The Interdepartmental Committee on Physical Deterioration

Calls for greater forms of public health intervention came from all sides. Eugenicists attributed the threat of “degeneration” to hereditary causes. Karl Pearson made this clear in his 1903 Huxley Memorial Lecture to the Royal Anthropological Institute “On the Inheritance of the Mental and Moral Characters in Man,” in which he frighteningly concluded that the “mentally better stock of the nation is not reproducing itself at the same rate as it did of old; the less able, and the less energetic, are more fertile than the better stocks,” and that “the only remedy, if one be possible at all, is to alter the relative fertility of the good and bad stocks.”1Pearson, “On the Inheritance of the Mental and Moral Characters in Man,” 206–7. Conservative Member of Parliament (MP) and Vice-President of the Committee on Education (1895–1902) Sir John Gorst placed children’s health at the center of concerns about the future of the Empire. Gorst believed that children “will form the future British people; and upon their condition and capacity will depend not only the happiness of our own country but also the influence of our Empire in the world. No proper development of either their character or intelligence is possible unless their bodies are cared for first.”2Gorst, The Children of the Nation, 1. He argued in his 1907 book, The Children of the Nation: How Their Health and Vigour Should Be Promoted by the State, that “the visit of a parish doctor or midwife, at the cost of a few shillings, might save the ‘valuable national asset.’”3Gorst, The Children of the Nation, 17.

The medical profession, especially the British Medical Association, urged the Balfour government to pay attention to the ecology of urban life, which shaped “the physical constitution of a nation and its power.” Members of the British Medical Association urged the prime minister to “help us to obtain all those sanitary reforms towards which medical men and others are so earnestly striving, and . . . to teach the people to understand and practise the rules of healthy life.”4“‘De-Germanizing’ and Degeneration,” 455. With greater state aid, the medical community believed it could expand important work mitigating individual hazards to public health, including “drink, over-crowding, the ignorance of mothers, the educational hustling of the young and defects in the milk and other food supplies.”5“‘De-Germanizing’ and Degeneration,” 455.

With great reluctance, the Balfour government acquiesced, and on September 3, 1903 established the Inter-departmental Committee on Physical Deterioration to evaluate national fitness as it related to public health.6Gilbert, “Health and Politics,” 146–47. The Committee’s membership consisted of chairman Almeric W. Fitz Roy; Colonel G.M. Fox, Inspector of Physical Training under the Board of Education; J.G. Legge, Inspector of Reformatory and Industrial Schools; H.M. Lindsell, Principal Assistant Secretary to the Board of Education; Colonel G.T. Onslow, Inspector of Marine Recruiting; John Struthers, Assistant Secretary to the Scotch Education Department; and Dr. J.F.W. Tatham, who had previously served as the Medical Officer of Health for Manchester from 1888 to 1893, representing the General Register Office.7Report of the Inter-departmental Committee on Physical Deterioration, 1:v. The Committee’s mandate was to determine whether and to what degree the fears of unfitness among British society were true, and to verify the data emerging from medical surveys of soldiers bound for South Africa and other reports such as the 1903 Report of the Royal Commission on Physical Training (Scotland). Parliament further tasked the Committee to determine how the physical health of urban-dwelling and, especially, lower-class Britons might be improved.8Report of the Inter-departmental Committee on Physical Deterioration, 1:v.

Although both hereditarians (eugenicists) and environmentalists made their case for the potential causes of “degeneration” in evidence presented to the Inter-departmental Committee, the medically minded Committee was more receptive to an environmental explanation of the causes of national unfitness and proposed remedies.9Szreter, Fertility, Class and Gender in Britain, 211; Report of the Inter-departmental Committee on Physical Deterioration, 1:39, 46. As a result, the Committee was particularly receptive to the theory of University of Edinburgh anthropologist D.J. Cunningham that to restore “the mean standard of national physique, all that is required is to improve the conditions of living, and in one or two generations all the ground that has been lost will be recovered.”10Report of the Inter-departmental Committee on Physical Deterioration, 1:8. This made plain the importance of focusing public health efforts on the urban poor in particular, especially the “casual poor.”11On the casual poor see Stedman Jones, Outcast London.

The Committee met over twenty-three days and heard from sixty-seven witnesses from across the United Kingdom.12The sixty-seven witnesses included five Medical Officers of Health, twenty-three medical experts, fifteen philanthropists, sixteen public servants, four military witnesses, and five other miscellaneous witnesses, including two Members of Parliament (John Gorst and Thomas Macnamara). Szreter, Fertility, Class and Gender in Britain, 191n23, compiled this roster. The Conservative Balfour government hoped that the Committee would dispel any “alarms about physical deterioration.” But when the Committee published its three-­volume Report of the Inter-departmental Committee on Physical Deterioration in 1904 it proved “honest and frightening.”13Gilbert, “Health and Politics,” 144. The Report opened with some considerations on the state of the physical condition of the contemporary Briton’s life, in particular that of the potential military recruit. The Committee prefaced its findings with a note that a lack of comparative past data might lead to “erroneous conclusions” about an “increasing deterioration in physique . . . taking place in the classes of the population from which military recruits are chiefly drawn.”14Report of the Inter-departmental Committee on Physical Deterioration, 1:1–2. However, as director-general of the Army Medical Service Sir William Taylor argued in his testimony, a comparative study was not the Committee’s purpose. Rather, Taylor urged the Committee to “inquire into the causes and present extent of the physical unfitness that undoubtedly exists in a large degree.” He argued that 40 to 60 percent of men “are found to be physically unfit for military service” and that this could not be in keeping with “the progressive spirit of the times we live in.”15Report of the Inter-departmental Committee on Physical Deterioration, 1:2.

