So long as a doctor is learning or adding to knowledge, he earns nothing, and the common, unintelligent man does not see why he should earn anything.  So that a doctor who has no religious passion for poverty and self-devotion gets through the minimum of training and learning as quickly and as cheaply as possible, and does all he can to fill up the rest of his time in passing rapidly from case to case.  The busier he keeps, the less his leisure for thought and learning, the richer he grows, and the more he is esteemed.  His four or five years of hasty, crowded study are supposed to give him a complete and final knowledge of the treatment of every sort of disease, and he goes on year after year, often without co-operation, working mechanically in the common incidents of practice, births, cases of measles and whooping cough, and so forth, and blundering more or less in whatever else turns up.

There are no public specialists to whom he can conveniently refer the difficulties he constantly encounters; only in the case of rich patients is the specialist available; there are no properly organised information bureaus for him, and no means whatever of keeping him informed upon progress and discovery in medical science.  He is not even required to set apart a month or so in every two or three years in order to return to lectures and hospitals and refresh his knowledge.  Indeed, the income of the average general practitioner would not permit of such a thing, and almost the only means of contact between him and current thought lies in the one or other of our two great medical weeklies to which he happens to subscribe.

Now just as I have nothing but praise for the average general practitioner, so I have nothing but praise and admiration for those stalwart-looking publications.  Without them I can imagine nothing but the most terrible intellectual atrophy among our medical men.  But since they are private properties run for profit they have to pay, and half their bulk consists of the brilliantly written advertisements of new drugs and apparatus.  They give much knowledge, they do much to ventilate perplexing questions, but a broadly conceived and properly endowed weekly circular could, I believe, do much more.  At any rate, in my Utopia this duty of feeding up the general practitioners will not be left to private enterprise.

Behind the first line of my medical army will be a second line of able men constantly digesting new research for its practical needs—­correcting, explaining, announcing; and, in addition, a force of public specialists to whom every difficulty in diagnosis will be at once referred.  And there will be a properly organised system of reliefs that will allow the general practitioner and his right hand, the nurse, to come back to the refreshment of study before his knowledge and mind have got rusty.  But then my Utopia is a Socialistic system.  Under our present system of competitive scramble, under any system that reduces medical practice to mere fee-hunting nothing of this sort is possible.