This sort of inconsiderateness gets cured only in the classes where poverty, pretentious as it is even at its worst, cannot pitch its pretences high enough to make it possible for the doctor (himself often no better off than the patient) to assume that the average income of an English family is about £2,000 a year, and that it is quite easy to break up a home, sell an old family seat at a sacrifice, and retire into a foreign sanatorium devoted to some “treatment” that did not exist two years ago and probably will not exist (except as a pretext for keeping an ordinary hotel) two years hence. In a poor practice the doctor must find cheap treatments for cheap people or humiliate and lose his patients either by prescribing beyond their means or sending them to the public hospitals. When it comes to prophylactic inoculation, the alternative lies between the complete scientific process, which can only be brought down to a reasonable cost by being very highly organized as a public service in a public institution, and such cheap, nasty, dangerous and scientifically spurious imitations as ordinary vaccination, which seems not unlikely to be ended, like its equally vaunted forerunner, XVIII. century inoculation, by a purely reactionary law making all sorts of vaccination, scientific or not, criminal offences. Naturally, the poor doctor (that is, the average doctor) defends ordinary vaccination frantically, as it means to him the bread of his children. To secure the vehement and practically unanimous support of the rank and file of the medical profession for any sort of treatment or operation, all that is necessary is that it can be easily practised by a rather shabbily dressed man in a surgically dirty room in a surgically dirty house without any assistance, and that the materials for it shall cost, say, a penny, and the charge for it to a patient with £100 a year be half-a-crown. And, on the other hand, a hygienic measure has only to be one of such refinement, difficulty, precision and costliness as to be quite beyond the resources of private practice, to be ignored or angrily denounced as a fad.

TRADE UNIONISM AND SCIENCE

Here we have the explanation of the savage rancor that so amazes people who imagine that the controversy concerning vaccination is a scientific one. It has really nothing to do with science. The medical profession, consisting for the most part of very poor men struggling to keep up appearances beyond their means, find themselves threatened with the extinction of a considerable part of their incomes: a part, too, that is easily and regularly earned, since it is independent of disease, and brings every person born into the nation, healthy or not, to the doctors. To boot, there is the occasional windfall of an epidemic, with its panic and rush for revaccination. Under such circumstances, vaccination would be defended desperately were it twice as dirty, dangerous, and unscientific in method as it actually is. The note of fury in the defence, the feeling that the anti-vaccinator is doing a cruel, ruinous, inconsiderate thing in a mood of malignant folly: all this, so puzzling to the observer who knows nothing of the economic side of the question, and only sees that the anti-vaccinator, having nothing whatever to gain and a good deal to lose by placing himself in opposition to the law and to the outcry that adds private persecution to legal penalties, can have no interest in the matter except the interest of a reformer in abolishing a corrupt and mischievous superstition, becomes intelligible the moment the tragedy of medical poverty and the lucrativeness of cheap vaccination is taken into account.

In the face of such economic pressure as this, it is silly to expect that medical teaching, any more than medical practice, can possibly be scientific. The test to which all methods of treatment are finally brought is whether they are lucrative to doctors or not. It would be difficult to cite any proposition less obnoxious to science than that advanced by Hahneman:[105] to wit, that drugs which in large doses produce certain symptoms, counteract them in very small doses, just as in more modern practice it is found that a sufficiently small inoculation with typhoid rallies our powers to resist the disease instead of prostrating us with it. But Hahnemann and his followers were frantically persecuted for a century by generations of apothecary-doctors whose incomes depended on the quantity of drugs they could induce their patients to swallow. These two cases of ordinary vaccination and homeopathy are typical of all the rest. Just as the object of a trade union under existing conditions must finally be, not to improve the technical quality of the work done by its members, but to secure a living wage for them, so the object of the medical profession today is to secure an income for the private doctor; and to this consideration all concern for science and public health must give way when the two come into conflict. Fortunately they are not always in conflict. Up to a certain point doctors, like carpenters and masons, must earn their living by doing the work that the public wants from them; and as it is not in the nature of things possible that such public want should be based on unmixed disutility, it may be admitted that doctors have their uses, real as well as imaginary. But just as the best carpenter or mason will resist the introduction of a machine that is likely to throw him out of work, or the public technical education of unskilled laborers’ sons to compete with him, so the doctor will resist with all his powers of persecution every advance of science that threatens his income. And as the advance of scientific hygiene tends to make the private doctor’s visits rarer, and the public inspector’s frequenter, whilst the advance of scientific therapeutics is in the direction of treatments that involve highly organized laboratories, hospitals, and public institutions generally, it unluckily happens that the organization of private practitioners which we call the medical profession is coming more and more to represent, not science, but desperate and embittered anti-science: a statement of things which is likely to get worse until the average doctor either depends upon or hopes for an appointment in the public health service for his livelihood.

So much for our guarantees as to medical science. Let us now deal with the more painful subject of medical kindness.

DOCTORS AND VIVISECTION

The importance to our doctors of a reputation for the tenderest humanity is so obvious, and the quantity of benevolent work actually done by them for nothing (a great deal of it from sheer good nature) so large, that at first sight it seems unaccountable that they should not only throw all their credit away, but deliberately choose to band themselves publicly with outlaws and scoundrels by claiming that in the pursuit of their professional knowledge they should be free from the restraints of law, of honor, of pity, of remorse, of everything that distinguishes an orderly citizen from a South Sea buccaneer, or a philosopher from an inquisitor. For here we look in vain for either an economic or a sentimental motive. In every generation fools and blackguards have made this claim; and honest and reasonable men, led by the strongest contemporary minds, have repudiated it and exposed its crude rascality. From Shakespear and Dr. Johnson to Ruskin and Mark Twain, the natural abhorrence of sane mankind for the vivisector’s cruelty, and the contempt of able thinkers for his imbecile casuistry, have been expressed by the most popular spokesmen of humanity. If the medical profession were to outdo the Anti-Vivisection Societies in a general professional protest against the practice and principles of the vivisectors, every doctor in the kingdom would gain substantially by the immense relief and reconciliation which would follow such a reassurance of the humanity of the doctor. Not one doctor in a thousand is a vivisector, or has any interest in vivisection, either pecuniary or intellectual, or would treat his dog cruelly or allow anyone else to do it. It is true that the doctor complies with the professional fashion of defending vivisection, and assuring you that people like Shakespear and Dr. Johnson and Ruskin and Mark Twain are ignorant sentimentalists, just as he complies with any other silly fashion: the mystery is, how it became the fashion in spite of its being so injurious to those who follow it. Making all possible allowance for the effect of the brazen lying of the few men who bring a rush of despairing patients to their doors by professing in letters to the newspapers to have learnt from vivisection how to cure certain diseases, and the assurances of the sayers of smooth things that the practice is quite painless under the law, it is still difficult to find any civilized motive for an attitude by which the medical profession has everything to lose and nothing to gain.