With a skin of infinite delicacy that life will harden very speedily, with a discomforted writhing little body, with a weak and wailing outcry that stirs the heart, the creature comes protesting into the world, and unless death win a victory, we and chance and the forces of life in it, make out of that soft helplessness a man. Certain things there are inevitable in that man and unalterable, stamped upon his being long before the moment of his birth, the inherited things, the inherent things, his final and fundamental self. This is his “heredity,” his incurable reality, the thing that out of all his being, stands the test of survival and passes on to his children. Certain things he must be, certain things he may be, and certain things are for ever beyond his scope. That much his parentage defines for him, that is the natural man.
But, in addition, there is much else to make up the whole adult man as we know him. There is all that he has learnt since his birth, all that he has been taught to do and trained to do, his language, the circle of ideas he has taken to himself, the disproportions that come from unequal exercise and the bias due to circumambient suggestion. There are a thousand habits and a thousand prejudices, powers undeveloped and skill laboriously acquired. There are scars upon his body, and scars upon his mind. All these are secondary things, things capable of modification and avoidance; they constitute the manufactured man, the artificial man. And it is chiefly with all this superposed and adherent and artificial portion of a man that this and the following paper will deal. The question of improving the breed, of raising the average human heredity we have discussed and set aside. We are going to draw together now as many things as possible that bear upon the artificial constituent, the made and controllable constituent in the mature and fully-developed man. We are going to consider how it is built up and how it may be built up, we are going to attempt a rough analysis of the whole complex process by which the civilized citizen is evolved from that raw and wailing little creature.
Before his birth, at the very moment when his being becomes possible, the inherent qualities and limitations of a man are settled for good and all, whether he will be a negro or a white man, whether he will be free or not of inherited disease, whether he will be passionate or phlegmatic or imaginative or six-fingered or with a snub or aquiline nose. And not only that, but even before his birth the qualities that are not strictly and inevitably inherited are also beginning to be made. The artificial, the avoidable handicap also, may have commenced in the worrying, the overworking or the starving of his mother. In the first few months of his life very slight differences in treatment may have life-long consequences. No doubt there is an extraordinary recuperative power in very young children; if they do not die under neglect or ill-treatment they recover to an extent incomparably greater than any adult could do, but there remains still a wide marginal difference between what they become and what they might have been. With every year of life the recuperative quality diminishes, the initial handicap becomes more irrevocable, the effects of ill-feeding, of unwholesome surroundings, of mental and moral infections, become more inextricably a part of the growing individuality. And so we may well begin our study by considering the circumstances under which the opening phase, the first five years of life, are most safely and securely passed.
Food, warmth, cleanliness and abundant fresh air there must be from the first, and unremitting attention, such attention as only love can sustain. And in addition there must be knowledge. It is a pleasant superstition that Nature (who in such connections becomes feminine and assumes a capital N) is to be trusted in these matters. It is a pleasant superstition to which, some of us, under the agreeable counsels of sentimental novelists, of thoughtless mercenary preachers, and ignorant and indolent doctors, have offered up a child or so. We are persuaded to believe that a mother has an instinctive knowledge of whatever is necessary for a child’s welfare, and the child, until it reaches the knuckle-rapping age at least, an instinctive knowledge of its own requirements. Whatever proceedings are most suggestive of an ideal naked savage leading a “natural” life, are supposed to be not only more advantageous to the child but in some mystical way more moral. The spectacle of an undersized porter-fed mother, for example, nursing a spotted and distressful baby, is exalted at the expense of the clean and simple artificial feeding that is often advisable to-day. Yet the mortality of first-born children should indicate that a modern woman carries no instinctive system of baby management about with her in her brain, even if her savage ancestress had anything of the sort, and both the birth rate and the infantile death rate of such noble savages as our civilization has any chance of observing, suggest a certain generous carelessness, a certain spacious indifference to individual misery, rather than a trustworthy precision of individual guidance about Nature’s way.
