The Task of Social Hygiene. Havelock Ellis

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