The Thesis of the Book and the Position Reviewed
The opponent of Birth Control to-day has a twofold task of immense difficulty. He has not only to face and, if possible, independently to solve the problem of over-population or the evils that appear to result from it, but he has also to show valid reasons for rejecting a certain attempt at a solution of this problem which has achieved very wide publicity and owing to the apparent efficacy and simplicity of its means and the plausibility of the arguments advanced in favour of it gained very general public, and some scientific, support.
To attack Birth Control without attempting to offer some solution of the problem of over-population, or of the problems associated with it, or without recognising that there are such problems, is comparatively easy so easy that it is a task which quite a number people have accomplished with some brilliance. But it seems to the writer that this sort of attack is not only out of date, but also deplorably short-sighted. It cannot hope to win much sympathy with the majority of thinking people to-day, and, in view of the urgency of some of the problems connected with
But, having said so much, and having acknowledged the difficulty of the situation with which we are faced, we must not allow undue credit to fall to the lot of Birth Control, simply because it happens to come to us in extremis, as it were, and to offer us a panic solution of our panic. There is no need for us to be hypnotised by the contemplation of our dilemma. Due allowance should be made for the fact that we are rather at our wits' end about our present condition, and that therefore we may be too ready to look with favour on the first apparent solution of it that is offered. Besides, in view of the many grave disadvantages which even now, despite our imperfect knowledge of the physical laws involved, may be shown to result from Birth Control, we should remember that we are entitled to oppose its too general acceptance on the simple grounds that its very need may have arisen through ills that have nothing whatever to do with over-population per se, and that in applying it as a remedy, it may not only distract our attention from these ills, but also bar the way to their correction by more radical and less harmful methods.
While, therefore, the object of this book is to contest the whole position of the advocates of Birth Control, particularly of those who would make the knowledge and use of contraceptive methods general, and who regard such methods as essential for the welfare of the nation, it is hoped to achieve this object more
It is true that doctors are more or less agreed concerning the pathological conditions in which the use of contraceptives is indicated, and medical authorities of high standing have dealt exhaustively with this matter in various publications. 1 But it will be enough in the present work only to mention this aspect of the question; for, apart from the fact that it would
1 For a good summary of the medical grounds for Birth Control, see the contribution made by Arthur E. Giles, M.D., B.Sc., F.R.C.S, to Medical Views on Birth Control, edited by Sir J. Marchant, K.B.E., pp. 707. See also this same doctor's address on Birth Control, delivered before the Manchester Medico-Chirurgical Society on January 12th, 1927, and reported in the Lancet of January 22nd (pp. 165, 166, 167). See also Lady Florence Barrett's contribution to the Practitioner, July, 1923.
When once, however, we leave pathology, and begin to think of contraceptive practices for mankind in a state of health, then the medical aspects are confined to the question of the effect of Birth Control on normal people, and the rest belongs to Biology, Sociology, Ethics and (in the view of many) to Religion. And it is precisely in this limited sphere the question of the effect of Birth Control on normal people that the weight and value of the medical ruling is largely diminished owing to the grave lack of unanimity among the qualified authorities. To say that the medical profession is so deeply divided on the question that one-half or even only one-third, opposes Birth Control, while the other half or two-thirds supports it, would not be true; for there has been attempt to obtain the suffrages of the whole profession on the matter, and, according to Lord Dawson of Penn, "there has been no systematic investigation of contraceptive methods by the medical profession this country." 1 Groups of doctors have been con-
1 Quoted by the Archbishop of Canterbury in the House of Lords, April 28th, 1926. See Parliamentary Debates, House of Lords, Vol. 63, No. 29, Col. 1024.
1 See Parliamentary Debates (Vol. 63, No. 29, House of Lords, April 28th, 1926, Col. 1034), where are mentioned: Dr. H. R. Andrews, Senior Obstetric Physician, London Hospital; Dr. Hector Cameron, Physician to Guy's Hospital; Mr. Bellington-Smith, Senior Obstetric Surgeon to Guy's Hospital; Dr. Ernest Ware, Senior Surgeon, Hospital of St. John and Elizabeth; Dr. A. E. Giles, Senior Surgeon, Chelsea Hospital for Women; Dr. R. A. Gibbons, Physician to the Grosvenor Hospital for Women; Dr. T. S. McCann, Surgeon to the Samaritan Free Hospital for Women, and Lady Barrett, Dr. Mary Scharlieb, and Dr. Louise McIlroy.
