PROLIFICITY.

General Historic Observations.--Prolificity is a much discussed

subject, for besides its medical and general interest it is of

importance in social as well as in political economy. Superfluous

population was a question that came to consciousness early; Aristotle

spoke of legislation to prevent the increase of population and the

physical and mental deterioration of the race,--he believed in a

population fixed as regards numbers,--and later Lycurgus transformed

these precepts into a terrible law. Strabonius reports that the

inhabitants of Cathea brought their infants at the age of two months

before a magistrate for inspection. The strong and promising were

preserved and the weak destroyed. The founders of the Roman Empire

followed a similar usage. With great indignation Seneca, Ovid, and

Juvenal reproved this barbarity of the Romans. With the domination of

Christianity this custom gradually diminished, and Constantine stopped

it altogether, ordering succor to the people too poor to rear their own

children. The old Celts were so jealous of their vigor that they placed

their babes on a shield in the river, and regarded those that the waves

respected as legitimate and worthy to become members of their clans. In

many of the Oriental countries, where the population is often very

excessive and poverty great, the girl babies of the lower classes were

destroyed. At one time the crocodiles, held sacred in the Nile, were

given the surplus infants. By destroying the females the breeding

necessarily diminished, and the number of the weaker and dependent

classes became less. In other countries persons having children beyond

their ability to support were privileged to sell them to citizens, who

contracted to raise them on condition that they became their slaves.

General Law, and the Influence of War.--In the increase of the world's

population, although circumstances may for the time alter it, a general

average of prolificity has, in the long run, been maintained. In the

history of every nation artificial circumstances, such as fashion, war,

poverty, etc., at some period have temporarily lowered the average of

prolificity; but a further search finds another period, under opposite

circumstances, which will more than compensate for it. The effect of a

long-continued war or wars on generation and prolificity has never been

given proper consideration. In such times marriages become much less

frequent; the husbands are separated from their wives for long periods;

many women are left widows; the females become in excess of the males;

the excitement of the times overtops the desire for sexual intercourse,

or, if there is the same desire, the unprolific prostitute furnishes

the satisfaction; and such facts as these, coupled with many similar

ones, soon produce an astonishing effect upon the comparative

birth-rate and death-rate of the country. The resources of a country,

so far as concerns population, become less as the period of

peace-disturbance is prolonged. Mayo-Smith quotes von Mayr in the

following example of the influence of the war of 1870-71 on the

birth-rate in Bavaria,--the figures for births are thrown back nine

months, so as to show the time of conception: Before the war under

normal conception the number of births was about 16,000 per month.

During the war it sank to about 2000 per month. Immediately on the

cessation of hostilities it arose to its former number, while the

actual return of the troops brought an increase of 2000 per month. The

maximum was reached in March, 1872, when it was 18,450. The war of 1866

seems to have passed over Germany without any great influence, the

birth-rate in 1865 being 39.2; in 1866, 39.4; in 1867, 38.3; in 1868,

38.4. On the other hand, while the birth-rate in 1870 was 40.1, in 1871

it was only 35.9; in 1872 it recovered to 41.1, and remained above 41

down to 1878. Von Mayr believes the war had a depressing influence upon

the rate apart from the mere absence of the men, as shown in the fact

that immediately upon the cessation of hostilities it recovered in

Bavaria, although it was several months before the return of the troops.

Mayo-Smith, in remarking on the influence of war on the marriage-rate,

says that in 1866 the Prussian rate fell from 18.2 to 15.6, while the

Austrian rate fell from 15.5 to 13.0. In the war of 1870-71 the

Prussian rate fell from 17.9 in 1869 to 14.9 in 1870 and 15.9 in 1871;

but in the two years after peace was made it rose to 20.6 and 20.2, the

highest rates ever recorded. In France the rate fell from 16.5 to 12.1

and 14.4, and then rose to 19.5 and 17.7, the highest rates ever

recorded in France.

