thus studied by a medical man, who has thus possessed himself of the key to his future maladies.

In these studies of infantile phenomena none is more interesting or important than that of the vasomotor apparatus. There is often a congenital disequilibrium that sometimes is startling in its manifestations. It is always of moment. One child will show perturbations of wide range from causes that may not affect any other of a large number of its fellows. There is meaning to a pulse of 100 in one that will not apply to a pulse of 120 in another. The pulse tension denotes more than fever, toxemia or temper, at times.

The best student here is the mother. Every prospective mother should have a training in medical science to fit her for her duties and opportunities. She is apt and willing, most anxious and quick to learn. Let her education be a part of the duty of the family physician, who should prescribe the books and elucidate their obscurities to her. She will see far more than he, and give warning in advance that will render many a perilous attack abortive.

Many advances in the management of children have been made by such studies. We do not now allow a child to drift into chorea before sending for the doctor to cure him, but when it commences to attract attention by grimacing, we have its eyes examined and correct the accommodation with glasses. We do not allow a boy to fall hopelessly behind at school for lack of attention to the obstructing adenoids and tonsils. Nor do we sit idly by and permit bad sexual habits to be aroused by the neglect of circumcision when that is indicated. Every intelligent mother now knows how much temper, nervousness and general naughtiness are due to digestive derangements, and many physicians are beginning to realize this. In time we may possibly learn to estimate correctly our children's intellectual capabilities and to gauge the extent and rapidity with which they can absorb and assimilate instruction.

The introduction of lecithin by Danilewski and its application by Cotton to certain forms of maldevelopment have opened up

a line for useful observation that may prove fruitful. How many other forms of imperfect growth may this remedy reach? Who can tell its limitations and possibilities, until it has been tried out in all promising directions? Add it to the well-established methods of developing the backward intellect and the unsymmetrical frame, and we may have in this curious remedy a most valuable aid.

Whenever we begin to consider the directions in which the most promising paths for advance are opened, we come back to that ideal relation of the physician with the community which we have heretofore advocated. It is during health, and not after illness has occurred, that our best work may be done. Prevention is our duty, and the future doctor will be a director during life, not a mere doser during sickness.

THE DRINK PROBLEM

Among the many excellent papers read at the last meeting of The Illinois State Medical Society, none was more favorably received than that of Dr. Charles B. Johnson of Champaign, upon "The Health Conscience and the Drink Problem." In this paper the author reviewed in detail the terrible devastation wrought by alcohol, telling of its influence upon the individual and collective health, of how it produces a predisposition to disease, of its alliance with immorality, and how it is undermining the very foundations of society.

While some of the statistics given by Dr. Johnson may be questioned, yet his general conclusions are irrefutable. It is certainly a gratifying index of the change of opinion concerning this problem that his deductions were practically accepted unquestioned, and his presentation received with an enthusiasm accorded to no other article read at this meeting of the society.

Instead of these attacks and counterattacks, this hot strife for personal ascendency, the strong men of our organizations might far better concentrate their efforts upon the solution of the great medicoeconomic problems, such as that of alcohol and the social evil. Are they afraid to tackle something big?

of having them too soon. You will find that it isn't the fear of supporting a wife for two often can live as cheaply as one, and if the wife is a good one, even cheaper but it is the fear of the children, whose possible number is indefinite. It is not the fear of supporting two, it is the fear of the possible ten. The universal dissemination of the knowledge of contraception would have a wonderful effect in this respect. Let us see:

1. Such knowledge would induce many men to get married much earlier than they otherwise would, and it would decidedly diminish the number of bachelors and of old maids; and this would have a decided effect on the diminution of prostitution and, consequently, on venereal disease.

2. Numberless women exhaust their vitality and become chronically invalided by too frequent child-bearing and lactation. Prevention would obviate this evil. 3. Numberless women are today chronic invalids on account of employing improper means of prevention. Freedom to discuss this question would put the proper means into the hands of married women and this evil would be obviated.

4. Numberless women have killed themselves, have been killed, have been driven into premature graves by abortions or attempts at abortion. This is a terrible evil. And whenever I hear of a case of a woman dying from an abortion, I blame not the woman, I blame society or the State, and I feel like sending those responsible for our brutal laws concerning the prevention of conception to the whipping post. Prevention would obviate this terrible evil, this terrible crime which society commits against the female sex.

