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The Doctor's Dilemma is a play by George Bernard about the moral dilemmas created by limited medical resources, and the conflicts between the demands of private medicine as a business and a vocation.
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George Bernard Shaw
The Doctor’s Dilemma
LONDON ∙ NEW YORK ∙ TORONTO ∙ SAO PAULO ∙ MOSCOW
PARIS ∙ MADRID ∙ BERLIN ∙ ROME ∙ MEXICO CITY ∙ MUMBAI ∙ SEOUL ∙ DOHA
TOKYO ∙ SYDNEY ∙ CAPE TOWN ∙ AUCKLAND ∙ BEIJING
Published by Sovereign
This Edition first published in 2018
Copyright © 2018 Sovereign
All Rights Reserved.
On the 15th June 1903, in the early forenoon, a medical student, surname Redpenny, Christian name unknown and of no importance, sits at work in a doctor’s consulting-room. He devils for the doctor by answering his letters, acting as his domestic laboratory assistant, and making himself indispensable generally, in return for unspecified advantages involved by intimate intercourse with a leader of his profession, and amounting to an informal apprenticeship and a temporary affiliation. Redpenny is not proud, and will do anything he is asked without reservation of his personal dignity if he is asked in a fellow-creaturely way. He is a wide-open-eyed, ready, credulous, friendly, hasty youth, with his hair and clothes in reluctant transition from the untidy boy to the tidy doctor.
Redpenny is interrupted by the entrance of an old serving-woman who has never known the cares, the preoccupations, the responsibilities, jealousies, and anxieties of personal beauty. She has the complexion of a never-washed gypsy, incurable by any detergent; and she has, not a regular beard and moustaches, which could at least be trimmed and waxed into a masculine presentableness, but a whole crop of small beards and moustaches, mostly springing from moles all over her face. She carries a duster and toddles about meddlesomely, spying out dust so diligently that whilst she is flicking off one speck she is already looking elsewhere for another. In conversation she has the same trick, hardly ever looking at the person she is addressing except when she is excited. She has only one manner, and that is the manner of an old family nurse to a child just after it has learnt to walk. She has used her ugliness to secure indulgences unattainable by Cleopatra or Fair Rosamund, and has the further great advantage over them that age increases her qualification instead of impairing it. Being an industrious, agreeable, and popular old soul, she is a walking sermon on the vanity of feminine prettiness. Just as Redpenny has no discovered Christian name, she has no discovered surname, and is known throughout the doctors’ quarter between Cavendish Square and the Marylebone Road simply as Emmy.
The consulting-room has two windows looking on Queen Anne Street. Between the two is a marble-topped console, with haunched gilt legs ending in sphinx claws. The huge pier-glass which surmounts it is mostly disabled from reflection by elaborate painting on its surface of palms, ferns, lilies, tulips, and sunflowers. The adjoining wall contains the fireplace, with two arm-chairs before it. As we happen to face the corner we see nothing of the other two walls. On the right of the fireplace, or rather on the right of any person facing the fireplace, is the door. On its left is the writing-table at which Redpenny sits. It is an untidy table with a microscope, several test tubes, and a spirit lamp standing up through its litter of papers. There is a couch in the middle of the room, at right angles to the console, and parallel to the fireplace. A chair stands between the couch and the windowed wall. The windows have green Venetian blinds and rep curtains; and there is a gasalier; but it is a convert to electric lighting. The wall paper and carpets are mostly green, coeval with the gasalier and the Venetian blinds. The house, in fact, was so well furnished in the middle of the XIXth century that it stands unaltered to this day and is still quite presentable.
EMMY [entering and immediately beginning to dust the couch] Theres a lady bothering me to see the doctor.
REDPENNY [distracted by the interruption] Well, she cant see the doctor. Look here: whats the use of telling you that the doctor cant take any new patients, when the moment a knock comes to the door, in you bounce to ask whether he can see somebody?
EMMY. Who asked you whether he could see somebody?
REDPENNY. You did.
EMMY. I said theres a lady bothering me to see the doctor. That isnt asking. Its telling.
REDPENNY. Well, is the lady bothering you any reason for you to come bothering me when I’m busy?
EMMY. Have you seen the papers?
EMMY. Not seen the birthday honors?
REDPENNY [beginning to swear] What the—
EMMY. Now, now, ducky!
REDPENNY. What do you suppose I care about the birthday honors? Get out of this with your chattering. Dr Ridgeon will be down before I have these letters ready. Get out.
EMMY. Dr Ridgeon wont never be down any more, young man.
She detects dust on the console and is down on it immediately.
