activities of the country at home an^ 
 abroad, nor will there be an adequate supply 
 of good practical work: a lowered standard 
 of efficiency must result. From a national 
 point of view, therefore, we regard the propa- 
 ganda in favour of conception control to be a 
 real and increasing danger. 
 
 The problem of the mentally deficient is of 
 another order. In this case another kind of 
 control is urgently needed, but it is one which 
 can only be undertaken by the State, and not 
 by the individual. It is to put in force such 
 
50 CONCEPTION CONTROL 
 
 a method of compulsory segregation as would 
 ensure the comfort and contentment of the 
 mentally deficient, and safeguard them and 
 the nation from the reproduction of their kind. 
 The problem also of the insane and criminal 
 classes in relation to heredity is one which 
 demands careful consideration by those com- 
 petent to give it 
 
SUMMARY OF CONCLUSIONS 
 
 1. There are certain women who for 
 medical reasons should be prevented from 
 ■bearing children. 
 
 2. There are couples with undesirable 
 inheritance who rightly decline to bear 
 children. 
 
 3. There are many women of the poorer 
 classes in whom child-bearing is sometimes 
 the last straw in circumstances all of which 
 tend to destroy health and vitality. 
 
 4. Public teaching on contraceptives, like 
 medical advice advertised in newspapers, is 
 generally applied to cases for which it is 
 unsuitable and applied in the wrong way. 
 
 It is therefore detrimental to public health 
 as well as being detrimental to public moralFty. 
 
 5. A public opinion in favour of small 
 spaced families does not serve the best interests 
 of the children or of their mother. 
 
 6. Married love should express itself at 
 once in the usual way without the use of 
 artificial contraceptives. 
 
 51 
 
52 SUMMARY 
 
 7. The diminishing fertility of the more 
 capable classes is a national peril. 
 
 To counteract this tendency every encour- 
 agement should be given to the intelligent 
 and efficient classes of the community to bear 
 healthy children. 
 
 The study of problems which give rise 
 periodically to a propaganda in favour of the 
 practice of conception control reveal the fact 
 that excessive child-bearing is found in those 
 classes who suffer the greatest privation, and 
 in whom large families are a real hardship, 
 while many couples among the well-to-do are 
 childless though greatly desiring children. 
 
 Such facts suggest that the true remedy for 
 the general problem lies in raising the standard 
 of living among working-class mothers and 
 advising a more simple life to the more richly 
 endowed. 
 
 8. It is desirable that the Government 
 should make provision for methods which will 
 arrest the propagation of the mentally defi- 
 cient, insane and criminal classes.