Yet most vivisectors would probably come triumphant out of such a series of experiments, because vivisection is now a routine, like butchering or hanging or flogging; and many of the men who practise it do so only because it has been established as part of the profession they have adopted. Far from enjoying it, they have simply overcome their natural repugnance and become indifferent to it, as men inevitably become indifferent to anything they do often enough. It is this dangerous power of custom that makes it so difficult to convince the common sense of mankind that any established commercial or professional practice has its root in passion. Let a routine once spring from passion, and you will presently find thousands of routineers following it passionlessly for a livelihood. Thus it always seems strained to speak of the religious convictions of a clergyman, because nine out of ten clergymen have no religions convictions: they are ordinary officials carrying on a routine of baptizing, marrying, and churching; praying, reciting, and preaching; and, like solicitors or doctors, getting away from their duties with relief to hunt, to garden, to keep bees, to go into society, and the like. In the same way many people do cruel and vile things without being in the least cruel or vile, because the routine to which they have been brought up is superstitiously cruel and vile. To say that every man who beats his children and every schoolmaster who flogs a pupil is a conscious debauchee is absurd: thousands of dull, conscientious people beat their children conscientiously, because they were beaten themselves and think children ought to be beaten. The ill-tempered vulgarity that instinctively strikes at and hurts a thing that annoys it (and all children are annoying), and the simple stupidity that requires from a child perfection beyond the reach of the wisest and best adults (perfect truthfulness coupled with perfect obedience is quite a common condition of leaving a child unwhipped), produce a good deal of flagellation among people who not only do not lust after it, but who hit the harder because they are angry at having to perform an uncomfortable duty. These people will beat merely to assert their authority, or to carry out what they conceive to be a divine order on the strength of the precept of Solomon recorded in the Bible, which carefully adds that Solomon completely spoilt his own son and turned away from the god of his fathers to the sensuous idolatry in which he ended his days.
In the same way we find men and women practising vivisection as senselessly as a humane butcher, who adores his fox terrier, will cut a calf's throat and hang it up by its heels to bleed slowly to death because it is the custom to eat veal and insist on its being white; or as a German purveyor nails a goose to a board and stuffs it with food because fashionable people eat pate de foie gras; or as the crew of a whaler breaks in on a colony of seals and clubs them to death in wholesale massacre because ladies want sealskin jackets; or as fanciers blind singing birds with hot needles, and mutilate the ears and tails of dogs and horses. Let cruelty or kindness or anything else once become customary and it will be practised by people to whom it is not at all natural, but whose rule of life is simply to do only what everybody else does, and who would lose their employment and starve if they indulged in any peculiarity. A respectable man will lie daily, in speech and in print, about the qualities of the article he lives by selling, because it is customary to do so. He will flog his boy for telling a lie, because it is customary to do so. He will also flog him for not telling a lie if the boy tells inconvenient or disrespectful truths, because it is customary to do so. He will give the same boy a present on his birthday, and buy him a spade and bucket at the seaside, because it is customary to do so, being all the time neither particularly mendacious, nor particularly cruel, nor particularly generous, but simply incapable of ethical judgment or independent action.
Just so do we find a crowd of petty vivisectionists daily committing atrocities and stupidities, because it is the custom to do so. Vivisection is customary as part of the routine of preparing lectures in medical schools. For instance, there are two ways of making the action of the heart visible to students. One, a barbarous, ignorant, and thoughtless way, is to stick little flags into a rabbit's heart and let the students see the flags jump. The other, an elegant, ingenious, well-informed, and instructive way, is to put a sphygmograph on the student's wrist and let him see a record of his heart's action traced by a needle on a slip of smoked paper. But it has become the custom for lecturers to teach from the rabbit; and the lecturers are not original enough to get out of their groove. Then there are the demonstrations which are made by cutting up frogs with scissors. The most humane man, however repugnant the operation may be to him at first, cannot do it at lecture after lecture for months without finally—and that very soon—feeling no more for the frog than if he were cutting up pieces of paper. Such clumsy and lazy ways of teaching are based on the cheapness of frogs and rabbits. If machines were as cheap as frogs, engineers would not only be taught the anatomy of machines and the functions of their parts: they would also have machines misused and wrecked before them so that they might learn as much as possible by using their eyes, and as little as possible by using their brains and imaginations. Thus we have, as part of the routine of teaching, a routine of vivisection which soon produces complete indifference to it on the part even of those who are naturally humane. If they pass on from the routine of lecture preparation, not into general practice, but into research work, they carry this acquired indifference with them into the laboratory, where any atrocity is possible, because all atrocities satisfy curiosity. The routine man is in the majority in his profession always: consequently the moment his practice is tracked down to its source in human passion there is a great and quite sincere poohpoohing from himself, from the mass of the profession, and from the mass of the public, which sees that the average doctor is much too commonplace and decent a person to be capable of passionate wickedness of any kind.
