,,the ,,doctor',s ,,dilemma3 ,,preface ,,on ,,doctors ,by ,bernard ,shaw #aiji ,it is not the fault of our doctors that the medical service of the community1 as at present provided for1 is a murderous absurdity4 ,that any sane nation1 having observed that you could provide for the supply of bread by giving bakers a pecuniary interest in baking for you1 should go on to give a surgeon a pecuniary interest in cutting off your leg1 is enough to make one despair of political humanity4 ,but that is precisely what we have done4 ,and the more appalling the mutilation1 the more the mutilator is paid4 ,he who corrects the ingrowing toe-nail receives a few shillings3 he who cuts your inside out receives hundreds of guineas1 except when he does it to a poor person for practice4 ,scandalized voices murmur that these operations are necessary4 ,they may be4 ,it may also be necessary to hang a man or pull down a house4 ,but we take good care not to make the hangman and the housebreaker the judges of that4 ,if we did1 no man's neck would be safe and no man's house stable4 ,but we do make the doctor the judge1 and fine him anything from sixpence to several hundred guineas if he decides in our favor4 ,i cannot knock my shins severely without forcing on some surgeon the difficult question1 ,could ,i not make a better use of a pocketful of guineas than this man is making of his leg8 ,could he not write as well--or even better--on one leg than on two8 ,and the guineas would make all the difference in the world to me just now4 ,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 leglessness1 etc41 etc41 etc4 ,now there is no calculation that an engineer can make as to the behavior of a girder under a strain1 or an astronomer as to the recurrence of a comet1 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 them4 ,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 us4 ,after all1 what harm is there in it8 ,the surgeon need not take off the rich man's 7or woman's7 leg or arm3 he can remove the appendix or the uvula1 and leave the patient none the worse after a fortnight or so in bed1 whilst the nurse1 the general practitioner1 the apothecary1 and the surgeon will be the better4 ,,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 members4 ,i must reply that the medical profession has not a high character3 it has an infamous character4 ,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 mistrust1 because it not only advocates and practises the most revolting cruelties in the pursuit of knowledge1 and justifies them on grounds which would equally justify practising the same cruelties on yourself or your children1 or burning down ,london to test a patent fire extinguisher1 but1 when it has shocked the public1 tries to reassure it with lies of breath-bereaving brazenness4 ,that is the character the medical profession has got just now4 ,it may be deserved or it may not3 there it is at all events1 and the doctors who have not realized this are living in a fool's paradise4 ,as to the humor and conscience of doctors1 they have as much as any other class of men1 no more and no less4 ,and what other men dare pretend to be impartial where they have a strong pecuniary interest on one side8 ,nobody supposes that doctors are less virtuous than judges2 but a judge whose salary and reputation depended on whether the verdict was for plaintiff or defendant1 prosecutor or prisoner1 would be as little trusted as a general in the pay of the enemy4 ,to offer me a doctor as my judge1 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 him1 is to go wildly beyond the ascertained strain which human nature will bear4 ,it is simply unscientific to allege or believe that doctors do not under existing circumstances perform unnecessary operations and manufacture and prolong lucrative illnesses4 ,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 ones4 ,and there is this curious psychological fact to be remembered3 a serious illness or a death advertizes the doctor exactly as a hanging advertizes the barrister who defended the person hanged4 ,suppose1 for example1 a royal personage gets something wrong with his throat1 or has a pain in his inside4 ,if a doctor effects some trumpery cure with a wet compress or a peppermint lozenge nobody takes the least notice of him4 ,but if he operates on the throat and kills the patient1 or extirpates an internal organ and keeps the whole nation palpitating for days whilst the patient hovers in pain and fever between life and death1 his fortune is made3 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 patient4 ,the wonder is that there is a king or queen left alive in ,europe4 ,,doctor',s ,,consciences ,there is another difficulty in trusting to the honor and conscience of a doctor4 ,doctors are just like other ,englishmen3 most of them have no honor and no conscience3 what they commonly mistake for these is sentimentality and an intense dread of doing anything that everybody else does not do1 or omitting to do anything that everybody else does4 ,this of course does amount to a sort of working or rule-of-thumb conscience2 but it means that you will do anything1 good or bad1 provided you get enough people to keep you in countenance by doing it also4 ,it is the sort of conscience that makes it possible to keep order on a pirate ship1 or in a troop of brigands4 ,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 ethics4 ,no doubt this holds good in political practice4 ,if mankind knew the facts1 and agreed with the doctors1 then the doctors would be in the right2 and any person who thought otherwise would be a lunatic4 ,but mankind does not agree1 and does not know the facts4 ,all that can be said for medical popularity is that until there is a practicable alternative to blind trust in the doctor1 the truth about the doctor is so terrible that we dare not face it4 ,moliere saw through the doctors2 but he had to call them in just the same4 ,napoleon had no illusions about them2 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 medicine4 ,in this predicament most people1 to save themselves from unbearable mistrust and misery1 or from being driven by their conscience into actual conflict with the law1 fall back on the old rule that if you cannot have what you believe in you must believe in what you have4 ,when your child is ill or your wife dying1 and you happen to be very fond of them1 or even when1 if you are not fond of them1 you are human enough to forget every personal grudge before the spectacle of a fellow creature in pain or peril1 what you want is comfort1 reassurance1 something to clutch at1 were it but a straw4 ,this the doctor brings you4 ,you have a wildly urgent feeling that something must be done2 and the doctor does something4 ,sometimes what he does kills the patient2 but you do not know that2 and the doctor assures you that all that human skill could do has been done4 ,and nobody has the brutality to say to the newly bereft father1 mother1 husband1 wife1 brother1 or sister1 ,you have killed your lost darling by your credulity4 ,,the ,,peculiar ,,people ,besides1 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 taken4 ,we are subject to prosecution for manslaughter or for criminal neglect if the patient dies without the consolations of the medical profession4 ,this menace is kept before the public by the ,peculiar ,people4 ,the ,peculiars1 as they are called1 have gained their name by believing that the ,bible is infallible1 and taking their belief quite seriously4 ,the ,bible is very clear as to the treatment of illness4 ,the ,epistle of ,james2 chapter v41 contains the following explicit directions3 #ad4 ,is any sick among you8 let him call for the elders of the ,church2 and let them pray over him1 anointing him with oil in the name of the ,lord3 #ae4 ,and the prayer of faith shall save the sick1 and the ,lord shall raise him up2 and if he have committed sins1 they shall be forgiven him4 ,the ,peculiars obey these instructions and dispense with doctors4 ,they are therefore prosecuted for manslaughter when their children die4 ,when ,i was a young man1 the ,peculiars were usually acquitted4 ,the prosecution broke down when the doctor in the witness box was asked whether1 if the child had had medical attendance1 it would have lived4 ,it was1 of course1 impossible for any man of sense and honor to assume divine omniscience by answering this in the affirmative1 or indeed pretending to be able to answer it at all4 ,and on this the judge had to instruct the jury that they must acquit the prisoner4 ,thus a judge with a keen sense of law 7a very rare phenomenon on the ,bench1 by the way7 was spared the possibility of leaving to sentence one prisoner 7under the ,blasphemy laws7 for questioning the authority of ,scripture1 and another for ignorantly and superstitiously accepting it as a guide to conduct4 ,to-day all this is changed4 ,the doctor never hesitates to claim divine omniscience1 nor to clamor for laws to punish any scepticism on the part of laymen4 ,a modern doctor thinks nothing of signing the death certificate of one of his own diphtheria patients1 and then going into the witness box and swearing a peculiar into prison for six months by assuring the jury1 on oath1 that if the prisoner's child1 dead of diphtheria1 had been placed under his treatment instead of that of ,st4 ,james1 it would not have lived4 ,and he does so not only with impunity1 but with public applause1 though the logical course would be to prosecute him either for the murder of his own patient or for perjury in the case of ,st4 ,james4 ,yet no barrister1 apparently1 dreams of asking for the statistics of the relative case-mortality in diphtheria among the ,peculiars and among the believers in doctors1 on which alone any valid opinion could be founded4 ,the barrister is as superstitious as the doctor is infatuated2 and the ,peculiar goes unpitied to his cell1 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 care4 ,,recoil ,,of ,,the ,,dogma ,,of ,,medical ,,infallibility ,,on ,,the ,,doctor ,on the other hand1 when the doctor is in the dock1 or is the defendant in an action for malpractice1 he has to struggle against the inevitable result of his former pretences to infinite knowledge and unerring skill4 ,he has taught the jury and the judge1 and even his own counsel1 to believe that every doctor can1 with a glance at the tongue1 a touch on the pulse1 and a reading of the clinical thermometer1 diagnose with absolute certainty a patient's complaint1 also that on dissecting a dead body he can infallibly put his finger on the cause of death1 and1 in cases where poisoning is suspected1 the nature of the poison used4 ,now all this supposed exactness and infallibility is imaginary2 and to treat a doctor as if his mistakes were necessarily malicious or corrupt malpractices 7an inevitable deduction from the postulate that the doctor1 being omniscient1 cannot make mistakes7 is as unjust as to blame the nearest apothecary for not being prepared to supply you with sixpenny-worth of the elixir of life1 or the nearest motor garage for not having perpetual motion on sale in gallon tins4 ,but if apothecaries and motor car makers habitually advertized elixir of life and perpetual motion1 and succeeded in creating a strong general belief that they could supply it1 they would find themselves in an awkward position if they were indicted for allowing a customer to die1 or for burning a chauffeur by putting petrol into his car4 ,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 fallibility4 ,his plea is received with flat credulity2 and he gets little sympathy1 even from laymen who know1 because he has brought the incredulity on himself4 ,if he escapes1 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 witchcraft2 that diagnosis1 though it means in many instances 7including even the identification of pathogenic bacilli under the microscope7 only a choice among terms so loose that they would not be accepted as definitions in any really exact science1 is1 even at that1 an uncertain and difficult matter on which doctors often differ2 and that the very best medical opinion and treatment varies widely from doctor to doctor1 one practitioner prescribing six or seven scheduled poisons for so familiar a disease as enteric fever where another will not tolerate drugs at all2 one starving a patient whom another would stuff2 one urging an operation which another would regard as unnecessary and dangerous2 one giving alcohol and meat which another would sternly forbid1 etc41 etc41 etc43 all these discrepancies arising not between the opinion of good doctors and bad ones 7the medical contention is1 of course1 that a bad doctor is an impossibility71 but between practitioners of equal eminence and authority4 ,usually it is impossible to persuade the jury that these facts are facts4 ,juries seldom notice facts2 and they have been taught to regard any doubts of the omniscience and omnipotence of doctors as blasphemy4 ,even the fact that doctors themselves die of the very diseases they profess to cure passes unnoticed4 ,we do not shoot out our lips and shake our heads1 saying1 ,they save others3 themselves they cannot save3 their reputation stands1 like an ,african king's palace1 on a foundation of dead bodies2 and the result is that the verdict goes against the defendant when the defendant is a doctor accused of malpractice4 ,fortunately for the doctors1 they very seldom find themselves in this position1 because it is so difficult to prove anything against them4 ,the only evidence that can decide a case of malpractice is expert evidence3 that is1 the evidence of other doctors2 and every doctor will allow a colleague to decimate a whole countryside sooner than violate the bond of professional etiquet by giving him away4 ,it is the nurse who gives the doctor away in private1 because every nurse has some particular doctor whom she likes2 and she usually assures her patients that all the others are disastrous noodles1 and soothes the tedium of the sick-bed by gossip about their blunders4 ,she will even give a doctor away for the sake of making the patient believe that she knows more than the doctor4 ,but she dare not1 for her livelihood1 give the doctor away in public4 ,and the doctors stand by one another at all costs4 ,now and then some doctor in an unassailable position1 like the late ,sir ,william ,gull1 will go into the witness box and say what he really thinks about the way a patient has been treated2 but such behavior is considered little short of infamous by his colleagues4 ,,why ,,doctors ,,do ,,not ,,differ ,the truth is1 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 right4 ,yet the two guinea man never thinks that the five shilling man is right3 if he did1 he would be understood as confessing to an overcharge of one pound seventeen shillings2 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 mark4 ,thus even the layman has to be taught that infallibility is not quite infallible1 because there are two qualities of it to be had at two prices4 ,but there is no agreement even in the same rank at the same price4 ,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 day1 and published their advice and prescriptions2 a proceeding passionately denounced by the medical papers as a breach of confidence of these eminent physicians4 ,the case was the same2 but the prescriptions were different1 and so was the advice4 ,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 same4 ,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 errors1 and that the theory of their omniscience and omnipotence no more holds good among themselves than it did with ,moliere and ,napoleon4 ,but for this very reason no doctor dare accuse another of malpractice4 ,he is not sure enough of his own opinion to ruin another man by it4 ,he knows that if such conduct were tolerated in his profession no doctor's livelihood or reputation would be worth a year's purchase4 ,i do not blame him3 ,i would do the same myself4 ,but the effect of this state of things is to make the medical profession a conspiracy to hide its own shortcomings4 ,no doubt the same may be said of all professions4 ,they are all conspiracies against the laity2 and ,i do not suggest that the medical conspiracy is either better or worse than the military conspiracy1 the legal conspiracy1 the sacerdotal conspiracy1 the pedagogic conspiracy1 the royal and aristocratic conspiracy1 the literary and artistic conspiracy1 and the innumerable industrial1 commercial1 and financial conspiracies1 from the trade unions to the great exchanges1 which make up the huge conflict which we call society4 ,but it is less suspected4 ,the ,radicals who used to advocate1 as an indispensable preliminary to social reform1 the strangling of the last king with the entrails of the last priest1 substituted compulsory vaccination for compulsory baptism without a murmur4 ,,the ,,craze ,,for ,,operations ,thus everything is on the side of the doctor4 ,when men die of disease they are said to die from natural causes4 ,when they recover 7and they mostly do7 the doctor gets the credit of curing them4 ,in surgery all operations are recorded as successful if the patient can be got out of the hospital or nursing home alive1 though the subsequent history of the case may be such as would make an honest surgeon vow never to recommend or perform the operation again4 ,the large range of operations which consist of amputating limbs and extirpating organs admits of no direct verification of their necessity4 ,there is a fashion in operations as there is in sleeves and skirts3 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 doctors1 but actually among their patients4 ,there are men and women whom the operating table seems to fascinate2 half-alive people who through vanity1 or hypochondria1 or a craving to be the constant objects of anxious attention or what not1 lose such feeble sense as they ever had of the value of their own organs and limbs4 ,they seem to care as little for mutilation as lobsters or lizards1 which at least have the excuse that they grow new claws and new tails if they lose the old ones4 ,whilst this book was being prepared for the press a case was tried in the ,courts1 