The Task of Social Hygiene

by Havelock Ellis

The case of Japan is interesting as that of a vigorous young Eastern nation, which has assimilated Western ways and is encountering the evils which come of those ways. Japan is certainly worthy of all our admiration for the skill and vigour with which it has affirmed its young nationality along Western lines. But when the vital statistics of Japan are vaguely referred to either as a model for our imitation or as a threatening peril to us, we may do well to look into the matter a little more closely. The infantile mortality of Japan (1908) is 157, a very high figure, 50 per cent higher than that of England, much more than double that of New Zealand, or South Australia. Moreover, it has rapidly risen during the last ten years. The birth-rate of Japan in 1901-2 was high (36), though it has since fallen to the level of ten years ago. But the death-rate has risen concomitantly (to over 24 per 1000), and has continued to rise notwithstanding the slight decline in the birth-rate. We see here a tendency to the sinister combination of a falling birth-rate with a rising death-rate. [107] It is obvious that such a tendency, if continued, will furnish a serious problem to Japanese social reformers, and at the same time make it impossible for Western alarmists to regard the rise of Japan as a menace to the world.

It is behind China that these alarmists, when driven from every other position, finally entrench themselves. "The ultimate future of these islands may be to the Chinese," incautiously exclaims Mr. Sidney Webb, who on many subjects, unconnected with China, speaks with authority. The knowledge of the vital statistics of China possessed by our alarmists is vague to the most extreme degree, but as the knowledge of all of us is scarcely less vague, they assume that their position is fairly safe. That, however, is an altogether questionable assumption. It seems to be quite true—though in the absence of exact statistics it may not be certain—that the birth-rate in China is very high. But it is quite certain that the infantile death-rate is extremely high. "Out of ten children born among us, three, normally the weakest three, will fail to grow up: out of ten children born in China these weakest three will die, and probably five more besides," writes Professor Ross, who is intimately acquainted with Chinese conditions, and has closely questioned thirty-three physicians practising in various parts of China. [108] Matignon, a French physician familiar with China, states that it is the custom for a woman to suckle her child for at least three years; should pregnancy occur during this period, it is usual, and quite legal, to procure abortion. Infants brought up by hand are fed on rice-flour and water, and consequently they nearly all die. [109]

Putting aside altogether the question of infanticide, such a state of things is far from incredible when we remember the extremely insanitary state of China, the superstitions that flourish unchecked, and the famines, floods, and pestilences that devastate the country. It would appear probable that when vital statistics are introduced into China they will reveal a condition of things very similar to that we find in Russia, but in a more marked degree. No doubt it is a state of things which will be remedied. It is a not unreasonable assumption, supported by many indications, that China will follow Japan in the adoption of Western methods of civilization. [110] These methods, as we know, involve in the end a low birth-rate with a general tendency to a lower death-rate. Neither in the near nor in the remote future, under present conditions or under probable future conditions, is there any reason for imagining that the Chinese are likely to replace the Europeans in Europe. [111]

This preliminary survey of the ground may enable us to realize that not only must we be cautious in attaching importance to the crude birth-rate until it is corrected, but that even as usually corrected the birth-rate can give us no clue at all to natural increase because there is a marked tendency for the birth-rate and the infantile death-rate to rise or sink together. Moreover, it is evident that we have also to realize that from the point of view of society and civilization there is a vast difference between the natural increase which is achieved by the effort of an enormously high birth-rate to overcome an almost correspondingly high death-rate and the natural increase which is attained by the dominance of a low birth-rate over a still lower death-rate.

Having thus cleared the ground, we may proceed to attempt the interpretation of the declining birth-rate which marks civilization, and to discuss its significance.

II

It must be admitted that it is not usual to consider the question of the declining birth-rate from a broad or scientific standpoint. As we have seen, no attempt is usually made to correct the crude birth-rate; still more rarely is it pointed out that we cannot consider the significance of a falling birth-rate apart from the question of the death-rate, and that the net increase or decrease in a nation can only be judged by taking both these factors into account. It is scarcely necessary to add, in view of so superficial a way of looking at the problem, that we hardly ever find any attempt to deal with the more fundamental question of the meaning of a low birth-rate, and the problematical character of the advantages of rapid multiplication. The whole question is usually left to the ignorant preachers of the gospel of brute force, would-be patriots who desire their own country to increase at the cost of all other countries, not merely in ignorance of the fact that the crude birth-rate is not the index of increase, but reckless of the effect their desire, if fulfilled, would have upon all the higher and finer ends of living.

