Medicine and Statesmanship

I

To most of us, nothing is so personal as medicine. The lawyer, or even the theologian, may speak of his vocation with some chance that his hearers will accept his words impersonally. But when the doctor speaks, his hearers apply his words immediately to themselves. If the address is about disease, doubts and fears assail them. If he discusses appendicitis or duodenal ulcer, he will have his audience feeling about to see if they are afflicted with the ailments he describes. We all know to what extremes doubts and fears about disease can go. A distinguished friend once wrote to me: ‘I am so much better. I have not had cancer for three months.’

But despite our habit of applying personally anything said about disease, medicine in its wider reaches far transcends the personal. In fact, at its broadest, it becomes a branch of statesmanship. Disease is not my present theme. I wish rather to discuss medicine in some of its comparative relationships.

There have been periods in history when statesmanship was great, but medicine was crude and little thought of. I need only instance the age of Elizabeth, one of our great masters of statecraft. Throughout her reign she furthered peace and secured strength of government; but public health was a question she almost completely ignored. It is interesting to observe in passing that when she had the dropsy the Queen herself was treated with a prescription of numerous ingredients any one of which would have killed a man to-day in a very few minutes. There could be no greater tribute to her constitution than the fact that she was able to take it. Indeed, I have a shrewd suspicion that she never did take it.

I often think that a remarkable feature of the Elizabethan age was its contradictions. Consider her palace at Greenwich: the walls were hung with the most wonderful tapestries and carpets, yet the floor was covered with reeds. When one layer of reeds got dirty, it was not removed; others were merely placed on top, with the easily imagined result that a certain kind of life multiplied more profusely on the palace floor than we should think desirable. On his visit to England the great Erasmus complained of this kind of inconvenience, and only recently I came across a reference to wormwood as a valuable remedy for the condition he found so painful: —

II

Until the last part of the nineteenth century, statesmanship thought in terms of individuals. The fight was for freedom of conscience, equality of opportunity, self-government. The state was looked upon as an aggregate of individuals. During the same period doctors were concerned for the most, part with people so entirely sick that they were detached for the time being from the stream of life, and in looking after this cloistered class the doctors themselves were apt to become cloistered in thought. The sick, for their part, regarded illness not as a natural product of their working or playing lives, but as something which had inexplicably fallen upon them, as a fate sent by Providence which could not be avoided.

Then came, toward the end of the last century, the wider appreciation of the importance of preventive medicine, and the increased study of ill health in its early beginnings, which in turn directed attention to the day-byday life of people and the conditions that surrounded them. At the same time, methods of diagnosis increased in range and accuracy. Treatment became more precise in its objectives and resourceful in its means by the inclusion of such agencies as air, light, and food. With this knowledge came an awakening to the possibilities of constructive nurture.

Accompanying these developments in the art of medicine, statesmanship also made advances. Having achieved liberty and equality for the individual, it began to assume a parental function, and concerned itself more and more with constructive measures for the health, prosperity, and contentment of people generally. Thus the lines of development of medicine and statesmanship approximated.

Perhaps I ought to say here, by parenthesis, that some of the examples I am seeking to give may apply with greater force to an old country than to a new one. But I hope that this will not impair the general argument. It is, in fact, quite possible that the dangers which an older country has already faced, and might perhaps have avoided, may point the way to those that are still young.

Certainly the parental rôle of the state is growing apace. In England and in many European countries it has reached an advanced stage. It provides help for those who are born, taught, sick, unemployed, for the hungry, and even for those who are thirsty. It regulates wages and hours of labor. True, it is prompted by a social conscience which inspires man’s onward progress. At the same time it costs England a quarter of her national income to maintain the services which shepherd her people from the cradle to the grave. Other countries have found that the cost of the parental function of government steadily mounts.

It seems reasonable to pause and ask, Is the result of this tendency as good as its purpose? No one surely would contemplate a return to the haphazard methods of an outworn individualism. Everyone recognizes the desirability of a constructive social policy on the part of the state, although the rigid and standardized methods which these gigantic efforts involve create difficulties and doubts. The more the cost of social policy is centralized, the farther its administration removed from the man who receives the benefit, the more apt is that man to lean upon a prop, to become a creature of fate rather than a master of effort.

I suggest that a study of the governance of the human body prompts useful reflection. There is no attribute of the human being more notable than his individuality. Parade a thousand men, and each one will be distinct. Indeed, so definite is his individuality that his fingerprints are sometimes his undoing.

What makes diagnosis of disease the most difficult branch of the doctor’s art is this very problem of individuality. No two men are ill in the same way. The statements in textbooks represent a very poor average of experience. They often represent a type which seldom occurs. Evidences present in one patient are absent in another. In the same disease, pain will be a feature of one case and not of another. Morphia will give rest to one patient and excitement to another. The effective dose of that valuable remedy belladonna may vary by 200 per cent. The application of radium under like conditions of disease will not produce like results. Moreover, the mind reactions of one man differ from those of another. The doctor has ever, by the exercise of his own intuition, to take stock of the personal factor. As the famous saying puts it: ‘There is no sickness; there are only sick people.’

Should not personality and the rich variations of individual life be equally an object of care to the statesman? Is it not one of the problems of statesmanship to see that in its broad attempts at social legislation personality is not forgotten? Just as the doctor, in treating the individual, cannot neglect his social background, so the statesman, in treating the social problem, cannot neglect the individual. He must weigh in a just balance the rôles of the state and the individual. The varying problems arising from unemployment in different occupations illustrate this theme.

