Anthony M. Ludovici
with discussion by Dr. V. E. Khanolkar, Lt.-Col. W. C. Spackman
and Lt.-Col. S. S. Sokhey
Marriage Hygiene 1 (1st series), 193435, pp. 393407
- p. 393 -
That the medical profession is baffled seems to be evident from the vast literature on the subject of the failures of modem midwifery. And the question suggested by its perusal is, "Are the medical men and above all the medical women, really in earnest about discovering a solution of the problem?"
There are many obscure causes of disaster in midwifery, which are inadequately considered by orthodox medicine I refer, among others, to a premature ossification of the female pelvis, hypoplasia of the generative organs vicious feeding before and during pregnancy, racial or statural disparity between spouses, delayed parturition, or post-maturity, 2 etc. I propose
1. The figures in this paragraph are from an article by Professor Blair Bell on Maternal Disablement in The Lancet, 30531.
2. The fact that "writers and teachers of obstetrics are unduly reticent" on this subject has been pointed out by a writer in The Lancet of 16634 See article entitled The Determination of Post-maturity.
At present the medical profession is largely responsible for the public impression that parturition, instead of being a normal function, is a physiological disaster. It ought long ago to have persuaded the public that the normal function of child-birth acquires morbid features only when there are abnormal or morbid factors present either in the mother or the foetus, and that these morbid features cast no reflection whatsoever on the normal function of childbearing as such.
Except for a few rare hints strewn throughout the literature hints which, for reasons into which I cannot enter here, never emanate from a female medical authority, medicine never seems to suspect that youth may be one of the essential conditions of normal, happy and efficient motherhood. On the contrary, when, as the result of Feminist tendencies, girls are set to study for one of the professions, or are sent to Oxford or Cambridge, everything is said and done to increase the sexual-monomorphic illusion that a girl between 19 and 24, who delays marriage, is as normal as the youth of the same age who is in a like case. I am not suggesting that our academic courses or curricula should be altered to allow girls of a more tender age to qualify for scientific or other careers, because I believe this would be impossible; but because it is impossible let us not delude ourselves into supposing that delaying marriage is the same for women as for men.
In regard to maternal mortality and disablement, however, it is most important to question the Feminist assimilation of the female to the male, according to which the same delay in marriage for girls as for men is allowed, if not applauded. And, when we find that to-day the average age of women at marriage in England and Wales is 25 years and 6 months, we may usefully ask ourselves whether this may not have some connexion with the persistently high rate of child-bed casualties.
Medical men, and above all medical women, 3 complacently and quite gratuitously assuming that human intelligence is increasing, argue that difficult deliveries are due to the increasing disproportion between the foetal head and the maternal pelvis. 4 But this can at once be disproved by a study of the
3. See Brit. Med. Journ. 221032. Ibid. 15230.
4. They should know that much commoner causes of trouble in midwifery are uterine inertia, rigidity of the soft parts, malpresentations, etc.
Having for reasons sufficiently elaborated in my recent book The Choice of a Mate, 8 concluded that the normal (not the average) age for the menarche in England is the 13th year, and that the healthier and more perfectly developed the girl, the more closely will she approach a norm centring somewhere between 11 and 14 years, I suggest that a wait of 12 years after normal mature virginal functioning has started, before the normal sexual cycle is completed, is much too long, and must lead to manifold undesirable conditions, not only in the organs of generation themselves, but also in the whole body of the female, including particularly those parts of her anatomy which co-operate in the act of parturition the bony structure of the pelvis, the adjacent and surrounding muscles, etc.
To compare a girl with her brother, and to say that if he can wait unmarried and remain unimpaired, until his 26th or even 30th year, "why shouldn't she?" is to display ignorance. Because whereas an unmarried man from adolescence onwards completes a whole sexual cycle every time he ejaculates semen
5. Journ. of Amer. Med. Assoc. 27134. p. 304.
6. See Knud Rasmussen: The Netsilik Eskimos. Rep. of 5th Thule Exp. Vol VIII Nos. 12. Copenhagen, 1931. p. 258; Diamond Jeness: The People of the Twilight (New York, 1928, p. 207); David Crantz: Hist. of Greenland (London, 1767, Vol. I, p. 161; Vol. II, p. 101); J. W. Powell (9th. Ann. Rep. Bur. Amer. Ethn. xxx 1892. pp. 414415) and many more.
