Tuberculosis and eugenics

In the United Kingdom every year fifty thousand people die of consumption or tuberculosis of the lung; twenty thousand more from other forms of the disease; a hundred and fifty thousand are disabled, while there are at least five hundred thousand infected persons, of whom a tenth constitute the potential cases of the future. In the course of nature, as things are, one out of every eight will die of tuberculosis. Remember, also, that this disease strikes down men and women in their prime, after they have founded a home, but before their children are self-supporting. Prior to the war, consumption created one-eleventh of the total pauperism in England and Wales.

So said Halliday Sutherland on Tuesday, 4th September 1917 in a speech to the National Council of the Y.M.C.A.  As a protégé of Sir Robert Philip, the founder of the Edinburgh system that was so effective in the treatment and control of tuberculosis, Sutherland had implemented Philip’s schemes at the anti-tuberculosis clinic in Marylebone and through the establishment an “open-air” school in the Regent’s Park bandstand.

He stated: “modern medicine [has]…found the cause, sources and cure of this disease,” which might have led one to expect a speech with a celebratory air.  It did not and, in an address which was as much political as it was medical, Sutherland expressed his frustration that the largest obstacles to the elimination of the disease were man-made:

As long as apathy, arrogance, ignorance and indifference endure, so surely will tuberculosis claim its hourly victims…while at every point this dread disease is opposed, as will be shown, by the non-moral forces of nature, man and man alone has created the conditions under which it may arise, spread and destroy.

Following an outline of the causes of consumption, he turned to this question:

Is the disease inherited?  It is not.  No child is born tuberculous; nay more, every child who acquires the disease is infected after birth.  There is not even, in my judgement, an inherited disposition…

It was important, he said, to

…dispel the sinister nightmare of an inherited predisposition, under which, during the past hundred years, men, women and children have often resigned themselves to die just because one of their forbears had died of consumption.

The issue of heredity was not, however, merely an issue of patient morale. Heritability was central to Eugenics, the ideology of race science that was then fashionable amoung the British elite. If consumption, or a susceptibility to it, was an inherited condition – and many eugenicists believed that it was – doctors could do little to prevent the disease let alone cure it.

The eugenic alternative was to limit the reproduction of the genetically deficient, though they differed in opinion as to how to achieve this. Some advocated the voluntary sterilization of the unfit. Others urged that compulsory sterilization be legislated. Yet others suggested that each marriage be assessed for eugenic value by the State and for the provision of the appropriate carrot to encourage progeny of the right sort.

Sutherland saw them as “race-breeders with the souls of cattle-breeders” (borrowing this phrase from the Rev. Archibald Fleming, who chaired the council that day), and he railed against their view that the prevention of disease was not in itself a good thing :

But why should you set out to prevent this infection and to cure the disease?  There are some self-styled eugenists…who declaim that the prevention of disease is not in itself a good thing.  They say the efficiency of the State is based upon what they call ‘the survival of the fittest’.  This war has smashed their rhetorical phrase.  Who now talks about the survival of the fittest, or thinks himself fit because he survives?  I don’t know what they mean.  I do know that in preventing disease you are not preserving the weak, but conserving the strong.  And I do know that those evil conditions which will kill a child within a few months of birth, and slay another when he reaches the teens, will destroy yet another when he comes to adult life.

The significance of the Consumption Address is that it is evidence of Sutherland’s awareness that eugenicists blocked his path to the elimination of tuberculosis and, in so doing, it reveals the wider issues that led to the Stopes v. Sutherland trial of 1923 (the so-called “Birth Control Libel Trial”). In 1922, he wrote Birth Control: A Statement of Christian Doctrine Against the Neo-Malthusians which in turn led to a writ for libel from Marie Stopes who was a conspicuous advocate of both eugenics and Neo-Malthusianism.

Yet these wider issues are rarely, if ever, cited. Let us take the BBC History of Marie Stopes as one example (and there are many others) of the “standard” explanation of the Stopes v Sutherland dispute. It states:

In 1921, Stopes opened a family planning clinic in Holloway, north London, the first in the country. It offered a free service to married women and also gathered data about contraception. In 1925, the clinic moved to central London and others opened across the country. By 1930, other family planning organisations had been set up and they joined forces with Stopes to form the National Birth Control Council (later the Family Planning Association).

The Catholic church was Stopes’s fiercest critic. In 1923, Stopes sued Catholic doctor Halliday Sutherland for libel. She lost, won at appeal and then lost again in the House of Lords, but the case generated huge publicity for Stopes’ views.

Stopes continued to campaign for women to have better access to birth control…

Now I will admit that all that the BBC wrote is true, but I would also point out that what they left out that makes their history essentially false. For instance, there is no mention of:

• Stopes’ membership of the Eugenics Education Society (she joined in 1912 and became a life fellow in 1921);
• the Society for Constructive Birth Control and Racial Progress, a society with eugenic aims founded by Stopes to run her free clinic;
• Sutherland’s work on tuberculosis and his opposition to Eugenicists;
• Stopes advocacy of the compulsory sterilization of those with “inherent disease” (see page 133 of Problems of Population and Parenthood, the second Report of The National Birth Rate Commission (link) and Chapter XX of Stopes’ book Radiant Motherhood (link)).

Incredibly, the BBC’s history leaves out a major part of Dr Marie Stopes’ birth control agenda, what it was that Sutherland opposed and why he opposed it. In their hands it becomes the story of a Catholic doctor who, because he was a Catholic, opposed Stopes over contraception. As a “dog bites man” story, it isn’t hard to believe, yet this approach is disingenuous, because the 1917 Consumption Address pre-dated Sutherland’s 1919 conversion to Catholicism by two years. A reading of the speech  (linked below) shows his fervour for the eradication of tuberculosis and his ire with those who blocked his path. Further clashes were highly likely, if not inevitable, regardless of whether he converted to Catholicism.

Without doubt, Sutherland’s Catholicism accorded with his views on artificial contraception and vice versa, but tuberculosis, and his opposition to those who wanted to reduce the birth-rate of poor and working class people through state intervention and compulsory sterelization, was an equally significant factor, if not more so.