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Advanced iOS 4
Programming: Developing
Mobile Applications for
Apple iPhone, iPad,
and iPod touch

Maher Ali, PhD

Bell Labs, Alcatel-Lucent

A John Wiley and Sons, Ltd., Publication

This edition first published 2010
© 2010 Maher Ali

Registered office
John Wiley & Sons Ltd, The Atrium, Southern Gate, Chichester, West Sussex, PO19 8SQ, United Kingdom

Editorial office
John Wiley & Sons Ltd, The Atrium, Southern Gate, Chichester, West Sussex, PO19 8SQ, United Kingdom

For details of our global editorial offices, for customer services and for information about how to apply for permission to
reuse the copyright material in this book please see our website at www.wiley.com/wiley-blackwell.

The right of the author to be identified as the author of this work has been asserted in accordance with the Copyright,
Designs and Patents Act 1988.

All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or
by any means, electronic, mechanical, photocopying, recording or otherwise, except as permitted by the UK Copyright,
Designs and Patents Act 1988, without the prior permission of the publisher.

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Trademarks: Wiley and the Wiley Publishing logo are trademarks or registered trademarks of John Wiley and Sons, Inc. and/
or its affiliates in the United States and/or other countries, and may not be used without written permission. iPhone, iPad and
iPod are trademarks of Apple Computer, Inc. All other trademarks are the property of their respective owners. Wiley
Publishing, Inc. is not associated with any product or vendor mentioned in the book. This book is not endorsed by Apple
Computer, Inc.

ISBN 978-0-470-97123-9 (paperback),

ISBN 978-0-470-97144-4 (ebk),
ISBN 978-0-470-97165-9 (ebk),
ISBN 978-0-470-97954-9 (ebk)

A catalogue record for this book is available from the British Library.

Typeset in 10/12 Times by Laserwords Private Limited, Chennai, India

Printed in the United States of America
Contents

Preface xiv

Publisher’s Acknowledgments xxi

1 Getting Started 1
1.1 iOS SDK and IDE Basics 1
1.1.1 Obtaining and installing the SDK 1
1.1.2 Creating a project 1
1.1.3 Familiarizing yourself with the IDE 3
1.1.4 Looking closely at the generated code 4
1.2 Creating Interfaces 6
1.2.1 Interface Builder 6
1.2.2 Revising the application 9
1.3 Using the Debugger 14
1.4 Getting More Information 16
1.5 Summary 17
Exercises 18

2 Objective-C and Cocoa 19

2.1 Classes 19
2.1.1 Class declaration 20
2.1.2 How do I use other declarations? 21
2.1.3 Class definition 21
2.1.4 Method invocation and definition 22
2.1.5 Important types 23
2.1.6 Important Cocoa classes 23
2.2 Memory Management 24
2.2.1 Creating and deallocating objects 24
2.2.2 Preventing memory leaks 25
2.3 Protocols 27
2.4 Properties 29
2.4.1 Property declaration 29
2.4.2 Circular references 33
iv Contents

2.5 Categories 36
2.6 Posing 37
2.7 Exceptions and Errors 38
2.7.1 Exceptions 38
2.7.2 Errors 42
2.8 Key-Value Coding (KVC) 44
2.8.1 An example illustrating KVC 45
2.8.2 KVC in action 46
2.9 Multithreading 51
2.10 Notifications 54
2.11 Blocks 56
2.11.1 Declaration and definition 56
2.11.2 Block literal 57
2.11.3 Invocation 57
2.11.4 Variable binding 58
2.12 Grand Central Dispatch (GCD) 59
2.12.1 Queues 59
2.12.2 Scheduling a task 60
2.12.3 Putting it together 60
2.13 The Objective-C Runtime 61
2.13.1 Required header files 62
2.13.2 The NSObject class 62
2.13.3 Objective-C methods 63
2.13.4 Examples 66
2.14 Summary 82
Exercises 83

3 Collections 87
3.1 Arrays 87
3.1.1 Immutable copy 89
3.1.2 Mutable copy 91
3.1.3 Deep copy 93
3.1.4 Sorting an array 96
3.2 Sets 101
3.2.1 Immutable sets 101
3.2.2 Mutable sets 102
3.2.3 Additional important methods for NSSet 104
3.3 Dictionaries 104
3.4 Summary 106
Exercises 107

4 Anatomy of an iPhone Application 109

4.1 Hello World Application 109
4.1.1 Create a main.m file 109
 Contents v

4.1.2 Create the application delegate class 110

4.1.3 Create the user interface subclasses 111
4.2 Building the Hello World Application 112
4.3 Summary 116
Exercises 117

5 The View 119

5.1 View Geometry 119
5.1.1 Useful geometric type definitions 119
5.1.2 The UIScreen class 120
5.1.3 The frame and center properties 121
5.1.4 The bounds property 123
5.2 The View Hierarchy 124
5.3 The Multitouch Interface 125
5.3.1 The UITouch class 126
5.3.2 The UIEvent class 126
5.3.3 The UIResponder class 127
5.3.4 Handling a swipe 131
5.3.5 More advanced gesture recognition 136
5.4 Animation 140
5.4.1 Using the UIView class animation support 140
5.4.2 Sliding view 145
5.4.3 Flip animation 145
5.4.4 Transition animation 146
5.5 Drawing 148
5.5.1 Fundamentals 148
5.5.2 The Summary View application 150
5.6 Summary 159
Exercises 159

6 Controls 161
6.1 The Foundation of All Controls 161
6.1.1 UIControl attributes 161
6.1.2 Target-action mechanism 162
6.2 The Text Field 165
6.2.1 Interacting with the keyboard 167
6.2.2 The delegate 170
6.2.3 Creating and working with a UITextField 171
6.3 Sliders 172
6.4 Switches 173
6.5 Buttons 174
6.6 Segmented Controls 175
6.7 Page Controls 178
6.8 Date Pickers 179
vi Contents

6.9 Summary 181

Exercises 181

7 View Controllers 183

7.1 The Simplest View Controller 183
7.1.1 The view controller 183
7.1.2 The view 185
7.1.3 The application delegate 186
7.1.4 A simple MVC application 187
7.2 Tab-Bar Controllers 189
7.2.1 A detailed example of a tab-bar application 189
7.2.2 Some comments on tab-bar controllers 194
7.3 Navigation Controllers 198
7.3.1 A detailed example of a navigation controller 199
7.3.2 Customization 204
7.4 Modal View Controllers 208
7.5 Summary 214
Exercises 214

8 Special-Purpose Views 215

8.1 Picker View 215
8.1.1 The delegate 216
8.1.2 An example of picker view 217
8.2 Progress View 221
8.3 Scroll View 225
8.4 Text View 227
8.4.1 The delegate 228
8.4.2 An example of text view 228
8.5 Alert View 231
8.6 Action Sheet 233
8.7 Web View 235
8.7.1 A simple web view application 235
8.7.2 Viewing local files 240
8.7.3 Evaluating JavaScript 244
8.7.4 The web view delegate 251
8.8 Summary 256
Exercises 257

9 Table View 259

9.1 Overview 259
9.2 The Simplest Table View Application 260
9.3 A Table View with Both Images and Text 265
9.4 A Table View with Section Headers and Footers 267
9.5 A Table View with the Ability to Delete Rows 269
 Contents vii

9.6 A Table View with the Ability to Insert Rows 275

9.7 Reordering Table Rows 280
9.8 Presenting Hierarchical Information 285
9.8.1 Detailed example 288
9.9 Grouped Table Views 295
9.10 Indexed Table Views 298
9.11 Dynamic Table Views 304
9.12 Whitening Text in Custom Cells 307
9.13 Summary 311
Exercises 313

10 File Management 315

10.1 The Home Directory 315
10.2 Enumerating a Directory 316
10.3 Creating and Deleting a Directory 318
10.4 Creating Files 319
10.5 Retrieving and Changing Attributes 323
10.5.1 Retrieving attributes 324
10.5.2 Changing attributes 325
10.6 Working with Resources and Low-Level File Access 327
10.7 Summary 330
Exercises 331

11 Working with Databases 333

11.1 Basic Database Operations 333
11.1.1 Opening, creating, and closing databases 335
11.1.2 Table operations 335
11.2 Processing Row Results 337
11.3 Prepared Statements 340
11.3.1 Preparation 340
11.3.2 Execution 341
11.3.3 Finalization 341
11.3.4 Putting it together 341
11.4 User-Defined Functions 343
11.5 Storing BLOBs 347
11.6 Retrieving BLOBs 351
11.7 Summary 353
Exercises 353

12 XML Processing 355

12.1 XML and RSS 355
12.1.1 XML 355
12.1.2 RSS 357
12.1.3 Configuring the XCode project 360
viii Contents

12.2 Document Object Model (DOM) 361

12.3 Simple API for XML (SAX) 368
12.4 An RSS Reader Application 377
12.5 Putting It Together 380
12.6 Summary 381
Exercises 381

13 Location Awareness 383

13.1 The Core Location Framework 383
13.1.1 The CLLocation class 385
13.2 A Simple Location-Aware Application 387
13.3 Google Maps API 390
13.4 A Tracking Application with Maps 396
13.5 Working with Zip Codes 401
13.6 Working with the Map Kit API 404
13.6.1 The MKMapView class 404
13.6.2 The MKCoordinateRegion structure 404
13.6.3 The MKAnnotation protocol 405
13.6.4 The MKAnnotationView class 407
13.6.5 The MKUserLocation class 409
13.6.6 The MKPinAnnotationView class 409
13.7 Summary 411
Exercises 411

14 Working with Devices 413

14.1 Working with the Accelerometer 413
14.1.1 Basic accelerometer values 413
14.1.2 Accelerometer example 414
14.2 Working with Audio 418
14.2.1 Playing short audio files 418
14.2.2 Recording audio files 420
14.2.3 Playing audio files 421
14.2.4 Using the media picker controller 422
14.2.5 Searching the iPod Library 424
14.3 Playing Video 427
14.4 Accessing Device Information 428
14.5 Taking and Selecting Pictures 429
14.5.1 Overall approach to taking and selecting pictures 429
14.5.2 Detailed example of taking and selecting pictures 430
14.6 Monitoring the Device Battery 432
14.6.1 Battery level 432
14.6.2 Battery state 433
14.6.3 Battery state and level notifications 434
14.6.4 Putting it together 434
 Contents ix

