account (and I am by no means sure that even this reservation
need be made), are equivalent to doctor's fees in the case of
second-class passengers, and double doctor's fees in the case of
first. Any class of educated men thus treated tends to become a
brigand class, and doctors are no exception to the rule. They
are offered disgraceful prices for advice and medicine. Their
patients are for the most part so poor and so ignorant that good
advice would be resented as impracticable and wounding. When you
are so poor that you cannot afford to refuse eighteenpence from a
man who is too poor to pay you any more, it is useless to tell
him 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