The Task of Social Hygiene

by Havelock Ellis

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."

There is, however, more to be said. Not only must an undue struggle with unfavourable conditions enfeeble the strong as well as kill the feeble; it also imposes an intolerable burden upon these enfeebled survivors. The process of destruction is not sudden, it is gradual. It is a long-drawn-out process. It involves the multiplication of the diseased, the maimed, the feeble-minded, of paupers and lunatics and criminals. Even natural selection thus includes the need for protecting the feeble, and so renders urgent the task of social reform, while the more thoroughly this task is carried out with the growth of civilization, the more stupendous and overwhelming the task becomes.