Here then, we have in vivisection, as in all the other tolerated and instituted cruelties, this anti-climax: that only a negligible percentage of those who practise and consequently defend it get any satisfaction out of it. As in Mr. Galsworthy's play Justice the useless and detestable torture of solitary imprisonment is shown at its worst without the introduction of a single cruel person into the drama, so it would be possible to represent all the torments of vivisection dramatically without introducing a single vivisector who had not felt sick at his first experience in the laboratory. Not that this can exonerate any vivisector from suspicion of enjoying his work (or her work: a good deal of the vivisection in medical schools is done by women). In every autobiography which records a real experience of school or prison life, we find that here and there among the routineers there is to be found the genuine amateur, the orgiastic flogging schoolmaster or the nagging warder, who has sought out a cruel profession for the sake of its cruelty. But it is the genuine routineer who is the bulwark of the practice, because, though you can excite public fury against a Sade, a Bluebeard, or a Nero, you cannot rouse any feeling against dull Mr. Smith doing his duty: that is, doing the usual thing. He is so obviously no better and no worse than anyone else that it is difficult to conceive that the things he does are abominable. If you would see public dislike surging up in a moment against an individual, you must watch one who does something unusual, no matter how sensible it may be. The name of Jonas Hanway lives as that of a brave man because he was the first who dared to appear in the streets of this rainy island with an umbrella.
But there is still a distinction to be clung to by those who dare not tell themselves the truth about the medical profession because they are so helplessly dependent on it when death threatens the household. That distinction is the line that separates the brute from the man in the old classification. Granted, they will plead, that we are all cruel; yet the tame-stag-hunter does not hunt men; and the sportsman who lets a leash of greyhounds loose on a hare would be horrified at the thought of letting them loose on a human child. The lady who gets her cloak by flaying a sable does not flay a negro; nor does it ever occur to her that her veal cutlet might be improved on by a slice of tender baby.
Now there was a time when some trust could be placed in this distinction. The Roman Catholic Church still maintains, with what it must permit me to call a stupid obstinacy, and in spite of St. Francis and St. Anthony, that animals have no souls and no rights; so that you cannot sin against an animal, or against God by anything you may choose to do to an animal. Resisting the temptation to enter on an argument as to whether you may not sin against your own soul if you are unjust or cruel to the least of those whom St. Francis called his little brothers, I have only to point out here that nothing could be more despicably superstitious in the opinion of a vivisector than the notion that science recognizes any such step in evolution as the step from a physical organism to an immortal soul. That conceit has been taken out of all our men of science, and out of all our doctors, by the evolutionists; and when it is considered how completely obsessed biological science has become in our days, not by the full scope of evolution, but by that particular method of it which has neither sense nor purpose nor life nor anything human, much less godlike, in it: by the method, that is, of so-called Natural Selection (meaning no selection at all, but mere dead accident and luck), the folly of trusting to vivisectors to hold the human animal any more sacred than the other animals becomes so clear that it would be waste of time to insist further on it. As a matter of fact the man who once concedes to the vivisector the right to put a dog outside the laws of honor and fellowship, concedes to him also the right to put himself outside them; for he is nothing to the vivisector but a more highly developed, and consequently more interesting-to-experiment-on vertebrate than the dog.
