The Task of Social Hygiene

It is not enough, however, to consider the mechanism by which the birth-rate declines; to realize the significance of the decline we must consider the causes which set the mechanism in action.

We begin to obtain a truer insight into the meaning of the curve of a country's birth-rate when we realize that it is in relation with the industrial and commercial activity of the country. 123 It is sometimes stated that a high birth-rate goes with a high degree of national prosperity. That, however, is scarcely the case; we have to look into the matter a little more closely. And, when we do so, we find that, not only is the statement of a supposed connection between a high birth-rate and a high degree of prosperity an imperfect statement; it is altogether misleading.

If, in the first place, we attempt to consider the state of things among savages, we find, indeed, great variations, and the birth-rate is not infrequently low. But, on the whole, it would appear, the marriage-rate, the birth-rate, and, it may be added, the death-rate are all alike high. Karl Ranke has investigated the question with considerable care among the Trumai and Nahuqua Indians of Central Brazil. 124 These tribes are yet totally uncontaminated by contact with European influences; consumption and syphilis are alike unknown. In the two villages he investigated in detail, Ranke found that every man over twenty-five years of age was married, and that the only unmarried woman he discovered was feeble-minded. The average size of the families of those women who were over forty years of age was between five and six children, while, on the other hand, the mortality among children was great, and a relatively small proportion of the population reached old age. We see therefore that, among these fairly typical savages, living under simple natural conditions, the fertility of the women is as high as it is among all but the most prolific of European peoples; while, in striking contrast with European peoples, among whom a large percentage of the population never marry, and of those who do, many have no children, practically every man and woman both marries and produces children.

If we leave savages out of the question and return to Europe, it is still instructive to find that among those peoples who live under the most primitive conditions much the same state of things may be found as among savages. This is notably the case as regards Russia. In no other great European country do the bulk of the women marry at so early an age, and in no other is the average size of the family so large. And, concomitantly with a very high marriage-rate and a very high birth-rate, we find in Russia, in an equally high degree, the prevalence among the masses of infantile and general mortality, disease (epidemical and other), starvation, misery. 125

So far we scarcely see any marked connection between high fertility and prosperity. It is more nearly indicated in the high birth-rate of Hungary—only second to that of Russia, and also accompanied by a high mortality—which is associated with the rapid and notable development of a young nationality. The case of Hungary is, indeed, typical. In so far as high fertility is associated with prosperity, it is with the prosperity of a young and unstable community, which has experienced a sudden increase of wealth and a sudden expansion. The case of Western Australia illustrates the same point. Thirty years ago the marriage-rate and the birth-rate of this colony were on the same level as those of the other Australian colonies; but a sudden industrial expansion occurred, both rates rose, and in 1899 the fertility of Western Australia was higher than that of any other English-speaking community. 126

If now we put together the facts observed in savage life and the facts observed in civilized life, we shall begin to see the real nature of the factors that operate to raise or lower the fertility of a community. It is far, indeed, from being prosperity which produces a high fertility, for the most wretched communities are the most prolific, but, on the other hand, it is by no means the mere absence of prosperity which produces fertility, for we constantly observe that the on-coming of a wave of prosperity elevates the birth-rate. In both cases alike it is the absence of social-economic restraints which conduces to high fertility. In the simple, primitive community of savages, serfs, or slaves, there is no restraint on either nutritive or reproductive enjoyments; there is no adequate motive for restraint; there are no claims of future wants to inhibit the gratification of present wants; there are no high standards, no ideals. Supposing, again, that such restraints have been established by a certain amount of forethought as regards the future, or a certain calculation as to social advantages to be gained by limiting the number of children, a check on natural fertility is established. But a sudden accession of prosperity—a sudden excess of work and wages and food—sweeps away this check by apparently rendering it unnecessary; the natural reproductive impulse is liberated by this rising wave, and we here see whatever truth there is in the statement that prosperity means a high birth-rate. In reality, however, prosperity in such a case merely increases fertility because its sudden affluence reduces a community to the same careless indifference in regard to the future, the same hasty snatching at the pleasures of the moment, as we find among the most hopeless and least prosperous communities. It is a significant fact, as shown by Beveridge, that the years when the people of Great Britain marry most are the years when they drink most. It is in the absence of social-economic restraints—the absence of the perception of such restraints, or the absence of the ability to act in accordance with such perception—that the birth-rate is high.