This cant of Nature’s trustworthiness is partly a survival of the day of Rousseau and Sturm (of the Reflections), when untravelled men, orthodox and unorthodox alike, in artificial wigs, spouted in unison in this regard; partly it is the half instinctive tactics of the lax and lazy-minded to evade trouble and austerities. The incompetent medical practitioner, incapable of regimen, repeats this cant even to-day, though he knows full well that, left to Nature, men over-eat themselves almost as readily as dogs, contract a thousand diseases and exhaust their last vitality at fifty, and that half the white women in the world would die with their first children still unborn. He knows, too, that to the details of such precautionary measures as vaccination, for example, instinct is strongly opposed, and that drainage and filterage and the use of soap in washing are manifestly unnatural things. That large, naked, virtuous, pink, Natural Man, drinking pure spring water, eating the fruits of the earth, and living to ninety in the open air is a fantasy; he never was nor will be. The real savage is a nest of parasites within and without, he smells, he rots, he starves. Forty is a great age for him. He is as full of artifice as his civilized brother, only not so wise. As for his moral integrity, let the curious inquirer seek an account of the Tasmanian, or the Australian, or the Polynesian before “sophistication” came.
The very existence and nature of man is an interference with Nature and Nature’s ways, using Nature in this sense of the repudiation of expedients. Man is the tool-using animal, the word-using animal, the animal of artifice and reason, and the only possible “return to Nature” for him – if we scrutinize the phrase – would be a return to the scratching, promiscuous, arboreal simian. To rebel against instinct, to rebel against limitation, to evade, to trip up, and at last to close with and grapple and conquer the forces that dominate him, is the fundamental being of man. And from the very outset of his existence, from the instant of his birth, if the best possible thing is to be made of him, wise contrivance must surround him. The soft, new, living thing must be watched for every sign of discomfort, it must be weighed and measured, it must be thought about, it must be talked to and sung to, skilfully and properly, and presently it must be given things to see and handle that the stirring germ of its mind may not go unsatisfied. From the very beginning, if we are to do our best for a child, there must be forethought and knowledge quite beyond the limit of instinct’s poor equipment.
Now, for a child to have all these needs supplied implies certain other conditions. The constant loving attention is to be got only from a mother or from some well-affected girl or woman. It is not a thing to be hired for money, nor contrivable on any wholesale plan. Possibly there may be ways of cherishing and nursing infants by wholesale that will keep them alive, but at best these are second best ways, and we are seeking the best possible. A very noble, exceptionally loving and quite indefatigable woman might conceivably direct the development of three or four little children from their birth onward, or, with very good assistance, even of six or seven at a time, as well as a good mother could do for one, but it would be a very rare and wonderful thing. We must put that aside as an exceptional thing, quite impossible to provide when it is most needed, and we must fall back upon the fact that the child must have a mother or nurse – and it must have that attendant exclusively to itself for the first year or so of life. The mother or nurse must be in health, physically and morally, well fed and contented, and able to give her attention mainly, if not entirely, to the little child. The child must lie warmly in a well-ventilated room, with some one availably in hearing day and night, there must be plentiful warm water to wash it, plenty of wrappings and towellings and so forth for it; it is best to take it often into the open air, and for this, under urban or suburban conditions at any rate, a perambulator is almost necessary. The room must be clean and brightly lit, and prettily and interestingly coloured if we are to get the best results. These things imply a certain standard of prosperity in the circumstances of the child’s birth. Either the child must be fed in the best way from a mother in health and abundance, or if it is to be bottle fed, there must be the most elaborate provision for sterilizing and warming the milk, and adjusting its composition to the changing powers of the child’s assimilation. These conditions imply a house of a certain standard of comfort and equipment, and it is manifest the mother cannot be earning her own living before and about the time of the child’s birth, nor, unless she is going to employ a highly skilled, trustworthy, and probably expensive person as nurse, for some year or so after it. She or the nurse must be of a certain standard of intelligence and education, trained to be observant and keep her temper, and she must speak her language with a good, clear accent. Moreover, behind the mother and readily available, must be a highly-skilled medical man.
