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´╗┐Title: The Doctor's Dilemma: Preface on Doctors
Author: Shaw, Bernard, 1856-1950
Language: English
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THE DOCTOR'S DILEMMA: PREFACE ON DOCTORS


By Bernard Shaw


1909



It is not the fault of our doctors that the medical service of the
community, as at present provided for, is a murderous absurdity. That
any sane nation, having observed that you could provide for the supply
of bread by giving bakers a pecuniary interest in baking for you, should
go on to give a surgeon a pecuniary interest in cutting off your leg, is
enough to make one despair of political humanity. But that is precisely
what we have done. And the more appalling the mutilation, the more the
mutilator is paid. He who corrects the ingrowing toe-nail receives a
few shillings: he who cuts your inside out receives hundreds of guineas,
except when he does it to a poor person for practice.

Scandalized voices murmur that these operations are unnecessary. They
may be. It may also be necessary to hang a man or pull down a house.
But we take good care not to make the hangman and the housebreaker the
judges of that. If we did, no man's neck would be safe and no man's
house stable. But we do make the doctor the judge, and fine him anything
from sixpence to several hundred guineas if he decides in our favor.
I cannot knock my shins severely without forcing on some surgeon the
difficult question, "Could I not make a better use of a pocketful
of guineas than this man is making of his leg? Could he not write as
well--or even better--on one leg than on two? And the guineas would
make all the difference in the world to me just now. My wife--my pretty
ones--the leg may mortify--it is always safer to operate--he will be
well in a fortnight--artificial legs are now so well made that they
are really better than natural ones--evolution is towards motors and
leglessness, etc., etc., etc."

Now there is no calculation that an engineer can make as to the behavior
of a girder under a strain, or an astronomer as to the recurrence of a
comet, more certain than the calculation that under such circumstances
we shall be dismembered unnecessarily in all directions by surgeons
who believe the operations to be necessary solely because they want to
perform them. The process metaphorically called bleeding the rich man
is performed not only metaphorically but literally every day by surgeons
who are quite as honest as most of us. After all, what harm is there
in it? The surgeon need not take off the rich man's (or woman's) leg or
arm: he can remove the appendix or the uvula, and leave the patient none
the worse after a fortnight or so in bed, whilst the nurse, the general
practitioner, the apothecary, and the surgeon will be the better.



DOUBTFUL CHARACTER BORNE BY THE MEDICAL PROFESSION

Again I hear the voices indignantly muttering old phrases about the
high character of a noble profession and the honor and conscience of
its members. I must reply that the medical profession has not a
high character: it has an infamous character. I do not know a single
thoughtful and well-informed person who does not feel that the tragedy
of illness at present is that it delivers you helplessly into the hands
of a profession which you deeply mistrust, because it not only advocates
and practises the most revolting cruelties in the pursuit of knowledge,
and justifies them on grounds which would equally justify practising the
same cruelties on yourself or your children, or burning down London to
test a patent fire extinguisher, but, when it has shocked the public,
tries to reassure it with lies of breath-bereaving brazenness. That
is the character the medical profession has got just now. It may be
deserved or it may not: there it is at all events, and the doctors who
have not realized this are living in a fool's paradise. As to the humor
and conscience of doctors, they have as much as any other class of men,
no more and no less. And what other men dare pretend to be impartial
where they have a strong pecuniary interest on one side? Nobody supposes
that doctors are less virtuous than judges; but a judge whose salary
and reputation depended on whether the verdict was for plaintiff or
defendant, prosecutor or prisoner, would be as little trusted as a
general in the pay of the enemy. To offer me a doctor as my judge, and
then weight his decision with a bribe of a large sum of money and a
virtual guarantee that if he makes a mistake it can never be proved
against him, is to go wildly beyond the ascertained strain which human
nature will bear. It is simply unscientific to allege or believe
that doctors do not under existing circumstances perform unnecessary
operations and manufacture and prolong lucrative illnesses. The only
ones who can claim to be above suspicion are those who are so much
sought after that their cured patients are immediately replaced by fresh
ones. And there is this curious psychological fact to be remembered: a
serious illness or a death advertizes the doctor exactly as a hanging
advertizes the barrister who defended the person hanged. Suppose, for
example, a royal personage gets something wrong with his throat, or has
a pain in his inside. If a doctor effects some trumpery cure with a wet
compress or a peppermint lozenge nobody takes the least notice of him.
But if he operates on the throat and kills the patient, or extirpates
an internal organ and keeps the whole nation palpitating for days whilst
the patient hovers in pain and fever between life and death, his fortune
is made: every rich man who omits to call him in when the same symptoms
appear in his household is held not to have done his utmost duty to
the patient. The wonder is that there is a king or queen left alive in
Europe.



DOCTOR'S CONSCIENCES

There is another difficulty in trusting to the honor and conscience of
a doctor. Doctors are just like other Englishmen: most of them have
no honor and no conscience: what they commonly mistake for these is
sentimentality and an intense dread of doing anything that everybody
else does not do, or omitting to do anything that everybody else
does. This of course does amount to a sort of working or rule-of-thumb
conscience; but it means that you will do anything, good or bad,
provided you get enough people to keep you in countenance by doing it
also. It is the sort of conscience that makes it possible to keep order
on a pirate ship, or in a troop of brigands. It may be said that in
the last analysis there is no other sort of honor or conscience in
existence--that the assent of the majority is the only sanction known to
ethics. No doubt this holds good in political practice. If mankind knew
the facts, and agreed with the doctors, then the doctors would be in
the right; and any person who thought otherwise would be a lunatic. But
mankind does not agree, and does not know the facts. All that can
be said for medical popularity is that until there is a practicable
alternative to blind trust in the doctor, the truth about the doctor is
so terrible that we dare not face it. Moliere saw through the doctors;
but he had to call them in just the same. Napoleon had no illusions
about them; but he had to die under their treatment just as much as the
most credulous ignoramus that ever paid sixpence for a bottle of strong
medicine. In this predicament most people, to save themselves from
unbearable mistrust and misery, or from being driven by their conscience
into actual conflict with the law, fall back on the old rule that if you
cannot have what you believe in you must believe in what you have. When
your child is ill or your wife dying, and you happen to be very fond of
them, or even when, if you are not fond of them, you are human enough to
forget every personal grudge before the spectacle of a fellow creature
in pain or peril, what you want is comfort, reassurance, something to
clutch at, were it but a straw. This the doctor brings you. You have a
wildly urgent feeling that something must be done; and the doctor does
something. Sometimes what he does kills the patient; but you do not know
that; and the doctor assures you that all that human skill could do
has been done. And nobody has the brutality to say to the newly bereft
father, mother, husband, wife, brother, or sister, "You have killed your
lost darling by your credulity."



THE PECULIAR PEOPLE

Besides, the calling in of the doctor is now compulsory except in cases
where the patient is an adult--and not too ill to decide the steps to
be taken. We are subject to prosecution for manslaughter or for criminal
neglect if the patient dies without the consolations of the medical
profession. This menace is kept before the public by the Peculiar
People. The Peculiars, as they are called, have gained their name by
believing that the Bible is infallible, and taking their belief quite
seriously. The Bible is very clear as to the treatment of illness.
The Epistle of James; chapter v., contains the following explicit
directions:

14. Is any sick among you? let him call for the elders of the Church;
and let them pray over him, anointing him with oil in the name of the
Lord:

15. And the prayer of faith shall save the sick, and the Lord shall
raise him up; and if he have committed sins, they shall be forgiven him.

The Peculiars obey these instructions and dispense with doctors. They
are therefore prosecuted for manslaughter when their children die.

When I was a young man, the Peculiars were usually acquitted. The
prosecution broke down when the doctor in the witness box was asked
whether, if the child had had medical attendance, it would have lived.
It was, of course, impossible for any man of sense and honor to assume
divine omniscience by answering this in the affirmative, or indeed
pretending to be able to answer it at all. And on this the judge had to
instruct the jury that they must acquit the prisoner. Thus a judge with
a keen sense of law (a very rare phenomenon on the Bench, by the way)
was spared the possibility of leaving to sentence one prisoner (under
the Blasphemy laws) for questioning the authority of Scripture, and
another for ignorantly and superstitiously accepting it as a guide to
conduct. To-day all this is changed. The doctor never hesitates to claim
divine omniscience, nor to clamor for laws to punish any scepticism on
the part of laymen. A modern doctor thinks nothing of signing the death
certificate of one of his own diphtheria patients, and then going into
the witness box and swearing a peculiar into prison for six months
by assuring the jury, on oath, that if the prisoner's child, dead of
diphtheria, had been placed under his treatment instead of that of St.
James, it would not have lived. And he does so not only with impunity,
but with public applause, though the logical course would be to
prosecute him either for the murder of his own patient or for perjury
in the case of St. James. Yet no barrister, apparently, dreams of asking
for the statistics of the relative case-mortality in diphtheria among
the Peculiars and among the believers in doctors, on which alone any
valid opinion could be founded. The barrister is as superstitious as the
doctor is infatuated; and the Peculiar goes unpitied to his cell, though
nothing whatever has been proved except that his child does without
the interference of a doctor as effectually as any of the hundreds of
children who die every day of the same diseases in the doctor's care.



RECOIL OF THE DOGMA OF MEDICAL INFALLIBILITY ON THE DOCTOR

On the other hand, when the doctor is in the dock, or is the defendant
in an action for malpractice, he has to struggle against the inevitable
result of his former pretences to infinite knowledge and unerring skill.
He has taught the jury and the judge, and even his own counsel, to
believe that every doctor can, with a glance at the tongue, a touch
on the pulse, and a reading of the clinical thermometer, diagnose with
absolute certainty a patient's complaint, also that on dissecting a dead
body he can infallibly put his finger on the cause of death, and, in
cases where poisoning is suspected, the nature of the poison used. Now
all this supposed exactness and infallibility is imaginary; and to
treat a doctor as if his mistakes were necessarily malicious or corrupt
malpractices (an inevitable deduction from the postulate that the
doctor, being omniscient, cannot make mistakes) is as unjust as to
blame the nearest apothecary for not being prepared to supply you with
sixpenny-worth of the elixir of life, or the nearest motor garage for
not having perpetual motion on sale in gallon tins. But if apothecaries
and motor car makers habitually advertized elixir of life and perpetual
motion, and succeeded in creating a strong general belief that they
could supply it, they would find themselves in an awkward position if
they were indicted for allowing a customer to die, or for burning a
chauffeur by putting petrol into his car. That is the predicament the
doctor finds himself in when he has to defend himself against a charge
of malpractice by a plea of ignorance and fallibility. His plea is
received with flat credulity; and he gets little sympathy, even from
laymen who know, because he has brought the incredulity on himself. If
he escapes, he can only do so by opening the eyes of the jury to the
facts that medical science is as yet very imperfectly differentiated
from common curemongering witchcraft; that diagnosis, though it means in
many instances (including even the identification of pathogenic bacilli
under the microscope) only a choice among terms so loose that they would
not be accepted as definitions in any really exact science, is, even at
that, an uncertain and difficult matter on which doctors often differ;
and that the very best medical opinion and treatment varies widely from
doctor to doctor, one practitioner prescribing six or seven scheduled
poisons for so familiar a disease as enteric fever where another will
not tolerate drugs at all; one starving a patient whom another would
stuff; one urging an operation which another would regard as unnecessary
and dangerous; one giving alcohol and meat which another would sternly
forbid, etc., etc., etc.: all these discrepancies arising not between
the opinion of good doctors and bad ones (the medical contention is,
of course, that a bad doctor is an impossibility), but between
practitioners of equal eminence and authority. Usually it is impossible
to persuade the jury that these facts are facts. Juries seldom notice
facts; and they have been taught to regard any doubts of the omniscience
and omnipotence of doctors as blasphemy. Even the fact that doctors
themselves die of the very diseases they profess to cure passes
unnoticed. We do not shoot out our lips and shake our heads, saying,
"They save others: themselves they cannot save": their reputation
stands, like an African king's palace, on a foundation of dead bodies;
and the result is that the verdict goes against the defendant when the
defendant is a doctor accused of malpractice.

Fortunately for the doctors, they very seldom find themselves in this
position, because it is so difficult to prove anything against them. The
only evidence that can decide a case of malpractice is expert evidence:
that is, the evidence of other doctors; and every doctor will allow a
colleague to decimate a whole countryside sooner than violate the bond
of professional etiquet by giving him away. It is the nurse who gives
the doctor away in private, because every nurse has some particular
doctor whom she likes; and she usually assures her patients that all the
others are disastrous noodles, and soothes the tedium of the sick-bed
by gossip about their blunders. She will even give a doctor away for the
sake of making the patient believe that she knows more than the doctor.
But she dare not, for her livelihood, give the doctor away in public.
And the doctors stand by one another at all costs. Now and then some
doctor in an unassailable position, like the late Sir William Gull, will
go into the witness box and say what he really thinks about the way a
patient has been treated; but such behavior is considered little short
of infamous by his colleagues.



WHY DOCTORS DO NOT DIFFER

The truth is, there would never be any public agreement among doctors if
they did not agree to agree on the main point of the doctor being always
in the right. Yet the two guinea man never thinks that the five shilling
man is right: if he did, he would be understood as confessing to an
overcharge of one pound seventeen shillings; and on the same ground
the five shilling man cannot encourage the notion that the owner of the
sixpenny surgery round the corner is quite up to his mark. Thus even
the layman has to be taught that infallibility is not quite infallible,
because there are two qualities of it to be had at two prices.

But there is no agreement even in the same rank at the same price.
During the first great epidemic of influenza towards the end of
the nineteenth century a London evening paper sent round a
journalist-patient to all the great consultants of that day, and
published their advice and prescriptions; a proceeding passionately
denounced by the medical papers as a breach of confidence of these
eminent physicians. The case was the same; but the prescriptions were
different, and so was the advice. Now a doctor cannot think his own
treatment right and at the same time think his colleague right in
prescribing a different treatment when the patient is the same. Anyone
who has ever known doctors well enough to hear medical shop talked
without reserve knows that they are full of stories about each other's
blunders and errors, and that the theory of their omniscience and
omnipotence no more holds good among themselves than it did with Moliere
and Napoleon. But for this very reason no doctor dare accuse another of
malpractice. He is not sure enough of his own opinion to ruin another
man by it. He knows that if such conduct were tolerated in his
profession no doctor's livelihood or reputation would be worth a year's
purchase. I do not blame him: I would do the same myself. But the effect
of this state of things is to make the medical profession a conspiracy
to hide its own shortcomings. No doubt the same may be said of all
professions. They are all conspiracies against the laity; and I do not
suggest that the medical conspiracy is either better or worse than the
military conspiracy, the legal conspiracy, the sacerdotal conspiracy,
the pedagogic conspiracy, the royal and aristocratic conspiracy, the
literary and artistic conspiracy, and the innumerable industrial,
commercial, and financial conspiracies, from the trade unions to the
great exchanges, which make up the huge conflict which we call society.
But it is less suspected. The Radicals who used to advocate, as an
indispensable preliminary to social reform, the strangling of the
last king with the entrails of the last priest, substituted compulsory
vaccination for compulsory baptism without a murmur.



