THE HISTORICAL ORIGINS OF HEALTH FASCISM

In most western countries today the most insidious threat to personal freedom is that of "health fascism". This a body of ideas and attitudes which has great influence on public opinion in general and, what is more significant, on the political elite in particular. The putative nature of these ideas gives them an undeserved status and immunity from criticism which, coupled with their influence, means that they exert a profound and malign influence on public policy. The ideas of "health fascism" are put forward by many powerful and influential organisations, notably the medical profession, but also by a plethora of overlapping interconnected pressure groups. The ideas themselves, however, are not new but have rather existed as a coherent body with an associated programme of action for about a hundred and fifty years. The precise content of the arguments and the consequential programme have varied from time to time; today the focus is on diet, smoking, and alcohol whereas it has previously been on such matters as "feeblemindedness" and "moral delinquency" but there is a continuity at a deeper level of fundamental assumptions and modes of argument. The debates over health and public policy which happen today are in essence concerned with the same issues as earlier ones. The study of these earlier debates and their outcome helps us to understand better the nature of contemporary health pressure groups and both what is at stake and how best to resist the "health fascists".

What, though, are the underlying ideas of "health fascism"? The basic premise is that the health of a population is determined primarily by social rather than environmental or inherent factors. That is, the health of both particular individuals and aggregate populations is determined by such matters as diets, customary practices, lifestyles, patterns of work, social structures such as household organisation, the class system. This implies that we can best assure the health of individuals and of society at large by attempting to control these social factors rather than by using therapeutic medicine. Preventive action involving the use of an unregulated social life. This in itself is not necessarily controversial - a great deal of health and illness is clearly only explicable in this way, hence the marked class and national variation in the incidence of certain diseases or conditions. However, in "health fascism" other, normative, assumptions are made which make this seemingly platitudinous belief a profoundly dangerous one.

Firstly, there is the assumption of methodological and ethical collectivism. In this way of thinking the collective, whether defined as nation, race or society, is primary. The health and well being of individuals is important insofar as it contributes to the well being of the reified collective. Conversely, sickness and ill health on the part of individuals is harmful not only to them but to the larger, primary, collective entity. As an individual can only exist within a group which defines their identity so they are obliged to contribute to the group; they do not have an autonomous existence in their own right. Therefore, the ill health of individuals, however brought about, is not of concern only to that individual or those associated with them but also to society at large and those in authority. Health is not a private matter, nor are such associated matters as choices of recreation, diet and reproduction.

Secondly, it is denied, whether implicitly or explicitly, that the choices made by individuals in such matters as lifestyle, diet, and reproduction are truly free. Instead they are predetermined by impersonal social forces or by biological necessity or by malign influences such as advertising and the desire to conform. Even if an element of free will is admitted it is argued that people, through ignorance and weakness of will, are not the best judges of what is good for them. In any case, given collectivist assumptions, such choices should not and cannot be made in a purely self-regarding manner. There is a superior, collective interest in such matters as whether or not one should smoke, drink or have children.

Thirdly, there is supposed to be an elite, possessed of a superior knowledge, which does know better than the masses what is good for them. The most prominent members of this elite are doctors and medical scientists but other groups and persons can also be admitted to the elect. The reverse of this thesis is the singling out of the lower or working classes as those most reprobate and in need of guidance.

Fourthly, the superior knowledge of the elite is seen as scientific, based upon neutral, value free investigation, and superior precisely because of its scientific origin. This of course plays upon the high status enjoyed by science in modern culture. Arguments and judgments are thereby rendered immune to criticism from ordinary people.

All of this leads to a conclusion: that collective interests, taken with the unfree or mistaken choices of the majority and the superior knowledge of the elite, justify compelling individuals to act and live in a particular way or to desist from doing things they would otherwise choose to do. The public authority, the state, has an overriding interest in promoting the public good of general health and in pursuit of this end, acting on the advice of the scientific elite, it is justified in interfering in, and detailed regulation of, peoples' private lives.

This can involve anything from indirect methods such as taxation and licensing to the full force of state power. Matters such as lifestyle become a part of public policy.

In practice this generates a truly formidable agenda of state action and regulation. Today this finds it most complete expression in the publications of the World Health Organisation which propose the politicisation and manipulation of almost every aspect of life. There are other more focused versions in the many campaigns and pressure groups advocating state regulation of private life on health grounds. These include groups concerned with such matters as smoking, diet, alcohol, general lifestyle, and sexual behaviour. [2] All of these campaigns are connected by common ideology and overlapping membership and support. Their purportedly scientific basis and commitment to the undoubted good of health gives their arguments great persuasive force.

