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Titel: The Doctor's Dilemma: Preface on Doctors
von Oliver Goldsmith, Samuel Pepys, William Dean Howells, John Burroughs, William Harmon Norton, L. Mühlbach, Franklin Knight Lane, Walter Pater, Jonathan Swift, Augusta J. Evans, Trumbull White, Kathleen Thompson Norris, Matthew Arnold, Charles W. Colby, Shakespeare, James Fenimore Cooper, D. H. Lawrence, James Joyce, Ada Cambridge, Philip E. Muskett, Catherine Helen Spence, Rolf Boldrewood, Ernest Scott, Fergus Hume, H. G. Wells, Victor [pseud.] Appleton, Roald Amundsen, Max Simon Nordau, Henry David Thoreau, E. Phillips Oppenheim, Richard Wagner, Franz Liszt, Charlotte Mary Yonge, Charles Henry Eden, Charles Babbage, T. R. Malthus, Unknown, Joseph Ernest Morris, Robert Southey, Isabella L. 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Crockett, Austin Hall, Homer Eon Flint, Various, Clarence Edward Mulford, Upton Sinclair, John Andreas Widtsoe, Thomas Bulfinch, David Graham Phillips, John Kendrick Bangs, Edmond Jaloux, Emile Littré, 13th cent. de Boron Robert, Samuel Butler, James Huneker, Jessie Graham [pseud.] Flower, St. George Rathborne, Charles Wesley Emerson, Winston Churchill, Edith Bancroft, Lloyd Osbourne, Jack London, Lyman Abbott, Belle K. Abbott, Sinclair Lewis, H. W. Conn, Ludwig Thoma, Sir Walter Scott, August Strindberg, Thomas Chapais, Ernest Giles, David Wynford Carnegie, Zoeth Skinner Eldredge, Eusebius Joseph Molera, C. C. Andrews, Robert Barr, John Hendricks Bechtel, Robert W. Chambers, Alice B. Emerson, Anna M. Galbraith, Laura Lee Hope, L. T. Meade, Harry Steele Morrison, Frank Gee Patchin, Louise Clarke Pyrnelle, William MacLeod Raine, Roy Rockwood, Edward Stratemeyer, Louis Tracy, Matthew White, Leonardo da Vinci, Albert Einstein, Clarence Young, Ludwig Leichhardt, Arthur B. Reeve, Mrs. Georgie Sheldon, Samuel Hopkins Adams, George Washington, John Adams, Thomas Jefferson, James Madison, James Monroe, John Quincy Adams, Andrew Jackson, Martin Van Buren, John Tyler, James K. Polk, Zachary Taylor, Millard Fillmore, Franklin Pierce, James Buchanan, Abraham Lincoln, Andrew Johnson, Rutherford Birchard Hayes, Chester Alan Arthur, Grover Cleveland, Benjamin Harrison, William McKinley, Theodore Roosevelt, William H. Taft, Woodrow Wilson, Warren G. Harding, Calvin Coolidge, Herbert Hoover, Franklin Delano Roosevelt, Harry S. Truman, Dwight D. Eisenhower, John F. Kennedy, Lyndon B. Johnson, Richard M. Nixon, Gerald R. Ford, Jimmy Carter, Ronald Reagan, George Bush, William Jefferson Clinton, George W. Bush, United States. Presidents., Bjørnstjerne Bjørnson, Rex Ellingwood Beach, Euripides, Henry C. Northam, Mary Raymond Shipman Andrews, Alice Brown, Mary Stewart Doubleday Cutting, Elizabeth Garver Jordan, Elizabeth Stuart Phelps, Mary Heaton Vorse, Edith Wyatt, Bernard Shaw
Alle Rechte vorbehalten.
DOUBTFUL CHARACTER BORNE BY THE MEDICAL PROFESSION
THE PECULIAR PEOPLE
RECOIL OF THE DOGMA OF MEDICAL INFALLIBILITY ON THE DOCTOR
WHY DOCTORS DO NOT DIFFER
THE CRAZE FOR OPERATIONS
CREDULITY AND CHLOROFORM
THE SUCCESSFUL DOCTOR
THE PSYCHOLOGY OF SELF-RESPECT IN SURGEONS
ARE DOCTORS MEN OF SCIENCE?
