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Title: The Doctor's Dilemma: Preface on Doctors

Author: George Bernard Shaw

Release Date: February, 2004 [EBook #5069]
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THE DOCTOR'S DILEMMA: PREFACE ON DOCTORS

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 he 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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