14.7 Accessing the Proximity Sensor 435

14.7.1 Enabling proximity monitoring 435
14.7.2 Subscribing to proximity change notification 436
14.7.3 Retrieving the proximity state 436
14.8 Summary 437
Exercises 437

15 Internationalization 439
15.1 String Localization 439
15.2 Date Formatting 445
15.3 Number Formatting 448
15.4 Sorted List of Countries 450
15.5 Summary 451
Exercises 451

16 Custom User Interface Components 453

16.1 Text Field Alert View 453
16.2 Table Alert View 457
16.3 Progress Alert View 462
16.4 Summary 467
Exercises 467

17 Advanced Networking 469

17.1 Determining Network Connectivity 469
17.1.1 Determining network connectivity via EDGE or GPRS 470
17.1.2 Determining network connectivity in general 471
17.1.3 Determining network connectivity via Wi-Fi 471
17.2 Uploading Multimedia Content 472
17.3 Computing MD5 Hash Value 475
17.4 Multithreaded Downloads 477
17.4.1 The Multithreaded Downloads application 477
17.4.2 Asynchronous networking 479
17.5 Push Notification 484
17.5.1 Configuring push notification on the server 484
17.5.2 Configuring the client 490
17.5.3 Coding the client 493
17.5.4 Coding the server 496
17.6 Local Notification 497
17.7 Large Downloads and Uploads 497
17.8 Sending Email 499
17.9 Summary 502
Exercises 503
x Contents

18 Working with the Address Book Database 505

18.1 Introduction 505
18.2 Property Types 506
18.3 Accessing Single-Value Properties 506
18.3.1 Retrieving single-value properties 507
18.3.2 Setting single-value properties 508
18.4 Accessing Multivalue Properties 508
18.4.1 Retrieving multivalue properties 508
18.4.2 Setting multivalue properties 510
18.5 Person and Group Records 512
18.6 Address Book 513
18.7 Multithreading and Identifiers 515
18.8 Person Photo Retriever Application 515
18.9 Using the ABUnknownPersonViewController Class 517
18.10 Using the ABPeoplePickerNavigationController Class 518
18.11 Using the ABPersonViewController Class 520
18.12 Using the ABNewPersonViewController Class 522
18.13 Summary 523
Exercises 524

19 Core Data 525

19.1 Core Data Application Components 525
19.2 Key Players 525
19.2.1 Entity 526
19.2.2 Managed object model 526
19.2.3 Persistent store coordinator 527
19.2.4 Managed object context 527
19.2.5 Managed object 527
19.2.6 The Core Data wrapper class 528
19.3 Using the Modeling Tool 531
19.4 Create, Read, Update, and Delete (CRUD) 536
19.4.1 Create 536
19.4.2 Delete 537
19.4.3 Read and update 537
19.5 Working with Relationships 539
19.6 A Search Application 540
19.6.1 The UISearchDisplayController class 540
19.6.2 Main pieces 543
19.7 Summary 547
Exercises 548

20 Undo Management 549

20.1 Understanding Undo Management 549
20.1.1 Basic idea 549
 Contents xi

20.1.2 Creating an undo manager 550

20.1.3 Registering an undo operation 550
20.1.4 Hooking into the undo management mechanism 551
20.1.5 Enabling shake-to-edit behavior 552
20.2 Detailed Example 552
20.2.1 The view controller class 553
20.2.2 First-responder status 553
20.2.3 Editing mode and the NSUndoManager instance 553
20.2.4 Registering undo actions 554
20.3 Wrapping Up 555
20.4 Summary 556
Exercises 556

21 Copy and Paste 557

21.1 Pasteboards 557
21.1.1 System pasteboards 557
21.1.2 Creating pasteboards 557
21.1.3 Properties of a pasteboard 558
21.2 Pasteboard Items 558
21.2.1 Pasteboard items 558
21.2.2 Manipulating pasteboard items 559
21.3 The Editing Menu 560
21.3.1 The standard editing actions 561
21.3.2 The UIMenuController class 561
21.3.3 The role of the view controller 562
21.4 Putting It Together 562
21.4.1 The image view 563
21.4.2 The view controller 564
21.5 Summary 568
Exercises 569

22 Offline Mode 571

22.1 Setting Up the Project 571
22.1.1 Adding support for libxml2 572
22.1.2 Adding the TouchXML Objective-C wrapper 573
22.2 Parsing XML Using the TouchXML Wrapper 574
22.2.1 The structure of the RSS feed 574
22.2.2 Obtaining the XML document 575
22.2.3 Extracting parking availability 575
22.2.4 Monitoring the feed and disseminating the updates 577
22.3 Showing a Screen Shot of the Last Session 579
22.4 The TableView Controller 580
22.5 Summary 584
Exercises 584
xii Contents

23 Peer-to-Peer Communication 587

23.1 Basic Chat Application 587
23.1.1 Peer discovery and connection establishment 587
23.1.2 Creating the session 588
23.1.3 Setting up a data-receive handler 589
23.1.4 Sending data 591
23.2 Exchanging Pictures 592
23.2.1 Sending an image 592
23.2.2 Receiving an image 592
23.3 Summary 593
Exercises 593

24 Developing for the iPad 595

24.1 The Cities App: Iteration 1 595
24.1.1 The application delegate class 595
24.1.2 The CitiesViewController class 596
24.1.3 The StatesViewController class 598
24.1.4 Creating the UI 600
24.1.5 Wrapping it up 604
24.2 The Cities App: Iteration 2 604
24.2.1 Initializing the popover view controller with a navigation controller 605
24.2.2 Showing the popover 607
24.2.3 Wrapping it up 607
24.3 Split View Controller 608
24.3.1 An example of the split view controller 608
24.3.2 Dissecting the split view controller 610
24.4 Modal View Controller Presentation Styles 612
24.5 Summary 612
Exercises 614

Appendix A Saving and Restoring App State 615

Appendix B Invoking External Applications 619

Appendix C App Store Distribution 621

Appendix D Using XCode 623

D.1 XCode Shortcuts 623
D.2 Creating Custom Templates 623
D.3 Build-Based Configurations 626
D.4 Using Frameworks 629

Appendix E Unit Testing 633

E.1 Adding a Unit Test Target 633
E.2 Adapting to Foundation 634
 Contents xiii

E.3 The Model 636

E.4 Writing Unit Tests for the Employee Class 638
E.4.1 The setUp and tearDown methods 639
E.4.2 Testing for equality 640
E.4.3 Testing for nullity 640
E.5 Adding a Build Dependency 641
E.6 Running the Tests 641

Appendix F Working with Interface Builder 643

F.1 National Debt Clock Application 643
F.1.1 Creating the project 643
F.1.2 Creating the view controller class 643
F.1.3 The application delegate class 646
F.1.4 Building the UI 647
F.2 Toolbar Application 661
F.2.1 Writing code 661
F.2.2 Building the UI 663
F.2.3 Putting it together 669

References and Bibliography 671

Index 673
 Another Random Document on
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decline, or, it may be, because, after a while, sexual intercourse becomes less
frequent, or because precautions against procreation are taken.
The number of children to which during the three decades of her sexual life,
from the menarche to the menopause, a woman might theoretically give birth,
is never actually born. If we assume that, during the period of active sexual
life, a woman requires a period of fifteen months to two years for each
pregnancy, parturition, and lactation, a woman could easily during this period
have fifteen or sixteen children, and this figure would represent the normal
product of the normal fertility of the human female. There are indeed, women
who, it may be in consequence of an exceptionally long period of sexual
activity, or through giving birth repeatedly to twins or triplets, or because they
have married several husbands in succession, have given birth to twenty-four
children or even more. In Berlin, in the year 1901, there lived a woman 41
years of age who had had 23 children; there were three women, aged
respectively 40, 43, and 46 years, who had had each 21 children; 246 women
with families numbering 13 to 20; and 169 women each of whom had given
birth to 12 children. In the very great majority of cases, however, the fertility of
the wife of the present day is never fully developed. It is modified in various
ways by the conditions of marriage, by social circumstances, by considerations
relating to the health of husband or wife, by actual illnesses, and by voluntary
limitation of fertility. Generally speaking, according to the investigations of
Quetelet, Sadler, and Finlayson, the fertility of women is greatest in marriages
in which the husband is as old as the wife, or a little older, but without marked
difference in age. Marriages contracted at a very early age are less fruitful; the
highest fertility is found in marriages contracted when the husband is 23 and
the wife 26 years of age.
Conception does not generally take place until sexual intercourse has been
frequently repeated. As the result of a statistical enquiry of my own, relating to
556 fruitful marriages, I ascertained that in these the first delivery occurred:
Within 10 months after marriage in 156 cases.
Within 11 to 15 months after marriage in 199 cases.
Within 16 to 24 months after marriage in 115 cases.
Within 2 to 3 years after marriage in 60 cases.
More than 3 years after marriage in 26 cases.