5. Numberless men are today pitiable sexual neurasthenics from coitus interruptus, which they practise through ignorance of better methods of prevention. The knowledge of prevention of conception would do away with this evil.

6. Many men, knowing no means of prevention and fearing to impregnate their wives, are forced to go to prostitutes. In fact, I know and you know of wives who encourage their husbands in this practice only to avoid the terrible ordeals

of repeated pregnancies, labors, lactations, and bringing up of children. What the results of such practices may be it is easy to foresee. A knowledge of the prevention of conception would do away with this evil. 7. This point may seem trivial to you. It does not seem trivial to me. How many women have you known who had talent for singing, for painting, for poetry and literature, and in whom the arrival of children in rapid succession crushed out every ambition, deadened every desire, shattered every illusion? Children are a great thing-in measure-but their arrival at inopportune times or at too frequent intervals has rapidly metamorphosed many a high-strung, high-spirited girl into a spiritless, apathetic drudge. You who consider women good for nothing else except for child-breeding, may consider this of little importance. To me this is one of the greatest tragedies of life.

8. There are thousands of women whom to impregnate is almost equivalent to murder. I refer to women with advanced heart or kidney disease, with a tendency to eclampsia, with narrow and deformed pelves. I say, to make such women pregnant often means pronouncing the death-sentence upon them. The knowledge of prevention would save many such women from premature graves. Isn't it worth while?

9. Thousands and thousands of children, being borne by their mothers unwillingly, in anguish and in anger, are born into the world with an unstable mental and physical equilibrium, and being besides improperly brought up, on account of the mother's inability to attend to too many, forever after remain a burden to themselves and to others. The knowledge of prevention would obviate this evil.

10. We now come to an extremely important point. There are millions of married couples of whom either the husband or the wife, or both, are afflicted with some disease of a hereditary character. As examples of such hereditary diseases may be mentioned syphilis, epilepsy, insanity, perhaps also cancer. And people with such diseases, or with tendencies to such disease, for a long time yet will

continue to marry. (It will be centuries before people will be so imbued with the welfare-of-the-race idea that they will be ready to sacrifice their individual happiness and give up the object of their love and remain single whenever the abstract good of the race may demand it.)

What shall we do with such couples? Shall we permit them to breed syphilitic, epileptic and insane children? Shall we still further increase the burden of humanity, and shall we permit the number of defectives and degenerates to increase without any restriction? Surely not. So, what else can we do with such couples except to teach them fully how to avoid having children?

It Is Not Malthusianism

When I discussed this subject recently with some friends, one of them said: "Why, you are simply preaching Malthusianism." Now, first, if I were, that would be nothing against it. There will be a time when Malthus' essay on population will be taken down from the dusty shelves where it has been relegated for a century and will again be studied with care and attention. And it would do you no harm to read it now and try to learn something at first hand, and learn something about Malthus, who has been lied about and misrepresented, as all reformers and intellectual pioneers are.

And, second, I am not preaching Malthusianism. Malthus cared chiefly for the future. While I also care for the future, I care more for the present, and if we take care of the present, the future will take care of itself. Then, the only remedy that Malthus proposed or considered permissible was self-restraint, absti

nence.

We know now that, from a practical point of view, that remedy is worthless, while the remedy we propose is an efficient one, in fact the only one that would be readily accepted by the vast mass of the people.

Bear in mind that the chief theme of my discourse are the poor, the relatively poor, and those who for certain mental or physical disabilities are unfit for parenthood. It is they who should be taught

the heavy responsibility of parenthood and the means of avoiding it. Those who are rich or well-to-do and are free from transmissible mental or physical taints may have just as many children as they wish. Not only as many as are considered proper by Professor Emeritus Eliot, namely, eight, but three times that many. So long as the mother has no objection to almost continuous pregnancies and lactations and so long as the parents are able and willing to care for and bring up a large progeny, nobody will say them nay. Later on, when the earth is really populated to its limit, the State may have something to say even to the rich, that is, if there will still be a rich and poor at that time; but that is not our concern. We are dealing with the now and here and not with the future or the hereafter.

