The Task of Social Hygiene

PREFACE

The study of social hygiene means the study of those things which concern the welfare of human beings living in societies. There can, therefore, be no study more widely important or more generally interesting. I fear, however, that by many persons social hygiene is vaguely regarded either as a mere extension of sanitary science, or else as an effort to set up an intolerable bureaucracy to oversee every action of our lives, and perhaps even to breed us as cattle are bred.

That is certainly not the point of view from which this book has been written. Plato and Rabelais, Campanella and More, have been among those who announced the principles of social hygiene here set forth. There must be a social order, all these great pioneers recognized, but the health of society, like the health of the body, is marked by expansion as much as by restriction, and, the striving for order is only justified because without order there can be no freedom. If it were not the mission of social hygiene to bring a new joy and a new freedom into life I should not have concerned myself with the writing of this book.

When we thus contemplate the process of social hygiene, we are no longer in danger of looking upon it as an artificial interference with Nature. It is in the Book of Nature, as Campanella put it, that the laws of life and of government are to be read. Or, as Quesnel said two centuries ago, more precisely for our present purpose, "Nature is universal hygiene." All animals are scrupulous in hygiene; the elaboration of hygiene moves pari passu with the rank of a species in intelligence. Even the cockroach, which lives on what we call filth, spends the greater part of its time in the cultivation of personal cleanliness. And all social hygiene, in its fullest sense, is but an increasingly complex and extended method of purification—the purification of the conditions of life by sound legislation, the purification of our own minds by better knowledge, the purification of our hearts by a growing sense of responsibility, the purification of the race itself by an enlightened eugenics, consciously aiding Nature in her manifest effort to embody new ideals of life. It was not Man, but Nature, who realized the daring and splendid idea—risky as it was—of placing the higher anthropoids on their hind limbs and so liberating their fore-limbs in the service of their nimble and aspiring brains. We may humbly follow in the same path, liberating latent forces of life and suppressing those which no longer serve the present ends of life. For, as Shakespeare said, when in The Winter's Tale he set forth a luminous philosophy of social hygiene and applied it to eugenics,

In whatever way it may be understood, however, social hygiene is now very much to the front of people's minds. The present volume, I wish to make clear, has not been hastily written to meet any real or supposed demand. It has slowly grown during a period of nearly twenty-five years, and it expresses an attitude which is implicit or explicit in the whole of my work. By some readers, doubtless, it will be seen to constitute an extension in various directions of the arguments developed in the larger work on "Sex in Relation to Society," which is the final volume of my Studies in the Psychology of Sex. The book I now bring forward may, however, be more properly regarded as a presentation of the wider scheme of social reform out of which the more special sex studies have developed. We are faced to-day by the need for vast and complex changes in social organization. In these changes the welfare of individuals and the welfare of communities are alike concerned. Moreover, they are matters which are not confined to the affairs of this nation or of that nation, but of the whole family of nations participating in the fraternity of modern progress.

The word "progress," indeed, which falls so easily from our lips is not a word which any serious writer should use without precaution. The conception of "progress" is a useful conception in so far as it binds together those who are working for common ends, and stimulates that perpetual slight movement in which life consists. But there is no general progress in Nature, nor any unqualified progress; that is to say, that there is no progress for all groups along the line, and that even those groups which progress pay the price of their progress. It was so even when our anthropoid ancestors rose to the erect position; that was "progress," and it gained us the use of hands. But it lost us our tails, and much else that is more regrettable than we are always able to realize. There is no general and ever-increasing evolution towards perfection. "Existence is realized in its perfection under whatever aspect it is manifested," says Jules de Gaultier. Or, as Whitman put it, "There will never be any more perfection than there is now." We cannot expect an increased power of growth and realization in existence, as a whole, leading to any general perfection; we can only expect to see the triumph of individuals, or of groups of individuals, carrying out their own conceptions along special lines, every perfection so attained involving, on its reverse side, the acquirement of an imperfection. It is in this sense, and in this sense only, that progress is possible. We need not fear that we shall ever achieve the stagnant immobility of a general perfection.

The problems of progress we are here concerned with are such as the civilized world, as represented by some of its foremost individuals or groups of individuals, is just now waking up to grapple with. No doubt other problems might be added, and the addition give a greater semblance of completion to this book. I have selected those which seem to me very essential, very fundamental. The questions of social hygiene, as here understood, go to the heart of life. It is the task of this hygiene not only to make sewers, but to re-make love, and to do both in the same large spirit of human fellowship, to ensure finer individual development and a larger social organization. At the one end social hygiene may be regarded as simply the extension of an elementary sanitary code; at the other end it seems to some to have in it the glorious freedom of a new religion. The majority of people, probably, will be content to admit that we have here a scheme of serious social reform which every man and woman will soon be called upon to take some share in.