REDPENNY [jumping up and following her] What?
EMMY. He’s been made a knight. Mind you dont go Dr Ridgeoning him in them letters. Sir Colenso Ridgeon is to be his name now.
REDPENNY. I’m jolly glad.
EMMY. I never was so taken aback. I always thought his great discoveries was fudge (let alone the mess of them) with his drops of blood and tubes full of Maltese fever and the like. Now he’ll have a rare laugh at me.
REDPENNY. Serve you right! It was like your cheek to talk to him about science. [He returns to his table and resumes his writing].
EMMY. Oh, I dont think much of science; and neither will you when youve lived as long with it as I have. Whats on my mind is answering the door. Old Sir Patrick Cullen has been here already and left first congratulations—hadnt time to come up on his way to the hospital, but was determined to be first—coming back, he said. All the rest will be here too: the knocker will be going all day. What Im afraid of is that the doctor’ll want a footman like all the rest, now that he’s Sir Colenso. Mind: dont you go putting him up to it, ducky; for he’ll never have any comfort with anybody but me to answer the door. I know who to let in and who to keep out. And that reminds me of the poor lady. I think he ought to see her. Shes just the kind that puts him in a good temper. [She dusts Redpenny’s papers].
REDPENNY. I tell you he cant see anybody. Do go away, Emmy. How can I work with you dusting all over me like this?
EMMY. I’m not hindering you working—if you call writing letters working. There goes the bell. [She looks out of the window]. A doctor’s carriage. Thats more congratulations. [She is going out when Sir Colenso Ridgeon enters]. Have you finished your two eggs, sonny?
EMMY. Have you put on your clean vest?
EMMY. Thats my ducky diamond! Now keep yourself tidy and dont go messing about and dirtying your hands: the people are coming to congratulate you. [She goes out].
Sir Colenso Ridgeon is a man of fifty who has never shaken off his youth. He has the off-handed manner and the little audacities of address which a shy and sensitive man acquires in breaking himself in to intercourse with all sorts and conditions of men. His face is a good deal lined; his movements are slower than, for instance, Redpenny’s; and his flaxen hair has lost its lustre; but in figure and manner he is more the young man than the titled physician. Even the lines in his face are those of overwork and restless scepticism, perhaps partly of curiosity and appetite, rather than of age. Just at present the announcement of his knighthood in the morning papers makes him specially self-conscious, and consequently specially off-hand with Redpenny.
RIDGEON. Have you seen the papers? Youll have to alter the name in the letters if you havnt.
REDPENNY. Emmy has just told me. I’m awfully glad. I—
RIDGEON. Enough, young man, enough. You will soon get accustomed to it.
REDPENNY. They ought to have done it years ago.
RIDGEON. They would have; only they couldnt stand Emmy opening the door, I daresay.
EMMY [at the door, announcing] Dr Shoemaker. [She withdraws].
A middle-aged gentleman, well dressed, comes in with a friendly but propitiatory air, not quite sure of his reception. His combination of soft manners and responsive kindliness, with a certain unseizable reserve and a familiar yet foreign chiselling of feature, reveal the Jew: in this instance the handsome gentlemanly Jew, gone a little pigeon-breasted and stale after thirty, as handsome young Jews often do, but still decidedly good-looking.
THE GENTLEMAN. Do you remember me? Schutzmacher. University College school and Belsize Avenue. Loony Schutzmacher, you know.
RIDGEON. What! Loony! [He shakes hands cordially]. Why, man, I thought you were dead long ago. Sit down. [Schutzmacher sits on the couch: Ridgeon on the chair between it and the window]. Where have you been these thirty years?
SCHUTZMACHER. In general practice, until a few months ago. I’ve retired.
RIDGEON. Well done, Loony! I wish I could afford to retire. Was your practice in London?
RIDGEON. Fashionable coast practice, I suppose.
SCHUTZMACHER. How could I afford to buy a fashionable practice? I hadnt a rap. I set up in a manufacturing town in the midlands in a little surgery at ten shillings a week.
RIDGEON. And made your fortune?
SCHUTZMACHER. Well, I’m pretty comfortable. I have a place in Hertfordshire besides our flat in town. If you ever want a quiet Saturday to Monday, I’ll take you down in my motor at an hours notice.
RIDGEON. Just rolling in money! I wish you rich g.p.’s would teach me how to make some. Whats the secret of it?
SCHUTZMACHER. Oh, in my case the secret was simple enough, though I suppose I should have got into trouble if it had attracted any notice. And I’m afraid you’ll think it rather infra dig.
RIDGEON. Oh, I have an open mind. What was the secret?
