Let me enunciate these fundamental principles which must control my judgment:

1. That the medical profession must continually deal with the moral aspects of a case, and to-day our great loss is the unwillingness of some doctors to have anything to do with morals, because they have had no moral training and have done no moral thinking. Remember, please, that morality has a negative side in the avoidance of all that is impure, and it has a correlative, positive side in its unremitting attacks upon immorality at all times and in all places wherever this death specter rears its head.

2. That in times of great decadence we are not to try to accommodate ourselves to decadent conditions by temporizing expedients but by the highest moral remedies and by righteousness-at whatever cost. Practically I find that the people who came to me having used various mechanical means of preventing conception, have lost something in their married life which ought to have been more precious to them than life itself. All meddling with the sexual relation to secure facultative sterility degrades the wife to the level of a prostitute.

Therefore there is no right or decent way of controlling births but by total abstinence.

Now, as regards the wider social side, some references have been made here to the birth rates, and the suggestion, of course, easily arises in one's mind when statistics are inadequately used to quote the very ancient statement about three degrees of lies. There are lies, d- lies, and statistics, in ascending grade. It all depends on how the statistics are used. The birth rate of Holland was mentioned as being higher, despite apparently the general information on this birth-control matter, than that of any other country in Europe except Germany. I challenge that statement, and I should like to see the figures for it. Here is a summary of the birth_rates of Europe, taken from Prof. Warren S. Thompson's work on Population, published in 1916:

If we divide the countries of the world for which we have appropriate statistics into two classes, calling those with a birth rate of 30 or more per thousand high birth-rate countries

By the way, it was mentioned here that if the births were not under control the birth rate should be over 50 per thousand. As a matter of fact, that rate has not been reached in any country of the world in modern times, and I doubt if it was ever reached in any country anywhere. The highest that I have ever seen was 48 a thousand, and that was in Austria or Russia, I do not know which.

Calling those with a birth rate of 30 or more per thousand high birth-rate countries, and those falling below that figure low birth-rate countries, we get the following results: In the 9 low birth-rate countries, including Holland but excepting Denmark, the rate of increase of population declined between 1880 and 1910.

They excluded Holland because Holland's birth rate is below 30. But excluding Denmark, the rate of increase of population declined between 1880 and 1910.

That is the corrected birth rate. The birth rate, however, has got to be taken into consideration at the same time with the death

rate.

Declined between 1880 and 1910. At the former date the average rate of increase in these 9 countries was 14.2 per cent per thousand; in 1910 it was only 11.6 per cent.

Now, taking the 9 high birth-rate countries we find they increased in population between 1880 and 1910. The average rate of in

crease of all 9 countries was 13.3 per cent, which was 2.1 per cent higher than the average at the earlier date. So we have the fact that the low birth-rate countries are decreasing in population everywhere. The high birth-rate countries are, I think, now, at least many of them, decreasing also.

As to the United States, in 1915 the excess rate of births over deaths, the corrected birth rate was 11.5 per cent. That is in the registration area. In 1919 it was 9.4, a decrease of a little over 2 per cent in the increase of births or rather in population, in this region in 4 years. The average number of children per family in 1919, among the foreign-born people, or where the mother was foreign born, was 4 per family. The average among native born was 3.2.

All statisticians who have studied this matter of increase of population are agreed that in order to provide for a stationary population, no decrease, the average number of children per married family must be somewhere between 3.5 and 4. For example, the statistician of the Metropolitan Life Insurance Co. says that it is 3.9. Others have different figures, but all agree that there must be at least 3.5 children per married family average in order to keep the population stationary. This rate, as we see, of the native-born parents in the registration area of the United States, is 3.2 less than 3.5, which is necessary to keep the population alive, and it is notorious that in any group which practices voluntary restriction of birth, that group does not continue to reproduce itself.

Mr. HERSEY. May I ask if there are groups of that kind in the United States?

Mr. RYAN. There are groups concerning which the probabilities point strongly-oh, I beg your pardon. Do you mean are there any groups that are decreasing regardless of how it happened?

Mr. HERSEY. Any groups in the United States that have practiced it?

Mr. RYAN. But you can not prove it.

Mr. HERSEY. No.