7. J. W. Powell, (Op. cit. 1899, p. 291, and 1892, pp. 411412) and Alex. Armstrong: A Personal Narrative of the North West Passage (London, 1857. p. 178), etc.
8. John Lane, Ltd. (London, March 1935).
I do not propose to describe in detail here the marvellous provisions made by Nature for easy confinement, as these are well-known. Suffice it to say that except when some abnormal formation of the maternal pelvis or some abnormal proportion or position of the foetus occurs, every possible provision is made to render child-birth a painless, if not a pleasurable function. But let no one who is aware of a fact even so simple as the difference between tender-young and tough-old chicken be in any doubt as to the important part tender youth of the tissues plays in the mother. Even this simple statement is sufficient to convince anyone who is unprejudiced that obviously any long postponement of this physiological function of parturition must lead to an undesirable, if not dangerous setting and toughening of the parts. It is all very well to retort glibly, "Oh, but nobody nowadays considers a women of 25 1/2 years old and tough!" What is important to remember in this connexion is that the normal woman of 25 1/2 years who is childless has already waited 12 years without allowing her elaborate genital apparatus to function normally. This waiting cannot have improved the resilience of the soft parts of her genital tract. Neither can it have left the pristine resilience of her bony structure unimpaired.
The very fact that innumerable cases of normal painless parturition in civilized women not to mention uncivilized are recorded in the literature, should have been sufficient for medical men to conclude that since parturition is a fundamentally vital necessity for survival, it should be a pleasant or easy function, at least in conscious animals. Anything like the present state of this function in civilized countries with its accompanying terrors must be outside Nature's scheme or at least, not essential to the natural function as evolved in the species.
During this wait of 12 1/2 years between menstruation and first pregnancy, what happens to the normal woman? What parallels have we in other departments of life, where a structure ready to function is not used for 12 1/2 years? We know what parallels we have, and we know that the structure loses its tone, its strength, its efficiency.
What evidence is there that Nature herself resents this long
There is overwhelming evidence. First of all, we know that when the stimulative changes which occur in the organs of generation and the breasts of a woman at every menstrual period, are not followed by their normal sequelae (gestation, parturition and lactation), cancer of the ovaries, of the fundus of the womb, and of the breasts are of frequent occurrence, i.e., decidedly much more common in spinsters and sterile wives, or wives who have borne too few children, than in normal multiparae. Secondly, we know that in modern England and Wales, where spinsterhood or married sterility is now very common, and where even among fertile-wives lactation is a declining practice, cancer of the breast is a little more than nine times as frequent as in Japan, where like conditions are rare. 10
Thirdly, we know that benign and fibroid tumours of the uterus are more common in spinsters and sterile or relatively sterile wives than in, the normal multipara. This was already observed by Bayle in 1813. Virchow declared that "he had examined the corpses of few old virgins in which fibroids were not found, although in many women who had borne children the uterus remained free from them in extreme old age." 11
But we must resolutely look away from these extreme penalties of generative idleness in the female, and try to appreciate that if such extreme disasters are the final outcome of bad use or no use of the organs in question in a large number of cases, degenerative changes heralding these extreme disasters must occur long beforehand in the life history of these women changes which affect the organism and reduce its powers to function happily and normally. In short, I submit that, although the woman of 25 1/2 years who marries may not be a potential sufferer from fibroid or malignant tumours of the uterus, or of any other part of her generative apparatus, or of her breasts, changes have already occurred in her which are the herald of such disastrous consummations in many of her sisters, and which m her, at any rate, have at least modified her generative organs adversely for happy and effective functioning.