I have in my hand a printed and published account by a doctor of how he tested his remedy for pulmonary tuberculosis, which was to inject a powerful germicide directly into the circulation by stabbing a vein with a syringe. He was one of those doctors who are able to command public sympathy by saying, quite truly, that when they discovered that the proposed treatment was dangerous, they experimented thenceforth on themselves. In this case the doctor was devoted enough to carry his experiments to the point of running serious risks, and actually making himself very uncomfortable. But he did not begin with himself. His first experiment was on two hospital patients. On receiving a message from the hospital to the effect that these two martyrs to therapeutic science had all but expired in convulsions, he experimented on a rabbit, which instantly dropped dead. It was then, and not until then, that he began to experiment on himself, with the germicide modified in the direction indicated by the experiments made on the two patients and the rabbit. As a good many people countenance vivisection because they fear that if the experiments are not made on rabbits they will be made on themselves, it is worth noting that in this case, where both rabbits and men were equally available, the men, being, of course, enormously more instructive, and costing nothing, were experimented on first. Once grant the ethics of the vivisectionists and you not only sanction the experiment on the human subject, but make it the first duty of the vivisector. If a guinea pig may be sacrificed for the sake of the very little that can be learnt from it, shall not a man be sacrificed for the sake of the great deal that can be learnt from him? At all events, he is sacrificed, as this typical case shows. I may add (not that it touches the argument) that the doctor, the patients, and the rabbit all suffered in vain, as far as the hoped-for rescue of the race from pulmonary consumption is concerned.
Now at the very time when the lectures describing these experiments were being circulated in print and discussed eagerly by the medical profession, the customary denials that patients are experimented on were as loud, as indignant, as high-minded as ever, in spite of the few intelligent doctors who point out rightly that all treatments are experiments on the patient. And this brings us to an obvious but mostly overlooked weakness in the vivisector's position: that is, his inevitable forfeiture of all claim to have his word believed. It is hardly to be expected that a man who does not hesitate to vivisect for the sake of science will hesitate to lie about it afterwards to protect it from what he deems the ignorant sentimentality of the laity. When the public conscience stirs uneasily and threatens suppression, there is never wanting some doctor of eminent position and high character who will sacrifice himself devotedly to the cause of science by coming forward to assure the public on his honor that all experiments on animals are completely painless; although he must know that the very experiments which first provoked the antivivisection movement by their atrocity were experiments to ascertain the physiological effects of the sensation of extreme pain (the much more interesting physiology of pleasure remains uninvestigated) and that all experiments in which sensation is a factor are voided by its suppression. Besides, vivisection may be painless in cases where the experiments are very cruel. If a person scratches me with a poisoned dagger so gently that I do not feel the scratch, he has achieved a painless vivisection; but if I presently die in torment I am not likely to consider that his humility is amply vindicated by his gentleness. A cobra's bite hurts so little that the creature is almost, legally speaking, a vivisector who inflicts no pain. By giving his victims chloroform before biting them he could comply with the law completely.
Here, then, is a pretty deadlock. Public support of vivisection is founded almost wholly on the assurances of the vivisectors that great public benefits may be expected from the practice. Not for a moment do I suggest that such a defence would be valid even if proved. But when the witnesses begin by alleging that in the cause of science all the customary ethical obligations (which include the obligation to tell the truth) are suspended, what weight can any reasonable person give to their testimony? I would rather swear fifty lies than take an animal which had licked my hand in good fellowship and torture it. If I did torture the dog, I should certainly not have the face to turn round and ask how any person there suspect an honorable man like myself of telling lies. Most sensible and humane people would, I hope, reply flatly that honorable men do not behave dishonorably, even to dogs. The murderer who, when asked by the chaplain whether he had any other crimes to confess, replied indignantly, "What do you take me for?" reminds us very strongly of the vivisectors who are so deeply hurt when their evidence is set aside as worthless.
