After the War---The Future of the Doctor

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The Canadian Forum/Editorial/1921-08 After the War---The Future of the Doctor
written by Gilbert Edward Jackson
C. N. R.
From The Canadian Forum, August 1921, p.326



In contrast to the reaction against individualism, which has been gathering force for many years in Europe, the educated American is now beginning to find a good deal of comfort in old-fashioned individualist principles. Their working is to be seen in many walks of life. Anti-trust legislation has generally rested on a glorification of free competition. The great campaign speeches of Mr. Woodrow Wilson (published under the name of The New Freedom) are instinct with the notion of giving free play to the great creative energies of America by restoring free competition. The present drive in favour of the "open shop" is often supported for purely selfish reasons; instead of the shop closed to non-unionists we are to have shops closed to members of trade unions. There are also many whose vindication of the open shop — a shop (in their minds) open alike to union and non-union workmen — rests on the purest principles of individualism. For all the difference in experience which lies between these men and the great political thinkers of the nineteenth century, their views are not so far apart.

Now one outstanding mark of a belief in free competition is its conservatism. Not political conservatism (which is sometimes merely radicalism in disguise) but the desire to preserve existing institutions. The competitive system is our legacy from the Victorian era, which swept away so many boundaries and broke so many shackles. Its permanence would help to make permanent our present order of society. In its permanence, therefore, are interested all the small property holders who, having done pretty well under the present regime, are not quite sure that they would do equally well if some other were to take its place. "Where your heart is there will your treasure be also."

But the mere fact that large numbers of people are in favour of preserving an existing system will not alone preserve it. Many people once supported chattel slavery, the right to wage private warfare, the gilds of the middle ages, the stage coach — but all of these perished long ago. Most human institutions barely ripen before the conditions that produced them are profoundly modified. Almost as soon as men's minds have got used to them they begin to be replaced. We are bound, if we have any scientific temper, to recognize that it is far less natural for human institutions to crystallize than it is for them to change. No matter how closely our chief interests may be bound up with the present it is well in any contemplation of the future to recognize the probability of change.

To do this is not to commit one's self to definite forecasts of the future. The world is already too full of prophets. Communists, socialists, guild socialists, novelists, clergymen, biologists — the world is full of people who can foretell exactly the lines of evolution. We may conclude with a good deal of reason that all of them are likely to be wrong. For whenever great changes have come upon us in the past they have come like a thief in the night. They have often been explained, but only some time after their arrival. The more a man appreciates how complex are the forces through whose interaction change occurs, the less is he likely to have a taste for dogmatic speculation. But if he refuses to prophesy he need not refuse to think. He can at least look at some of the forces which are at work around him.

One of these is sometimes to be found in a great experience shared by a whole generation. And since the war did, in an extraordinary manner, unite more than twenty millions of men in a common experience of military service, we naturally look for their possible heritage from this expeiience.

Generations hence men will still be trying to sum it up in a formula — to find the measure of experience common to young and old, combatant and non-combatant, vanquished and victor — to all who were drawn into the maelstrom of the war. A wonderful difference of temperament separated the man who liked fighting — a rare bird but one not yet extinct — from the chocolate soldier, and both from the married man, whose main ambition is the same in all wars:

"'E wants to finish 'is little bit,
And 'e wants to get 'ome to 'is tea."

Many will fail to see that these had anything in common. Other observers have studied at first hand the healing genius of memory; how Nature sifts our past impressions, and often consigns the most painful of them to oblivion, causing us to remember only those whose recollection is a pleasant thing. They may doubt whether the men of our generation will as a body carry with them any coherent memory which dominates their thought on social questions.

The judgment here expressed was not reached as the result of any process of logic, or on the basis of a definite collection of evidence. But it is the result of an honest effort to gain a general impression from men who served in several armies and in many regiments, who sometimes formed no very clear opinions, and often could not state them clearly.

I believe that the men who came back from the war were imbued fairly deeply with three main impressions which will influence their thinking everywhere. In the first place they had seen — often for the first time — the power of organized effort. They had seen with how small an expenditure of energy the daily life of a thousand men can be conducted, if each man plays his proper part. They had seen troops assembled in enormous numbers, from different places and by different routes, often without mishap, and sometimes without loss of time. They had seen how small a force of men, armed and disciplined, is [p.327] required to control a large mass of unarmed and unorganized civilians. They came back with a belief in organization, which is attested by the demand of the returned scldier for education (that is, for organised knowledge), by the growth in numbers of the trade union movement, and by the readiness of men to put themselves under discipline for purposes which they support.

In the second place they came back with a new dislike of interference by the state. At the best of times we have seldom treated the state as an equal. Some of us have regarded it as an elderly grandparent — some as a grandchild needing careful guidance — all of us as if it were something of a nuisance. But to the soldier it was an infernal nuisance. It decided what he was to wear, and how he was to wear it, what he was to eat and how much, when he was to get up and when to go to bed, when he might go home and how long he might stay there. No man who has not experienced the freedom of being a civilian, after being for months or years at the call of a sergeant can realise completely what that freedom meant. In proportion as men had grown tired of listening always for the word of command they came back determined to live out the balance of their lives in their own way. Organization they believed in, but it was to be their own organization and not one imposed upon them.