Not to have these things means a handicap. Not to have that very watchful feeding and attention at first means a loss of nutrition, a retarding of growth, that will either never be recovered or will be recovered later at the expense of mental development or physical strength. The early handicap may also involve a derangement of the digestion, a liability to stomachic and other troubles, that may last throughout life. Not to have the singing and talking, and the varied interest of coloured objects and toys, means a falling away from the best mental development, and a taciturn nurse, or a nurse with a base accent, means backwardness and needless difficulty with the beginning of speech. Not to be born within reach of abundant changes of clothing and abundant water, means – however industrious and cleanly the instincts of nurse and mother – a lack of the highest possible cleanliness and a lack of health and vitality. And the absence of highly-skilled medical advice, or the attentions of over-worked and under-qualified practitioners, may convert a transitory crisis or a passing ailment into permanent injury or fatal disorder.
It is very doubtful if these most favourable conditions fall to the lot of more than a quarter of the children born to-day even in England, where infant mortality is at its lowest. The rest start handicapped. They start handicapped, and fail to reach their highest possible development. They are born of mothers preoccupied by the necessity of earning a living or by vain occupations, or already battered and exhausted by immoderate child-bearing; they are born into insanity and ugly or inconvenient homes, their mothers or nurses are ignorant and incapable, there is insufficient food or incompetent advice, there is, if they are town children, nothing for their lungs but vitiated air, and there is not enough sunlight for them. And accordingly they fall away at the very outset from what they might be, and for the most part they never recover their lost start.
Just what this handicap amounts to, so far as it works out in physical consequences, is to be gauged by certain almost classical figures, which I have here ventured to present again in graphic form. These figures do not present our total failure, they merely show how far the less fortunate section of the community falls short of the more fortunate. They are taken from Clifford Allbutt’s System of Medicine (art. “Hygiene of Youth,” Dr. Clement Dukes). 15,564 boys and young men were measured and weighed to get these figures. The black columns indicate the weight (+9 lbs. of clothes) and height respectively of youths of the town artisan population, for the various ages from ten to twenty-five indicated at the heads of the columns. The white additions to these columns indicate the additional weight and height of the more favoured classes at the same ages. Public school-boys, naval and military cadets, medical and university students, were taken to represent the more favoured classes. It will be noted that while the growth in height of the lower class boy falls short from the very earliest years, the strain of the adolescent period tells upon his weight, and no doubt upon his general stamina, most conspicuously. These figures, it must be borne in mind, deal with the living members of each class at the ages given. The mortality, however, in the black or lower class is probably far higher than in the upper class year by year, and if this could be allowed for it would greatly increase the apparent failure of the lower class. And these matters of height and weight are only coarse material deficiencies. They serve to suggest, but they do not serve to gauge, the far graver and sadder loss, the invisible and immeasurable loss through mental and moral qualities undeveloped, through activities warped and crippled and vitality and courage lowered.
Moreover, defective as are these urban artisans, they are, after all, much more “picked” than the youth of the upper classes. They are survivors of a much more stringent process of selection than goes on amidst the more hygienic upper and middle-class conditions. The opposite three columns represent the mortality of children under five in Rutlandshire, where it is lowest, in the year 1900, in Dorsetshire, a reasonably good county, and in Lancashire, the worst in England, for the same year. Each entire column represents 1,000 births, and the blackened portion represents the proportion of that 1,000 dead before the fifth birthday. Now, unless we are going to assume that the children born in Lancashire are inherently weaker than the children born in Rutland or Dorset – and there is not the shadow of a reason why we should believe that – we must suppose that at least 161 children out of every 1,000 in Lancashire were killed by the conditions into which they were born. That excess of blackness in the third column over that in the first represents a holocaust of children, that goes on year by year, a perennial massacre of the innocents, out of which no political capital can be made, and which is accordingly outside the sphere of practical politics altogether as things are at present. The same men who spouted infinite mischief because a totally unforeseen and unavoidable epidemic of measles killed some thousands of children in South Africa, who, for some idiotic or wicked vote-catching purpose, attempted to turn that epidemic to the permanent embitterment of Dutch and English, these same men allow thousands and thousands of avoidable deaths of English children close at hand to pass absolutely unnoticed. The fact that more than 21,000 little children died needlessly in Lancashire in that very same year means nothing to them at all. It cannot be used to embitter race against race, and to hamper that process of world unification which it is their pious purpose to delay.
