It must not be hastily concluded that this involves the extinction of
the private practitioner. What it will really mean for him is release
from his present degrading and scientifically corrupting slavery to his
patients. As I have already shown the doctor who has to live by pleasing
his patients in competition with everybody who has walked the hospitals,
scraped through the examinations, and bought a brass plate, soon finds
himself prescribing water to teetotallers and brandy or champagne jelly
to drunkards; beefsteaks and stout in one house, and "uric acid free"
vegetarian diet over the way; shut windows, big fires, and heavy
overcoats to old Colonels, and open air and as much nakedness as is
compatible with decency to young faddists, never once daring to say
either "I don't know," or "I don't agree." For the strength of the
doctor's, as of every other man's position when the evolution of social
organization at last reaches his profession, will be that he will always
have open to him the alternative of public employment when the private
employer becomes too tyrannous. And let no one suppose that the words
doctor and patient can disguise from the parties the fact that they are
employer and employee. 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 indispensable; but the average
doctor is not in this position: he is struggling for life in an
overcrowded profession, and knows well that "a good bedside manner"
will carry him to solvency through a morass of illness, whilst the
least attempt at plain dealing with people who are eating too much, or
drinking too much, or frowsting too much (to go no further in the list
of intemperances that make up so much of family life) would soon land
him in the Bankruptcy Court.
Private practice, thus protected, would itself protect individuals, as
far as such protection is possible, against the errors and superstitions
of State medicine, which are at worst no worse than the errors and
superstitions of private practice, being, indeed, all derived from it.
Such monstrosities as vaccination are, as we have seen, founded, not on
science, but on half-crowns. If the Vaccination Acts, instead of being
wholly repealed as they are already half repealed, were strengthened by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 him, and for whom there was plenty of alternative public
health work waiting, vaccination would be dead in two years, as the
vaccinator would not only not gain by it, but would lose credit through
the depressing effects on the vital statistics of his district of the
illness and deaths it causes, 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 infection. Such
absurd panic scandals as that of the last London epidemic, where a fee
of half-a-crown per re-vaccination produced raids on houses during
the absence of parents, and the forcible seizure and re-vaccination of
children left to answer the door, can be prevented simply by abolishing
the half-crown and all similar follies, paying, not for this or that
ceremony of witchcraft, but for immunity from disease, and paying, too,
in a rational way. The officer with a fixed salary saves himself trouble
by doing his business with the least possible interference with the
private citizen. The man paid by the job loses money by not forcing his
job on the public as often as possible without reference to its results.