What evidence is there that undesirable changes do
9. Professor Whitehouse actually speaks of menstruation as "the disorderly action of a disappointed uterus," and Dr. V. B. Green-Armytage says it is the uterus weeping for the death of an ovum."
10. Tumours and Cancers by Hastings Gilford (London, 1925), pp. 383384.
11. Ibid. p. 385.
In a material of 6,000 school girls, it was found: (a) That at the early period of menstruation, a smaller proportion of girls suffer pain than later; (b) that the rise of incidence of pain is steady and gradual throughout the menstrual histories studied; (c) that the evidence of disturbed general health and happiness also increases progressively with length of menstrual history. 15
It is important to bear in mind that, as the data relating to child-birth in youthful mothers include all cases of child-birth in primiparae, the figures and statistics are grossly deceiving unless properly analysed. Why is this so? Because, into the general class of primiparae there naturally enter all those cases of first pregnancies which reveal their congenital abnormalities for the first time. This contingent is eliminated, or largely so, from the statistics of child-birth in older women. For instance, if the population contain 50 per cent of rachitic women, these will tend to appear in greater numbers among the young primiparae than among the older multiparae, because they will tend to have been eliminated in the senior generations. They reveal their abnormality at their first pregnancy. Consequently, the statistics of primiparae are adversely laden with such cases. And the same applies to girls and women with nephritis, genital hypoplasia and every other kind of abnormality which may lead to a disastrous first child-bed. 16
When, therefore, in spite of this adverse factor, we find medical men commenting favourably on the girl under 20 as a
12. Brit. Med. Journ.10928, p. 447. See also Lancet, (18733), p. 143, where Dr. Wilfred Shaw says: "commonly menstruation is painless until about the age of 19."
13. Brit. Med. Journ., p. 447, 10927.
14. Ibid. p. 448.
15. Lancet, pp. 5762, (5730).
16. Brit. Med. Journ., p. 49, (12730), and Journ. of Hygiene, July, 1929.
Dr. Peckham, reporting on births in negresses and white women in America, says: In both races the percentage of operative deliveries increases with age and in the white race reaches a point in the late thirties when it exceeds the spontaneous type. 18 Dr. John Harris, from a study of 160 confinements in young white primiparae and 340 young coloured primiparae, of ages 12 to 16 years, concludes as follows: "Based upon the study of 500 patients comprised in this report, it seems permissible to conclude that pregnancy and labour are attended by no greater danger to the young primipara than in older women. On the other hand, the duration of labour is actually shorter. As our figures show that the size of the children is not inferior to that noted in older women, and that abnormal pelves occur quite frequently this result must be attributed to the greater elasticity of the parts. Consequently, speaking from a purely obstetrical point of view, the ages under consideration appear to be the optimum time for the occurrence of the first labour. 19 Dr. K. Wepschek, of Czechoslovakia, examined the records of 96 girls who became mothers below the age of 17, and of 96 women who became mothers between 20 and 24, and "he found that the first group did not compare unfavourably with the second group, but that in some respects, particularly in regard to puerperal morbidity, conditions were more favourable for them than for the older group of patients." 20
In a general view of the German and French literature on adolescent primiparae in 1916, Dr. Alfred Specht comes to the following conclusions:
That in such cases the disorders of pregnancy are fewer than
17. Modern Marriage (New York, 1927), p. 52.
18. Journ. of Amer. Med. Assoc., p. 504, (6832).
19. From Dr. G. D. Maynard's Study in Human Fertility, (Biometrika XIV, p. 345).
20. Journ. of Amer. Med. Assoc., p. 1041 (23933).
As to the unfavourable results, he found they all come under the head of abnormalities not essential to youth, but of a land which would in any event have become noticeable at a first confinement i.e., eclampsia, rachitic pelves, weakness of pains (asthenia?) and premature births. 22
Speaking of the ease of the births, he says: "I am inclined to ascribe this as Bondy does, to the great elasticity of the youthful tissues, which shows a sharp contrast to those of the old primiparae, in whom rigidity of the soft parts so greatly prolongs labour, despite stronger pains and adequately large pelves." 23
It is impossible for want of space to reproduce here the details of this most interesting review, in which no less than twelve authorities, with their respective statistical tables, are quoted.