of a man who sued a railway company for damages because a train had run over him and amputated both his legs4 ,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 company1 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 hopes4 ,thus amazing case makes it possible to say1 with some prospect of being believed1 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 integrity1 7including the capacity for parentage7 and the pleasure of talking about themselves and hearing themselves talked about as the heroes and heroines of sensational operations1 that they tempt surgeons to operate on them not only with large fees1 but with personal solicitation4 ,now it cannot be too often repeated that when an operation is once performed1 nobody can ever prove that it was unnecessary4 ,if ,i refuse to allow my leg to be amputated1 its mortification and my death may prove that ,i was wrong2 but if ,i let the leg go1 nobody can ever prove that it would not have mortified had ,i been obstinate4 ,operation is therefore the safe side for the surgeon as well as the lucrative side4 ,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 it1 and who are sought after by the people who have vitality enough to regard an operation as a last resort4 ,but no surgeon is bound to take the conservative view4 ,if he believes that an organ is at best a useless survival1 and that if he extirpates it the patient will be well and none the worse in a fortnight1 whereas to await the natural cure would mean a month's illness1 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 be4 ,thus the conservative surgeon and the radical or extirpatory surgeon may both be right as far as the ultimate cure is concerned2 so that their consciences do not help them out of their differences4 ,,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 intensity1 without observation or reasoning1 and even in defiance of both1 by the simple desire to believe founded on a strong interest in believing4 ,everybody recognizes this in the case of the amatory infatuations of the adolescents who see angels and heroes in obviously 7to others7 commonplace and even objectionable maidens and youths4 ,but it holds good over the entire field of human activity4 ,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 irresistible4 ,the cobbler believes that there is nothing like leather4 ,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 conquered4 ,doctors are no more proof against such illusions than other men4 ,can anyone then doubt that under existing conditions a great deal of unnecessary and mischievous operating is bound to go on1 and that patients are encouraged to imagine that modern surgery and anesthesia have made operations much less serious matters than they really are8 ,when doctors write or speak to the public about operations1 they imply1 and often say in so many words1 that chloroform has made surgery painless4 ,people who have been operated on know better4 ,the patient does not feel the knife1 and the operation is therefore enormously facilitated for the surgeon2 but the patient pays for the anesthesia with hours of wretched sickness2 and when that is over there is the pain of the wound made by the surgeon1 which has to heal like any other wound4 ,this is why operating surgeons1 who are usually out of the house with their fee in their pockets before the patient has recovered consciousness1 and who therefore see nothing of the suffering witnessed by the general practitioner and the nurse1 occasionally talk of operations very much as the hangman in ,barnaby ,rudge talked of executions1 as if being operated on were a luxury in sensation as well as in price4 ,,medical ,,poverty ,to make matters worse1 doctors are hideously poor4 ,the ,irish gentleman doctor of my boyhood1 who took nothing less than a guinea1 though he might pay you four visits for it1 seems to have no equivalent nowadays in ,english society4 ,better be a railway porter than an ordinary ,english general practitioner4 ,a railway porter has from eighteen to twenty-three shillings a week from the ,company merely as a retainer2 and his additional fees from the public1 if we leave the third-class twopenny tip out of account 7and ,i am by no means sure that even this reservation need be made71 are equivalent to doctor's fees in the case of second-class passengers1 and double doctor's fees in the case of first4 ,any class of educated men thus treated tends to become a brigand class1 and doctors are no exception to the rule4 ,they are offered disgraceful prices for advice and medicine4 ,their patients are for the most part so poor and so ignorant that good advice would be resented as impracticable and wounding4 ,when you are so poor that you cannot afford to refuse eighteenpence from a man who is too poor to pay you any more1 it is useless to tell him that what he or his sick child needs is not medicine1 but more leisure1 better clothes1 better food1 and a better drained and ventilated house4 ,it is kinder to give him a bottle of something almost as cheap as water1 and tell him to come again with another eighteenpence if it does not cure him4 ,when you have done that over and over again every day for a week1 how much scientific conscience have you left8 ,if you are weak-minded enough to cling desperately to your eighteenpence as denoting a certain social superiority to the sixpenny doctor1 you will be miserably poor all your life2 whilst the sixpenny doctor1 with his low prices and quick turnover of patients1 visibly makes much more than you do and kills no more people4 ,a doctor's character can no more stand out against such conditions than the lungs of his patients can stand out against bad ventilation4 ,the only way in which he can preserve his self-respect is by forgetting all he ever learnt of science1 and clinging to such help as he can give without cost merely by being less ignorant and more accustomed to sick-beds than his patients4 ,finally1 he acquires a certain skill at nursing cases under poverty-stricken domestic conditions1 just as women who have been trained as domestic servants in some huge institution with lifts1 vacuum cleaners1 electric lighting1 steam heating1 and machinery that turns the kitchen into a laboratory and engine house combined1 manage1 when they are sent out into the world to drudge as general servants1 to pick up their business in a new way1 learning the slatternly habits and wretched makeshifts of homes where even bundles of kindling wood are luxuries to be anxiously economized4 ,,the ,,successful ,,doctor ,the doctor whose success blinds public opinion to medical poverty is almost as completely demoralized4 ,his promotion means that his practice becomes more and more confined to the idle rich4 ,the proper advice for most of their ailments is typified in ,abernethy's ,live on sixpence a day and earn it4 ,but here1 as at the other end of the scale1 the right advice is neither agreeable nor practicable4 ,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 doctor4 ,operations enable a surgeon to earn similar sums in a couple of hours2 and if the surgeon also keeps a nursing home1 he may make considerable profits at the same time by running what is the most expensive kind of hotel4 ,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 one4 ,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 doctor4 ,he always has plenty of genuine cases which can afford genuine treatment2 and these provide him with enough sincere scientific professional work to save him from the ignorance1 obsolescence1 and atrophy of scientific conscience into which his poorer colleagues sink4 ,but on the other hand his expenses are enormous4 ,even as a bachelor1 he must1 at ,london west end rates1 make over a thousand a year before he can afford even to insure his life4 ,his house1 his servants1 and his equipage 7or autopage7 must be on the scale to which his patients are accustomed1 though a couple of rooms with a camp bed in one of them might satisfy his own requirements4 ,above all1 the income which provides for these outgoings stops the moment he himself stops working4 ,unlike the man of business1 whose managers1 clerks1 warehousemen and laborers keep his business going whilst he is in bed or in his club1 the doctor cannot earn a farthing by deputy4 ,though he is exceptionally exposed to infection1 and has to face all weathers at all hours of the night and day1 often not enjoying a complete night's rest for a week1 the money stops coming in the moment he stops going out2 and therefore illness has special terrors for him1 and success no certain permanence4 ,he dare not stop making hay while the sun shines2 for it may set at any time4 ,men do not resist pressure of this intensity4 ,when they come under it as doctors they pay unnecessary visits2 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 finger2 they conspire with surgeons to promote operations2 they nurse the delusions of the malade imaginaire 7who is always really ill because1 as there is no such thing as perfect health1 nobody is ever really well72 they exploit human folly1 vanity1 and fear of death as ruthlessly as their own health1 strength1 and patience are exploited by selfish hypochondriacs4 ,they must do all these things or else run pecuniary risks that no man can fairly be asked to run4 ,and the healthier the world becomes1 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 corruption4 ,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 gin1 has to help a mother through child-bearing often enough to feel that he is not living wholly in vain4 ,,the ,,psychology ,,of ,,self-,,respect ,,in ,,surgeons ,the surgeon1 though often more unscrupulous than the general practitioner1 retains his self-respect more easily4 ,the human conscience can subsist on very questionable food4 ,no man who is occupied in doing a very difficult thing1 and doing it very well1 ever loses his self-respect4 ,the shirk1 the duffer1 the malingerer1 the coward1 the weakling1 may be put out of countenance by his own failures and frauds2 but the man who does evil skilfully1 energetically1 masterfully1 grows prouder and bolder at every crime4 ,the common man may have to found his self-respect on sobriety1 honesty and industry2 but a ,napoleon needs no such props for his sense of dignity4 ,if ,nelson's conscience whispered to him at all in the silent watches of the night1 you may depend on it it whispered about the ,baltic and the ,nile and ,cape ,st4 ,vincent1 and not about his unfaithfulness to his wife4 ,a man who robs little children when no one is looking can hardly have much self-respect or even self-esteem2 but an accomplished burglar must be proud of himself4 ,in the play to which ,i am at present preluding ,i have represented an artist who is so entirely satisfied with his artistic conscience1 even to the point of dying like a saint with its support1 that he is utterly selfish and unscrupulous in every other relation without feeling at the smallest disadvantage4 ,the same thing may be observed in women who have a genius for personal attractiveness3 they expend more thought1 labor1 skill1 inventiveness1 taste and endurance on making themselves lovely than would suffice to keep a dozen ugly women honest2 and this enables them to maintain a high opinion of themselves1 and an angry contempt for unattractive and personally careless women1 whilst they lie and cheat and slander and sell themselves without a blush4 ,the truth is1 hardly any of us have ethical energy enough for more than one really inflexible point of honor4 ,andrea del ,sarto1 like ,louis ,dubedat in my play1 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 churchwardens2 but 7if ,vasari is to be believed7 when the ,king of ,france entrusted him with money to buy pictures for him1 he stole it to spend on his wife4 ,such cases are not confined to eminent artists4 ,unsuccessful1 unskilful men are often much more scrupulous than successful ones4 ,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 strong1 indefatigable1 and skilful1 and who therefore are bold in a high opinion of themselves2 but they are selfish and tyrannical1 gluttonous and drunken1 as their wives and children know to their cost4 ,not only do these talented energetic people retain their self-respect through shameful misconduct3 they do not even lose the respect of others1 because their talents benefit and interest everybody1 whilst their vices affect only a few4 ,an actor1 a painter1 a composer1 an author1 may be as selfish as he likes without reproach from the public if only his art is superb2 and he cannot fulfil his condition without sufficient effort and sacrifice to make him feel noble and martyred in spite of his selfishness4 ,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 him4 ,in sacrificing others to himself he is sacrificing them to the public he gratifies2 and the public is quite content with that arrangement4 ,the public actually has an interest in the artist's vices4 ,it has no such interest in the surgeon's vices4 ,the surgeon's art is exercised at its expense1 not for its gratification4 ,we do not go to the operating table as we go to the theatre1 to the picture gallery1 to the concert room1 to be entertained and delighted3 we go to be tormented and maimed1 lest a worse thing should befall us4 ,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 of2 should judge our cases scientifically2 and should feel about them kindly4 ,let us see what guarantees we have3 first for the science1 and then for the kindness4 ,,are ,,doctors ,,men ,,of ,,science8 ,i presume nobody will question the existence of widely spread popular delusion that every doctor is a titan of science4 ,it is escaped only in the very small class which understands by science something more than conjuring with retorts and spirit lamps1 magnets and microscopes1 and discovering magical cures for disease4 ,to a sufficiently ignorant man every captain of a trading schooner is a ,galileo1 every organ-grinder a ,beethoven1 every piano-tuner a ,hemholtz1 every ,old ,bailey barrister a ,solon1 every ,seven ,dials pigeon dealer a ,darwin1 every scrivener a ,shakespear1 every locomotive engine a miracle1 and its driver no less wonderful than ,george ,stephenson4 ,as a matter of fact1 the rank and file of doctors are no more scientific than their tailors2 or1 if you prefer to put it the reverse way1 their tailors are no less scientific than they4 ,doctoring is an art1 not a science3 any layman who is interested in science sufficiently to take in one of the scientific journals and follow the literature of the scientific movement1 knows more about it than those doctors 7probably a large majority7 who are not interested in it1 and practise only to earn their bread4 ,doctoring is not even the art of keeping people in health 7no doctor seems able to advise you what to eat any better than his grandmother or the nearest quack73 it is the art of curing illnesses4 ,it does happen exceptionally that a practising doctor makes a contribution to science 7my play describes a very notable one72 but it happens much oftener that he draws disastrous conclusions from his clinical experience because he has no conception of scientific method1 and believes1 like any rustic1 that the handling of evidence and statistics needs no expertness4 ,the distinction between a quack doctor and a qualified one is mainly that only the qualified one is authorized to sign death certificates1 for which both sorts seem to have about equal occasion4 ,unqualified practitioners now make large incomes as hygienists1 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 dupes4 ,bone-setters make fortunes under the very noses of our greatest surgeons from educated and wealthy patients2 and some of the most successful doctors on the register use quite heretical methods of treating disease1 and have qualified themselves solely for convenience4 ,leaving out of account the village witches who prescribe spells and sell charms1 the humblest professional healers in this country are the herbalists4 ,these men wander through the fields on ,sunday seeking for herbs with magic properties of curing disease1 preventing childbirth1 and the like4 ,each of them believes that he is on the verge of a great discovery1 in which ,virginia ,snake ,root will be an ingredient1 heaven knows why6 ,virginia ,snake ,root fascinates the imagination of the herbalist as mercury used to fascinate the alchemists4 ,on week days he keeps a shop in which he sells packets of pennyroyal1 dandelion1 etc41 labelled with little lists of the diseases they are supposed to cure1 and apparently do cure to the satisfaction of the people who keep on buying them4 ,i have never been able to perceive any distinction between the science of the herbalist and that of the duly registered doctor4 ,a relative of mine recently consulted a doctor about some of the ordinary symptoms which indicate the need for a holiday and a change4 ,the doctor satisfied himself that the patient's heart was a little depressed4 ,digitalis being a drug labelled as a heart specific by the profession1 he promptly administered a stiff dose4 ,fortunately the patient was a hardy old lady who was not easily killed4 ,she recovered with no worse result than her conversion to ,christian ,science1 which owes its vogue quite as much to public despair of doctors as to superstition4 ,i am not1 observe1 here concerned with the question as to whether the dose of digitalis was judicious or not2 the point is1 that a farm laborer consulting a herbalist would have been treated in exactly the same way4 ,,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 be4 ,wise men used to take care to consult doctors qualified before #ahfj1 who were usually contemptuous of or indifferent to the germ theory and bacteriological therapeutics2 but now that these veterans have mostly retired or died1 we are left in the hands of the generations which1 having heard of microbes much as ,st4 ,thomas ,aquinas heard of angels1 suddenly concluded that the whole art of healing could be summed up in the formula3 ,find the microbe and kill it4 ,and even that they did not know how to do4 ,the simplest way to kill most microbes is to throw them into an open street