The Interdepartmental Committee heard lengthy testimony on the ecological conditions of city life, repeatedly hearing the same concerns about poor air quality and a lack of sunlight that Cantlie had first raised in 1885. Affirming the findings of the Medical Officers of Health that urban population growth and overcrowding created conditions ripe for the spread of infectious diseases that particularly threatened the lives of infants, the Interdepartmental Committee’s Report noted that one- and two-room tenements, especially, contributed to the rise in infant mortality rates across the country. The Committee thus urged local authorities to “exercise of their powers to treat ‘any house or part of a house so overcrowded as to be dangerous or injurious to the health of the inmates’ as a nuisance” subject to closure.16Report of the Inter-departmental Committee on Physical Deterioration, 1:16–17.

The Committee heard specific testimony about the local ecological conditions in Manchester and suggested that the growing systems of public health that existed in Manchester offered a model for other cities to follow. Local philanthropist and founder of the Manchester Art Museum, T.C. Horsfall, testified that “the filthiness of the air makes those inhabitants of all parts of Manchester who value cleanliness most unwilling to ventilate their dwellings.”17Report of the Inter-departmental Committee on Physical Deterioration, 1:20. This, in turn, made houses increasingly susceptible to dirt and pathogens, such as those that caused summer diarrhea. These atmospheric conditions were worst in Ancoats, where, according to Horsfall, even the “well-to-do classes” have a physique that is “below the general average of England.”18Report of the Inter-departmental Committee on Physical Deterioration 2:221.

Despite these problems, the Committee praised the efforts undertaken by local authorities in Manchester (as well as those in Birmingham and Liverpool) for “setting an example of persistent devotion to a high standard of civic duty.”19Report of the Inter-departmental Committee on Physical Deterioration, 1:21. The Committee specifically commended Medical Officer of Health James Niven for his important work in improving the public health of the city. But, in his own testimony before the Committee, Niven acknowledged that much work could still be done to improve the health of his city.20Report of the Inter-departmental Committee on Physical Deterioration, 1:21. Niven testified that the central districts of Manchester were “improving.” He reported that “the conditions with regard to housing are very much greatly improved . . . back-to-back two-roomed houses – and a great many courts have been opened out.”21Report of the Inter-departmental Committee on Physical Deterioration, 2:251. However, Niven lamented that roughly 3,000 badly ventilated, back-to-back houses remained in the city.22Report of the Inter-departmental Committee on Physical Deterioration, 2:252. Still, when the Committee compared Manchester to other cities, such as Dundee, Edinburgh, and Sheffield, where it found far greater evidence of neglect of public health by the local authorities, it noted the comparable successes found in Manchester.23Report of the Inter-departmental Committee on Physical Deterioration, 1:21–22.

Perhaps most significantly, the Inter-departmental Committee on Physical Deterioration considered how experiences during a Briton’s youth contributed to the rise of unfitness later in life (e.g., when they volunteered for military service). Thus, it is wholly unsurprising that one of the lengthiest sections of the Report was dedicated to the “Conditions Attending Life of the Juvenile Population.” While the problem of infant mortality was a well-established public health concern by 1904, the Report of the Inter-departmental Committee brought greater national attention to it by linking infant mortality to more dire concerns about the future of the nation and the British Empire. The Committee made a series of recommendations seeking ways to allow mothers to properly care for their infants rather than being forced to work long hours in factories. Through this alone, the members of the Committee believed, infant mortality could be cut nearly in half.24Report of the Inter-departmental Committee on Physical Deterioration, 1:50–51.

Almost every testimony about children’s health before the Committee suggested in some way that “the whole problem of degeneracy” revolved around food – whether it be a lack of sufficient food, irregular feeding, or the poor quality of food.25Report of the Inter-departmental Committee on Physical Deterioration, 1:56. For example, Niven testified that diets were often deeply inadequate in “a large portion of the poorer families.”26Report of the Inter-departmental Committee on Physical Deterioration, 2:251. Even when they had good-quality, local milk supplies, Niven warned that the value of milk to a child’s health was often “rendered futile by dirt in the house, by purchase of rubbishy fruit, and various causes of that kind.”27Report of the Inter-departmental Committee on Physical Deterioration, 2:253. Resolving improper feeding would have the greatest benefit to children’s health, Niven believed, and was especially relevant to concerns about military fitness. Niven argued that “in order to get good soldiers you must rear good children.”28Report of the Inter-departmental Committee on Physical Deterioration, 2:258. Assenting with Niven’s testimony, the members of the Inter-departmental Committee shared the belief of the Medical Officers of Health that when mothers neglected to breastfeed children or were unwilling to do so because it inhibited their ability to work, this was a major cause of premature childhood death. However, the Committee also acknowledged the financial burden of the cost of high-quality cow’s milk to those working mothers who could not breastfeed for financial reasons.29Report of the Inter-departmental Committee on Physical Deterioration, 1:52. Thus, through its collection of testimony the Committee highlighted a public health challenge but left the solution to the local authorities.

