Chapter 2

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."

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.

It is thus that civilization, at a certain point in its course, renders inevitable the appearance of that wider and deeper organization of life which in the present volume we are concerned with under the name of Social Hygiene. That movement is far from being an abrupt or revolutionary manifestation in the ordinary progress of social growth. As we have seen, social reform during the past eighty years may be said to have proceeded in four successive stages, each of which has involved a nearer approach to the sources of life. The fourth stage, which in its beginnings dates only from the last years of the nineteenth century, takes us to the period before birth, and is concerned with the care of the child in the mother's womb. The next stage cannot fail to take us to the very source of life itself, lifting us beyond the task of purifying the conditions, and laying on us the further task of regulating the quantity and raising the quality of life at its very source. The duty of purifying, ordering, and consolidating the banks of the stream must still remain.[8] But when we are able to control the stream at its source we are able to some extent to prevent the contamination of that stream by filth, and ensure that its muddy floods shall not sweep away the results of our laborious work on the banks. Our sense of social responsibility is developing into a sense of racial responsibility, and that development is expressed in the nature of the tasks of Social Hygiene which now lie before us.

It is the control of the reproduction of the race which renders possible the new conception of Social Hygiene. We have seen that the gradual process of social reform during the first three quarters of the nineteenth century, by successive stages of movement towards the sources of life, finally reached the moment of conception. The first result of reform at this point was that procreation became a deliberate act. Up till then the method of propagating the race was the same as that which savages have carried on during thousands of years, the chief difference being that whereas savages have frequently sought to compensate their recklessness by destroying their inferior offspring, we had accepted all the offspring, good, bad, and indifferent, produced by our indiscriminate recklessness, shielding ourselves by a false theology. Children "came," and their parents disclaimed all responsibility for their coming. The children were "sent by God," and if they all turned out to be idiots, the responsibility was God's. But when it became generally realized that it was possible to limit offspring without interfering with conjugal life a step of immense importance was achieved. It became clear to all that the Divine force works through us, and that we are not entitled to cast the burden of our evil actions on any Higher Power. Marriage no longer fatally involved an endless procession of children who, in so far as they survived at all, were in a large number of cases doomed to disease, neglect, misery, and ignorance. The new Social Hygiene was for the first time rendered possible.

It was in France during the first half of the nineteenth century that the control of reproduction first began to become a social habit. In Sweden and in Denmark, the fall in the birth-rate, though it has been irregular, may be said to have begun in 1860. It was not until about the year 1876 that, in so far as we may judge by the arrest of the birth-rate, the movement began to spread to Europe generally. In England it is usual to associate this change with a famous prosecution which brought a knowledge of the means of preventing conception to the whole population of Great Britain. Undoubtedly this prosecution was an important factor in the movement, but we cannot doubt that, even if the prosecution had not taken place, the course of social progress must still have pursued the same course. It is noteworthy that it was about this same period, in various European countries, that the tide turned, and the excessively high birth-rate began to fall.[9] Recklessness was giving place to foresight and self-control. Such foresight and self-control are of the essence of civilization.[10]

It cannot be disputed that the transformation by which the propagation of the race became deliberate and voluntary has not been established in social custom without a certain amount of protestation from various sides. No social change, however beneficial, ever is established without such protestation, which may, therefore, be regarded as an inevitable and probably a salutary part of social change. Even some would-be scientific persons, with a display of elaborate statistics, set forth various alarmistic doctrines. If, said these persons, this new movement goes on at the present pace, and if all other conditions remain unchanged, then all sorts of terrible results will ensue. But the alarming conclusion failed to ensue, and for a very sufficient reason. The assumed premises of the argument were unsound. Nothing ever goes on at the same pace, nor do all other conditions ever remain unchanged.

The world is a living fire, as Heraclitus long ago put it. All things are in perpetual flux. Life is a process of perpetual movement. It is idle to bid the world stand still, and then to argue about the consequences. The world will not stand still, it is for ever revolving, for ever revealing some new facet that had not been allowed for in the neatly arranged mechanism of the statistician.

It is perhaps unnecessary to dwell on a point which is now at last, one may hope, becoming clear to most intelligent persons. But I may perhaps be allowed to refer in passing to an argument that has been brought forward with the wearisome iteration which always marks the progress of those who are feeble in argument. The good stocks of upper social class are decreasing in fertility, it is said; the bad stocks of lower social class are not decreasing; therefore the bad stocks are tending to replace the good stocks.[11]

It must, however, be pointed out that, even assuming that the facts are as stated; it is a hazardous assumption that the best stocks are necessarily the stocks of high social class. In the main no doubt this is so, but good stocks are nevertheless so widely spread through all classes--such good stocks in the lower social classes being probably the most resistent to adverse conditions--that we are not entitled to regard even a slightly greater net increase of the lower social classes as an unmitigated evil. It may be that, as Mercier has expressed it, "we have to regard a civilized community somewhat in the light of a lamp, which burns at the top and is replenished from the bottom."[12]

The soundness of a stock, and its aptitude for performing efficiently the functions of its own social sphere, cannot, indeed, be accurately measured by any tendency to rise into a higher social sphere. On the whole, from generation to generation, the men of a good stock remain within their own social sphere, whether high or low, adequately performing their functions in that sphere, from generation to generation. They remain, we may say, in that social stratum of which the specific gravity is best suited for their existence.[13]

Yet, undoubtedly, from time to time, there is a slight upward social tendency, due in most cases to the exceptional energy and ability of some individual who succeeds in permanently lifting his family into a slightly higher social stratum.[14] Such a process has always taken place, in the past even more conspicuously than in the present. The Normans who came over to England with William the Conqueror and constituted the proud English nobility were simply a miscellaneous set of adventurers, professional fighting men, of unknown, and no doubt for the most part undistinguished, lineage. William the Conqueror himself was the son of a woman of the people. The Catholic Church founded no families, but its democratic constitution opened a career to men of all classes, and the most brilliant sons of the Church were often of the lowliest social rank. We should not, therefore, say that the bad stocks are replacing the good stocks. There is not the slightest evidence for any such theory. All that we are entitled to say is that when in the upward progression of a community the vanishing point of culture and refinement is attained the bearers of that culture and refinement die off as naturally and inevitably as flowers in autumn, and from their roots spring up new and more vigorous shoots to replace them and to pass in their turn through the same stages, with that perpetual slight novelty in which lies the secret of life, as well as of art. An aristocracy which is merely an aristocracy because it is "old"--whether it is an aristocracy of families, or of races, or of species--has already ceased to be an aristocracy in any sound meaning of the term. We need not regret its disappearance.

Do not, therefore, let us waste our time in crying over the dead roses of the summer that is past. There is something morbid in the perpetual groaning over that inevitable decay which is itself a part of all life. Such a perpetual narrow insistence on one aspect of life is scarcely sane. One suspects that these people are themselves of those stocks over whose fate they grieve. Let us, therefore, mercifully leave them to manure their dead roses in peace. They will soon be forgotten. The world is for ever dying. The world is also for ever bursting with life. The spring song of _Sursum corda_ easily overwhelms the dying autumnal wails of the _Dies Iræ_.