Public health is an interesting area of research and political activism. Especially since the growth of industrial cities, inefficient disposal of human excreta has been known to favor epidemics of certain diseases. In the 19th century, it was also noticed than sewer workers were, quite understandably, more affected by these diseases. The scope of public health was extended to occupational health.

This suggests a series of questions and considerations that public health activists seem to ignore (as they generally continue to ignore economics): Why sacrifice the health of sewer workers to an improvement of the general population’s health? Do we need a cost-benefit analysis to count the corpses? No, because sewage workers—contrary to, say, the slaves who built the Egyptian pyramids—chose their jobs freely. The same could be said of the typesetters who were victims of lead poisoning: nobody forced them to work in that business and we cannot say that they were sacrificial lambs on the altar of free speech.

It is true that the sewer workers or typesetters of previous ages lacked information about the risks of their occupations. The problem was thus an information problem, which was bound to be automatically solved as medical sciences identified it. Once the information was known, we must assume that adult workers were the most able to make the choices and trade-offs adapted to their own circumstances. Adults are adults, and no less so because they don’t work for the government. Economic research has shown that hazardous jobs carry a wage premium to attract voluntary workers.

Until the Industrial Revolution bore its fruits, the trade-offs available to the poorest individuals were much less attractive. But one must distinguish the impact of poverty from the consequences of economic freedom. Indeed, it is only through a large measure of economic freedom that poverty could be overcome. Until then, the sewer worker was certainly better off (in his own opinion) than in other occupations: this is why, among the alternatives available to him, he chose that one.

Other things (including wealth and poverty) being equal, every walk of life carries its own costs, including often health risks. Some public health reformers, when they became concerned about problems of occupational health, noticed that even intellectual life had its own health risks.

One of them was Dr. George Hayward. In his Lecture on Some of the Diseases of a Literary Life (Boston: Carter, Hendee and Co., 1833), Hayward argued that literary men lack exercise, “confine themselves too long in hot and perhaps ill-ventilated apartments,” eat too much, and “indulge themselves not unfrequently both in smoking and chewing tobacco.” One must beware of “great mental efforts, made without proper attention to bodily exercise.” Even “great public interest and excitement” can increase “the passions of the mind” and lead to the diseases of intellectual life of the kind that occurred “among the distinguished actors in the French Revolution.”

An anonymous book also published in Boston at roughly the same time, Remarks on the Disorders of Literary Men, or An Inquiry into the Means of Preventing the Evils Usually Incident to Sedentary and Studious Habits (Boston: Cummins, Hilliard, and Co., 1825), which Rosen also presents as a public health precursor, gave similar advice with a few addenda—for example, that literary men should eat slowly and not take more than one bath a week.

Medical historian George Rosen (A History of Public Health, John Hopkins University Press, 1958, 1993) tells us that both works were influenced by public health thinking in Europe. According to public-health historian Elizabeth Fee, Rosen, at different times in his life, “might have characterized himself as a democratic socialist or left liberal,” which is far from unusual for people in the field of public health.

Interestingly, 19th-century public-health experts did not argue for laws limiting the working time of literary men like they did regarding other adult workers. They did not propose to forbid them from smoking in their preferred pubs, saloons, or bistrots. (Before the war on smoking, the use of tobacco was especially prevalent among artists, “literary men,” and other creative types.) The authors of the Lecture and the Disorders of Literary Men were content to recommend to literary men voluntary ways of prevention through “temperance and exercise.”

Unexpectedly (did Rosen notice?), the anonymous author of the Lecture has a lesson for today’s public-health warriors. In the last few lines of his book, he wrote:

Besides, as Rochefaucault observes, it is paying too great a tax even for health, when its preservation is made the business of our life.