or river and let the sun shine on them1 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 it4 ,but doctors instinctively avoid all facts that are reassuring1 and eagerly swallow those that make it a marvel that anyone could possibly survive three days in an atmosphere consisting mainly of countless pathogenic germs4 ,they conceive microbes as immortal until slain by a germicide administered by a duly qualified medical man4 ,all through ,europe people are adjured1 by public notices and even under legal penalties1 not to throw their microbes into the sunshine1 but to collect them carefully in a handkerchief2 shield the handkerchief from the sun in the darkness and warmth of the pocket2 and send it to a laundry to be mixed up with everybody else's handkerchiefs1 with results only too familiar to local health authorities4 ,in the first frenzy of microbe killing1 surgical instruments were dipped in carbolic oil1 which was a great improvement on not dipping them in anything at all and simply using them dirty2 but as microbes are so fond of carbolic oil that they swarm in it1 it was not a success from the anti-microbe point of view4 ,formalin was squirted into the circulation of consumptives until it was discovered that formalin nourishes the tubercle bacillus handsomely and kills men4 ,the popular theory of disease is the common medical theory3 namely1 that every disease had its microbe duly created in the garden of ,eden1 and has been steadily propagating itself and producing widening circles of malignant disease ever since4 ,it was plain from the first that if this had been even approximately true1 the whole human race would have been wiped out by the plague long ago1 and that every epidemic1 instead of fading out as mysteriously as it rushed in1 would spread over the whole world4 ,it was also evident that the characteristic microbe of a disease might be a symptom instead of a cause4 ,an unpunctual man is always in a hurry2 but it does not follow that hurry is the cause of unpunctuality3 on the contrary1 what is the matter with the patient is sloth4 ,when ,florence ,nightingale said bluntly that if you overcrowded your soldiers in dirty quarters there would be an outbreak of smallpox among them1 she was snubbed as an ignorant female who did not know that smallpox can be produced only by the importation of its specific microbe4 ,if this was the line taken about smallpox1 the microbe of which has never yet been run down and exposed under the microscope by the bacteriologist1 what must have been the ardor of conviction as to tuberculosis1 tetanus1 enteric fever1 ,maltese fever1 diphtheria1 and the rest of the diseases in which the characteristic bacillus had been identified6 ,when there was no bacillus it was assumed that1 since no disease could exist without a bacillus1 it was simply eluding observation4 ,when the bacillus was found1 as it frequently was1 in persons who were not suffering from the disease1 the theory was saved by simply calling the bacillus an impostor1 or pseudobacillus4 ,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 hunters4 ,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 lungs1 for seven-and-sixpense4 ,i do not suggest that the analysts were dishonest4 ,no doubt they carried the analysis as far as they could afford to carry it for the money4 ,no doubt also they could afford to carry it far enough to be of some use4 ,but the fact remains that just as doctors perform for half-a-crown1 without the least misgiving1 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 pounds1 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 fare4 ,,economic ,,difficulties ,,of ,,immunization ,i have heard doctors affirm and deny almost every possible proposition as to disease and treatment4 ,i can remember the time when doctors no more dreamt of consumption and pneumonia being infectious than they now dream of sea-sickness being infectious1 or than so great a clinical observer as ,sydenham dreamt of smallpox being infectious4 ,i have heard doctors deny that there is such a thing as infection4 ,i have heard them deny the existence of hydrophobia as a specific disease differing from tetanus4 ,i have heard them defend prophylactic measures and prophylactic legislation as the sole and certain salvation of mankind from zymotic disease2 and ,i have heard them denounce both as malignant spreaders of cancer and lunacy4 ,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 system4 ,they buy some stuff from somebody for a shilling1 and inject a pennyworth of it under their patient's skin for half-a-crown1 concluding that1 since this primitive rite pays the somebody and pays them1 the problem of prophylaxis has been satisfactorily solved4 ,the results are sometimes no worse than the ordinary results of dirt getting into cuts2 but neither the doctor nor the patient is quite satisfied unless the inoculation takes2 that is1 unless it produces perceptible illness and disablement4 ,sometimes both doctor and patient get more value in this direction than they bargain for4 ,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 known2 and doctors1 to save the credit of the inoculation1 have been driven to accuse their patient or their patient's parents of having contracted this disease independently of the inoculation1 an excuse which naturally does not make the family any more resigned1 and leads to public recriminations in which the doctors1 forgetting everything but the immediate quarrel1 naively excuse themselves by admitting1 and even claiming as a point in their favor1 that it is often impossible to distinguish the disease produced by their inoculation and the disease they have accused the patient of contracting4 ,and both parties assume that what is at issue is the scientific soundness of the prophylaxis4 ,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 catastrophe1 and that the casual dirt introduced with it may be at fault4 ,when1 as in the case of smallpox or cowpox1 the germ has not yet been detected1 what you inoculate is simply undefined matter that has been scraped off an anything but chemically clean calf suffering from the disease in question4 ,you take your chance of the germ being in the scrapings1 and1 lest you should kill it1 you take no precautions against other germs being in it as well4 ,anything may happen as the result of such an inoculation4 ,yet this is the only stuff of the kind which is prepared and supplied even in ,state establishments3 that is1 in the only establishments free from the commercial temptation to adulterate materials and scamp precautionary processes4 ,even if the germ were identified1 complete precautions would hardly pay4 ,it is true that microbe farming is not expensive4 ,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 it4 ,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 beefsteaks4 ,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 pins4 ,,the ,,perils ,,of ,,inoculation ,the trouble does not end with the matter to be inoculated4 ,there is the question of the condition of the patient4 ,the discoveries of ,sir ,almroth ,wright have shown that the appalling results which led to the hasty dropping in #ahid of ,koch's tuberculin were not accidents1 but perfectly orderly and inevitable phenomena following the injection of dangerously strong vaccines at the wrong moment1 and reinforcing the disease instead of stimulating the resistance to it4 ,to ascertain the right moment a laboratory and a staff of experts are needed4 ,the general practitioner1 having no such laboratory and no such experience1 has always chanced it1 and insisted1 when he was unlucky1 that the results were not due to the inoculation1 but to some other cause3 a favorite and not very tactful one being the drunkenness or licentiousness of the patient4 ,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 inoculation1 and though those other doctors who are denouncing the danger as imaginary and opsonin as a craze or a fad1 obviously do so because it involves an operation which they have neither the means nor the knowledge to perform1 there is still no grasp of the economic change in the situation4 ,they have never been warned that the practicability of any method of extirpating disease depends not only on its efficacy1 but on its cost4 ,for example1 just at present the world has run raving mad on the subject of radium1 which has excited our credulity precisely as the apparitions at ,lourdes excited the credulity of ,roman ,catholics4 ,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 milk4 ,the world would be none the healthier1 because not even a ,crown ,prince--no1 not even the son of a ,chicago ,meat ,king1 could afford the treatment4 ,yet it is doubtful whether doctors would refrain from prescribing it on that ground4 ,the recklessness with which they now recommend wintering in ,egypt or at ,davos to people who cannot afford to go to ,cornwall1 and the orders given for champagne jelly and old port in households where such luxuries must obviously be acquired at the cost of stinting necessaries1 often make one wonder whether it is possible for a man to go through a medical training and retain a spark of common sense4 ,this sort of inconsiderateness gets cured only in the classes where poverty1 pretentious as it is even at its worst1 cannot pitch its pretences high enough to make it possible for the doctor 7himself often no better off than the patient7 to assume that the average income of an ,english family is about #b1jjj pounds a year1 and that it is quite easy to break up a home1 sell an old family seat at a sacrifice1 and retire into a foreign sanatorium devoted to some treatment that did not exist two years ago and probably will not exist 7except as a pretext for keeping an ordinary hotel7 two years hence4 ,in a poor practice the doctor must find cheap treatments for cheap people1 or humiliate and lose his patients either by prescribing beyond their means or sending them to the public hospitals4 ,when it comes to prophylactic inoculation1 the alternative lies between the complete scientific process1 which can only be brought down to a reasonable cost by being very highly organized as a public service in a public institution1 and such cheap1 nasty1 dangerous and scientifically spurious imitations as ordinary vaccination1 which seems not unlikely to be ended1 like its equally vaunted forerunner1 ,,xviii4 century inoculation1 by a purely reactionary law making all sorts of vaccination1 scientific or not1 criminal offences4 ,naturally1 the poor doctor 7that is1 the average doctor7 defends ordinary vaccination frantically1 as it means to him the bread of his children4 ,to secure the vehement and practically unanimous support of the rank and file of the medical profession for any sort of treatment or operation1 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 assistance1 and that the materials for it shall cost1 say1 a penny1 and the charge for it to a patient with #ajj pounds a year be half-a-crown4 ,and1 on the other hand1 a hygienic measure has only to be one of such refinement1 difficulty1 precision and costliness as to be quite beyond the resources of private practice1 to be ignored or angrily denounced as a fad4 ,,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 one4 ,it has really nothing to do with science4 ,the medical profession1 consisting for the most part of very poor men struggling to keep up appearances beyond their means1 find themselves threatened with the extinction of a considerable part of their incomes3 a part1 too1 that is easily and regularly earned1 since it is independent of disease1 and brings every person born into the nation1 healthy or not1 to the doctors4 ,to boot1 there is the occasional windfall of an epidemic1 with its panic and rush for revaccination4 ,under such circumstances1 vaccination would be defended desperately were it twice as dirty1 dangerous1 and unscientific in method as it actually is4 ,the note of fury in the defence1 the feeling that the anti-vaccinator is doing a cruel1 ruinous1 inconsiderate thing in a mood of indignant folly3 all this1 so puzzling to the observer who knows nothing of the economic side of the question1 and only sees that the anti-vaccinator1 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 penalties1 can have no interest in the matter except the interest of a reformer in abolishing a corrupt and mischievous superstition1 becomes intelligible the moment the tragedy of medical poverty and the lucrativeness of cheap vaccination is taken into account4 ,in the face of such economic pressure as this1 it is silly to expect that medical teaching1 any more than medical practice1 can possibly be scientific4 ,the test to which all methods of treatment are finally brought is whether they are lucrative to doctors or not4 ,it would be difficult to cite any proposition less obnoxious to science1 than that advanced by ,hahnemann3 to wit1 that drugs which in large doses produce certain symptoms1 counteract them in very small doses1 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 it4 ,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 swallow4 ,these two cases of ordinary vaccination and homeopathy are typical of all the rest4 ,just as the object of a trade union under existing conditions must finally be1 not to improve the technical quality of the work done by its members1 but to secure a living wage for them1 so the object of the medical profession today is to secure an income for the private doctor2 and to this consideration all concern for science and public health must give way when the two come into conflict4 ,fortunately they are not always in conflict4 ,up to a certain point doctors1 like carpenters and masons1 must earn their living by doing the work that the public wants from them2 and as it is not in the nature of things possible that such public want should be based on unmixed disutility1 it may be admitted that doctors have their uses1 real as well as imaginary4 ,but just as the best carpenter or mason will resist the introduction of a machine that is likely to throw him out of work1 or the public technical education of unskilled laborers' sons to compete with him1 so the doctor will resist with all his powers of persecution every advance of science that threatens his income4 ,and as the advance of scientific hygiene tends to make the private doctor's visits rarer1 and the public inspector's frequenter1 whilst the advance of scientific therapeutics is in the direction of treatments that involve highly organized laboratories1 hospitals1 and public institutions generally1 it unluckily happens that the organization of private practitioners which we call the medical profession is coming more and more to represent1 not science1 but desperate and embittered antiscience3 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 livelihood4 ,so much for our guarantees as to medical science4 ,let us now deal with the more painful subject of medical kindness4 ,,doctors ,,and ,,vivisection ,the importance to our doctors of a reputation for the tenderest humanity is so obvious1 and the quantity of benevolent work actually done by them for nothing 7a great deal of it from sheer good nature7 so large1 that at first sight it seems unaccountable that they should not only throw all their credit away1 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 law1 of honor1 of pity1 of remorse1 of everything that distinguishes an orderly citizen from a ,south ,sea buccaneer1 or a philosopher from an inquisitor4 ,for here we look in vain for either an economic or a sentimental motive4 ,in every generation fools and blackguards have made this claim2 and honest and reasonable men1 led by the strongest contemporary minds1 have repudiated it and exposed its crude rascality4 ,from ,shakespear and ,dr4 ,johnson to ,ruskin and ,mark ,twain1 the natural abhorrence of sane mankind for the vivisector's cruelty1 and the contempt of able thinkers for his imbecile casuistry1 have been expressed by the most popular spokesmen of humanity4 ,if the medical profession were to outdo the ,anti-,vivisection ,societies in a general professional protest against the practice and principles of the vivisectors1 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 doctor4 ,not one doctor in a thousand is a vivisector1 or has any interest in vivisection1 either pecuniary or intellectual1 or would treat his dog cruelly or allow anyone else to do it4 ,it is true that the doctor complies with the professional fashion of defending vivisection1 and assuring you that people like ,shakespear and ,dr4 ,johnson and ,ruskin and ,mark ,twain are ignorant sentimentalists1 just as he complies with any other silly fashion3 the mystery is1 how it became the fashion in spite of its being so injurious to those who follow it4 ,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 diseases1 and the assurances of the sayers of smooth things that the practice is quite painless under the law1 it is still difficult to find any civilized motive for an attitude by which the medical profession has everything to lose and nothing to gain4 ,,the ,,primitive ,,savage ,,motive ,i say civilized motive advisedly2 for primitive tribal motives are easy enough to find4 ,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 unnaturalness4 ,we are far from being as superior to such tribes as we imagine4 ,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 escapades4 ,had he been a nineteenth-century king of ,england1 he would have had to wait for some huge accidental calamity3 a cholera epidemic1 a war1 or an insurrection1 before waking us up sufficiently to get anything done4 ,vivisection helps the doctor to rule us as ,peter ruled the ,russians4 ,the notion that the man who does dreadful things is superhuman1 and that therefore he can also do wonderful things either as ruler1 avenger1 healer1 or what not1 is by no means confined to barbarians4 ,just as the manifold wickednesses and stupidities of our criminal code are supported1 not by any general comprehension of law or study of jurisprudence1 not even by simple vindictiveness1 but by the superstition that a calamity of any sort must be expiated by a human sacrifice2 