Thus we learn that in 35.5% of the cases the first delivery occurred within
1¼ years after marriage; in 15.6% within 10 months; and in 19.9% within 15
months after marriage; and 11.5% of the cases, the first delivery was more
than 1¼ years and less than 2 years after marriage; in 6.0% it was between 2
and 3 years after marriage; and in 2.6%, the first delivery did not occur until
more than 3 years after marriage.
 From examination of the birth registers of Edinburgh and Glasgow, Matthews
Duncan determined the mean interval between marriage and the birth of a
living child to be seventeen months. In the majority of cases, the first delivery
does not occur until a complete year has elapsed since marriage; in fact, in
nearly two-thirds of the instances the first delivery occurs during the second
year of married life.
The interval between two successive births is, according to Matthews
Duncan, on the average 18 to 24 months, according to Goehlert, 24 to 26
months; the latter, however, points out that in cases in which the child dies
very soon after birth, the birth of the next child ensues on the average in 16 to
18 months. In this connection, we must not fail to take into consideration the
influence of lactation, inasmuch as mothers who do not suckle their children
become pregnant considerably earlier, on the average, than those who
undertake this duty. In reigning families, for instance, it is by no means
uncommon for the consort to be delivered twice within a single year. The
degree to which lactation hinders conception is so widely known, that women
often suckle their infant for a very long period, with the definite aim of
preventing the speedy recurrence of pregnancy. A high official from the Dutch
Indies informed me that for this reason the native women were accustomed to
suckle their infants for several years, and that it was by no means uncommon
to see a small boy running about smoking a cigar, and then hurrying to his
mother in order to be suckled.
The age at which a woman contracts marriage has also to this extent an
influence upon her fertility, inasmuch as it appears that those who marry very
young are far less fertile than those who marry between the ages of 20 and 25
years; the latter moreover have, on the average, a shorter time to wait for
their first conception than women who marry before the age of 20. Women
who marry after the age of 25 have to wait longer after marriage for their first
delivery; in fact the older the woman after 25, the greater, on the average, the
interval between marriage and the first delivery.
Arranging the data already referred to, regarding 556 fruitful women, in
relation to this point of view, it appears that the first birth ensued:
 15
Within months More
10 10 to 15 to 2 2 to 3 than 3
months months years years years
of after after after after
marriage. marriage. marriage. marriage. marriage.
In 163 women marrying at
ages 15 to 20 years 36 53 46 18 10
In 313 women marrying at
ages 20 to 25 years 98 113 56 32 14
In 70 women marrying at
ages 25 to 33 years 18 30 12 9 1
In 10 women marrying at
ages over 33 years 4 3 1 1 1
To give percentages, the first birth occurred,
15
Within months More
10 10 to 15 to 2 2 to 3 than 3
months months years years years
of after after after after
marriage. marriage. marriage. marriage. marriage.
Women marrying at ages
15 to 20 years, in 22.0% 32.5% 28.2% 11.0% 8.1%
Women marrying at ages
20 to 25 years, in 31.3% 36.1% 17.8% 10.2% 4.4%
Women marrying at ages
25 to 33 years, in 25.7% 42.8% 17.1% 12.8% 1.4%
Women marrying at ages
over 33 years, in 40.0% 30.0% 10.0% 10.0% 10.0%
Thus whereas in women who contracted marriage between the ages of 15
and 20 years, only 54.5% were confined for the first time within 15 months
after marriage, in women who contracted marriage between the ages of 20
and 25 years, in 67.4% the first delivery occurred within 15 months of
marriage. And whereas in those who married at the earlier age, the percentage
of first deliveries occurring between 15 months and 2 years after marriage was
28.2, in those who married between the ages of 20 and 25, the percentage of
first deliveries after the stated interval was only 17.8.
The figures compiled by Whitehead and Pfannkuch give similar results. Of
700 women who married between the ages of 15 to 20 years, there were 306
only who gave birth to a child within the first two years after marriage;
whereas of 1,835 women who married between the ages of 20 and 25 years,
no less than 1,661 gave birth to a child within two years after marriage—a
percentage of 43.7 in the former case, and 90.6 in the latter case. Pfannkuch,
as the result of a very large collection of figures relating to this question, found
that in women marrying before the age of 20 years, the average number of
months before the first delivery was 26; whereas in women marrying after the
age of 20 years, the average number of months before the first delivery was
20.
According to Matthews Duncan
Of Every 100 Women Who There Become Mothers
Marry In the 1st year of In the 2d year of married
married life. life.
Between the ages of 15 and 20
years 13.71 43.70
Between the ages of 20 and 25
years 18.48 90.51
Between the ages of 25 and 30
years 12.41 75.80
Between the ages of 30 and 35
years 11.44 62.93
Between the ages of 35 and 40
years 9.27 40.97
Sadler examined the relationship between the age at which marriage was
contracted and the number of offspring in the case of the wives of English
peers. He obtained the following results:

Age at marriage. Births per marriage.

12 to 16 years 4.40
16 to 20 years 4.63
20 to 24 years 5.21
24 to 28 years 5.43

From exact statistical data of births in the Scandinavian countries of Europe

(Denmark, Sweden and Norway), Goehlert compiled the following table,
showing the percentages of fertility at various ages:
 Married Women. Unmarried Women.
Ages.
Denmark. Sweden. Norway. Denmark. Sweden. Norway.
Under 20 years. 1.0 1.0 0.7 9.1 7.0 4.9
From 20 to 25
13.9 12.8 11.9 43.9 35.1 37.0
years.
From 25 to 30
26.5 24.7 24.7 28.1 27.9 32.4
years.
From 30 to 35
26.7 26.1 25.3 11.4 16.8 14.9
years.
From 35 to 40
21.0 21.6 21.3 5.4 9.0 7.1
years.
From 40 to 45
9.9 12.0 13.0
years. 2.1 4.2 3.7
Over 45 years. 1.1 1.8 3.1
From this table it appears that the fertility of married women increases
steadily up to the age of 35 years, but after this age it begins to decline. What
a marked influence the age at marriage has upon fertility is shown by the
comparison of the figures relating to married women with those relating to
unmarried women; the fertility of unmarried mothers attains its maximum at
the ages of 20 to 25 years. In the countries under consideration the average
age of women at the time of marriage is 25 to 27 years.
In order to obtain a still clearer picture of the fertility of women in relation to
age, Goehlert has combined the figures relating to the married and the
unmarried, and then calculated the percentages, with the following results:
Ages. Married and Unmarried Women.
Denmark. Sweden. Norway.
Under 20 years. 1.7 1.6 1.1
From 20 to 25 years. 16.6 15.1 14.1
From 25 to 30 year 26.6 25.0 25.3
From 30 to 35 years. 25.3 25.1 24.4
From 35 to 40 years. 19.6 20.4 20.0
From 40 to 45 years. 9.2 11.2 12.2
From 45 to 50 years.
1.0 1.6 2.9
Over 50 years.
If, finally, we combine into a single table the figures relating to all three of
these countries, we obtain the following results:
 Under 20 years 1.5%
From 20 to 25 years 15.3%
From 25 to 30 years 25.6%
From 30 to 35 years 24.9%
From 35 to 40 years 20.0%
From 40 to 45 years 10.9%
Over 45 years 1.8%

From these figures it appears that the maximum fertility of married women is
attained, in Denmark at the age of 31, in Norway at the age of 31.7, and in
Sweden at the age of 32 years. In the case of unmarried women, the
maximum fertility is at the ages of 24 to 26 years. In the Austrian Empire, the
maximum fertility of women is attained at about the age of 30 years; in
England it is attained between the ages of 20 and 25 years.
Divergent results as regards the fertility of married women at different ages
were obtained by Goehlert from the examination of 5,290 cases from the
reigning families of Europe. In the favourable position as regards means of
subsistence occupied by the members of these families, marriage naturally
occurs, in most cases, much earlier in life, the mean age at marriage being
between 19 and 22 years—the youngest mother (in the Capet dynasty) was
only 13 years of age—and for this reason the figures relating to the younger
age-classes are larger than in the previous tables. But as a result of this, the
reproductive capacity also undergoes an earlier extinction, so that of these
women, not one gave birth to a child when she was over 50 years of age.
Goehlert gives the following table, compiled from these 5,290 instances:

Under 20 years 8.8%

From 20 to 25 years 25.4%
From 25 to 30 years 29.4%
From 30 to 35 years 21.6%
From 35 to 40 years 11.5%
Over 40 years 3.3%