As mentioned earlier, this is not new: modern pressure groups such as ASH (Action on Smoking and Health) and Alcohol Concern are the intellectual descendants of other, earlier groups. Historical investigation reveals several aspects of such groups or movements. The are rather elite groups in terms of their membership and their agenda contains a pronounced element of class legislation, i.e. a programme which will affect one particular class of people rather than being neutral in its effect. This is because the programme will either hit some classes more heavily or because its aim is to mould and change the lifestyle and choices of the lower classes rather than the elites. The health movements have historically drawn their membership not from the elites in general but from one in particular, the class of skilled, qualified professionals employed mainly in public service. [3]

Secondly, such movements have historically played a major part in the elaboration of state power. [4] This does not make them "left wing" in any conventional sense. The specific political colouration of individuals and groups is as likely to be conservative or reactionary as socialist. Resistance to such "health fascist" movements is not confined to any one part of the political spectrum and has often been led by socialists. [5] The division is rather between collectivists and libertarians of all hues and also between elitists who rely on the testimony of "experts" and others who may not. [6]

Thirdly, the arguments put by health movements, while purportedly scientific, can be seen in retrospect to be ideological in the strict sense. The actual scientific content is often slight and highly debatable. The arguments have usually had the effect of promoting the interest of a clearly defined social group while purporting to be neutral and disinterested. As any Marxist would tell you, this not an accident. [7] What we have historically is a classic example of scientism, of the mistaken application of scientific arguments and the use of the prestige and status of science to promote self-interested ends.

All this means that debates today over such matters as tobacco and alcohol consumption are not simply matters of science. They rather concern matters of fundamental political principle as well as having a distinct class element. In previous debates this had been clearly recognised and study of these shows both what is at stake and the wider affinities and roots of modern "health fascism", which justify the use of this highly pejorative term.

One excellent example of both the results of a coercive approach to public health and of a successful resistance is the Victorian controversy over compulsory smallpox vaccination. [8] In the course of that debate the essential ideological differences between the two sides were clearly brought out in a way that is often not true today. Surprisingly little has been written about this controversy despite its importance in itself and for the light it casts on the growth of the state in the nineteenth century. As one historian has said: "In its conception, the vaccination service has a unique departure from the general evolutionary trend of Victorian public health policy and a unique experiment in the application of social medicine". [9]

The growth of state involvement in vaccination and in the use of compulsion was gradual but relentless. Jenner published his original paper on the prevention of smallpox by vaccination in 1798, and by 1807 he had been awarded a grant of £30,000 by Parliament. The following year Parliament set up a National Vaccine Establishment, based in London, at a cost £3,000 per annum. This body was given two main functions by the statute: to provide free vaccination within the bounds of the metropolis and to supply voluntary vaccination bodies in the provinces with lymph, free of charge. From then until 1840 the position was that vaccination was voluntary, carried out primarily by private or charitable bodies, but given official recognition, encouragement and financial support by the state. At this point there was little controversy surrounding the subject.

During the 1830's all agitation grew up, carried on by the predecessors of the British Medical Association (BMA), for the state to provide vaccination generally and on a free basis. This led in 1840 to an Act, introduced by Lord Ellenborough, which provided for the provision of free vaccination to all children by public vaccination officers. These were placed under the control of the Poor Law Guardians and were to be paid on a per capita basis out of the Poor Rates. The placing of the service under the Guardians was resisted by the medical profession and made it necessary for Parliament to pass a clarificatory act the following year to establish that the service (unlike all the others provided by the Poor Law) was non-pauperising.

However, the rate of take up was low and there were administrative problems at a local level. consequently, in 1850 a new pressure group was formed, the Epidemiological Society, which included among its leading members Sir John Simon, later to play a leading role in the vaccination service. In 1853 they published a report which was submitted to Parliament and subsequently published as a Blue Book, calling for compulsory vaccination of all infants, local officers to enforce this, and a central inspectorate to check on the local administration. A private Bill introduced by Lord Lyttelton was taken up by the Eugenics Society and passed with minimal debate, putting the entire programme into effect. However the Society did not rest there, and in 1855 produced another report which was also reprinted as a Parliamentary Paper. This suggested removing the vaccination service from the jurisdiction of the Guardians and placing it under the Board of Health, as well as creating a post of Medical Officer to the government. This was done and Sir John Simon was appointed to the position. [10]

