I have heard doctors affirm and deny almost every possible proposition
as to disease and treatment. I can remember the time when doctors no
more dreamt of consumption and pneumonia being infectious than they
now dream of sea-sickness being infectious, or than so great a clinical
observer as Sydenham dreamt of smallpox being infectious. I have heard
doctors deny that there is such a thing as infection. I have heard them
deny the existence of hydrophobia as a specific disease differing from
tetanus. I have heard them defend prophylactic measures and prophylactic
legislation as the sole and certain salvation of mankind from zymotic
disease; and I have heard them denounce both as malignant spreaders
of cancer and lunacy. But the one objection I have never heard from a
doctor is the objection that prophylaxis by the inoculatory methods most
in vogue is an economic impossibility under our private practice
system. They buy some stuff from somebody for a shilling, and inject a
pennyworth of it under their patient's skin for half-a-crown, concluding
that, since this primitive rite pays the somebody and pays them, the
problem of prophylaxis has been satisfactorily solved. The results are
sometimes no worse than the ordinary results of dirt getting into cuts;
but neither the doctor nor the patient is quite satisfied unless the
inoculation "takes"; that is, unless it produces perceptible illness and
disablement. Sometimes both doctor and patient get more value in
this direction than they bargain for. The results of ordinary
private-practice-inoculation at their worst are bad enough to be
indistinguishable from those of the most discreditable and dreaded
disease known; and doctors, to save the credit of the inoculation, have
been driven to accuse their patient or their patient's parents of having
contracted this disease independently of the inoculation, an excuse
which naturally does not make the family any more resigned, and leads
to public recriminations in which the doctors, forgetting everything but
the immediate quarrel, naively excuse themselves by admitting, and
even claiming as a point in their favor, that it is often impossible to
distinguish the disease produced by their inoculation and the disease
they have accused the patient of contracting. And both parties assume
that what is at issue is the scientific soundness of the prophylaxis.
It never occurs to them that the particular pathogenic germ which they
intended to introduce into the patient's system may be quite innocent of
the catastrophe, and that the casual dirt introduced with it may be at
fault. When, as in the case of smallpox or cowpox, the germ has not yet
been detected, what you inoculate is simply undefined matter that has
been scraped off an anything but chemically clean calf suffering from
the disease in question. You take your chance of the germ being in the
scrapings, and, lest you should kill it, you take no precautions against
other germs being in it as well. Anything may happen as the result of
such an inoculation. Yet this is the only stuff of the kind which is
prepared and supplied even in State establishments: that is, in the
only establishments free from the commercial temptation to adulterate
materials and scamp precautionary processes.
Even if the germ were identified, complete precautions would hardly pay.
It is true that microbe farming is not expensive. The cost of breeding
and housing two head of cattle would provide for the breeding and
housing of enough microbes to inoculate the entire population of
the globe since human life first appeared on it. But the precautions
necessary to insure that the inoculation shall consist of nothing else
but the required germ in the proper state of attenuation are a very
different matter from the precautions necessary in the distribution
and consumption of beefsteaks. Yet people expect to find vaccines
and antitoxins and the like retailed at "popular prices" in private
enterprise shops just as they expect to find ounces of tobacco and
papers of pins.