THE CRAZE FOR OPERATIONS

Thus everything is on the side of the doctor. When men die of disease
they are said to die from natural causes. When they recover (and they
mostly do) the doctor gets the credit of curing them. In surgery all
operations are recorded as successful if the patient can be got out of
the hospital or nursing home alive, though the subsequent history of the
case may be such as would make an honest surgeon vow never to recommend
or perform the operation again. The large range of operations which
consist of amputating limbs and extirpating organs admits of no direct
verification of their necessity. There is a fashion in operations as
there is in sleeves and skirts: the triumph of some surgeon who has at
last found out how to make a once desperate operation fairly safe
is usually followed by a rage for that operation not only among the
doctors, but actually among their patients. There are men and women whom
the operating table seems to fascinate; half-alive people who through
vanity, or hypochondria, or a craving to be the constant objects of
anxious attention or what not, lose such feeble sense as they ever had
of the value of their own organs and limbs. They seem to care as little
for mutilation as lobsters or lizards, which at least have the excuse
that they grow new claws and new tails if they lose the old ones. Whilst
this book was being prepared for the press a case was tried in the
Courts, of a man who sued a railway company for damages because a train
had run over him and amputated both his legs. He lost his case because
it was proved that he had deliberately contrived the occurrence himself
for the sake of getting an idler's pension at the expense of the railway
company, being too dull to realize how much more he had to lose than
to gain by the bargain even if he had won his case and received damages
above his utmost hopes.

Thus amazing case makes it possible to say, with some prospect of
being believed, that there is in the classes who can afford to pay
for fashionable operations a sprinkling of persons so incapable
of appreciating the relative importance of preserving their bodily
integrity, (including the capacity for parentage) and the pleasure of
talking about themselves and hearing themselves talked about as the
heroes and heroines of sensational operations, that they tempt
surgeons to operate on them not only with large fees, but with personal
solicitation. Now it cannot be too often repeated that when an operation
is once performed, nobody can ever prove that it was unnecessary. If I
refuse to allow my leg to be amputated, its mortification and my death
may prove that I was wrong; but if I let the leg go, nobody can ever
prove that it would not have mortified had I been obstinate. Operation
is therefore the safe side for the surgeon as well as the lucrative
side. The result is that we hear of "conservative surgeons" as a
distinct class of practitioners who make it a rule not to operate if
they can possibly help it, and who are sought after by the people who
have vitality enough to regard an operation as a last resort. But no
surgeon is bound to take the conservative view. If he believes that an
organ is at best a useless survival, and that if he extirpates it the
patient will be well and none the worse in a fortnight, whereas to
await the natural cure would mean a month's illness, then he is clearly
justified in recommending the operation even if the cure without
operation is as certain as anything of the kind ever can be. Thus the
conservative surgeon and the radical or extirpatory surgeon may both
be right as far as the ultimate cure is concerned; so that their
consciences do not help them out of their differences.



CREDULITY AND CHLOROFORM

There is no harder scientific fact in the world than the fact that
belief can be produced in practically unlimited quantity and intensity,
without observation or reasoning, and even in defiance of both, by the
simple desire to believe founded on a strong interest in believing.
Everybody recognizes this in the case of the amatory infatuations of
the adolescents who see angels and heroes in obviously (to others)
commonplace and even objectionable maidens and youths. But it holds good
over the entire field of human activity. The hardest-headed materialist
will become a consulter of table-rappers and slate-writers if he loses
a child or a wife so beloved that the desire to revive and communicate
with them becomes irresistible. The cobbler believes that there is
nothing like leather. The Imperialist who regards the conquest of
England by a foreign power as the worst of political misfortunes
believes that the conquest of a foreign power by England would be a boon
to the conquered. Doctors are no more proof against such illusions than
other men. Can anyone then doubt that under existing conditions a great
deal of unnecessary and mischievous operating is bound to go on,
and that patients are encouraged to imagine that modern surgery and
anesthesia have made operations much less serious matters than they
really are? When doctors write or speak to the public about operations,
they imply, and often say in so many words, that chloroform has made
surgery painless. People who have been operated on know better.
The patient does not feel the knife, and the operation is therefore
enormously facilitated for the surgeon; but the patient pays for the
anesthesia with hours of wretched sickness; and when that is over there
is the pain of the wound made by the surgeon, which has to heal like any
other wound. This is why operating surgeons, who are usually out of the
house with their fee in their pockets before the patient has recovered
consciousness, and who therefore see nothing of the suffering witnessed
by the general practitioner and the nurse, occasionally talk of
operations very much as the hangman in Barnaby Rudge talked of
executions, as if being operated on were a luxury in sensation as well
as in price.



MEDICAL POVERTY

To make matters worse, doctors are hideously poor. The Irish gentleman
doctor of my boyhood, who took nothing less than a guinea, though he
might pay you four visits for it, seems to have no equivalent nowadays
in English society. Better be a railway porter than an ordinary English
general practitioner. A railway porter has from eighteen to twenty-three
shillings a week from the Company merely as a retainer; and his
additional fees from the public, if we leave the third-class twopenny
tip out of account (and I am by no means sure that even this reservation
need be made), are equivalent to doctor's fees in the case of
second-class passengers, and double doctor's fees in the case of first.
Any class of educated men thus treated tends to become a brigand class,
and doctors are no exception to the rule. They are offered disgraceful
prices for advice and medicine. Their patients are for the most part so
poor and so ignorant that good advice would be resented as impracticable
and wounding. When you are so poor that you cannot afford to refuse
eighteenpence from a man who is too poor to pay you any more, it
is useless to tell him that what he or his sick child needs is not
medicine, but more leisure, better clothes, better food, and a better
drained and ventilated house. It is kinder to give him a bottle of
something almost as cheap as water, and tell him to come again with
another eighteenpence if it does not cure him. When you have done that
over and over again every day for a week, how much scientific conscience
have you left? If you are weak-minded enough to cling desperately to
your eighteenpence as denoting a certain social superiority to the
sixpenny doctor, you will be miserably poor all your life; whilst the
sixpenny doctor, with his low prices and quick turnover of patients,
visibly makes much more than you do and kills no more people.

A doctor's character can no more stand out against such conditions than
the lungs of his patients can stand out against bad ventilation. The
only way in which he can preserve his self-respect is by forgetting
all he ever learnt of science, and clinging to such help as he can
give without cost merely by being less ignorant and more accustomed to
sick-beds than his patients. Finally, he acquires a certain skill at
nursing cases under poverty-stricken domestic conditions, just as women
who have been trained as domestic servants in some huge institution with
lifts, vacuum cleaners, electric lighting, steam heating, and machinery
that turns the kitchen into a laboratory and engine house combined,
manage, when they are sent out into the world to drudge as general
servants, to pick up their business in a new way, learning the
slatternly habits and wretched makeshifts of homes where even bundles of
kindling wood are luxuries to be anxiously economized.



THE SUCCESSFUL DOCTOR

The doctor whose success blinds public opinion to medical poverty is
almost as completely demoralized. His promotion means that his practice
becomes more and more confined to the idle rich. The proper advice for
most of their ailments is typified in Abernethy's "Live on sixpence a
day and earn it." But here, as at the other end of the scale, the right
advice is neither agreeable nor practicable. And every hypochondriacal
rich lady or gentleman who can be persuaded that he or she is a lifelong
invalid means anything from fifty to five hundred pounds a year for the
doctor. Operations enable a surgeon to earn similar sums in a couple
of hours; and if the surgeon also keeps a nursing home, he may make
considerable profits at the same time by running what is the most
expensive kind of hotel. These gains are so great that they undo much
of the moral advantage which the absence of grinding pecuniary anxiety
gives the rich doctor over the poor one. It is true that the temptation
to prescribe a sham treatment because the real treatment is too dear for
either patient or doctor does not exist for the rich doctor. He always
has plenty of genuine cases which can afford genuine treatment; and
these provide him with enough sincere scientific professional work to
save him from the ignorance, obsolescence, and atrophy of scientific
conscience into which his poorer colleagues sink. But on the other hand
his expenses are enormous. Even as a bachelor, he must, at London west
end rates, make over a thousand a year before he can afford even to
insure his life. His house, his servants, and his equipage (or autopage)
must be on the scale to which his patients are accustomed, though a
couple of rooms with a camp bed in one of them might satisfy his own
requirements. Above all, the income which provides for these outgoings
stops the moment he himself stops working. Unlike the man of business,
whose managers, clerks, warehousemen and laborers keep his business
going whilst he is in bed or in his club, the doctor cannot earn a
farthing by deputy. Though he is exceptionally exposed to infection, and
has to face all weathers at all hours of the night and day, often not
enjoying a complete night's rest for a week, the money stops coming in
the moment he stops going out; and therefore illness has special terrors
for him, and success no certain permanence. He dare not stop making
hay while the sun shines; for it may set at any time. Men do not resist
pressure of this intensity. When they come under it as doctors they pay
unnecessary visits; they write prescriptions that are as absurd as the
rub of chalk with which an Irish tailor once charmed away a wart from my
father's finger; they conspire with surgeons to promote operations; they
nurse the delusions of the malade imaginaire (who is always really ill
because, as there is no such thing as perfect health, nobody is ever
really well); they exploit human folly, vanity, and fear of death as
ruthlessly as their own health, strength, and patience are exploited
by selfish hypochondriacs. They must do all these things or else
run pecuniary risks that no man can fairly be asked to run. And the
healthier the world becomes, the more they are compelled to live by
imposture and the less by that really helpful activity of which all
doctors get enough to preserve them from utter corruption. For even the
most hardened humbug who ever prescribed ether tonics to ladies whose
need for tonics is of precisely the same character as the need of poorer
women for a glass of gin, has to help a mother through child-bearing
often enough to feel that he is not living wholly in vain.



THE PSYCHOLOGY OF SELF-RESPECT IN SURGEONS

The surgeon, though often more unscrupulous than the general
practitioner, retains his self-respect more easily. The human conscience
can subsist on very questionable food. No man who is occupied in doing
a very difficult thing, and doing it very well, ever loses his
self-respect. The shirk, the duffer, the malingerer, the coward, the
weakling, may be put out of countenance by his own failures and frauds;
but the man who does evil skilfully, energetically, masterfully, grows
prouder and bolder at every crime. The common man may have to found his
self-respect on sobriety, honesty and industry; but a Napoleon needs no
such props for his sense of dignity. If Nelson's conscience whispered to
him at all in the silent watches of the night, you may depend on it it
whispered about the Baltic and the Nile and Cape St. Vincent, and not
about his unfaithfulness to his wife. A man who robs little children
when no one is looking can hardly have much self-respect or even
self-esteem; but an accomplished burglar must be proud of himself. In
the play to which I am at present preluding I have represented an artist
who is so entirely satisfied with his artistic conscience, even to the
point of dying like a saint with its support, that he is utterly selfish
and unscrupulous in every other relation without feeling at the smallest
disadvantage. The same thing may be observed in women who have a genius
for personal attractiveness: they expend more thought, labor, skill,
inventiveness, taste and endurance on making themselves lovely than
would suffice to keep a dozen ugly women honest; and this enables them
to maintain a high opinion of themselves, and an angry contempt for
unattractive and personally careless women, whilst they lie and cheat
and slander and sell themselves without a blush. The truth is, hardly
any of us have ethical energy enough for more than one really inflexible
point of honor. Andrea del Sarto, like Louis Dubedat in my play, must
have expended on the attainment of his great mastery of design and his
originality in fresco painting more conscientiousness and industry
than go to the making of the reputations of a dozen ordinary mayors and
churchwardens; but (if Vasari is to be believed) when the King of France
entrusted him with money to buy pictures for him, he stole it to
spend on his wife. Such cases are not confined to eminent artists.
Unsuccessful, unskilful men are often much more scrupulous than
successful ones. In the ranks of ordinary skilled labor many men are to
be found who earn good wages and are never out of a job because they are
strong, indefatigable, and skilful, and who therefore are bold in a high
opinion of themselves; but they are selfish and tyrannical, gluttonous
and drunken, as their wives and children know to their cost.

Not only do these talented energetic people retain their self-respect
through shameful misconduct: they do not even lose the respect of
others, because their talents benefit and interest everybody, whilst
their vices affect only a few. An actor, a painter, a composer, an
author, may be as selfish as he likes without reproach from the public
if only his art is superb; and he cannot fulfil his condition without
sufficient effort and sacrifice to make him feel noble and martyred in
spite of his selfishness. It may even happen that the selfishness of
an artist may be a benefit to the public by enabling him to concentrate
himself on their gratification with a recklessness of every other
consideration that makes him highly dangerous to those about him. In
sacrificing others to himself he is sacrificing them to the public he
gratifies; and the public is quite content with that arrangement. The
public actually has an interest in the artist's vices.

It has no such interest in the surgeon's vices. The surgeon's art is
exercised at its expense, not for its gratification. We do not go to the
operating table as we go to the theatre, to the picture gallery, to the
concert room, to be entertained and delighted: we go to be tormented and
maimed, lest a worse thing should befall us. It is of the most extreme
importance to us that the experts on whose assurance we face this horror
and suffer this mutilation should leave no interests but our own to
think of; should judge our cases scientifically; and should feel about
them kindly. Let us see what guarantees we have: first for the science,
and then for the kindness.



ARE DOCTORS MEN OF SCIENCE?

I presume nobody will question the existence of widely spread popular
delusion that every doctor is a titan of science. It is escaped only in
the very small class which understands by science something more than
conjuring with retorts and spirit lamps, magnets and microscopes, and
discovering magical cures for disease. To a sufficiently ignorant man
every captain of a trading schooner is a Galileo, every organ-grinder
a Beethoven, every piano-tuner a Hemholtz, every Old Bailey barrister
a Solon, every Seven Dials pigeon dealer a Darwin, every scrivener a
Shakespear, every locomotive engine a miracle, and its driver no less
wonderful than George Stephenson. As a matter of fact, the rank and file
of doctors are no more scientific than their tailors; or, if you prefer
to put it the reverse way, their tailors are no less scientific than
they. Doctoring is an art, not a science: any layman who is interested
in science sufficiently to take in one of the scientific journals and
follow the literature of the scientific movement, knows more about it
than those doctors (probably a large majority) who are not interested in
it, and practise only to earn their bread. Doctoring is not even the art
of keeping people in health (no doctor seems able to advise you what to
eat any better than his grandmother or the nearest quack): it is the
art of curing illnesses. It does happen exceptionally that a practising
doctor makes a contribution to science (my play describes a very notable
one); but it happens much oftener that he draws disastrous conclusions
from his clinical experience because he has no conception of scientific
method, and believes, like any rustic, that the handling of evidence and
statistics needs no expertness. The distinction between a quack doctor
and a qualified one is mainly that only the qualified one is authorized
to sign death certificates, for which both sorts seem to have about
equal occasion. Unqualified practitioners now make large incomes as
hygienists, and are resorted to as frequently by cultivated amateur
scientists who understand quite well what they are doing as by ignorant
people who are simply dupes. Bone-setters make fortunes under the very
noses of our greatest surgeons from educated and wealthy patients; and
some of the most successful doctors on the register use quite heretical
methods of treating disease, and have qualified themselves solely for
convenience. Leaving out of account the village witches who prescribe
spells and sell charms, the humblest professional healers in this
country are the herbalists. These men wander through the fields on
Sunday seeking for herbs with magic properties of curing disease,
preventing childbirth, and the like. Each of them believes that he is on
the verge of a great discovery, in which Virginia Snake Root will be
an ingredient, heaven knows why! Virginia Snake Root fascinates
the imagination of the herbalist as mercury used to fascinate the
alchemists. On week days he keeps a shop in which he sells packets of
pennyroyal, dandelion, etc., labelled with little lists of the diseases
they are supposed to cure, and apparently do cure to the satisfaction of
the people who keep on buying them. I have never been able to perceive
any distinction between the science of the herbalist and that of the
duly registered doctor. A relative of mine recently consulted a doctor
about some of the ordinary symptoms which indicate the need for a
holiday and a change. The doctor satisfied himself that the patient's
heart was a little depressed. Digitalis being a drug labelled as a
heart specific by the profession, he promptly administered a stiff dose.
Fortunately the patient was a hardy old lady who was not easily killed.
She recovered with no worse result than her conversion to Christian
Science, which owes its vogue quite as much to public despair of doctors
as to superstition. I am not, observe, here concerned with the question
as to whether the dose of digitalis was judicious or not; the point is,
that a farm laborer consulting a herbalist would have been treated in
exactly the same way.