2 See the Lancet's report of the meeting of the Royal Society of Medicine, Section of Obstetrics and Gynæcology, May 14th, 1921, p. 1024.
1 See Report, p. 139.
2 Ibid., p. 247.
The spectacle of such a conflict between thoroughly expert men, not only over the fundamental problem concerning the harmfulness or harmlessness of Birth Control, but also over the value of a particular contraceptive practice, is apt to shake our faith in the value of medical views on Birth Control, and to make us wonder whether the medical contribution to the discussion ever rises above the level of mere "opinion."
As a further example of the disagreement of eminent medical authorities on this whole question, the articles contributed to the Practitioner in July, 1923, are very instructive. Sir Maurice Abbot-Anderson, in the first article, recommends either the asepticised sponge or else the combined use of some form of soluble pessary, and on the part of the male of the condom. 3 Lady Florence E. Barrett recommends the condom and deprecates the use of the quinine pessary (a) because it is not safe, and (b) because it may bring about sterility in the future. 4 Dr. A. Louise Mcilroy recommends the condom and condemns the quinine pessary. 5 Dr. J. S. Fairbairn recommends the quinine pessary. 6 Dr. W. E. Fothergill recommends condoms or pessaries, according to whether prevention is essential or merely desirable. 7 Dr. Eric Pritchard recommends the quinine pessary with subsequent douching. 8 And
1 See Medical Views of Birth Control, pp. 856.
2 See Birth Control, by Dr. Halliday G. Sutherland (p. 84).
3 p. 9.
4 pp. 22, 23.
5 pp. 29, 31.
6 p. 38
7 p. 52
8 pp. 601.
So that on the question of the kind of contraceptive which is supposed to be harmless or best, out of seven eminent authorities, two recommend the condom, two recommend both the condom and the soluble pessary, one recommends the quinine pessary unreservedly, and two recommend it under certain conditions, two condemn the quinine pessary, and finally one advocates the Dutch pessary. While on the general question of the harmfulness of contraceptives, one, Dr. Henry Corby, says: 2 "I am thoroughly convinced that the use of contraceptives is distinctly dangerous to health"; another, Sir Maurice Abbot-Anderson, says: 3 "Any deviation from the natural consummation of the act as dictated and intended by Nature must be detrimental in some degree to both parties contracting"; and a third, Dr. J. S. Fairbairn, says: 4 "Apart, then from local diseases from bad methods and psychical effects from over-limitation of maternity, no ill results to health can justly be attributed to birth control." Dr. Norman Haire, on the other hand, who recommends the use of the Dutch (Mensinga) pessary, writes elsewhere 5 upon the general question of contraception as follows:
"To-day the methods of contraception most commonly used are untrustworthy and even harmful. There are trustworthy and harmless methods, but the public finds it difficult to learn them. When married people ask their medical
1 pp. 749.
2 p. 64.
3 p. 9.
4 p. 39
5 See Hymen, pp. 812.
Now Dr. Haire is an eminent authority on the subject he discusses. He came forward in September, 1926, with the records of 4,000 cases, 1 in which he had had to advise on contraceptive methods, and there are probably few medical men who can base their views on an experience so wide and so varied. He recommends the appliance known as the Mensinga, Dutch, or Haire pessary, and condemns most other methods, and was the authority consulted by the Malthusian League.
But let it not be supposed that his position is uncontested. Marie Stopes, who, despite the fact that she has no medical qualifications, possesses not only a very wide practical knowledge of the whole subject of contraception, but is also presumably in a position to avail herself of the best medical advice, is strongly opposed to Dr. Haire's method of contraception, and