Influence of Rural and Urban Life.--Rural districts are always very

prolific, and when we hear the wails of writers on "Social Economy,"

bemoaning the small birth-rates of their large cities, we need have no

fear for urban extinction, as emigration from the country by many

ambitious sons and daughters, to avail themselves of the superior

advantages that the city offers, will not only keep up but to a certain

point increase the population, until the reaction of overcrowding,

following the self-regulating law of compensation, starts a return

emigration.

The effect of climate and race on prolificity, though much spoken of,

is not so great a factor as supposed. The inhabitants of Great Britain

are surpassed by none in the point of prolificity; yet their location

is quite northern. The Swedes have always been noted for their

fecundity. Olaf Rudbeck says that from 8 to 12 was the usual family

number, and some ran as high as 25 or 30. According to Lord Kames, in

Iceland before the plague (about 1710) families of from 15 to 20 were

quite common. The old settlers in cold North America were always

blessed with large families, and Quebec is still noted for its

prolificity. There is little difference in this respect among nations,

woman being limited about the same everywhere, and the general average

of the range of the productive function remaining nearly identical in

all nations. Of course, exception must be made as to the extremes of

north or south.

Ancient and Modern Prolificity.--Nor is there much difference between

ancient and modern times. We read in the writings of Aristotle, Pliny,

and Albucasis of the wonderful fertility of the women of Egypt, Arabia,

and other warm countries, from 3 to 6 children often being born at once

and living to maturity; but from the wonder and surprise shown in the

narration of these facts, they were doubtless exceptions, of which

parallels may be found in the present day. The ancient Greek and Roman

families were no larger than those of to-day, and were smaller in the

zenith of Roman affluence, and continued small until the period of

decadence.

Legal Encouragement of Prolificity.--In Quebec Province, Canada,

according to a Montreal authority, 100 acres of land are allotted to

the father who has a dozen children by legitimate marriage. The same

journal states that, stimulated by the premium offered, families of 20

or more are not rare, the results of patriotic efforts. In 1895, 1742

"chefs de famille" made their claim according to the conditions of the

law, and one, Paul Bellanger, of the River du Loup, claimed 300 acres

as his premium, based on the fact that he was the father of 36

children. Another claimant, Monsieur Thioret de Sainte Genevieve, had

been presented by his wife, a woman not yet thirty years old, with 17

children. She had triplets twice in the space of five years and twins

thrice in the mean time. It is a matter of conjecture what the effect

would be of such a premium in countries with a lowering birth-rate, and

a French medical journal, quoting the foregoing, regretfully wishes for

some countrymen at home like their brothers in Quebec.

Old Explanations of Prolificity.--The old explanation of the causation

of the remarkable exceptions to the rules of prolificity was similar to

that advanced by Empedocles, who says that the greater the quantity of

semen, the greater the number of children at birth. Pare, later, uses a

similar reason to explain the causation of monstrosities, grouping them

into two classes, those due to deficiency of semen, such as the

acephalous type, and those due to excess, such as the double monsters.

Hippocrates, in his work on the "Nature of the Infant," tells us that

twins are the result of a single coitus, and we are also informed that

each infant has a chorion; so that both kinds of plural gestation

(monochorionic and dichorionic) were known to the ancients. In this

treatise it is further stated that the twins may be male or female, or

both males or both females; the male is formed when the semen is thick

and strong.

The greatest number of children at a single birth that it is possible

for a woman to have has never been definitely determined. Aristotle

gives it as his opinion that one woman can bring forth no more than 5

children at a single birth, and discredits reports of multiplicity

above this number; while Pliny, who is not held to be so trustworthy,

positively states that there were authentic records of as many as 12 at

a birth. Throughout the ages in which superstitious distortion of

facts and unquestioning credulity was unchecked, all sorts of

incredible accounts of prolificity are found. Martin Cromerus, a Polish

historian, quoted by Pare, who has done some good work in statistical

research on this subject, says a that Margaret, of a noble and ancient

family near Cracovia, the wife of Count Virboslaus, brought forth 36

living children on January 20, 1296.