In these cases the maximum fertility was obtained at the age of 27.
The physiological fertility of women is much more clearly manifested when
we compare the fertility of women who have been married a few years only,
with the fertility of women in the later years of married life. In the earlier
period, the effective fertility more nearly approaches the physiological fertility,
because at this time the various influences by means of which fertility is later
so greatly diminished have not yet come into operation. In this connection the
following data, published by Körösi, regarding the percentage fertility of
recently married women, and that of married women in general, will be found
of interest:
Recently-married women. All married women.
At ages 20 to 35 years. 32.9% 20.6%
At ages 35 to 40 years. 32.7% 14.7%
At ages 40 to 45 years. 21.4% 5.9%
Inasmuch as we learn from this table that in the case of women aged 40 and
upward, the newly married exhibit a fertility of four times as great as that of
married women in general, in whom pregnancy has already become rare, we
can infer the influence upon fertility of abstinence and of artificial measures for
the prevention of conception.
On the average, the maximum fertility of woman, that is, the maximum of
effective fertility, is attained at the age of 18 to 20 years. Extreme
youthfulness, and also the opposite condition, too advanced an age, when
marriage is entered on, impair a woman’s fertility; whereas the conditions most
favourable to fertility are that, at the time of marriage, the uterus should have
attained its fullest development, and the ovaries also should be completely
mature; this is not usually the case at puberty, but rather at the age of 20, 21,
or 22 years. In Austria-Hungary, of 100 marriages in which the wife’s age at
marriage was less than 18 years, the average offspring in the course of a
single year were 36 to 38 children; in the case of 100 marriages in which the
wife’s age at marriage was 18 to 20 years, the average offspring in a year were
40; this being the maximum fertility, the number of offspring in a year per
hundred marriages (i. e., the percentage fertility), now undergoes a regular
decline as the wife’s age at marriage increases; at an age of 25, the
percentage fertility is 32; at the age of 30 years, the fertility is 24%; at the age
of 35, 17%; at the age of 40 years barely 10%; at the age of 45, 7%; at ages
45 to 50, 0.1%. Thus, from the last figure, we see that of a thousand women
marrying at the age of 50 years, one only gives birth to a child. Men obtain
their maximum fertility (i. e., procreative capacity) at the age of 25 or 26 years;
at this age their fertility amounts to 35% (that is, of 100 marriages at this age,
35 children will on the average be born within a single year); at the age of 35
years, the percentage fertility of men falls to 23; at the age of 45 years, it is
9½%; at 55, 2.2%; at 65, ½% (Körösi-Blaschko).
Whereas hitherto we have considered only the monogenous fertility of
married women, we must remember that the figures relating to their
biogenous fertility are also of interest—that is to say, the changes which a
woman’s fertility experiences in married life in respect of the peculiarities of her
husband; and of these peculiarities, the easiest to make the object of statistical
investigation is the husband’s age. The age of the husband exercises an
important influence upon the fertility of the wife, as is proved by the following
figures published by Körösi:
Age of the Father. Age of the Mother.
25 years. 30 years. 35 years.
25 to 30 years 35.6% 25.0% 21.2%
30 to 35 years 31.2% 23.6% 19.9%
35 to 40 years 27.5% 21.8% 19.4%
40 to 45 years 16.7% 14.0%
45 to 50 years 14.4% 10.9%
50 to 55 years 10.9%
Also:
Age of the Age of the Father.
Mother. 25 years. 35 years. 45 years. 55 years.
Under 20 years 49.1%
20 to 25 years 43.0% 31.3% 16.0%
25 to 30 years 30.8% 27.3% 18.5%
30 to 35 years 33.5% 23.7% 14.4% 8.1%
35 to 40 years 18.9% 11.8% 6.7%
40 to 45 years 6.6% 6.1% 3.0%
We learn from these figures that the maximum fertility is exhibited by a
woman 18 years of age, when married to a man 25 years of age; less fertile is
a woman 25 to 30 years of age married to a man 28 years of age; still less
fertile is a woman 35 years of age married to a man 29 years of age. Neither
the age of the mother alone, nor that of the father alone, is determinative of
the fertility of the marriage, for the fertility of young wives married to elderly
husbands is quite different from that of young wives married to young
husbands. Very various age-combinations are possible, and each exhibits an
average fertility peculiar to itself.
We can also regard the question from the standpoint of the difference
between the ages of husband and wife respectively. In this connection, Körösi
is led by his tables to the conclusion that wives between the ages of 18 and 20
years attain their maximum fertility when married to men 7 years older than
themselves; women of 25 years when married to men 3 years older than
themselves; women of 29 years when married to men of the same age;
women of 30 years and upward attain their maximum fertility only when
married to men younger than themselves. Men, on the contrary, always attain
their maximum fertility when married to women younger than themselves. The
age of maximum fertility differs in the two sexes, and those marriages will be
most fruitful in which husband and wife are each of the age most favorable to
fertility. This will be the case when the age of the wife is 18 to 20 years, and
that of the husband 24 to 26 or perhaps 29 years.
In connection with the question of fertility, we have also to take into
consideration the vitality of the children born, that is, what proportion of those
born survive. According to Körösi’s interesting papers regarding the fertility of
the inhabitants of Buda-Pesth, we learn that for every 100 marriages which
have persisted for thirty years and upward, there were born, on the average,
539 children, of whom during this period 241 died, so that the percentage of
survivals was 55.28. Parents who have lost one only of several children must,
therefore, regard themselves as exceptionally favoured by fortune.
Social position, occupation, and religion, have, according to the last-quoted
author, a notable influence on fertility. His investigations showed that the
Roman Catholics and the Jews exhibited the greatest fertility; among the
Catholics there were 541 children, and among the Jews 557 children, per 100
marriages. Amongst 100 Protestant families, on the other hand, only 479
children had been born. It will be seen that the theory of the comparatively
enormous fertility of the Jewish race is not supported by these statistics. The
Jews do, however, exhibit a greater power of rearing children, for among them
the marriages of more than 30 years’ duration had 61⅔ % of the children still
living; among the Protestants 57¾% survived; and among the Catholics only
52–⅗%. It thus appears that the surviving offspring per 100 marriages of 30
years’ duration were, among the Catholics 278, among the Protestants 252,
and among the Jews 349.
The question whether, and to what extent, the age of the parents has an
influence on the vitality of the children, is answered by Körösi’s mortality
statistics in the sense that mothers below 20 years of age give birth to a larger
proportion of children deficient in vital power. Where the mothers had married
at the age of 16, the mortality of their offspring was, among Catholics 43%,
among Jews 33%; married at 17, Catholic mortality 44%, Jewish 30%; married
at 18, Catholic mortality 42%, Jewish 32%; married at 19, Catholic mortality
41%, Jewish 29%; married at 20, Catholic mortality 40%, Jewish 26%. Of the
children whose fathers had married at the age of 24, 32% had died; of those
whose fathers had married at 23, 37% had died; of those whose fathers had
married at 20, 42% had died; and of those whose fathers had married before
20, actually 44% had died. It thus appears that the children alike of very
young mothers and of very young fathers have a lessened chance of survival.
Inasmuch as the fertility of the wife is a product of two factors, her own
peculiar fertility, and that of the procreating male, the question of the fertility
of women cannot be accurately treated independently of this second
consideration; hereby, however, is introduced a multiplicity of obscure
combinations, by which the value of all the statistical data of fertility in women
is seriously impaired.
These data give as the measure of fertility, the number of children per
marriage actually brought up, embracing fruitful marriages, sterile marriages,
and those not yet fruitful. In Berlin, in Copenhagen, and in Buda-Pesth, the
average thus attained was slightly less than three births to each family, whilst
the number of children actually living averaged two per family. A more accurate
representation of fertility is obtained by ascertaining the number of children
born, and the number of children living in relation to the duration of marriages
reckoned in years, that is beginning with marriages of one year’s duration, and
proceeding year by year to the highest recorded duration of marriage. In this
way interesting statistics have been obtained; for example, one who has
completed thirty years of married life may count on the average that five or six
children will have been born to him, but may also reckon on having buried two
or three at least of these. (Körösi.)
Fertility is, as many facts indicate, also dependent on nutrition. A distinct
proof, says Spencer, writing on the “Coincidence between high Nutrition and
Genesis,” that abundant nutriment increases the number of births, and vice
versa, is found among the mammalia; compare, for instance, the litter of the
dog with that of the wolf and the fox. Whilst the dog’s litter numbers 6 to 14,
that of the wolf numbers 5 to 7, that of the fox 4 to 6. The wild cat gives birth
to 4 or 5 kittens once a year, the domesticated cat to 5 or 6, twice or thrice
annually. The most remarkable contrast, in this respect, exists between the
wild and the domesticated breeds of swine. The wild sow gives birth once a
year to a litter of 4, 8, or 10 pigs (the number increasing in successive litters);
the domesticated sow has often as many as 17 in a single litter, whilst in two
years five litters, each numbering 10 pigs, are commonly born.
Darwin also draws attention to the fact that animals under domestication,
being fed more abundantly and regularly than their wild allies, procreate at
shorter intervals and are markedly more fertile than the latter. He states that
the wild rabbit has four litters annually, each numbering 4 to 8 young; whereas
the tame rabbit reproduces its kind six to seven times annually, and gives birth
to litters numbering 4 to 11. Among birds, analogous phenomena are
observed. The wild duck, for instance, lays 5 to 10 eggs in the course of the
year, whereas the tame duck lays from 80 to 100; the wild grey goose lays 5 to
8 eggs, the domesticated goose 13 to 18.
It must be added that this exceptional fertility is manifested in animals that
are quite inactive in comparison with their wild allies; not only are they richly
fed, but they get their food without working for it. Moreover, it is easy to
observe that among the domesticated mammals the well-fed are more fertile
than the ill-fed.
That in the human species also, fertility is influenced to a notable degree by
nutritive conditions, is shown by statistical investigation. After years
distinguished by an exceptionally good harvest the number of children born is
considerably greater than in normal conditions; whereas after a famine the
opposite is observed. Malthus’s law of population states, inter alia, that the
population increases when the amount of available nutriment increases, that is,
that favourable nutritive conditions cause an increase, that unfavourable
nutritive conditions cause a decrease, of population. Hardships and exhausting
occupations diminish the fertility of women. The remarkable fertility of the
Kaffirs is referred to the fact that this people, possessing large herds of cattle,
lead a life comparatively free from care; it is no less true that the Boer women,
who lead a life of well-fed leisure, have very large families; whereas the
Hottentot women, poor, ill-nourished, and hard working, seldom bear more
than three children.
Generally speaking, it may be said that fertility of the soil, in connection with
an easily gained livelihood, favours also human fertility, notwithstanding the
fact that certain statistical data seem to conflict with this proposition. Sadler,
for instance, concludes that an increase in the price of the necessaries of life
does not per se check fertility, but, indeed, rather increases it; he considers
that the apparent decline in fertility is due to the fact that the number of
marriages diminishes, owing to the rise in prices. We must, however, point out,
that an increase in price of the necessaries of life is often associated with a rise
in wages, and is therefore not necessarily identified with deficient nutrition;
when, however, such a rise in prices leads to actual want, a limitation of
fertility will certainly result; this has been proved by Legoyt and Villermé with
regard to failure of the crops. Famine and disease lower the number of births;
a less severe deficiency of nutriment often lowers only the quality of those