When the question is thus narrowly and ignorantly considered, it is usual to account for the decreased birth-rate, the smaller average families, and the tendency to postpone the age of marriage, as due mainly to a love of luxury and vice, combined with a newly acquired acquaintance with Neo-Malthusian methods, [112] which must be combated, and may successfully be combated, by inculcating, as a moral and patriotic duty, the necessity of marrying early and procreating large families. [113] In France, the campaign against the religious Orders in their educational capacity, while doubtless largely directed against educational inefficiency, was also supported by the feeling that such education is not on the side of family life; and Arsène Dumont, one of the most vigorous champions of a strenuously active policy for increasing the birth-rate, openly protested against allowing any place as teachers to priests, monks, and nuns, whose direct and indirect influence must degrade the conception of sex and its duties while exalting the place of celibacy. In the United States, also, Engelmann, who, as a gynæcologist, was able to see this process from behind the scenes, urged his fellow-countrymen "to stay the dangerous and criminal practices which are the main determining factors of decreasing fecundity, and which deprive women of health, the family of its highest blessings, and the nation of its staunchest support." [114]

We must, however, look at these phenomena a little more broadly, and bring them into relation with other series of phenomena. It is almost beyond dispute that a voluntary restriction of the number of offspring by Neo-Malthusian practices is at least one of the chief methods by which the birth-rate has been lowered. It may not indeed be—and probably, as we shall see, is not—the only method. It has even been denied that the prevalence of Neo-Malthusian practices counts at all. [115] Thus while Coghlan, the Government Statistician of New South Wales, concludes that the decline in the birth-rate in the Australian Commonwealth was due to "the art of applying artificial checks to conception," McLean, the Government Statistician of Victoria, concludes that it was "due mainly to natural causes." [116] He points out that when the birth-rate in Australia, half a century ago, was nearly 43 per 1000, the population consisted chiefly of men and women at the reproductive period of life, and that since then the proportion of persons at these ages has declined, leading necessarily to a decline in the crude birth-rate. If we compare the birth-rate of communities among women of the same age-periods, McLean argues, we may obtain results quite different from the crude birth-rate. Thus the crude birth-rate of Buda-Pesth is much higher than that of New South Wales, but if we ascertain the birth-rate of married women at different age-periods (15 to 20, 20 to 25, etc.) the New South Wales birth-rate is higher for every age-period than that of Buda-Pesth. McLean considers that in young communities with many vigorous immigrants the population is normally more prolific than in older and more settled communities, and that hardships and financial depression still more depress the birth-rate. He further emphasizes the important relationship, which we must never lose sight of in this connection, between a high birth-rate and a high death-rate, especially a high infantile death-rate, and he believes, indeed, that "the solution of the problem of the general decline in the birth-rate throughout all civilized communities lies in the preservation of human life." The mechanism of the connection would be, he maintains, that prolonged suckling in the case of living children increases the intervals between childbearing. As we have seen, there is a tendency, though not a rigid and invariable necessity, [117] for a high birth-rate to be associated with a high infantile death-rate, and a low birth-rate with a low infantile death-rate. Thus in Victoria, we have the striking fact that while the birth-rate has declined 24 per cent the infantile death-rate has declined approximately to the still greater extent of 27 per cent.

No doubt the chief cause of the reduction of the birth-rate has been its voluntary restriction by preventive methods due to the growth of intelligence, knowledge, and foresight. In all the countries where a marked decline in the birth-rate has occurred there is good reason to believe that Neo-Malthusian methods are generally known and practised. So far as England is concerned this is certainly the case. A few years ago Mr. Sidney Webb made inquiries among middle-class people in all parts of the country, and found that in 316 marriages 242 were thus limited and only 74 unlimited, while for the ten years 1890-9 out of 120 marriages 107 were limited and only 13 unlimited, but as five of these 13 were childless there were only 8 unlimited fertile marriages out of 120. As to the causes assigned for limiting the number of children, in 73 out of 128 cases in which particulars were given under this head the poverty of the parents in relation to their standard of comfort was a factor; sexual ill-health—that is, generally, the disturbing effect of child-bearing—in 24; and other forms of ill-health of the parents in 38 cases; in 24 cases the disinclination of the wife was a factor, and the death of a parent had in 8 cases terminated the marriage. [118] In the skilled artisan class there is also good reason to believe that the voluntary limitation of families is constantly becoming more usual, and the statistics of benefit societies show a marked decline in the fertility of superior working-class people during recent years; thus it is stated by Sidney Webb that the Hearts of Oak Friendly Society paid benefits on child-birth to 2472 per 10,000 members in 1880; by 1904 the proportion had fallen to 1165 per 10,000, a much greater fall than occurred in England generally.