BACTERIOLOGY AS A SUPERSTITION

The smattering of science that all--even doctors--pick up from the
ordinary newspapers nowadays only makes the doctor more dangerous than
he used to be. Wise men used to take care to consult doctors qualified
before 1860, who were usually contemptuous of or indifferent to the germ
theory and bacteriological therapeutics; but now that these veterans
have mostly retired or died, we are left in the hands of the generations
which, having heard of microbes much as St. Thomas Aquinas heard of
angels, suddenly concluded that the whole art of healing could be summed
up in the formula: Find the microbe and kill it. And even that they did
not know how to do. The simplest way to kill most microbes is to throw
them into an open street or river and let the sun shine on them, which
explains the fact that when great cities have recklessly thrown all
their sewage into the open river the water has sometimes been cleaner
twenty miles below the city than thirty miles above it. But doctors
instinctively avoid all facts that are reassuring, and eagerly swallow
those that make it a marvel that anyone could possibly survive three
days in an atmosphere consisting mainly of countless pathogenic
germs. They conceive microbes as immortal until slain by a germicide
administered by a duly qualified medical man. All through Europe people
are adjured, by public notices and even under legal penalties, not to
throw their microbes into the sunshine, but to collect them carefully in
a handkerchief; shield the handkerchief from the sun in the darkness
and warmth of the pocket; and send it to a laundry to be mixed up with
everybody else's handkerchiefs, with results only too familiar to local
health authorities.

In the first frenzy of microbe killing, surgical instruments were dipped
in carbolic oil, which was a great improvement on not dipping them in
anything at all and simply using them dirty; but as microbes are so fond
of carbolic oil that they swarm in it, it was not a success from the
anti-microbe point of view. Formalin was squirted into the circulation
of consumptives until it was discovered that formalin nourishes the
tubercle bacillus handsomely and kills men. The popular theory of
disease is the common medical theory: namely, that every disease had
its microbe duly created in the garden of Eden, and has been steadily
propagating itself and producing widening circles of malignant disease
ever since. It was plain from the first that if this had been even
approximately true, the whole human race would have been wiped out by
the plague long ago, and that every epidemic, instead of fading out as
mysteriously as it rushed in, would spread over the whole world. It was
also evident that the characteristic microbe of a disease might be a
symptom instead of a cause. An unpunctual man is always in a hurry;
but it does not follow that hurry is the cause of unpunctuality: on the
contrary, what is the matter with the patient is sloth. When Florence
Nightingale said bluntly that if you overcrowded your soldiers in dirty
quarters there would be an outbreak of smallpox among them, she was
snubbed as an ignorant female who did not know that smallpox can be
produced only by the importation of its specific microbe.

If this was the line taken about smallpox, the microbe of which
has never yet been run down and exposed under the microscope by the
bacteriologist, what must have been the ardor of conviction as to
tuberculosis, tetanus, enteric fever, Maltese fever, diphtheria, and
the rest of the diseases in which the characteristic bacillus had been
identified! When there was no bacillus it was assumed that, since
no disease could exist without a bacillus, it was simply eluding
observation. When the bacillus was found, as it frequently was, in
persons who were not suffering from the disease, the theory was saved
by simply calling the bacillus an impostor, or pseudobacillus. The same
boundless credulity which the public exhibit as to a doctor's power of
diagnosis was shown by the doctors themselves as to the analytic
microbe hunters. These witch finders would give you a certificate of the
ultimate constitution of anything from a sample of the water from your
well to a scrap of your lungs, for seven-and-sixpense. I do not suggest
that the analysts were dishonest. No doubt they carried the analysis as
far as they could afford to carry it for the money. No doubt also they
could afford to carry it far enough to be of some use. But the fact
remains that just as doctors perform for half-a-crown, without the least
misgiving, operations which could not be thoroughly and safely performed
with due scientific rigor and the requisite apparatus by an unaided
private practitioner for less than some thousands of pounds, so did they
proceed on the assumption that they could get the last word of science
as to the constituents of their pathological samples for a two hours cab
fare.



ECONOMIC DIFFICULTIES OF IMMUNIZATION

I have heard doctors affirm and deny almost every possible proposition
as to disease and treatment. I can remember the time when doctors no
more dreamt of consumption and pneumonia being infectious than they
now dream of sea-sickness being infectious, or than so great a clinical
observer as Sydenham dreamt of smallpox being infectious. I have heard
doctors deny that there is such a thing as infection. I have heard them
deny the existence of hydrophobia as a specific disease differing from
tetanus. I have heard them defend prophylactic measures and prophylactic
legislation as the sole and certain salvation of mankind from zymotic
disease; and I have heard them denounce both as malignant spreaders
of cancer and lunacy. But the one objection I have never heard from a
doctor is the objection that prophylaxis by the inoculatory methods most
in vogue is an economic impossibility under our private practice
system. They buy some stuff from somebody for a shilling, and inject a
pennyworth of it under their patient's skin for half-a-crown, concluding
that, since this primitive rite pays the somebody and pays them, the
problem of prophylaxis has been satisfactorily solved. The results are
sometimes no worse than the ordinary results of dirt getting into cuts;
but neither the doctor nor the patient is quite satisfied unless the
inoculation "takes"; that is, unless it produces perceptible illness and
disablement. Sometimes both doctor and patient get more value in
this direction than they bargain for. The results of ordinary
private-practice-inoculation at their worst are bad enough to be
indistinguishable from those of the most discreditable and dreaded
disease known; and doctors, to save the credit of the inoculation, have
been driven to accuse their patient or their patient's parents of having
contracted this disease independently of the inoculation, an excuse
which naturally does not make the family any more resigned, and leads
to public recriminations in which the doctors, forgetting everything but
the immediate quarrel, naively excuse themselves by admitting, and
even claiming as a point in their favor, that it is often impossible to
distinguish the disease produced by their inoculation and the disease
they have accused the patient of contracting. And both parties assume
that what is at issue is the scientific soundness of the prophylaxis.
It never occurs to them that the particular pathogenic germ which they
intended to introduce into the patient's system may be quite innocent of
the catastrophe, and that the casual dirt introduced with it may be at
fault. When, as in the case of smallpox or cowpox, the germ has not yet
been detected, what you inoculate is simply undefined matter that has
been scraped off an anything but chemically clean calf suffering from
the disease in question. You take your chance of the germ being in the
scrapings, and, lest you should kill it, you take no precautions against
other germs being in it as well. Anything may happen as the result of
such an inoculation. Yet this is the only stuff of the kind which is
prepared and supplied even in State establishments: that is, in the
only establishments free from the commercial temptation to adulterate
materials and scamp precautionary processes.

Even if the germ were identified, complete precautions would hardly pay.
It is true that microbe farming is not expensive. The cost of breeding
and housing two head of cattle would provide for the breeding and
housing of enough microbes to inoculate the entire population of
the globe since human life first appeared on it. But the precautions
necessary to insure that the inoculation shall consist of nothing else
but the required germ in the proper state of attenuation are a very
different matter from the precautions necessary in the distribution
and consumption of beefsteaks. Yet people expect to find vaccines
and antitoxins and the like retailed at "popular prices" in private
enterprise shops just as they expect to find ounces of tobacco and
papers of pins.



THE PERILS OF INOCULATION

The trouble does not end with the matter to be inoculated. There is the
question of the condition of the patient. The discoveries of Sir Almroth
Wright have shown that the appalling results which led to the hasty
dropping in 1894 of Koch's tuberculin were not accidents, but perfectly
orderly and inevitable phenomena following the injection of dangerously
strong "vaccines" at the wrong moment, and reinforcing the disease
instead of stimulating the resistance to it. To ascertain the right
moment a laboratory and a staff of experts are needed. The general
practitioner, having no such laboratory and no such experience, has
always chanced it, and insisted, when he was unlucky, that the results
were not due to the inoculation, but to some other cause: a favorite
and not very tactful one being the drunkenness or licentiousness of
the patient. But though a few doctors have now learnt the danger of
inoculating without any reference to the patient's "opsonic index"
at the moment of inoculation, and though those other doctors who are
denouncing the danger as imaginary and opsonin as a craze or a fad,
obviously do so because it involves an operation which they have neither
the means nor the knowledge to perform, there is still no grasp of the
economic change in the situation. They have never been warned that the
practicability of any method of extirpating disease depends not only on
its efficacy, but on its cost. For example, just at present the world
has run raving mad on the subject of radium, which has excited our
credulity precisely as the apparitions at Lourdes excited the credulity
of Roman Catholics. Suppose it were ascertained that every child in the
world could be rendered absolutely immune from all disease during its
entire life by taking half an ounce of radium to every pint of its
milk. The world would be none the healthier, because not even a Crown
Prince--no, not even the son of a Chicago Meat King, could afford
the treatment. Yet it is doubtful whether doctors would refrain from
prescribing it on that ground. The recklessness with which they now
recommend wintering in Egypt or at Davos to people who cannot afford to
go to Cornwall, and the orders given for champagne jelly and old port in
households where such luxuries must obviously be acquired at the cost of
stinting necessaries, often make one wonder whether it is possible for a
man to go through a medical training and retain a spark of common sense.
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 pounds 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 pounds 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 indignant 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 Hahnemann: 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 antiscience: 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.



THE PRIMITIVE SAVAGE MOTIVE

I say civilized motive advisedly; for primitive tribal motives are easy
enough to find. Every savage chief who is not a Mahomet learns that if
he wishes to strike the imagination of his tribe--and without doing that
he can rule them--he must terrify or revolt them from time to time by
acts of hideous cruelty or disgusting unnaturalness. We are far from
being as superior to such tribes as we imagine. It is very doubtful
indeed whether Peter the Great could have effected the changes he made
in Russia if he had not fascinated and intimidated his people by
his monstrous cruelties and grotesque escapades. Had he been a
nineteenth-century king of England, he would have had to wait for some
huge accidental calamity: a cholera epidemic, a war, or an insurrection,
before waking us up sufficiently to get anything done. Vivisection helps
the doctor to rule us as Peter ruled the Russians. The notion that the
man who does dreadful things is superhuman, and that therefore he can
also do wonderful things either as ruler, avenger, healer, or what not,
is by no means confined to barbarians. Just as the manifold wickednesses
and stupidities of our criminal code are supported, not by any general
comprehension of law or study of jurisprudence, not even by simple
vindictiveness, but by the superstition that a calamity of any sort must
be expiated by a human sacrifice; so the wickednesses and stupidities
of our medicine men are rooted in superstitions that have no more to do
with science than the traditional ceremony of christening an ironclad
has to do with the effectiveness of its armament. We have only to turn
to Macaulay's description of the treatment of Charles II in his last
illness to see how strongly his physicians felt that their only chance
of cheating death was by outraging nature in tormenting and disgusting
their unfortunate patient. True, this was more than two centuries ago;
but I have heard my own nineteenth-century grandfather describe the
cupping and firing and nauseous medicines of his time with perfect
credulity as to their beneficial effects; and some more modern
treatments appear to me quite as barbarous. It is in this way that
vivisection pays the doctor. It appeals to the fear and credulity of the
savage in us; and without fear and credulity half the private doctor's
occupation and seven-eighths of his influence would be gone.



THE HIGHER MOTIVE. THE TREE OF KNOWLEDGE.

But the greatest force of all on the side of vivisection is the mighty
and indeed divine force of curiosity. Here we have no decaying tribal
instinct which men strive to root out of themselves as they strive to
root out the tiger's lust for blood. On the contrary, the curiosity of
the ape, or of the child who pulls out the legs and wings of a fly
to see what it will do without them, or who, on being told that a cat
dropped out of the window will always fall on its legs, immediately
tries the experiment on the nearest cat from the highest window in
the house (I protest I did it myself from the first floor only), is as
nothing compared to the thirst for knowledge of the philosopher, the
poet, the biologist, and the naturalist. I have always despised Adam
because he had to be tempted by the woman, as she was by the serpent,
before he could be induced to pluck the apple from the tree of
knowledge. I should have swallowed every apple on the tree the moment
the owner's back was turned. When Gray said "Where ignorance is bliss,
'tis folly to be wise," he forgot that it is godlike to be wise; and
since nobody wants bliss particularly, or could stand more than a very
brief taste of it if it were attainable, and since everybody, by the
deepest law of the Life Force, desires to be godlike, it is stupid, and
indeed blasphemous and despairing, to hope that the thirst for knowledge
will either diminish or consent to be subordinated to any other end
whatsoever. We shall see later on that the claim that has arisen in this
way for the unconditioned pursuit of knowledge is as idle as all dreams
of unconditioned activity; but none the less the right to knowledge must
be regarded as a fundamental human right. The fact that men of science
have had to fight so hard to secure its recognition, and are still so
vigorously persecuted when they discover anything that is not quite
palatable to vulgar people, makes them sorely jealous for that right;
and when they hear a popular outcry for the suppression of a method of
research which has an air of being scientific, their first instinct is
to rally to the defence of that method without further consideration,
with the result that they sometimes, as in the case of vivisection,
presently find themselves fighting on a false issue.



THE FLAW IN THE ARGUMENT

I may as well pause here to explain their error. The right to know
is like the right to live. It is fundamental and unconditional in its
assumption that knowledge, like life, is a desirable thing, though any
fool can prove that ignorance is bliss, and that "a little knowledge is
a dangerous thing" (a little being the most that any of us can attain),
as easily as that the pains of life are more numerous and constant than
its pleasures, and that therefore we should all be better dead. The
logic is unimpeachable; but its only effect is to make us say that if
these are the conclusions logic leads to, so much the worse for logic,
after which curt dismissal of Folly, we continue living and learning by
instinct: that is, as of right. We legislate on the assumption that no
man may be killed on the strength of a demonstration that he would be
happier in his grave, not even if he is dying slowly of cancer and
begs the doctor to despatch him quickly and mercifully. To get killed
lawfully he must violate somebody else's right to live by committing
murder. But he is by no means free to live unconditionally. In society
he can exercise his right to live only under very stiff conditions. In
countries where there is compulsory military service he may even have to
throw away his individual life to save the life of the community.