The celebrated case of Countess Margaret, daughter of Florent IV, Earl

of Holland, and spouse of Count Hermann of Henneberg, was supposed to

have occurred just before this, on Good Friday, 1278. She was at this

time forty-two years of age, and at one birth brought forth 365

infants, 182 males, 182 females, and 1 hermaphrodite. They were all

baptized in two large brazen dishes by the Bishop of Treras, the males

being called John, the females Elizabeth. During the last century the

basins were still on exhibition in the village church of Losdun, and

most of the visitors to Hague went out to see them, as they were

reckoned one of the curiosities of Holland. The affliction was ascribed

to the curse of a poor woman who, holding twins in her arms, approached

the Countess for aid. She was not only denied alms, but was insulted by

being told that her twins were by different fathers, whereupon the poor

woman prayed God to send the Countess as many children as there were

days in the year. There is room for much speculation as to what this

case really was. There is a possibility that it was simply a case of

hydatidiform or multiple molar pregnancy, elaborated by an exhaustive

imagination and superstitious awe. As late as 1799 there was a woman of

a town of Andalusia who was reported to have been delivered of 16 male

infants, 7 of which were alive two months later.

Mayo-Smith remarks that the proportion of multiple births is not more

than 1 per cent of the total number of parturitions. The latest

statistics, by Westergaard, give the following averages to number of

cases of 100 births in which there were 2 or more at a birth:--

Sweden, 1.45

Germany, 1.24

Bavaria, 1.38

Denmark, 1.34

Holland, 1.30

Prussia, 1.26

Scotland, 1.22

Norway, 1.32

Saxony, 1.20

Italy, 1.21

Austria, 1.17

Switzerland, 1.16

France, 0.99

Belgium, 0.97

Spain, 0.85

In Prussia, from 1826 to 1880, there were 85 cases of quadruplets and 3

cases of 5 at a birth.

The most extensive statistics in regard to multiple births are those of

Veit, who reviews 13,000,000 births in Prussia. According to his

deductions, twins occur once in 88 births; triplets, once in 7910; and

quadruplets, once in 371,126. Recent statistics supplied by the Boards

of Health of New York and Philadelphia place the frequency of twin

births in these cities at 1 in every 120 births, while in Bohemia twins

occur once in about 60 births, a proportion just twice as great. Of

150,000 twin pregnancies studied by Veit, in one-third both children

were boys; in slightly less than one-third both were girls; in the

remaining third both sexes were represented.

Authentic records of 5 and 6 at a birth are extremely rare and

infinitesimal in proportion. The reputed births in excess of 6 must be

looked on with suspicion, and, in fact, in the great majority of

reports are apochryphal.

The examples of multiple births of a single pregnancy will be taken up

under their respective numbers, several examples of each being given,

together with the authorities. Many twin and triplet brothers have

figured prominently in history, and, in fact, they seem especially

favored. The instance of the Horatii and the Curatii, and their famous

battle, on which hung the fate of Rome and Alba, is familiar to every

one, their strength and wisdom being legendary with the Romans.

Twins and triplets, being quite common, will not be considered here,

although there are 2 cases of interest of the latter that deserve

citation. Sperling reports 2 instances of triplets; in the first there

was 1 placenta and chorion, 2 amnions, and the sex was the same; in the

second case, in which the sexes were different, there were 3 placentas,

3 chorions, and 3 amnions. What significance this may have is only a

matter of conjecture. Petty describes a case of triplets in which one

child was born alive, the other 2 having lost their vitality three

months before. Mirabeau has recently found that triple births are most

common (1 to 6500) in multiparous women between thirty and thirty-four

years of age. Heredity seems to be a factor, and duplex uteruses

predispose to multiple births. Ross reports an instance of double

uterus with triple pregnancy.

Quadruplets are supposed to occur once in about every 400,000 births.

There are 72 instances recorded in the Index Catalogue of the Surgeon

General's Library, U. S. A., up to the time of compilation, not

including the subsequent cases in the Index Medicus. At the Hotel-Dieu,

in Paris, in 108,000 births, covering a period of sixty years, mostly

in the last century, there was only one case of quadruplets. The

following extract of an account of the birth of quadruplets is given by

Dr. De Leon of Ingersoll, Texas:--

"I was called to see Mrs. E. T. Page, January 10, 1890, about 4 o'clock

A.M.; found her in labor and at full time, although she assured me that

her 'time' was six weeks ahead. At 8 o'clock A.M. I delivered her of a

girl baby; I found there were triplets, and so informed her. At 11 A.M.