A further act in 1861 rationalised the administration by requiring the appointment of full time vaccination officers in every Poor Law union. Even after all this however the ES and Simon claimed that the powers of the service were insufficient, particularly in respect of the lack of enforcement powers. The conclusion to all of this was the Act of 1867 which set up much more elaborate administration. More to the point, clause 29 of the Act allowed repeated fines of parents who refused to comply and seizure of goods to pay such fines or even imprisonment. This "cat-and-mouse" procedure was confirmed in clause 31 of the subsequent Act of 1871. This was an unprecedented step, violating the longstanding principle of nemo debet bis puniri pro uno delicto (no more than one penalty for a single offence). As Lambert says "the state's action of 1853 and thereafter advanced far beyond what English governments have attempted since. No modern government, even when facing a deadly disease like diphtheria, and possessing a certain prophylactic, has dared to force such a preventive method upon its civilian population, much less resort to such an inhumane extreme of compulsion as clause 31." [11]

So, we can see a steady movement from state support of an encouragement of vaccination, to state provision of the service, to the making of the service compulsory, to the conclusion of an extraordinarily severe enforcement. The process is clearly described by Lambert: "The process of intervention was repetitive. Each time a private investigation followed by medical pressure and a private Bill induced an otherwise uninformed and indifferent government to interfere. The failure of each step, proved and publicised by expert report, paved the way for yet another extension of interference." [12] The motivation force behind this growth of compulsion is also apparent. Lambert again sums it up:

"There seems but little exaggeration in the anti-vaccinationist claim that it was foisted and maintained on the state by organised medical pressure: one of the earliest triumphs of this powerful force in English social politics. Each move towards the principle of a compulsory service came from medical bodies wielding authoritative private information, surpassing the government's own, and inspiring private legislation." [13]

So long as vaccination was supplied on a voluntary basis it attracted little or no controversy. There is some scientific argument over the relative effectiveness of vaccination and inoculation (the latter was outlawed by the Act of 1841) but little popular concern. The move towards making vaccination compulsory in the 1850s provoked some scattered resistance, largely from radical and working class leaders, but the lack of an enforcement mechanism meant that opposition took the passive form of non-compliance. However the appointment of local enforcement officers under the 1861 Act led to more organised resistance, mainly in working class districts of the North, while the draconian provisions of the act of 1867 provoked an explosion of outrage and the rapid appearance of a well organised movement for the repeal or amendment of the vaccination legislation. Between 1868 and 1907 compulsory vaccination became one of the great controversies of the age. [14]

The relative absence of opposition to compulsory vaccination before the 1860's tells us something important about the nature of the campaign against it after that date, although much of the literature was replete with arguments of a medical or scientific nature, especially as regarding the effectiveness of vaccination as a protection against smallpox and the danger of secondary or consequential infection from vaccination, these took second place to questions or personal liberty and autonomy. [15] The freedoms of individuals were explicitly opposed to the claims of the state to promote social health. As Macleod puts it: "Anti-vaccinationists numbered many who had few essentially scientific objections against vaccination, but who opposed its compulsion on constitutional grounds as an interference with individual liberty." [16]

This was recognised by people on both sides of the debate. One of the leading anti-vaccinators declared in 1874: "We claim the right of free men and women to act for ourselves according to our own consciences in medical as in other matters." [17]

On the other side, Sir Lyon Playfair argued that "individual disbelief in a remedy which science and experience had confirmed beyond all reasonable doubt was no justification for relieving the conscience of that individual at the expense of society." [18]

Some other features of the anti-compulsory vaccination campaign are worth noting.

Although it had many middle class members and leaders, particularly in the South, it was primarily an artisan and working class movement. The record shows clearly that it was working class people who were most resistant to compulsory vaccination and who suffered most from the severe enforcement of the legislation. [19] The campaign can be seen in part as an element of the now forgotten tradition of working class anti-statism. Politically, the anti-vaccination movement was diverse, encompassing socialists such as Shaw and Wallace, libertarians such as J. H. Levy and Herbert Spencer, and many liberals. Generally speaking, support for compulsory vaccination came from the Tory party and the imperialist wing of the Liberal party, while the opposition drew its strength from Labour and the other side of the Liberals. [20]

