In that extravagant world of which I dream, in which people will live in delightful cottages and ground rents will serve instead of rates, and everyone will have a chance of being happy—in that impossible world all doctors will be members of one great organisation for the public health, with all or most of their income guaranteed to them: I doubt if there will be any private doctors at all.

Heaven forbid I should seem to write a word against doctors as they are. Daily I marvel at the wonders the general practitioner achieves, having regard to the difficulties of his position.

But I cannot hide from myself, and I do not intend to hide from anyone else, my firm persuasion that the services the general practitioner is able to render us are not one-tenth so effectual as they might be if, instead of his being a private adventurer, he were a member of a sanely organised public machine. Consider what his training and equipment are, consider the peculiar difficulties of his work, and then consider for a moment what better conditions might be invented, and perhaps you will not think my estimate of one-tenth an excessive understatement in this matter.

Nearly the whole of our medical profession and most of our apparatus for teaching and training doctors subsist on strictly commercial lines by earning fees. This chief source of revenue is eked out by the wanton charity of old women, and conspicuous subscriptions by popularity hunters, and a small but growing contribution (in the salaries of medical officers of health and so forth) from the public funds. But the fact remains that for the great mass of the medical profession there is no living to be got except at a salary for hospital practice or by earning fees in receiving or attending upon private cases.

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.

Then in my Utopia, for every medical man who was mainly occupied in practice, I would have another who was mainly occupied in or about research. People hear so much about modern research that they do not realise how entirely inadequate it is in amount and equipment. Our general public is still too stupid to understand the need and value of sustained investigations in any branch of knowledge at all. In spite of all the lessons of the last century, it still fails to realise how discovery and invention enrich the community and how paying an investment is the public employment of clever people to think and experiment for the benefit of all. It still expects to get a Newton or a Joule for #800 a year, and requires him to conduct his researches in the margin of time left over when he has got through his annual eighty or ninety lectures. It imagines discoveries are a sort of inspiration that comes when professors are running to catch trains. It seems incapable of imagining how enormous are the untried possibilities of research. Of course, if you will only pay a handful of men salaries at which the cook of any large London hotel would turn up his nose, you cannot expect to have the master minds of the world at your service; and save for a few independent or devoted men, therefore, it is not reasonable to suppose that such a poor little dribble of medical research as is now going on is in the hands of persons of much more than average mental equipment. How can it be?

One hears a lot of the rigorous research into the problem of cancer that is now going on. Does the reader realise that all the men in the whole world who are giving any considerable proportion of their time to this cancer research would pack into a very small room, that they are working in little groups without any properly organised system of intercommunication, and that half of them are earning less than a quarter of the salary of a Bond Street shopwalker by those vastly important inquiries? Not one cancer case in twenty thousand is being properly described and reported. And yet, in comparison with other diseases, cancer is being particularly well attended to.

The general complacency with the progress in knowledge we have made and are making is ridiculously unjustifiable. Enormous things were no doubt done in the nineteenth century in many fields of knowledge, but all that was done was out of all proportion petty in comparison with what might have been done. I suppose the whole of the unprecedented progress in material knowledge of the nineteenth century was the work of two or three thousand men, who toiled against opposition, spite and endless disadvantages, without proper means of intercommunication and with wretched facilities for experiment. Such discoveries as were distinctively medical were the work of only a few hundred men. Now, suppose instead of that scattered band of un-co-ordinated workers a great army of hundreds of thousands of well-paid men; suppose, for instance, the community had kept as many scientific and medical investigators as it has bookmakers and racing touts and men about town—should we not know a thousand times as much as we do about disease and health and strength and power?

But these are Utopian questionings. The sane, practical man shakes his head, smiles pityingly at my dreamy impracticability, and passes them by.