Arsène Dumont seems to have been one of the first who observed this significance of the oscillation of the birth-rate, though he expressed it in a somewhat peculiar way, as the social capillarity theory. It is the natural and universal tendency of mankind to ascend, he declared; a high birth-rate and a strong ascensional impulse are mutually contradictory. Large families are only possible when there is no progress, and no expectation of it can be cherished; small families become possible when the way has been opened to progress. "One might say," Dumont puts it, "that invisible valves, like those which direct the circulation of the blood, have been placed by Nature to direct the current of human aspiration in the upward path it has prescribed." As the proletariat is enabled to enjoy the prospect of rising it comes under the action of this law of social capillarity, and the birth-rate falls. It is the effort towards an indefinite perfection, Dumont declares, which justifies Nature and Man, consoles us for our griefs, and constitutes our sovereign safeguard against the philosophy of despair. 127

When we thus interpret the crude facts of the falling birth-rate, viewing them widely and calmly in connection with the other social facts with which they are intimately related, we are able to see how foolish has been the outcry against a falling birth-rate, and how false the supposition that it is due to a new selfishness replacing an ancient altruism. 128 On the contrary, the excessive birth-rate of the early industrial period was directly stimulated by selfishness. There were no laws against child-labour; children were produced that they might be sent out, when little more than babies, to the factories and the mines to increase their parents' income. The fundamental instincts of men and women do not change, but their direction can be changed. In this field the change is towards a higher transformation, introducing a finer economy into life, diminishing death, disease, and misery, making possible the finer ends of living, and at the same time indirectly and even directly improving the quality of the future race. 129 This is now becoming recognized by nearly all calm and sagacious inquirers. 130 The wild outcry of many unbalanced persons to-day, that a falling birth-rate means degeneration and disaster, is so altogether removed from the sphere of reason that we ought perhaps to regard it as comparable to those manias which, in former centuries, have assumed other forms more attractive to the neurotic temperament of those days; fortunately, it is a mania which, in the nature of things, is powerless to realize itself, and we need not anticipate that the outcry against small families will have the same results as the ancient outcry against witches. 131

It may be proper at this stage to point out that while, in the foregoing statement, a high birth-rate and a high marriage-rate have been regarded as practically the same thing, we need to make a distinction. The true relation of the two rates may be realized when it is stated that, the more primitive a community is, the more closely the two rates vary together. As a community becomes more civilized and more complex, the two rates tend to diverge; the restraints on child-production are deeper and more complex than those on marriage, so that the removal of the restraint on marriage by no means removes the restraint on fertility. They tend to diverge in opposite directions. Farr considered the marriage-rate among civilized peoples as a barometer of national prosperity. In former years, when corn was a great national product, the marriage-rate in England rose regularly as the price of wheat fell. Of recent years it has become very difficult to estimate exactly what economic factors affect the marriage-rate. It is believed by some that the marriage-rate rises or falls with the value of exports. 132 Udny Yule, however, in an expertly statistical study of the matter, 133 finds (in agreement with Hooker) that neither exports nor imports tally with the marriage-rate. He concludes that the movement of prices is a predominant—though by no means the sole—factor in the change of marriage-rates, a fall in prices producing a fall in the marriage-rates and also in the birth-rates, though he also thinks that pressure on the labour market has forced both rates lower than the course of prices would lead one to expect. In so far as these causes are concerned, Udny Yule states, the fall is quite normal and pessimistic views are misplaced. Udny Yule, however, appears to be by no means confident that his explanation covers a large part of the causation, and he admits that he cannot understand the rationale of the connection between marriage-rates and prices. The curves of the marriage-rates in many countries indicate a maximum about or shortly before, 1875, when the birth-rate also tended to reach a maximum, and another rise towards 1900, thus making the intermediate curve concave. There was, however, a large rise in money wages between 1860 and 1875, and the rise in the consuming power of the population has been continuous since 1850. Thus the factors favourable to a high marriage-rate must have risen from 1850 to a maximum about 1870-1875, and since then have fallen continuously. This statement, which Mr. Udny Yule emphasizes, certainly seems highly significant from our present point of view. It falls into line with the view here accepted, that the first result of a sudden access of prosperity is to produce a general orgy, a reckless and improvident haste to take advantage of the new prosperity, but that, as the effects of the orgy wear off, it necessarily gives place to new ideals, and to higher standards of life which lead to caution and prudence. Mr. N.A. Hooker seems to have perceived this, and in the discussion which followed the reading of Udny Yule's paper he set forth what (though it was not accepted by Udny Yule) may perhaps fairly be regarded as the sound view of the matter. "During the great expansion of trade prior to 1870," he remarked, "the means of satisfying the desired standard of comfort were increasing much more rapidly than the rise in the standard; hence a decreasing age of marriage and a marriage-rate above the normal. After about 1873, however, the means of satisfying the standard of comfort no longer increased with the same rapidity, and then a new factor, he thought, became important, viz. the increased intelligence of the people." 134 This seems to be precisely the same view of the matter as I have here sought to set forth; prosperity is not civilization, its first tendency is to produce a reckless abandonment to the satisfaction of the crudest impulses. But as prosperity develops it begins to engender more complex ideals and higher standards; the inevitable result is a greater forethought and restraint. 135

If we consider, not the marriage-rate, but the average age at marriage, and especially the age of the woman, which varies less than that of the man, the results, though harmonious, would not be quite the same. The general tendency as regards the age of girls at marriage is summed up by Ploss and Bartels, in their monumental work on Woman, in the statement: "It may be said in general that the age of girls at marriage is lower, the lower the stage of civilization is in the community to which they belong." 136 We thus see one reason why it is that, in an advanced stage of civilization, a high marriage-rate is not necessarily associated with a high birth-rate. A large number of women who marry late may have fewer children than a smaller number who marry early.

