The Task of Social Hygiene. Ellis Havelock

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,

4

Mrs. Bertrand Russell, "The Ghent School for Mothers," Nineteenth Century, December, 1906.

5

It is scarcely necessary to say that other classifications of social reform on its more hygienic side may be put forward. Thus W.H. Allen, looking more narrowly at the sanitary side of the matter, but without confining his consideration to the nineteenth century, finds that there are always seven stages: (1) that of racial tutelage, when sanitation becomes conscious and receives the sanction of law; (2) the introduction of sanitary comfort, well-paved streets, public sewers, extensive waterworks; (3) the period of commercial sanitation, when the mercantile classes insist upon such measures as quarantine and street-cleaning to check the immense ravages of epidemics; (4) the introduction of legislation against nuisances and the tendency to extend the definition of nuisance, which for Bracton, in the fourteenth century, meant an obstruction, and for Blackstone, in the eighteenth, included things otherwise obnoxious, such as offensive trades and foul watercourses; (5) the stage of precaution against the dangers incidental to the slums that are fostered by modern conditions of industry; (6) the stage of philanthropy, erecting hospitals, model tenements, schools, etc.; (7) the stage of socialistic sanitation, when the community as a whole actively seeks its own sanitary welfare, and devotes public funds to this end.

(W.H. Allen, "Sanitation and Social Progress," American Journal of Sociology, March, 1903.)

6

Dr. F. Bushee has pointed out ("Science and Social Progress," Popular Science Monthly, September, 1911) that there is a kind of related progression between science and practice in this matter: "The natural sciences developed first, because man was first interested in the conquest of nature, and the simpler physical laws could be grasped at an early period. This period brought an increase of wealth, but it was wasteful of human life. The desire to save life led the way to the study of biology. Knowledge of the physical environment and of life, however, did not prevent social disease from flourishing, and did not greatly improve the social condition of a large part of society. To overcome these defects the social sciences within recent years have been cultivated with great seriousness. Interest in the social sciences has had to wait for the enlarged sympathies and the sense of solidarity which has appeared with the growing interdependence of dense populations, and these conditions have been dependent upon the advance of the other sciences. With the cultivation of the social sciences, the chain of knowledge will be complete, at least so far as the needs which have already appeared are concerned. For each group of sciences will solve one or more of the great problems which man has encountered in the process of development. The physical sciences will solve the problems of environment, the biological sciences the problems of life, and the social sciences the problems of society."

7

This exclusive pre-occupation with the improvement of the environment has been termed Euthenics by Mrs. Ellen H. Richards, who has written a book with this title, advocating euthenics in opposition to eugenics.

8

Not one of the four stages of social reform already summarized can be neglected. On the contrary, they all need to be still further consolidated in a completely national organization of health. I may perhaps refer to the little book on The Nationalization of Health, in which, many years ago, I foreshadowed this movement, as well as to the recent work of Professor Benjamin Moore on the same subject. The gigantic efforts of Germany, and later of England, to establish National Insurance systems, bear noble witness to the ardour with which these two countries, at all events, are moving towards the desired goal.