Proper Sphere of Government: Letter IX

“That it is the duty of the state to adopt measures for protecting the health, as well as the property, of its subjects,” is the fundamental principle espoused by the Eastern Medical Association of Scotland. The majority of the medical profession hold the same opinion; a respectable portion of the public at large apparently agree with them; and, judging by the enactments that have from time to time been made, the state itself admits the truth of the doctrine. The position is a very plausible one. Some of the arguments urged on its behalf appear, at first sight, decisive. And great seem the evils that might result from the exclusion of legislative control, over matters affecting the sanitary state of the nation. The question, therefore, demands a careful consideration.

An advocate of an established church, may reasonably support this proposition. He maintains that it is one of the duties of a government, to look after the spiritual welfare of the community; that it ought not to permit unauthorised persons to administer to the religious necessities of their fellow-creatures, lest they should instil false doctrines; that without legislative supervision, the moral atmosphere of society would be vitiated by the contagious breath of wickedness; in short, that state superintendence is essential to the spiritual sanity of the nation. Holding these opinions, he may fairly employ similar arguments in reference to the physical condition of the body politic. He may submit that it is improper to allow unqualified persons to administer to the corporeal ailments of the people, lest they should prescribe deleterious medicines, or give dangerous advice; that, in default of legal regulations, the air of our populous towns would become impure from want of ventilation, or be contaminated by the malaria arising from uncleansed sewers, and other sources of corruption; in a word, that government interference is necessary to the preservation of the public health. The analogy between these arguments is obvious. But how stands the dissenter affected towards them? Denying, as he does, their cogency in the one case, he cannot consistently admit it in the other. In the first instance, the spiritual health of the people is the object in view; in the second, their bodily health; and the reasoning that is employed to show that legislation is not required in the one case, will go far to prove its needlessness in the other.

One would have thought that in these anti-monopoly days, when the calamities resulting from selfish legislation have awakened public attention, men would take especial care not to permit anything involving an approach to exclusive privileges, to make its appearance upon the political arena, without raising a vigorous outcry against it. But the expectation is not realised. The doctrine that it is the duty of the state to protect the public health, contains the germ of another gigantic monopoly. Years ago did that germ first show itself, in the shape of an enactment for restricting the prescribing practice of chemists and druggists. Again, is the noxious parasite gathering together its energies, to make another and stronger shoot, under the form of a more stringent law for the same purpose. That object gained, and some greater extension of power will be its aim. Already do the professional publications of the day, contain rumours of medical directors, medical inspectors, and various grades of officers, to be appointed as overseers of the public health. Willingly will the aristocracy come forward and lend a helping hand to so promising a project—one that holds out so inviting a prospect of more berths for their younger sons; and happy will they be to patronise an institution, which shall thus serve as another medium for the absorption of the nation’s wealth. In this way, if the people permit, will the system unfold itself, and may, in the lapse of a few generations, finally saddle itself upon the public after the manner of a national church.

