simply highlighted the vices of contemporary official data collection and analysis. Specifically on the latter, in early 1939 Titmuss wrote to H.W. Singer at the University of Manchester. Singer was a German refugee, one of John Maynard Keynes’s first doctoral students, and later famed for his work on the economics of developing countries. Titmuss had recently read a Ministry of Health report which denied any link between population health and economic distress. This contradicted both his own work and that of Singer. In response, Singer claimed that he knew that the Ministry fought shy of this linkage because of its ‘undue aversion to more refined statistical methods’.22 But while Singer was making a valid methodological point, there was more to it in that political concerns also came into play.
There was a coda to this exchange which reflects well on Titmuss. In July 1940, he wrote to the Ministry of Information protesting about the ‘harsh and altogether shameful policy applied to the internment of refugees’. The government was hypocritical in claiming to seek to defend Europe while behaving in this way, and its actions were having a negative impact on American public opinion. Titmuss explicitly cited Singer’s case. The latter had helped Titmuss in his own work, and contributed to the Pilgrim Trust’s survey Men Without Work, an important study of the corrosive effects of unemployment. But he was now interned near Liverpool.23 Why? Over the preceding two months the German armed forces had had stunning successes in Scandinavia, the Low Countries, and France. This had prompted the government to intern ‘enemy aliens’, that is British-based nationals of countries at war with Britain. By the time of Titmuss’s letter, France had fallen, and British and French military personnel had been evacuated from Dunkirk. The government was also tightening control over society through measures such as the Emergency Powers (Defence) Act, passed in May 1940. Most of the population felt a German invasion to be imminent.24 To take a stand on refugees in this understandably tense atmosphere showed courage on Titmuss’s part, and further evidence of his concern for civil liberties. Around this time Lafitte published an exposure of the treatment of ‘enemy aliens’, which Titmuss reviewed in early 1941. Lafitte’s book reminded British society of a ‘crime we committed in 1940, and for which we have not yet made full restitution’. It was necessary to ‘understand the nature of the war we are fighting, and that we discriminate, not between Britons and “aliens” or between “friendly aliens” and “enemy aliens” in the present way’. Rather, what was required was to distinguish between ‘those who stand for freedom and those who stand for tyranny in every country’. As Lafitte had demonstrated, the refugee issue was ‘indissolubly linked with the whole character and conduct of the present war’.25
To return to official data, in spring 1941, Titmuss, in a piece primarily concerned with inequalities in health outcomes, noted that for over three decades ‘we have relied on a Cost of Living Index based on family budgets collected soon after the Boer War’. While this might have been acceptable down to 1914, a lamentable lack of action ‘during the twenty uneasy years following the Armistice’ accurately reflected society’s failure to understand that the ‘condition of the people must always be at the root of all political doctrine in a democratic system’. The punchy title of this piece was ‘The Cost of Living and Dying’.26 A few months later, in a letter to the BMJ, Titmuss protested about what he called ‘the statistical black-out’ of medical data in England. This was not the case for Scotland, though, where material released showed ‘a serious rise in both infantile and maternal mortality’. Immediate measures were required to deal with these. If the medical profession, and local authorities, were to act effectively, then information was crucial. Should the latter need to be withheld for security reasons, then ‘let the authorities be democratically frank and tell us so’. Either way, the situation should be consistent across the whole country.27
More specifically on the question of population health and war, in 1939 Titmuss was co-author of Our Food Problem: A Study of National Security. Titmuss’s fellow author was Frederick (‘Bill’) Le Gros Clark, despite his blindness a prolific writer, and a leading activist in organisations such as the Committee Against Malnutrition. Le Gros Clark was clearly an admirer of Titmuss, having recommended him, for example, as a speaker on malnutrition to the Medical Society at University College Hospital (UCH) in London.28 As we shall see in Chapter 9, political radicals at UCH were central to the development of social medicine. Titmuss had previously contacted Le Gros Clark suggesting a joint survey of the depressed areas, but the actual outcome of their collaboration was to be their book.29 The volume was part of the popular, and influential, ‘Penguin Specials’ series whose aim was, as Nicholas Joicey puts it, ‘to provide a topical commentary on international and domestic events’. Published in paperback, and relatively cheaply priced, the series was a ‘phenomenal success’, with a ‘significant number of titles’ selling over 100,000 copies.30 It should also be seen as part of a broader demand, especially from those on the progressive left, for informed commentary on current affairs, domestic and international.31
As the title of the Le Gros Clark and Titmuss book suggests, it was written with the deepening European crisis very much in mind. If war came, Britain would have to call upon its citizens ‘for a show of courage and endurance as great as any that their forefathers had reason to display’. In order to do so, though, national ‘stamina’ would have to be increased. This could be done through, for example, state-subsidised milk for all pregnant and nursing mothers, all young children, all schoolchildren, and young workers up to at least the age of 25. The last group should also have access to subsidised canteens. While such schemes would undeniably be expensive, ‘we must take some measures if we are to survive’, and, in so doing, take a chance with the consequences. All this was ‘democratic’, for the ‘same rules of feeding hold good for rich and poor alike’. And while Britain was certainly living ‘through a serious phase in our history’, measures such as those suggested ‘could in a remarkably short time establish the physical and spiritual stamina of our people on a foundation that would be well-nigh unassailable’. There was such a flimsy ‘borderline between normal and sub-normal humanity’ that the ‘sacrifices we would have to make are trivial in comparison’.32 Phrases such as ‘normal and sub-normal humanity’ jar on the modern ear. But these are seen here as positions on a spectrum, rather than the fixed entities a more ‘hard-line’ eugenicist would claim. In summer 1939 Le Gros Clark wrote to Titmuss enclosing a cheque for £11. This reflected the proportion of the book, around one fifth, written by the latter. Sales were ‘at present almost thirty thousand. Not bad but might be better’.33 This was a considerable achievement, and one way in which Titmuss’s views were being brought a wider reading public.
This particular volume was also cited as an authority in Eleanor Rathbone’s own Penguin Special, The Case for Family Allowances, in which she noted, too, that she was ‘indebted to Mr R.M. Titmuss for his help in providing me with some of my facts and figures’.34 Rathbone was a leading advocate of family allowances, a supporter of refugees, a campaigner for women’s rights, and an independent MP. Oakley suggests that she paid Titmuss to do certain calculations, and to read the entire script, resulting in an eight-page memorandum which Rathbone duly took on board.35 Although the document in the Titmuss archives
