As the Covid-19 pandemic continues to sweep the globe, observers in the United States have noted its implications for the American healthcare system and the notoriously scanty coverage it provides. On the one hand, there is a question of justice: is it fair that people might suffer just because they can’t afford quality care in a society that doesn’t guarantee health insurance for all? But in addition to the question of justice, there is also the issue of public health. It is becoming more and more common to hear that we are all only as healthy as the least insured among us. From this perspective, guaranteed access to care as a social right represents enlightened self-interest because when sick, contagious people can receive treatment, it helps to protect everyone’s health. This reasoning may help explain why some polls have found a surge in support for Medicare for All, the single-payer health insurance plan associated with Vermont senator Bernie Sanders.
While possessing special urgency on account of the current pandemic, the insight that a right to social services like healthcare confers broad public health benefits is hardly novel. The Victorian writer Thomas Carlyle made the same point in the early 1840s. Essayist, translator, novelist, historian, and social critic, Carlyle was a cantankerous Scottish intellectual whose idiosyncratic views in some respects presaged 20th century fascism; however, he also forcefully criticized laissez faire capitalism, inspiring radical reformers who believed in progressive change. In his 1843 book, Past and Present, Carlyle wrote,
One of Dr. Alison’s Scotch facts struck us much. A poor Irish Widow, her husband having died in one of the Lanes of Edinburgh, went forth with her three children, bare of all resource, to solicit help from the Charitable Establishments of that City. At this Charitable Establishment and then at that she was refused; referred from one to the other, helped by none;–till she had exhausted them all; till her strength and heart failed her: she sank down in typhus-fever; died, and infected her Lane with fever, so that ‘seventeen other persons’ died of fever there in consequence. The humane Physician asks thereupon, as with a heart too full for speaking, Would it not have been economy to help this poor Widow? She took typhus-fever, and killed seventeen of you!–Very curious. The forlorn Irish Widow applies to her fellow-creatures, as if saying, “Behold I am sinking, bare of help: ye must help me! I am your sister, bone of your bone; one God made us: ye must help me!” They answer, “No; impossible: thou art no sister of ours.” But she proves her sisterhood; her typhus-fever kills them: they actually were her brothers, though denying it! Had man ever to go lower for a proof?
Past and Present exemplifies an influential genre of Victorian literature that is often discussed under the heading of the “Condition of England,” a phrase that Carlyle himself coined in his 1839 pamphlet, Chartism, which examined the deep social causes behind the rise of the Chartist working class movement for universal male suffrage (so called because of its advocacy of the People’s Charter). One of the hallmarks of Condition of England literature is its probing of social questions through engagement with parliamentary bluebooks, government reports, and other forms of expert testimony, such as that of medical doctors, in order to diagnose broader social maladies.
Although Carlyle was fond of invoking fictional personalities to illustrate differences of philosophical temperament—one recurring character in Past and Present is Dryasdust, an uninspired historian whom he borrowed from Sir Walter Scott—the Dr. Alison to whom Carlyle refers in the passage above was very real indeed. Born in 1790, Dr. William Pulteney Alison studied and taught medicine at the University of Edinburgh, where he was also the student of noted Scottish Enlightenment thinker Dugald Stewart. His interests stretched beyond the health of the individual, embracing philosophical and sociological themes with which he was convinced matters of health were intertwined. Given this breadth of interest, historian Christopher Hamlin describes Alison as a “medical philosopher” and practitioner of “political medicine” on par with other great Victorian social thinkers such as Karl Marx and Friedrich Engels. Indeed, the latter cited Alison’s work repeatedly.
Alison’s political and philosophical approach to medical issues is manifest in his 1840 treatise, Observations on the Management of the Poor in Scotland and its Effects on the Health of the Great Towns. In this work Alison discussed the effects of poverty on the prevalence of fever, concluding that Scotland’s lack of legally sanctioned provision for the poor contributed to the spread of disease. “The prevention of a disease may often be in the power of a community, although beyond the power of many of the inhabitants composing that community,” according to Alison. For this reason and others, he took issue with Thomas Malthus, whose influential theory of population inspired those who wanted to do away with poor relief altogether.
Despite living in an age when the miasma theory of disease still held sway with many writers, intellectuals, and public servants, Dr. Alison, and by extension Carlyle, anticipated a modern vision of public health. The Victorians may have a reputation for being repressive and conservative, but this example shows that they also counted plenty of progressives, radicals, and visionaries among their ranks whose insights remain relevant to our lives today.