I delivered her of the second girl, after having rectified

presentation, which was singular, face, hands, and feet all presented;

I placed in proper position and practised 'version.' This child was

'still-born,' and after considerable effort by artificial respiration

it breathed and came around 'all right.' The third girl was born at

11.40 A.M. This was the smallest one of the four. In attempting to

take away the placenta, to my astonishment I found the feet of another

child. At 1 P.M. this one was born; the head of this child got firmly

impacted at the lower strait, and it was with a great deal of

difficulty and much patient effort that it was finally disengaged; it

was blocked by a mass of placenta and cords. The first child had its

own placenta; the second and third had their placenta; the fourth had

also a placenta. They weighed at birth in the aggregate 19 1/2 pounds

without clothing; the first weighed 6 pounds; the second 5 pounds; the

third 4 1/2 pounds; the fourth 4 pounds. Mrs. Page is a blonde, about

thirty-six years old, and has given birth to 14 children, twins three

times before this, one pair by her first husband. She has been married

to Page three years, and has had 8 children in that time. I have waited

on her each time. Page is an Englishman, small, with dark hair, age

about twenty-six, and weighs about 115 pounds. They are in St. Joseph,

Mo., now, having contracted with Mr. Uffner of New York to travel and

exhibit themselves in Denver, St. Joseph, Omaha, and Nebraska City,

then on to Boston, Mass., where they will spend the summer."

There is a report from Canada of the birth of 4 living children at one

time. The mother, a woman of thirty-eight, of small stature, weighing

100 pounds, had 4 living children of the ages of twelve, ten, eight,

and seven years, respectively. She had aborted at the second month, and

at full term was delivered of 2 males, weighing, respectively, 4 pounds

9 1/4 ounces and 4 pounds 3 ounces; and of 2 females, weighing 4 pounds

3 ounces and 3 pounds 13 3/4 ounces, respectively. There was but one

placenta, and no more exhaustion or hemorrhage than at a single birth.

The father weighed 169 pounds, was forty-one years old, and was 5 feet

5 inches tall, healthy and robust. The Journal of St. Petersburg, a

newspaper of the highest standard, stated that at the end of July,

1871, a Jewish woman residing in Courland gave birth to 4 girls, and

again, in May, 1872, bore 2 boys and a girl; the mother and the 7

children, born within a period of ten months, were doing well at the

time of the report. In the village of Iwokina, on May 26, 1854, the

wife of a peasant bore 4 children at a birth, all surviving. Bousquet

speaks of a primiparous mother, aged twenty-four, giving birth to 4

living infants, 3 by the breech and 1 by the vertex, apparently all in

one bag of membranes. They were nourished by the help of 3 wet-nurses.

Bedford speaks of 4 children at a birth, averaging 5 pounds each, and

all nursing the mother.

Quintuplets are quite rare, and the Index Catalogue of the Surgeon

General's Library, U. S. A., gives only 19 cases, reports of a few of

which will be given here, together with others not given in the

Catalogue, and from less scientific though reliable sources. In the

year 1731 there was one case of quintuplets in Upper Saxony and another

near Prague, Bohemia. In both of these cases the children were all

christened and had all lived to maturity. Garthshore speaks of a

healthy woman, Margaret Waddington, giving birth to 5 girls, 2 of which

lived; the 2 that lived weighed at birth 8 pounds 12 ounces and 9

pounds, respectively. He discusses the idea that woman was meant to

bear more than one child at a birth, using as his argument the

existence of the double nipple and mamma, to which might be added the

not infrequent occurrence of polymazia.

