Dr. Agnes Bluhm contributes to the question of the deterioration of the race by therapeutic measures in dealing in Figure C 48 with "+The increasing frequency of surgical operations in connection with childbirth and its significance for the race.+" She writes in explanation "The number of doctors having increased relatively much more than the number of the population, it follows that for a growing number of women medical assistance at childbirth is available. To this must be added that progress in surgical technique, above all the diminished danger of infection, allows of a much more frequent operative interference with good results for mother and child. Both these facts find expression in the reduction of the number of stillbirths. The purpose of these operations being to assist a diminished birth capacity in women, and this diminished capacity arising partly from constitutional and consequently hereditary factors, this question suggests itself: Is the average birth capacity of women progressively diminished by the fact that an increasing number of women, more or less unfit for childbirth, are artificially assisted in bringing forth living children who inherit this weakness from the mother?"
"Our table attempts to answer this question on the basis of official Midwifery Statistics compiled in the Grand Duchy of Baden reaching back to 1871, that is the beginning of the antiseptic era.
"To avoid the errors, which small figures might lead to, each calculation has been based on the average figures of a lengthy period. The material dealt with comprises over two million births."
"Figure 1 shows the +increasing frequency of all childbirth operations taken together+. The period 1871 to 1879 shows an average of 4.38 operations to every 100 births, the period 1900 to 1907 up to 8.12 operations to every 100 births."
"Figure 2 shows the +frequency of each class of operation in every 1,000 births+. Each class of operation shows an increase in number, but the increase has not been uniform throughout the various classes."
"Figure 3, A and B, shows the +share of each class of operation in the total number for the various periods+. A more leading part is taken by aftermath operations, by artificially induced premature birth, by perforation of the head and by Caesarean section on the living. Aftermath operations depend (like the use of the forceps) to such a degree on the teachings of the various schools for midwifery (and on the time at the doctor's disposal) that they can hardly serve as a standard of birth capacity. The Caesarean section, too, can hardly be taken as a guide, as a much wider view is taken now of the indications for this operation. But the equally increasing numbers of perforations of the head and artificially induced premature birth are well worthy of attention. For these two operations exclude one another. With the existing tendency to avoid perforation of the head by artificially inducing premature birth, a rise in the curve of premature births should correspond with a sinking of the perforation curve. 1871 to 1879 a maximum of the former actually coincides with a minimum of the latter; but from there on both curves rise, though not in the same degree. Premature births have become since then (see Fig. 2) more than eight times as frequent; perforations of the head have trebled; and dismemberments of the child have doubled. This fact must be considered as a sign of lessened birth capacity."