born. Malthus was of opinion that the population of a country at any time was
related to the quantity of nutriment produced or imported therein, on the one
hand, and, on the other, to the liberality with which this nutriment was
distributed to the individual. In countries where corn forms the principal crop,
we find a thicker population than in pasture lands; and where rice is the
principal crop, the population is even more abundant than it is in corn growing
countries.
Passing to the consideration of the individual nutritive elements, we find that
these also influence fertility. Above all, it has been proved that alcohol notably
diminishes the fertility of women. Lippich states that of 100 women in Kärnten
and Krain suffering from chronic alcoholism, 28.3 were barren. In England,
where the abuse of alcoholic beverages is also very frequently observed in
women, the same phenomenon has been noted. Matthews Duncan held that
alcohol exercised a specific deleterious influence on fertility. Moreover, in
addition to the constitutional disturbances produced by the abuse of alcohol,
this beverage also exercises a well-known pathogenetic influence upon the
female reproductive organs; with especial frequency, chronic oöphoritis may be
shown to depend on this exciting cause.
A diet consisting mainly of fish is known to increase the sexual impulse, and
is said also to increase fertility. Further, a diet consisting mainly of potatoes or
rice is said to favour reproduction; compare, for instance, the fertility of the
Hindoos, who abstain entirely from animal food, and of the Chinese, who live
chiefly on rice. Davy maintained that the women of races living chiefly on fish
were handsomer and more fertile than others: and Montesquieu suggested
that there was an association between the abundant population of sea-ports
and also of Japan and China, and the large quantity of fish consumed in those
places. On the other hand, a diet consisting chiefly of meat is said to have an
unfavourable influence in this direction; in support of this view it is pointed out
that races living by the chase, and living therefore almost entirely on meat,
have very small families. This generalization is invalidated by the fact that
Englishwomen, who eat far more meat than the women of the Latin races, are
nevertheless distinguished by their great fertility.
In his “History of Civilisation in England” Buckle writes: “The population of a
country, although influenced by many other conditions, unquestionably rises
and falls in proportion as the supply of nutriment is abundant or the reverse.”
Herbert Spencer also states that “every increment in the supply of nutriment is
followed by an increment in fertility.”
It must not be forgotten that, in addition to the more or less abundant
supply of nutriment, there are always other influences affecting fertility; the
general mode of life, race, climatic conditions, etc., may, in various ways, co-
operate with or countervail the influence of nutritive conditions. If, with the
best possible supply of nutriment, there is associated a luxurious and
enervating mode of life, the abuse of alcohol, severe intellectual exertion, or
sexual excesses, the general result will be a diminution in fertility. And it is easy
to understand why Cros, although perhaps with little justification, goes so far
as to regard easy circumstances as an active cause of depopulation. “It is the
poor,” he writes, “and the less wealthy departments of France, in which we find
the most children.” In estimating fertility, however, we must never fail to take
into consideration the more extensive employment of means for the prevention
of pregnancy among the upper classes of society.
 To a certain extent we can trace the influence of climate and of season upon
fertility. Heat appears to favour fertility; Haycraft’s figures for the eight largest
towns of Scotland show clearly how the number of conceptions rises and falls
pari passu with the temperature. Lower animals also, when brought from a
colder to a warmer neighbourhood, exhibit an earlier and more frequently
recurring “heat.” In Europe, however, the Northern races appear more fertile
than those of the south.
Of the seasons, spring is the one especially favourable to fertility. Quetelet,
who proves by numerous statistical data that the maximum of conceptions
occurs in May, attributes this fact to a general increase in the vital forces
occurring in spring, after the cold of winter. Villermé, however, goes back to the
older explanation, that the increase in the number of conceptions in May and
June is due to social and economic conditions. The return of spring, especially
the end of spring and the beginning of summer, a time of year in which the
means of subsistence are provided in exceptional quantity, and of especially
good quality, the season also of festivals and social reunion, when the two
sexes are brought into more intimate contact and when the majority of
marriages occur—these are the conditions associated with the season of
greatest fertility. The figures of Wappaeus also confirm the influence of spring
in favouring fertility. He found, however, that there were two seasons of
maximal fertility. The first at the end of spring and the beginning of summer;
the second in winter, especially in December. Mid-winter is for most people a
period of domestic amusement and relaxation, one of exceptionally good
nutrition, and of social reunion; the spring increase in fertility is a part of the
awakening and increase of the reproductive forces of nature at large, which
recurs every spring-time.
Every marked and sudden change in the mode of life has an unfavourable
influence on fertility. Darwin reports that mares who have for some time been
stall-fed with dry fodder and are then put out to grass are at first infertile after
the change. Europeans going to reside in the tropics experience a notable
decline in fertility as a result of the change of climate. According to Virchow,
the fertility of European women who become acclimatized in the tropics
declines very gradually, but in the course of a few generations is almost
completely annulled.
The marriage of near kin is believed also to diminish fertility. As regards
inbreeding in the lower animals, it is well known that when nearly related
animals copulate, the number of the offspring is below the average. Nathusius
paired a sow with its own uncle, the boar having proved productive in
intercourse with other sows; the litter numbered five to six only. This sow,
which belonged to the great Yorkshire race, was then paired with a small black
boar, which in intercourse with sows of its own variety had procreated litters
numbering six or seven; as a result of her first pairing with the black boar, the
sow cast a litter numbering twenty-one whilst the second attempt produced a
litter of eighteen. Similar results were obtained by Crampe, in his experiments
in the inbreeding of rats.
Some authorities declare that the results of inbreeding are similar in the
human species, that the marriages of near kin are less fruitful than the
average. Darwin writes in this connection: “With regard to human beings, the
question whether breeding in-and-in is also deleterious, will probably never
receive a direct answer, for man reproduces his kind so very slowly, and cannot
be made the object of experiment. The very general disinclination of nearly all
races to the marriage of near kin, which has existed from the very earliest
times, is of weight in relation to this question. Indeed we appear almost
justified in applying to the human race the experience gained by experiment on
the higher mammals.”
Darwin’s assumption regarding the effect upon fertility of the marriage of
near kin in the human species, cannot, however, be accepted without
qualification. In ancient times there was no uniformity of opinion on this topic.
It is well known that among the Phœnicians, a son might marry his mother,
and a father his daughter; and among the ancient Arabs it was the legal duty
of the son to marry his widowed mother. Moses, on the contrary, forbade
marriages between parents and children, between brothers and sisters, also
marriage with a father’s sister, with a wife’s mother, and with an uncle’s widow.
Darwin considered that the marriage of first cousins was not unfavourable to
fertility. Of 97 such marriages, 14 were sterile, whilst of 217 marriages of those
not akin, 35 were sterile; the percentage in both cases being almost identical.
Mantegazza, who regards kinship in marriage as unfavourable to fertility, found
nevertheless that among 512 marriages of near kin, only 8 to 9% were sterile.
It is widely believed that the dying out of many aristocratic families is
dependent on the inbreeding so common in this class—but it must be admitted
that scientific evidence in support of this belief is lacking. Incest in the human
species may certainly result in fertilization. Among the Jews, marriages of near
kin are very common, and often prove extremely fruitful.
Göhlert made a statistical investigation of the fertility of the reigning families
of Europe, in order to throw light on this question. In the Capet dynasty, 118
marriages of near kin took place, and of these 41 were sterile; in the Wettin
dynasty (Saxony), there were 28 such marriages, of which 7 were sterile, and
1 produced one child only; in the Wittelsbach dynasty (Bavaria), 29 such
marriages, of which 9 were sterile, and 3 produced only one child each. Thus
of 175 marriages of near kin, 57, or 32.6% remained sterile. Further, in the
Habsburg-Lothringen dynasty, of 110 marriages, 25 were marriages of near
kin, and of these 33% remained sterile.
It has been assumed since the days of antiquity that temperament and
constitution exercise some influence on fertility. Hippocrates, Soranus, and
Diokles, are among the ancient authors who refer to this matter. Soranus says
very justly: “Since most marriages are contracted, not from love, but for the
procreation of children, it is irrational, when choosing a wife, to have regard,
not to her probable fruitfulness, but instead of this to the social position and
the wealth of her parents.”
It would appear that a certain dissimilarity in physical constitution and
temperament between husband and wife is favourable to the fertility of the
marriage. For instance, a vivacious, dark husband, and a lethargic, fair wife,
are better suited to one another than a husband and wife both extremely
active, or both of extremely phlegmatic temperament.
Toussaint Loua published the following figures regarding the fertility of the
women of the various countries of Europe:
Fertility of Women Between the Ages of 15
Number of births per and 45 Years.
Country.
hundred inhabitants.
Married. Unmarried. Average.
Hungary 4.94 17.8
Russia 4.12 20.5
Austria 3.93 16.4
Germany 3.77 34.8 2.9 17.7
Italy 3.67 28.8 2.4 16.1
Holland 3.67 35.3 1.0 16.0
Finland 3.63 15.8
England 3.58 29.7 1.6 15.5
Scotland 3.53 32.8 2.5 15.8
Belgium 3.25 33.7 1.8 14.8
Denmark 3.12 28.5 2.8 14.4
Roumania 3.12 13.5
Norway 3.10 29.3 2.2 14.0
Sweden 3.05 29.1 2.5 13.7
Switzerland 3.04 29.7 1.1 13.1
Greece 2.96 13.2
Ireland 2.69 29.8 0.5 12.3
France 2.63 20.3 1.8 11.6
In towns, conjugal fertility is less, extra-conjugal fertility greater, than in the
country. An increase in factory labour gives rise to an increase in the
population, but to a decline in the vitality of the offspring; that is to say, it
causes a quantitative increase, and a qualitative decrease, in fertility. An
increase in agricultural labour has precisely the opposite effect. The influence
of war upon fertility is unfavourable both quantitatively, and qualitatively.
According to Tschouriloff, the introduction of universal military service, by
withdrawing for a time all the most vigorous men from domestic life, tends to
diminish fertility. Extensive emigration from a country in which the soil is fertile,
and where the vital conditions are generally favourable, is stated by Bertillon to
cause an increased fertility in the mother country; he further states that an
increase in the number of the proprietors of the soil is followed by diminished
fertility, and vice versa.
Prostitutes show as a rule a very low fertility. According to the data of
Tarnowskaja, the fertility of prostitutes in Russia is 34%, whilst married women
of similar ages in Russia exhibit a fertility of 51.8%. Gurrieri found 60% of
prostitutes childless.
The fertility of female criminals was found by Lombroso to be undiminished.
On the average, poisoners had given birth to 4.5 children, other murderesses
to 3.2 children, child-murderesses to 2 children; thus the prisoners whose
crime is commonly dependent on an abnormal eroticism had a fertility above
the average.
The diminished fertility of prostitutes depends in part upon frequent venereal
infection, in part upon the unfavourable influence of the mercury and iodide of
potassium administered for the cure of such infection, also upon the frequency
with which they consume excessive quantities of alcohol, upon the excessive
frequency of coitus, which exercises a traumatic influence, upon the irregular
mode of life, and upon their disinclination to be burdened with children.
Conjugal fertility, that is to say, the ratio between legitimate births and the
number of married women between the ages of 15 and 50 years, has declined
in Germany during the last decades. It was:

During the years 1872 to 1875 29.7%

During the years 1879 to 1882 27.4%
During the years 1889 to 1892 26.5%

This decline is small, but it is much more manifest in urban than in rural
districts. This fact is shown by the following figures, relating to fertility in
Prussia:
 1872 to 1879. 1894 to 1897.
In all towns 26.9 24.0
In Berlin 23.8 16.9
In other large towns 26.7 23.5
In rural districts 28.8 29.0

This difference depends principally on the fact that in the large towns of
Germany (and still more in those of France) the use of means for the
prevention of pregnancy is continually increasing, whereas the population of
the rural districts is as yet less familiar with the use of these measures.
According to Hellstenius, conjugal fertility, that is, the number of children per
married couple, is as follows:

In the Netherlands 4.88

Norway 4.70
Prussia 4.60
Bavaria 4.55
Sweden 4.52
Saxony 4.35
England 4.33
Belgium 4.23
Denmark 4.18
France 3.46

Talquist, who has published a statistical investigation concerning the modern

tendency to diminished fertility, arrives at lower figures than Hellstenius.
According to him, conjugal fertility is:

In Prussia 4.11
England 4.10
Belgium 4.12
France 2.09
In various States of the American Union 2.5 to 3.0

From the Almanach de Gotha Vacher obtained figures showing that each
family of the higher aristocracy has on the average the following number of
children.
 In France 2.0
Italy 3.0
Germany 4.8
England 4.9
Russia 5.1

According to the figures we have published, the fertility of women suffices

for the production during the sexual life of a small number only of children,
averaging, in fact, 4 to 5 children per marriage. Many mothers, however, give
birth to a very large number of children. Among 73,000 families inhabiting
Buda-Pesth, Körösi found 300 mothers who had had 15 children or more; 7
mothers who had each had 21 children; and 3 mothers who had given birth
respectively to 22, 23 and 24 children.
A newspaper report states that the wife of a citizen of Buda-Pesth, during
the 43 years of her married life, gave birth to 32 children. In the year 1902, a
Bohemian woman gave birth to her twenty-fourth child. Stieda reports the
cases of two mothers, one of whom had 21, and the other 23 children. The
wife of the German Emperor, Albrecht I, and the wife of Prince Jost of Lippe-
Biesterfeld, each bore 21 children.
The so-called two-children-system obtains most commonly in France.
It is true that even in France there are on an average nearly three children
born per marriage; but if we take into account surviving children only we find
an average per family of 2.1 children only. Similar conditions obtain in New
England, and in Transylvania; and the same practice is spreading throughout
the United States. Another way in which the attempt is made to keep down the
population is that customary in Alsace, where, if there are several children in a
family one only marries, in order to avoid a division of the family property. It
cannot be denied that in France, doubtless in consequence of the two-children
system, a somewhat widely diffused prosperity exists, a prosperity which is
lacking in the rare districts in France, such as Brittany, in which limitation of the
family is not practised. What a disastrous influence the general use of
measures for the prevention of pregnancy exercises on the military power and
political status of a nation has, however, in recent years been made especially
manifest in the case of France. In that country, of ten million families, two
million are absolutely childless, and two million have only one child each, so
that two-fifths of the French families are as good as inactive in maintaining the
population of the country. The injury thus done to France is shown still more
clearly by a tabular comparison of the excess of births over deaths in the
German and French nations, respectively, during the two decades 1874 to 1894
(from G. von Mayr’s Population Statistics).

Year. Germany. France.

1874 +13.4 +4.8
1875 13.0 2.9
1876 14.6 3.6
1877 13.6 3.9
1878 12.7 2.6
1879 13.3 2.5
1880 11.6 1.7
1881 11.5 2.9
1882 11.5 2.6
1883 11.7 2.6
1884 11.2 2.3
1885 11.3 1.4
1886 10.8 1.5
1887 12.7 1.3
1888 12.9 2.5
1889 12.7 1.2
1890 11.3 –0.3
1891 13.6 –0.5
1892 11.7 +0.1
1893 12.2 –1.2
1894 13.6 –0.4

To what an extent in all times, and among all peoples, the fertility of women
was esteemed, is shown by religious writings and traditional customs which
aimed at enabling a wife who had had no children by her own husband, to
seek other conjugal embraces. Among the Jews, it was the duty of a man to
marry his widowed and childless sister-in-law; if he were unwilling or unable to
perform this duty he was compelled to take a part in a ritual termed “chaliza,”
in which his foot was bared and the bereaved woman spat upon him, because
he was unwilling to maintain his brother’s house. In the law book of the
Hindoos of Manus, we read, “If husband and wife have no children, it is proper
for them to obtain the desired offspring by a union between the wife and the
husband’s brother, or some other relative;” the child obtained in this way was
legally regarded as the child of the husband. Confucius wrote: “If your wife is
barren, take a second wife; she must be subordinate to the first wife, for her
only duty is the bearing of children.” An analogy to this ordinance is to be
found in the Bible; Abraham’s barren wife Sarai says to Abraham: “Behold now,
the Lord has restrained me from bearing: I pray thee, go in unto my maid; it
may be that I may obtain children by her. And Abraham hearkened unto the
voice of Sarai.” In the same way the barren Rachel speaks to her husband
Jacob, “Behold my maid Billah, go in unto her; and she shall bear upon my
knees, that I may also have children by her.”
Luther, in his treatise on marital love published in the year 1522, bases,
doubtless on the above biblical precedents, the following statement regarding
fertility: “If a sexually potent woman is married to an impotent man, if she is
unable to take any other man openly, yet is unwilling to do anything
dishonourable, she should say to her husband, “Dear husband, you cannot
fulfil your duty to me, and you have deceived my young body, you have
endangered my honour and my happiness, and in the eye of God our marriage
is null, forgive me therefore if I form a secret union with your brother or with
your nearest friend; the fruit of this union will be yours in name, thus your
possessions will not fall to strangers, and you will willingly allow me to deceive
you, because involuntarily you have deceived me.””
In ethnography, the term endogamy is used to denote a law or custom by
which marriage is allowed only within the limits of a specified race, tribe, or
caste; thus, in the Old Testament, Jews are forbidden to marry women of other
races. The ethnographical term exogamy indicates the prohibition of marriage
between persons who are more closely allied, as, for instance, the Mosaic
prohibition of marriage within certain degrees of blood-relationship. Such
exogamic prohibitions persist even in the legislation of the present day. In
many ecclesiastical and national laws we find the marriage of first cousins and
of uncle or aunt with niece or nephew forbidden; and even a prohibition of the
marriage of a man with his deceased wife’s sister.
Hegar considers the danger of inbreeding to be very great in the human
species; for whereas in the lower animals breeders employ a methodical and
carefully considered selection of the best specimens, nothing of this kind
occurs among human beings; and the health of modern civilized man is such
that there are few families without a skeleton in the closet. “Not only in
families, but also in villages, in small and large towns, even in classes, and in
entire nations, certain peculiar qualities, morbid tendencies, and
predispositions, are handed down from generation to generation. We have, for
instance, the tendency of the Jews to nervous disorders and diabetes, that of
the English to gout, that of the Germans to myopia.” Strahan has therefore
employed the term “social consanguinity,” to indicate that by means of
common customs, environment, occupation, and mode of nutrition, a similarity
in type is produced, leading to a similar predisposition to disorders and
diseases transmissible from father to son.
The dangers of inbreeding are believed by Hegar to be, under present-day
conditions, so considerable that he would allow the marriage of near kin in
exceptional cases only, and where the circumstances are peculiarly favourable
—for instance, where both parties to the projected marriage are in excellent
health, and where there is no great similarity between them in feature or
mental type. Certain anomalies transmitted from remote ancestors, dependent
on deeply-marked peculiarities of the germ cells, may be so developed by
inbreeding as to become absolutely fixed characteristics. If the morbid
manifestations can be traced back for several generations, if the bodily defects
and disturbances of development (the so-called stigmata of degeneration), are
well marked and numerous, if the functional disorders of the nervous system
and of the sense organs are pronounced, leading to idiocy, insanity, epilepsy,
congenital deafmutism, blindness, instinctive criminality,—there is in such cases
little or no hope of the regeneration of the family. It dies out, because the
members are sterile; because they are confined in prisons or asylums; or
because the children, if any are born, are deficient in vitality, and fail to reach
maturity.
According to the brief summary of the subject given by Hegar, the
peculiarities of the offspring at the time of birth depend upon:
Factors which give rise to peculiarities of the germ-cells:
I. Germinal rudiments derived from the ancestors;
II. Influences acting on the germ-cells within the parent organism;
a. Owing to peculiarities of the fluids and tissues of the parental body;
b. Owing to substances which penetrate the parental body and reach the germ.
Germinal rudiments altered by the conjugation of the male and female
reproductive cells:
I. On the mother’s side;
a. Owing to peculiarities of the fluids and tissues of the maternal body;
b. Owing to substances which penetrate the maternal organism and reach the fertilized
ovum.
II. On the father’s side, owing to substances which adhere to the paternal
reproductive cells, or are enclosed within these.
The number of consanguineous marriages at the present day is not less than
5½ to 6½ per 1,000; the fertility of these marriages appears to be identical
with the fertility of ordinary marriages. Mayet has made a statistical
investigation to determine the influence of consanguineous marriages in the
pathogenesis of mental disease. He finds that the number of those congenitally
affected with mental disorder is twice as great in the offspring of
consanguineous marriages as in the offspring of crossed marriages; in the case
of simple mental disorder, of paralytic dementia, and of epileptic dementia, the
ratio is actually greater than two to one (the actual figures are 218, 257, 208 :
100). Thus we see that when there exists any cause of inheritable mental
disorder, blood-relationship of the parents more than doubles the danger to the
children. In the case of imbecility and idiocy the danger is less in this respect
(the ratio is 150 : 100); the factor of inheritance plays a less prominent part
than in the case of other psychoses.
It was remarkable that among the offspring of marriages of nephew and
aunt, cases of mental disorder were almost entirely lacking. Among the
offspring of marriages of uncle and niece, the inheritance of mental disorder
was more prominent than among the children of first cousins. It is interesting
to determine the influence of blood-relationship in cases in which the existence
of inheritable predisposition could not be proved. In these cases, as regards
simple insanity, paralytic dementia, and epileptic dementia, the number of
cases among the offspring of consanguineous marriages was only one-half as
compared with the offspring of crossed marriages; whereas in the case of
imbecility and idiocy this ratio was reversed. In idiocy, where inheritance
generally speaking plays a small part, the origination of the disease would
often appear to depend directly on the blood-relationship of the parents; whilst
as regards other forms of mental disorder, if there is no inheritable
predisposition, blood relationship in the parents appears to be a positive
advantage; where, however, a family predisposition to insanity exists the
likelihood of actual insanity appearing in the offspring is notably enhanced by a
consanguineous marriage.