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 armament4 ,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 patient4 ,true1 this was more than two centuries ago2 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 effects2 and some more modern treatments appear to me quite as barbarous4 ,it is in this way that vivisection pays the doctor4 ,it appeals to the fear and credulity of the savage in us2 and without fear and credulity half the private doctor's occupation and seven-eighths of his influence would be gone4 ,,the ,,higher ,,motive4 ,,the ,,tree ,,of ,,knowledge4 ,but the greatest force of all on the side of vivisection is the mighty and indeed divine force of curiosity4 ,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 blood4 ,on the contrary1 the curiosity of the ape1 or of the child who pulls out the legs and wings of a fly to see what it will do without them1 or who1 on being told that a cat dropped out of the window will always fall on its legs1 immediately tries the experiment on the nearest cat from the highest window in the house 7,i protest ,i did it myself from the first floor only71 is as nothing compared to the thirst for knowledge of the philosopher1 the poet1 the biologist1 and the naturalist4 ,i have always despised ,adam because he had to be tempted by the woman1 as she was by the serpent1 before he could be induced to pluck the apple from the tree of knowledge4 ,i should have swallowed every apple on the tree the moment the owner's back was turned4 ,when ,gray said ,where ignorance is bliss1 'tis folly to be wise1 he forgot that it is godlike to be wise2 and since nobody wants bliss particularly1 or could stand more than a very brief taste of it if it were attainable1 and since everybody1 by the deepest law of the ,life ,force1 desires to be godlike1 it is stupid1 and indeed blasphemous and despairing1 to hope that the thirst for knowledge will either diminish or consent to be subordinated to any other end whatsoever4 ,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 activity2 but none the less the right to knowledge must be regarded as a fundamental human right4 ,the fact that men of science have had to fight so hard to secure its recognition1 and are still so vigorously persecuted when they discover anything that is not quite palatable to vulgar people1 makes them sorely jealous for that right2 and when they hear a popular outcry for the suppression of a method of research which has an air of being scientific1 their first instinct is to rally to the defence of that method without further consideration1 with the result that they sometimes1 as in the case of vivisection1 presently find themselves fighting on a false issue4 ,,the ,,flaw ,,in ,,the ,,argument ,i may as well pause here to explain their error4 ,the right to know is like the right to live4 ,it is fundamental and unconditional in its assumption that knowledge1 like life1 is a desirable thing1 though any fool can prove that ignorance is bliss1 and that a little knowledge is a dangerous thing 7a little being the most that any of us can attain71 as easily as that the pains of life are more numerous and constant than its pleasures1 and that therefore we should all be better dead4 ,the logic is unimpeachable2 but its only effect is to make us say that if these are the conclusions logic leads to1 so much the worse for logic1 after which curt dismissal of ,folly1 we continue living and learning by instinct3 that is1 as of right4 ,we legislate on the assumption that no man may be killed on the strength of a demonstration that he would be happier in his grave1 not even if he is dying slowly of cancer and begs the doctor to despatch him quickly and mercifully4 ,to get killed lawfully he must violate somebody else's right to live by committing murder4 ,but he is by no means free to live unconditionally4 ,in society he can exercise his right to live only under very stiff conditions4 ,in countries where there is compulsory military service he may even have to throw away his individual life to save the life of the community4 ,it is just so in the case of the right to knowledge4 ,it is a right that is as yet very imperfectly recognized in practice4 ,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 it4 ,parents and priests may forbid knowledge to those who accept their authority2 and social taboo may be made effective by acts of legal persecution under cover of repressing blasphemy1 obscenity1 and sedition2 but no government now openly forbids its subjects to pursue knowledge on the ground that knowledge is in itself a bad thing1 or that it is possible for any of us to have too much of it4 ,,limitations ,,of ,,the ,,right ,,to ,,knowledge ,but neither does any government exempt the pursuit of knowledge1 any more than the pursuit of life1 liberty1 and happiness 7as the ,american ,constitution puts it71 from all social conditions4 ,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 #ejj degrees ,fahrenheit1 no matter how important or interesting that particular addition to the store of human knowledge may be4 ,a man who did so would have short work made not only of his right to knowledge1 but of his right to live and all his other rights at the same time4 ,the right to knowledge is not the only right2 and its exercise must be limited by respect for other rights1 and for its own exercise by others4 ,when a man says to ,society1 ,may ,i torture my mother in pursuit of knowledge8 ,society replies1 ,no4 ,if he pleads1 ,what6 ,not even if ,i have a chance of finding out how to cure cancer by doing it8 ,society still says1 ,not even then4 ,if the scientist1 making the best of his disappointment1 goes on to ask may he torture a dog1 the stupid and callous people who do not realize that a dog is a fellow-creature and sometimes a good friend1 may say ,yes1 though ,shakespear1 ,dr4 ,johnson and their like may say ,no4 ,but even those who say ,you may torture ,a dog never say ,you may torture ,,my dog4 ,and nobody says1 ,yes1 because in the pursuit of knowledge you may do as you please4 ,just as even the stupidest people say1 in effect1 ,if you cannot attain to knowledge without burning your mother you must do without knowledge1 so the wisest people say1 ,if you cannot attain to knowledge without torturing a dog1 you must do without knowledge4 ,a ,,false ,,alternative ,but in practice you cannot persuade any wise man that this alternative can ever be forced on anyone but a fool1 or that a fool can be trusted to learn anything from any experiment1 cruel or humane4 ,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 dinner2 and the roast must have been spoiled after all 7a perfect type of the average vivisectionist experiment72 but this did not prove that the ,chinaman was right3 it only proved that the ,chinaman was an incapable cook and1 fundamentally1 a fool4 ,take another celebrated experiment3 one in sanitary reform4 ,in the days of ,nero ,rome was in the same predicament as ,london to-day4 ,if some one would burn down ,london1 and it were rebuilt1 as it would now have to be1 subject to the sanitary by-laws and ,building ,act provisions enforced by the ,london ,county ,council1 it would be enormously improved2 and the average lifetime of ,londoners would be considerably prolonged4 ,nero argued in the same way about ,rome4 ,he employed incendiaries to set it on fire2 and he played the harp in scientific raptures whilst it was burning4 ,i am so far of ,nero's way of thinking that ,i have often said1 when consulted by despairing sanitary reformers1 that what ,london needs to make her healthy is an earthquake4 ,why1 then1 it may be asked1 do not ,i1 as a public-spirited man1 employ incendiaries to set it on fire1 with a heroic disregard of the consequences to myself and others8 ,any vivisector would1 if he had the courage of his opinions4 ,the reasonable answer is that ,london can be made healthy without burning her down2 and that as we have not enough civic virtue to make her healthy in a humane and economical way1 we should not have enough to rebuild her in that way4 ,in the old ,hebrew legend1 ,god lost patience with the world as ,nero did with ,rome1 and drowned everybody except a single family4 ,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 spared3 things went on just as they did before4 ,in the same way1 the lists of diseases which vivisection claims to have cured is long2 but the returns of the ,registrar-,general show that people still persist in dying of them as if vivisection had never been heard of4 ,any fool can burn down a city or cut an animal open2 and an exceptionally foolish fool is quite likely to promise enormous benefits to the race as the result of such activities4 ,but when the constructive1 benevolent part of the business comes to be done1 the same want of imagination1 the same stupidity and cruelty1 the same laziness and want of perseverance that prevented ,nero or the vivisector from devising or pushing through humane methods1 prevents him from bringing order out of the chaos and happiness out of the misery he has made4 ,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 knife1 or to find out what the sun is made of without visiting it in a balloon4 ,both these impossibilities have been achieved1 but not by vivisectors4 ,the ,rontgen rays need not hurt the patient2 and spectrum analysis involves no destruction4 ,after such triumphs of humane experiment and reasoning1 it is useless to assure us that there is no other key to knowledge except cruelty4 ,when the vivisector offers us that assurance1 we reply simply and contemptuously1 ,you mean that you are not clever or humane or energetic enough to find one4 ,,cruelty ,,for ,,its ,,own ,,sake ,it will now1 ,i hope1 be clear why the attack on vivisection is not an attack on the right to knowledge3 why1 indeed1 those who have the deepest conviction of the sacredness of that right are the leaders of the attack4 ,no knowledge is finally impossible of human attainment2 for even though it may be beyond our present capacity1 the needed capacity is not unattainable4 ,consequently no method of investigation is the only method2 and no law forbidding any particular method can cut us off from the knowledge we hope to gain by it4 ,the only knowledge we lose by forbidding cruelty is knowledge at first hand of cruelty itself1 which is precisely the knowledge humane people wish to be spared4 ,but the question remains3 ,do we all really wish to be spared that knowledge8 ,are humane methods really to be preferred to cruel ones8 ,even if the experiments come to nothing1 may not their cruelty be enjoyed for its own sake1 as a sensational luxury8 ,let us face these questions boldly1 not shrinking from the fact that cruelty is one of the primitive pleasures of mankind1 and that the detection of its ,protean disguises as law1 education1 medicine1 discipline1 sport and so forth1 is one of the most difficult of the unending tasks of the legislator4 ,,our ,,own ,,cruelties ,at first blush it may seem not only unnecessary1 but even indecent1 to discuss such a proposition as the elevation of cruelty to the rank of a human right4 ,unnecessary1 because no vivisector confesses to a love of cruelty for its own sake or claims any general fundamental right to be cruel4 ,indecent1 because there is an accepted convention to repudiate cruelty2 and vivisection is only tolerated by the law on condition that1 like judicial torture1 it shall be done as mercifully as the nature of the practice allows4 ,but the moment the controversy becomes embittered1 the recriminations bandied between the opposed parties bring us face-to-face with some very ugly truths4 ,on one occasion ,i was invited to speak at a large ,anti-,vivisection meeting in the ,queen's ,hall in ,london4 ,i found myself on the platform with fox hunters1 tame stag hunters1 men and women whose calendar was divided1 not by pay days and quarter days1 but by seasons for killing animals for sport3 the fox1 the hare1 the otter1 the partridge and the rest having each its appointed date for slaughter4 ,the ladies among us wore hats and cloaks and head-dresses obtained by wholesale massacres1 ruthless trappings1 callous extermination of our fellow creatures4 ,we insisted on our butchers supplying us with white veal1 and were large and constant consumers of pate de foie gras2 both comestibles being obtained by revolting methods4 ,we sent our sons to public schools where indecent flogging is a recognized method of taming the young human animal4 ,yet we were all in hysterics of indignation at the cruelties of the vivisectors4 ,these1 if any were present1 must have smiled sardonically at such inhuman humanitarians1 whose daily habits and fashionable amusements cause more suffering in ,england in a week than all the vivisectors of ,europe do in a year4 ,i made a very effective speech1 not exclusively against vivisection1 but against cruelty2 and ,i have never been asked to speak since by that ,society1 nor do ,i expect to be1 as ,i should probably give such offence to its most affluent subscribers that its attempts to suppress vivisection would be seriously hindered4 ,but that does not prevent the vivisectors from freely using the youre another retort1 and using it with justice4 ,we must therefore give ourselves no airs of superiority when denouncing the cruelties of vivisection4 ,we all do just as horrible things1 with even less excuse4 ,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 burgling4 ,we are1 as a matter of fact1 a cruel nation2 and our habit of disguising our vices by giving polite names to the offences we are determined to commit does not1 unfortunately for my own comfort1 impose on me4 ,vivisectors can hardly pretend to be better than the classes from which they are drawn1 or those above them2 and if these classes are capable of sacrificing animals in various cruel ways under cover of sport1 fashion1 education1 discipline1 and even1 when the cruel sacrifices are human sacrifices1 of political economy1 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 science4 ,we are all tarred with the same brush2 and the vivisectors are not slow to remind us of it1 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 sport1 and whose requirements in the way of villainously cruel traps occupy pages of the catalogue of the ,army and ,navy ,stores4 ,,the ,,scientific ,,investigation ,,of ,,cruelty ,there is in man a specific lust for cruelty which infects even his passion of pity and makes it savage4 ,simple disgust at cruelty is very rare4 ,the people who turn sick and faint and those who gloat are often alike in the pains they take to witness executions1 floggings1 operations or any other exhibitions of suffering1 especially those involving bloodshed1 blows1 and laceration4 ,a craze for cruelty can be developed just as a craze for drink can2 and nobody who attempts to ignore cruelty as a possible factor in the attraction of vivisection and even of antivivisection1 or in the credulity with which we accept its excuses1 can be regarded as a scientific investigator of it4 ,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 hypothesis1 which is also simple1 human1 obvious1 and probable4 ,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 7remember ,goldsmith's anger when he was told that he could not move his upper jaw72 but science has to consider only the truth of the hypothesis1 and not whether conceited people will like it or not4 ,in vain do the sentimental champions of vivisection declare themselves the most humane of men1 inflicting suffering only to relieve it1 scrupulous in the use of anesthetics1 and void of all passion except the passion of pity for a disease-ridden world4 ,the really scientific investigator answers that the question cannot be settled by hysterical protestations1 and that if the vivisectionist rejects deductive reasoning1 he had better clear his character by his own favorite method of experiment4 ,,suggested ,,laboratory ,,tests ,,of ,,the ,,vivisector',s ,,emotions ,take the hackneyed case of the ,italian who tortured mice1 ostensibly to find out about the effects of pain rather less than the nearest dentist could have told him1 and who boasted of the ecstatic sensations 7he actually used the word love7 with which he carried out his experiments4 ,or the gentleman who starved sixty dogs to death to establish the fact that a dog deprived of food gets progressively lighter and weaker1 becoming remarkably emaciated1 and finally dying3 an undoubted truth1 but ascertainable without laboratory experiments by a simple enquiry addressed to the nearest policeman1 or1 failing him1 to any sane person in ,europe4 ,the ,italian is diagnosed as a cruel voluptuary3 the dog-starver is passed over as such a hopeless fool that it is impossible to take any interest in him4 ,why not test the diagnosis scientifically8 ,why not perform a careful series of experiments on persons under the influence of voluptuous ecstasy1 so as to ascertain its physiological symptoms8 ,then perform a second series on persons engaged in mathematical work or machine designing1 so as to ascertain the symptoms of cold scientific activity8 ,then note the symptoms of a vivisector performing a cruel experiment2 and compare them with the voluptuary symptoms and the mathematical symptoms8 ,such experiments would be quite as interesting and important as any yet undertaken by the vivisectors4 ,they might open a line of investigation which would finally make1 for instance1 the ascertainment of the guilt or innocence of an accused person a much exacter process than the very fallible methods of our criminal courts4 ,but instead of proposing such an investigation1 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 conduct4 ,,routine ,yet most vivisectors would probably come triumphant out of such a series of experiments1 because vivisection is now a routine1 like butchering or hanging or flogging2 and many of the men who practise it do so only because it has been established as part of the profession they have adopted4 ,far from enjoying it1 they have simply overcome their natural repugnance and become indifferent to it1 as men inevitably become indifferent to anything they do often enough4 ,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 passion4 ,let a routine once spring from passion1 and you will presently find thousands of routineers following it passionlessly for a livelihood4 ,thus it always seems strained to speak of the religious convictions of a clergyman1 because nine out of ten clergymen have no religions convictions3 they are ordinary officials carrying on a routine of baptizing1 marrying1 and churching2 praying1 reciting1 and preaching2 and1 like solicitors or doctors1 getting away from their duties with relief to hunt1 to garden1 to keep bees1 to go into society1 and the like4 ,in the same way many people do cruel and vile things without being in the least cruel or vile1 because the routine to which they have been brought up is superstitiously cruel and vile4 ,to say that every man who beats his children and every schoolmaster who flogs a pupil is a conscious debauchee is absurd3 thousands of dull1 conscientious people beat their children conscientiously1 because they were beaten themselves and think children ought to be beaten4 ,the ill-tempered vulgarity that instinctively strikes at and hurts a thing that annoys it 7and all children are annoying71 and the simple stupidity that requires from a child perfection beyond the reach of the wisest and best adults 7perfect truthfulness coupled with perfect obedience is quite a common condition of leaving a child unwhipped71 produce a good deal of flagellation among people who not only do not lust after it1 but who hit the harder because they are angry at having to perform an uncomfortable duty4 ,these people will beat merely to assert their authority1 or to carry out what they conceive to be a divine order on the strength of the precept of ,solomon recorded in the ,bible1 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 days4 ,in the same way we find men and women practising vivisection as senselessly as a humane butcher1 who adores his fox terrier1 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 white2 or as a ,german purveyor nails a goose to a board and stuffs it with food because fashionable people eat pate de foie gras2 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 jackets2 or as fanciers blind singing birds with hot needles1 and mutilate the ears and tails of dogs and horses4 ,let cruelty or kindness or anything else once become customary and it will be practised by people to whom it is not at all natural1 but whose rule of life is simply to do only what everybody else does1 and who would lose their employment and starve if they indulged in any peculiarity4 ,a respectable man will lie daily1 in speech and in print1 about the qualities of the article he lives by selling1 because it is customary to do so4 ,he will flog his boy for telling a lie1 because it is customary to do so4 ,he will also flog him for not telling a lie if the boy tells inconvenient or disrespectful truths1 because it is customary to do so4 ,he will give the same boy a present on his birthday1 and buy him a spade and bucket at the seaside1 because it is customary to do so1 being all the time neither particularly mendacious1 nor particularly cruel1 nor particularly generous1 but simply incapable of ethical judgment or independent action4 ,just so do we find a crowd of petty vivisectionists daily committing atrocities and stupidities1 because it is the custom to do so4 ,vivisection is customary as part of the routine of preparing lectures in medical schools4 ,for instance1 there are two ways of making the action of the heart visible to students4 ,one1 a barbarous1 ignorant1 and thoughtless way1 is to stick little flags into a rabbit's heart and let the students see the flags jump4 ,the other1 an elegant1 ingenious1 well-informed1 and instructive way1 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 paper4 ,but it has become the custom for lecturers to teach from the rabbit2 and the lecturers are not original enough to get out of their groove4 ,then there are the demonstrations which are made by cutting up frogs with scissors4 ,the most humane man1 however repugnant the operation may be to him at first1 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 paper4 ,such clumsy and lazy ways of teaching are based on the cheapness of frogs and rabbits4 ,if machines were as cheap as frogs1 engineers would not only be taught the anatomy of machines and the functions of their parts3 they would also have machines misused and wrecked before them so that they might learn as much as possible by using their eyes1 and as little as possible by using their brains and imaginations4 ,thus we have1 as part of the routine of teaching1 a routine of vivisection which soon produces complete indifference to it on the part even of those who are naturally humane4 ,if they pass on from the routine of lecture preparation1 not into general practice1 but into research work1 they carry this acquired indifference with them into the laboratory1 where any atrocity is possible1 because all atrocities satisfy curiosity4 ,the routine man is in the majority in his profession always3 consequently the moment his practice is tracked down to its source in human passion there is a great and quite sincere poohpoohing from himself1 from the mass of the profession1 and from the mass of the public1 which sees that the average doctor is much too commonplace and decent a person to be capable of passionate wickedness of any kind4 ,here then1 we have in vivisection1 as in all the other tolerated and instituted cruelties1 this anti-climax3 that only a negligible percentage of those who practise and consequently defend it get any satisfaction out of it4 ,as in ,mr4 ,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 drama1 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 laboratory4 ,not that this can exonerate any vivisector from suspicion of enjoying his work 7or her work3 a good deal of the vivisection in medical schools is done by women74 ,in every autobiography which records a real experience of school or prison life1 we find that here and there among the routineers there is to be found the genuine amateur1 the orgiastic flogging schoolmaster or the nagging warder1 who has sought out a cruel profession for the sake of its cruelty4 ,but it is the genuine routineer who is the bulwark of the practice1 because1 though you can excite public fury against a ,sade1 a ,bluebeard1 or a ,nero1 you cannot rouse any feeling against dull ,mr4 ,smith doing his duty3 that is1 doing the usual thing4 ,he is so obviously no better and no worse than anyone else that it is difficult to conceive that the things he does are abominable4 ,if you would see public dislike surging up in a moment against an individual1 you must watch one who does something unusual1 no matter how sensible it may be4 ,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 umbrella4 ,,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 household4 ,that distinction is the line that separates the brute from the man in the old classification4 ,granted1 they will plead1 that we are all cruel2 yet the tame-stag-hunter does not hunt men2 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 child4 ,the lady who gets her cloak by flaying a sable does not flay a negro2 nor does it ever occur to her that her veal cutlet might be improved on by a slice of tender baby4 ,now there was a time when some trust could be placed in this distinction4 ,the ,roman ,catholic ,church still maintains1 with what it must permit me to call a stupid obstinacy1 and in spite of ,st4 ,francis and ,st4 ,anthony1 that animals have no souls and no rights2 so that you cannot sin against an animal1 or against ,god by anything you may choose to do to an animal4 ,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 ,st4 ,francis called his little brothers1 ,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 soul4 ,that conceit has been taken out of all our men of science1 and out of all our doctors1 by the evolutionists2 and when it is considered how completely obsessed biological science has become in our days1 not by the full scope of evolution1 but by that particular method of it which has neither sense nor purpose nor life nor anything human1 much less godlike1 in it3 by the method1 that is1 of so-called ,natural ,selection 7meaning no selection at all1 but mere dead accident and luck71 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 it4 ,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 fellowship1 concedes to him also the right to put himself outside them2 for he is nothing to the vivisector but a more highly developed1 and consequently more interesting-to-experiment-on vertebrate than the dog4 ,,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 tuberculosis1 which was to inject a powerful germicide directly into the circulation by stabbing a vein with a syringe4 ,he was one of those doctors who are able to command public sympathy by saying1 quite truly1 that when they discovered that the proposed treatment was dangerous1 they experimented thenceforth on themselves4 ,in this case the doctor was devoted enough to carry his experiments to the point of running serious risks1 and actually making himself very uncomfortable4 ,but he did not begin with himself4 ,his first experiment was on two hospital patients4 ,on receiving a message from the hospital to the effect that these two martyrs to therapeutic science had all but expired in convulsions1 he experimented on a rabbit1 which instantly dropped dead4 ,it was then1 and not until then1 that he began to experiment on himself1 with the germicide modified in the direction indicated by the experiments made on the two patients and the rabbit4 ,as a good many people countenance vivisection because they fear that if the experiments are not made on rabbits they will be made on themselves1 it is worth noting that in this case1 where both rabbits and men were equally available1 the men1 being1 of course1 enormously more instructive1 and costing nothing1 were experimented on first4 ,once grant the ethics of the vivisectionists and you not only sanction the experiment on the human subject1 but make it the first duty of the vivisector4 ,if a guinea pig may be sacrificed for the sake of the very little that can be learnt from it1 shall not a man be sacrificed for the sake of the great deal that can be learnt from him8 ,at all events1 he is sacrificed1 as this typical case shows4 ,i may add 7not that it touches the argument7 that the doctor1 the patients1 and the rabbit all suffered in vain1 as far as the hoped-for rescue of the race from pulmonary consumption is concerned4 ,,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 profession1 the customary denials that patients are experimented on were as loud1 as indignant1 as high-minded as ever1 in spite of the few intelligent doctors who point out rightly that all treatments are experiments on the patient4 ,and this brings us to an obvious but mostly overlooked weakness in the vivisector's position3 that is1 his inevitable forfeiture of all claim to have his word believed4 ,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 laity4 ,when the public conscience stirs uneasily and threatens suppression1 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 painless2 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 7the much more interesting physiology of pleasure remains uninvestigated7 and that all experiments in which sensation is a factor are voided by its suppression4 ,besides1 vivisection may be painless in cases where the experiments are very cruel4 ,if a person scratches me with a poisoned dagger so gently that ,i do not feel the scratch1 he has achieved a painless vivisection2 but if ,i presently die in torment ,i am not likely to consider that his humility is amply vindicated by his gentleness4 ,a cobra's bite hurts so little that the creature is almost1 legally speaking1 a vivisector who inflicts no pain4 ,by giving his victims chloroform before biting them he could comply with the law completely4 ,here1 then1 is a pretty deadlock4 ,public support of vivisection is founded almost wholly on the assurances of the vivisectors that great public benefits may be expected from the practice4 ,not for a moment do ,i suggest that such a defence would be valid even if proved4 ,but when the witnesses begin by alleging that in the cause of science all the customary ethical obligations 7which include the obligation to tell the truth7 are suspended1 what weight can any reasonable person give to their testimony8 ,i would rather swear fifty lies than take an animal which had licked my hand in good fellowship and torture it4 ,if ,i did torture the dog1 ,i should certainly not have the face to turn round and ask how any person there suspect an honorable man like myself of telling lies4 ,most sensible and humane people would1 ,i hope1 reply flatly that honorable men do not behave dishonorably1 even to dogs4 ,the murderer who1 when asked by the chaplain whether he had any other crimes to confess1 replied indignantly1 ,what do you take me for8 reminds us very strongly of the vivisectors who are so deeply hurt when their evidence is set aside as worthless4 ,,an ,,argument ,,which ,,would ,,defend ,,any ,,crime ,the ,achilles heel of vivisection1 however1 is not to be found in the pain it causes1 but in the line of argument by which it is justified4 ,the medical code regarding it is simply criminal anarchism at its very worst4 ,indeed no criminal has yet had the impudence to argue as every vivisector argues4 ,no burglar contends that as it is admittedly important to have money to spend1 and as the object of burglary is to provide the burglar with money to spend1 and as in many instances it has achieved this object1 therefore the burglar is a public benefactor and the police are ignorant sentimentalists4 ,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 alderman4 ,thieves and assassins understand quite well that there are paths of acquisition1 even of the best things1 that are barred to all men of honor4 ,again1 has the silliest burglar ever pretended that to put a stop to burglary is to put a stop to industry8 ,all the vivisections that have been performed since the world began have produced nothing so important as the innocent and honorable discovery of radiography2 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 vivisection4 ,the law of the conservation of energy holds good in physiology as in other things3 every vivisector is a deserter from the army of honorable investigators4 ,but the vivisector does not see this4 ,he not only calls his methods scientific3 he contends that there are no other scientific methods4 ,when you express your natural loathing for his cruelty and your natural contempt for his stupidity1 he imagines that you are attacking science4 ,yet he has no inkling of the method and temper of science4 ,the point at issue being plainly whether he is a rascal or not1 he not only insists that the real point is whether some hotheaded antivivisectionist is a liar 7which he proves by ridiculously unscientific assumptions as to the degree of accuracy attainable in human statement71 but never dreams of offering any scientific evidence by his own methods4 ,there are many paths to knowledge already discovered2 and no enlightened man doubts that there are many more waiting to be discovered4 ,indeed1 all paths lead to knowledge2 because even the vilest and stupidest action teaches us something about vileness and stupidity1 and may accidentally teach us a good deal more3 for instance1 a cutthroat learns 7and perhaps teaches7 the anatomy of the carotid artery and jugular vein2 and there can be no question that the burning of ,st4 ,joan of ,arc must have been a most instructive and interesting experiment to a good observer1 and could have been made more so if it had been carried out by skilled physiologists under laboratory conditions4 ,the earthquake in ,san ,francisco proved invaluable as an experiment in the stability of giant steel buildings2 and the ramming of the ,victoria by the ,camperdown settled doubtful points of the greatest importance in naval warfare4 ,according to vivisectionist logic our builders would be justified in producing artificial earthquakes with dynamite1 and our admirals in contriving catastrophes at naval manoeuvres1 in order to follow up the line of research thus accidentally discovered4 ,the truth is1 if the acquisition of knowledge justifies every sort of conduct1 it justifies any sort of conduct1 from the illumination of ,nero's feasts by burning human beings alive 7another interesting experiment7 to the simplest act of kindness4 ,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 anarchy2 worse1 by far1 than an exemption of the pursuit of money or political power1 since there can hardly be attained without some regard for at least the appearances of human welfare1 whereas a curious devil might destroy the whole race in torment1 acquiring knowledge all the time from his highly interesting experiment4 ,there is more danger in one respectable scientist countenancing such a monstrous claim than in fifty assassins or dynamitards4 ,the man who makes it is ethically imbecile2 and whoever imagines that it is a scientific claim has not the faintest conception of what science means4 ,the paths to knowledge are countless4 ,one of these paths is a path through darkness1 secrecy1 and cruelty4 ,when a man deliberately turns from all other paths and goes down that one1 it is scientific to infer that what attracts him is not knowledge1 since there are other paths to that1 but cruelty4 ,with so strong and scientific a case against him1 it is childish for him to stand on his honor and reputation and high character and the credit of a noble profession and so forth3 he must clear himself either by reason or by experiment1 unless he boldly contends that evolution has retained a passion of cruelty in man just because it is indispensable to the fulness of his knowledge4 ,,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 profession4 ,i shall not damp so creditable and salutary a sentiment2 but ,i must point out that the guilt is shared by all of us4 ,it is not in his capacity of healer and man of science