RETROSPECT AND PROSPECT 367 



children. Dr. A. Bluhm states that in the Grand Duchy of 

 Eaden "since 187 1 to 1879 artificial premature births have 

 increased eight-fold, perforation three-fold, and embryotomy 

 has doubled; moreover the number of Caesarian sections, which 

 are generally intended to avoid perforation and embryotomy, 

 have increased nine-fold." This is not due, according to Dr. 

 Bluhm, to an increased tendency to perform operations. "Arti- 

 ficial premature birth, on the one hand and perforation and embry- 

 otomy on the other are two species of operations, one precluding 

 the other. If the number of premature births increases, the 

 numbers of perforation and embryotomy should fall. If both 

 rise this points of necessity to an increase in the inability to bear." 



The ease with which the women of primitive races bear children 

 has often been remarked upon. It is not improbable that the 

 matter has usually been exaggerated.^ The after effects of this 

 facile child bearing have not often been followed up to determine 

 how it affects the future health of the mother. Child-bearing is 

 easier among women who are used to a moderate amount of 

 physical labor. Undoubtedly the life of modem women, espe- 

 cially those of the more well-to-do classes, is not favorable to easy 

 child bearing. The form of the pelvis is unfavorably influenced 

 by a sedentary life. The employment of large numbers of young 

 women in sedentary occupations such as stenography, office work, 

 etc., cannot fail to multiply the troubles of childbirth. It is 

 difficult to estimate, however, the extent to which environment is 

 responsible for the present difficulties of parturition. The form 

 of the pelvis is a transmissible characteristic. The frequency of 

 narrow pelvis has been found by Rose to vary considerably in 

 different parts of Germany; those regions in which this defect is 

 common are found to have the largest number of children who 

 were artificially fed. This investigator also found that breast- 

 fed children were superior in later life to those artificially fed, in 

 weight, character of teeth, intelligence and general physical 

 development. 



If difficulty of bearing children depends upon a hereditary 



^ See Ploss-Bartels, Das Weib, 8th ed. 1905. 