A point worth special notice is that Specht in his material of 81 girls of 16 and under found that in almost every case in his material the pelvic measurements exceeded the normal measurements for the age. 24 He offers no explanation for this, although he sees that the increase is progressive. Now it is a point often made by the medical profession that since the female pelvis goes on growing until the 20th or 21st year, a girl is not really ripe for marriage until she is 22 or 23. 25 But why? I have never yet found one gynæcologist of note able to answer why, although all of them repeat the parrot cry about completed development and right age for marriage with the utmost unanimity.
In England and France even as late as the 17th century marriages still continued to be consummated with very young women. Evelyn, as a man of 27, married a girl of 12, Pepys married a girl of 15, Charles I married Henrietta Maria when she
21. Zentralbl. Für Gynäkologie, (Leipzig, Sat. 22116. Ueber Die Geburt Bei Minderjährigen, p. 73).
22. Ibid. p. 74.
23. Ueber Die Geburt Bei Minderjährigen, p. 69.
24. Ibid. p. 66.
25. See for instance B. W. Johnstone (Professor of Midwifery and Diseases of Women, University of Edinburgh), who says: "The bony pelvis, for example, probably does not reach its full size and width about 22 or 23 years, when the young woman may be said to have reached the age of nubility and can with safety become a mother."!! (Brit. Med. Journ., 10927).
Thus we fail to find either in primitive or in civilized people the disasters which attend marriages consummated at a period in a girl's life which Dr. E. W. Johnstone would regard as "unsafe" for motherhood!
An idea that would never occur to any medical man is why should not childbearing soon after puberty be actually necessary to the normal ultimate development of the female pelvis? And may it not be one of the worst vices of our marriage customs that only an insignificant fraction of our womenfolk are able to develop their pelves normally by the athletics of child-birth?
Anyone who thinks these questions are nonsense, anyone who is shocked at the very thought of a girl of fifteen having a child and knowing about all "that dreadful side of life", ought to be in a position to give satisfactory answers to the following further questions:
(a) If Nature intended child-birth to begin only when the maximum development of the pelvis was attained in a virgin, why does readiness for conception, readiness for pregnancy, readiness for motherhood, in fact, occur ten years earlier?
(b) If it is really detrimental to a race that early conceptions should occur, why has not the age of puberty become delayed through evolution?
(c) If desire and fulfilment only await opportunity among human beings and animals, why is it unreasonable to suppose .that the appearance of sexual passion should coincide with the best age for marriage 26 ?
26. The basis for these questions may be found in the work of that exceptionally enlightened medical man Dr. S. D. Maynard. Op. cit. p. 340.
This is one of the most important among the many causes of maternal mortality and disablement, though at a time when the ridiculous custom has spread of calling even women of thirty "girls", the very medical profession itself hushes up the fact.
When, therefore, we find two authorities as pre-eminent as Drs. Thomas Watts Eden and Eardly Holland saying quite conservatively that "from eighteen to twenty-three is the age at which the first labour may be expected to run the easiest and most favourable course," and when, despite their conventional conservatism, and impelled by the facts, they add, as if it were an after-thought: "From sixteen to eighteen years of age the difficulties are not greater than normal," 27 and we remember that 25 1/2 years is the average age of marriage for women, and that 26 to 27, therefore, is the average age of the primipara in England i.e., 3 to 4 years above the highest limit of the optimum years for labour according even to Eden and Holland!
27. A Manual of Midwifery (London, 7th Edit., 1931), p. 225.
In view of the above, therefore, I submit that the primipara of 26 1/2 or 27, which is the average today, is relatively senile, that her relative senility is a principal cause among many of the difficulties of parturition, and that consequently it is impossible to exaggerate the importance of a youthful marriage to women.