The Achilles heel of vivisection, however, is not to be found in the pain it causes, but in the line of argument by which it is justified. The medical code regarding it is simply criminal anarchism at its very worst. Indeed no criminal has yet had the impudence to argue as every vivisector argues. No burglar contends that as it is admittedly important to have money to spend, and as the object of burglary is to provide the burglar with money to spend, and as in many instances it has achieved this object, therefore the burglar is a public benefactor and the police are ignorant sentimentalists. No highway robber has yet harrowed us with denunciations of the puling moralist who allows his child to suffer all the evils of poverty because certain faddists think it dishonest to garotte an alderman. Thieves and assassins understand quite well that there are paths of acquisition, even of the best things, that are barred to all men of honor. Again, has the silliest burglar ever pretended that to put a stop to burglary is to put a stop to industry? All the vivisections that have been performed since the world began have produced nothing so important as the innocent and honorable discovery of radiography; and one of the reasons why radiography was not discovered sooner was that the men whose business it was to discover new clinical methods were coarsening and stupefying themselves with the sensual villanies and cutthroat's casuistries of vivisection. The law of the conservation of energy holds good in physiology as in other things: every vivisector is a deserter from the army of honorable investigators. But the vivisector does not see this. He not only calls his methods scientific: he contends that there are no other scientific methods. When you express your natural loathing for his cruelty and your natural contempt for his stupidity, he imagines that you are attacking science. Yet he has no inkling of the method and temper of science. The point at issue being plainly whether he is a rascal or not, he not only insists that the real point is whether some hotheaded antivivisectionist is a liar (which he proves by ridiculously unscientific assumptions as to the degree of accuracy attainable in human statement), but never dreams of offering any scientific evidence by his own methods.
There are many paths to knowledge already discovered; and no enlightened man doubts that there are many more waiting to be discovered. Indeed, all paths lead to knowledge; because even the vilest and stupidest action teaches us something about vileness and stupidity, and may accidentally teach us a good deal more: for instance, a cutthroat learns (and perhaps teaches) the anatomy of the carotid artery and jugular vein; and there can be no question that the burning of St. Joan of Arc must have been a most instructive and interesting experiment to a good observer, and could have been made more so if it had been carried out by skilled physiologists under laboratory conditions. The earthquake in San Francisco proved invaluable as an experiment in the stability of giant steel buildings; and the ramming of the Victoria by the Camperdown settled doubtful points of the greatest importance in naval warfare. According to vivisectionist logic our builders would be justified in producing artificial earthquakes with dynamite, and our admirals in contriving catastrophes at naval manoeuvres, in order to follow up the line of research thus accidentally discovered.
The truth is, if the acquisition of knowledge justifies every sort of conduct, it justifies any sort of conduct, from the illumination of Nero's feasts by burning human beings alive (another interesting experiment) to the simplest act of kindness. And in the light of that truth it is clear that the exemption of the pursuit of knowledge from the laws of honor is the most hideous conceivable enlargement of anarchy; worse, by far, than an exemption of the pursuit of money or political power, since there can hardly be attained without some regard for at least the appearances of human welfare, whereas a curious devil might destroy the whole race in torment, acquiring knowledge all the time from his highly interesting experiment. There is more danger in one respectable scientist countenancing such a monstrous claim than in fifty assassins or dynamitards. The man who makes it is ethically imbecile; and whoever imagines that it is a scientific claim has not the faintest conception of what science means. The paths to knowledge are countless. One of these paths is a path through darkness, secrecy, and cruelty. When a man deliberately turns from all other paths and goes down that one, it is scientific to infer that what attracts him is not knowledge, since there are other paths to that, but cruelty. With so strong and scientific a case against him, it is childish for him to stand on his honor and reputation and high character and the credit of a noble profession and so forth: he must clear himself either by reason or by experiment, unless he boldly contends that evolution has retained a passion of cruelty in man just because it is indispensable to the fulness of his knowledge.