The Restriction of Fertility and the Use of Means for the Prevention of
Pregnancy.

As we have already pointed out, a restriction of the fertility of women occurs

in the majority of marriages, to this extent, that the potential reproductive
powers of the wife are not fully utilized. In recent times, however, the
restriction of fertility, by the deliberate use of measures for the prevention of
pregnancy, has become so widely diffused, that it appears unwise from the
scientific standpoint simply to ignore the question, and it has become
indispensable to study how the practice developed, and to consider what are
its actual results. From our own point of view, it is the more necessary to do
this, for the reason that the use of preventive measures has come to play an
important part in the sexual life of woman, and therefore deserves the fullest
attention, not merely from the standpoint of the sociologist, but in addition
from the purely medical point of view.
In many divisions of the population, and even in entire nationalities, the
prevention of pregnancy, not merely in illicit intercourse, but also in married
life, has become so general a practice that the fertility of the nation as a whole
has been profoundly modified. Thus, in France at the present day, the average
number of children per marriage is less than two; and the two-children-system
is almost universally practised in Transylvania and Norway, whilst it is very
rapidly spreading in North America. In the principal towns of the whole of
Europe, this system is largely on the increase among the upper classes of
society. The marriages of the poor, partly owing to ignorance, and partly to
indolence, are as yet comparatively little affected by this depopulative principle.
In the days of antiquity, many lawgivers endeavoured to set bounds to
excessive fertility, and artificial abortion was methodically practised by those
who wished to avoid an inconveniently large family. Even among savage
peoples, we find that certain preventive measures are occasionally employed in
sexual intercourse. Among civilized peoples, however, until the beginning of the
nineteenth century, religious and moral ideas derived from the Bible continued
to dominate the sexual life. It is well known that Old Testament law and
Christian morality alike forbid any artificial restriction of human increase.
“Increase and multiply” was the command given in Genesis to the first parents
of the race; and the psalmist exclaims, “Happy is the man that hath his quiver
full” of children.
A remarkable revolution in thought was initiated toward the beginning of the
nineteenth century by the great philanthropist and powerful thinker, Thomas
Robert Malthus, founder of the doctrine of the propriety of checking the
increase of population, author of the work “An Essay on the Principle of
Population,” London, 1798, whose Law of Population soon attracted world-wide
attention. Modern civilization having greatly increased the cost of bringing up a
family, while simultaneously there has been a general rise in the price of the
necessaries of life, there has resulted an extraordinary diffusion of
Malthusianism; in comparison with the causes just alluded to for the use of
preventive measures, diseases which render renewal of pregnancy dangerous
to the mother’s life have comparatively little to do with the causation of
voluntary sterility.
In his “Essay on the Principle of Population,” Malthus indicates, as the cause
which has hitherto hindered mankind in the pursuit of happiness, the
unceasing tendency of all organic life to increase in excess of the means of
subsistence. In the case of plants and of unreasoning animals, the natural
process is a very simple one. Both animals and plants are impelled by a
powerful instinct to reproduce their kind, and the operation of this instinct is
quite undisturbed by any anxiety regarding the livelihood of their offspring. The
reproductive function is thus exercised at every available opportunity, and the
superfluous individuals of the next generation are destroyed by lack of space
and nutriment. In the human species the restriction of population is effected by
a more complex mode of operation. Man is impelled to reproduce his kind by
an instinct not less powerful than that of other animals; but the gratification of
this instinct is checked by reason, which makes him ask himself whether he is
not about to bring into the world beings for whom he will be unable to provide
the means of subsistence. If he is influenced by this consideration, the
resulting restriction of population may often entail serious consequences; if, on
the other hand, he gratifies his instinct, regardless of the appeal of reason, the
human species will inevitably tend to increase more rapidly than the means of
subsistence.
Malthus declared that population, when its increase was unrestricted,
doubled itself every twenty-five years, and therefore increased in a geometrical
progression; he considered that in the most favourable circumstances the
means of subsistence could not possibly increase more rapidly than in an
arithmetical progression. The contrast between these two modes of increase
will be more striking if we write out the actual figures. According to the theory
of Malthus, the increase of human population would be represented by the
figures 1, 2, 4, 8, 16, 32, 64, 128, 256, whereas the simultaneous increase in
the means of subsistence would be represented by the figures 1, 2, 3, 4, 5, 6,
7, 8, 9. Such an increase in population is, however, always prevented by certain
checks, classed by Malthus as of two kinds, preventive checks and positive
checks.
A preventive check, in so far as it is voluntary, is peculiar to the human
species, and originates in the intellectual faculty which enables man to foresee
the consequences of his actions. A man who looks around him, and sees the
poverty into which those with large families so often fall, who reckons up his
present property or earnings, which barely suffice to provide for his own
personal necessities, cannot fail, when he considers how hardly they would
suffice for seven or eight additional persons, to doubt whether it would be
possible for him to provide for the offspring he might bring into the world.
Such considerations as these are likely to lead a large number of persons of all
civilized nations to resist their natural instincts, and to refrain from early
marriage. If abstinence entailed no serious consequences, it would be the least
of all evils resulting from the principle of population.
The positive checks to increase of population are manifold, and embrace all
the causes which are competent to lessen the natural duration of human life.
Among these we may enumerate: all unhealthy occupations, severe toil,
climatic conditions, poverty, errors in the rearing of children, town life,
excesses of all kinds, the whole army of illnesses and epidemics, war,
pestilence, and famine. In all countries, preventive and positive checks are
more or less powerfully operative, and yet there are few in which the
population is not continually tending to increase beyond the means of
subsistence. As a further consequence of this tendency of population to
increase, we observe the wider diffusion of poverty among the lower classes,
so that any permanent improvement in their condition is rendered impossible.
After Malthus had carefully stated his thesis, he gave a summary record of
the conditions of population in nearly all nations of the past and of his own
time, in order to show how in all alike the three principal means of limiting
population, moral restraint, disease, and poverty, had been in continuous
operation.
He showed, for instance, how the population of the South Sea Islands had
been limited by certain conditions, cannibalism, castration of the males,
infibulation of the females, late marriages, the sanctification of virginity,
contempt for marriage, etc.
In ancient Greece, Solon’s laws permitted infanticide. Plato, in “The Republic”
asserts that it is the duty of the Government to regulate the number of the
citizens, and to prevent an immoderate increase; men and women should be
allowed to procreate only during their period of maximum strength, all weakly
children should be killed. Aristotle advised that men should not be allowed to
marry before the age of 37, and women before the age of 18; the women
should give birth to a limited number of children only; if, after this, they again
became pregnant, abortion should be induced. He maintained that if all were
at liberty, as was the case in most countries, to bring into the world as many
children as they pleased, poverty, the mother of crime and insurrection, must
inevitably ensue.
Among the Romans war was as a positive check unceasingly operative: in
this time of the Empire, preventive methods came into general use, in the form
of various kinds of sexual perversity. Juvenal complains of the skilled methods
employed in the induction of abortion; during the later period of the Roman
Empire, sexual morality became so degenerate that marriage was hated and
despised.
Passing to the consideration of the checks on population among the nations
of modern Europe, Malthus examined the registers of marriages and deaths,
and came to the conclusion that in few countries is the mass of people
sufficiently capable of self-restraint to postpone marriage until they are
reasonably assured of being able to provide for all the children they are likely
to have; still, he ascertained that at the present day positive checks on
population were less active, and preventive checks more active, than in earlier
times and among savage races.
Malthus did not base upon his conclusions the advice that in sexual
intercourse means of preventing pregnancy should be employed, as the
modern “Malthusians” advise; in his eyes, moral restraint, that is to say, sexual
abstinence, was the only remedy for the prevention of poverty and the other
evil consequences of the principle of population. Moral restraint was in his
opinion the only virtuous method of avoiding the evils of excessive fertility. It
was a man’s duty not to marry until he had a definite prospect of being able to
maintain his children; the interval between puberty and marriage must be
passed in strict chastity. Man’s duty is not the mere reproduction of his species,
but the reproduction of virtue and happiness, and if he is not able to do the
latter, he has no right whatever to do the former. Malthus lays great stress on
educating the people in this matter; “in addition to the ordinary subjects of
instruction, it is necessary to explain the principle of population, and the
manner in which it gives rise to poverty.” In the nature of the case, no lasting
and general improvement in the condition of the poor is possible without an
increase in the preventive restriction of population.
The Malthusian doctrine of the law of population gave rise to an enormous
sensation, and some of his disciples soon proceeded to translate his
conclusions into practice; such authorities as James Mill and Francis Place
recommended measures by means of which, “without any injury to health, or
to the feminine sense of delicacy, conception can be prevented:” the avowed
aim of these measures was to prevent the increase of population beyond the
means of subsistence. Physicians and physiologists joined the ranks of these
innovators; among others Raciborski, Robert Dale Owen in his “Moral
Physiology,” Richard Carlile in his “Book of Woman,” the first work to give an
exact description of the means to employ for the prevention of conception,
Knowlton in his “Fruits of Philosophy.” In the year 1827 in the Northern
counties of England leaflets were for the first time distributed among the
working classes to instruct them in the use of preventive measures. Bradlaugh
founded the Malthusian Society, which aimed at the dissemination of
instruction in the use of preventive methods. There is now in England a
“Malthusian League,” numbering leading physicians among its members; this
supplies to all classes the means by which the family can be artificially limited.
A new edition of the above-mentioned book, “The Fruits of Philosophy,” was