We may see the real character of the restraints on fertility very well illustrated by the varying birth-rate of the upper and lower social classes belonging to the same community. If a high birth-rate were a mark of prosperity or of advanced civilization, we should expect to find it among the better social class of a community. But the reverse is the case; it is everywhere the least prosperous and the least cultured classes of a community which show the highest birth-rate. As we go from the very poor to the very rich quarters of a great city—whether Paris, Berlin, or Vienna—the average number of children to the family diminishes regularly. The difference is found in the country as well as in the towns. In Holland, for instance, whether in town or country, there are 5.19 children per marriage among the poor, and only 4.50 among the rich. In London it is notorious that the same difference appears; thus Charles Booth, the greatest authority on the social conditions of London, in the concluding volume of his vast survey, sums up the condition of things in the statement that "the lower the class the earlier the period of marriage and the greater the number of children born to each marriage." The same phenomenon is everywhere found, and it is one of great significance.

The significance becomes clearer when we realize that an urban population must always be regarded as more "civilized" than a rural population, and that, in accordance with that fact, an urban population tends to be less prolific than a rural population. The town birth-rate is nearly always lower than the country birth-rate. In Germany this is very marked, and the rapidly growing urbanization of Germany is accompanied by a great fall of the birth-rate in the large cities, but not in the rural districts. In England the fall is more widespread, and though the birth-rate is much higher in the country than in the towns the decline in the rural birth-rate is now proceeding more rapidly than that in the urban birth-rate. England, which once contained a largely rural population, now possesses a mainly urban population. Every year it becomes more urban; while the town population grows, the rural population remains stationary; so that, at the present time, for every inhabitant of the country in England, there are more than three town-dwellers. As the country-dweller is more prolific than the town-dweller, this means that the rural population is constantly being poured into the towns. The larger our great cities grow, the more irresistible becomes the attraction which they exert on the children of the country, who are fascinated by them, as the birds are fascinated by the lighthouse or the moths by the candle. And the results are not altogether unlike those which this analogy suggests. At the present time, one-third of the population of London is made up of immigrants from the country. Yet, notwithstanding this immense and constant stream of new and vigorous blood, it never suffices to raise the urban population to the same level of physical and nervous stability which the rural population possesses. More alert, more vivacious, more intelligent, even more urbane in the finer sense, as the urban population becomes,—not perhaps at first, but in the end,—it inevitably loses its stamina, its reserves of vital energy. Dr. Cantlie very properly defines a Londoner as a person whose grandparents all belonged to London—and he could not find any. Dr. Harry Campbell has found a few who could claim London grandparents; they were poor specimens of humanity. 137 Even on the intellectual side there are no great Londoners. It is well known that a number of eminent men have been born in London; but, in the course of a somewhat elaborate study of the origins of British men of genius, I have not been able to find that any were genuinely Londoners by descent. 138 An urban life saps that calm and stolid strength which is necessary for all great effort and stress, physical or intellectual. The finest body of men in London, as a class, are the London police, and Charles Booth states that only 17 per cent of the London police are born in London, a smaller proportion than any other class of the London population except the army and navy. As Mr. N.C. Macnamara has pointed out, it is found that London men do not possess the necessary nervous stability and self-possession for police work; they are too excitable and nervous, lacking the equanimity, courage, and self-reliance of the rural men. Just in the same way, in Spain, the bull-fighters, a body of men admirable for their graceful strength, their modesty, courage, and skill, nearly always come from country districts, although it is in the towns that the enthusiasm for bull-fighting is centred. Therefore, it would appear that until urban conditions of life are greatly improved, the more largely urban a population becomes, the more is its standard of vital and physical efficiency likely to be lowered. This became clearly visible during the South African War; it was found at Manchester (as stated by Dr. T.P. Smith and confirmed by Dr. Clayton) that among 11,000 young men who volunteered for enlistment, scarcely more than 10 per cent could pass the surgeon's examination, although the standard of physique demanded was extremely low, while Major-General Sir F. Maurice has stated 139 that, even when all these rejections have been made, of those who actually are enlisted, at the end of two years only two effective soldiers are found for every five who enlist. It is not difficult to see a bearing of these facts on the birth-rate. The civilized world is becoming a world of towns, and, while the diminished birth-rate of towns is certainly not mainly the result of impaired vitality, these phenomena are correlative facts of the first importance for every country which is using up its rural population and becoming a land of cities.