Among its more tangible recommendations, the Committee proposed a “great scheme of social education” for mothers and encouraged local authorities to undertake such a project.30Report of the Inter-departmental Committee on Physical Deterioration, 1:57. Here again, the Committee pointed to the work being done in Manchester as a model, acknowledging the Manchester and Salford Ladies’ Public Health Society, which had for twenty-five years sought to find “all those conditions that are adverse to public health” and educate “mothers among the poor [on] such information as will enable them to do their duty by their children.” The Committee particularly praised the “preventative rather than remedial” work of health visitors as critical to this important public health work.31Report of the Inter-departmental Committee on Physical Deterioration, 1:58.

In addition to infant health, the Inter-departmental Committee offered an assessment of early childhood health as well, as its members believed that children of all ages were particularly susceptible to physical deterioration that resulted from the urban penalty. The Committee suggested that schools might be a useful site for public health officials to ensure British children were receiving proper nourishment. W.L. Mackenzie, Medical Officer of Health for the Local Government Board of Scotland, testified that “to subject a half-starved child to the routine of school would be the height of cruelty, and the educational result would be poor,” and so, ensuring the pupil was properly fed was essential.32Report of the Inter-departmental Committee on Physical Deterioration, 1:67. The Inter-departmental Committee members agreed. They believed that in schools local authorities could ensure the child received at least one nutritious meal per day at the minimum possible cost, or free for those children whose parents could not afford to pay.33Report of the Inter-departmental Committee on Physical Deterioration, 1:69–71.

In schools, the Committee encouraged the implementation of mandatory physical education, as well as compulsory courses in personal hygiene and household management, such as cookery and domestic economy, for girls.34522 Report of the Inter-departmental Committee on Physical Deterioration, 1:61–62. According to the Report, “in a country without compulsory military service the period of the school life offers the state its only opportunity for taking stock of the physique of the whole population and securing to its profit the conditions most favourable to healthy development.”35Report of the Inter-departmental Committee on Physical Deterioration, 1:59. In the schools it was possible to monitor the physical health (including eyesight and posture) and development of the British youth, which the Committee members deemed a matter of “public duty.”36Report of the Inter-departmental Committee on Physical Deterioration, 1:64–65. As we will consider further in the next chapter, schools did become a major site for expanding and standardizing public health campaigns by the first decade of the twentieth century, and this was, in part, a result of the call to arms in the Report of the Inter-departmental Committee.

The Report of the Inter-departmental Committee on Physical Deterioration offered a list of fifty-three recommendations to improve the health and fitness of the nation. While we have considered only a small sample of its recommendations, the Report was a landmark document in the history of British public health. Most of its findings and conclusions were not new, as many of the Medical Officers of Health, like James Niven, who offered lengthy testimony about the condition of Manchester, were already aware of the problems. The Report made clear that it was within the power of the state to remedy the dirt, the ignorance, and the neglect that caused the “urban penalty.” To do so, though, required public health administrators to think beyond just “cities and sewers” and to also consider more carefully “the physical health of individuals and what could be done to improve its quality.”37Woods, “Newman’s Infant Mortality as an Agenda for Research,” 45. To Niven, many of the recommendations of the Report of the Inter-departmental Committee on Physical Deterioration seemed to validate the importance of more intimate approaches to public health that had emerged in the preceding decade. However, the origins of the Report in the aftermath of the Second Anglo-Boer War made its publication an important inflection point in the history of public health. The Report of the Inter-departmental Committee was consequential because it drew national attention to the concerns that Medical Officers of Health were already addressing locally. Contemporaries believed that it was crucial that English children received a healthy developmental start, so that they could grow up to become the next generation of British soldiers, laborers, and political leaders. Children were, after all, “the future of the race” according to one editorial in the British Medical Journal.38“The Claims of the Child,” 140. Thus, as a result of the Report of the Inter-departmental Committee, children’s health became an important feature of the “quest for national efficiency” that, historian G.R. Searle argues, had become a prevailing concern in British imperial politics at the turn of the twentieth century.39Searle, The Quest for National Efficiency.

In response to the concerns raised by and the recommendations in the Report of the Inter-departmental Committee, public health work focusing on children’s health widened further in the first decade of the twentieth century. Public health officials began to ask important questions about the healthy development of British children after infancy. Were young children also being properly fed? Were children receiving sufficient physical education? Schools offered a useful site for continuing to monitor children’s health and hygiene in ways that in-home visits, which ceased sometime between the ages of one and five, could not.