It is needless, however, to enter into any arguments to show that medical men are endeavouring to establish a monopoly, for they publicly acknowledge it. They openly avow that they are seeking for protection, and boldly maintain that they have a right to it. But then, it is all done out of a friendly desire to defend the public against quackery! And, in proof of the benefits that the nation is to derive from this exclusive dealing, these patterns of disinterestedness, hold forth upon the danger of allowing the illiterate to be gulled by unlicensed practitioners. Hear Mr. Wakley. Speaking of a recently revived law relating to chemists and druggists—he says, “It must have the effect of checking, to a vast extent, that frightful evil called counter practice, exercised by unqualified persons, which has so long been a disgrace to the operation of the laws relating to medicine in this country, and which, doubtless, has been attended with a dreadful sacrifice of human life.” (Lancet for Sept. 11, 1841.) And again, “There is not a chemist and druggist in the empire who would refuse to prescribe in his own shop in medical cases, or who would hesitate day by day to prescribe simple remedies for the ailments of infants and children.” * * * * * “We had previously considered the evil to be of enormous magnitude, but it is quite clear that we had under-estimated the extent of the danger to which the public are exposed.” (Lancet for Oct. 16, 1841.) One hardly knows how sufficiently to admire the great penetration that has discovered this “evil of enormous magnitude,” so completely overlooked by society at large. Truly, it affords matter for much wonderment, that the “dreadful sacrifice of human life,” resulting from this “frightful evil,” has never yet opened men’s eyes to a sense of the great “danger” of their situation. But would it not have been more prudent, if this grand discovery had been made public, and the agitation carried forward by unprofessional persons? Mr. Wakley should remember, that we are told to avoid the appearance of evil, and he may discover to his cost, that the world is so suspicious, as to ascribe these seeming fruits of patriotic feeling to some less noble origin. And why does Mr. Wakley stop short of the full extent of his principle? If it is really the duty of the state to take care of the public health, it is surely bound to adopt the most efficient means of fulfilling that duty. Why not then act upon the old adage, that “prevention is better than cure,” endeavour to keep the people always well? Enact a national dietary—prescribe so many meals a day for each individual—fix the quantities and qualities of food, both for men and women, how much animal and how much vegetable—state the proportion of fluids; when to be taken, and of what kind—specify the amount of exercise, and define its character—describe the clothing to be employed—determine the hours of sleep, allowing for the difference of age and sex, and so on with all other particulars, necessary to complete a perfect synopsis, for the daily guidance of the nation. Surely this would be much more efficient than any of these half measures, and, in principle, much about as reasonable. If you insist upon a man getting rid of his ailments according to law, you may as well endeavour to keep him in health by law also.

But seriously, all legislation of the kind desired by Mr. Wakley and his colleagues, virtually, rests upon the assumption, that men are not fitted to take care of themselves. It treats them as so many children. It puts the people into leading strings. Poor things! if we do not look after them, they will be going to ignorant quacks for advice, and, perhaps, get poisoned! Such is practically the language of the state towards its subjects, and the longer they are treated in this manner, the more helpless will they become. If any one foolishly chooses, for the sake of saving a little money, to employ an uneducated empiric he must take the consequences, be they what they may. He has acted under the guidance of his own free will, and, if he suffers, he has no one to blame but himself. Imagine a man to have a watch that wants repairing; and, suppose that, from considerations of economy, he takes it to a blacksmith, who tells him that he can rectify it—the blacksmith spoils it—the man is angry—complains that he has been ill used—enlists a number of the mawkishly benevolent upon his side, and gets them to petition parliament, that all blacksmiths be in future prevented from repairing watches. Who would not laugh at such foolishness? The man was in fault for putting his watch into such hands, and richly deserved the reward of his stupidity. Yet the case is perfectly parallel to the one before us. Instead of his timepiece, he takes himself (a much more complicated machine) to be repaired—he applies to one who knows as little about the human frame, as a blacksmith does about a watch—the ignorant pretender prescribes—the patient gets no better—by and by his constitution is permanently injured, and perhaps he becomes an invalid for life—that is, instead of having his watch spoiled, he has been spoiled himself. But what then? The consequence may be more serious in the one case than in the other, but the man has no greater right to complain. If he had exercised his reason, he might have known, that it was as silly to put his body under the care of one who did not understand its mechanism, as to give a chronometer into the hands of a blacksmith; and there is abstractly no more ground for legislative interference to guard against such imprudence in the one instance than in the other.