But is it possible for the large organization of the state to appreciate the varying needs of separate men! Is not the state compelled to postulate a man so standardized as to be virtually unreal? I recall the story of a railway company which tried to economize in its use of locomotives. In order to utilize the engine for a larger number of hours, the officials duplicated the engineer and the fireman. The effort failed. It was found that more could be got from the engine in the long run by entrusting it to an individual engineer who looked upon it as his personal property and, as long as it was his, obtained the best from it. Personality told.

Again, physiology teaches that man’s health depends upon initiative and effort. In some, such initiative and effort are inborn. In most, the stimulus of necessity is needed. The same amount of external assistance may help one man and damage another. This, I take it, is another of the difficulties of governments. Their problem is to apply their remedies in such a way as to prevent them from becoming rigid and mechanical, so that they may be adjusted to the infinite variety of human nature.

Of this kind is one of the problems of unemployment. In the modern state, work is more narrowed, more specialized, and it is more difficult to find a job for the unemployed man in his own kind of labor. If he is given help, the difficulty is to prevent his coming to regard what was meant as a temporary prop as natural and belonging to him by right. And the farther the cost of the benefit which he receives is separated from his own sense of responsibility, the greater the danger becomes.

I should like to offer an anecdote, and a true one, as illustrating this theme. In one of the outlying counties of England a farm laborer had been out of work for many months and had been living on the dole. He went to his doctor one day, and when he had received the required treatment he said: ‘Doctor, do you know, I had an offer of work some days ago which would have given me five shillings more a week than I am getting from the dole, but after giving it thorough reflection I preferred to remain independent.’

III

Years ago the statesman was able to bring freedom — in a political sense, at least — to the individual, and it would be an irony indeed if, having achieved that, the state in turn should enslave the individual by a too close and controlling care. How to avoid this appears to me one of the great problems of modern life. A workman in a large factory which had grown from a personal business expressed a preference for the latter. When asked why, he replied: ‘The boss used to excite us.’ He was expressing the necessity of emotional interest, the demands of individual personality. The direct control and care by the state must, I suggest, become more rather than less mechanical, more seductive than helpful, and at a cost disproportionate to the results.

The world has moved ahead so fast as regards material civilization that man has almost, for the moment, got behind in his power of adaptation. This is certainly true of disease. Whereas we have got rid, to a large extent, of the diseases that come to us from without, in the shape of microbic infections and the like, we are now replacing them by illnesses which are — in part, at any rate — the result of man’s constant struggle to adapt himself to the rapid advance of material civilization. In medicine we are familiar with the mind which deteriorates by retaining too much direction within its conscious and even conscientious self. It means increasing anxiety for itself and fretful misguidance of others.

The sovereign state is faced with problems economic and social so numerous and perplexing as to overtax its capacity. In the realm of thought, new aspirations and discoveries crowd upon the statesman’s attention so fast that there is no time for them to crystallize into clarity of purpose, and so they produce conflict. Medicine is always teaching that diagnosis must precede treatment, but democracy is impatient for treatment. In his attempt to prescribe treatment for the problems of the day, the statesman is confronted with a task almost beyond him. It is characteristic of our contemporary difficulties that, more than ever before, they require specialized knowledge, and those who possess such knowledge show a tendency to hold aloof from political life. The result is that governments by their very burdens are forced into mechanical methods. Parliaments become intensive rather than deliberative, for institutions, like individuals, can suffer from high blood pressure. And peoples lose confidence in government.

Once more, personality needs valuation and free play. Would this not be obtained by smaller groupings in which the skilled helper, inspired by human interest, would play a part? Let me turn again to physiology for an illustration. It seems as though some rearrangement of function were needed — a rearrangement which would harmonize quite well with the layout of the human nervous system. In the nervous organization are the supreme centres of the brain, but with certain powers delegated, and with certain parts of the nervous system semiautonomous. Would not the state, like the higher centres of the brain, sometimes fulfill its function better by direction rather than administration, and by encouraging variations within its general control? While retaining the reins of policy and securing adequate responsibility, could not statesmen delegate many of the great, problems that come before them to other bodies, small in number of members and containing experts endowed with the necessary skilled knowledge — bodies sufficiently independent to be uninfluenced by political exigencies and to be able to take the long view as regards public policy?

Such experiments have been tried. They are in force with regard to certain public utilities, and to broadcasting. As for agencies of social welfare, these bodies, in addition to expert knowledge and disinterestedness, would require humanity. Admittedly this is a more difficult quality to secure, if it is to be the pure juice of the grape of human understanding, and not mere sentimentality. One of the dangers of democracies is that they so often mistake sentimentality for sensibility.

Fortunately the polities of the English-speaking nations seem to produce citizens who understand human needs and have an aptitude for ministering to them. That has been the secret of much successful voluntary work — the recognition of personality and a genius for spontaneous rather than prearranged organization. What we need is unity of purpose with scope for diversity of expression. What we seek is men, not a massive organization, however admirable in design — men with the impulse to think and to strive, and to solve the problems of life and health conformably to knowledge and each to his own way of searching. For citizenship should be a recognition of mutual dependence and the value of service. The state claims from each citizen a positive allegiance, not a negative acceptance.