It is just so in the case of the right to knowledge. It is a right that
is as yet very imperfectly recognized in practice. But in theory it
is admitted that an adult person in pursuit of knowledge must not be
refused it on the ground that he would be better or happier without
it. Parents and priests may forbid knowledge to those who accept their
authority; and social taboo may be made effective by acts of legal
persecution under cover of repressing blasphemy, obscenity, and
sedition; but no government now openly forbids its subjects to pursue
knowledge on the ground that knowledge is in itself a bad thing, or that
it is possible for any of us to have too much of it.



LIMITATIONS OF THE RIGHT TO KNOWLEDGE

But neither does any government exempt the pursuit of knowledge, any
more than the pursuit of life, liberty, and happiness (as the American
Constitution puts it), from all social conditions. No man is allowed
to put his mother into the stove because he desires to know how long an
adult woman will survive at a temperature of 500 degrees Fahrenheit,
no matter how important or interesting that particular addition to the
store of human knowledge may be. A man who did so would have short work
made not only of his right to knowledge, but of his right to live and
all his other rights at the same time. The right to knowledge is not
the only right; and its exercise must be limited by respect for other
rights, and for its own exercise by others. When a man says to Society,
"May I torture my mother in pursuit of knowledge?" Society replies,
"No." If he pleads, "What! Not even if I have a chance of finding out
how to cure cancer by doing it?" Society still says, "Not even then." If
the scientist, making the best of his disappointment, goes on to ask may
he torture a dog, the stupid and callous people who do not realize that
a dog is a fellow-creature and sometimes a good friend, may say Yes,
though Shakespear, Dr. Johnson and their like may say No. But even those
who say "You may torture A dog" never say "You may torture MY dog." And
nobody says, "Yes, because in the pursuit of knowledge you may do as
you please." Just as even the stupidest people say, in effect, "If
you cannot attain to knowledge without burning your mother you must do
without knowledge," so the wisest people say, "If you cannot attain to
knowledge without torturing a dog, you must do without knowledge."



A FALSE ALTERNATIVE

But in practice you cannot persuade any wise man that this alternative
can ever be forced on anyone but a fool, or that a fool can be trusted
to learn anything from any experiment, cruel or humane. The Chinaman who
burnt down his house to roast his pig was no doubt honestly unable to
conceive any less disastrous way of cooking his dinner; and the
roast must have been spoiled after all (a perfect type of the average
vivisectionist experiment); but this did not prove that the Chinaman
was right: it only proved that the Chinaman was an incapable cook and,
fundamentally, a fool.

Take another celebrated experiment: one in sanitary reform. In the days
of Nero Rome was in the same predicament as London to-day. If some one
would burn down London, and it were rebuilt, as it would now have to be,
subject to the sanitary by-laws and Building Act provisions enforced
by the London County Council, it would be enormously improved; and the
average lifetime of Londoners would be considerably prolonged. Nero
argued in the same way about Rome. He employed incendiaries to set it
on fire; and he played the harp in scientific raptures whilst it was
burning. I am so far of Nero's way of thinking that I have often said,
when consulted by despairing sanitary reformers, that what London needs
to make her healthy is an earthquake. Why, then, it may be asked, do not
I, as a public-spirited man, employ incendiaries to set it on fire,
with a heroic disregard of the consequences to myself and others? Any
vivisector would, if he had the courage of his opinions. The reasonable
answer is that London can be made healthy without burning her down; and
that as we have not enough civic virtue to make her healthy in a humane
and economical way, we should not have enough to rebuild her in that
way. In the old Hebrew legend, God lost patience with the world as Nero
did with Rome, and drowned everybody except a single family. But the
result was that the progeny of that family reproduced all the vices of
their predecessors so exactly that the misery caused by the flood might
just as well have been spared: things went on just as they did before.
In the same way, the lists of diseases which vivisection claims to have
cured is long; but the returns of the Registrar-General show that people
still persist in dying of them as if vivisection had never been
heard of. Any fool can burn down a city or cut an animal open; and an
exceptionally foolish fool is quite likely to promise enormous benefits
to the race as the result of such activities. But when the constructive,
benevolent part of the business comes to be done, the same want of
imagination, the same stupidity and cruelty, the same laziness and want
of perseverance that prevented Nero or the vivisector from devising or
pushing through humane methods, prevents him from bringing order out of
the chaos and happiness out of the misery he has made. At one time
it seemed reasonable enough to declare that it was impossible to find
whether or not there was a stone inside a man's body except by exploring
it with a knife, or to find out what the sun is made of without visiting
it in a balloon. Both these impossibilities have been achieved, but not
by vivisectors. The Rontgen rays need not hurt the patient; and
spectrum analysis involves no destruction. After such triumphs of humane
experiment and reasoning, it is useless to assure us that there is no
other key to knowledge except cruelty. When the vivisector offers us
that assurance, we reply simply and contemptuously, "You mean that you
are not clever or humane or energetic enough to find one."

CRUELTY FOR ITS OWN SAKE

It will now, I hope, be clear why the attack on vivisection is not
an attack on the right to knowledge: why, indeed, those who have the
deepest conviction of the sacredness of that right are the leaders of
the attack. No knowledge is finally impossible of human attainment; for
even though it may be beyond our present capacity, the needed capacity
is not unattainable. Consequently no method of investigation is the only
method; and no law forbidding any particular method can cut us off
from the knowledge we hope to gain by it. The only knowledge we lose by
forbidding cruelty is knowledge at first hand of cruelty itself, which
is precisely the knowledge humane people wish to be spared.

But the question remains: Do we all really wish to be spared that
knowledge? Are humane methods really to be preferred to cruel ones? Even
if the experiments come to nothing, may not their cruelty be enjoyed
for its own sake, as a sensational luxury? Let us face these questions
boldly, not shrinking from the fact that cruelty is one of the primitive
pleasures of mankind, and that the detection of its Protean disguises as
law, education, medicine, discipline, sport and so forth, is one of the
most difficult of the unending tasks of the legislator.



OUR OWN CRUELTIES

At first blush it may seem not only unnecessary, but even indecent, to
discuss such a proposition as the elevation of cruelty to the rank of a
human right. Unnecessary, because no vivisector confesses to a love of
cruelty for its own sake or claims any general fundamental right to be
cruel. Indecent, because there is an accepted convention to repudiate
cruelty; and vivisection is only tolerated by the law on condition that,
like judicial torture, it shall be done as mercifully as the nature of
the practice allows. But the moment the controversy becomes embittered,
the recriminations bandied between the opposed parties bring us
face-to-face with some very ugly truths. On one occasion I was invited
to speak at a large Anti-Vivisection meeting in the Queen's Hall in
London. I found myself on the platform with fox hunters, tame stag
hunters, men and women whose calendar was divided, not by pay days and
quarter days, but by seasons for killing animals for sport: the fox, the
hare, the otter, the partridge and the rest having each its appointed
date for slaughter. The ladies among us wore hats and cloaks and
head-dresses obtained by wholesale massacres, ruthless trappings,
callous extermination of our fellow creatures. We insisted on our
butchers supplying us with white veal, and were large and constant
consumers of pate de foie gras; both comestibles being obtained by
revolting methods. We sent our sons to public schools where indecent
flogging is a recognized method of taming the young human animal. Yet
we were all in hysterics of indignation at the cruelties of the
vivisectors. These, if any were present, must have smiled sardonically
at such inhuman humanitarians, whose daily habits and fashionable
amusements cause more suffering in England in a week than all the
vivisectors of Europe do in a year. I made a very effective speech, not
exclusively against vivisection, but against cruelty; and I have never
been asked to speak since by that Society, nor do I expect to be, as I
should probably give such offence to its most affluent subscribers that
its attempts to suppress vivisection would be seriously hindered. But
that does not prevent the vivisectors from freely using the "youre
another" retort, and using it with justice.

We must therefore give ourselves no airs of superiority when denouncing
the cruelties of vivisection. We all do just as horrible things, with
even less excuse. But in making that admission we are also making short
work of the virtuous airs with which we are sometimes referred to the
humanity of the medical profession as a guarantee that vivisection is
not abused--much as if our burglars should assure us that they arc too
honest to abuse the practice of burgling. We are, as a matter of fact,
a cruel nation; and our habit of disguising our vices by giving
polite names to the offences we are determined to commit does not,
unfortunately for my own comfort, impose on me. Vivisectors can hardly
pretend to be better than the classes from which they are drawn, or
those above them; and if these classes are capable of sacrificing
animals in various cruel ways under cover of sport, fashion, education,
discipline, and even, when the cruel sacrifices are human sacrifices, of
political economy, it is idle for the vivisector to pretend that he is
incapable of practising cruelty for pleasure or profit or both under
the cloak of science. We are all tarred with the same brush; and the
vivisectors are not slow to remind us of it, and to protest vehemently
against being branded as exceptionally cruel and its devisors of
horrible instruments of torture by people whose main notion of enjoyment
is cruel sport, and whose requirements in the way of villainously cruel
traps occupy pages of the catalogue of the Army and Navy Stores.



THE SCIENTIFIC INVESTIGATION OF CRUELTY

There is in man a specific lust for cruelty which infects even his
passion of pity and makes it savage. Simple disgust at cruelty is very
rare. The people who turn sick and faint and those who gloat are
often alike in the pains they take to witness executions, floggings,
operations or any other exhibitions of suffering, especially those
involving bloodshed, blows, and laceration. A craze for cruelty can
be developed just as a craze for drink can; and nobody who attempts to
ignore cruelty as a possible factor in the attraction of vivisection and
even of antivivisection, or in the credulity with which we accept its
excuses, can be regarded as a scientific investigator of it. Those who
accuse vivisectors of indulging the well-known passion of cruelty
under the cloak of research are therefore putting forward a strictly
scientific psychological hypothesis, which is also simple, human,
obvious, and probable. It may be as wounding to the personal vanity of
the vivisector as Darwin's Origin of Species was to the people who
could not bear to think that they were cousins to the monkeys (remember
Goldsmith's anger when he was told that he could not move his upper
jaw); but science has to consider only the truth of the hypothesis,
and not whether conceited people will like it or not. In vain do the
sentimental champions of vivisection declare themselves the most humane
of men, inflicting suffering only to relieve it, scrupulous in the use
of anesthetics, and void of all passion except the passion of pity for
a disease-ridden world. The really scientific investigator answers that
the question cannot be settled by hysterical protestations, and that if
the vivisectionist rejects deductive reasoning, he had better clear his
character by his own favorite method of experiment.

SUGGESTED LABORATORY TESTS OF THE VIVISECTOR'S EMOTIONS

Take the hackneyed case of the Italian who tortured mice, ostensibly to
find out about the effects of pain rather less than the nearest dentist
could have told him, and who boasted of the ecstatic sensations (he
actually used the word love) with which he carried out his experiments.
Or the gentleman who starved sixty dogs to death to establish the fact
that a dog deprived of food gets progressively lighter and weaker,
becoming remarkably emaciated, and finally dying: an undoubted truth,
but ascertainable without laboratory experiments by a simple enquiry
addressed to the nearest policeman, or, failing him, to any sane
person in Europe. The Italian is diagnosed as a cruel voluptuary: the
dog-starver is passed over as such a hopeless fool that it is impossible
to take any interest in him. Why not test the diagnosis scientifically?
Why not perform a careful series of experiments on persons under the
influence of voluptuous ecstasy, so as to ascertain its physiological
symptoms? Then perform a second series on persons engaged in
mathematical work or machine designing, so as to ascertain the symptoms
of cold scientific activity? Then note the symptoms of a vivisector
performing a cruel experiment; and compare them with the voluptuary
symptoms and the mathematical symptoms? Such experiments would be quite
as interesting and important as any yet undertaken by the vivisectors.
They might open a line of investigation which would finally make, for
instance, the ascertainment of the guilt or innocence of an accused
person a much exacter process than the very fallible methods of our
criminal courts. But instead of proposing such an investigation, our
vivisectors offer us all the pious protestations and all the huffy
recriminations that any common unscientific mortal offers when he is
accused of unworthy conduct.



ROUTINE

Yet most vivisectors would probably come triumphant out of such a series
of experiments, because vivisection is now a routine, like butchering
or hanging or flogging; and many of the men who practise it do so only
because it has been established as part of the profession they have
adopted. Far from enjoying it, they have simply overcome their natural
repugnance and become indifferent to it, as men inevitably become
indifferent to anything they do often enough. It is this dangerous power
of custom that makes it so difficult to convince the common sense of
mankind that any established commercial or professional practice has its
root in passion. Let a routine once spring from passion, and you will
presently find thousands of routineers following it passionlessly for
a livelihood. Thus it always seems strained to speak of the religious
convictions of a clergyman, because nine out of ten clergymen have no
religions convictions: they are ordinary officials carrying on a routine
of baptizing, marrying, and churching; praying, reciting, and preaching;
and, like solicitors or doctors, getting away from their duties with
relief to hunt, to garden, to keep bees, to go into society, and the
like. In the same way many people do cruel and vile things without being
in the least cruel or vile, because the routine to which they have been
brought up is superstitiously cruel and vile. To say that every man
who beats his children and every schoolmaster who flogs a pupil is a
conscious debauchee is absurd: thousands of dull, conscientious people
beat their children conscientiously, because they were beaten themselves
and think children ought to be beaten. The ill-tempered vulgarity that
instinctively strikes at and hurts a thing that annoys it (and all
children are annoying), and the simple stupidity that requires from a
child perfection beyond the reach of the wisest and best adults (perfect
truthfulness coupled with perfect obedience is quite a common condition
of leaving a child unwhipped), produce a good deal of flagellation among
people who not only do not lust after it, but who hit the harder because
they are angry at having to perform an uncomfortable duty. These people
will beat merely to assert their authority, or to carry out what they
conceive to be a divine order on the strength of the precept of Solomon
recorded in the Bible, which carefully adds that Solomon completely
spoilt his own son and turned away from the god of his fathers to the
sensuous idolatry in which he ended his days.

In the same way we find men and women practising vivisection as
senselessly as a humane butcher, who adores his fox terrier, will cut
a calf's throat and hang it up by its heels to bleed slowly to death
because it is the custom to eat veal and insist on its being white; or
as a German purveyor nails a goose to a board and stuffs it with food
because fashionable people eat pate de foie gras; or as the crew of
a whaler breaks in on a colony of seals and clubs them to death in
wholesale massacre because ladies want sealskin jackets; or as fanciers
blind singing birds with hot needles, and mutilate the ears and tails
of dogs and horses. Let cruelty or kindness or anything else once become
customary and it will be practised by people to whom it is not at all
natural, but whose rule of life is simply to do only what everybody else
does, and who would lose their employment and starve if they indulged
in any peculiarity. A respectable man will lie daily, in speech and in
print, about the qualities of the article he lives by selling, because
it is customary to do so. He will flog his boy for telling a lie,
because it is customary to do so. He will also flog him for not telling
a lie if the boy tells inconvenient or disrespectful truths, because
it is customary to do so. He will give the same boy a present on his
birthday, and buy him a spade and bucket at the seaside, because it is
customary to do so, being all the time neither particularly mendacious,
nor particularly cruel, nor particularly generous, but simply incapable
of ethical judgment or independent action.