I can hear the infuriated feminists protesting, as they always do, when it is a question of health and happy functioning, "but what about economic conditions? Where should we be if every girl of 15 started breeding as you say she should?"
Apart from the fact that I have already answered this merely obstructive question in great detail in my Night Hoers, let me remind those who are so glib with their economic objections that I never hear any economic objections raised today against increased expenditure on human rubbish on cripples, incurables, mental defectives, lunatics, the deaf and dumb, the blind, the tuberculous and the syphilitic. But, when it is a question of giving the healthy and normal a chance of leading normal lives, and making humanity happier and more fragrant, every envious spinster in trousers or skirts in the Empire, croaks: "Oh, but what about economic conditions!" There is obviously a deep prejudice here, and it is one in favour of the bitter smell of corpses.
To round off the argument and carry conviction, I must as briefly as possible face the question of the effect of early marriage of women on the offspring.
In the first place, according to Dr. Fritz Lenz the famous geneticist, "the belief that mental maturity is of importance for the favourable endowment of children is a Lamarckian superstition." 28
Certainly, in the great men, who we know were born of adolescent mothers, there is no sign of any stigma due to the age of their female parent. Edward I and Edward III were both brilliant members of the Plantagenet dynasty. Henry VII was a most gifted man. Confucius the issue of a marriage between a man of 70 and a girl of 17 was a conspicuous genius. Dürer and Weber, both the sons of adolescent mothers, were remarkable men, as was also Goethe, the son of a "schoolgirl" mother (in the English sense). Galton found that
28. Menschliche Auslese Und Rassenhygiene (Munich, 1931), p. 494.
Now the evidence that the average age of women at marriage has greatly increased in England since the Middle Ages and the Renaissance is overwhelming. Overwhelming too is the evidence that it has increased ever since 1870. 36 To argue, therefore, that the difficult confinements associated with "relatively senile" primiparæ are necessary for the production of the great men of our "great and glorious Age" is nonsense, and those who are inclined to take this line had better first engage in a close study of European biographies.
29. Inquiry into Human Faculties (Dent's Edit.), pp. 209211.
30. Op. cit. p. 340.
31. Eugenics Congress, 1912, pp. 115117.
32. See for instance Amer. Journ. of Diseases of Children, p. 764, Oct. 1934.
33. Op. cit. p. 54.
34. Op. cit. p. 345.
35. Klinische Wochen-Schrift (i. Jahrgang. No. 51. Einfluss von Alter der Mutter und Gebürtigkeit des Kindes auf dessen Entwicklung). The investigation dealt with a material of 634 children born in wedlock in Rostock.
36. See my tables in The Choice of Mate, p. 448.
The people in most countries are not influenced in the choice of their future partners in life, or as regards the age of contracting marriage or even the optimum age for commencing their sex life, by the current medical opinions on the subject. Mr. Ludovici is, therefore, giving the medical men whom he does not like individually or collectively, a much greater importance than they deserve in these sociological questions. An average man or woman marries when he; or she can afford it or when he or she is driven into it. As regards the bearing of children few married couples plan the time of the birth of the first child; many look upon it with despair as the necessary consequence of a conjugal life. It is likely that in a differently planned society, the bearing of children and their care will be a matter of great importance to the state and the whole question will be studied with the care and thought it deserves. It is conceivable that only suitable people will bring forth children, under optimum conditions for the mother and the child. But until such time the advocacy of a very early marriage, if accepted by the people can do more harm than good.
An average woman nowadays does not believe herself to be designed solely for the purpose of bearing children. Her ancestors in former times, and Mr. Ludovici, the Nazis and Fascists in modern times look upon women as child-bearing machines, but the majority of young men and women are not satisfied with this concept of womanhood and a young man when he marries does not seek only a mother for his future children, but also a comrade and a companion in his everyday struggle in life.
Some of Mr. Ludovici's conclusions derived from his extensive reading are such as may be expected from a lay person who deals with a subject with which he does not come in practical contact. Only two of these may be considered here.