During the 1860's local anti-compulsory vaccination leagues sprang up in many Northern towns, as well as a larger organisation in London led by the pioneer "anti", R. B. Gibbs. In August 1869 the nascent movement acquired its mouthpiece when Henry Pitman and Francis Newman set up the Anti-Vaccinator in Manchester. [21] However, at this time organisation was mostly local, with little national coordination and the movement suffered from a chronic lack of funds. Even so, anti-vaccination activity showed no signs of disappearing because of widespread popular resentment of the Acts and the severe punishments meted out to non-compliers. These included heavy and repeated fines, forced sale of goods where the parents could not afford to pay the fines, and, frequently, imprisonment. All of these fell most on the working classes who could not pay fines and were in any case most likely to be opposed to vaccination. Many local leagues paid the fines of poor resisters out of a hardship fund but in some places they were forbidden to do this by the magistrates. [22]

Around 1874 a national leadership emerged led by a Cheltenham based couple, the Hume-Rotherys, and in that year a National Anti-Compulsory Vaccination League (NACVL) was set up, holding its first convention in Lees. Subsequent meetings were held in Birmingham, Lincoln, and Manchester, reflecting the provincial bias to the NACVL's membership and leaders. [23] The strategy followed by the Hume-Rotherys was to promote acts of individual martyrdom and strong, even violent, resistance. This kept the issue in the public eye but also alienated public support, as did the "crankish" tone of much of the movement's propaganda. [24] Meanwhile, several attempts were made in Parliament to retain the principle of compulsory vaccination while mitigating the penalties for non-compliance but these all failed due to determined opposition from the Tories [24]

By the later 1870's the movement appeared becalmed, however things were soon to change. In 1880 W. Tebb and the veteran "anti" W. White formed the London Society Against Compulsory Vaccination (LSACV). Soon this captured the leadership of the movement from Cheltenham and many provincial leagues affiliated to the LSACV while others sprang up. The leadership of the LSACV adopted a new strategy. Activities became more coordinated with less localism and a full time professional "head office" in London. The LSACV itself was put on a sound financial basis, enabling it to produce a regular periodical and provide full time lecturers. There was less emphasis on individual martyrdom and more on influencing public opinion and working through Parliament. The explicit goal of the campaign became abolition of compulsory vaccination rather than mitigation of penalty. Also, the movement was given an international flavour through the holding of international conferences and came to be allied in several other campaigns. [25]

The activities of the LSACV were successful in provoking an intense and principled debate during the 1880's. This was brought to a head by events in Leicester. Severe enforcement of the Acts following the 1871 smallpox epidemic led to the appearance of a strong local league in the town. In response to pressure from the league the local authority developed a new anti-smallpox strategy based on the isolation of sufferers rather than mass, compulsory vaccination. This proved highly effective. However, the local Guardians continued to enforce the law with great rigour and by October 1884 996 cases had been prosecuted and 21 fathers sent to jail. By February there were over 4,000 people awaiting summonses. This led to a mass demonstration organised by the LSACV on 23rd march 1885, involving over 20,000 people, and in the face of such popular hostility the Guardians abandoned prosecutions.[26]

Following the events in Leicester the movement gained support, especially in the Liberal party, and this was given a great boost when, in 1889, several eminent medical scientists defected from the compulsory vaccination camp. In April of that year the movements parliamentary spokesman, J.A. Picton, persuaded the government to set up a Royal Commission to examine the whole question of compulsory vaccination. The Commission's terms of reference show that matters of principle were held to be at stake as the Lancet (ardently pro compulsion) recognised, stating that "in many respects, we are not at the threshold of some of the most important questions of human liberty in civilised communities".[27] The commission's proceedings proved to be a triumph for the opponents of compulsion and in its interim Report of 1892 it recommended the cessation of criminal enforcement. Its final report in 1894, while cautious, recommended that the enforcement mechanism be abandoned. In 1896 the various local leagues and the LSACV formally set up a new National Anti-Compulsory Vaccination League (NACVL), and in 1898 scored a great success in bringing about the defeat of a pro-compulsion Conservative in a by-election.

This provoked the Conservative government into introducing the Vaccination Act of 1898 which removed the "cat-and-mouse" clause and allowed for conscientious refusal to comply with the 1871 Act. Finally, in 1907, the Liberal government elected in the great landslide of 1906 effectively abolished compulsory vaccination.[28]

So, after a prolonged campaign the opponents of compulsion had won. As Macleod says: "A comparatively small but fanatically earnest section of the population had, by dint of widespread agitation, dissemination of information, education and the example of personal suffering, dislodged the network of Government control and had revealed its functional errors." [29]

The whole story of the compulsory vaccination controversy highlights several features of the problem of health fascism and the necessary response to it. A measure believed to be necessary to promote public health (despite scientific doubt) was enforced by progressively more severe penalties, culminating in a measure which, had it gone unchallenged, would have constituted a major inroad on individual liberty and the rule of law. This was done at the behest of a small group of professionals who, no doubt sincerely, articulated the fundamental arguments of "health fascism" as set out above: in particularly the argument that a collective need justified severe compulsion and regulation of individuals. The opposition, while articulating criticism of the medical case for mass vaccination, concentrated rather on opposing the ideological justification for compulsion. by winning this argument they were able to undermine support for compulsion among both the general public and the elite.

