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George Bernard Shaw.

The Doctor's Dilemma: Preface on Doctors online

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If the priests of Ireland could only be persuaded to teach their flocks
that it is a deadly insult to the Blessed Virgin to place her image in a
cottage that is not kept up to that high standard of Sunday cleanliness
to which all her worshippers must believe she is accustomed, and to
represent her as being especially particular about stables because
her son was born in one, they might do more in one year than all the
Sanitary Inspectors in Ireland could do in twenty; and they could hardly
doubt that Our Lady would be delighted. Perhaps they do nowadays; for
Ireland is certainly a transfigured country since my youth as far as
clean faces and pinafores can transfigure it. In England, where so
many of the inhabitants are too gross to believe in poetic faiths, too
respectable to tolerate the notion that the stable at Bethany was a
common peasant farmer's stable instead of a first-rate racing one, and
too savage to believe that anything can really cast out the devil of
disease unless it be some terrifying hoodoo of tortures and stinks, the
M.O.H. will no doubt for a long time to come have to preach to fools
according to their folly, promising miracles, and threatening hideous
personal consequences of neglect of by-laws and the like; therefore it
will be important that every M.O.H. shall have, with his (or her) other
qualifications, a sense of humor, lest (he or she) should come at last
to believe all the nonsense that must needs be talked. But he must, in
his capacity of an expert advising the authorities, keep the government
itself free of superstition. If Italian peasants are so ignorant that
the Church can get no hold of them except by miracles, why, miracles
there must be. The blood of St. Januarius must liquefy whether the
Saint is in the humor or not. To trick a heathen into being a dutiful
Christian is no worse than to trick a whitewasher into trusting himself
in a room where a smallpox patient has lain, by pretending to exorcise
the disease with burning sulphur. But woe to the Church if in deceiving
the peasant it also deceives itself; for then the Church is lost, and
the peasant too, unless he revolt against it. Unless the Church works
the pretended miracle painfully against the grain, and is continually
urged by its dislike of the imposture to strive to make the peasant
susceptible to the true reasons for behaving well, the Church will
become an instrument of his corruption and an exploiter of his
ignorance, and will find itself launched upon that persecution of
scientific truth of which all priesthoods are accused and none with more
justice than the scientific priesthood.

And here we come to the danger that terrifies so many of us: the danger
of having a hygienic orthodoxy imposed on us. But we must face that: in
such crowded and poverty ridden civilizations as ours any orthodoxy
is better than laisser-faire. If our population ever comes to consist
exclusively of well-to-do, highly cultivated, and thoroughly instructed
free persons in a position to take care of themselves, no doubt they
will make short work of a good deal of official regulation that is now
of life-and-death necessity to us; but under existing circumstances, I
repeat, almost any sort of attention that democracy will stand is better
than neglect. Attention and activity lead to mistakes as well as
to successes; but a life spent in making mistakes is not only more
honorable but more useful than a life spent doing nothing. The one
lesson that comes out of all our theorizing and experimenting is that
there is only one really scientific progressive method; and that is the
method of trial and error. If you come to that, what is laisser-faire
but an orthodoxy? the most tyrannous and disastrous of all the
orthodoxies, since it forbids you even to learn.




THE LATEST THEORIES

Medical theories are so much a matter of fashion, and the most fertile
of them are modified so rapidly by medical practice and biological
research, which are international activities, that the play which
furnishes the pretext for this preface is already slightly outmoded,
though I believe it may be taken as a faithful record for the year
(1906) in which it was begun. I must not expose any professional man to
ruin by connecting his name with the entire freedom of criticism which
I, as a layman, enjoy; but it will be evident to all experts that my
play could not have been written but for the work done by Sir Almroth
Wright in the theory and practice of securing immunization from
bacterial diseases by the inoculation of "vaccines" made of their own
bacteria: a practice incorrectly called vaccinetherapy (there is nothing
vaccine about it) apparently because it is what vaccination ought to be
and is not. Until Sir Almroth Wright, following up one of Metchnikoff's
most suggestive biological romances, discovered that the white
corpuscles or phagocytes which attack and devour disease germs for us do
their work only when we butter the disease germs appetizingly for them
with a natural sauce which Sir Almroth named opsonin, and that our
production of this condiment continually rises and falls rhythmically
from negligibility to the highest efficiency, nobody had been able
even to conjecture why the various serums that were from time to time
introduced as having effected marvellous cures, presently made such
direful havoc of some unfortunate patient that they had to be dropped
hastily. The quantity of sturdy lying that was necessary to save the
credit of inoculation in those days was prodigious; and had it not been
for the devotion shown by the military authorities throughout Europe,
who would order the entire disappearance of some disease from their
armies, and bring it about by the simple plan of changing the name
under which the cases were reported, or for our own Metropolitan Asylums
Board, which carefully suppressed all the medical reports that revealed
the sometimes quite appalling effects of epidemics of revaccination,
there is no saying what popular reaction might not have taken place
against the whole immunization movement in therapeutics.