From our present point of view it is thus a very significant fact that the equipoise between country-dwellers and town-dwellers has been lost, that the towns are gaining at the expense of the country whose surplus population they absorb and destroy. The town population is not only disinclined to propagate; it is probably in some measure unfit to propagate.

At the same time, we must not too strongly emphasize this aspect of the matter; such over-emphasis of a single aspect of highly complex phenomena constantly distorts our vision of great social processes. We have already seen that it is inaccurate to assert any connection between a high birth-rate and a high degree of national prosperity, except in so far as at special periods in the history of a country a sudden wave of prosperity may temporarily remove the restraints on natural fertility. Prosperity is only one of the causes that tend to remove the restraint on the birth-rate; and it is a cause that is never permanently effective.

III

To get to the bottom of the matter, we thus find it is necessary to look into it more closely than is usually attempted. When we ask ourselves why prosperity fails permanently to remove the restraints on fertility the answer is, that it speedily creates new restraints. Prosperity and civilization are far from being synonymous terms. The savage who is able to glut himself with the whale that has just been stranded on his coast, is more prosperous than he was the day before, but he is not more civilized, perhaps a trifle less so. The working community that is suddenly glutted by an afflux of work and wages is in exactly the same position as the savage who is suddenly enabled to fill himself with a rich mass of decaying blubber. It is prosperity; it is not civilization. 140 But, while prosperity leads at first to the reckless and unrestrained gratification of the simplest animal instincts of nutrition and reproduction, it tends, when it is prolonged, to evolve more complex instincts. Aspirations become less crude, the needs and appetites engendered by prosperity take on a more social character, and are sharpened by social rivalries. In place of the earlier easy and reckless gratification of animal impulses, a peaceful and organized struggle is established for securing in ever fuller degree the gratification of increasingly insistent and increasingly complex desires. Such a struggle involves a deliberate calculation and forethought, which, sooner or later, cannot fail to be applied to the question of offspring. Thus it is that affluence, in the long run, itself imposes a check on reproduction. Prosperity, under the stress of the urban conditions with which it tends to be associated, has been transformed into that calculated forethought, that deliberate self-restraint for the attainment of ever more manifold ends, which in its outcome we term "civilization."

It is frequently assumed, as we have seen, that the process by which civilization is thus evolved is a selfish and immoral process. To procreate large families, it is said, is unselfish and moral, as well as a patriotic, even a religious duty. This assumption, we now find, is a little too hasty and is even the reverse of the truth; it is necessary to take into consideration the totality of the social phenomena accompanying a high birth-rate, more especially under the conditions of town life. A community in which children are born rapidly is necessarily in an unstable position; it is growing so quickly that there is insufficient time for the conditions of life to be equalized. The state of ill-adjustment is chronic; the pressure is lifted from off the natural impulse of procreation, but is increased on all the conditions under which the impulse is exerted. There is increased overcrowding, increased filth, increased disease, increased death. It can never happen, in modern times, that the readjustment of the conditions of life can be made to keep pace with a high birth-rate. It is sufficient if we consider the case of English towns, of London in particular, during the period when British prosperity was most rapidly increasing, and the birth-rate nearing its maximum, in the middle of the great Victorian epoch, of which Englishmen are, for many reasons, so proud. It was certainly not an age lacking in either energy or philanthropy; yet, when we read the memorable report which Chadwick wrote in 1842, on the Sanitary Condition of the Labouring Population of Great Britain, or the minute study of Bethnal Green which Gavin published in 1848 as a type of the conditions prevailing in English towns, we realize that the magnificence of this epoch was built up over circles of Hell to which the imagination of Dante never attained.

As reproductive activity dies down, social conditions become more stable, a comparatively balanced state of adjustment tends to be established, insanitary surroundings can be bettered, disease diminished, and the death-rate lowered. How much may thus be accomplished we realize when we compare the admirably precise and balanced pages in which Charles Booth, in the concluding volumes of his great work, has summarized his survey of London, with the picture presented by Chadwick and Gavin half a century earlier. Ugly and painful as are many of the features of this modern London, the vision which is, on the whole, evoked is that of a community which has attained self-consciousness, which is growing into some faint degree of harmony with its environment, and is seeking to gain the full amount of the satisfaction which an organized urban life can yield. Booth, who appears to have realized the significance of a decreased fertility in the attainment of this progress, hopes for a still greater fall in the birth-rate; and those who seek to restore the birth-rate of half a century ago are engaged on a task which would be criminal if it were not based on ignorance, and which is, in any case, fatuous.