Mr. RYAN. But there are groups which belong to the United States concerning whom the proponents of this measure declare that it is practiced, because they are the so-called upper classes or the richer classes, or the better educated classes. I have in mind certain qualities

It

Mr. HERSEY (interposing). But you have no proof? Mr. RYAN. No; there is no way of proving that, of course. is simply the general presumption that we have. I believe firmly, from what I have been able to observe of the groups in which this thing is supposed to be practiced, that no group that adopts this practice will have on the average 3.5 or 4 children per married family. I think that may be taken as almost a social statistical axiom as long as we have the kind of human nature we are dealing with now. What the proponents of this bill, then, offer to the country is a means by which the groups in the population who still have sufficient moral stamina to avoid the evil way and the way of national extinction through race suicide which is proposed here, that these shall be afforded an easy means to get information to become themselves educated.

Let me close by quoting a couple of paragraphs from an article by Prof. Warren Thompson, whom I have referred to already, which will be found in the Monthly Labor Review for February of this year, on this point of the supposed superiority.

Mr. YATES. What is that publication-the Labor Review?

Mr. RYAN. This is published by the Department of Labor. The advocates of this measure are continually talking about getting quality rather than quantity in children, and talking about pointing to the superior classes, who presumably have quality and have it as a result of these practices, and implying then that it would be a good thing that all people should have this quality, so called. Of course, it all depends upon the definition you make of "quality." If quality means merely the possession of wealth, the possession of education, but a lack of capacity to endure, to overcome obstacles, to achieve, to do without the softer things of life-if those are the qualities which are necessary for social survival, if quality means that, then we contend that proposals of this kind are in the direction of being opposed not merely to quantity but to genuine quality likewise.

May I call your attention to another aspect of this? The proponents of this kind of thing have occasionally talked of instances where one of seven or eight children became famous. I have not any of them in my memory now, and I do not think that they prove very much one way or another. I think it is sometimes suggested that some of the most famous men were the last of a family of seven or eight children. There is a friend of mine in St. Paul, my home city, named Jim Manahan, who was once a Member of the House of Representatives. At one time Prof. Edwin A. Ross, now of the University of Wisconsin, was teaching in the University of Nebraska, and was teaching birth control, and particularly the evil physical aspects of the matter so far as the mother was concerned who had more than what is called the medium-sized family-four or five children. Manahan said, "That may be all right in some cases, but it is not true always, and there may be as many exceptions on the one side as the other. My mother had 12 children, and she is about 70 years of age and she looks and acts like a woman of 60. Professor Ross answered, "That may be true; but suppose your mother had 6 instead of 12, don't you suppose that she would look younger still?" My friend Manahan answered, "But the trouble about that scheme is that it would leave me out." Professor Ross said, "Oh, any scheme that would leave you out would be a bad

one."

As a matter of fact, this young Manahan was the man who got through the Interstate Commerce Commission the measure which reduced upper berths by 20 per cent in our Pullman cars, made them 20 per cent less than the lower berths. Perhaps

Mr. YATES (interposing). He ought to have reduced them 50 per cent instead of 20 per cent.

Mr. RYAN. Yes, sir; I suppose that was as far as he could go. I agree with you there, Mr. Congressman. [Reading:]

People who have passed beyond the stage where reproduction is entirely uncontrolled, and who yet fail to reproduce, must certainly accept the charge of lack of abiding faith in the worthwhileness of life as a whole. In effect, though probably unconsciously, they say, "We find our daily life so engrossing

and strenuous, and yet so little worth while, that we do not care to participate in the larger, more enduring life of the race." I can but wonder whether people who thus confess a feeble interest in the future and who are so lacking in faith in life are really so superior that the direction of civilization can be safely intrusted to them.

Nature's answer is clear. She says they are unfit. She shows clearly that she prefers the lower classes who live simply, who reproduce more or less instinctively. who do not think about the future of the race or of civilization, but who are carrying the burden of the future in the rearing of children. We may call these people brutish, we may say that they are intellectually inferior, we may hold that they have not risen above the level of instinctive reactions, we may believe that they carry the burden of the future only because they know not how to avoid it, and because they do not yet feel it to be a burden, but they survive, and the future belongs to them. We may believe and prove to our own satisfaction that a civilization developed by such a people will be distinctly inferior to ours, but if nature prefers it because we can not, or will not, participate in the future by rearing children, we should have no fault to find with her.