The situation was saved when Sir Almroth Wright pointed out that if you
inoculated a patient with pathogenic germs at a moment when his powers
of cooking them for consumption by the phagocytes was receding to its
lowest point, you would certainly make him a good deal worse and perhaps
kill him, whereas if you made precisely the same inoculation when the
cooking power was rising to one of its periodical climaxes, you would
stimulate it to still further exertions and produce just the opposite
result. And he invented a technique for ascertaining in which phase the
patient happened to be at any given moment. The dramatic possibilities
of this discovery and invention will be found in my play. But it is one
thing to invent a technique: it is quite another to persuade the medical
profession to acquire it. Our general practitioners, I gather, simply
declined to acquire it, being mostly unable to afford either the
acquisition or the practice of it when acquired. Something simple,
cheap, and ready at all times for all comers, is, as I have shown, the
only thing that is economically possible in general practice, whatever
may be the case in Sir Almroth's famous laboratory in St. Mary's
Hospital. It would have become necessary to denounce opsonin in the
trade papers as a fad and Sir Almroth as a dangerous man if his practice
in the laboratory had not led him to the conclusion that the customary
inoculations were very much too powerful, and that a comparatively
infinitesimal dose would not precipitate a negative phase of cooking
activity, and might induce a positive one. And thus it happens that the
refusal of our general practitioners to acquire the new technique is
no longer quite so dangerous in practice as it was when The Doctor's
Dilemma was written: nay, that Sir Ralph Bloomfield Boningtons way of
administering inoculations as if they were spoonfuls of squills may
sometimes work fairly well. For all that, I find Sir Almroth Wright,
on the 23rd May, 1910, warning the Royal Society of Medicine that "the
clinician has not yet been prevailed upon to reconsider his position,"
which means that the general practitioner ("the doctor," as he is called
in our homes) is going on just as he did before, and could not afford
to learn or practice a new technique even if he had ever heard of it.
To the patient who does not know about it he will say nothing. To the
patient who does, he will ridicule it, and disparage Sir Almroth. What
else can he do, except confess his ignorance and starve?

But now please observe how "the whirligig of time brings its revenges."
This latest discovery of the remedial virtue of a very, very tiny
hair of the dog that bit you reminds us, not only of Arndt's law of
protoplasmic reaction to stimuli, according to which weak and strong
stimuli provoke opposite reactions, but of Hahnemann's homeopathy, which
was founded on the fact alleged by Hahnemann that drugs which produce
certain symptoms when taken in ordinary perceptible quantities, will,
when taken in infinitesimally small quantities, provoke just the
opposite symptoms; so that the drug that gives you a headache will
also cure a headache if you take little enough of it. I have already
explained that the savage opposition which homeopathy encountered from
the medical profession was not a scientific opposition; for nobody seems
to deny that some drugs act in the alleged manner. It was opposed simply
because doctors and apothecaries lived by selling bottles and boxes of
doctor's stuff to be taken in spoonfuls or in pellets as large as peas;
and people would not pay as much for drops and globules no bigger than
pins' heads. Nowadays, however, the more cultivated folk are beginning
to be so suspicious of drugs, and the incorrigibly superstitious people
so profusely supplied with patent medicines (the medical advice to take
them being wrapped round the bottle and thrown in for nothing) that
homeopathy has become a way of rehabilitating the trade of prescription
compounding, and is consequently coming into professional credit. At
which point the theory of opsonins comes very opportunely to shake hands
with it.

Add to the newly triumphant homeopathist and the opsonist that other
remarkable innovator, the Swedish masseur, who does not theorize about
you, but probes you all over with his powerful thumbs until he finds out
your sore spots and rubs them away, besides cheating you into a little
wholesome exercise; and you have nearly everything in medical practice
to-day that is not flat witchcraft or pure commercial exploitation of
human credulity and fear of death. Add to them a good deal of vegetarian
and teetotal controversy raging round a clamor for scientific eating
and drinking, and resulting in little so far except calling digestion
Metabolism and dividing the public between the eminent doctor who tells
us that we do not eat enough fish, and his equally eminent colleague
who warns us that a fish diet must end in leprosy, and you have all that
opposes with any sort of countenance the rise of Christian Science with
its cathedrals and congregations and zealots and miracles and cures:
all very silly, no doubt, but sane and sensible, poetic and hopeful,
compared to the pseudo science of the commercial general practitioner,
who foolishly clamors for the prosecution and even the execution of the
Christian Scientists when their patients die, forgetting the long death
roll of his own patients.