However this was not the only example of such a debate nor of the dangerous implications of the coercive approach to public health. Another, more alarming to contemporary thinking, began just as the vaccination debate ended.

The social hygiene movement, as described by its outstanding historian, Greta Jones, appeared towards the end of the nineteenth century, although the term "social hygiene" did not come into widespread use until after 1900, It came about via the merging of two other sets of ideas; firstly those associated with the sanitary reform movement of the early to mid-nineteenth century and propounded by figures such as Chadwick and Southwood Smith, and secondly the new ideas of eugenics and mental science which first appeared in the 1880's [30] From the first came the idea the general health was determined by structural factors such as housing and sanitation but also including such matters as diet, personal and domestic cleanliness, and child care.

The early sanitary reformers also provided the notion that such matters were the proper concern of the state and that the problems of urban civilisation and economic efficiency required extensive state action. From the eugenic movement came the idea that many social problems were caused by the persistence of inherited traits and that improvement of the "nations health" would require a close regulation of breeding and childcare. Although she places less stress on them, Jones's own account makes clear that there were at least three other sources on which the movement drew: the pressure for "national efficiency" which played such a great part in all shades of politics before 1914, the scientistic ideas of many early Fabians, and the notion, widespread among those active in the Charity Organisation Movement, of an irredeemable "residuum" of undeserving poor. [31] However, as Jones emphasises, the crucial element in all of this was the broadening interpretation of health and the increased role perceived for the state.[32]

The term "eugenic" was first coined in 1883 by its first great advocate, Sir Francis Galton (Darwin's cousin). As developed by Galton and his epigones the term meant the belief that it was possible to improve the quality of the human stock in the same way that one could do so with animals - by preventing the reproduction of those of lesser quality while encouraging propagation of the superior variety. This was often associated with more detailed utopian ideas of a perfected social order arrived at by social and biological engineering.[33]

During the 1890's in Britain the prescriptive programme of the eugenicists gained support as two other beliefs acquired wide currency. The first was that many social problems, notable inebriacy, mendicity, and crime were the product of inherited characteristics. So, for example, the idea of a criminal type complete with inherited physiognomy, became popular. The second was the fear that the quality of the "stock" of the "nation" or "race" (the two terms often being used interchangeably, although there were interesting differences in meaning as well) was declining due to over reproduction by the "unfit" while the "fit" were failing to reproduce. In crude terms the lower classes were having too many children, the respectable classes not enough!![34]

By the period around 1900 and later these ideas and their associated programme had gained wide acceptance - right across the political spectrum. [35] Indeed it is hard to find writers and political figures of the time who did not articulate some part of this body of belief. For example, the "new liberal" J.A. Hobson argued in 1909 that "to abandon the production of children to unrestricted private enterprise is the most dangerous abnegation of [the state's] function" and the society had "the right to insist that worthless, or even noxious lives shall not be thrust upon it by reckless or unfit parents". [36] As this indicates the, the ideas of social hygiene were common currency on the 'left' at this time and many Fabians were enthusiasts [37] It was also found on the 'right', particularly among those most concerned with Britain's imperial role [37] The many people associated with organisations such as the Charity Organisation Society (COS) and its provincial counterparts were also highly receptive. [38] There were only two political groups generally immune to its lure. The first was the dwindling band of supporters of laissez faire, a fact recognised by Sidney Webb who was moved to declare "No consistent eugenist can be a 'Laissez Faire' individualist unless he throws up the game in despair. He must interfere, interfere, interfere!" [39] (Webb was himself sceptical about eugenics on scientific grounds). The second group were a large part of the Labour movement, who were to play a key role in checking the impact of this form of "health fascism".[40]

In the years before and after World War I a well organised social hygiene movement came into existence in Britain. [41] The most important organisations were the Eugenics Society, set up in 1907 with many provincial branches, the Society for Combating Venereal Disease which later become the British Social Hygiene Council; the Central Association for Mental Welfare, formed in 1913; the National Institute of Industrial Psychology and the National Council for Mental Hygiene, created in 1919 and 1922 respectively; the People's League of Health and the New Health Society which came into being in 1917 and 1926. [42] Among the leading figures in the movement were Olga Nethersole, Sir William Arbuthnot Lane, Mrs. Nevelle Rolfe, and Elizabeth Sloane Chesser. [43]