Parturition has never been a "happy, pleasant" and pleasure giving function that Mr. Ludovici would like it to be. The pain and travail associated with child-birth have been remarked by the oldest workers on the subject. An easy child-birth in a normal woman very often means a child-birth which is not associated with an undue feeling of pain. This is very often due to two things. Firstly a relative insensibility to pain, which is noticeable in most primitive, hard-working people, and secondly a youthful and active physique, so rarely seen in town dwellers. One of the best examples of easy child-birth when uncomplicated by other conditions is seen in the jungle dwellers in the Western Ghats in India. The women walk several miles to the forest to cut wood and carry it back to villages every day. Pregnant women carry on this daily routine sometimes to the very day when they are surprised with the birth of a child in the jungle. The mother in that
The transition from childhood to womanhood is not effected overnight and the fact that a girl has started to menstruate does not mean that she has become perfectly adapted for child-bearing. As a matter of fact in countries where women occasionally become pregnant within a year after their first menstruation, it has been found that the child is very much undersized and remains a weakling for a long time. For instance in Bombay the average weight of such children at full term is only about 4.5 lbs. as against 5.6 lbs. of other children. There are no accurate data available as regards the physical and psychological traumata resulting from early child-birth and it would be inadvisable at this stage to express a definite opinion on the subject. It might, however, be said that though cervical, vaginal and perineal tears are much less frequent in child-mothers, a histological study of these parts shows that the resiliency and distensibility of these parts is not very much altered between the ages of 14 and 22 years."
Lt.-Col. W. C. Spackman, F.R.C.S.E., F.C.O.G., I.M.S., Professor of Gynæcology, Grant Medical College, writes: "In the article by Mr. Ludovici, it is contended that extreme youth is the best time for a girl to commence bearing children and presumably that, if this plan were followed, a notable fall in the frequency of ill-effects resulting from child-birth would be apparent; and that the female pelvis will only reach its optimum anatomical and physiological development by 'the athletics of child-birth' performed during adolescence.
It is not clear why the whole medical profession is held responsible for what is manifestly a sociological and economic fault (the progressively later age at which women marry) which I believe the great majority of medical men deplore. Fortunately in this arraignment of the medical profession the counsel for the defence is also Mr. Ludovici who quotes freely from the works and opinions of a great variety of eminent medical men of many countries in favour of youthful marriage.
It would be held, I believe, by the majority of gynæcologists who see much of the effects of juvenile child-bearing that it is rarely from a physical point of view that these children are damaged by child-birth unless, as sometimes happens, pregnancy occurs whilst the pelvis is still much below adult size. But there is a mental shock and strain suddenly
I believe Mr. Ludovici is adopting an extreme view about the optimum age for a girl to bear her first child deliberately with the good old idea of bargaining with the opposition and so arriving at a more reasonable average. It may be conceded that if there be no undue mental and economic strain the first child can very easily and safely (but not painlessly) be borne by a girl of average maturity a year or two below 20, but as he has not, as I suppose, attended women in pregnancy and labour he may not realise the greater fortitude exhibited by a woman of 25 and upwards over a girl of 16 or less. As for applauding the mother of 13 or 14 years, I hope this is his compassionate and sentimental heart rather than his considered opinion, for these are but children in mind and rarely more in body."
Lt.-Col. S. S. Sokhey, M.D., I.M.S., Director, Haffkine Institute, writes: "As regards Mr. Ludovici's article, I am of opinion that it does well in drawing attention to a very important subject 'Youthful Marriage.' But it is to be noted that there are no worth while scientific data on the subject in so far as the physical aspect of the question is concerned. That being the case, medical practitioners generally reflect the prejudices of the community in which they happen to practise. There is need for a scientific investigation of the subject. But from the psychological aspect I do not think there are two opinions on the subject. Sex starvation during adolescence, when sex urge is very powerful, does very definitely produce mental trauma, resulting in neurosis or at least generating in individuals a wholly warped outlook on sex for the rest of their existence. With contraceptives easily available it would be to the well-being of human society if the satisfaction of sex urge is not impeded during adolescence."