I shall not be at all surprised if what I have written above has induced in sympathetic readers a transport of virtuous indignation at the expense of the medical profession. I shall not damp so creditable and salutary a sentiment; but I must point out that the guilt is shared by all of us. It is not in his capacity of healer and man of science that the doctor vivisects or defends vivisection, but in his entirely vulgar lay capacity. He is made of the same clay as the ignorant, shallow, credulous, half-miseducated, pecuniarily anxious people who call him in when they have tried in vain every bottle and every pill the advertizing druggist can persuade them to buy. The real remedy for vivisection is the remedy for all the mischief that the medical profession and all the other professions are doing: namely, more knowledge. The juries which send the poor Peculiars to prison, and give vivisectionists heavy damages against humane persons who accuse them of cruelty; the editors and councillors and student-led mobs who are striving to make Vivisection one of the watchwords of our civilization, are not doctors: they are the British public, all so afraid to die that they will cling frantically to any idol which promises to cure all their diseases, and crucify anyone who tells them that they must not only die when their time comes, but die like gentlemen. In their paroxysms of cowardice and selfishness they force the doctors to humor their folly and ignorance. How complete and inconsiderate their ignorance is can only be realized by those who have some knowledge of vital statistics, and of the illusions which beset Public Health legislation.
The demands of this poor public are not reasonable, but they are quite simple. It dreads disease and desires to be protected against it. But it is poor and wants to be protected cheaply. Scientific measures are too hard to understand, too costly, too clearly tending towards a rise in the rates and more public interference with the insanitary, because insufficiently financed, private house. What the public wants, therefore, is a cheap magic charm to prevent, and a cheap pill or potion to cure, all disease. It forces all such charms on the doctors.
Thus it was really the public and not the medical profession that took up vaccination with irresistible faith, sweeping the invention out of Jenner's hand and establishing it in a form which he himself repudiated. Jenner was not a man of science; but he was not a fool; and when he found that people who had suffered from cowpox either by contagion in the milking shed or by vaccination, were not, as he had supposed, immune from smallpox, he ascribed the cases of immunity which had formerly misled him to a disease of the horse, which, perhaps because we do not drink its milk and eat its flesh, is kept at a greater distance in our imagination than our foster mother the cow. At all events, the public, which had been boundlessly credulous about the cow, would not have the horse on any terms; and to this day the law which prescribes Jennerian vaccination is carried out with an anti-Jennerian inoculation because the public would have it so in spite of Jenner. All the grossest lies and superstitions which have disgraced the vaccination craze were taught to the doctors by the public. It was not the doctors who first began to declare that all our old men remember the time when almost every face they saw in the street was horribly pitted with smallpox, and that all this disfigurement has vanished since the introduction of vaccination. Jenner himself alluded to this imaginary phenomenon before the introduction of vaccination, and attributed it to the older practice of smallpox inoculation, by which Voltaire, Catherine II. and Lady Mary Wortley Montagu so confidently expected to see the disease made harmless. It was not Jenner who set people declaring that smallpox, if not abolished by vaccination, had at least been made much milder: on the contrary, he recorded a pre-vaccination epidemic in which none of the persons attacked went to bed or considered themselves as seriously ill. Neither Jenner, nor any other doctor ever, as far as I know, inculcated the popular notion that everybody got smallpox as a matter of course before vaccination was invented. That doctors get infected with these delusions, and are in their unprofessional capacity as members of the public subject to them like other men, is true; but if we had to decide whether vaccination was first forced on the public by the doctors or on the doctors by the public, we should have to decide against the public.