There was a considerable overlap in membership between all of these organisations which all drew their membership overwhelmingly from the middle and professional classes. They operated within a particular context with two main elements: a concern about the persistence of a number of social problems, notably bad housing, crime, unemployment, drunkenness, venereal disease, and the perceived poor physical quality of the working population; and secondly, a concern for improved economic performance in the face of competition from more efficient nations, particularly Germany. [44] The social hygiene movement saw all of this as a health problem. The difficulty was partly environmental (poor quality housing, etc.), partly economic, but primarily due to two things. These were incorrect lifestyles, as reflected in poor diet, excessive consumption of drink and tobacco, and sexual laxity, and the existence in society of a large number of eugenically unfit persons. The poor lifestyle was partly caused by the second factor, hence the stress on eugenics.

In response to this diagnosis the movement put forward a wide ranging prescription for government-led social reform including action to regulate diet, leisure, and child rearing practise. [45] In the classic form of "health fascism" the combination of methodological and ethical collectivism with elitism led to demands for a massive extension of state control over people's lives. Some of the proposals urged most strongly by the movement were of a kind few would not hesitate to describe as fascist.

In particular the various organisations came up with a set of proposals for dealing with what they saw as three interconnected problem groups. The first were "chronic inebriates", in the typically prissy and pseudo-scientific language of the movement, and the second were the "feeble minded". This extraordinarily wide category was invented around the turn of the century and first given formal definition in the Report of the Royal Commission on the Care and Control of the Feebleminded in 1908 as "persons who may be capable of earning a living under favourable circumstances but are incapable (a) of competing on equal terms with normal fellows; or (b) of managing themselves or their affairs with ordinary prudence".[46] The third group were the "moral imbeciles", i.e. people who would not amend their naughty ways even when punished. The key proposals put forward by the various organisations were categorisation and identification of these groups, their institutional segregation and incarceration, and sterilisation to prevent their reproduction.[46]

This campaign led to several bills being laid before Parliament in 1910/1911 which led to the government putting forward it own measure. This became the 1918 Mental Deficiency Act. In its initial form this was one of the most draconian Bills ever laid before a British Parliament. It provided for the detention in an institution of a "defective" charged with a crime, regardless of whether they had been convicted. It allowed the indefinite detention of "moral imbeciles" referred from the courts. Two other powers were proposed that "defectives" "in whose case it is desirable in the interests of the community that they should be deprived of the opportunity of producing children" should be detained in institutions and that there should be detention on the grounds of "other circumstances", to be defined at the discretion of the Secretary of State.[47]

The Bill provoked intense opposition, led by the Liberal (later Labour) MP for Toke-on-Trent, Josiah Wedgwood. As a result of this opposition the Bill was severely amended, with its more radical proposals excised. In his opposition Wedgwood clearly brought out the essential ideological issues involved. Firstly, he identified it as an attack on personal freedom. Secondly, he argued for its being a class measure, intended to police and "reform" the lower classes.

Thirdly, the Bill was for Wedgwood the product of what we would now call a "moral Panic", got up by agitation. Fourthly, it was produced by a class of "experts" who would be given enormous and unchecked powers by it. Wedgwood explicitly identified this with a kind of "priestly power". Lastly he argued against the element of ethical collectivism. The Bill and its authors, he asserted, saw individuals not as ends in themselves but simply as cogs in a productive machine, means to a greater collective end, a view he strongly rebutted as profoundly anti-liberal. [48]

During the 1920's and 1930's the various bodies which formed the social hygiene movement continued to campaign for a variety of reforms. However, they had only limited success as compared to their prospects between 1910 and 1923. One reason for this was the common reaction against state power after the experience of the World War. More significant was the growing hostility of the Labour movement and the Labour Party. Initially many Labour MPs had supported the ideas of social hygiene with a fair number supporting the Mental Deficiency Act. [49] During the 1920's the great majority of the movement came to oppose social hygiene, primarily because of their identification of it as a body of anti-working class organisations and ideas. At the same time a new force entered the field against the hygienists, the Roman Catholic church, especially after the explicit condemnation of eugenics by the Papacy in 1929. Moreover, the remaining individualists were able to exercise some influence in the Liberal and Conservative parties. The kind of people most attracted to social hygiene by the 1930's were those who advocated a combination of monopoly capital with state regulation and control - something Jones is too polite to describe by its obvious name, fascism. [50]