The Morality of Having Few or No Children

I have answered the objections to the prevention-of-conception teachings and have shown the great benefits which the knowledge of prevention would confer upon mankind, the great evils it would obviate. We will now discuss the general ethics of small families, the ethics of having few children or none at all.

Of course, I take decided issue with one of our energetic, but somewhat superficial and somewhat blatant national leaders, who would stamp every childless couple as villains of the deepest dye, as men and women deserving the execration of all right-thinking people. I admit that there are people in whom the decision not to have children arises from selfish and perhaps ignoble motives. They don't want any children because they don't want any trouble, they don't want their social pleasures disturbed, they want fun and material comfort. We cannot respect such people very highly, but, as stated previously, the race is better off without their children; for, if they had children, they would not be properly brought up and the children. themselves would probably grow up selfish, ignoble prigs. But in the vast majority of couples the determination to have one or two children only or even none at all arises from very high motives, and a low

birth-rate is, in general, not a sign of a low morality, but of a high morality, of a high intelligence, high sense of responsibility.

You will find that the stupidest, the most ignorant, the most wretched nations have the highest birth-rates, while the most advanced, the most civilized nations have the lowest birth-rate. As examples, it is sufficient to mention China and Russia on the one hand and France on the other. And in parentheses I will say that, if you have become imbued with the puritanical idea that France is degenerating, decaying, you should get that idea out of your head, for it is a false idea, and you certainly do not wish to harbor false ideas. In everything that makes life worth living-I have said this before-in general culture, in advanced, liberal ideas, in sculpture, in painting, in literature in all its ramifications, in science, France still stands at the head of nations. There is only one other country that stands fully abreast of France, and that country is no, not the United States, not England that country is Germany. And in Germany the birthrate is also diminishing.

The Declining Birth-Rate

For instance, only in today's Journal of the American Medical Association (January 21, 1911, p. 208) we find an item entitled "Reduction of the Birth-rate in Prussia." From that highly significant item we learn that the ratio per 1000 child-bearing women, i. e., between the ages of 15 and 45, has declined (leaving out fractions) from 174 in the quinquennium from 1876 to 1880, to 161 for 1896 to 1900, and 154 in the period from 1901 to 1905. In the cities the ratio has declined from 160 to 129. In the rural districts, the ratio of fertility for the same period was 182, 183 and 178, respectively.

As you see, it is the falling birth-rate in the cities which occasions the marked diminution of the general fertility. This phenomenon is especially notable in Berlin and the cities of the Province of Brandenburg. The fertility ratio in Berlin sank from 149 in 1876 to 1880 to 88 in 1901 to 1905, a reduction of more than 40 percent.

In short, you can take it for granted that the higher the civilization, the lower the birth-rate; and, within limits, this will continue to be the case until our socialeconomic system has undergone a definite radical change.

And it is natural it should be so. For the responsibility of bringing a child into the world under our present social and economic conditions is a very great one. The primitive savage or the coarse ignorant man does not care. It does not bother him much what becomes of his offspring: if they get an education, if they have what to eat, if they learn a trade or a profession, well; if they don't, also well; if they achieve a competence or a decent social position, he is satisfied; if not, he can't help it. God willed it so.

But, on the other hand, the cultured, refined men and women look at the matter differently. The thought of bringing into the world a human being which may be physically handicapped, which may be mentally inferior, which may have a hard struggle through life, which may have to go through endless misery and suffering, fills them with anguish. For this is not a beautiful world. Let the softheads, the unthinking, the reactionaries repeat that this is a kind world, a good world, the best of all possible worlds. We who have thrown off all illusions, we who despise the untruthful fairy tales, we who demand. to know the truth as it is, we who dare to face the facts as they are, know that this is not so.

We know that we have evolved from the jungle, and we know that this is a mean world, a cruel world, a hard world, a world full of tears, of heartaches, of degradation, of weariness, of never-ending drudgery; for many it is a world of misery without beginning and without end. It may be a beautiful world to some, but their number is so small as to be almost inexpressible in percentages.

The Dismal Life of the Hopeless Millions

He who can not see should not be blamed for his disability. A person should not be blamed for being affected with congenital or acquired blindness. But neither