Public ignorance of the laws of evidence and of statistics can hardly be exaggerated. There may be a doctor here and there who in dealing with the statistics of disease has taken at least the first step towards sanity by grasping the fact that as an attack of even the commonest disease is an exceptional event, apparently over-whelming statistical evidence in favor of any prophylactic can be produced by persuading the public that everybody caught the disease formerly. Thus if a disease is one which normally attacks fifteen per cent of the population, and if the effect of a prophylactic is actually to increase the proportion to twenty per cent, the publication of this figure of twenty per cent will convince the public that the prophylactic has reduced the percentage by eighty per cent instead of increasing it by five, because the public, left to itself and to the old gentlemen who are always ready to remember, on every possible subject, that things used to be much worse than they are now (such old gentlemen greatly outnumber the laudatores tempori acti), will assume that the former percentage was about 100. The vogue of the Pasteur treatment of hydrophobia, for instance, was due to the assumption by the public that every person bitten by a rabid dog necessarily got hydrophobia. I myself heard hydrophobia discussed in my youth by doctors in Dublin before a Pasteur Institute existed, the subject having been brought forward there by the scepticism of an eminent surgeon as to whether hydrophobia is really a specific disease or only ordinary tetanus induced (as tetanus was then supposed to be induced) by a lacerated wound. There were no statistics available as to the proportion of dog bites that ended in hydrophobia; but nobody ever guessed that the cases could be more than two or three per cent of the bites. On me, therefore, the results published by the Pasteur Institute produced no such effect as they did on the ordinary man who thinks that the bite of a mad dog means certain hydrophobia. It seemed to me that the proportion of deaths among the cases treated at the Institute was rather higher, if anything, than might have been expected had there been no Institute in existence. But to the public every Pasteur patient who did not die was miraculously saved from an agonizing death by the beneficent white magic of that most trusty of all wizards, the man of science.
Even trained statisticians often fail to appreciate the extent to which statistics are vitiated by the unrecorded assumptions of their interpreters. Their attention is too much occupied with the cruder tricks of those who make a corrupt use of statistics for advertizing purposes. There is, for example, the percentage dodge. In some hamlet, barely large enough to have a name, two people are attacked during a smallpox epidemic. One dies: the other recovers. One has vaccination marks: the other has none. Immediately either the vaccinists or the antivaccinists publish the triumphant news that at such and such a place not a single vaccinated person died of smallpox whilst 100 per cent of the unvaccinated perished miserably; or, as the case may be, that 100 per cent of the unvaccinated recovered whilst the vaccinated succumbed to the last man. Or, to take another common instance, comparisons which are really comparisons between two social classes with different standards of nutrition and education are palmed off as comparisons between the results of a certain medical treatment and its neglect. Thus it is easy to prove that the wearing of tall hats and the carrying of umbrellas enlarges the chest, prolongs life, and confers comparative immunity from disease; for the statistics show that the classes which use these articles are bigger, healthier, and live longer than the class which never dreams of possessing such things. It does not take much perspicacity to see that what really makes this difference is not the tall hat and the umbrella, but the wealth and nourishment of which they are evidence, and that a gold watch or membership of a club in Pall Mall might be proved in the same way to have the like sovereign virtues. A university degree, a daily bath, the owning of thirty pairs of trousers, a knowledge of Wagner's music, a pew in church, anything, in short, that implies more means and better nurture than the mass of laborers enjoy, can be statistically palmed off as a magic-spell conferring all sorts of privileges.
In the case of a prophylactic enforced by law, this illusion is intensified grotesquely, because only vagrants can evade it. Now vagrants have little power of resisting any disease: their death rate and their case-mortality rate is always high relatively to that of respectable folk. Nothing is easier, therefore, than to prove that compliance with any public regulation produces the most gratifying results. It would be equally easy even if the regulation actually raised the death-rate, provided it did not raise it sufficiently to make the average householder, who cannot evade regulations, die as early as the average vagrant who can.
There is another statistical illusion which is independent of class differences. A common complaint of houseowners is that the Public Health Authorities frequently compel them to instal costly sanitary appliances which are condemned a few years later as dangerous to health, and forbidden under penalties. Yet these discarded mistakes are always made in the first instance on the strength of a demonstration that their introduction has reduced the death-rate. The explanation is simple. Suppose a law were made that every child in the nation should be compelled to drink a pint of brandy per month, but that the brandy must be administered only when the child was in good health, with its digestion and so forth working normally, and its teeth either naturally or artificially sound. Probably the result would be an immediate and startling reduction in child mortality, leading to further legislation increasing the quantity of brandy to a gallon. Not until the brandy craze had been carried to a point at which the direct harm done by it would outweigh the incidental good, would an anti-brandy party be listened to. That incidental good would be the substitution of attention to the general health of children for the neglect which is now the rule so long as the child is not actually too sick to run about and play as usual. Even if this attention were confined to the children's teeth, there would be an improvement which it would take a good deal of brandy to cancel.