Just so do we find a crowd of petty vivisectionists daily committing
atrocities and stupidities, because it is the custom to do so.
Vivisection is customary as part of the routine of preparing lectures in
medical schools. For instance, there are two ways of making the action
of the heart visible to students. One, a barbarous, ignorant, and
thoughtless way, is to stick little flags into a rabbit's heart and
let the students see the flags jump. The other, an elegant, ingenious,
well-informed, and instructive way, is to put a sphygmograph on the
student's wrist and let him see a record of his heart's action traced
by a needle on a slip of smoked paper. But it has become the custom for
lecturers to teach from the rabbit; and the lecturers are not original
enough to get out of their groove. Then there are the demonstrations
which are made by cutting up frogs with scissors. The most humane man,
however repugnant the operation may be to him at first, cannot do it
at lecture after lecture for months without finally--and that very
soon--feeling no more for the frog than if he were cutting up pieces of
paper. Such clumsy and lazy ways of teaching are based on the cheapness
of frogs and rabbits. If machines were as cheap as frogs, engineers
would not only be taught the anatomy of machines and the functions of
their parts: they would also have machines misused and wrecked before
them so that they might learn as much as possible by using their eyes,
and as little as possible by using their brains and imaginations. Thus
we have, as part of the routine of teaching, a routine of vivisection
which soon produces complete indifference to it on the part even of
those who are naturally humane. If they pass on from the routine of
lecture preparation, not into general practice, but into research work,
they carry this acquired indifference with them into the laboratory,
where any atrocity is possible, because all atrocities satisfy
curiosity. The routine man is in the majority in his profession always:
consequently the moment his practice is tracked down to its source
in human passion there is a great and quite sincere poohpoohing from
himself, from the mass of the profession, and from the mass of the
public, which sees that the average doctor is much too commonplace and
decent a person to be capable of passionate wickedness of any kind.

Here then, we have in vivisection, as in all the other tolerated
and instituted cruelties, this anti-climax: that only a negligible
percentage of those who practise and consequently defend it get any
satisfaction out of it. As in Mr. Galsworthy's play Justice the useless
and detestable torture of solitary imprisonment is shown at its worst
without the introduction of a single cruel person into the drama, so
it would be possible to represent all the torments of vivisection
dramatically without introducing a single vivisector who had not felt
sick at his first experience in the laboratory. Not that this can
exonerate any vivisector from suspicion of enjoying his work (or her
work: a good deal of the vivisection in medical schools is done by
women). In every autobiography which records a real experience of school
or prison life, we find that here and there among the routineers there
is to be found the genuine amateur, the orgiastic flogging schoolmaster
or the nagging warder, who has sought out a cruel profession for the
sake of its cruelty. But it is the genuine routineer who is the bulwark
of the practice, because, though you can excite public fury against a
Sade, a Bluebeard, or a Nero, you cannot rouse any feeling against
dull Mr. Smith doing his duty: that is, doing the usual thing. He is so
obviously no better and no worse than anyone else that it is difficult
to conceive that the things he does are abominable. If you would see
public dislike surging up in a moment against an individual, you must
watch one who does something unusual, no matter how sensible it may be.
The name of Jonas Hanway lives as that of a brave man because he was the
first who dared to appear in the streets of this rainy island with an
umbrella.



THE OLD LINE BETWEEN MAN AND BEAST

But there is still a distinction to be clung to by those who dare not
tell themselves the truth about the medical profession because they are
so helplessly dependent on it when death threatens the household. That
distinction is the line that separates the brute from the man in the old
classification. Granted, they will plead, that we are all cruel; yet the
tame-stag-hunter does not hunt men; and the sportsman who lets a leash
of greyhounds loose on a hare would be horrified at the thought of
letting them loose on a human child. The lady who gets her cloak by
flaying a sable does not flay a negro; nor does it ever occur to her
that her veal cutlet might be improved on by a slice of tender baby.

Now there was a time when some trust could be placed in this
distinction. The Roman Catholic Church still maintains, with what it
must permit me to call a stupid obstinacy, and in spite of St. Francis
and St. Anthony, that animals have no souls and no rights; so that you
cannot sin against an animal, or against God by anything you may choose
to do to an animal. Resisting the temptation to enter on an argument as
to whether you may not sin against your own soul if you are unjust or
cruel to the least of those whom St. Francis called his little brothers,
I have only to point out here that nothing could be more despicably
superstitious in the opinion of a vivisector than the notion that
science recognizes any such step in evolution as the step from a
physical organism to an immortal soul. That conceit has been taken
out of all our men of science, and out of all our doctors, by the
evolutionists; and when it is considered how completely obsessed
biological science has become in our days, not by the full scope of
evolution, but by that particular method of it which has neither sense
nor purpose nor life nor anything human, much less godlike, in it:
by the method, that is, of so-called Natural Selection (meaning no
selection at all, but mere dead accident and luck), the folly of
trusting to vivisectors to hold the human animal any more sacred than
the other animals becomes so clear that it would be waste of time to
insist further on it. As a matter of fact the man who once concedes
to the vivisector the right to put a dog outside the laws of honor and
fellowship, concedes to him also the right to put himself outside them;
for he is nothing to the vivisector but a more highly developed, and
consequently more interesting-to-experiment-on vertebrate than the dog.



VIVISECTING THE HUMAN SUBJECT

I have in my hand a printed and published account by a doctor of how
he tested his remedy for pulmonary tuberculosis, which was to inject a
powerful germicide directly into the circulation by stabbing a vein with
a syringe. He was one of those doctors who are able to command public
sympathy by saying, quite truly, that when they discovered that the
proposed treatment was dangerous, they experimented thenceforth on
themselves. In this case the doctor was devoted enough to carry his
experiments to the point of running serious risks, and actually making
himself very uncomfortable. But he did not begin with himself. His first
experiment was on two hospital patients. On receiving a message from the
hospital to the effect that these two martyrs to therapeutic science
had all but expired in convulsions, he experimented on a rabbit, which
instantly dropped dead. It was then, and not until then, that he began
to experiment on himself, with the germicide modified in the direction
indicated by the experiments made on the two patients and the rabbit. As
a good many people countenance vivisection because they fear that if the
experiments are not made on rabbits they will be made on themselves,
it is worth noting that in this case, where both rabbits and men
were equally available, the men, being, of course, enormously more
instructive, and costing nothing, were experimented on first. Once
grant the ethics of the vivisectionists and you not only sanction the
experiment on the human subject, but make it the first duty of the
vivisector. If a guinea pig may be sacrificed for the sake of the very
little that can be learnt from it, shall not a man be sacrificed for the
sake of the great deal that can be learnt from him? At all events, he is
sacrificed, as this typical case shows. I may add (not that it touches
the argument) that the doctor, the patients, and the rabbit all suffered
in vain, as far as the hoped-for rescue of the race from pulmonary
consumption is concerned.



"THE LIE IS A EUROPEAN POWER"

Now at the very time when the lectures describing these experiments
were being circulated in print and discussed eagerly by the medical
profession, the customary denials that patients are experimented on
were as loud, as indignant, as high-minded as ever, in spite of the
few intelligent doctors who point out rightly that all treatments are
experiments on the patient. And this brings us to an obvious but
mostly overlooked weakness in the vivisector's position: that is, his
inevitable forfeiture of all claim to have his word believed. It is
hardly to be expected that a man who does not hesitate to vivisect for
the sake of science will hesitate to lie about it afterwards to protect
it from what he deems the ignorant sentimentality of the laity. When
the public conscience stirs uneasily and threatens suppression, there
is never wanting some doctor of eminent position and high character
who will sacrifice himself devotedly to the cause of science by coming
forward to assure the public on his honor that all experiments on
animals are completely painless; although he must know that the very
experiments which first provoked the antivivisection movement by their
atrocity were experiments to ascertain the physiological effects of
the sensation of extreme pain (the much more interesting physiology
of pleasure remains uninvestigated) and that all experiments in
which sensation is a factor are voided by its suppression. Besides,
vivisection may be painless in cases where the experiments are very
cruel. If a person scratches me with a poisoned dagger so gently that I
do not feel the scratch, he has achieved a painless vivisection; but if
I presently die in torment I am not likely to consider that his humility
is amply vindicated by his gentleness. A cobra's bite hurts so little
that the creature is almost, legally speaking, a vivisector who inflicts
no pain. By giving his victims chloroform before biting them he could
comply with the law completely.

Here, then, is a pretty deadlock. Public support of vivisection is
founded almost wholly on the assurances of the vivisectors that great
public benefits may be expected from the practice. Not for a moment do I
suggest that such a defence would be valid even if proved. But when
the witnesses begin by alleging that in the cause of science all the
customary ethical obligations (which include the obligation to tell
the truth) are suspended, what weight can any reasonable person give
to their testimony? I would rather swear fifty lies than take an animal
which had licked my hand in good fellowship and torture it. If I did
torture the dog, I should certainly not have the face to turn round and
ask how any person there suspect an honorable man like myself of telling
lies. Most sensible and humane people would, I hope, reply flatly that
honorable men do not behave dishonorably, even to dogs. The murderer
who, when asked by the chaplain whether he had any other crimes to
confess, replied indignantly, "What do you take me for?" reminds us very
strongly of the vivisectors who are so deeply hurt when their evidence
is set aside as worthless.



AN ARGUMENT WHICH WOULD DEFEND ANY CRIME

The Achilles heel of vivisection, however, is not to be found in the
pain it causes, but in the line of argument by which it is justified.
The medical code regarding it is simply criminal anarchism at its very
worst. Indeed no criminal has yet had the impudence to argue as
every vivisector argues. No burglar contends that as it is admittedly
important to have money to spend, and as the object of burglary is to
provide the burglar with money to spend, and as in many instances it has
achieved this object, therefore the burglar is a public benefactor
and the police are ignorant sentimentalists. No highway robber has yet
harrowed us with denunciations of the puling moralist who allows his
child to suffer all the evils of poverty because certain faddists think
it dishonest to garotte an alderman. Thieves and assassins understand
quite well that there are paths of acquisition, even of the best things,
that are barred to all men of honor. Again, has the silliest burglar
ever pretended that to put a stop to burglary is to put a stop to
industry? All the vivisections that have been performed since the world
began have produced nothing so important as the innocent and honorable
discovery of radiography; and one of the reasons why radiography was not
discovered sooner was that the men whose business it was to discover
new clinical methods were coarsening and stupefying themselves with the
sensual villanies and cutthroat's casuistries of vivisection. The law of
the conservation of energy holds good in physiology as in other things:
every vivisector is a deserter from the army of honorable investigators.
But the vivisector does not see this. He not only calls his methods
scientific: he contends that there are no other scientific methods.
When you express your natural loathing for his cruelty and your natural
contempt for his stupidity, he imagines that you are attacking science.
Yet he has no inkling of the method and temper of science. The point at
issue being plainly whether he is a rascal or not, he not only insists
that the real point is whether some hotheaded antivivisectionist is a
liar (which he proves by ridiculously unscientific assumptions as to the
degree of accuracy attainable in human statement), but never dreams of
offering any scientific evidence by his own methods.

There are many paths to knowledge already discovered; and no enlightened
man doubts that there are many more waiting to be discovered. Indeed,
all paths lead to knowledge; because even the vilest and stupidest
action teaches us something about vileness and stupidity, and may
accidentally teach us a good deal more: for instance, a cutthroat learns
(and perhaps teaches) the anatomy of the carotid artery and jugular
vein; and there can be no question that the burning of St. Joan of Arc
must have been a most instructive and interesting experiment to a good
observer, and could have been made more so if it had been carried out by
skilled physiologists under laboratory conditions. The earthquake in San
Francisco proved invaluable as an experiment in the stability of giant
steel buildings; and the ramming of the Victoria by the Camperdown
settled doubtful points of the greatest importance in naval warfare.
According to vivisectionist logic our builders would be justified in
producing artificial earthquakes with dynamite, and our admirals in
contriving catastrophes at naval manoeuvres, in order to follow up the
line of research thus accidentally discovered.

The truth is, if the acquisition of knowledge justifies every sort of
conduct, it justifies any sort of conduct, from the illumination
of Nero's feasts by burning human beings alive (another interesting
experiment) to the simplest act of kindness. And in the light of that
truth it is clear that the exemption of the pursuit of knowledge
from the laws of honor is the most hideous conceivable enlargement of
anarchy; worse, by far, than an exemption of the pursuit of money or
political power, since there can hardly be attained without some regard
for at least the appearances of human welfare, whereas a curious devil
might destroy the whole race in torment, acquiring knowledge all the
time from his highly interesting experiment. There is more danger in one
respectable scientist countenancing such a monstrous claim than in fifty
assassins or dynamitards. The man who makes it is ethically imbecile;
and whoever imagines that it is a scientific claim has not the faintest
conception of what science means. The paths to knowledge are countless.
One of these paths is a path through darkness, secrecy, and cruelty.
When a man deliberately turns from all other paths and goes down that
one, it is scientific to infer that what attracts him is not knowledge,
since there are other paths to that, but cruelty. With so strong and
scientific a case against him, it is childish for him to stand on
his honor and reputation and high character and the credit of a noble
profession and so forth: he must clear himself either by reason or by
experiment, unless he boldly contends that evolution has retained
a passion of cruelty in man just because it is indispensable to the
fulness of his knowledge.



THOU ART THE MAN

I shall not be at all surprised if what I have written above has induced
in sympathetic readers a transport of virtuous indignation at the
expense of the medical profession. I shall not damp so creditable and
salutary a sentiment; but I must point out that the guilt is shared by
all of us. It is not in his capacity of healer and man of science that
the doctor vivisects or defends vivisection, but in his entirely vulgar
lay capacity. He is made of the same clay as the ignorant, shallow,
credulous, half-miseducated, pecuniarily anxious people who call him in
when they have tried in vain every bottle and every pill the advertizing
druggist can persuade them to buy. The real remedy for vivisection is
the remedy for all the mischief that the medical profession and all the
other professions are doing: namely, more knowledge. The juries which
send the poor Peculiars to prison, and give vivisectionists heavy
damages against humane persons who accuse them of cruelty; the
editors and councillors and student-led mobs who are striving to make
Vivisection one of the watchwords of our civilization, are not doctors:
they are the British public, all so afraid to die that they will cling
frantically to any idol which promises to cure all their diseases, and
crucify anyone who tells them that they must not only die when their
time comes, but die like gentlemen. In their paroxysms of cowardice and
selfishness they force the doctors to humor their folly and ignorance.
How complete and inconsiderate their ignorance is can only be realized
by those who have some knowledge of vital statistics, and of the
illusions which beset Public Health legislation.



WHAT THE PUBLIC WANTS AND WILL NOT GET

The demands of this poor public are not reasonable, but they are quite
simple. It dreads disease and desires to be protected against it. But it
is poor and wants to be protected cheaply. Scientific measures are too
hard to understand, too costly, too clearly tending towards a rise in
the rates and more public interference with the insanitary, because
insufficiently financed, private house. What the public wants,
therefore, is a cheap magic charm to prevent, and a cheap pill or potion
to cure, all disease. It forces all such charms on the doctors.