that the doctor vivisects or defends vivisection1 but in his entirely vulgar lay capacity4 ,he is made of the same clay as the ignorant1 shallow1 credulous1 half-miseducated1 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 buy4 ,the real remedy for vivisection is the remedy for all the mischief that the medical profession and all the other professions are doing3 namely1 more knowledge4 ,the juries which send the poor ,peculiars to prison1 and give vivisectionists heavy damages against humane persons who accuse them of cruelty2 the editors and councillors and student-led mobs who are striving to make ,vivisection one of the watchwords of our civilization1 are not doctors3 they are the ,british public1 all so afraid to die that they will cling frantically to any idol which promises to cure all their diseases1 and crucify anyone who tells them that they must not only die when their time comes1 but die like gentlemen4 ,in their paroxysms of cowardice and selfishness they force the doctors to humor their folly and ignorance4 ,how complete and inconsiderate their ignorance is can only be realized by those who have some knowledge of vital statistics1 and of the illusions which beset ,public ,health legislation4 ,,what ,,the ,,public ,,wants ,,and ,,will ,,not ,,get ,the demands of this poor public are not reasonable1 but they are quite simple4 ,it dreads disease and desires to be protected against it4 ,but it is poor and wants to be protected cheaply4 ,scientific measures are too hard to understand1 too costly1 too clearly tending towards a rise in the rates and more public interference with the insanitary1 because insufficiently financed1 private house4 ,what the public wants1 therefore1 is a cheap magic charm to prevent1 and a cheap pill or potion to cure1 all disease4 ,it forces all such charms on the doctors4 ,,the ,,vaccination ,,craze ,thus it was really the public and not the medical profession that took up vaccination with irresistible faith1 sweeping the invention out of ,jenner's hand and establishing it in a form which he himself repudiated4 ,jenner was not a man of science2 but he was not a fool2 and when he found that people who had suffered from cowpox either by contagion in the milking shed or by vaccination1 were not1 as he had supposed1 immune from smallpox1 he ascribed the cases of immunity which had formerly misled him to a disease of the horse1 which1 perhaps because we do not drink its milk and eat its flesh1 is kept at a greater distance in our imagination than our foster mother the cow4 ,at all events1 the public1 which had been boundlessly credulous about the cow1 would not have the horse on any terms2 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 ,jenner4 ,all the grossest lies and superstitions which have disgraced the vaccination craze were taught to the doctors by the public4 ,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 smallpox1 and that all this disfigurement has vanished since the introduction of vaccination4 ,jenner himself alluded to this imaginary phenomenon before the introduction of vaccination1 and attributed it to the older practice of smallpox inoculation1 by which ,voltaire1 ,catherine ,,ii4 and ,lady ,mary ,wortley ,montagu so confidently expected to see the disease made harmless4 ,it was not ,jenner who set people declaring that smallpox1 if not abolished by vaccination1 had at least been made much milder3 on the contrary1 he recorded a pre-vaccination epidemic in which none of the persons attacked went to bed or considered themselves as seriously ill4 ,neither ,jenner1 nor any other doctor ever1 as far as ,i know1 inculcated the popular notion that everybody got smallpox as a matter of course before vaccination was invented4 ,that doctors get infected with these delusions1 and are in their unprofessional capacity as members of the public subject to them like other men1 is true2 but if we had to decide whether vaccination was first forced on the public by the doctors or on the doctors by the public1 we should have to decide against the public4 ,,statistical ,,illusions ,public ignorance of the laws of evidence and of statistics can hardly be exaggerated4 ,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 event1 apparently over-whelming statistical evidence in favor of any prophylactic can be produced by persuading the public that everybody caught the disease formerly4 ,thus if a disease is one which normally attacks fifteen per cent of the population1 and if the effect of a prophylactic is actually to increase the proportion to twenty per cent1 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 five1 because the public1 left to itself and to the old gentlemen who are always ready to remember1 on every possible subject1 that things used to be much worse than they are now 7such old gentlemen greatly outnumber the laudatores tempori acti71 will assume that the former percentage was about #ajj4 ,the vogue of the ,pasteur treatment of hydrophobia1 for instance1 was due to the assumption by the public that every person bitten by a rabid dog necessarily got hydrophobia4 ,i myself heard hydrophobia discussed in my youth by doctors in ,dublin before a ,pasteur ,institute existed1 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 7as tetanus was then supposed to be induced7 by a lacerated wound4 ,there were no statistics available as to the proportion of dog bites that ended in hydrophobia2 but nobody ever guessed that the cases could be more than two or three per cent of the bites4 ,on me1 therefore1 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 hydrophobia4 ,it seemed to me that the proportion of deaths among the cases treated at the ,institute was rather higher1 if anything1 than might have been expected had there been no ,institute in existence4 ,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 wizards1 the man of science4 ,even trained statisticians often fail to appreciate the extent to which statistics are vitiated by the unrecorded assumptions of their interpreters4 ,their attention is too much occupied with the cruder tricks of those who make a corrupt use of statistics for advertizing purposes4 ,there is1 for example1 the percentage dodge4 ,in some hamlet1 barely large enough to have a name1 two people are attacked during a smallpox epidemic4 ,one dies3 the other recovers4 ,one has vaccination marks3 the other has none4 ,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 #ajj per cent of the unvaccinated perished miserably2 or1 as the case may be1 that #ajj per cent of the unvaccinated recovered whilst the vaccinated succumbed to the last man4 ,or1 to take another common instance1 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 neglect4 ,thus it is easy to prove that the wearing of tall hats and the carrying of umbrellas enlarges the chest1 prolongs life1 and confers comparative immunity from disease2 for the statistics show that the classes which use these articles are bigger1 healthier1 and live longer than the class which never dreams of possessing such things4 ,it does not take much perspicacity to see that what really makes this difference is not the tall hat and the umbrella1 but the wealth and nourishment of which they are evidence1 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 virtues4 ,a university degree1 a daily bath1 the owning of thirty pairs of trousers1 a knowledge of ,wagner's music1 a pew in church1 anything1 in short1 that implies more means and better nurture than the mass of laborers enjoy1 can be statistically palmed off as a magic-spell conferring all sorts of privileges4 ,in the case of a prophylactic enforced by law1 this illusion is intensified grotesquely1 because only vagrants can evade it4 ,now vagrants have little power of resisting any disease3 their death rate and their case-mortality rate is always high relatively to that of respectable folk4 ,nothing is easier1 therefore1 than to prove that compliance with any public regulation produces the most gratifying results4 ,it would be equally easy even if the regulation actually raised the death-rate1 provided it did not raise it sufficiently to make the average householder1 who cannot evade regulations1 die as early as the average vagrant who can4 ,,the ,,surprises ,,of ,,attention ,,and ,,neglect ,there is another statistical illusion which is independent of class differences4 ,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 health1 and forbidden under penalties4 ,yet these discarded mistakes are always made in the first instance on the strength of a demonstration that their introduction has reduced the death-rate4 ,the explanation is simple4 ,suppose a law were made that every child in the nation should be compelled to drink a pint of brandy per month1 but that the brandy must be administered only when the child was in good health1 with its digestion and so forth working normally1 and its teeth either naturally or artificially sound4 ,probably the result would be an immediate and startling reduction in child mortality1 leading to further legislation increasing the quantity of brandy to a gallon4 ,not until the brandy craze had been carried to a point at which the direct harm done by it would outweigh the incidental good1 would an anti-brandy party be listened to4 ,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 usual4 ,even if this attention were confined to the children's teeth1 there would be an improvement which it would take a good deal of brandy to cancel4 ,this imaginary case explains the actual case of the sanitary appliances which our local sanitary authorities prescribe today and condemn tomorrow4 ,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 continents1 like the black death and the cholera4 ,if it were proposed at this time of day to discharge all the sewage of ,london crude and untreated into the ,thames1 instead of carrying it1 after elaborate treatment1 far out into the ,north ,sea1 there would be a shriek of horror from all our experts4 ,yet if ,cromwell had done that instead of doing nothing1 there would probably have been no ,great ,plague of ,london4 ,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 things1 then it matters not how erroneous or even directly mischievous may be the specific measures taken3 the net result at first is sure to be an improvement4 ,not until attention has been effectually substituted for neglect as the general rule1 will the statistics begin to show the merits of the particular methods of attention adopted4 ,and as we are far from having arrived at this stage1 being as to health legislation only at the beginning of things1 we have practically no evidence yet as to the value of methods4 ,simple and obvious as this is1 nobody seems as yet to discount the effect of substituting attention for neglect in drawing conclusions from health statistics4 ,everything is put to the credit of the particular method employed1 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 thousand4 ,the net gain of ten per thousand is credited to the method1 and made the excuse for enforcing more of it4 ,,stealing ,,credit ,,from ,,civilization ,there is yet another way in which specifics which have no merits at all1 either direct or incidental1 may be brought into high repute by statistics4 ,for a century past civilization has been cleaning away the conditions which favor bacterial fevers4 ,typhus1 once rife1 has vanished3 plague and cholera have been stopped at our frontiers by a sanitary blockade4 ,we still have epidemics of smallpox and typhoid2 and diphtheria and scarlet fever are endemic in the slums4 ,measles1 which in my childhood was not regarded as a dangerous disease1 has now become so mortal that notices are posted publicly urging parents to take it seriously4 ,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 preventable2 and they already are to a large extent prevented4 ,the dangers of infection and the way to avoid it are better understood than they used to be4 ,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 catching4 ,nowadays the troubles of consumptive patients are greatly increased by the growing disposition to treat them as lepers4 ,no doubt there is a good deal of ignorant exaggeration and cowardly refusal to face a human and necessary share of the risk4 ,that has always been the case4 ,we now know that the medieval horror of leprosy was out of all proportion to the danger of infection1 and was accompanied by apparent blindness to the infectiousness of smallpox1 which has since been worked up by our disease terrorists into the position formerly held by leprosy4 ,but the scare of infection1 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 spot1 has led to much greater care and cleanliness4 ,and the net result has been a series of victories over disease4 ,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 finger2 and that if this joint be amputated immediately after birth1 typhus fever will disappear4 ,had such a suggestion been adopted1 the theory would have been triumphantly confirmed2 for as a matter of fact1 typhus fever has disappeared4 ,on the other hand cancer and madness have increased 7statistically7 to an appalling extent4 ,the opponents of the little finger theory would therefore be pretty sure to allege that the amputations were spreading cancer and lunacy4 ,the vaccination controversy is full of such contentions4 ,so is the controversy as to the docking of horses' tails and the cropping of dogs' ears4 ,so is the less widely known controversy as to circumcision and the declaring certain kinds of flesh unclean by the ,jews4 ,to advertize any remedy or operation1 you have only to pick out all the most reassuring advances made by civilization1 and boldly present the two in the relation of cause and effect3 the public will swallow the fallacy without a wry face4 ,it has no idea of the need for what is called a control experiment4 ,in ,shakespear's time and for long after it1 mummy was a favorite medicament4 ,you took a pinch of the dust of a dead ,egyptian in a pint of the hottest water you could bear to drink2 and it did you a great deal of good4 ,this1 you thought1 proved what a sovereign healer mummy was4 ,but if you had tried the control experiment of taking the hot water without the mummy1 you might have found the effect exactly the same1 and that any hot drink would have done as well4 ,,biometrika ,another difficulty about statistics is the technical difficulty of calculation4 ,before you can even make a mistake in drawing your conclusion from the correlations established by your statistics you must ascertain the correlations4 ,when ,i turn over the pages of ,biometrika1 a quarterly journal in which is recorded the work done in the field of biological statistics by ,professor ,karl ,pearson and his colleagues1 ,i am out of my depth at the first line1 because mathematics are to me only a concept3 ,i never used a logarithm in my life1 and could not undertake to extract the square root of four without misgiving4 ,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 business1 not to be tackled successfully except by high mathematicians2 and ,i cannot resist ,professor ,karl ,pearson's immense contempt for1 and indignant sense of grave social danger in1 the unskilled guesses of the ordinary sociologist4 ,now the man in the street knows nothing of ,biometrika3 all he knows is that you can prove anything by figures1 though he forgets this the moment figures are used to prove anything he wants to believe4 ,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 out2 though the mathematician whose correlations would fill a ,newton with admiration may1 in collecting and accepting data and drawing conclusions from them1 fall into quite crude errors by just such popular oversights as ,i have been describing4 ,,patient-,,made ,,therapeutics ,to all these blunders and ignorances doctors are no less subject than the rest of us4 ,they are not trained in the use of evidence1 nor in biometrics1 nor in the psychology of human credulity1 nor in the incidence of economic pressure4 ,further1 they must believe1 on the whole1 what their patients believe1 just as they must wear the sort of hat their patients wear4 ,the doctor may lay down the law despotically enough to the patient at points where the patient's mind is simply blank2 but when the patient has a prejudice the doctor must either keep it in countenance or lose his patient4 ,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 ventilation4 ,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 possible4 ,had ,mr4 ,pickwick's doctor told him that he would be much healthier if he slept on a camp bed by an open window1 ,mr4 ,pickwick would have regarded him as a crank and called in another doctor4 ,had he gone on to forbid ,mr4 ,pickwick to drink brandy and water whenever he felt chilly1 and assured him that if he were deprived of meat or salt for a whole year1 he would not only not die1 but would be none the worse1 ,mr4 ,pickwick would have fled from his presence as from that of a dangerous madman4 ,and in these matters the doctor cannot cheat his patient4 ,if he has no faith in drugs or vaccination1 and the patient has1 he can cheat him with colored water and pass his lancet through the flame of a spirit lamp before scratching his arm4 ,but he cannot make him change his daily habits without knowing it4 ,,the ,,reforms ,,also ,,come ,,from ,,the ,,laity ,in the main1 then1 the doctor learns that if he gets ahead of the superstitions of his patients he is a ruined man2 and the result is that he instinctively takes care not to get ahead of them4 ,that is why all the changes come from the laity4 ,it was not until an agitation had been conducted for many years by laymen1 including quacks and faddists of all kinds1 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 air1 cold water1 temperance1 and the rest of the new fashions in hygiene4 ,at present the tables have been turned on many old prejudices4 ,plenty of our most popular elderly doctors believe that cold tubs in the morning are unnatural1 exhausting1 and rheumatic2 that fresh air is a fad and that everybody is the better for a glass or two of port wine every day2 but they no longer dare say as much until