By the time this preface is in print the kaleidoscope may have had
another shake; and opsonin may have gone the way of phlogiston at the
hands of its own restless discoverer. I will not say that Hahnemann may
have gone the way of Diafoirus; for Diafoirus we have always with us.
But we shall still pick up all our knowledge in pursuit of some Will o'
the Wisp or other. What is called science has always pursued the Elixir
of Life and the Philosopher's Stone, and is just as busy after them
to-day as ever it was in the days of Paracelsus. We call them by
different names: Immunization or Radiology or what not; but the dreams
which lure us into the adventures from which we learn are always at
bottom the same. Science becomes dangerous only when it imagines that
it has reached its goal. What is wrong with priests and popes is that
instead of being apostles and saints, they are nothing but empirics
who say "I know" instead of "I am learning," and pray for credulity and
inertia as wise men pray for scepticism and activity. Such abominations
as the Inquisition and the Vaccination Acts are possible only in the
famine years of the soul, when the great vital dogmas of honor, liberty,
courage, the kinship of all life, faith that the unknown is greater than
the known and is only the As Yet Unknown, and resolution to find a
manly highway to it, have been forgotten in a paroxysm of littleness and
terror in which nothing is active except concupiscence and the fear of
death, playing on which any trader can filch a fortune, any blackguard
gratify his cruelty, and any tyrant make us his slaves.

Lest this should seem too rhetorical a conclusion for our professional
men of science, who are mostly trained not to believe anything unless it
is worded in the jargon of those writers who, because they never really
understand what they are trying to say, cannot find familiar words for
it, and are therefore compelled to invent a new language of nonsense
for every book they write, let me sum up my conclusions as dryly as is
consistent with accurate thought and live conviction.

1. Nothing is more dangerous than a poor doctor: not even a poor
employer or a poor landlord.

2. Of all the anti-social vested interests the worst is the vested
interest in ill-health.

3. Remember that an illness is a misdemeanor; and treat the doctor as an
accessory unless he notifies every case to the Public Health authority.

4. Treat every death as a possible and under our present system a
probable murder, by making it the subject of a reasonably conducted
inquest; and execute the doctor, if necessary, as a doctor, by striking
him off the register.

5. Make up your mind how many doctors the community needs to keep
it well. Do not register more or less than this number; and let
registration constitute the doctor a civil servant with a dignified
living wage paid out of public funds.

6. Municipalize Harley Street.

7. Treat the private operator exactly as you would treat a private
executioner.

8. Treat persons who profess to be able to cure disease as you
treat fortune tellers.

9. Keep the public carefully informed, by special statistics and
announcements of individual cases, of all illnesses of doctors or in
their families.

10. Make it compulsory for a doctor using a brass plate to
have inscribed on it, in addition to the letters indicating his
qualifications, the words "Remember that I too am mortal."

11. In legislation and social organization, proceed on the principle
that invalids, meaning persons who cannot keep themselves alive by their
own activities, cannot, beyond reason, expect to be kept alive by
the activity of others. There is a point at which the most energetic
policeman or doctor, when called upon to deal with an apparently drowned
person, gives up artificial respiration, although it is never possible
to declare with certainty, at any point short of decomposition, that
another five minutes of the exercise would not effect resuscitation. The
theory that every individual alive is of infinite value is legislatively
impracticable. No doubt the higher the life we secure to the individual
by wise social organization, the greater his value is to the community,
and the more pains we shall take to pull him through any temporary
danger or disablement. But the man who costs more than he is worth is
doomed by sound hygiene as inexorably as by sound economics.

12. Do not try to live for ever. You will not succeed.

13. Use your health, even to the point of wearing it out. That is
what it is for. Spend all you have before you die; and do not outlive
yourself.

14. Take the utmost care to get well born and well brought up. This
means that your mother must have a good doctor. Be careful to go to
a school where there is what they call a school clinic, where your
nutrition and teeth and eyesight and other matters of importance to you
will be attended to. Be particularly careful to have all this done at
the expense of the nation, as otherwise it will not be done at all, the
chances being about forty to one against your being able to pay for it
directly yourself, even if you know how to set about it. Otherwise
you will be what most people are at present: an unsound citizen of an
unsound nation, without sense enough to be ashamed or unhappy about it.












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Online LibraryGeorge Bernard ShawThe Doctor's Dilemma: Preface on Doctors → online text (page 7 of 7)