BACTERIOLOGY AS A SUPERSTITION
ECONOMIC DIFFICULTIES OF IMMUNIZATION
THE PERILS OF INOCULATION
DOCTORS AND VIVISECTION
THE PRIMITIVE SAVAGE MOTIVE
THE HIGHER MOTIVE. THE TREE OF KNOWLEDGE.
THE FLAW IN THE ARGUMENT
LIMITATIONS OF THE RIGHT TO KNOWLEDGE
A FALSE ALTERNATIVE
OUR OWN CRUELTIES
THE SCIENTIFIC INVESTIGATION OF CRUELTY
THE OLD LINE BETWEEN MAN AND BEAST
VIVISECTING THE HUMAN SUBJECT
"THE LIE IS A EUROPEAN POWER"
AN ARGUMENT WHICH WOULD DEFEND ANY CRIME
THOU ART THE MAN
WHAT THE PUBLIC WANTS AND WILL NOT GET
THE VACCINATION CRAZE
THE SURPRISES OF ATTENTION AND NEGLECT
STEALING CREDIT FROM CIVILIZATION
THE REFORMS ALSO COME FROM THE LAITY
FASHIONS AND EPIDEMICS
THE DOCTOR'S VIRTUES
THE DOCTOR'S HARDSHIPS
THE PUBLIC DOCTOR
THE SOCIAL SOLUTION OF THE MEDICAL PROBLEM
THE FUTURE OF PRIVATE PRACTICE
THE TECHNICAL PROBLEM
THE LATEST THEORIES
It is not the fault of our doctors that the medical service of the community, as at present provided for, is a murderous absurdity. That any sane nation, having observed that you could provide for the supply of bread by giving bakers a pecuniary interest in baking for you, should go on to give a surgeon a pecuniary interest in cutting off your leg, is enough to make one despair of political humanity. But that is precisely what we have done. And the more appalling the mutilation, the more the mutilator is paid. He who corrects the ingrowing toe-nail receives a few shillings: he who cuts your inside out receives hundreds of guineas, except when he does it to a poor person for practice.
Scandalized voices murmur that these operations are unnecessary. They may be. It may also be necessary to hang a man or pull down a house. But we take good care not to make the hangman and the housebreaker the judges of that. If we did, no man's neck would be safe and no man's house stable. But we do make the doctor the judge, and fine him anything from sixpence to several hundred guineas if he decides in our favor. I cannot knock my shins severely without forcing on some surgeon the difficult question, "Could I not make a better use of a pocketful of guineas than this man is making of his leg? Could he not write as well—or even better—on one leg than on two? And the guineas would make all the difference in the world to me just now. My wife—my pretty ones—the leg may mortify—it is always safer to operate—he will be well in a fortnight—artificial legs are now so well made that they are really better than natural ones—evolution is towards motors and leglessness, etc., etc., etc."
Now there is no calculation that an engineer can make as to the behavior of a girder under a strain, or an astronomer as to the recurrence of a comet, more certain than the calculation that under such circumstances we shall be dismembered unnecessarily in all directions by surgeons who believe the operations to be necessary solely because they want to perform them. The process metaphorically called bleeding the rich man is performed not only metaphorically but literally every day by surgeons who are quite as honest as most of us. After all, what harm is there in it? The surgeon need not take off the rich man's (or woman's) leg or arm: he can remove the appendix or the uvula, and leave the patient none the worse after a fortnight or so in bed, whilst the nurse, the general practitioner, the apothecary, and the surgeon will be the better.
