392Section IV.A. Bluhm.
of the child), an artificial premature birth is often brought on before the
end of the normal pregnancy, i.e., at a time when the child is indeed
(capable of) living, but its skull has not yet reached the full circumference.
Artificial premature birth on the one hand and perforation and em
bryotomy on the other are therefore two species of operations, one pre
cluding the other. If the number of premature births increases, the
numbers of perforation and embryotomy should fall.
If both rise, that points of necessity to an increase in the inability to
bear. The latter has taken place as a matter of fact in the Grand Duchy
of Baden. Since 1871 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.
The deterioration in the ability for bearing among the women of Baden
can, however, not have increased much, for the cases of faulty position of
the child, which is also the outcome of a pathological maternal “ bearing
apparatus ” (especially of the pelvis) have, with exception of the transverse
position (which is slightly on the increase), rather decreased than increased.
It may be foreseen that the case will be altered in the next decade,
for then most of the daughters of those unfit women to whom the advances
of operative technique made possible the bearing of living children, and
therewith the transmission of their unfitness, will themselves come to bear
children. More plainly even than the Baden figures, those of Hamburg show an
increasing unfitness for bearing. Notwithstanding that through the
advances of operative technique, a prognosis from year to year more favour
able to mother and child may be formed, the death-rate of mothers in
Hamburg in operations has been increasing for some time.
In 100 operations it has risen from 3.30 in the years 1895 to 1899, to
4.80 in 1900 to 1904, and 5.21 in 1905 to 1909.
In relation to the number of confinements in general it has, since 1885
to 1889, increased every five years.
The death-rate of infants per 100 instrumental births has, indeed, de
creased ; in 100 of the births in general it has, however, steadily risen since
1885-89. In 1885 to 1889 it amounted to 10.70% births, 1905 to 1909, to 13.65%.
The frequency of operations has risen during the same period from
4.74% to 7.49% of the confinements.
It can be inferred from these statistics that in Hamburg the progress of
Obstetrics no longer keeps pace with the decrease in the power of bearing,
nor can it compensate for the evil effects. They show most plainly the
danger which is threatening the race through the limitation of “ selection ”
(fitness) caused by the increase of artificial help at birth. Obstetrics not
only influences the capacity for bearing of future generations, but possesses
