Note: When Dalrymple’s long-running BMJ column ended in 2012, he had a backlog of around 50 or 60 unpublished pieces, and he kindly gave them to us to post here at Skeptical Doctor. We are posting one each Wednesday to coincide with the schedule of his old BMJ column. We hope you enjoy them.

There was a time when I should have despised the sermons of seventeenth and eighteenth century divines, but perhaps it is a sign of advancing age that I no longer do. The sermons are often exceedingly well written and full of sense, even if one does not necessarily share the underlying religious standpoint. If one read only that with which one was in complete agreement, one would read very little.

Joseph Butler (1692 – 1752), Lord Bishop of Durham, was considerable as a philosopher (his most famous dictum being “Everything is what it is, and not another thing,” which is actually more metaphysically profound than might at first appear), and he also wrote memorable sermons. He was a deeply charitable man, and believed in hospitals for the poor: he was the most generous contributor to the founding of an infirmary in Newcastle.

The preface to his Fifteen Sermons opens with words that could hardly be less congenial to the spirit of our age:

…it is scarce possible to avoid judging, in some way or other, of almost everything which offers itself to one’s thoughts…

Personally, I am with Butler there, and against the spirit of the age.

The other sermons are subtle explorations of human psychology, still well worth the reading; while the sixth of his Six Sermons Preached upon Public Occasions, before the Duke of Richmond and the Governors of the London Infirmary for the Relief of Sick and Diseased Persons, Especially Manufacturers and Seamen in Merchant-Service, of 1748, is of surprising contemporary relevance.

For example, he treats of the question of whether those whose illnesses are self-inflicted should be treated on the same basis as those whose illnesses are not. Butler believes that they should be; not surprisingly as a bishop, he uses the argument that “we have divine example for relieving those distresses which are brought upon persons by their own faults.”

But he goes further:

Though the natural miseries which are foreseen to be annexed to a vicious course of life are providentially intended to prevent it… yet those miseries, those natural penalties admit of and receive natural reliefs, no less than any other miseries, which could not have been seen or prevented. Charitable providence then… leads us to relieve, not only such distresses as were unavoidable, but also such as people by their own faults have brought upon themselves.

The example he gives is of the diseases brought on by drunkenness, and not so long ago I was asked by a newspaper to write an article denouncing (which I declined to do) the second liver transplant given to a late drunken footballer.

Butler even deals with the economic problems of health care. The infirmary’s rules stated that “none who are judged to be in an asthmatic, consumptive, or dying condition be admitted on any account whatsoever.” Harsh as these words sound, says Butler, they proceed out of the mouth of Charity itself, for:

Charity pronounces it to be better, that poor creatures, who might receive much ease and relief, should be denied it, if their case does not admit of recovery, rather than that others, whose case does admit of it, be left to perish.

The need to ration is nothing new.

My edition of Butler’s works, incidentally, was edited by W E Gladstone in retirement: hard to imagine a recent Prime Minister on such a task in retirement.