In March, 1736, in a dairy cellar in the Strand, London, a poor woman

gave birth to 3 boys and 9 girls. In the same journal was reported the

birth at Wells, Somersetshire, in 1739, of 4 boys and a girl, all of

whom were christened and were healthy. Pare in 1549 gives several

instances of 5 children at a birth, and Pliny reports that in the

peninsula of Greece there was a woman who gave birth to quintuplets on

four different occasions. Petritus, a Greek physician, speaks of the

birth of quintuplets at the seventh month. Two males and one female

were born dead, being attached to the same placenta; the others were

united to a common placenta and lived three days. Chambon mentions an

instance of 5 at a birth. Not far from Berne, Switzerland, the wife of

John Gelinger, a preacher in the Lordship of Berne, brought forth

twins, and within a year after she brought forth quintuplets, 3 sons

and 2 daughters. There is a similar instance reported in 1827 of a

woman of twenty-seven who, having been delivered of twins two years

before, was brought to bed with 5 children, 3 boys and 2 girls. Their

length was from 15 1/2 to 16 1/2 inches. Although regularly formed,

they did not seem to have reached maturity. The mother was much

exhausted, but recovered. The children appeared old-looking, had

tremulous voices, and slept continually; during sleep their

temperatures seemed very low.

Kennedy showed before the Dublin Pathological Society 5 fetuses with

the involucra, the product of an abortion at the third month. At Naples

in 1839 Giuseppa Califani gave birth to 5 children; and about the same

time Paddock reported the birth in Franklin County, Pa., of

quintuplets. The Lancet relates an account of the birth of quintuplets,

2 boys and 3 girls, by the wife of a peasant on March 1, 1854. Moffitt

records the birth at Monticello, Ill., of quintuplets. The woman was

thirty-five years of age; examination showed a breech presentation; the

second child was born by a foot-presentation, as was the third, but the

last was by a head-presentation. The combined weight was something over

19 pounds, and of the 5, 3 were still-born, and the other 2 died soon

after birth. The Elgin Courant (Scotland), 1858, speaks of a woman

named Elspet Gordon, at Rothes, giving birth to 3 males and 2 females.

Although they were six months' births, the boys all lived until the

following morning. The girls were still-born. One of the boys had two

front teeth when born. Dr. Dawson of Rothes is the obstetrician

mentioned in this case.

The following recent instance is given with full details to illustrate

the difficulties attending the births of quintuplets. Stoker has

reported the case of a healthy woman, thirty-five years old, 5 feet 1

inch high, and of slight build, whom he delivered of 5 fetuses in the

seventh month of pregnancy, none of the children surviving. The

patient's mother had on two occasions given birth to twins. The woman

herself had been married for six years and had borne 4 children at full

term, having no difficulty in labor. When she came under observation

she computed that she had been pregnant for six months, and had had her

attention attracted to the unusually large size of her abdomen. She

complained of fixed pain in the left side of the abdomen on which side

she thought she was larger. Pains set in with regularity and the labor

lasted eight and three-quarter hours. After the rupture of the

membranes the first child presented by the shoulder. Version was

readily performed; the child was dead (recently). Examination after

the birth of the first child disclosed the existence of more than one

remaining fetus. The membranes protruded and became tense with each

contraction. The presentation was a transverse one. In this case also

there was little difficulty in effecting internal version. The child

lived a couple of hours. The third fetus was also enclosed in a

separate sac, which had to be ruptured. The child presented by the

breech and was delivered naturally, and lived for an hour. In the

fourth case the membranes had likewise to be ruptured, and alarming

hemorrhage ensued. Version was at once practised, but the chin became

locked with that of the remaining fetus. There was some difficulty and

considerable delay in freeing the children, though the extent of

locking was not at any time formidable. The child was dead (recently).

The fifth fetus presented by the head and was delivered naturally. It

lived for half an hour. The placenta was delivered about five minutes

after the birth of the last child, and consisted of two portions united

by a narrow isthmus. One, the smaller, had two cords attached centrally

and close together; the other, and larger, had two cords attached in a

similar way and one where it was joined to the isthmus. The organ

appeared to be perfectly healthy. The cord of the fourth child was so

short that it had to be ligated in the vagina. The children were all

females and of about the same size, making a total weight of 8 pounds.

Date: 2014-12-29; view: 637