1 See "The Comparative Value of Contraceptive Methods," read before the International Sex Congress in Berlin.
"Some who use it profess great satisfaction with it, but there is a good deal of evidence that it is very unreliable and very difficult to secure absolutely in place in order to maintain its position. 1 . . . The size used has to be so much larger than the natural size of the unstretched vaginal canal that the tendency is to expand the canal unduly, which is neither good for the man nor good for the woman. 2
"This cap is still pressed upon the public by the Malthusian League regardless of the objection noted above and of another and still more serious one: the metal band which forms the spring of the cap, as used by Malthusians, is not welded but is bound by rusting wire with rough-cut ends which may cause lacerations." 3
Finally, says Marie Stopes, still referring to the Dutch pessary: "I condemn it for general use and consider it unwholesome owing to the stretching of the vaginal canal and the resultant evils." 4
These strictures do not prevent her, however, from recommending Dr. Haire's pessary when three specified sets of circumstances are present, 5 though she is careful to add that her recommendation applies only to the Dutch pessary when properly made.
1 Op. cit., p. 160.
2 Ibid., p. 161.
3 This objection seems to be feeble, as it is one which would disappear if a slight modification were made in the manufacture of the Dutch pessary. This comment applies to Marie Stopes' further criticism of the Dutch pessary on p. 165 of her book. Dr. Haire informs me that there is no recorded case in medical literature of such a laceration resulting from the use of this appliance.
4 Op. cit., p. 165.
5 See pp. 188, 189 and 191 of Contraception.
"There are a small number of small rubber caps of slightly different form, but of the same main type, and all are unsatisfactory. On the same principle are constructed a number of Ôsmall occlusive pessaries,' or 'small black pessaries,' of which perhaps the best known is the Pro-Race advocated by Marie Stopes. These consist of a small cap of rubber with a thickened rim, and may best be compared to a diminutive copy of the man's hat known in England as a Bowler and in America as a Christie. This cap is supposed to fit on the cervix as a thimble does on the finger, and to adhere to it by suction. The device is made in three sizes. I have had a wide experience of this type of pessary and, until five years ago, used to recommend it, but in my experience it was very unsatisfactory. The majority of women find it difficult to fit at all, owing to the ignorance of their own anatomy. One patient of mine, who is herself a medical woman with two children and quite normal, is unable to use it even with her professional knowledge of her own anatomy. Further, the cervix is so often scarred or misshapen by previous confinements that even a gynæcologist cannot fit one accurately. In the few cases where this type of pessary is applied correctly and fits accurately, it prevents the escape of discharge from the cervix, damming back the secretions which are liberated at the female orgasm as well as any unhealthy discharges which exist. In the presence of the latter, absorption may occur, with consequent danger to the woman's health."
1 Op. cit., pp. 203 and 13857.
2 Berlin paper already referred to.
"Unless our profession devotes far more attention to the problem of Contraception, the Birth Control movement will remain in the hands of unqualified lay persons, quacks and charlatans, and non-medical 'Doctors,' who write erotic treatises on Contraception, conveying misleading information in a sexually stimulating form."
These conflicting opinions have been given, not in order to cast any reflections upon the honourable profession to which the above authorities belong, or to which they may have had access, but to demonstrate the fact that medical opinion on Birth Control, as well as the opinion of such experienced lay workers as Marie Stopes (who, as we have pointed out, must be able to have access to the best medical authorities), cannot in the present state of knowledge be regarded as a reliable guide. At all events they compel us to avoid as arguments against Birth Control, or against any particular contraceptive method, all medical or quasi-scientific views which have not the unanimous support of the profession, and to disregard altogether conclusions that have been based by special pleaders upon medical views of this kind. Above all they compel us, merely as a matter of caution, to pause before we recommend contraceptive practices, until such time as there is more unanimity among expert medical men, regarding the effect of such practices upon those who adopt them.
1 p. 1.
2 p. 10.
Thus the writer will adduce the conclusions of medical science only when (a) there appears to be no doubt about the general validity of the conclusions given, and they have remained unchallenged, as, for instance, those regarding the occasions when contraceptives are universally recognised as necessary, or (b) sufficiently cogent evidence is advanced by any particular scientist in support of the general conclusion at which he has arrived. This will greatly simplify not only our own task, but also that of the reader; for there is no subject which has suffered more than Birth Control from having the plain and elementary principles which underlie it obscured and confused by interminable and often acrimonious pseudo-scientific discussion, and by the expression of views which, despite the qualifications of those who have expressed them, frequently do not rise above the level of mere personal opinion.