they know exactly where they are2 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 grass4 ,he who shows the least scepticism as to this practice is at once suspected of being an old-fashioned doctor1 and dismissed to make room for a younger man4 ,in short1 private medical practice is governed not by science but by supply and demand2 and however scientific a treatment may be1 it cannot hold its place in the market if there is no demand for it2 nor can the grossest quackery be kept off the market if there is a demand for it4 ,,fashions ,,and ,,epidemics ,a demand1 however1 can be inculcated4 ,this is thoroughly understood by fashionable tradesmen1 who find no difficulty in persuading their customers to renew articles that are not worn out and to buy things they do not want4 ,by making doctors tradesmen1 we compel them to learn the tricks of trade2 consequently we find that the fashions of the year include treatments1 operations1 and particular drugs1 as well as hats1 sleeves1 ballads1 and games4 ,tonsils1 vermiform appendices1 uvulas1 even ovaries are sacrificed because it is the fashion to get them cut out1 and because the operations are highly profitable4 ,the psychology of fashion becomes a pathology2 for the cases have every air of being genuine3 fashions1 after all1 are only induced epidemics1 proving that epidemics can be induced by tradesmen1 and therefore by doctors4 ,,the ,,doctor',s ,,virtues ,it will be admitted that this is a pretty bad state of things4 ,and the melodramatic instinct of the public1 always demanding2 that every wrong shall have1 not its remedy1 but its villain to be hissed1 will blame1 not its own apathy1 superstition1 and ignorance1 but the depravity of the doctors4 ,nothing could be more unjust or mischievous4 ,doctors1 if no better than other men1 are certainly no worse4 ,i was reproached during the performances of ,the ,doctor's ,dilemma at the ,court ,theatre in #aijg because ,i made the artist a rascal1 the journalist an illiterate incapable1 and all the doctors angels4 ,but ,i did not go beyond the warrant of my own experience4 ,it has been my luck to have doctors among my friends for nearly forty years past 7all perfectly aware of my freedom from the usual credulity as to the miraculous powers and knowledge attributed to them72 and though ,i know that there are medical blackguards as well as military1 legal1 and clerical blackguards 7one soon finds that out when one is privileged to hear doctors talking shop among themselves71 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 scale1 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 practice4 ,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 work4 ,but the true doctor is inspired by a hatred of ill-health1 and a divine impatience of any waste of vital forces4 ,unless a man is led to medicine or surgery through a very exceptional technical aptitude1 or because doctoring is a family tradition1 or because he regards it unintelligently as a lucrative and gentlemanly profession1 his motives in choosing the career of a healer are clearly generous4 ,however actual practice may disillusion and corrupt him1 his selection in the first instance is not a selection of a base character4 ,,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 tradesman3 that is1 out of his poverty and dependence4 ,and it should be borne in mind that doctors are expected to treat other people specially well whilst themselves submitting to specially inconsiderate treatment4 ,the butcher and baker are not expected to feed the hungry unless the hungry can pay2 but a doctor who allows a fellow-creature to suffer or perish without aid is regarded as a monster4 ,even if we must dismiss hospital service as really venal1 the fact remains that most doctors do a good deal of gratuitous work in private practice all through their careers4 ,and in his paid work the doctor is on a different footing to the tradesman4 ,although the articles he sells1 advice and treatment1 are the same for all classes1 his fees have to be graduated like the income tax4 ,the successful fashionable doctor may weed his poorer patients out from time to time1 and finally use the ,college of ,physicians to place it out of his own power to accept low fees2 but the ordinary general practitioner never makes out his bills without considering the taxable capacity of his patients4 ,then there is the disregard of his own health and comfort which results from the fact that he is1 by the nature of his work1 an emergency man4 ,we are polite and considerate to the doctor when there is nothing the matter1 and we meet him as a friend or entertain him as a guest2 but when the baby is suffering from croup1 or its mother has a temperature of #ajd degrees1 or its grandfather has broken his leg1 nobody thinks of the doctor except as a healer and saviour4 ,he may be hungry1 weary1 sleepy1 run down by several successive nights disturbed by that instrument of torture1 the night bell2 but who ever thinks of this in the face of sudden sickness or accident8 ,we think no more of the condition of a doctor attending a case than of the condition of a fireman at a fire4 ,in other occupations night-work is specially recognized and provided for4 ,the worker sleeps all day2 has his breakfast in the evening2 his lunch or dinner at midnight2 his dinner or supper before going to bed in the morning2 and he changes to day-work if he cannot stand night-work4 ,but a doctor is expected to work day and night4 ,in practices which consist largely of workmen's clubs1 and in which the patients are therefore taken on wholesale terms and very numerous1 the unfortunate assistant1 or the principal if he has no assistant1 often does not undress1 knowing that he will be called up before he has snatched an hour's sleep4 ,to the strain of such inhuman conditions must be added the constant risk of infection4 ,one wonders why the impatient doctors do not become savage and unmanageable1 and the patient ones imbecile4 ,perhaps they do1 to some extent4 ,and the pay is wretched1 and so uncertain that refusal to attend without payment in advance becomes often a necessary measure of self-defence1 whilst the ,county ,court has long ago put an end to the tradition that the doctor's fee is an honorarium4 ,even the most eminent physicians1 as such biographies as those of ,paget show1 are sometimes miserably1 inhumanly poor until they are past their prime4 ,in short1 the doctor needs our help for the moment much more than we often need his4 ,the ridicule of ,moliere1 the death of a well-informed and clever writer like the late ,harold ,frederic in the hands of ,christian ,scientists 7a sort of sealing with his blood of the contemptuous disbelief in and dislike of doctors he had bitterly expressed in his books71 the scathing and quite justifiable exposure of medical practice in the novel by ,mr4 ,maarten ,maartens entitled ,the ,new ,religion3 all these trouble the doctor very little1 and are in any case well set off by the popularity of ,sir ,luke ,fildes' famous picture1 and by the verdicts in which juries from time to time express their conviction that the doctor can do no wrong4 ,the real woes of the doctor are the shabby coat1 the wolf at the door1 the tyranny of ignorant patients1 the work-day of #bd hours1 and the uselessness of honestly prescribing what most of the patients really need3 that is1 not medicine1 but money4 ,,the ,,public ,,doctor ,what then is to be done8 ,fortunately we have not to begin absolutely from the beginning3 we already have1 in the ,medical ,officer of ,health1 a sort of doctor who is free from the worst hardships1 and consequently from the worst vices1 of the private practitioner4 ,his position depends1 not on the number of people who are ill1 and whom he can keep ill1 but on the number of people who are well4 ,he is judged1 as all doctors and treatments should be judged1 by the vital statistics of his district4 ,when the death rate goes up his credit goes down4 ,as every increase in his salary depends on the issue of a public debate as to the health of the constituency under his charge1 he has every inducement to strive towards the ideal of a clean bill of health4 ,he has a safe1 dignified1 responsible1 independent position based wholly on the public health2 whereas the private practitioner has a precarious1 shabby-genteel1 irresponsible1 servile position1 based wholly on the prevalence of illness4 ,it is true1 there are grave scandals in the public medical service4 ,the public doctor may be also a private practitioner eking out his earnings by giving a little time to public work for a mean payment4 ,there are cases in which the position is one which no successful practitioner will accept1 and where1 therefore1 incapables or drunkards get automatically selected for the post1 faute de mieux2 but even in these cases the doctor is less disastrous in his public capacity than in his private one3 besides1 the conditions which produce these bad cases are doomed1 as the evil is now recognized and understood4 ,a popular but unstable remedy is to enable local authorities1 when they are too small to require the undivided time of such men as the ,medical ,officers of our great municipalities1 to combine for public health purposes so that each may share the services of a highly paid official of the best class2 but the right remedy is a larger area as the sanitary unit4 ,,medical ,,organization ,another advantage of public medical work is that it admits of organization1 and consequently of the distribution of the work in such a manner as to avoid wasting the time of highly qualified experts on trivial jobs4 ,the individualism of private practice leads to an appalling waste of time on trifles4 ,men whose dexterity as operators or almost divinatory skill in diagnosis are constantly needed for difficult cases1 are poulticing whitlows1 vaccinating1 changing unimportant dressings1 prescribing ether drams for ladies with timid leanings towards dipsomania1 and generally wasting their time in the pursuit of private fees4 ,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 is4 ,the judge passes sentence of death2 but he is not expected to hang the criminal with his own hands1 as he would be if the legal profession were as unorganized as the medical4 ,the bishop is not expected to blow the organ or wash the baby he baptizes4 ,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 two4 ,even if they were1 things would still not be as bad as in the medical profession2 for in it not only is the first-class man set to do third-class work1 but1 what is much more terrifying1 the third-class man is expected to do first-class work4 ,every general practitioner is supposed to be capable of the whole range of medical and surgical work at a moment's notice2 and the country doctor1 who has not a specialist nor a crack consultant at the end of his telephone1 often has to tackle without hesitation cases which no sane practitioner in a town would take in hand without assistance4 ,no doubt this develops the resourcefulness of the country doctor1 and makes him a more capable man than his suburban colleague2 but it cannot develop the second-class man into a first-class one4 ,if the practice of law not only led to a judge having to hang1 but the hangman to judge1 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 ,brussels1 we should not be consoled by the reflection that our hangmen were thereby made a little more judicial-minded1 and our drummers more responsible1 than in foreign countries where the legal and military professions recognized the advantages of division of labor4 ,under such conditions no statistics as to the graduation of professional ability among doctors are available4 ,assuming that doctors are normal men and not magicians 7and it is unfortunately very hard to persuade people to admit so much and thereby destroy the romance of doctoring7 we may guess that the medical profession1 like the other professions1 consists of a small percentage of highly gifted persons at one end1 and a small percentage of altogether disastrous duffers at the other4 ,between these extremes comes the main body of doctors 7also1 of course1 with a weak and a strong end7 who can be trusted to work under regulations with more or less aid from above according to the gravity of the case4 ,or1 to put it in terms of the cases1 there are cases that present no difficulties1 and can be dealt with by a nurse or student at one end of the scale1 and cases that require watching and handling by the very highest existing skill at the other2 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 of1 say1 seven to none1 seven to one1 three to one1 one to one1 or1 for a day or two1 none to one4 ,such a service is organized at present only in hospitals2 though in large towns the practice of calling in the consultant acts1 to some extent1 as a substitute for it4 ,but in the latter case it is quite unregulated except by professional etiquet1 which1 as we have seen1 has for its object1 not the health of the patient or of the community at large1 but the protection of the doctor's livelihood and the concealment of his errors4 ,and as the consultant is an expensive luxury1 he is a last resource rather1 as he should be1 than a matter of course1 in all cases where the general practitioner is not equal to the occasion3 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 experience4 ,,the ,,social ,,solution ,,of ,,the ,,medical ,,problem ,the social solution of the medical problem1 then1 depends on that large1 slowly advancing1 pettishly resisted integration of society called generally ,socialism4 ,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 present3 a conspiracy to exploit popular credulity and human suffering4 ,already our ,m4,o4,h4s 7,medical ,officers of ,health7 are in the new position3 what is lacking is appreciation of the change1 not only by the public but by the private doctors4 ,for1 as we have seen1 when one of the first-rate posts becomes vacant in one of the great cities1 and all the leading ,m4,o4,h4s compete for it1 they must appeal to the good health of the cities of which they have been in charge1 and not to the size of the incomes the local private doctors are making out of the ill-health of their patients4 ,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 accidents1 his claims are irresistible2 and this is the ideal at which every ,m4,o4,h4 should aim4 ,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 salvation4 ,for the ,m4,o4,h4 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 forces4 ,it is silly that an ,englishman should be more afraid of a ,german soldier than of a ,british disease germ1 and should clamor for more barracks in the same newspapers that protest against more school clinics1 and cry out that if the ,state fights disease for us it makes us paupers1 though they never say that if the ,state fights the ,germans for us it makes us cowards4 ,fortunately1 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 perish4 ,every year sees an increase in the number of persons employed in the ,public ,health ,service1 who would formerly have been mere adventurers in the ,private ,illness ,service4 ,to put it another way1 a host of men and women who have now a strong incentive to be mischievous and even murderous rogues will have a much stronger1 because a much honester1 incentive to be not only good citizens but active benefactors to the community4 ,and they will have no anxiety whatever about their incomes4 ,,the ,,future ,,of ,,private ,,practice ,it must not be hastily concluded that this involves the extinction of the private practitioner4 ,what it will really mean for him is release from his present degrading and scientifically corrupting slavery to his patients4 ,as ,i have already shown the doctor who has to live by pleasing his patients in competition with everybody who has walked the hospitals1 scraped through the examinations1 and bought a brass plate1 soon finds himself prescribing water to teetotallers and brandy or champagne jelly to drunkards2 beefsteaks and stout in one house1 and uric acid free vegetarian diet over the way2 shut windows1 big fires1 and heavy overcoats to old ,colonels1 and open air and as much nakedness as is compatible with decency to young faddists1 never once daring to say either ,i don't know1 or ,i don't agree4 ,for the strength of the doctor's1 as of every other man's position when the evolution of social organization at last reaches his profession1 will be that he will always have open to him the alternative of public employment when the private employer becomes too tyrannous4 ,and let no one suppose that the words doctor and patient can disguise from the parties the fact that they are employer and employee4 ,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 indispensable2 but the average doctor is not in this position3 he is struggling for life in an overcrowded profession1 and knows well that a good bedside manner will carry him to solvency through a morass of illness1 whilst the least attempt at plain dealing with people who are eating too much1 or drinking too much1 or frowsting too much 7to go no further in the list of intemperances that make up so much of family life7 would soon land him in the ,bankruptcy ,court4 ,private practice1 thus protected1 would itself protect individuals1 as far as such protection is possible1 against the errors and superstitions of ,state medicine1 which are at worst no worse than the errors and superstitions of private practice1 being1 indeed1 all derived from it4 ,such monstrosities as vaccination are1 as we have seen1 founded1 not on science1 but on half-crowns4 ,if the ,vaccination ,acts1 instead of being wholly repealed as they are already half repealed1 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 him1 and for whom there was plenty of alternative public health work waiting1 vaccination would be dead in two years1 as the vaccinator would not only not gain by it1 but would lose credit through the depressing effects on the vital statistics of his district of the illness and deaths it causes1 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 infection4 ,such absurd panic scandals as that of the