Here we have the explanation of the savage rancor that so amazes people
who imagine that the controversy concerning vaccination is a scientific
one. It has really nothing to do with science. The medical profession,
consisting for the most part of very poor men struggling to keep up
appearances beyond their means, find themselves threatened with the
extinction of a considerable part of their incomes: a part, too, that
is easily and regularly earned, since it is independent of disease,
and brings every person born into the nation, healthy or not, to the
doctors. To boot, there is the occasional windfall of an epidemic,
with its panic and rush for revaccination. Under such circumstances,
vaccination would be defended desperately were it twice as dirty,
dangerous, and unscientific in method as it actually is. The note of
fury in the defence, the feeling that the anti-vaccinator is doing a
cruel, ruinous, inconsiderate thing in a mood of indignant folly: all
this, so puzzling to the observer who knows nothing of the economic side
of the question, and only sees that the anti-vaccinator, having
nothing whatever to gain and a good deal to lose by placing himself in
opposition to the law and to the outcry that adds private persecution to
legal penalties, can have no interest in the matter except the interest
of a reformer in abolishing a corrupt and mischievous superstition,
becomes intelligible the moment the tragedy of medical poverty and the
lucrativeness of cheap vaccination is taken into account.
In the face of such economic pressure as this, it is silly to expect
that medical teaching, any more than medical practice, can possibly
be scientific. The test to which all methods of treatment are finally
brought is whether they are lucrative to doctors or not. It would be
difficult to cite any proposition less obnoxious to science, than that
advanced by Hahnemann: to wit, that drugs which in large doses produce
certain symptoms, counteract them in very small doses, just as in more
modern practice it is found that a sufficiently small inoculation with
typhoid rallies our powers to resist the disease instead of prostrating
us with it. But Hahnemann and his followers were frantically persecuted
for a century by generations of apothecary-doctors whose incomes
depended on the quantity of drugs they could induce their patients to
swallow. These two cases of ordinary vaccination and homeopathy are
typical of all the rest. Just as the object of a trade union under
existing conditions must finally be, not to improve the technical
quality of the work done by its members, but to secure a living wage
for them, so the object of the medical profession today is to secure an
income for the private doctor; and to this consideration all concern for
science and public health must give way when the two come into conflict.
Fortunately they are not always in conflict. Up to a certain point
doctors, like carpenters and masons, must earn their living by doing the
work that the public wants from them; and as it is not in the nature
of things possible that such public want should be based on unmixed
disutility, it may be admitted that doctors have their uses, real as
well as imaginary. But just as the best carpenter or mason will resist
the introduction of a machine that is likely to throw him out of work,
or the public technical education of unskilled laborers' sons to compete
with him, so the doctor will resist with all his powers of persecution
every advance of science that threatens his income. And as the advance
of scientific hygiene tends to make the private doctor's visits rarer,
and the public inspector's frequenter, whilst the advance of scientific
therapeutics is in the direction of treatments that involve highly
organized laboratories, hospitals, and public institutions generally, it
unluckily happens that the organization of private practitioners which
we call the medical profession is coming more and more to represent, not
science, but desperate and embittered antiscience: a statement of things
which is likely to get worse until the average doctor either depends
upon or hopes for an appointment in the public health service for his
livelihood.
So much for our guarantees as to medical science. Let us now deal with
the more painful subject of medical kindness.