It does not at all follow that even the Rutland 103 represents the possible minimum of infant mortality. One learns from the Register-General’s returns for 1891 that among the causes of death specified in the three counties of Dorset, Wiltshire, and Hereford, where infant mortality is scarcely half what it is in the three vilest towns in England in this respect, Preston, Leicester, and Blackburn, the number of children killed by injury at birth is three times as great as it is in these same towns. Unclassified “violence” also accounts for more infant deaths in the country than in towns. This suggests pretty clearly a delayed and uncertain medical attendance and rough conditions, and it points us to still better possibilities. These diagrams and these facts justify together a reasonable hope that the mortality of infants under five throughout England might be brought to less than one-third what it is in child-destroying Lancashire at the present time, to a figure that is well under ninety in the thousand.
A portion of infant and child mortality represents no doubt the lingering and wasteful removal from this world of beings with inherent defects, beings who, for the most part, ought never to have been born, and need not have been born under conditions of greater foresight. These, however, are the merest small fraction of our infant mortality. It leaves untouched the fact that a vast multitude of children of untainted blood and good mental and moral possibilities, as many, perhaps, as 100 in each 1,000 born, die yearly through insufficient food, insufficient good air, and insufficient attention. The plain and simple truth is that they are born needlessly. There are still too many births for our civilisation to look after, we are still unfit to be trusted with a rising birth-rate. [Footnote: It is a digression from the argument of this Paper, but I would like to point out here a very popular misconception about the birth-rate which needs exposure. It is known that the birth-rate is falling in all European countries – a fall which has a very direct relation to a rise in the mean standard of comfort and the average age at marriage – and alarmists foretell a time when nations will be extinguished through this decline. They ascribe it to a certain decay in religious faith, to the advance of science and scepticism, and so forth; it is a part, they say, of a general demoralization. The thing is a popular cant and quite unsupported by facts. The decline in the birth-rate is – so far as England and Wales goes – partly a real decline due to a decline in gross immorality, partly to a real decline due to the later age at which women marry, and partly a statistical decline due to an increased proportion of people too old or too young for child-bearing. Wherever the infant mortality is falling there is an apparent misleading fall in the birth-rate due to the “loading” of the population with children. Here are the sort of figures that are generally given. They are the figures for England and Wales for two typical periods.
Period 1846-1850 33 8 births per 1000
Period 1896-1900 28 0 births per 1000
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5.8 fall in the birth-rate.
This as it stands is very striking. But if we take the death-rates of these two periods we find that they have fallen also.
Period 1846-1850 23 3 deaths per 1000
Period 1896-1900 17 7 deaths per 1000
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5.6 fall in the death-rate.
Let us subtract death-rate from birth-rate and that will give the effective rate of increase of the population.
Period 1846-1850 10 5 effective rate of increase
Period 1896-1900 10 3 effective rate of increase
– — -
.2 fall in the rate of increase.
But now comes a curious thing that those who praise the good old pre-Board School days – the golden age of virtuous innocence – ignore. The Illegitimate births in 1846-1850 numbered 2.2 per 1000, in 1896-1900 they numbered 1.2 per 1000. So that if it were not for this fall in illegitimate births the period 1896-1900 would show a positive rise in the effective rate of increase of .8 per thousand. The eminent persons therefore who ascribe our falling birth-rate to irreligion and so forth, either speak without knowledge or with some sort of knowledge beyond my ken. England is, as a matter of fact, becoming not only more hygienic and rational, but more moral and more temperate. The highly moral, healthy, prolific, pious England of the past is just another poetical delusion of the healthy savage type.]
These poor little souls are born, amidst tears and suffering they gain such love as they may, they learn to feel and suffer, they struggle and cry for food, for air, for the right to develop; and our civilisation at present has neither the courage to kill them outright quickly, cleanly, and painlessly, nor the heart and courage and ability to give them what they need. They are overlooked and misused, they go short of food and air, they fight their pitiful little battle for life against the cruellest odds; and they are beaten. Battered, emaciated, pitiful, they are thrust out of life, borne out of our regardless world, stiff little life-soiled sacrifices to the spirit of disorder against which it is man’s preeminent duty to battle. There has been all the pain in their lives, there has been the radiated pain of their misery, there has been the waste of their grudged and insufficient food, and all the pain and labour of their mothers, and all the world is the sadder for them because they have lived in vain.