last ,london epidemic1 where a fee of half-a-crown per re-vaccination produced raids on houses during the absence of parents1 and the forcible seizure and re-vaccination of children left to answer the door1 can be prevented simply by abolishing the half-crown and all similar follies1 paying1 not for this or that ceremony of witchcraft1 but for immunity from disease1 and paying1 too1 in a rational way4 ,the officer with a fixed salary saves himself trouble by doing his business with the least possible interference with the private citizen4 ,the man paid by the job loses money by not forcing his job on the public as often as possible without reference to its results4 ,,the ,,technical ,,problem ,as to any technical medical problem specially involved1 there is none4 ,if there were1 ,i should not be competent to deal with it1 as ,i am not a technical expert in medicine3 ,i deal with the subject as an economist1 a politician1 and a citizen exercising my common sense4 ,everything that ,i have said applies equally to all the medical techniques1 and will hold good whether public hygiene be based on the poetic fancies of ,christian ,science1 the tribal superstitions of the druggist and the vivisector1 or the best we can make of our real knowledge4 ,but ,i may remind those who confusedly imagine that the medical problem is also the scientific problem1 that all problems are finally scientific problems4 ,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 diseases1 transmute metals1 and enable us to live for ever4 ,it may still be necessary for some time to come to practise on popular credulity1 popular love and dread of the marvellous1 and popular idolatry1 to induce the poor to comply with the sanitary regulations they are too ignorant to understand4 ,as ,i have elsewhere confessed1 ,i have myself been responsible for ridiculous incantations with burning sulphur1 experimentally proved to be quite useless1 because poor people are convinced1 by the mystical air of the burning and the horrible smell1 that it exorcises the demons of smallpox and scarlet fever and makes it safe for them to return to their houses4 ,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 die1 and wish to save money at their expense4 ,so you perform the incantation2 and back they go to their houses1 satisfied4 ,a religious ceremony--a poetic blessing of the threshold1 for instance--would be much better2 but unfortunately our religion is weak on the sanitary side4 ,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 piety1 and in some unlucky places 7the ,sandwich ,islands for example7 made the introduction of ,christianity also the introduction of disease1 because the formulators of the superseded native religion1 like ,mahomet1 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 body1 even to nail clippings and hairs2 and our missionaries thoughtlessly discredited this godly doctrine without supplying its place1 which was promptly taken by laziness and neglect4 ,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 accustomed1 and to represent her as being especially particular about stables because her son was born in one1 they might do more in one year than all the ,sanitary ,inspectors in ,ireland could do in twenty2 and they could hardly doubt that ,our ,lady would be delighted4 ,perhaps they do nowadays2 for ,ireland is certainly a transfigured country since my youth as far as clean faces and pinafores can transfigure it4 ,in ,england1 where so many of the inhabitants are too gross to believe in poetic faiths1 too respectable to tolerate the notion that the stable at ,bethany was a common peasant farmer's stable instead of a first-rate racing one1 and too savage to believe that anything can really cast out the devil of disease unless it be some terrifying hoodoo of tortures and stinks1 the ,m4,o4,h4 will no doubt for a long time to come have to preach to fools according to their folly1 promising miracles1 and threatening hideous personal consequences of neglect of by-laws and the like2 therefore it will be important that every ,m4,o4,h4 shall have1 with his 7or her7 other qualifications1 a sense of humor1 lest 7he or she7 should come at last to believe all the nonsense that must needs be talked4 ,but he must1 in his capacity of an expert advising the authorities1 keep the government itself free of superstition4 ,if ,italian peasants are so ignorant that the ,church can get no hold of them except by miracles1 why1 miracles there must be4 ,the blood of ,st4 ,januarius must liquefy whether the ,saint is in the humor or not4 ,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 lain1 by pretending to exorcise the disease with burning sulphur4 ,but woe to the ,church if in deceiving the peasant it also deceives itself2 for then the ,church is lost1 and the peasant too1 unless he revolt against it4 ,unless the ,church works the pretended miracle painfully against the grain1 and is continually urged by its dislike of the imposture to strive to make the peasant susceptible to the true reasons for behaving well1 the ,church will become an instrument of his corruption and an exploiter of his ignorance1 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 priesthood4 ,and here we come to the danger that terrifies so many of us3 the danger of having a hygienic orthodoxy imposed on us4 ,but we must face that3 in such crowded and poverty ridden civilizations as ours any orthodoxy is better than laisser-faire4 ,if our population ever comes to consist exclusively of well-to-do1 highly cultivated1 and thoroughly instructed free persons in a position to take care of themselves1 no doubt they will make short work of a good deal of official regulation that is now of life-and-death necessity to us2 but under existing circumstances1 ,i repeat1 almost any sort of attention that democracy will stand is better than neglect4 ,attention and activity lead to mistakes as well as to successes2 but a life spent in making mistakes is not only more honorable but more useful than a life spent doing nothing4 ,the one lesson that comes out of all our theorizing and experimenting is that there is only one really scientific progressive method2 and that is the method of trial and error4 ,if you come to that1 what is laisser-faire but an orthodoxy8 the most tyrannous and disastrous of all the orthodoxies1 since it forbids you even to learn4 ,,the ,,latest ,,theories ,medical theories are so much a matter of fashion1 and the most fertile of them are modified so rapidly by medical practice and biological research1 which are international activities1 that the play which furnishes the pretext for this preface is already slightly outmoded1 though ,i believe it may be taken as a faithful record for the year 7#aijf7 in which it was begun4 ,i must not expose any professional man to ruin by connecting his name with the entire freedom of criticism which ,i1 as a layman1 enjoy2 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 bacteria3 a practice incorrectly called vaccinetherapy 7there is nothing vaccine about it7 apparently because it is what vaccination ought to be and is not4 ,until ,sir ,almroth ,wright1 following up one of ,metchnikoff's most suggestive biological romances1 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 opsonin1 and that our production of this condiment continually rises and falls rhythmically from negligibility to the highest efficiency1 nobody had been able even to conjecture why the various serums that were from time to time introduced as having effected marvellous cures1 presently made such direful havoc of some unfortunate patient that they had to be dropped hastily4 ,the quantity of sturdy lying that was necessary to save the credit of inoculation in those days was prodigious2 and had it not been for the devotion shown by the military authorities throughout ,europe1 who would order the entire disappearance of some disease from their armies1 and bring it about by the simple plan of changing the name under which the cases were reported1 or for our own ,metropolitan ,asylums ,board1 which carefully suppressed all the medical reports that revealed the sometimes quite appalling effects of epidemics of revaccination1 there is no saying what popular reaction might not have taken place against the whole immunization movement in therapeutics4 ,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 point1 you would certainly make him a good deal worse and perhaps kill him1 whereas if you made precisely the same inoculation when the cooking power was rising to one of its periodical climaxes1 you would stimulate it to still further exertions and produce just the opposite result4 ,and he invented a technique for ascertaining in which phase the patient happened to be at any given moment4 ,the dramatic possibilities of this discovery and invention will be found in my play4 ,but it is one thing to invent a technique3 it is quite another to persuade the medical profession to acquire it4 ,our general practitioners1 ,i gather1 simply declined to acquire it1 being mostly unable to afford either the acquisition or the practice of it when acquired4 ,something simple1 cheap1 and ready at all times for all comers1 is1 as ,i have shown1 the only thing that is economically possible in general practice1 whatever may be the case in ,sir ,almroth's famous laboratory in ,st4 ,mary's ,hospital4 ,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 powerful1 and that a comparatively infinitesimal dose would not precipitate a negative phase of cooking activity1 and might induce a positive one4 ,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 written3 nay1 that ,sir ,ralph ,bloomfield ,boningtons way of administering inoculations as if they were spoonfuls of squills may sometimes work fairly well4 ,for all that1 ,i find ,sir ,almroth ,wright1 on the #bcrd ,may1 #aiaj1 warning the ,royal ,society of ,medicine that the clinician has not yet been prevailed upon to reconsider his position1 which means that the general practitioner 7the doctor1 as he is called in our homes7 is going on just as he did before1 and could not afford to learn or practice a new technique even if he had ever heard of it4 ,to the patient who does not know about it he will say nothing4 ,to the patient who does1 he will ridicule it1 and disparage ,sir ,almroth4 ,what else can he do1 except confess his ignorance and starve8 ,but now please observe how the whirligig of time brings its revenges4 ,this latest discovery of the remedial virtue of a very1 very tiny hair of the dog that bit you reminds us1 not only of ,arndt's law of protoplasmic reaction to stimuli1 according to which weak and strong stimuli provoke opposite reactions1 but of ,hahnemann's homeopathy1 which was founded on the fact alleged by ,hahnemann that drugs which produce certain symptoms when taken in ordinary perceptible quantities1 will1 when taken in infinitesimally small quantities1 provoke just the opposite symptoms2 so that the drug that gives you a headache will also cure a headache if you take little enough of it4 ,i have already explained that the savage opposition which homeopathy encountered from the medical profession was not a scientific opposition2 for nobody seems to deny that some drugs act in the alleged manner4 ,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 peas2 and people would not pay as much for drops and globules no bigger than pins' heads4 ,nowadays1 however1 the more cultivated folk are beginning to be so suspicious of drugs1 and the incorrigibly superstitious people so profusely supplied with patent medicines 7the medical advice to take them being wrapped round the bottle and thrown in for nothing7 that homeopathy has become a way of rehabilitating the trade of prescription compounding1 and is consequently coming into professional credit4 ,at which point the theory of opsonins comes very opportunely to shake hands with it4 ,add to the newly triumphant homeopathist and the opsonist that other remarkable innovator1 the ,swedish masseur1 who does not theorize about you1 but probes you all over with his powerful thumbs until he finds out your sore spots and rubs them away1 besides cheating you into a little wholesome exercise2 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 death4 ,add to them a good deal of vegetarian and teetotal controversy raging round a clamor for scientific eating and drinking1 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 fish1 and his equally eminent colleague who warns us that a fish diet must end in leprosy1 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 cures3 all very silly1 no doubt1 but sane and sensible1 poetic and hopeful1 compared to the pseudo science of the commercial general practitioner1 who foolishly clamors for the prosecution and even the execution of the ,christian ,scientists when their patients die1 forgetting the long death roll of his own patients4 ,by the time this preface is in print the kaleidoscope may have had another shake2 and opsonin may have gone the way of phlogiston at the hands of its own restless discoverer4 ,i will not say that ,hahnemann may have gone the way of ,diafoirus2 for ,diafoirus we have always with us4 ,but we shall still pick up all our knowledge in pursuit of some ,will o' the ,wisp or other4 ,what is called science has always pursued the ,elixir of ,life and the ,philosopher's ,stone1 and is just as busy after them to-day as ever it was in the days of ,paracelsus4 ,we call them by different names3 ,immunization or ,radiology or what not2 but the dreams which lure us into the adventures from which we learn are always at bottom the same4 ,science becomes dangerous only when it imagines that it has reached its goal4 ,what is wrong with priests and popes is that instead of being apostles and saints1 they are nothing but empirics who say ,i know instead of ,i am learning1 and pray for credulity and inertia as wise men pray for scepticism and activity4 ,such abominations as the ,inquisition and the ,vaccination ,acts are possible only in the famine years of the soul1 when the great vital dogmas of honor1 liberty1 courage1 the kinship of all life1 faith that the unknown is greater than the known and is only the ,as ,yet ,unknown1 and resolution to find a manly highway to it1 have been forgotten in a paroxysm of littleness and terror in which nothing is active except concupiscence and the fear of death1 playing on which any trader can filch a fortune1 any blackguard gratify his cruelty1 and any tyrant make us his slaves4 ,lest this should seem too rhetorical a conclusion for our professional men of science1 who are mostly trained not to believe anything unless it is worded in the jargon of those writers who1 because they never really understand what they are trying to say1 cannot find familiar words for it1 and are therefore compelled to invent a new language of nonsense for every book they write1 let me sum up my conclusions as dryly as is consistent with accurate thought and live conviction4 #a4 ,nothing is more dangerous than a poor doctor3 not even a poor employer or a poor landlord4 #b4 ,of all the anti-social vested interests the worst is the vested interest in ill-health4 #c4 ,remember that an illness is a misdemeanor2 and treat the doctor as an accessory unless he notifies every case to the ,public ,health authority4 #d4 ,treat every death as a possible and under our present system a probable murder1 by making it the subject of a reasonably conducted inquest2 and execute the doctor1 if necessary1 as a doctor1 by striking him off the register4 #e4 ,make up your mind how many doctors the community needs to keep it well4 ,do not register more or less than this number2 and let registration constitute the doctor a civil servant with a dignified living wage paid out of public funds4 #f4 ,municipalize ,harley ,street4 #g4 ,treat the private operator exactly as you would treat a private executioner4 #h4 ,treat persons who profess to be able to cure disease as you treat fortune tellers4 #i4 ,keep the public carefully informed1 by special statistics and announcements of individual cases1 of all illnesses of doctors or in their families4 #aj4 ,make it compulsory for a doctor using a brass plate to have inscribed on it1 in addition to the letters indicating his qualifications1 the words ,remember that ,i too am mortal4 #aa4 ,in legislation and social organization1 proceed on the principle that invalids1 meaning persons who cannot keep themselves alive by their own activities1 cannot1 beyond reason1 expect to be kept alive by the activity of others4 ,there is a point at which the most energetic policeman or doctor1 when called upon to deal with an apparently drowned person1 gives up artificial respiration1 although it is never possible to declare with certainty1 at any point short of decomposition1 that another five minutes of the exercise would not effect resuscitation4 ,the theory that every individual alive is of infinite value is legislatively impracticable4 ,no doubt the higher the life we secure to the individual by wise social organization1 the greater his value is to the community1 and the more pains we shall take to pull him through any temporary danger or disablement4 ,but the man who costs more than he is worth is doomed by sound hygiene as inexorably as by sound economics4 #ab4 ,do not try to live for ever4 ,you will not succeed4 #ac4 ,use your health1 even to the point of wearing it out4 ,that is what it is for4 ,spend all you have before you die2 and do not outlive yourself4 #ad4 ,take the utmost care to get well born and well brought up4 ,this means that your mother must have a good doctor4 ,be careful to go to a school where there is what they call a school clinic1 where your nutrition and teeth and eyesight and other matters of importance to you will be attended to4 ,be particularly careful to have all this done at the expense of the nation1 as otherwise it will not be done at all1 the chances being about forty to one against your being able to pay for it directly yourself1 even if you know how to set about it4 ,otherwise you will be what most people are at present3 an unsound citizen of an unsound nation1 without sense enough to be ashamed or unhappy about it4