I

INTRODUCTION

The Aim of Social Hygiene—Social Reform—The Rise of Social Reform out of English Industrialism—The Four Stages of Social Reform—(1) The Stage of Sanitation—(2) Factory Legislation—(3) The Extension of the Scope of Education—(4) Puericulture—The Scientific Evolution corresponding to these Stages—Social Reform only Touched the Conditions of Life—Yet Social Reform Remains highly Necessary—The Question of Infantile Mortality and the Quality of the Race—The Better Organization of Life Involved by Social Hygiene—Its Insistence on the Quality rather than on the Conditions of Life—The Control of Reproduction—The Fall of the Birth-rate in Relation to the Quality of the Population—The Rejuvenation of a Society—The Influence of Culture and Refinement on a Race—Eugenics—The Regeneration of the Race—The Problem of Feeble-Mindedness—The Methods of Eugenics—Some of the Problems which Face us.

Social Hygiene, as it will be here understood, may be said to be a development, and even a transformation, of what was formerly known as Social Reform. In that transformation it has undergone two fundamental changes. In the first place, it is no longer merely an attempt to deal with the conditions under which life is lived, seeking to treat bad conditions as they occur, without going to their source, but it aims at prevention. It ceases to be simply a reforming of forms, and approaches in a comprehensive manner not only the conditions of life, but life itself. In the second place, its method is no longer haphazard, but organized and systematic, being based on a growing knowledge of those biological sciences which were scarcely in their infancy when the era of social reform began. Thus social hygiene is at once more radical and more scientific than the old conception of social reform. It is the inevitable method by which at a certain stage civilization is compelled to continue its own course, and to preserve, perhaps to elevate, the race.

The era of social reform followed on the rise of modern industrialism, and, no doubt largely on this account, although an international movement, it first became definite and self-conscious in England. There were perhaps other reasons why it should have been in the first place specially prominent in England. When at the end of the seventeenth century, Muralt, a highly intelligent Swiss gentleman, visited England, and wrote his by no means unsympathetic Lettres sur les Anglais, he was struck by a curious contradiction in the English character. They are a good-natured people, he observed, very rich, so well-nourished that sometimes they die of obesity, and they detest cruelty so much that by royal proclamation it is ordained that the fish and the ducks of the ponds should be duly and properly fed. Yet he found that this good-natured, rich, cruelty-hating nation systematically allowed the prisoners in their gaols to die of starvation. "The great cruelty of the English," Muralt remarks, "lies in permitting evil rather than in doing it." 1 The root of the apparent contradiction lay clearly in a somewhat excessive independence and devotion to liberty. We give a man full liberty, they seem to have said, to work, to become rich, to grow fat. But if he will not work, let him starve. In that point of view there were involved certain fallacies, which became clearer during the course of social evolution.

It was obvious, indeed, that such an attitude, while highly favourable to individual vigour and independence, and not incompatible with fairly healthy social life under the conditions which prevailed at the time, became disastrous in the era of industrialism. The conditions of industrial life tore up the individual from the roots by which he normally received strength, and crowded the workers together in masses, thus generating a confusion which no individual activity could grapple with. So it was that the very spirit which, under the earlier conditions, made for good now made for evil. To stand by and applaud the efforts of the individual who was perhaps slowly sinking deeper and deeper into a miry slough of degradation began to seem an even diabolical attitude. The maxim of laissez-faire, which had once stood for the whole unfettered action of natural activities in life, began to be viewed with horror and contempt. It was realized that there must be an intelligent superintendence of social conditions, humane regulation, systematic organization. The very intensity of the evils which the English spirit produced led to a reaction by which that spirit, while doubtless remaining the same at heart, took on a different form, and manifested its energy in a new direction.

The modern industrial era, replacing domestic industry by collective work carried out by "hands" in factories, began in the eighteenth century. The era of social reform was delayed until the second quarter of the nineteenth century. It has proceeded by four successively progressive stages, each stage supplementing, rather than supplanting, the stage that preceded it. In 1842 Sir Edwin Chadwick wrote an official Report on the Sanitary Condition of the Labouring Population of Great Britain, in which was clearly presented for the first time a vivid, comprehensive, and authoritative picture of the incredibly filthy conditions under which the English labouring classes lived. The times were ripe for this Report. It attracted public attention, and exerted an important influence. Its appearance marks the first stage of social reform, which was mainly a sanitary effort to clear away the gross filth from our cities, to look after the cleansing, lighting, and policing of the streets, to create a drainage system, to improve dwellings, and in these ways to combat disease and to lower the very high death-rate.

