To make matters worse, doctors are hideously poor. The Irish gentleman
doctor of my boyhood, who took nothing less than a guinea, though he
might pay you four visits for it, seems to have no equivalent nowadays
in English society. Better be a railway porter than an ordinary English
general practitioner. A railway porter has from eighteen to twenty-three
shillings a week from the Company merely as a retainer; and his
additional fees from the public, if we leave the third-class twopenny
tip out of account (and I am by no means sure that even this reservation
need be made), are equivalent to doctor's fees in the case of
second-class passengers, and double doctor's fees in the case of first.
Any class of educated men thus treated tends to become a brigand class,
and doctors are no exception to the rule. They are offered disgraceful
prices for advice and medicine. Their patients are for the most part so
poor and so ignorant that good advice would be resented as impracticable
and wounding. When you are so poor that you cannot afford to refuse
eighteenpence from a man who is too poor to pay you any more, it
is useless to tell him that what he or his sick child needs is not
medicine, but more leisure, better clothes, better food, and a better
drained and ventilated house. It is kinder to give him a bottle of
something almost as cheap as water, and tell him to come again with
another eighteenpence if it does not cure him. When you have done that
over and over again every day for a week, how much scientific conscience
have you left? If you are weak-minded enough to cling desperately to
your eighteenpence as denoting a certain social superiority to the
sixpenny doctor, you will be miserably poor all your life; whilst the
sixpenny doctor, with his low prices and quick turnover of patients,
visibly makes much more than you do and kills no more people.
A doctor's character can no more stand out against such conditions than
the lungs of his patients can stand out against bad ventilation. The
only way in which he can preserve his self-respect is by forgetting
all he ever learnt of science, and clinging to such help as he can
give without cost merely by being less ignorant and more accustomed to
sick-beds than his patients. Finally, he acquires a certain skill at
nursing cases under poverty-stricken domestic conditions, just as women
who have been trained as domestic servants in some huge institution with
lifts, vacuum cleaners, electric lighting, steam heating, and machinery
that turns the kitchen into a laboratory and engine house combined,
manage, when they are sent out into the world to drudge as general
servants, to pick up their business in a new way, learning the
slatternly habits and wretched makeshifts of homes where even bundles of
kindling wood are luxuries to be anxiously economized.