And in the third place was not the outstanding lesson of the war, at least for those who took part in it, a lesson in human decency? The millions of men who served, volunteer and conscript alike, enlisted, as a rule, in the spirit of self-sacrifice. Individuals were selfish, individuals stole from the common store, individuals thought of their promotion, or schemed for their personal safety. But in the mass men did nothing of the kind. In no place did a man fulfil his duty to his neighbour so well as on active service. There he shared freely with his mates, and if he had a care it was to see that he got less, not more than his due. The greater the hardship, the shorter the rations, the harder the life, the more intent he was to live according to his rule — to "play the game."

These three things, I believe, will influence ex-soldiers everywhere in dealing with the problems which wait for us now war is over "in that new world which is the old." Nor need we suppose that they will only affect soldiers for there were vast numbers of men and women who belonged to neither of the services, but who dedicated themselves to war work of one kind and another, in exactly the same spirit as those who were enlisted. All the lessons of team work for a common object, supreme but quite impersonal, were open to workers in munition factories, and if they were never seared into them by the keenest experience of all, they will not altogether be forgotten.

Those who retain as dominant impressions of the war the three which have been sketched, are likely to bring a spirit into public affairs which is the reverse of Prussianism. We may suppose that they will organize into groups rather readily for objects common to the group, not expecting the state to nurse their enterprise, nor willingly letting the state interfere with it. And when other groups do likewise they will be rather less ready to look for selfish motives, rather more ready to suppose that their motives are decent and generous, than if they had never received these impressions or had lost them. There will be rather less rivalry, rather more of a spirit of partnership. We shall be more organised, and less centralised because of them.

Keen observers had already seen a movement in this direction before the war began. If there is anything in our analysis it simply means that this movement will be strengthened. Our social fabric is honeycombed to-day with what are called class-organisations. Every trade union is open to this description, every manufacturers' association, every professional organisation, each lodge of the united farmers. But the thing that matters most in all these bodies is not the form but the spirit. The words "Sinn Fein," we are told, may be simply translated as "ourselves alone." If each group of persons with a common interest is to live in the spirit of those words, we have indeed produced a dangerous series of class organisations. Their efiforts will only weaken the structure of society, where they do not fail entirely through conflict with economic law. But an organised group is by no means inevitably swayed by selfishness. The medical profession is itself a group, organised loosely but organised for all that, with no selfish object before it, but only the performance of a public service.

The driving force behind these spontaneous groupings does not come always from the same direction. In broad contrast are the bodies organized by those who purchase goods or services, and the bodies organised by those who produce them for sale. To the former class belong all consumers' co-operative societies, and some producers' societies also; in the latter we find merchants' and manufacturers' associations, and unions of workmen. Sometimes (as in the Grain Growers of Western Canada) we come across a body which is both, which exists in order to sell the produce of its members, and at the same time to buy for them the things they need. But in spite of hard cases of this kind, the distinction is fundamental and important between group action to satisfy the wants of buyers and group action on the part of those who sell.

Nowhere is it seen more clearly than in the case of medicine itself. The whole of society depends on the work of the doctor. We are all of us consumers of his services; indeed, unlike the consumers of most other things, we cannot do without them. The public has thus an interest as real as that of the profession [p.328] in the modern practice of medicine. It has usually sense enough at least to confess its own ignorance on matters purely technical. But if it knows nothing about disease it may presume to have opinions on certain other things. The doctor himself is not concerned more directly with what we may call the economic aspect of medicine. For it is sometimes the misfortune of a community that the more it needs adequate medical attendance, the less chance there is of ever getting it, and it is often the misfortune of an individual that the more medical treatment he requires and gets, the less able he finds himself to pay for it. Chance spells of sickness have sometimes crippled families and scattered the savings of a lifetime, and in other cases (doubtless far more common) the doctor has worked in the knowledge that the greater his service to the patient, the less his prospect of ever being fully paid for it.

Now the public has learned in the last generation that the risk of sickness is insurable. If it did not know this before 1911 it has learned a great deal since then. And as we cannot follow the custom (said to be practised in China) by which a man pays his doctor so long as his health is good and he can earn a living (ceasing to pay the moment he has to call in medical attendance), a system of payment for insurance naturally suggests itself as a convenience. In England, for instance, the National Insurance Act was imposed on the medical profession from outside. As the doctors themselves described the situation, it came like a wolf on the fold. It found them for the most part unprepared, and quite without alternative proposals. They did succeed in producing certain amendments, but under the circumstances they could not but put up with the scheme.

Here is a classic instance in which the consumer took charge. He did this, and imposed his will on the producer, because the producer had done nothing effective for himself. In a world which is at present in unstable equilibrium, which is being lifted this way and that by the pressure of contending forces, it offers a lesson on which there is no need to dwell. Probably the reaction against a system of health insurance would be much the same here as in Britain. No professional man is a more thoroughgoing individualist than the doctor. But his opposition to health insurance legislation would be decisive on one condition only. Without an adequate plan of his own, to distribute equitably the cost of medical attendance, while at the same time reducing unattended sickness to the minimum, he would he helpless. If on the other hand, his plans already provided for the public health with suth completeness and economy, that an arbitrary panel system offered nothing, the public would accept them gladly. Here, indeed, would group action vindicate itself.

Gilbert E. Jackson.