At an early stage, however, it began to be seen that this process of sanitation, necessary as it had become, was far too crude and elementary to achieve the ends sought. It was not enough to improve the streets, or even to regulate the building of dwellings. It was clearly necessary to regulate also the conditions of work of the people who lived in those streets and dwellings. Thus it was that the scheme of factory legislation was initiated. Rules were made as to the hours of labour, more especially as regards women and children, for whom, moreover, certain specially dangerous or unhealthy occupations were forbidden, and an increasingly large number of avocations were brought under Government inspection. This second stage of social reform encountered a much more strenuous opposition than the first stage. The regulation of the order and cleanliness of the streets was obviously necessary, and it had indeed been more or less enforced even in medieval times; 2 but the regulation of the conditions of work in the interests of the worker was a more novel proceeding, and it appeared to clash both with the interests of the employers and the ancient principles of English freedom and independence, behind which the employers consequently sheltered themselves. The early attempts to legislate on these lines were thus fruitless. It was not until a distinguished aristocratic philanthropist of great influence, the seventh Earl of Shaftesbury, took up the question, that factory legislation began to be accepted. It continues to develop even to-day, ever enlarging the sphere of its action, and now meeting with no opposition. But, in England, at all events, its acceptance marks a memorable stage in the growth of the national spirit. It was no longer easy and natural for the Englishmen to look on at suffering without interference. It began to be recognized that it was perfectly legitimate, and even necessary, to put a curb on the freedom and independence which involved suffering to others.

But as the era of factory legislation became established, a further advance was seen to be necessary. Factory legislation had forbidden the child to work. But the duty of the community towards the child, the citizen of the future, was evidently by no means covered by this purely negative step. The child must be prepared to take his future part in life, in the first place by education. The nationalization of education in England dates from 1870. But during the subsequent half century "education" has come to mean much more than mere instruction; it now covers a certain amount of provision for meals when necessary, the enforcement of cleanliness, the care of defective conditions, inborn or acquired, with special treatment for mentally defective children, an ever-increasing amount of medical inspection and supervision, while it is beginning to include arrangements for placing the child in work suited to his capacities when he leaves school.

During the past ten years the movement of social reform has entered a fourth stage. The care of the child during his school-days was seen to be insufficient; it began too late, when probably the child's fate for life was already decided. It was necessary to push the process further back, to birth and even to the stage before birth, by directing social care to the infant, and by taking thought of the mother. This consideration has led to a whole series of highly important and fruitful measures which are only beginning to develop, although they have already proved very beneficial. The immediate notification to the authorities of a child's birth, and the institution of Health Visitors to ascertain what is being done for the infant's well-being, and to aid the mother with advice, have certainly been a large factor in the recent reduction in the infantile death-rate in England. 3

The care of the infant has indeed now become a new applied science, the science of puericulture. Professor Budin of Paris may fairly be regarded as the founder of puericulture by the establishment in Paris, in 1892, of Infant Consultations, to which mothers were encouraged to bring their babies to be weighed and examined, any necessary advice being given regarding the care of the baby. The mothers are persuaded to suckle their infants if possible, and if their own health permits. For the cases in which suckling is undesirable or impossible, Budin established Milk Depôts, where pure milk is supplied at a low price or freely. Infant Consultations and Milk Depôts are now becoming common everywhere. A little later than Budin, another distinguished French physician, Pinard, carried puericulture a step further back, but a very important step, by initiating a movement for the care of the pregnant woman. Pinard and his pupils have shown by a number of detailed investigations that the children born to working mothers who rest during the last three months of pregnancy, are to a marked extent larger and finer than the children of those mothers who enjoy no such period of rest, even though the mothers themselves may be equally robust and healthy in both cases. Moreover, it is found that premature birth, one of the commonest accidents of modern life, tends to be prevented by such rest. The children of mothers who rest enjoy on the average three weeks longer development in the womb than the children of the mothers who do not rest, and this prolonged ante-natal development cannot fail to be a benefit for the whole of the child's subsequent life. The movement started by Pinard, though strictly a continuation of the great movement for the improvement of the conditions of life, takes us as far back as we are able to go on these lines, and has in it the promise of an immense benefit to human efficiency.