The two accounts given above should teach us several things. Firstly, that the ideas described earlier, and labelled as "health fascist" have a long history. The basic idea, that the pursuit of health entitles the state to interfere with and regulate people's most private activities persists. What changes is the theory employed by the "health fascists" and hence the actual details of the programme they propose. Secondly that this whole approach is highly dangerous and can lead to proposals which anyone might call fascist. Thirdly, that there is a distinct element of elitism in all of this. Typically it is ordinary people and their habits which are seen as a problem and the programme involves an enlightened elite doing things to the mass for their own good. This somehow also serves the interests of the elite. Fourthly, this is not a straightforward 'right' versus 'left' issue. Support for "health fascism" comes from all parts of the political spectrum, as does opposition. Fifth, a key part of the strategy of health movements is the provoking of moral panics. Last, but by no means least, resistance is both essential and, if principled, likely to be successful. The anti-vaccinators and men like Josiah Wedgwood were able to resist their opponents by exposing their assumptions. We should do the same.

[1] See, for example, Global Strategy for Health For All By The Year 2000, Geneva, 1981, especially p. 34 (item 9, headings 3 & 4), p.36 (item 11) and Evaluation of the Strategy for Health for All By the Year 2000, Copenhagen, 1986, pp.38-9, 62-3, 68-71.

[2] See A. Smith & B. Jacobsen eds., The Nation's Health, London, 1988, pp.75-104, 229-31, 239-59

[3] For a historical account of the rise of this social group see H. Perkins, The Rise of Professional Society: England Since 1880, London, 1989.

[4] For discussion of this point see W. E. H. Greenleaf, The British Political Tradition: Vol 1 The Rise of Collectivism, London 1983, pp. 84-997, 237-86

[5] See for example G. Jones "Eugenics and Social Policy Between the Wars", Historical Journal, Vol. 25, 192, pp. 717-28 and the anti-compulsory vaccination campaign discussed infra.

[6] For an elaboration of this see Greenleaf, op cit pp. 14-28

[7] For a general account of this see Perkins, op cit. More specifically see D. Mackenzie Statistics In Britain 1865-1930.

[8] For an account of both sides of this debate see R. J. Lambert "A Victorian National Health Service: State Vaccination 1855-71", Historical Journal, Vol. 5, 1962, pp. 1-20, and R. M. Macleod, "Law, Medicine and Public Opinion: The Resistance to Compuslry Health Legislation 1870-1907", Public Law, Vol. 12, 1967, pp. 107-28, 189-211.

[9] Macleod, op cit, p. 107.

[10] Lambert, op cit, pp. 1-4. See also his Sir John Simon 1816-1907 and English Social Administration, London, 1963.

[11] Lambert, "Victorian National Health Service", op cit, p. 15.

[12] Ibid p.3.

[13] Ibid p.15.

[14] So, for example it appeared regularly as an issue in the debaters hand books of the time. For examples of the controversial literature see J.P. Swan, The Vaccination Problem London, 1936, W.White, the Story Of A Great Delusion London, 1885.

[15] In fact it would seem that both sides had mistaken ideas about the nature and effects of vaccination and the aetiology of smallpox. In retrospect the whole story, from Jenner's vaccine to the ultimate decline in smallpox mortality can best be seen as a chapter of happy accidents. For the medical debates see Macleod op cit pp. 108-14. See also P.Rassell Edward Jenner's Cowpox Vaccine: The History of a Medical Myth, Firle, Sussex, 1977.

[16] Macleod op cit p.113.

[17] Mary Hume-Rotherby in F. Newman, The Political Side Of The Vaccination System (Address to the Birmingham Anti-Vaccination conference 26th October 1874).

[18] Quoted in Macleod op cit p.121.

[19] Ibid p.120 and passim.

[20] Ibid passim. For Spencer's position see Social Statics, New York, 1871, pp.263,285. For the position of other libertarians see E. Bristow Individualism Versus Socialism In Britain, 1880-1914, New York, 1987, pp.69-71.

[21] Macleod op cit pp.115-117

[22] For the number of prosecution and their increase see Lambert, "Victorian National Health Service", op cit pp.13-14. For examples of sentences see Macleod, op cit pp.121-2

[23] Ibid pp.126-7. See Newman, op cit for extneded discussion.

[24] Macleod, op cit pp.126-7.