After all, the proof of the fitness of any civilization is the fact that it survives.

Now, just two words more. Some of you may recall the famous apostrophe that Tertullian made back in the second century to the decayed Roman civilization of his day, that were filling the fields and the market places, and so on, that "We will leave you nothing but your gods and your empty temples."

While on this line let me express what I honestly believe to be the prospects, on behalf of those who are willing to accept those burdens to which Professor Thompson refers:

We, too. are of yesterday, but we shall be the America of to-morrow; we shall be the majority. We shall occupy and dominate every sphere of activity: The farm, the factory, the counting house, the schools, the professions, the press, the legislature. We shall dominate because we shall have the numbers, the intelligence, and above all because we shall have the moral strength to struggle, to endure, and to persevere, the moral capacity which is indispensable to great achievements. To you we shall leave the gods and goddesses which you have made to your own image and likeness, the divinities of ease, and enjoyment and lust. We shall leave you the comforts of decadence and the sentence of inevitable extinction.

I thank you.

Senator SPENCER. We shall be very glad to hear Doctor Litchfield now.

STATEMENT OF DR. LAWRENCE LITCHFIELD, PITTSBURGH, PA.

Doctor LITCHFIELD. I came here simply to speak on the medical aspects of birth control, knowing that this bill is not a bill authorizing birth control or advocating birth control, but it is necessary for all of us who consider the bill to realize what birth control

means.

I find myself a little bit in the position of speaking for immorality, on the other side from the previous speaker, who spoke for morality so strongly. I do not pretend to be particularly immoral. My idea of God Almighty's plan is that if he gave certain human beings more intelligence than others they were to use them for the rest. If the terrible toll of suffering which is put upon the women of certain classes is necessary for their high moral and Christian development, it is not fair. I do not wish to go further into that argument, but briefly go over the medical aspects of the case.

I have practiced medicine for 36 years. I have been interested in international movements for the control of and the abating of venereal diseases, child labor, and tuberculosis. All of these problems for the benefit of the human race bring us back one after another to the necessity for intelligent birth control. The human race has the same right and need for scientific development that other animals have. We have many laws and many books and many theories that control the breeding of animals, but the breeding of human beings is left entirely to chance.

Senator SPENCER. In what State do you practice?
Doctor LITCHFIELD. Pennsylvania.

Senator SPENCER. Is there any law in Pennsylvania against a physician freely communicating to his patients?

Doctor LITCHFIELD. Yes. If a patient of mine whom I believe would be seriously injured by not having the information to prevent conception, if she wrote me for such information I am legally unable to send it to her. If she comes into my office and the doors are locked, I tell her what I think is wise.

Senator SPENCER. Do the doors necessarily have to be locked? Doctor LITCHFIELD. The information can not be given publicly. Senator SPENCER. But I mean, there is no law in Pennsylvania, is there, which prevents a doctor from communicating information of this sort to his patients?

Doctor LITCHFIELD. There is, as I understand it. I might say, further, as a side light on this question, last summer in Europe my wife and I found a book which we read and thought would be a very good thing for our young married daughter to have, and I decided to import some of these books and give them to my patients who were recently married. I sent an order to England and received an answer that the book could not be imported, because it was regarded as obscene.

There is another aspect of the question. Medicine, as you all know, is more and more depending upon the results of other branches of scientific inquiry. A physician is going back to the laboratory and to the sociologist and the eugenist and other investigators. The present law, the repeal of certain features of which we ask, is a handicap on all branches of medical science which have to do with propagation and conception, and its results. It is claimed that there are no methods of contraception which can be offered which are physiologically safe and not injurious to the health. That is absolutely not true. It is claimed, as suggested by my predecessor, that abstinence and self-control are the only admissable means of limiting birth; the only safe means, they say. Abstinence and self-control as practiced largely at the present time are distinctly injurious to the health of the men and the woman both. That can not be gainsaid by any scientists who have studied the question. All psychiatrists and neurologists see every day cases of neuresthenia and psychasthenia, and worse, that are the result of attempts at birth control by the practice of abstinence and self-control. This does not take account of the vast amount of marital unhappiness and recourse to the divorce courts which are due to misunderstandings and to ignorance of these subjects.