If we approach the question along these lines, therefore, and for the present leave out of account,
From the history of the Birth Control movement in recent years that is to say, ever since the publication of Dr. George Drysdale's The Elements of Social Science in 1854, 1 and the formation of the Malthusian League in 1877, it is clear that the prevention of pregnancy for the purposes of limiting the number of children was first advocated as a means of reducing population. This is the principal object of the movement, and although other reasons for recommending Birth Control have been added since, we must regard over-population as the chief evil against which contraceptive practices were originally and are even still advocated by most of the birth-controllers. Many eminent modern birth-controllers, like their predecessors of last century, believe that this country is over-populated, and that many evils which now appear to result from this over-population will vanish if the population is reduced. Let us try to follow the argument of the modern birth-controller. 2
1 This was published anonymously.
2 Most of the facts and figures in this summary of the birth-controller's reasoning have been taken from Mr. Harold Cox's The Problem of Population. Mr. R. B. Kerr's little booklet, Is Britain Over-Populated? (both Mr. Cox and Mr. Kerr are
He points out that in spite of , what ill-informed alarmists may say concerning the declining birth rate, the population of Great Britain is still growing at a tremendous pace; for whereas it stood at 41,714,167 in 1914, in 1926 it was 43,970,300, although a devastating war had occurred meanwhile. And he reminds us that the decline of the birth rate by no means implies that there is likely to be any reduction in the population; for when a population is increasing, the rate of increase inevitably tends to decline.
convinced birth-controllers), and the essays by various authors, published in the Report of the Fifth International Neo-Malthusian and Birth Control Conference (Heinemann, 1922).
1 It is true that density of population is no sign of over-population, because the food supply has to be considered, and a fertile country can afford to be much more densely populated than an infertile one. Nevertheless, if supplies were uniformly proportionate to superficial areas, density would be a sign of over-population, and the birth-controller may contend that international trade and industrial production do not make up for England's restricted agricultural output.
The increase in population in England and Wales for the year 1921 amounted to 390,000 (which figure represents the excess of births over deaths), and, seeing that the population before this increase stood at 36,070,492, it seems fairly obvious that, despite the proportional decline in the actual birth rate per 1,000, we cannot hope indefinitely to accommodate and feed our people if this normal increase remains at anything like the present figure. 2 At all events, if this annual increase is maintained, we can hardly look forward to a future free from pauperism and unemployment, or in which the standard of living among the masses is to be very much improved.
"Unless our old industrial and commercial system," says one writer, "can be regarded as providing an adequate basis for the economic life of a nation unrestrictedly increasing its numbers on the one hand, and with deepening emphasis demanding a rise in its standards of life on the other, a situation of gathering complexity and danger lies before the leaders of the State." 3
1 Harold Cox, op. cit., p. 16. See also Marie Stopes ingenious argument on this subject, op. cit., pp. 21617.
2 In 1926 the excess of births over deaths was 279,777, and the population before this access was 38,890,000.
3 Mr. John Martin in the Fortnightly Review, January, 1923, p. 48.
"that inference cannot be maintained. However great the still untouched resources of the earth may be, beyond question, they are limited. Therefore, if the expansion of the human race continues indefinitely, a time must come when man will find himself face to face with an empty cupboard. It is purposeless to argue that this prospect is remote." 1
And to those Socialists and Communists who frequently pretend that their schemes will abolish all problems, Mr. Cox points out that,
"if the institution of private property were abolished, and all were entitled to draw according to their needs upon the common stock, to which all would contribute according to their capacity, then it would become apparent to everyone that a high birth rate was incompatible with a high standard of living." 2
Among the further signs adduced by birth-controllers to demonstrate the excessive numbers of our population, are the increase in unemployment in recent years and the increase in pauperism. Before the war, in
1 Op.cit., pp. 35, 36.
2 Op. cit., pp. 111, 119, 122.
It is further argued that emigration can be of little avail in reducing numbers, for, while the excess of births over deaths now amounts to about 300,000, the Government emigration scheme at present only allows for the expatriation of about 80,000 persons a year. Besides which., there are these two grave objections to continuous emigration on a scale large enough to be of use:
(a) It would inevitably tend to reduce the surplus supply of food in those thinly populated areas on whose surplus we now draw 2 and
(b) Owing to the conditions laid down by our Dominions and other thinly populated States, it is a dysgenic method of reducing population. The