In connection with the movement of puericulture initiated by Budin and Pinard must be mentioned the institution of Schools for Mothers, for it is closely associated with the aims of puericulture. The School for Mothers arose in Belgium, a little later than the activities of Budin and Pinard commenced. About 1900 a young Socialist doctor of Ghent, Dr. Miele, started the first school of this kind, with girls of from twelve to sixteen years of age as students and assistants. The School eventually included as many as twelve different services, among these being dispensaries for mothers, a mothers' friendly society, milk depôts both for babies and nursing mothers, health talks to mothers with demonstrations, courses on puericulture (including anatomy, physiology, preparation of foods, weighing, etc.) to girls between fourteen and eighteen, who afterwards become eligible for appointment as paid assistants. 4 In 1907 Schools for Mothers were introduced into England, at first under the auspices of Dr. Sykes, Medical Officer of Health for St. Pancras, London. Such Schools are now spreading everywhere. In the end they will probably be considered necessary centres for any national system of puericulture. Every girl at the end of her school life should be expected to pass through a certain course of training at a School for Mothers. It would be the technical school for the working-class mother, while such a course would be invaluable for any girl, whatever her social class, even if she is never called to be a mother herself or to have the care of children.

The great movement of social reform during the nineteenth century, we thus see, has moved in four stages, each of which has reinforced rather than replaced that which went before: (1) the effort to cleanse the gross filth of cities and to remedy obvious disorder by systematic attention to scavenging, drainage, the supply of water and of artificial light, as well as by improved policing; (2) the great system of factory legislation for regulating the conditions of work, and to some extent restraining the work of women and of children; (3) the introduction of national systems of education, and the gradual extension of the idea of education to cover far more than mere instruction; and (4), most fundamental of all and last to appear, the effort to guard the child before the school age, even at birth, even before birth, by bestowing due care on the future mother. 5

It may be pointed out that this movement of practical social reform has been accompanied, stimulated, and guided by a corresponding movement in the sciences which in their application are indispensable to the progress of civilized social reform. There has been a process of mutual action and reaction between science and practice. The social movement has stimulated the development of abstract science, and the new progress in science has enabled further advances to be made in social practice. The era of expansion in sanitation was the era of development in chemistry and physics, which alone enabled a sound system of sanitation to be developed. The fight against disease would have been impossible but for bacteriology. The new care for human life, and for the protection of its source, is associated with fresh developments of biological science. Sociological observations and speculation, including economics, are intimately connected with the efforts of social reform to attain a broad, sound, and truly democratic basis. 6

When we survey this movement as a whole, we have to recognize that it is exclusively concerned with the improvement of the conditions of life. It makes no attempt to influence either the quantity or the quality of life. 7 It may sometimes have been carried out with the assumption that to improve the conditions of life is, in some way or other, to improve the quality of life itself. But it accepted the stream of life as it found it, and while working to cleanse the banks of the stream it made no attempt to purify the stream itself.

It must, however, be remembered that the arguments which, especially nowadays, are brought against the social reform of the condition of life, will not bear serious examination. It is said, for instance, or at all events implied, that we need bestow very little care on the conditions of life because such care can have no permanently beneficial effect on the race, since acquired characters, for the most part, are not transmitted to descendants. But to assume that social reform is unnecessary because it is not inherited is altogether absurd. The people who make this assumption would certainly not argue that it is useless for them to satisfy their own hunger and thirst, because their children will not thereby be safeguarded from experiencing hunger and thirst. Yet the needs which the movement of organized social reform seeks to satisfy are precisely on a level with, and indeed to some extent identical with, the needs of hunger and thirst. The impulse and the duty which move every civilized community to elaborate and gratify its own social needs to the utmost are altogether independent of the race, and would not cease to exist even in a community vowed to celibacy or the most absolute Neo-Malthusianism. Nor, again, must it be said that social reform destroys the beneficial results of natural selection.

Here, indeed, we encounter a disputed point, and it may be admitted that the precise data for absolute demonstration in one direction or the other cannot yet be found. Whenever human beings breed in reckless and unrestrained profusion—as is the case under some conditions before a free and self-conscious civilization is attained—there is an immense infantile mortality. It is claimed, on the one hand, that this is beneficial, and need not be interfered with. The weak are killed off, it is said, and the strong survive; there is a process of natural survival of the fittest. That is true. But it is equally true, as has also been clearly seen on the other hand, that though the relatively strongest survive, their relative strength has been impaired by the very influences which have proved altogether fatal to their weaker brethren. There is an immense infantile mortality in Russia. Yet, notwithstanding any resulting "survival of the fittest," Russia is far more ravaged by disease than Norway, where infantile mortality is low. "A high infantile mortality," as George Carpenter, a great authority on the diseases of childhood, remarks, "denotes a far higher infantile deterioration rate"; or, as another doctor puts it, "the dead baby is next of kin to the diseased baby," The protection of the weak, so frequently condemned by some Neo-Darwinians, is thus in reality, as Goldscheid terms it, "the protection of the strong from degeneration."