SCHUTZMACHER. Well, the secret was just two words.
RIDGEON. Not Consultation Free, was it?
SCHUTZMACHER [shocked] No, no. Really!
RIDGEON [apologetic] Of course not. I was only joking.
SCHUTZMACHER. My two words were simply Cure Guaranteed.
RIDGEON [admiring] Cure Guaranteed!
SCHUTZMACHER. Guaranteed. After all, thats what everybody wants from a doctor, isnt it?
RIDGEON. My dear loony, it was an inspiration. Was it on the brass plate?
SCHUTZMACHER. There was no brass plate. It was a shop window: red, you know, with black lettering. Doctor Leo Schutzmacher, L.R.C.P.M.R.C.S. Advice and medicine sixpence. Cure Guaranteed.
RIDGEON. And the guarantee proved sound nine times out of ten, eh?
SCHUTZMACHER [rather hurt at so moderate an estimate] Oh, much oftener than that. You see, most people get well all right if they are careful and you give them a little sensible advice. And the medicine really did them good. Parrish’s Chemical Food: phosphates, you know. One tablespoonful to a twelve-ounce bottle of water: nothing better, no matter what the case is.
RIDGEON. Redpenny: make a note of Parrish’s Chemical Food.
SCHUTZMACHER. I take it myself, you know, when I feel run down. Good-bye. You dont mind my calling, do you? Just to congratulate you.
RIDGEON. Delighted, my dear Loony. Come to lunch on Saturday next week. Bring your motor and take me down to Hertford.
SCHUTZMACHER. I will. We shall be delighted. Thank you. Good-bye. [He goes out with Ridgeon, who returns immediately].
REDPENNY. Old Paddy Cullen was here before you were up, to be the first to congratulate you.
RIDGEON. Indeed. Who taught you to speak of Sir Patrick Cullen as old Paddy Cullen, you young ruffian?
REDPENNY. You never call him anything else.
RIDGEON. Not now that I am Sir Colenso. Next thing, you fellows will be calling me old Colly Ridgeon.
REDPENNY. We do, at St. Anne’s.
RIDGEON. Yach! Thats what makes the medical student the most disgusting figure in modern civilization. No veneration, no manners—no—
EMMY [at the door, announcing]. Sir Patrick Cullen. [She retires].
Sir Patrick Cullen is more than twenty years older than Ridgeon, not yet quite at the end of his tether, but near it and resigned to it. His name, his plain, downright, sometimes rather arid common sense, his large build and stature, the absence of those odd moments of ceremonial servility by which an old English doctor sometimes shews you what the status of the profession was in England in his youth, and an occasional turn of speech, are Irish; but he has lived all his life in England and is thoroughly acclimatized. His manner to Ridgeon, whom he likes, is whimsical and fatherly: to others he is a little gruff and uninviting, apt to substitute more or less expressive grunts for articulate speech, and generally indisposed, at his age, to make much social effort. He shakes Ridgeon’s hand and beams at him cordially and jocularly.
SIR PATRICK. Well, young chap. Is your hat too small for you, eh?
RIDGEON. Much too small. I owe it all to you.
SIR PATRICK. Blarney, my boy. Thank you all the same. [He sits in one of the arm-chairs near the fireplace. Ridgeon sits on the couch]. Ive come to talk to you a bit. [To Redpenny] Young man: get out.
REDPENNY. Certainly, Sir Patrick [He collects his papers and makes for the door].
SIR PATRICK. Thank you. Thats a good lad. [Redpenny vanishes]. They all put up with me, these young chaps, because I’m an old man, a real old man, not like you. Youre only beginning to give yourself the airs of age. Did you ever see a boy cultivating a moustache? Well, a middle-aged doctor cultivating a grey head is much the same sort of spectacle.
RIDGEON. Good Lord! yes: I suppose so. And I thought that the days of my vanity were past. Tell me at what age does a man leave off being a fool?
SIR PATRICK. Remember the Frenchman who asked his grandmother at what age we get free from the temptations of love. The old woman said she didn’t know. [Ridgeon laughs]. Well, I make you the same answer. But the world’s growing very interesting to me now, Colly.
RIDGEON. You keep up your interest in science, do you?
SIR PATRICK. Lord! yes. Modern science is a wonderful thing. Look at your great discovery! Look at all the great discoveries! Where are they leading to? Why, right back to my poor dear old father’s ideas and discoveries. He’s been dead now over forty years. Oh, it’s very interesting.
RIDGEON. Well, theres nothing like progress, is there?
