I shall be told that many marriages are unfruitful. Granted. That many must necessarily be such. Also granted, but with a limitation. Every man of the present day knows that, of these unfruitful marriages, by far the majority are such from intention. We seldom now see families of any size; and yet women conceive as easily and men are as potent as in the olden time. Every physician who has considered the subject will aver that my statement is true, and will acknowledge, moreover, that of the unfruitful marriages where children are yet desired, the barrenness of the woman is often owing to a brace of causes that are frequently easily removed by treatment; in the one instance there being some form of organic displacement or physical obstruction on the wife’s part, in the other temporary or persistent impotence on that of the husband, generally owing to previous careless or unphysiological ways of life. It is folly to think, as so many do, that early years of intentional childlessness can be atoned for by subsequent years of intentional plenty. Those who begin by thwarting the laws of nature very constantly find that in later life, when mere sensations pall, and physical weariness supplants the freshness and ardor of youth, these laws, disobeyed, will in turn disappoint them. This subject is of such importance, and is so little understood, that I must here quote again from one of my own previous writings upon the subject; indeed so few physicians have dared to write or apparently to think of these matters, that there are hardly others to whom I can refer. In a paper read before the Massachusetts Medical Society in May of last year, and published in one of the New York professional periodicals,[38] I have laid down the following series of propositions, which are startling, but undoubtedly true. “1. That while, owing to the advance of our knowledge in the treatment of childbed, more children are born living than formerly, and more mothers saved, and owing to our wiser treatment of the diseases of children, and their exposure to better sanitary conditions, a much larger percentage of them reach maturity, yet among the better class of inhabitants fewer infants are born; that is to say, that the average number of births to each Protestant family is less than it was half a century ago. “2. That of the pregnancies in reality occurring in this class, fewer reach completion. “3. That of the instances of conjugal intercourse taking place, fewer result in impregnation. “4. That of these incompleted pregnancies and apparent instances of sterility, a large proportion are intentional. “5. That such wilful interference with the laws of nature is productive, as might have been expected, of a vast amount of disease—disease whose causation has been unexplained, and whose character is made evident alike by the confessions of the patient, and by the results of a more natural course of life.