[25] Ibid, pp.189-91. For links to other campaigns see Bristow, op cit, pp.61-113.

[30] Greta Jones, Social Hygiene in Twentieth Century Britain, London, 1986,pp.1-21. See also her Social Darwinism and English Thought, Brighton, 1980.

[31] For the importance of the idea of "national efficeincy" see G. Searle, The Quest For National Efficiency: A Study in British Politics And Political Thought 1899 - 1914, Oxford, 1971. The scientific ideas of the early Fabians are discussed in Greenleaf op cit pp. 262-7. For the role of COS members see Jones, Social Hygiene, pp.13-15.

[32] Ibid p.7.

[33] See Sir Francis Galton, "Eugenics: Its Definition, Scope and Aims", Nature, Vol. 70, 1904, and C.P. Blacker, Eugenics, Galton And After, London, 1952.

[34] For instances of this see Lothrop Stoddard, The Revolt Against Civilisation: The Menace Of The Underman, London, 1922. R.A. Freeman, Social Decay And Regeneration, London, 1921. Marie Stopes and many of the other early birth control advocates were also exercised by this "problem". See R. Soloway, Birth Control and the Population Question in England 1877-1930, Chapel Hill, North Carolina, 1982.

[35] See G. R. Scarie, Eugenics and Politics in Britain 1900-1914, Leyden, 1876, especially Chapter 2.

[36] J. A. Hobson, The Social Problem: Life And Work, London, 1909, pp. 214-5, 213-7. This passage is discussed in Greenleaf, op cit, p.271.

[37] For the links between eugenics and the 'left' see M. Freeden "Eugenics and Progressive thought: A Study in Ideological Affinity", Historical Journal, Vol. 22, 1979, pp. 645-71 and also Idem, "Eugenics and Ideology", Historical Journal, Vol. 26, 1983, pp. 959-62, D. Paul, "Eugenics and the Left", Journal of the History of Ideas, Vol. 45, 1984. As an example of 'left wing' eugenicism see the works of Karl Pearson, such as The Groundwork of Eugenics, London, 1909. For the connections with imperialism see Bernard Semmel, Imperialism and Social Reform, London, 1960.

[38] Jones, Social Hygiene, p.15.

[39] S. Webb, "Eugenics and the Poor Law: The Minority Reprt", Eugenic Review, Vol. 11, 1910-11. The quote and citation are in Greenleaf, op cit p. 269.

[40] Jones, Social Hygiene passim, but especially Chapters 5 & 6. There were also "new liberals" who did not share Hobson's enthusiasm, notably L. T. Hobhouse. See his "The Value and Limitation of Eugenics". Sociological Review, Vol. 4, 1911, pp. 281-302 and "Biology and Temperance Reform", Speaker, Vol. 5, 1901, pp. 189-90. See also Stefan Collini, Liberalism and Sociology, Cambridge, 1979, Chapter 6.

[41] Jones, Social Hygiene, Chapter 2

[42] Ibid pp. 26-29.

[43] For Lane, who had a number of eccentric ideas, mostly to do with constipation, see Alex Comfort, The Anxiety Makers, London, 1967, pp. 115-35.

[44] On this see Searle, National Efficiency, op cit, passim.

[45] Jones, Social Hygiene, pp. 27-30. See also Searle, Eugenics And Politics, passim but especially Chapter 9. For other aspects see E. J. Bristow Vice And Vigiliance: Purity Movements In Britain Since 1700, Dublin, 1977; A. White, "Eugenics and National Efficiency" Eugenics Review, Vol. 1, 1909-10; J. Lewis, The Politics of Motherhood, London, 1980; Havelock Ellis, "Sterilisation of the Unfit", Eugenics Review, Vol. 1, 1909-10.

[46] Jones, Social Hygiene, p.30.

[47] Ibid pp. 31-32.

[48] Ibid pp. 32-35.

[49] Ibid pp. 58-62.

[50] Ibid Chapter 6. See also g. R. Searle, "Euguenics and Politics in the 1930's" Annals of Science, Vol. 36, 1979, pp.159-69.

Dr. Stephen Davies is Lecturer in History at Manchester Polytechnic. He has contributed to such books as Crime and the Law, City, Class and Cultur, The State or the Market, and The 'New Right' Enlightenment, and to such journals as Economic Affairs and Humane Studies Review. He is also the author of Beveridge Revisted: New Foundations For Tomorrow's Welfare, and co-editor of the forthcomeing Dictionary of Conservative and Classical Liberal Thought.