THE VACCINATION CRAZE

Thus it was really the public and not the medical profession that took
up vaccination with irresistible faith, sweeping the invention out of
Jenner's hand and establishing it in a form which he himself repudiated.
Jenner was not a man of science; but he was not a fool; and when he
found that people who had suffered from cowpox either by contagion in
the milking shed or by vaccination, were not, as he had supposed, immune
from smallpox, he ascribed the cases of immunity which had formerly
misled him to a disease of the horse, which, perhaps because we do not
drink its milk and eat its flesh, is kept at a greater distance in our
imagination than our foster mother the cow. At all events, the public,
which had been boundlessly credulous about the cow, would not have the
horse on any terms; and to this day the law which prescribes Jennerian
vaccination is carried out with an anti-Jennerian inoculation because
the public would have it so in spite of Jenner. All the grossest lies
and superstitions which have disgraced the vaccination craze were taught
to the doctors by the public. It was not the doctors who first began to
declare that all our old men remember the time when almost every face
they saw in the street was horribly pitted with smallpox, and that all
this disfigurement has vanished since the introduction of vaccination.
Jenner himself alluded to this imaginary phenomenon before the
introduction of vaccination, and attributed it to the older practice
of smallpox inoculation, by which Voltaire, Catherine II. and Lady
Mary Wortley Montagu so confidently expected to see the disease made
harmless. It was not Jenner who set people declaring that smallpox, if
not abolished by vaccination, had at least been made much milder: on the
contrary, he recorded a pre-vaccination epidemic in which none of the
persons attacked went to bed or considered themselves as seriously ill.
Neither Jenner, nor any other doctor ever, as far as I know, inculcated
the popular notion that everybody got smallpox as a matter of course
before vaccination was invented. That doctors get infected with these
delusions, and are in their unprofessional capacity as members of the
public subject to them like other men, is true; but if we had to decide
whether vaccination was first forced on the public by the doctors or on
the doctors by the public, we should have to decide against the public.



STATISTICAL ILLUSIONS

Public ignorance of the laws of evidence and of statistics can hardly
be exaggerated. There may be a doctor here and there who in dealing
with the statistics of disease has taken at least the first step towards
sanity by grasping the fact that as an attack of even the commonest
disease is an exceptional event, apparently over-whelming statistical
evidence in favor of any prophylactic can be produced by persuading the
public that everybody caught the disease formerly. Thus if a disease is
one which normally attacks fifteen per cent of the population, and if
the effect of a prophylactic is actually to increase the proportion to
twenty per cent, the publication of this figure of twenty per cent will
convince the public that the prophylactic has reduced the percentage by
eighty per cent instead of increasing it by five, because the public,
left to itself and to the old gentlemen who are always ready to
remember, on every possible subject, that things used to be much worse
than they are now (such old gentlemen greatly outnumber the laudatores
tempori acti), will assume that the former percentage was about 100. The
vogue of the Pasteur treatment of hydrophobia, for instance, was due
to the assumption by the public that every person bitten by a rabid dog
necessarily got hydrophobia. I myself heard hydrophobia discussed in
my youth by doctors in Dublin before a Pasteur Institute existed,
the subject having been brought forward there by the scepticism of an
eminent surgeon as to whether hydrophobia is really a specific disease
or only ordinary tetanus induced (as tetanus was then supposed to be
induced) by a lacerated wound. There were no statistics available as to
the proportion of dog bites that ended in hydrophobia; but nobody ever
guessed that the cases could be more than two or three per cent of the
bites. On me, therefore, the results published by the Pasteur Institute
produced no such effect as they did on the ordinary man who thinks that
the bite of a mad dog means certain hydrophobia. It seemed to me that
the proportion of deaths among the cases treated at the Institute was
rather higher, if anything, than might have been expected had there been
no Institute in existence. But to the public every Pasteur patient
who did not die was miraculously saved from an agonizing death by the
beneficent white magic of that most trusty of all wizards, the man of
science.

Even trained statisticians often fail to appreciate the extent to
which statistics are vitiated by the unrecorded assumptions of their
interpreters. Their attention is too much occupied with the cruder
tricks of those who make a corrupt use of statistics for advertizing
purposes. There is, for example, the percentage dodge. In some hamlet,
barely large enough to have a name, two people are attacked during a
smallpox epidemic. One dies: the other recovers. One has vaccination
marks: the other has none. Immediately either the vaccinists or the
antivaccinists publish the triumphant news that at such and such a place
not a single vaccinated person died of smallpox whilst 100 per cent of
the unvaccinated perished miserably; or, as the case may be, that 100
per cent of the unvaccinated recovered whilst the vaccinated succumbed
to the last man. Or, to take another common instance, comparisons
which are really comparisons between two social classes with different
standards of nutrition and education are palmed off as comparisons
between the results of a certain medical treatment and its neglect. Thus
it is easy to prove that the wearing of tall hats and the carrying of
umbrellas enlarges the chest, prolongs life, and confers comparative
immunity from disease; for the statistics show that the classes which
use these articles are bigger, healthier, and live longer than the class
which never dreams of possessing such things. It does not take much
perspicacity to see that what really makes this difference is not the
tall hat and the umbrella, but the wealth and nourishment of which they
are evidence, and that a gold watch or membership of a club in Pall Mall
might be proved in the same way to have the like sovereign virtues. A
university degree, a daily bath, the owning of thirty pairs of trousers,
a knowledge of Wagner's music, a pew in church, anything, in short, that
implies more means and better nurture than the mass of laborers enjoy,
can be statistically palmed off as a magic-spell conferring all sorts of
privileges.

In the case of a prophylactic enforced by law, this illusion is
intensified grotesquely, because only vagrants can evade it. Now
vagrants have little power of resisting any disease: their death rate
and their case-mortality rate is always high relatively to that of
respectable folk. Nothing is easier, therefore, than to prove that
compliance with any public regulation produces the most gratifying
results. It would be equally easy even if the regulation actually raised
the death-rate, provided it did not raise it sufficiently to make the
average householder, who cannot evade regulations, die as early as the
average vagrant who can.



THE SURPRISES OF ATTENTION AND NEGLECT

There is another statistical illusion which is independent of class
differences. A common complaint of houseowners is that the Public Health
Authorities frequently compel them to instal costly sanitary appliances
which are condemned a few years later as dangerous to health, and
forbidden under penalties. Yet these discarded mistakes are always made
in the first instance on the strength of a demonstration that their
introduction has reduced the death-rate. The explanation is simple.
Suppose a law were made that every child in the nation should be
compelled to drink a pint of brandy per month, but that the brandy
must be administered only when the child was in good health, with its
digestion and so forth working normally, and its teeth either naturally
or artificially sound. Probably the result would be an immediate and
startling reduction in child mortality, leading to further legislation
increasing the quantity of brandy to a gallon. Not until the brandy
craze had been carried to a point at which the direct harm done by
it would outweigh the incidental good, would an anti-brandy party be
listened to. That incidental good would be the substitution of attention
to the general health of children for the neglect which is now the rule
so long as the child is not actually too sick to run about and play as
usual. Even if this attention were confined to the children's teeth,
there would be an improvement which it would take a good deal of brandy
to cancel.

This imaginary case explains the actual case of the sanitary appliances
which our local sanitary authorities prescribe today and condemn
tomorrow. No sanitary contrivance which the mind of even the very worst
plumber can devize could be as disastrous as that total neglect for
long periods which gets avenged by pestilences that sweep through whole
continents, like the black death and the cholera. If it were proposed
at this time of day to discharge all the sewage of London crude and
untreated into the Thames, instead of carrying it, after elaborate
treatment, far out into the North Sea, there would be a shriek of horror
from all our experts. Yet if Cromwell had done that instead of doing
nothing, there would probably have been no Great Plague of London. When
the Local Health Authority forces every householder to have his sanitary
arrangements thought about and attended to by somebody whose special
business it is to attend to such things, then it matters not how
erroneous or even directly mischievous may be the specific measures
taken: the net result at first is sure to be an improvement. Not until
attention has been effectually substituted for neglect as the general
rule, will the statistics begin to show the merits of the particular
methods of attention adopted. And as we are far from having arrived
at this stage, being as to health legislation only at the beginning of
things, we have practically no evidence yet as to the value of methods.
Simple and obvious as this is, nobody seems as yet to discount the
effect of substituting attention for neglect in drawing conclusions from
health statistics. Everything is put to the credit of the particular
method employed, although it may quite possibly be raising the death
rate by five per thousand whilst the attention incidental to it is
reducing the death rate fifteen per thousand. The net gain of ten per
thousand is credited to the method, and made the excuse for enforcing
more of it.



STEALING CREDIT FROM CIVILIZATION

There is yet another way in which specifics which have no merits at
all, either direct or incidental, may be brought into high repute by
statistics. For a century past civilization has been cleaning away
the conditions which favor bacterial fevers. Typhus, once rife, has
vanished: plague and cholera have been stopped at our frontiers by a
sanitary blockade. We still have epidemics of smallpox and typhoid; and
diphtheria and scarlet fever are endemic in the slums. Measles, which in
my childhood was not regarded as a dangerous disease, has now become
so mortal that notices are posted publicly urging parents to take it
seriously. But even in these cases the contrast between the death and
recovery rates in the rich districts and in the poor ones has led to
the general conviction among experts that bacterial diseases are
preventable; and they already are to a large extent prevented. The
dangers of infection and the way to avoid it are better understood
than they used to be. It is barely twenty years since people exposed
themselves recklessly to the infection of consumption and pneumonia
in the belief that these diseases were not "catching." Nowadays the
troubles of consumptive patients are greatly increased by the growing
disposition to treat them as lepers. No doubt there is a good deal of
ignorant exaggeration and cowardly refusal to face a human and necessary
share of the risk. That has always been the case. We now know that the
medieval horror of leprosy was out of all proportion to the danger
of infection, and was accompanied by apparent blindness to the
infectiousness of smallpox, which has since been worked up by our
disease terrorists into the position formerly held by leprosy. But the
scare of infection, though it sets even doctors talking as if the only
really scientific thing to do with a fever patient is to throw him into
the nearest ditch and pump carbolic acid on him from a safe distance
until he is ready to be cremated on the spot, has led to much greater
care and cleanliness. And the net result has been a series of victories
over disease.

Now let us suppose that in the early nineteenth century somebody had
come forward with a theory that typhus fever always begins in the
top joint of the little finger; and that if this joint be amputated
immediately after birth, typhus fever will disappear. Had such a
suggestion been adopted, the theory would have been triumphantly
confirmed; for as a matter of fact, typhus fever has disappeared. On
the other hand cancer and madness have increased (statistically) to
an appalling extent. The opponents of the little finger theory would
therefore be pretty sure to allege that the amputations were spreading
cancer and lunacy. The vaccination controversy is full of such
contentions. So is the controversy as to the docking of horses' tails
and the cropping of dogs' ears. So is the less widely known controversy
as to circumcision and the declaring certain kinds of flesh unclean by
the Jews. To advertize any remedy or operation, you have only to pick
out all the most reassuring advances made by civilization, and boldly
present the two in the relation of cause and effect: the public will
swallow the fallacy without a wry face. It has no idea of the need for
what is called a control experiment. In Shakespear's time and for long
after it, mummy was a favorite medicament. You took a pinch of the dust
of a dead Egyptian in a pint of the hottest water you could bear to
drink; and it did you a great deal of good. This, you thought, proved
what a sovereign healer mummy was. But if you had tried the control
experiment of taking the hot water without the mummy, you might have
found the effect exactly the same, and that any hot drink would have
done as well.



BIOMETRIKA

Another difficulty about statistics is the technical difficulty
of calculation. Before you can even make a mistake in drawing your
conclusion from the correlations established by your statistics you must
ascertain the correlations. When I turn over the pages of Biometrika,
a quarterly journal in which is recorded the work done in the field of
biological statistics by Professor Karl Pearson and his colleagues, I am
out of my depth at the first line, because mathematics are to me only a
concept: I never used a logarithm in my life, and could not undertake to
extract the square root of four without misgiving. I am therefore unable
to deny that the statistical ascertainment of the correlations between
one thing and another must be a very complicated and difficult technical
business, not to be tackled successfully except by high mathematicians;
and I cannot resist Professor Karl Pearson's immense contempt for, and
indignant sense of grave social danger in, the unskilled guesses of the
ordinary sociologist.

Now the man in the street knows nothing of Biometrika: all he knows is
that "you can prove anything by figures," though he forgets this the
moment figures are used to prove anything he wants to believe. If he did
take in Biometrika he would probably become abjectly credulous as to all
the conclusions drawn in it from the correlations so learnedly worked
out; though the mathematician whose correlations would fill a Newton
with admiration may, in collecting and accepting data and drawing
conclusions from them, fall into quite crude errors by just such popular
oversights as I have been describing.



PATIENT-MADE THERAPEUTICS

To all these blunders and ignorances doctors are no less subject than
the rest of us. They are not trained in the use of evidence, nor
in biometrics, nor in the psychology of human credulity, nor in the
incidence of economic pressure. Further, they must believe, on the
whole, what their patients believe, just as they must wear the sort of
hat their patients wear. The doctor may lay down the law despotically
enough to the patient at points where the patient's mind is simply
blank; but when the patient has a prejudice the doctor must either keep
it in countenance or lose his patient. If people are persuaded that
night air is dangerous to health and that fresh air makes them catch
cold it will not be possible for a doctor to make his living in private
practice if he prescribes ventilation. We have to go back no further
than the days of The Pickwick Papers to find ourselves in a world where
people slept in four-post beds with curtains drawn closely round to
exclude as much air as possible. Had Mr. Pickwick's doctor told him that
he would be much healthier if he slept on a camp bed by an open window,
Mr. Pickwick would have regarded him as a crank and called in another
doctor. Had he gone on to forbid Mr. Pickwick to drink brandy and water
whenever he felt chilly, and assured him that if he were deprived of
meat or salt for a whole year, he would not only not die, but would be
none the worse, Mr. Pickwick would have fled from his presence as from
that of a dangerous madman. And in these matters the doctor cannot cheat
his patient. If he has no faith in drugs or vaccination, and the patient
has, he can cheat him with colored water and pass his lancet through the
flame of a spirit lamp before scratching his arm. But he cannot make him
change his daily habits without knowing it.



THE REFORMS ALSO COME FROM THE LAITY

In the main, then, the doctor learns that if he gets ahead of the
superstitions of his patients he is a ruined man; and the result is that
he instinctively takes care not to get ahead of them. That is why all
the changes come from the laity. It was not until an agitation had been
conducted for many years by laymen, including quacks and faddists of all
kinds, that the public was sufficiently impressed to make it possible
for the doctors to open their minds and their mouths on the subject of
fresh air, cold water, temperance, and the rest of the new fashions in
hygiene. At present the tables have been turned on many old prejudices.
Plenty of our most popular elderly doctors believe that cold tubs in the
morning are unnatural, exhausting, and rheumatic; that fresh air is a
fad and that everybody is the better for a glass or two of port wine
every day; but they no longer dare say as much until they know exactly
where they are; for many very desirable patients in country houses have
lately been persuaded that their first duty is to get up at six in the
morning and begin the day by taking a walk barefoot through the dewy
grass. He who shows the least scepticism as to this practice is at once
suspected of being "an old-fashioned doctor," and dismissed to make room
for a younger man.

In short, private medical practice is governed not by science but by
supply and demand; and however scientific a treatment may be, it cannot
hold its place in the market if there is no demand for it; nor can the
grossest quackery be kept off the market if there is a demand for it.



