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