In short, private medical practice is governed not by science but by supply and demand; and however scientific a treatment may be, it cannot hold its place in the market if there is no demand for it; nor can the grossest quackery be kept off the market if there is a demand for it.

FASHIONS AND EPIDEMICS

A demand, however, can be inculcated.  This is thoroughly understood by fashionable tradesmen, who find no difficulty in persuading their customers to renew articles that are not worn out and to buy things they do not want.  By making doctors tradesmen, we compel them to learn the tricks of trade; consequently we find that the fashions of the year include treatments, operations, and particular drugs, as well as hats, sleeves, ballads, and games.  Tonsils, vermiform appendices, uvulas, even ovaries are sacrificed because it is the fashion to get them cut out, and because the operations are highly profitable.  The psychology of fashion becomes a pathology; for the cases have every air of being genuine:  fashions, after all, are only induced epidemics, proving that epidemics can be induced by tradesmen, and therefore by doctors.

THE DOCTOR’S VIRTUES

It will be admitted that this is a pretty bad state of things.  And the melodramatic instinct of the public, always demanding; that every wrong shall have, not its remedy, but its villain to be hissed, will blame, not its own apathy, superstition, and ignorance, but the depravity of the doctors.  Nothing could be more unjust or mischievous.  Doctors, if no better than other men, are certainly no worse.  I was reproached during the performances of The Doctor’s Dilemma at the Court Theatre in 1907 because I made the artist a rascal, the journalist an illiterate incapable, and all the doctors “angels.”  But I did not go beyond the warrant of my own experience.  It has been my luck to have doctors among my friends for nearly forty years past (all perfectly aware of my freedom from the usual credulity as to the miraculous powers and knowledge attributed to them); and though I know that there are medical blackguards as well as military, legal, and clerical blackguards (one soon finds that out when one is privileged to hear doctors talking shop among themselves), the fact that I was no more at a loss for private medical advice and attendance when I had not a penny in my pocket than I was later on when I could afford fees on the highest scale, has made it impossible for me to share that hostility to the doctor as a man which exists and is growing as an inevitable result of the present condition of medical practice.  Not that the interest in disease and aberrations which turns some men and women to medicine and surgery is not sometimes as morbid as the interest in misery and vice which turns some others to philanthropy and “rescue work.”  But the true doctor is inspired by a hatred of ill-health,