In the first act of Shaw’s play, several doctors come to congratulate Sir Colenso Ridgeon, recently knighted for discovering that white blood cells will not eat invading microbes unless they are rendered appetizing by being nicely buttered with opsonins. Patients supposedly manufacture these opsonins on and off, and would be cured if inoculated when their production is on the upgrade but suffer unspeakable consequences if treated at the wrong time. Only Sir Colenso’s grossly overextended laboratory can determine what that best time would be, and in his hands tuberculosis patients no longer die.
First to arrive to offer his congratulations is an old surgeon, Sir Patrick Cullen, who has seen everything, and is not impressed with Sir Colenso’s discovery. He says that most discoveries are made regularly every fifteen years and this one was made a full hundred years ago in the time of his father, who inoculated patients until the practice became illegal which made him die from a broken heart. Indeed Sir Patrick himself had practiced inoculation but gave it up because he could not tell whom he would save and whom he would kill.
Next comes Cutler Walpole, whom Sir Patrick despises as “one of these chloroform surgeons” who would not have been capable of operating until it was made all too easy by the discovery of anesthesia. Sir Patrick recalls the time when Walpole’s father would snip off the ends of uvulas for fifty guineas and paint throats with caustic for two guineas a time for every day for a year, and when his brother-in-law extirpated tonsils for two hundred guineas until he undertook operations on women at double the fee; while Cutler himself, looking for something fresh to operate upon, discovered a new organ, the nuciform sack. This organ is the cause of all diseases because it is full of decaying matter, undigested food, waste products, and poisonous ptomaines. Cutler claims that removing the nuciform sack is ten times more important than vaccination and should be made compulsory. Only five percent of the general population are born without a nuciform sack and that includes himself, hence he does not need the operation.
The next arrival is Sir Ralph Bloomfield Bonington, a distinguished physician with a voice so musical that even broken bones have been said to heal at its sound. Known as BB, he is a colossal ignorant humbug, willing to try everything, and has already treated a royal prince with Ridgeon’s opsonins with complete success. Claiming to be a man of science, he understands this business of microbes, and is willing to inoculate any patient three times a day half an hour before meals regardless of the diagnosis and without going through the rigmarole of determining whether the patient is in a positive or negative phase, especially when his wife is waiting alone in the carriage. To the horror of his colleagues, he describes how he inoculated a typhoid case for tetanus and a case of tetanus for typhoid and both recovered.
Next comes Doctor Blenkinsop, “flabby and shabby, cheaply fed and cheaply clothed.” He used to read medical journals but can no longer afford them, and cannot even buy a “frockcoat” or tuxedo, so he wishes one of the other doctors could lend him a used one. His favorite treatment is a pound of ripe greengages everyday half an hour before lunch. Finally there comes Doctor Shoemaker, who has a front store shop in the Midlands and sees patients for ten shillings a week, has a sign in the window saying Cure Guaranteed, but which consists of a little sensible advice and a twelve ounce bottle of patent medicine regardless of the diagnosis.
The five doctors are now visited by the beautiful wife of a rascally genius painter who suffers from advanced tuberculosis and whom she hopes the doctors will save. The doctors face two dilemmas, deciding whom to save and whom to let die, and how to use a medicine with such unpredictable effects. Colenso decides not to treat the young man because he is in love with the young woman, but like in Pygmalion she will eventually reject him anyway because he is old enough to be her father.
The play was written in 1913, when most doctors were self-employed entrepreneurs, a few exceedingly rich, others barely making it. Treatments were largely ineffective, and a patient was said to have had only a 50-50 chance of benefiting from an encounter with a member of the medical profession. Most doctors, in fact, had preciously little to offer. There were no antibiotics, and even chemotherapy for syphilis was just being developed. The very concept of diseases being caused by microbes and not by miasmas and foul air was still quite new; as was the work of Louis Pasteur, Joseph Lister, and Robert Koch.
Shaw had a poor opinion of doctors. He thought they were pretentious, ignorant, incompetent, greedy, and not to be trusted, no more scientific than their tailors. In his ponderous preface, as long as the play itself, he opposes vaccination as ineffective and dangerous, perhaps an understandable point of view then but not now when parents’ refusal to vaccinate their children is bringing back once deadly epidemics. He called using animals in research torture, and said he would not want to go to heaven if there were no animals there. But on earth he admired the great Soviet exterminator of men and went several times to Moscow to fawn. Not having ever had to stand in line to buy a loaf of bread, he enthusiastically espoused socialism and the management of human affairs by the state. He was for abolishing private practice, nationalizing or “municipalizing” medicine, having medical boards run by laypeople, and removing financial incentives from medical practice. He favored eugenics as way to improve the human race.
As an avowed vegetarian, he said he did not want to make his stomach a graveyard for the rotting corpses of dead animals, but advised other vegetarians not to tell their hostesses about this lest they serve them only tomatoes and breadcrumbs
Though clearly outdated in many respects, The Doctor’s Dilemma was a brilliantly written satire of the more objectionable traits of private medical practice. Many of these have been eradicated by time, legislation, regulation, and malpractice lawyers who metaphorically snip off uvulae and remove nuciform sacs. Doctors are now undoubtedly more scientific than their tailors, often addicted to statistics and evidence based medicine, sometimes in preference to experience and common sense. If allowed to come back to this earthly, capitalist paradise from the place where one would hope he had plenty of animal companions, Shaw would find that newspapers still have the same appetite for scandalous news; and that many professions and other organizations remain conspiracies against the public designed to keep out competition. If allowed to visit the local health club, organic foods store, or overused CT scan facility, he would find people still trying to live forever, though, as he suggested, they are unlikely to succeed.
GEORGE DUNEA, MD, Editor-in-Chief