This imaginary case explains the actual case of the sanitary appliances which our local sanitary authorities prescribe today and condemn tomorrow. No sanitary contrivance which the mind of even the very worst plumber can devize could be as disastrous as that total neglect for long periods which gets avenged by pestilences that sweep through whole continents, like the black death and the cholera. If it were proposed at this time of day to discharge all the sewage of London crude and untreated into the Thames, instead of carrying it, after elaborate treatment, far out into the North Sea, there would be a shriek of horror from all our experts. Yet if Cromwell had done that instead of doing nothing, there would probably have been no Great Plague of London. When the Local Health Authority forces every householder to have his sanitary arrangements thought about and attended to by somebody whose special business it is to attend to such things, then it matters not how erroneous or even directly mischievous may be the specific measures taken: the net result at first is sure to be an improvement. Not until attention has been effectually substituted for neglect as the general rule, will the statistics begin to show the merits of the particular methods of attention adopted. And as we are far from having arrived at this stage, being as to health legislation only at the beginning of things, we have practically no evidence yet as to the value of methods. Simple and obvious as this is, nobody seems as yet to discount the effect of substituting attention for neglect in drawing conclusions from health statistics. Everything is put to the credit of the particular method employed, although it may quite possibly be raising the death rate by five per thousand whilst the attention incidental to it is reducing the death rate fifteen per thousand. The net gain of ten per thousand is credited to the method, and made the excuse for enforcing more of it.
There is yet another way in which specifics which have no merits at all, either direct or incidental, may be brought into high repute by statistics. For a century past civilization has been cleaning away the conditions which favor bacterial fevers. Typhus, once rife, has vanished: plague and cholera have been stopped at our frontiers by a sanitary blockade. We still have epidemics of smallpox and typhoid; and diphtheria and scarlet fever are endemic in the slums. Measles, which in my childhood was not regarded as a dangerous disease, has now become so mortal that notices are posted publicly urging parents to take it seriously. But even in these cases the contrast between the death and recovery rates in the rich districts and in the poor ones has led to the general conviction among experts that bacterial diseases are preventable; and they already are to a large extent prevented. The dangers of infection and the way to avoid it are better understood than they used to be. It is barely twenty years since people exposed themselves recklessly to the infection of consumption and pneumonia in the belief that these diseases were not "catching." Nowadays the troubles of consumptive patients are greatly increased by the growing disposition to treat them as lepers. No doubt there is a good deal of ignorant exaggeration and cowardly refusal to face a human and necessary share of the risk. That has always been the case. We now know that the medieval horror of leprosy was out of all proportion to the danger of infection, and was accompanied by apparent blindness to the infectiousness of smallpox, which has since been worked up by our disease terrorists into the position formerly held by leprosy. But the scare of infection, though it sets even doctors talking as if the only really scientific thing to do with a fever patient is to throw him into the nearest ditch and pump carbolic acid on him from a safe distance until he is ready to be cremated on the spot, has led to much greater care and cleanliness. And the net result has been a series of victories over disease.
Now let us suppose that in the early nineteenth century somebody had come forward with a theory that typhus fever always begins in the top joint of the little finger; and that if this joint be amputated immediately after birth, typhus fever will disappear. Had such a suggestion been adopted, the theory would have been triumphantly confirmed; for as a matter of fact, typhus fever has disappeared. On the other hand cancer and madness have increased (statistically) to an appalling extent. The opponents of the little finger theory would therefore be pretty sure to allege that the amputations were spreading cancer and lunacy. The vaccination controversy is full of such contentions. So is the controversy as to the docking of horses' tails and the cropping of dogs' ears. So is the less widely known controversy as to circumcision and the declaring certain kinds of flesh unclean by the Jews. To advertize any remedy or operation, you have only to pick out all the most reassuring advances made by civilization, and boldly present the two in the relation of cause and effect: the public will swallow the fallacy without a wry face. It has no idea of the need for what is called a control experiment. In Shakespear's time and for long after it, mummy was a favorite medicament. You took a pinch of the dust of a dead Egyptian in a pint of the hottest water you could bear to drink; and it did you a great deal of good. This, you thought, proved what a sovereign healer mummy was. But if you had tried the control experiment of taking the hot water without the mummy, you might have found the effect exactly the same, and that any hot drink would have done as well.