FASHIONS AND EPIDEMICS

A demand, however, can be inculcated. This is thoroughly understood
by fashionable tradesmen, who find no difficulty in persuading their
customers to renew articles that are not worn out and to buy things they
do not want. By making doctors tradesmen, we compel them to learn the
tricks of trade; consequently we find that the fashions of the year
include treatments, operations, and particular drugs, as well as hats,
sleeves, ballads, and games. Tonsils, vermiform appendices, uvulas, even
ovaries are sacrificed because it is the fashion to get them cut out,
and because the operations are highly profitable. The psychology of
fashion becomes a pathology; for the cases have every air of being
genuine: fashions, after all, are only induced epidemics, proving that
epidemics can be induced by tradesmen, and therefore by doctors.



THE DOCTOR'S VIRTUES

It will be admitted that this is a pretty bad state of things. And the
melodramatic instinct of the public, always demanding; that every wrong
shall have, not its remedy, but its villain to be hissed, will blame,
not its own apathy, superstition, and ignorance, but the depravity of
the doctors. Nothing could be more unjust or mischievous. Doctors, if no
better than other men, are certainly no worse. I was reproached during
the performances of The Doctor's Dilemma at the Court Theatre in
1907 because I made the artist a rascal, the journalist an illiterate
incapable, and all the doctors "angels." But I did not go beyond the
warrant of my own experience. It has been my luck to have doctors
among my friends for nearly forty years past (all perfectly aware of
my freedom from the usual credulity as to the miraculous powers and
knowledge attributed to them); and though I know that there are medical
blackguards as well as military, legal, and clerical blackguards (one
soon finds that out when one is privileged to hear doctors talking shop
among themselves), the fact that I was no more at a loss for private
medical advice and attendance when I had not a penny in my pocket than I
was later on when I could afford fees on the highest scale, has made it
impossible for me to share that hostility to the doctor as a man which
exists and is growing as an inevitable result of the present condition
of medical practice. Not that the interest in disease and aberrations
which turns some men and women to medicine and surgery is not sometimes
as morbid as the interest in misery and vice which turns some others
to philanthropy and "rescue work." But the true doctor is inspired by
a hatred of ill-health, and a divine impatience of any waste of vital
forces. Unless a man is led to medicine or surgery through a very
exceptional technical aptitude, or because doctoring is a family
tradition, or because he regards it unintelligently as a lucrative and
gentlemanly profession, his motives in choosing the career of a healer
are clearly generous. However actual practice may disillusion and
corrupt him, his selection in the first instance is not a selection of a
base character.



THE DOCTOR'S HARDSHIPS

A review of the counts in the indictment I have brought against private
medical practice will show that they arise out of the doctor's position
as a competitive private tradesman: that is, out of his poverty and
dependence. And it should be borne in mind that doctors are expected
to treat other people specially well whilst themselves submitting
to specially inconsiderate treatment. The butcher and baker are not
expected to feed the hungry unless the hungry can pay; but a doctor who
allows a fellow-creature to suffer or perish without aid is regarded as
a monster. Even if we must dismiss hospital service as really venal,
the fact remains that most doctors do a good deal of gratuitous work
in private practice all through their careers. And in his paid work the
doctor is on a different footing to the tradesman. Although the articles
he sells, advice and treatment, are the same for all classes, his fees
have to be graduated like the income tax. The successful fashionable
doctor may weed his poorer patients out from time to time, and finally
use the College of Physicians to place it out of his own power to accept
low fees; but the ordinary general practitioner never makes out his
bills without considering the taxable capacity of his patients.

Then there is the disregard of his own health and comfort which results
from the fact that he is, by the nature of his work, an emergency man.
We are polite and considerate to the doctor when there is nothing the
matter, and we meet him as a friend or entertain him as a guest; but
when the baby is suffering from croup, or its mother has a temperature
of 104 degrees, or its grandfather has broken his leg, nobody thinks
of the doctor except as a healer and saviour. He may be hungry,
weary, sleepy, run down by several successive nights disturbed by that
instrument of torture, the night bell; but who ever thinks of this
in the face of sudden sickness or accident? We think no more of the
condition of a doctor attending a case than of the condition of
a fireman at a fire. In other occupations night-work is specially
recognized and provided for. The worker sleeps all day; has his
breakfast in the evening; his lunch or dinner at midnight; his dinner or
supper before going to bed in the morning; and he changes to day-work
if he cannot stand night-work. But a doctor is expected to work day and
night. In practices which consist largely of workmen's clubs, and in
which the patients are therefore taken on wholesale terms and very
numerous, the unfortunate assistant, or the principal if he has no
assistant, often does not undress, knowing that he will be called up
before he has snatched an hour's sleep. To the strain of such inhuman
conditions must be added the constant risk of infection. One wonders
why the impatient doctors do not become savage and unmanageable, and the
patient ones imbecile. Perhaps they do, to some extent. And the pay is
wretched, and so uncertain that refusal to attend without payment in
advance becomes often a necessary measure of self-defence, whilst the
County Court has long ago put an end to the tradition that the doctor's
fee is an honorarium. Even the most eminent physicians, as such
biographies as those of Paget show, are sometimes miserably, inhumanly
poor until they are past their prime. In short, the doctor needs our
help for the moment much more than we often need his. The ridicule of
Moliere, the death of a well-informed and clever writer like the late
Harold Frederic in the hands of Christian Scientists (a sort of sealing
with his blood of the contemptuous disbelief in and dislike of doctors
he had bitterly expressed in his books), the scathing and quite
justifiable exposure of medical practice in the novel by Mr. Maarten
Maartens entitled The New Religion: all these trouble the doctor very
little, and are in any case well set off by the popularity of Sir Luke
Fildes' famous picture, and by the verdicts in which juries from time to
time express their conviction that the doctor can do no wrong. The
real woes of the doctor are the shabby coat, the wolf at the door,
the tyranny of ignorant patients, the work-day of 24 hours, and the
uselessness of honestly prescribing what most of the patients really
need: that is, not medicine, but money.



THE PUBLIC DOCTOR

What then is to be done?

Fortunately we have not to begin absolutely from the beginning: we
already have, in the Medical Officer of Health, a sort of doctor who is
free from the worst hardships, and consequently from the worst vices,
of the private practitioner. His position depends, not on the number
of people who are ill, and whom he can keep ill, but on the number of
people who are well. He is judged, as all doctors and treatments should
be judged, by the vital statistics of his district. When the death rate
goes up his credit goes down. As every increase in his salary depends on
the issue of a public debate as to the health of the constituency under
his charge, he has every inducement to strive towards the ideal of a
clean bill of health. He has a safe, dignified, responsible, independent
position based wholly on the public health; whereas the private
practitioner has a precarious, shabby-genteel, irresponsible, servile
position, based wholly on the prevalence of illness.

It is true, there are grave scandals in the public medical service. The
public doctor may be also a private practitioner eking out his earnings
by giving a little time to public work for a mean payment. There are
cases in which the position is one which no successful practitioner will
accept, and where, therefore, incapables or drunkards get automatically
selected for the post, faute de mieux; but even in these cases the
doctor is less disastrous in his public capacity than in his private
one: besides, the conditions which produce these bad cases are doomed,
as the evil is now recognized and understood. A popular but unstable
remedy is to enable local authorities, when they are too small to
require the undivided time of such men as the Medical Officers of our
great municipalities, to combine for public health purposes so that each
may share the services of a highly paid official of the best class; but
the right remedy is a larger area as the sanitary unit.



MEDICAL ORGANIZATION

Another advantage of public medical work is that it admits of
organization, and consequently of the distribution of the work in such
a manner as to avoid wasting the time of highly qualified experts
on trivial jobs. The individualism of private practice leads to an
appalling waste of time on trifles. Men whose dexterity as operators or
almost divinatory skill in diagnosis are constantly needed for difficult
cases, are poulticing whitlows, vaccinating, changing unimportant
dressings, prescribing ether drams for ladies with timid leanings
towards dipsomania, and generally wasting their time in the pursuit of
private fees. In no other profession is the practitioner expected to
do all the work involved in it from the first day of his professional
career to the last as the doctor is. The judge passes sentence of death;
but he is not expected to hang the criminal with his own hands, as he
would be if the legal profession were as unorganized as the medical. The
bishop is not expected to blow the organ or wash the baby he baptizes.
The general is not asked to plan a campaign or conduct a battle at
half-past twelve and to play the drum at half-past two. Even if they
were, things would still not be as bad as in the medical profession; for
in it not only is the first-class man set to do third-class work, but,
what is much more terrifying, the third-class man is expected to do
first-class work. Every general practitioner is supposed to be capable
of the whole range of medical and surgical work at a moment's notice;
and the country doctor, who has not a specialist nor a crack consultant
at the end of his telephone, often has to tackle without hesitation
cases which no sane practitioner in a town would take in hand without
assistance. No doubt this develops the resourcefulness of the country
doctor, and makes him a more capable man than his suburban colleague;
but it cannot develop the second-class man into a first-class one. If
the practice of law not only led to a judge having to hang, but the
hangman to judge, or if in the army matters were so arranged that it
would be possible for the drummer boy to be in command at Waterloo
whilst the Duke of Wellington was playing the drum in Brussels, we
should not be consoled by the reflection that our hangmen were thereby
made a little more judicial-minded, and our drummers more responsible,
than in foreign countries where the legal and military professions
recognized the advantages of division of labor.

Under such conditions no statistics as to the graduation of professional
ability among doctors are available. Assuming that doctors are normal
men and not magicians (and it is unfortunately very hard to persuade
people to admit so much and thereby destroy the romance of doctoring)
we may guess that the medical profession, like the other professions,
consists of a small percentage of highly gifted persons at one end,
and a small percentage of altogether disastrous duffers at the other.
Between these extremes comes the main body of doctors (also, of
course, with a weak and a strong end) who can be trusted to work under
regulations with more or less aid from above according to the gravity
of the case. Or, to put it in terms of the cases, there are cases that
present no difficulties, and can be dealt with by a nurse or student at
one end of the scale, and cases that require watching and handling by
the very highest existing skill at the other; whilst between come
the great mass of cases which need visits from the doctor of ordinary
ability and from the chiefs of the profession in the proportion of, say,
seven to none, seven to one, three to one, one to one, or, for a day
or two, none to one. Such a service is organized at present only
in hospitals; though in large towns the practice of calling in the
consultant acts, to some extent, as a substitute for it. But in the
latter case it is quite unregulated except by professional etiquet,
which, as we have seen, has for its object, not the health of the
patient or of the community at large, but the protection of the doctor's
livelihood and the concealment of his errors. And as the consultant is
an expensive luxury, he is a last resource rather, as he should be, than
a matter of course, in all cases where the general practitioner is not
equal to the occasion: a predicament in which a very capable man may
find himself at any time through the cropping up of a case of which he
has had no clinical experience.



THE SOCIAL SOLUTION OF THE MEDICAL PROBLEM

The social solution of the medical problem, then, depends on that large,
slowly advancing, pettishly resisted integration of society called
generally Socialism. Until the medical profession becomes a body of men
trained and paid by the country to keep the country in health it will
remain what it is at present: a conspiracy to exploit popular credulity
and human suffering. Already our M.O.H.s (Medical Officers of Health)
are in the new position: what is lacking is appreciation of the change,
not only by the public but by the private doctors. For, as we have seen,
when one of the first-rate posts becomes vacant in one of the great
cities, and all the leading M.O.H.s compete for it, they must appeal to
the good health of the cities of which they have been in charge, and not
to the size of the incomes the local private doctors are making out of
the ill-health of their patients. If a competitor can prove that he has
utterly ruined every sort of medical private practice in a large city
except obstetric practice and the surgery of accidents, his claims are
irresistible; and this is the ideal at which every M.O.H. should aim.
But the profession at large should none the less welcome him and set
its house in order for the social change which will finally be its own
salvation. For the M.O.H. as we know him is only the beginning of that
army of Public Hygiene which will presently take the place in general
interest and honor now occupied by our military and naval forces. It is
silly that an Englishman should be more afraid of a German soldier than
of a British disease germ, and should clamor for more barracks in the
same newspapers that protest against more school clinics, and cry out
that if the State fights disease for us it makes us paupers, though
they never say that if the State fights the Germans for us it makes us
cowards. Fortunately, when a habit of thought is silly it only needs
steady treatment by ridicule from sensible and witty people to be put
out of countenance and perish. Every year sees an increase in the number
of persons employed in the Public Health Service, who would formerly
have been mere adventurers in the Private Illness Service. To put it
another way, a host of men and women who have now a strong incentive
to be mischievous and even murderous rogues will have a much stronger,
because a much honester, incentive to be not only good citizens but
active benefactors to the community. And they will have no anxiety
whatever about their incomes.



THE FUTURE OF PRIVATE PRACTICE

It must not be hastily concluded that this involves the extinction of
the private practitioner. What it will really mean for him is release
from his present degrading and scientifically corrupting slavery to his
patients. As I have already shown the doctor who has to live by pleasing
his patients in competition with everybody who has walked the hospitals,
scraped through the examinations, and bought a brass plate, soon finds
himself prescribing water to teetotallers and brandy or champagne jelly
to drunkards; beefsteaks and stout in one house, and "uric acid free"
vegetarian diet over the way; shut windows, big fires, and heavy
overcoats to old Colonels, and open air and as much nakedness as is
compatible with decency to young faddists, never once daring to say
either "I don't know," or "I don't agree." For the strength of the
doctor's, as of every other man's position when the evolution of social
organization at last reaches his profession, will be that he will always
have open to him the alternative of public employment when the private
employer becomes too tyrannous. And let no one suppose that the words
doctor and patient can disguise from the parties the fact that they are
employer and employee. No doubt doctors who are in great demand can be
as high-handed and independent as employees are in all classes when a
dearth in their labor market makes them indispensable; but the average
doctor is not in this position: he is struggling for life in an
overcrowded profession, and knows well that "a good bedside manner"
will carry him to solvency through a morass of illness, whilst the
least attempt at plain dealing with people who are eating too much, or
drinking too much, or frowsting too much (to go no further in the list
of intemperances that make up so much of family life) would soon land
him in the Bankruptcy Court.

Private practice, thus protected, would itself protect individuals, as
far as such protection is possible, against the errors and superstitions
of State medicine, which are at worst no worse than the errors and
superstitions of private practice, being, indeed, all derived from it.
Such monstrosities as vaccination are, as we have seen, founded, not on
science, but on half-crowns. If the Vaccination Acts, instead of being
wholly repealed as they are already half repealed, were strengthened by
compelling every parent to have his child vaccinated by a public officer
whose salary was completely independent of the number of vaccinations
performed by him, and for whom there was plenty of alternative public
health work waiting, vaccination would be dead in two years, as the
vaccinator would not only not gain by it, but would lose credit through
the depressing effects on the vital statistics of his district of the
illness and deaths it causes, whilst it would take from him all the
credit of that freedom from smallpox which is the result of good
sanitary administration and vigilant prevention of infection. Such
absurd panic scandals as that of the last London epidemic, where a fee
of half-a-crown per re-vaccination produced raids on houses during
the absence of parents, and the forcible seizure and re-vaccination of
children left to answer the door, can be prevented simply by abolishing
the half-crown and all similar follies, paying, not for this or that
ceremony of witchcraft, but for immunity from disease, and paying, too,
in a rational way. The officer with a fixed salary saves himself trouble
by doing his business with the least possible interference with the
private citizen. The man paid by the job loses money by not forcing his
job on the public as often as possible without reference to its results.