1 R. B. Kerr, op. cit., p. 27.
2 This is very cogently argued by Mr. R. B. Kerr, op. cit., pp. 8299.
Besides, there is a further practical difficulty in the way of extensive emigration, and that is the disinclination on the part of the Dominions and other new countries to be filled up by Europe. The United States have already passed drastic legislation against immigration, and in Australia and Canada, where no numerical figure is fixed, the trade unions are apparently hostile to much immigration. In the former country "the attitude of the unions is such as to restrict it to narrow limits." 1
Even for the surplus women of the country, emigration is hardly a practical solution. They numbered in 1921, 1,923,434 (1,720,902 in England and Wales alone); but in reality the figure is a much higher one, owing to celibacy among the available men, and the remarriage of widows, 2 the number of women
1 Kerr, p. 88.
2 The number of widows remarried in recent years was as follows: 1918, 30,469; 1919, 40,229; 1920, 29,141; 1922, 23,778; 1923, 20,778 i.e. 144,414 in five years. See author's Man: An Indictment, pp. 2389.
Now the self-governing Dominions could not in the most favourable circumstances absorb more than 432,284 of these surplus women, for this figure represents the excess of men over women in Canada, Australia, New Zealand and South Africa in 1921; and even if they could, it is doubtful whether such a large number of girls could be induced to leave their native country, because, while they are still young, they can reasonably hope to stand as good a chance as the rest of their sex of finding a mate, and when that period of hope has lapsed they are usually settled in some calling. 1
Nor are the prospects of Dominion life for women particularly bright either. Writing about this, Dame Meriel Talbot, O.B.E., says: "For the women it means only too often an unduly heavy burden of work, since there are so few at hand to help." 2
We may pause to make a comment here. The birth-controllers of the present day who urge us to reduce our numbers, are concerned with a population which, for England and Wales alone, amounted in 1921 to 37,885,242. But it might be pointed out to them that one of the first birth-controllers of last century, Dr. George Drysdale, used exactly the same arguments as they do, and also made very much. the same doleful prophecies, and he was concerned, when his book was published, 3 with a population which, for England and
1 See my Lysistrata, p. 43.
3 The Elements of Social Science, by A Doctor of Medicine (London, 1854). The quotations made here are from the 25th Edition of 1886.
"Can either the Registrar-General, or any other man in his senses," Dr. Drysdale asks, "believe that the population of this country can continue to increase at the insane rate of the last fifty years? . . . Can he believe that in another fifty years we may have 50,000,000 of inhabitants?" 1 But this is just what has happened. In 1911, hardly more than fifty years after Dr. Drysdale was writing, the population of Great Britain had grown to 45,370,530!
It would be desirable," said Dr. Drysdale, "that
1 Op. cit, p. 387.
"The working classes have their fate in their own hands," wrote Dr. Drysdale. "There is one method and one only, by which they may escape from the great evils which oppress them the want of leisure and food, hard work and low wages. This is, by reducing their numbers by preventive intercourse, and so lessening the supply of labour in proportion to the demand. All other means, which have been held out for getting rid of Poverty, are a mere delusion; socialism, emigration, national education, organisation of industry, are
1 Op. cit., p. 381.
2 See Dr. B. Dunlop's contribution to the Fifth International Conference on Neo-Malthusianism and Birth Control (Report, pp. 11115).
3 Op. cit., p. 471.
With but a few unimportant modifications, the above paragraph instead of having come from Dr. George Drysdale seventy-three years ago, might have been written by Mr. Harold Cox only the day before yesterday. Both write as if a crisis had been reached in our state of over-population, both dismiss socialism and emigration as remedies, and both recommend the reduction of numbers by preventive intercourse. And yet the first was concerned with a population of only 21,000,000, and the second with a population of about 48,000,000.