Another difficulty about statistics is the technical difficulty of calculation. Before you can even make a mistake in drawing your conclusion from the correlations established by your statistics you must ascertain the correlations. When I turn over the pages of Biometrika, a quarterly journal in which is recorded the work done in the field of biological statistics by Professor Karl Pearson and his colleagues, I am out of my depth at the first line, because mathematics are to me only a concept: I never used a logarithm in my life, and could not undertake to extract the square root of four without misgiving. I am therefore unable to deny that the statistical ascertainment of the correlations between one thing and another must be a very complicated and difficult technical business, not to be tackled successfully except by high mathematicians; and I cannot resist Professor Karl Pearson's immense contempt for, and indignant sense of grave social danger in, the unskilled guesses of the ordinary sociologist.
Now the man in the street knows nothing of Biometrika: all he knows is that "you can prove anything by figures," though he forgets this the moment figures are used to prove anything he wants to believe. If he did take in Biometrika he would probably become abjectly credulous as to all the conclusions drawn in it from the correlations so learnedly worked out; though the mathematician whose correlations would fill a Newton with admiration may, in collecting and accepting data and drawing conclusions from them, fall into quite crude errors by just such popular oversights as I have been describing.
To all these blunders and ignorances doctors are no less subject than the rest of us. They are not trained in the use of evidence, nor in biometrics, nor in the psychology of human credulity, nor in the incidence of economic pressure. Further, they must believe, on the whole, what their patients believe, just as they must wear the sort of hat their patients wear. The doctor may lay down the law despotically enough to the patient at points where the patient's mind is simply blank; but when the patient has a prejudice the doctor must either keep it in countenance or lose his patient. If people are persuaded that night air is dangerous to health and that fresh air makes them catch cold it will not be possible for a doctor to make his living in private practice if he prescribes ventilation. We have to go back no further than the days of The Pickwick Papers to find ourselves in a world where people slept in four-post beds with curtains drawn closely round to exclude as much air as possible. Had Mr. Pickwick's doctor told him that he would be much healthier if he slept on a camp bed by an open window, Mr. Pickwick would have regarded him as a crank and called in another doctor. Had he gone on to forbid Mr. Pickwick to drink brandy and water whenever he felt chilly, and assured him that if he were deprived of meat or salt for a whole year, he would not only not die, but would be none the worse, Mr. Pickwick would have fled from his presence as from that of a dangerous madman. And in these matters the doctor cannot cheat his patient. If he has no faith in drugs or vaccination, and the patient has, he can cheat him with colored water and pass his lancet through the flame of a spirit lamp before scratching his arm. But he cannot make him change his daily habits without knowing it.
In the main, then, the doctor learns that if he gets ahead of the superstitions of his patients he is a ruined man; and the result is that he instinctively takes care not to get ahead of them. That is why all the changes come from the laity. It was not until an agitation had been conducted for many years by laymen, including quacks and faddists of all kinds, that the public was sufficiently impressed to make it possible for the doctors to open their minds and their mouths on the subject of fresh air, cold water, temperance, and the rest of the new fashions in hygiene. At present the tables have been turned on many old prejudices. Plenty of our most popular elderly doctors believe that cold tubs in the morning are unnatural, exhausting, and rheumatic; that fresh air is a fad and that everybody is the better for a glass or two of port wine every day; but they no longer dare say as much until they know exactly where they are; for many very desirable patients in country houses have lately been persuaded that their first duty is to get up at six in the morning and begin the day by taking a walk barefoot through the dewy grass. He who shows the least scepticism as to this practice is at once suspected of being "an old-fashioned doctor," and dismissed to make room for a younger man.
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.