THE TECHNICAL PROBLEM

As to any technical medical problem specially involved, there is none.
If there were, I should not be competent to deal with it, as I am not a
technical expert in medicine: I deal with the subject as an economist, a
politician, and a citizen exercising my common sense. Everything that I
have said applies equally to all the medical techniques, and will hold
good whether public hygiene be based on the poetic fancies of Christian
Science, the tribal superstitions of the druggist and the vivisector, or
the best we can make of our real knowledge. But I may remind those
who confusedly imagine that the medical problem is also the scientific
problem, that all problems are finally scientific problems. The notion
that therapeutics or hygiene or surgery is any more or less scientific
than making or cleaning boots is entertained only by people to whom
a man of science is still a magician who can cure diseases, transmute
metals, and enable us to live for ever. It may still be necessary for
some time to come to practise on popular credulity, popular love and
dread of the marvellous, and popular idolatry, to induce the poor
to comply with the sanitary regulations they are too ignorant
to understand. As I have elsewhere confessed, I have myself been
responsible for ridiculous incantations with burning sulphur,
experimentally proved to be quite useless, because poor people are
convinced, by the mystical air of the burning and the horrible smell,
that it exorcises the demons of smallpox and scarlet fever and makes it
safe for them to return to their houses. To assure them that the real
secret is sunshine and soap is only to convince them that you do not
care whether they live or die, and wish to save money at their expense.
So you perform the incantation; and back they go to their houses,
satisfied. A religious ceremony--a poetic blessing of the threshold, for
instance--would be much better; but unfortunately our religion is weak
on the sanitary side. One of the worst misfortunes of Christendom was
that reaction against the voluptuous bathing of the imperial Romans
which made dirty habits a part of Christian piety, and in some unlucky
places (the Sandwich Islands for example) made the introduction of
Christianity also the introduction of disease, because the formulators
of the superseded native religion, like Mahomet, had been enlightened
enough to introduce as religious duties such sanitary measures as
ablution and the most careful and reverent treatment of everything
cast off by the human body, even to nail clippings and hairs; and our
missionaries thoughtlessly discredited this godly doctrine without
supplying its place, which was promptly taken by laziness and neglect.
If the priests of Ireland could only be persuaded to teach their flocks
that it is a deadly insult to the Blessed Virgin to place her image in a
cottage that is not kept up to that high standard of Sunday cleanliness
to which all her worshippers must believe she is accustomed, and to
represent her as being especially particular about stables because
her son was born in one, they might do more in one year than all the
Sanitary Inspectors in Ireland could do in twenty; and they could hardly
doubt that Our Lady would be delighted. Perhaps they do nowadays; for
Ireland is certainly a transfigured country since my youth as far as
clean faces and pinafores can transfigure it. In England, where so
many of the inhabitants are too gross to believe in poetic faiths, too
respectable to tolerate the notion that the stable at Bethany was a
common peasant farmer's stable instead of a first-rate racing one, and
too savage to believe that anything can really cast out the devil of
disease unless it be some terrifying hoodoo of tortures and stinks, the
M.O.H. will no doubt for a long time to come have to preach to fools
according to their folly, promising miracles, and threatening hideous
personal consequences of neglect of by-laws and the like; therefore it
will be important that every M.O.H. shall have, with his (or her) other
qualifications, a sense of humor, lest (he or she) should come at last
to believe all the nonsense that must needs be talked. But he must, in
his capacity of an expert advising the authorities, keep the government
itself free of superstition. If Italian peasants are so ignorant that
the Church can get no hold of them except by miracles, why, miracles
there must be. The blood of St. Januarius must liquefy whether the
Saint is in the humor or not. To trick a heathen into being a dutiful
Christian is no worse than to trick a whitewasher into trusting himself
in a room where a smallpox patient has lain, by pretending to exorcise
the disease with burning sulphur. But woe to the Church if in deceiving
the peasant it also deceives itself; for then the Church is lost, and
the peasant too, unless he revolt against it. Unless the Church works
the pretended miracle painfully against the grain, and is continually
urged by its dislike of the imposture to strive to make the peasant
susceptible to the true reasons for behaving well, the Church will
become an instrument of his corruption and an exploiter of his
ignorance, and will find itself launched upon that persecution of
scientific truth of which all priesthoods are accused and none with more
justice than the scientific priesthood.

And here we come to the danger that terrifies so many of us: the danger
of having a hygienic orthodoxy imposed on us. But we must face that: in
such crowded and poverty ridden civilizations as ours any orthodoxy
is better than laisser-faire. If our population ever comes to consist
exclusively of well-to-do, highly cultivated, and thoroughly instructed
free persons in a position to take care of themselves, no doubt they
will make short work of a good deal of official regulation that is now
of life-and-death necessity to us; but under existing circumstances, I
repeat, almost any sort of attention that democracy will stand is better
than neglect. Attention and activity lead to mistakes as well as
to successes; but a life spent in making mistakes is not only more
honorable but more useful than a life spent doing nothing. The one
lesson that comes out of all our theorizing and experimenting is that
there is only one really scientific progressive method; and that is the
method of trial and error. If you come to that, what is laisser-faire
but an orthodoxy? the most tyrannous and disastrous of all the
orthodoxies, since it forbids you even to learn.



THE LATEST THEORIES

Medical theories are so much a matter of fashion, and the most fertile
of them are modified so rapidly by medical practice and biological
research, which are international activities, that the play which
furnishes the pretext for this preface is already slightly outmoded,
though I believe it may be taken as a faithful record for the year
(1906) in which it was begun. I must not expose any professional man to
ruin by connecting his name with the entire freedom of criticism which
I, as a layman, enjoy; but it will be evident to all experts that my
play could not have been written but for the work done by Sir Almroth
Wright in the theory and practice of securing immunization from
bacterial diseases by the inoculation of "vaccines" made of their own
bacteria: a practice incorrectly called vaccinetherapy (there is nothing
vaccine about it) apparently because it is what vaccination ought to be
and is not. Until Sir Almroth Wright, following up one of Metchnikoff's
most suggestive biological romances, discovered that the white
corpuscles or phagocytes which attack and devour disease germs for us do
their work only when we butter the disease germs appetizingly for them
with a natural sauce which Sir Almroth named opsonin, and that our
production of this condiment continually rises and falls rhythmically
from negligibility to the highest efficiency, nobody had been able
even to conjecture why the various serums that were from time to time
introduced as having effected marvellous cures, presently made such
direful havoc of some unfortunate patient that they had to be dropped
hastily. The quantity of sturdy lying that was necessary to save the
credit of inoculation in those days was prodigious; and had it not been
for the devotion shown by the military authorities throughout Europe,
who would order the entire disappearance of some disease from their
armies, and bring it about by the simple plan of changing the name
under which the cases were reported, or for our own Metropolitan Asylums
Board, which carefully suppressed all the medical reports that revealed
the sometimes quite appalling effects of epidemics of revaccination,
there is no saying what popular reaction might not have taken place
against the whole immunization movement in therapeutics.

The situation was saved when Sir Almroth Wright pointed out that if you
inoculated a patient with pathogenic germs at a moment when his powers
of cooking them for consumption by the phagocytes was receding to its
lowest point, you would certainly make him a good deal worse and perhaps
kill him, whereas if you made precisely the same inoculation when the
cooking power was rising to one of its periodical climaxes, you would
stimulate it to still further exertions and produce just the opposite
result. And he invented a technique for ascertaining in which phase the
patient happened to be at any given moment. The dramatic possibilities
of this discovery and invention will be found in my play. But it is one
thing to invent a technique: it is quite another to persuade the medical
profession to acquire it. Our general practitioners, I gather, simply
declined to acquire it, being mostly unable to afford either the
acquisition or the practice of it when acquired. Something simple,
cheap, and ready at all times for all comers, is, as I have shown, the
only thing that is economically possible in general practice, whatever
may be the case in Sir Almroth's famous laboratory in St. Mary's
Hospital. It would have become necessary to denounce opsonin in the
trade papers as a fad and Sir Almroth as a dangerous man if his practice
in the laboratory had not led him to the conclusion that the customary
inoculations were very much too powerful, and that a comparatively
infinitesimal dose would not precipitate a negative phase of cooking
activity, and might induce a positive one. And thus it happens that the
refusal of our general practitioners to acquire the new technique is
no longer quite so dangerous in practice as it was when The Doctor's
Dilemma was written: nay, that Sir Ralph Bloomfield Boningtons way of
administering inoculations as if they were spoonfuls of squills may
sometimes work fairly well. For all that, I find Sir Almroth Wright,
on the 23rd May, 1910, warning the Royal Society of Medicine that "the
clinician has not yet been prevailed upon to reconsider his position,"
which means that the general practitioner ("the doctor," as he is called
in our homes) is going on just as he did before, and could not afford
to learn or practice a new technique even if he had ever heard of it.
To the patient who does not know about it he will say nothing. To the
patient who does, he will ridicule it, and disparage Sir Almroth. What
else can he do, except confess his ignorance and starve?

But now please observe how "the whirligig of time brings its revenges."
This latest discovery of the remedial virtue of a very, very tiny
hair of the dog that bit you reminds us, not only of Arndt's law of
protoplasmic reaction to stimuli, according to which weak and strong
stimuli provoke opposite reactions, but of Hahnemann's homeopathy, which
was founded on the fact alleged by Hahnemann that drugs which produce
certain symptoms when taken in ordinary perceptible quantities, will,
when taken in infinitesimally small quantities, provoke just the
opposite symptoms; so that the drug that gives you a headache will
also cure a headache if you take little enough of it. I have already
explained that the savage opposition which homeopathy encountered from
the medical profession was not a scientific opposition; for nobody seems
to deny that some drugs act in the alleged manner. It was opposed simply
because doctors and apothecaries lived by selling bottles and boxes of
doctor's stuff to be taken in spoonfuls or in pellets as large as peas;
and people would not pay as much for drops and globules no bigger than
pins' heads. Nowadays, however, the more cultivated folk are beginning
to be so suspicious of drugs, and the incorrigibly superstitious people
so profusely supplied with patent medicines (the medical advice to take
them being wrapped round the bottle and thrown in for nothing) that
homeopathy has become a way of rehabilitating the trade of prescription
compounding, and is consequently coming into professional credit. At
which point the theory of opsonins comes very opportunely to shake hands
with it.

Add to the newly triumphant homeopathist and the opsonist that other
remarkable innovator, the Swedish masseur, who does not theorize about
you, but probes you all over with his powerful thumbs until he finds out
your sore spots and rubs them away, besides cheating you into a little
wholesome exercise; and you have nearly everything in medical practice
to-day that is not flat witchcraft or pure commercial exploitation of
human credulity and fear of death. Add to them a good deal of vegetarian
and teetotal controversy raging round a clamor for scientific eating
and drinking, and resulting in little so far except calling digestion
Metabolism and dividing the public between the eminent doctor who tells
us that we do not eat enough fish, and his equally eminent colleague
who warns us that a fish diet must end in leprosy, and you have all that
opposes with any sort of countenance the rise of Christian Science with
its cathedrals and congregations and zealots and miracles and cures:
all very silly, no doubt, but sane and sensible, poetic and hopeful,
compared to the pseudo science of the commercial general practitioner,
who foolishly clamors for the prosecution and even the execution of the
Christian Scientists when their patients die, forgetting the long death
roll of his own patients.

By the time this preface is in print the kaleidoscope may have had
another shake; and opsonin may have gone the way of phlogiston at the
hands of its own restless discoverer. I will not say that Hahnemann may
have gone the way of Diafoirus; for Diafoirus we have always with us.
But we shall still pick up all our knowledge in pursuit of some Will o'
the Wisp or other. What is called science has always pursued the Elixir
of Life and the Philosopher's Stone, and is just as busy after them
to-day as ever it was in the days of Paracelsus. We call them by
different names: Immunization or Radiology or what not; but the dreams
which lure us into the adventures from which we learn are always at
bottom the same. Science becomes dangerous only when it imagines that
it has reached its goal. What is wrong with priests and popes is that
instead of being apostles and saints, they are nothing but empirics
who say "I know" instead of "I am learning," and pray for credulity and
inertia as wise men pray for scepticism and activity. Such abominations
as the Inquisition and the Vaccination Acts are possible only in the
famine years of the soul, when the great vital dogmas of honor, liberty,
courage, the kinship of all life, faith that the unknown is greater than
the known and is only the As Yet Unknown, and resolution to find a
manly highway to it, have been forgotten in a paroxysm of littleness and
terror in which nothing is active except concupiscence and the fear of
death, playing on which any trader can filch a fortune, any blackguard
gratify his cruelty, and any tyrant make us his slaves.

Lest this should seem too rhetorical a conclusion for our professional
men of science, who are mostly trained not to believe anything unless it
is worded in the jargon of those writers who, because they never really
understand what they are trying to say, cannot find familiar words for
it, and are therefore compelled to invent a new language of nonsense
for every book they write, let me sum up my conclusions as dryly as is
consistent with accurate thought and live conviction.

1. Nothing is more dangerous than a poor doctor: not even a poor
employer or a poor landlord.

2. Of all the anti-social vested interests the worst is the vested
interest in ill-health.

3. Remember that an illness is a misdemeanor; and treat the doctor as an
accessory unless he notifies every case to the Public Health authority.

4. Treat every death as a possible and under our present system a
probable murder, by making it the subject of a reasonably conducted
inquest; and execute the doctor, if necessary, as a doctor, by striking
him off the register.

5. Make up your mind how many doctors the community needs to keep
it well. Do not register more or less than this number; and let
registration constitute the doctor a civil servant with a dignified
living wage paid out of public funds.

6. Municipalize Harley Street.

7. Treat the private operator exactly as you would treat a private
executioner.

8. Treat persons who profess to be able to cure disease as you
treat fortune tellers.

9. Keep the public carefully informed, by special statistics and
announcements of individual cases, of all illnesses of doctors or in
their families.

10. Make it compulsory for a doctor using a brass plate to
have inscribed on it, in addition to the letters indicating his
qualifications, the words "Remember that I too am mortal."

11. In legislation and social organization, proceed on the principle
that invalids, meaning persons who cannot keep themselves alive by their
own activities, cannot, beyond reason, expect to be kept alive by
the activity of others. There is a point at which the most energetic
policeman or doctor, when called upon to deal with an apparently drowned
person, gives up artificial respiration, although it is never possible
to declare with certainty, at any point short of decomposition, that
another five minutes of the exercise would not effect resuscitation. The
theory that every individual alive is of infinite value is legislatively
impracticable. No doubt the higher the life we secure to the individual
by wise social organization, the greater his value is to the community,
and the more pains we shall take to pull him through any temporary
danger or disablement. But the man who costs more than he is worth is
doomed by sound hygiene as inexorably as by sound economics.

12. Do not try to live for ever. You will not succeed.

13. Use your health, even to the point of wearing it out. That is
what it is for. Spend all you have before you die; and do not outlive
yourself.

14. Take the utmost care to get well born and well brought up. This
means that your mother must have a good doctor. Be careful to go to
a school where there is what they call a school clinic, where your
nutrition and teeth and eyesight and other matters of importance to you
will be attended to. Be particularly careful to have all this done at
the expense of the nation, as otherwise it will not be done at all, the
chances being about forty to one against your being able to pay for it
directly yourself, even if you know how to set about it. Otherwise
you will be what most people are at present: an unsound citizen of an
unsound nation, without sense enough to be ashamed or unhappy about it.





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