SIR PATRICK. Dont misunderstand me, my boy. I’m not belittling your discovery. Most discoveries are made regularly every fifteen years; and it’s fully a hundred and fifty since yours was made last. Thats something to be proud of. But your discovery’s not new. It’s only inoculation. My father practised inoculation until it was made criminal in eighteen-forty. That broke the poor old man’s heart, Colly: he died of it. And now it turns out that my father was right after all. Youve brought us back to inoculation.
RIDGEON. I know nothing about smallpox. My line is tuberculosis and typhoid and plague. But of course the principle of all vaccines is the same.
SIR PATRICK. Tuberculosis? M-m-m-m! Youve found out how to cure consumption, eh?
RIDGEON. I believe so.
SIR PATRICK. Ah yes. It’s very interesting. What is it the old cardinal says in Browning’s play? “I have known four and twenty leaders of revolt.” Well, Ive known over thirty men that found out how to cure consumption. Why do people go on dying of it, Colly? Devilment, I suppose. There was my father’s old friend George Boddington of Sutton Coldfield. He discovered the open-air cure in eighteen-forty. He was ruined and driven out of his practice for only opening the windows; and now we wont let a consumptive patient have as much as a roof over his head. Oh, it’s very VERY interesting to an old man.
RIDGEON. You old cynic, you dont believe a bit in my discovery.
SIR PATRICK. No, no: I dont go quite so far as that, Colly. But still, you remember Jane Marsh?
RIDGEON. Jane Marsh? No.
SIR PATRICK. You dont!
SIR PATRICK. You mean to tell me you dont remember the woman with the tuberculosis ulcer on her arm?
RIDGEON [enlightened] Oh, your washerwoman’s daughter. Was her name Jane Marsh? I forgot.
SIR PATRICK. Perhaps youve forgotten also that you undertook to cure her with Koch’s tuberculin.
RIDGEON. And instead of curing her, it rotted her arm right off. Yes: I remember. Poor Jane! However, she makes a good living out of that arm now by shewing it at medical lectures.
SIR PATRICK. Still, that wasnt quite what you intended, was it?
RIDGEON. I took my chance of it.
SIR PATRICK. Jane did, you mean.
RIDGEON. Well, it’s always the patient who has to take the chance when an experiment is necessary. And we can find out nothing without experiment.
SIR PATRICK. What did you find out from Jane’s case?
RIDGEON. I found out that the inoculation that ought to cure sometimes kills.
SIR PATRICK. I could have told you that. Ive tried these modern inoculations a bit myself. Ive killed people with them; and Ive cured people with them; but I gave them up because I never could tell which I was going to do.
RIDGEON [taking a pamphlet from a drawer in the writing-table and handing it to him] Read that the next time you have an hour to spare; and youll find out why.
SIR PATRICK [grumbling and fumbling for his spectacles] Oh, bother your pamphlets. Whats the practice of it? [Looking at the pamphlet] Opsonin? What the devil is opsonin?
RIDGEON. Opsonin is what you butter the disease germs with to make your white blood corpuscles eat them. [He sits down again on the couch].
SIR PATRICK. Thats not new. Ive heard this notion that the white corpuscles—what is it that whats his name?—Metchnikoff—calls them?
SIR PATRICK. Aye, phagocytes: yes, yes, yes. Well, I heard this theory that the phagocytes eat up the disease germs years ago: long before you came into fashion. Besides, they dont always eat them.
RIDGEON. They do when you butter them with opsonin.
SIR PATRICK. Gammon.
RIDGEON. No: it’s not gammon. What it comes to in practice is this. The phagocytes wont eat the microbes unless the microbes are nicely buttered for them. Well, the patient manufactures the butter for himself all right; but my discovery is that the manufacture of that butter, which I call opsonin, goes on in the system by ups and downs—Nature being always rhythmical, you know—and that what the inoculation does is to stimulate the ups or downs, as the case may be. If we had inoculated Jane Marsh when her butter factory was on the up-grade, we should have cured her arm. But we got in on the downgrade and lost her arm for her. I call the up-grade the positive phase and the down-grade the negative phase. Everything depends on your inoculating at the right moment. Inoculate when the patient is in the negative phase and you kill: inoculate when the patient is in the positive phase and you cure.
SIR PATRICK. And pray how are you to know whether the patient is in the positive or the negative phase?
RIDGEON. Send a drop of the patient’s blood to the laboratory at St. Anne’s; and in fifteen minutes I’ll give you his opsonin index in figures. If the figure is one, inoculate and cure: if it’s under point eight, inoculate and kill. Thats my discovery: the most important that has been made since Harvey discovered the circulation of the blood. My tuberculosis patients dont die now.
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