circulated in London in an edition of several hundred thousand copies, and
prominent persons spoke at congresses on the subject of Neo-Malthusianism.
In Germany, also, a “Union of Social Harmony” was founded, for the free
distribution of a hand-book on the use of measures for the prevention of
conception, and for an investigation regarding the results of these.
We do not propose here to subject the teaching of Malthus to a critical
examination; he has found formidable opponents, who have endeavoured to
prove that his fundamental assumption is false; they maintain that work or the
power of work increases in direct ratio with the population; and they also
assert that population tends to increase, not, as Malthus maintained, in a
geometrical, but simply in an arithmetical progression. We shall merely quote
Liebig’s reply to the law of Malthus, “when human labour and manure are
provided in sufficient quantity, the soil is inexhaustible, and will continue to
yield unceasingly, the most abundant harvests;” and Rodbertus’ remark that
“agricultural chemistry will ultimately be competent to create nutritive
materials; this will some day be just as much within the power of society, as it
is at present to provide any requisite quantity of textiles, given the necessary
amount of raw material.” The celebrated socialist Bebel, is a strong opponent
of Malthus. He writes: “The earth is doubtless thickly populated, but none the
less only a small fraction of its surface is occupied and utilized. Not merely
could Great Britain produce, as has been proved, a far larger supply of nutritive
materials than at present, but the same is true of France, Germany and
Austria, and in a still higher degree of the other countries of Europe. European
Russia, were it as thickly populated as Germany, could support, instead of
ninety millions, as at present, a population of four hundred and seventy-five
millions. For the purposes of the higher civilization, toward which we are
striving, we have to-day in Europe, and shall have for a long time to come, not
an excess of population, but an insufficiency, and every day brings new
discoveries and inventions whereby the means of subsistence are potentially
increased. In other parts of the world, the insufficiency of population and the
superfluity of ground are even more noticeable. Carey is of opinion that the
single valley of the Orinoco, fifteen hundred miles in length, would suffice to
provide nutritive material in sufficient quantities to feed the whole existing
population of the world. Central and South America, and more especially Brazil,
have a soil of extraordinary fertility, but are as yet practically unutilized by the
world. To increase, not to diminish, the numbers of the human race, that is the
appeal made by civilization to mankind!” A similar position on this question was
recently taken by Roosevelt, the President of the United States, himself the
father of six children, in a letter to two American women, Mrs. J. and M. Van
Vorst, authors of the book “Woman Who Toils (Factory Life in America).” In this
book, the writers prove that in the United States the average size of the family
is now less than in any other country of the world, France alone excepted.
President Roosevelt, in his letter, declares himself an ardent supporter of the
biblical injunction, “increase and multiply!” He writes: “Whoever evades his
responsibilities, through desire for independence, convenience, and luxury,
commits a crime against the race to which he belongs, and should be an object
of contempt and horror to a healthy nation. When men avoid becoming fathers
of families, and when women cease to regard motherhood as the most
important career open to them, the nation to which these men and women
belong has cause for uneasiness about its future.” President Roosevelt
continues: “To the American woman marriage is no longer a life-duty, a
profession, as it is to her sisters who are members of the older civilizations. A
woman who manages an extensive business, who supervises her own landed
property, or who plays her own part in the world of finance,—for such as these,
the ‘lottery of marriage’ is naturally something they dread rather than desire.”
President Elliott, of Harvard College, has expressed similar views in a speech
on this subject. He deplores the late marriages and small families of the
cultured Americans. According to the last census, an American family has on
the average less than three children; twenty years ago the average number
was from four to five children.
I pass now to consider the medical point of view of this question of the
prevention of pregnancy. It is my opinion that the physician as such should
intervene in the matter, not in any case for the relief of the dominant economic
parental dread of insufficient means for the upbringing of children, but only on
account of the purely medical consideration of the physical dangers of
motherhood. That is to say, the physician should lend his skilled assistance
toward the attainment of facultative sterility, only when his own special
scientific knowledge leads him to consider this urgently necessary; it is not his
province to assist in preventing the birth of an immoderate number of
offspring; his intervention is justified only when deliberate reflection has
convinced him that his patient’s health or life would be endangered by
pregnancy or childbirth. A woman’s life and well-being must appear to him of
greater importance than the existence or non-existence of a possible infant.
That this view is morally sound, is shown by the fact that public opinion
justifies the accoucheur in the destruction of an already living child, when the
mother’s life is endangered. In this connection we may recall the words of the
great Napoleon; the physician Dubois, attending Marie Louise in a difficult
confinement, asked Napoleon whether, if matters came to an extremity, he
should save the mother or the child; Napoleon, notwithstanding his strong
desire for the birth of an heir to his dynasty, replied, “The mother, it is her
right.”
In isolated cases, which deserve always very serious consideration, some
pathological condition in the wife may justify the prevention of pregnancy. In
certain very serious general disorders, in diseases of the heart or of the lungs,
in pelvic deformity, and in pathological changes of the female reproductive
organs, it may be right to employ means for the prevention of pregnancy—not
merely sexual abstinence, but actual measures to prevent fertilization.
The misuse of medical knowledge for the recommendation or employment of
preventive measures, on the ground of humanitarian sentiment or social and
economic considerations, must, however, be strongly resisted. Even leading
gynecologists have erred in this way. Saenger writes, “Scientifically-trained
accoucheurs will do much more to promote the health and well-being of
women, and to protect them from sexual and other diseases, than the
humanitarian efforts of the Neo-Malthusians, who transfer a purely scientific
question, such as the disproportion between the number of births and the
supply of nutritive material, to the sphere of medicine, regarding themselves as
justified in preventing conception whenever they please, independently of
considerations relating to the health of the mother * * * * * * * * A woman
exhausted by frequent child-bearing, anæmic and suffering, is certainly a
figure to arouse everyone’s sympathy; in so far as she is ill in consequence of
injury received in childbirth, it is our duty to prevent further injury, and to
relieve to the best of our ability that which has already occurred; in so far,
however, as she is not suffering from any affection of the reproductive organs,
but is ill owing to the lack of sufficient food, or from overwork, it is the duty of
society to render assistance. Here we have to do with the social problem; the
solution of which will be brought no nearer by the use of the occlusive
pessary.” Fehling also maintained that a text-book of gynecology is not the
proper place in which to pass judgment on so important a socio-political
question. The business of the gynecologist in this matter is merely to say a
word of caution against the use of various measures which are so often
recommended as harmless, but are in fact dangerous to the woman who uses
them.
Kleinwächter, who declares that he is far from recommending the use of
preventive measures when a healthy woman wishes to save herself the trouble
of child-bearing, gives as legitimate indications for their use: 1, the various
forms of severe pelvic deformity; 2, certain tumours in the pelvic cavity; 3,
after the removal of malignant tumours of the reproductive organs, certain
general disorders, recently arrested pulmonary tuberculosis, organic heart
disease, etc. Regarding these cases, Kleinwächter writes: “The wife’s life would
be endangered by pregnancy, which must therefore be prevented without
forbidding coitus, and avoiding the practice of coitus interruptus, which
endangers her health, or of any mode of intercourse repugnant to the feelings
of wife or husband.”
 The most trustworthy, but unquestionably at the same time the least
practicable method, for the prevention of pregnancy, is that of Malthus—
permanent sexual continence. This recommendation, to which Tolstoi in “The
Kreuzer Sonata” gives his adhesion, has recently found an advocate in a
modified sense in a distinguished gynecologist, Hegar, who considers that the
great fertility of the modern civilized countries of Europe entails many
disadvantages—inferior physical development, increased general mortality,
emigration, an unfavourable distribution of population in relation to dwelling
and occupation, occasional famine—and who sees the only effective remedy in
a “regulation of reproduction,” whereby the tendency to marriage and the
number of births are to be diminished. The question “when is the number of
children in a family too large?” is answered by Hegar as follows “A maximal
limit is easy to establish. The most suitable age for child-bearing is from twenty
to forty. At an earlier and a later age than this, both the mother and the
offspring are liable to suffer. Between two successive births there should be an
interval of about two and a half years; this would leave time for the birth of
eight children. If we assume that pregnancy lasts nine months, that lactation is
continued from nine to twelve months after delivery, (and if the mother does
not herself nurse the child, artificial feeding or careful supervision of the wet-
nurse will occupy her for a like period), to devote an additional period of six
months to nine months to the complete restoration of the mother’s health
cannot be regarded as excessive. For this maximum family we assume a
perfect state of health on the part of the mother, a pure atmosphere, and a
sufficient supply of all the necessaries of life. Illnesses, weakness, or infirmity
of the mother, often indicate that the number of children should be further
limited. It is easier to provide a suitable dwelling and a pure atmosphere for a
small family than for a large one. The same thing is true as regards the means
of subsistence.
“If the reproductive function is to be intelligently controlled,” continues
Hegar, “above all it is necessary to devote attention to the age and health of
the parents; but occupation, dwelling, and general environment, must also not
be overlooked. Among the cultured classes of our Fatherland, people are
gradually learning to form sound opinions about these matters. Among the
working classes, on the other hand, especially among those engaged in factory
labour, the heedless gratification of the sexual impulse is responsible for untold
misery.” Hegar’s advice may be summarized as follows: If the marriage takes
place after the attainment of complete maturity, in the wife at twenty and in
the husband at twenty-five, and if procreation is discontinued in the wife at
forty and in the husband at forty-five to fifty, if between successive deliveries
the intervals necessary for the wife’s restoration to health are maintained, if
illness and states of debility are taken into account, if sickly, hereditarily-tainted
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