A large class of officiously humane people, can never see any social evil, but they propose to pass some law for its future prevention. It never strikes them that the misfortunes of one are lessons for thousands—that the world generally learns more by its mistakes than by its successes—and that it is by the continual endeavour to avoid errors, difficulties, and dangers, that society is to become wiser. It is not for a moment denied that many individuals have been injured by druggists’ prescriptions, and quack medicines—some temporarily weakened—others permanently debilitated—and a few perhaps killed outright. But, admitting this, it does not follow that it is not the wisest in the end, to let things take their own course. Such conduct may at first sight appear unkind, but when its effects upon future generations are considered, it will be found to be the reverse. Many arrangements in the animal creation cause much suffering and death, but we do not thence infer that the Almighty is unmerciful. Investigation explains the anomaly, and shows us that these apparent evils are collateral results of laws, ultimately tending to produce the greatest amount of health and happiness, and a careful consideration will satisfy us, that the pains inflicted upon human beings by their own imprudence, are of like character.

There is yet another position from which this question may be considered, and one, perhaps, whence the clearest and most extended view of it can be obtained. All legislation which assists the people in the satisfaction of their natural wants—which provides a fund for their maintenance in illness and old age, educates their children, takes care of their religious instruction, looks after their bodily health, or in any other way does for them what they may be fairly expected to do for themselves, arises from a radically wrong understanding of human existence. It wholly neglects the condition of man’s earthly being, and altogether loses sight of one of the great and universal laws of creation.

Every animate creature stands in a specific relation to the external world in which it lives. From the meanest zoophyte, up to the most highly organised of the vertebrata, one and all have certain fixed principles of existence. Each has its varied bodily wants to be satisfied—food to be provided for its proper nourishment—a habitation to be constructed for shelter from the cold, or for defence against enemies—now arrangements to be made for bringing up a brood of young, nests to be built, little ones to be fed and fostered—then a store of provisions to be laid in against winter, and so on, with a variety of other natural desires to be gratified. For the performance of all these operations, every creature has its appropriate organs and instincts—external apparatus and internal faculties; and the health and happiness of each being, are bound up with the perfection and activity of these powers. They, in their turn, are dependent upon the position in which the creature is placed. Surround it with circumstances which preclude the necessity for any one of its faculties, and that faculty will become gradually impaired. Nature provides nothing in vain. Instincts and organs are only preserved so long as they are required. Place a tribe of animals in a situation where one of their attributes is unnecessary—take away its natural exercise—diminish its activity, and you will gradually destroy its power. Successive generations will see the faculty, or instinct, or whatever it may be, become gradually weaker, and an ultimate degeneracy of the race will inevitably ensue. All this is true of man. He, in like manner, has wants, many and varied—he is provided with moral and intellectual faculties, commensurate with the complexity of his relation to the external world—his happiness essentially depends upon the activity of those faculties; and with him, as with all the rest of the creation, that activity is chiefly influenced by the requirements of his condition. The demands made upon his mental powers by his every day want—by the endeavour to overcome difficulties or avoid dangers, and by the desire to secure a comfortable provision for the decline of life, are so many natural and salutary incentives to the exercise of those powers. Imperious necessity is the grand stimulus to man’s physical and mental endowments, and without it he would sink into a state of hopeless torpidity. Establish a poor law to render his forethought and self-denial unnecessary—enact a system of national education to take the care of his children off his hands—set up a national church to look after his religious wants—make laws for the preservation of his health, that he may have less occasion to look after it himself—do all this, and he may then, to a great extent, dispense with the faculties that the Almighty has given to him. Every powerful spring of action is destroyed—acuteness of intellect is not wanted—force of moral feeling is never called for—the higher powers of his mind are deprived of their natural exercise, and a gradual deterioration of character must ensue. Take away the demand for exertion, and you will ensure inactivity. Induce inactivity, and you will soon have degradation.

The reader will therefore observe:

1. That the dissenter cannot consistently admit that the state should have the care of the bodily health of the people, when he denies that it has anything to do with their spiritual health.

2. That the warmest supporters of this theory of government superintendence, are only making it a blind for another monopoly.

3. That no man has a claim upon the legislature to take that care of his health which he will not take himself.

4. That in this case, as in every other, to do for the people what they are naturally fitted to do for themselves, is to adopt one of the most efficient means of lowering the standard of national character.