that what he or his sick child needs is not medicine, but more leisure, better clothes, better food, and a better drained and ventilated house.  It is kinder to give him a bottle of something almost as cheap as water, and tell him to come again with another eighteenpence if it does not cure him.  When you have done that over and over again every day for a week, how much scientific conscience have you left?  If you are weak-minded enough to cling desperately to your eighteenpence as denoting a certain social superiority to the sixpenny doctor, you will be miserably poor all your life; whilst the sixpenny doctor, with his low prices and quick turnover of patients, visibly makes much more than you do and kills no more people.

A doctor’s character can no more stand out against such conditions than the lungs of his patients can stand out against bad ventilation.  The only way in which he can preserve his self-respect is by forgetting all he ever learnt of science, and clinging to such help as he can give without cost merely by being less ignorant and more accustomed to sick-beds than his patients.  Finally, he acquires a certain skill at nursing cases under poverty-stricken domestic conditions, just as women who have been trained as domestic servants in some huge institution with lifts, vacuum cleaners, electric lighting, steam heating, and machinery that turns the kitchen into a laboratory and engine house combined, manage, when they are sent out into the world to drudge as general servants, to pick up their business in a new way, learning the slatternly habits and wretched makeshifts of homes where even bundles of kindling wood are luxuries to be anxiously economized.

THE SUCCESSFUL DOCTOR

The doctor whose success blinds public opinion to medical poverty is almost as completely demoralized.  His promotion means that his practice becomes more and more confined to the idle rich.  The proper advice for most of their ailments is typified in Abernethy’s “Live on sixpence a day and earn it.”  But here, as at the other end of the scale, the right advice is neither agreeable nor practicable.  And every hypochondriacal rich lady or gentleman who can be persuaded that he or she is a lifelong invalid means anything from fifty to five hundred pounds a year for the doctor.  Operations enable a surgeon to earn similar sums in a couple of hours; and if the surgeon also keeps a nursing home, he may make considerable profits at the same time by running what is the most expensive kind of hotel.  These gains are so great that they undo much of the moral advantage which the absence of grinding pecuniary anxiety gives the rich doctor over the poor one.  It is true that the temptation to prescribe a sham treatment because the real treatment is too dear for either patient or doctor does not exist for the rich doctor.  He always has plenty of genuine cases which can afford genuine treatment; and these provide him with enough