[1] The increase of venereal disease during the Great War has been noted alike in Germany, France, and England. Thus, as regards France, Gaucher has stated at the Paris Academy of Medicine (Journal de Medicine, May 10th, 1916) that since mobilisation syphilis had increased by nearly one half, alike among soldiers and civilians; it had much increased in quite young people and in elderly men. In Germany, Neisser, a leading authority, states (Deutsche Medizinische Wochenschrift, 14th Jan., 1915) that the prevalence of venereal disease is much greater than in the war of 1870, and that "every day many thousands, not to say tens of thousands, of otherwise able-bodied men are withdrawn from the service on this account."
[2] The chief is Iwan Bloch who, in his elaborate work, Der Ursprung der Syphilis (2 vols., 1901, 1911), has fully investigated the evidence.
[3] N. Bishop Harman, "The Influence of Syphilis on the Chances of Progeny," British Medical Journal, Feb. 5th, 1916.
[4] It is true that in my book, Sex in Relation to Society (Ch. VIII.) I have stated my belief that notification, as in the case of other serious infectious diseases, is the first step in the conquest of venereal disease. I still think it ought to be so. But a yet more preliminary step is popular enlightenment as to the need for such notification. The recommendations seem to me to go as far as it is possible to go at the moment in English-speaking countries without producing friction and opposition. In so far as they are carried out the recommendations will ensure the necessary popular enlightenment.
XII — THE NATIONALISATION OF HEALTH
It was inevitable that we should some day have to face the problem of medical reorganisation on a social basis. Along many lines social progress has led to the initiation of movements for the improvement of public health. But they are still incomplete and imperfectly co-ordinated. We have never realised that the great questions of health cannot safely be left to municipal tinkering and the patronage of Bumbledom. The result is chaos and a terrible waste, not only of what we call "hard cash," but also of sensitive flesh and blood. Health, there cannot be the slightest doubt, is a vastly more fundamental and important matter than education, to say nothing of such minor matters as the post office or the telephone system. Yet we have nationalised these before even giving a thought to the Nationalisation of Health.
At the present day medicine is mainly in the hands, as it was two thousand years ago, of the "private practitioner." His mental status has, indeed, changed. To-day he is submitted to a long and arduous training in magnificently equipped institutions; all the laboriously acquired processes and results of modern medicine and hygiene are brought within the student's reach. And when he leaves the hospital, often with the largest and noblest conception of the physician's place in life, what do we do with him? He becomes a "private practitioner," which means, as Duclaux, the late distinguished Director of the Pasteur Institute, put it, that we place him on the level of a retail grocer who must patiently stand behind his counter (without the privilege of advertising himself) until the public are pleased to come and buy advice or drugs which are usually applied for too late to be of much use, and may be thrown away at the buyer's good pleasure, without the possibility of any protest by the seller. It is little wonder that in many cases the doctor's work and aims suffer under such conditions; his nature is subdued to what it works in; he clings convulsively to his counter and its retail methods.
The fact is—and it is a fact that is slowly becoming apparent to all—that the private practice of medicine is out of date. It fails to answer the needs of our time. There are various reasons why this should be the case, but two are fundamental. In the first place, medicine has outgrown the capacity of any individual doctor; the only adequate private practitioner must have a sound general knowledge of medicine with an expert knowledge of a dozen specialties; that is to say, he must give place to a staff of doctors acting co-ordinately, for the present system, or lack of system, by which a patient wanders at random from private practitioner to specialist, from specialist to specialist ad infinitum, is altogether mischievous. Moreover, not only is it impossible for the private practitioner to possess the knowledge required to treat his patients adequately: he cannot possess the scientific mechanical equipment nowadays required alike for diagnosis and treatment, and every day becoming more elaborate, more expensive, more difficult to manipulate. It is installed in our great hospitals for the benefit of the poorest patient; it could, perhaps, be set up in a millionaire's palace, but it is hopelessly beyond the private practitioner, though without it his work must remain unsatisfactory and inadequate.[1] In the second place, the whole direction of modern medicine is being changed and to an end away from private practice; our thoughts are not now mainly bent on the cure of disease but on its prevention. Medicine is becoming more and more transformed into hygiene, and in this transformation, though the tasks presented are larger and more systematic, they are also easier and more economical. These two fundamental tendencies of modern medicine—greater complexity of its methods and the predominantly preventive character of its aims—alone suffice to render the position of the private practitioner untenable. He cannot cope with the complexity of modern medicine; he has no authority to enforce its hygiene.