So curious a parallel may well make us pause before we accept too unquestioningly the harangues of modern birth-controllers bent on reducing population; for we may confront them with the reminder that, just as Dr. George Drysdale could not possibly have foreseen the conditions of 1927, so they cannot pretend to know the conditions of 1999 and, therefore, that the whole of Birth Control propaganda lies under the suspicion of being prompted in those responsible for it by a belief that whereas population, if not interfered with, will be a changing factor in the future, other factors will remain unchanged.
The birth-controllers, however, do to some extent forestall this objection, and they do so in the following manner:
They argue that, without Dr. George Drysdale's propaganda in 1854 and later, and without the efforts of the other birth-controllers that followed him, our population, instead of being 48,000,000 at the present
(There is some truth in this. We must allow that ever since the wide publicity given to Birth Control by Dr. George Drysdale and his followers, contraceptive expedients have probably been much more generally used than theretofore; so that, at the present day in England, we are by no means faced with the situation which Dr. George Drysdale envisaged, when he foretold what would happen if the population were allowed to increase without restriction. Nevertheless, we must remember that, in spite of Dr. George Drysdale's dark forebodings in 1854, we have meanwhile more than doubled our population and, at the same time, effected a proportional reduction in pauperism events the possibility of which Dr. George Drysdale would probably have denied most strenuously.)
(b) The birth-controllers point out that, whereas in the last seventy years, as the event has proved, our resources have been able to meet a 100 per cent increase in our numbers, it would amount to the blindest optimism to expect our resources to meet anything like such an increase in the future. They even go further and maintain that our resources have in fact reached and passed their zenith, and that now we must
1 See Dr. C. V. Drysdale, The Small Family System (p. 7), and his presidential address at the Fifth International Conference on Neo-Malthusianism and Birth Control (Report, p. 6), where he claims a definite fall of the birth rate in most countries, including England, since the Bradlaugh-Besant trial in 1876. See also Ethel M. Elderton, Report on the English Birth Rate, "I. England North of the Humber" (Eugenics Laboratory Memoirs, XIX, XX, pp. 232, 2345).
They point out that while we have to import at least 70 per cent of our foodstuffs, and most of the raw material, such as cotton, wool, jute, copper and so on from which our manufactured goods are made, we rely for our payment of these imports chiefly upon our exported manufactured goods. If, however, we compare our imports and exports for the last three years, with our imports and exports for the year 1913, we find that they are given as follows:
"In other words, the exports by which we live have fallen nearly a third since 1913, and the net imports . . . have risen 17 per cent." 1 Nor is there much chance of our recovering our former position, for now the other nations of the world, no longer willing to let England be their workshop, are beginning to establish local factories, and to work them behind high tariffs.
Brazil, the Argentine, Japan, China, India and Australia, have all started to produce an appreciable quantity of the goods which they formerly used to import while other European countries and the U.S.A. have greatly developed their industrial output since the middle of last century, and now compete with us most fiercely for the markets of the world. Meantime,
1 Kerr, op. cit., p. 19.
The birth-controllers adduce other arguments: they point to the increasing expenditure on Public Assistance, which, according to Mr. Geoffrey Drage, 2 reached in 1923 the enormous figure of £225,000,000 per annum, and they argue that a good deal of this expenditure is due to the unrestricted multiplication of the lowest, least able, and least vigorous elements in the community.
There is much that cannot be denied in this reply of the advocates of Birth Control. There can be no question that whereas it remains true to say that modern birth-controllers can no more foresee the conditions which will prevail in 1997 than Dr. George Drysdale, writing in 1854, could foresee the conditions of 1927, it must also be acknowledged that the England of 1854 was faced with a position very much more favourable than that which confronts the England of to-day. Apart from all other considerations, the fact that such countries as Germany, Italy, Belgium, the United States of America, and Japan to mention only the most prominent have meanwhile developed into important industrial competitors has undoubtedly altered the outlook very materially and, despite the difficulty of determining with certainty whether we are over-populated or not, we may at least feel persuaded that such proportional increase as that which
1 Kerr, after Bowley and Stamp, in the National Income, p. 58.
2 See the Spectator, February 3rd, 1923.
Nevertheless, in spite of this admission, we may still be dissatisfied not only with (a) the birth-controllers' demand to limit our population to its present numbers, but also and still more with (b) their demand to proceed to a reduction of its present numbers; while we may definitely regret (c) the means whereby they propose to affect either of these ends.