Again I hear the voices indignantly muttering old phrases about the high character of a noble profession and the honor and conscience of its members. I must reply that the medical profession has not a high character: it has an infamous character. I do not know a single thoughtful and well-informed person who does not feel that the tragedy of illness at present is that it delivers you helplessly into the hands of a profession which you deeply mistrust, because it not only advocates and practises the most revolting cruelties in the pursuit of knowledge, and justifies them on grounds which would equally justify practising the same cruelties on yourself or your children, or burning down London to test a patent fire extinguisher, but, when it has shocked the public, tries to reassure it with lies of breath-bereaving brazenness. That is the character the medical profession has got just now. It may be deserved or it may not: there it is at all events, and the doctors who have not realized this are living in a fool's paradise. As to the humor and conscience of doctors, they have as much as any other class of men, no more and no less. And what other men dare pretend to be impartial where they have a strong pecuniary interest on one side? Nobody supposes that doctors are less virtuous than judges; but a judge whose salary and reputation depended on whether the verdict was for plaintiff or defendant, prosecutor or prisoner, would be as little trusted as a general in the pay of the enemy. To offer me a doctor as my judge, and then weight his decision with a bribe of a large sum of money and a virtual guarantee that if he makes a mistake it can never be proved against him, is to go wildly beyond the ascertained strain which human nature will bear. It is simply unscientific to allege or believe that doctors do not under existing circumstances perform unnecessary operations and manufacture and prolong lucrative illnesses. The only ones who can claim to be above suspicion are those who are so much sought after that their cured patients are immediately replaced by fresh ones. And there is this curious psychological fact to be remembered: a serious illness or a death advertizes the doctor exactly as a hanging advertizes the barrister who defended the person hanged. Suppose, for example, a royal personage gets something wrong with his throat, or has a pain in his inside. If a doctor effects some trumpery cure with a wet compress or a peppermint lozenge nobody takes the least notice of him. But if he operates on the throat and kills the patient, or extirpates an internal organ and keeps the whole nation palpitating for days whilst the patient hovers in pain and fever between life and death, his fortune is made: every rich man who omits to call him in when the same symptoms appear in his household is held not to have done his utmost duty to the patient. The wonder is that there is a king or queen left alive in Europe.
There is another difficulty in trusting to the honor and conscience of a doctor. Doctors are just like other Englishmen: most of them have no honor and no conscience: what they commonly mistake for these is sentimentality and an intense dread of doing anything that everybody else does not do, or omitting to do anything that everybody else does. This of course does amount to a sort of working or rule-of-thumb conscience; but it means that you will do anything, good or bad, provided you get enough people to keep you in countenance by doing it also. It is the sort of conscience that makes it possible to keep order on a pirate ship, or in a troop of brigands. It may be said that in the last analysis there is no other sort of honor or conscience in existence—that the assent of the majority is the only sanction known to ethics. No doubt this holds good in political practice. If mankind knew the facts, and agreed with the doctors, then the doctors would be in the right; and any person who thought otherwise would be a lunatic. But mankind does not agree, and does not know the facts. All that can be said for medical popularity is that until there is a practicable alternative to blind trust in the doctor, the truth about the doctor is so terrible that we dare not face it. Moliere saw through the doctors; but he had to call them in just the same. Napoleon had no illusions about them; but he had to die under their treatment just as much as the most credulous ignoramus that ever paid sixpence for a bottle of strong medicine. In this predicament most people, to save themselves from unbearable mistrust and misery, or from being driven by their conscience into actual conflict with the law, fall back on the old rule that if you cannot have what you believe in you must believe in what you have. When your child is ill or your wife dying, and you happen to be very fond of them, or even when, if you are not fond of them, you are human enough to forget every personal grudge before the spectacle of a fellow creature in pain or peril, what you want is comfort, reassurance, something to clutch at, were it but a straw. This the doctor brings you. You have a wildly urgent feeling that something must be done; and the doctor does something. Sometimes what he does kills the patient; but you do not know that; and the doctor assures you that all that human skill could do has been done. And nobody has the brutality to say to the newly bereft father, mother, husband, wife, brother, or sister, "You have killed your lost darling by your credulity."
Besides, the calling in of the doctor is now compulsory except in cases where the patient is an adult—and not too ill to decide the steps to be taken. We are subject to prosecution for manslaughter or for criminal neglect if the patient dies without the consolations of the medical profession. This menace is kept before the public by the Peculiar People. The Peculiars, as they are called, have gained their name by believing that the Bible is infallible, and taking their belief quite seriously. The Bible is very clear as to the treatment of illness. The Epistle of James; chapter v., contains the following explicit directions:
14. Is any sick among you? let him call for the elders of the Church; and let them pray over him, anointing him with oil in the name of the Lord:
15. And the prayer of faith shall save the sick, and the Lord shall raise him up; and if he have committed sins, they shall be forgiven him.
The Peculiars obey these instructions and dispense with doctors. They are therefore prosecuted for manslaughter when their children die.
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