§ 3
If there is one profession more than another in which devotion is implied and assumed, it is that of the doctor. It happens that on the morning when this chapter was drafted, I came upon the paragraph that follows; it seemed to me to supply just one striking concrete instance of how life is degraded by our present system, and to offer me a convenient text for a word or so more upon this question between gain and service. It is a little vague in its reference to Mr. Tompkins “of Birmingham,” and I should not be surprised if it were a considerable exaggeration of what really happened. But it is true enough to life in this, that it is a common practice, a necessity with doctors in poor neighbourhoods to insist inexorably upon a fee before attendance.
“A case of medical inhumanity is reported from Birmingham. A poor man named Tompkins was taken seriously ill early on Christmas morning, and although snow was falling and the atmosphere was terribly raw, his wife left the house in search of a doctor. The nearest practitioner declined to leave the house without being paid his fee; a second imposed the same condition, and the woman then went to the police station. As the horse ambulance was out, they could not help her, and she tried other doctors. In all the poor woman called on eight, and the only one who did not decline to get up without his fee was down with influenza. Eventually a local chemist was persuaded to see the man, and he ordered his removal to the hospital.”
That is the story. You note the charge of “inhumanity” in the very first line, and in much subsequent press comment there was the same note. Apparently every one expects a doctor to be ready at any point in the day or night to attend anybody for nothing. Most Socialists are disposed to agree with the spirit of that expectation. A practising doctor should be in lifelong perpetual war against pain and disease, just as a campaigning soldier is continually alert and serving. But existing conditions will not permit that. Existing conditions require the doctor to get his fee at any cost; if he goes about doing work for nothing, they punish him with shabbiness and incapacitating need, they forbid his marriage or doom his wife and children to poverty and unhappiness. A doctor must make money whatever else he does or does not do; he must secure his fees. He is a private adventurer, competing in a crowded market for gain, and keeping his energies perforce for those who can pay best for them. To expect him to behave like a public servant whose income and outlook are secure, or like a priest whose church will never let him want or starve, is ridiculous. If you put him on a footing with the greengrocer and coal merchant, you must expect him to behave like a tradesman. Why should the press blame the poor doctor of a poor neighbourhood because a moneyless man goes short of medical attendance, when it does not for one moment blame Mr. J. D. Rockefeller because a poor man goes short of oil, or the Duke of Devonshire because tramps need lodgings in Eastbourne? One never reads this sort of paragraph:—
“A case of commercial inhumanity is reported from Birmingham. A poor man named Tompkins was seriously hungry early on Christmas morning, and although snow was falling and the atmosphere was terribly raw, his wife left the house in search of food. The nearest grocer declined to supply provisions without being paid his price; a second imposed the same condition, and the woman then went to the police station. As that is not a soup-kitchen, they could not help her, and she tried other grocers and bread-shops. In all the poor woman called on eight, and the only one who did not decline to supply food without payment was for some reason bankrupt and out of stock. Eventually a local overseer was persuaded to see the man, and he ordered his removal to the workhouse, where, after considerable hardship, he was partly appeased with skilly.”
I, myself, have known an overworked, financially worried doctor at his bedroom window call out, “Have you brought the fee?” and have pitied and understood his ugly alternatives. “Once I began that sort of thing,” he explained to me a little apologetically, “they’d none of them pay—none.”
The Socialist’s remedy for this squalid state of affairs is plain and simple. Medicine is a public service, an honourable devotion; it should no more be a matter of profit-making than the food-supply service or the house-supply service—or salvation. It should be a part of the organization of a civilized State to have a Public Health service of well-paid, highly-educated men distributed over the country and closely correlated with public research departments and a reserve of specialists, who would be as ready and eager to face dangers and to sacrifice themselves for honour and social necessity as soldiers or sailors. I believe every honourable man in the medical profession under forty now would rather it were so. It is, indeed, a transition from private enterprise to public organization that is already beginning. We have the first intimation of the change in the appearance of the medical officer of health, underpaid, overworked and powerless though he is at the present time. It cannot be long before the manifest absurdity of our present conditions begins a process of socialization of the medical profession entirely analogous to that which has changed three-fourths of the teachers in Great Britain from private adventurers to public servants in the last forty years.
And that is the aim of Socialism all along the line; to convert one public service after another from a chaotic profit-scramble of proprietors amidst a mass of sweated employees into a secure and disciplined service, in which every man will work for honour, promotion, achievement and the commonweal.
I write a “secure and disciplined service,” and I intend by that not simply an exterior but an interior discipline. Let us have done with this unnatural theory that men may submit unreservedly to the guidance of “self-interest.” Self-interest never took a man or a community to any other end than damnation. For all services there is necessary a code of honour and devotion which a man must set up for himself and obey, to which he must subordinate a number of his impulses. The must is seconded by an internal imperative. Men and women want to have a code of honour. In the army, for example, there is among the officers particularly, a tradition of courage, cleanliness and good form, more imperative than any law; in the little band of men who have given the world all that we mean by science, the little host of volunteers and underpaid workers who have achieved the triumphs of research, there is a tradition of self-abnegation and of an immense, painstaking, self-forgetful veracity. These traditions work. They add something to the worth of every man who comes under them.
Every writer, again, knows clearly the difference between gain-seeking and doing good work, and few there are who have not at times done something, as they say, “to please themselves.” Then in the studio, for all the non-moral protests of Bohemia, there is a tradition, an admirable tradition, of disregard for mercenary imperatives, a scorn of shams and plagiarism that triumphs again and again over economic laws. The public services of the coming civilization will demand, and will develop, a far completer discipline and tradition of honour. Against the development and persistence of all such honourable codes now, against every attempt at personal nobility, at a new chivalry, at sincere artistry, our present individualist system wages pitiless warfare, says in effect, “Fools you are! Look at Rockefeller! Look at Pierpont Morgan! Get money! All your sacrifices only go to their enrichment. You cannot serve humanity however much you seek to do so. They block your way, enormously receptive of all you give. All the increment of human achievement goes to them—they own it a priori…. Get money! Money is freedom to do, to keep, to rule. Do you care nothing for your wives and children? Are you content to breed servants and dependants for the children of these men? Make things beautiful, make things abundant, make life glorious! Fools! if you work and sacrifice yourselves and do not get, they will possess. Your sons shall be the loan-monger’s employees, your daughters handmaidens to the millionaire. Or, if you cannot face that, go childless, and let your life-work gild the palace of the millionaire’s still more acquisitive descendants!”
Who can ignore the base scramble for money under these alternatives?