This popular play was written by George Bernard Shaw in 1906, partly to release a small portion of his tremendous creative wit and vitality, and partly to showcase some of his own ideas about medicine as it was practised in London at the turn of the century. 

Shaw was one of Ireland’s finest sons: ‘…by birth a Dubliner, (he) detested his native city and his native city did not much care for him either.’ He was born in 1856, and became one of the most outspoken people of his time. 

The Doctor’s Dilemma, like others of his plays, has an extraordinary preface of some 82 pages. It is both a cutting indictment of contemporary medical practice, a diatribe against the new craze of vaccination, and a crusade against the cruel researches of the vivisectionists.

Preface 

Here are Shaw’s opening shots: 

‘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 a 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.’ 

‘Again I hear voices indignantly muttering old phrases about the high character of a noble profession and the honour and conscience of its members. I must reply that the medical profession has not a high character: it has an infamous character.’ 

To think about: Shaw was accomplished at offending people. How can being the subject of a rapacious wit in any way assist the practice of medicine? 

 

In a section entitled Medical Poverty, Shaw takes the opposite position on money to that we have come to expect today: 

‘To make matters worse, doctors are hideously poor…Any class of educated men thus treated tends to become a brigand class, and doctors are no exception.’ 

‘The surgeon, though often more unscrupulous than the general practitioner, retains his self-respect more easily…the man who does evil skilfully, energetically, masterfully, grows prouder and bolder at every crime.’ 

‘Doctoring is an art, not a science’ insists Shaw, before going on to denounce the fads of his day, one of which was vaccination.

‘The psychology of fashion becomes a pathology…fashions, after all, are only induced epidemics…’ 

‘Public ignorance of the laws of evidence and of statistics can hardly be exaggerated.’ 

‘For example, just at present the world has run raving mad on the subject of radium…Suppose every child in the world could be rendered absolutely immune from all disease during its entire life by taking half an ounce of radium  to every pint of its milk. The world would be none the healthier, because…(no-one)…could afford the treatment.’ 

His contempt for vivisection is succinctly put with a few hard examples: 

‘Or the gentleman who starved sixty dogs to death to establish the fact that a dog deprived of food gets progressively lighter and weaker, becoming remarkably emaciated, and finally dying: an undoubted truth, but ascertainable without laboratory experiments by a simple enquiry addressed to the nearest policeman, or, failing him, to any sane person in Europe.’ 

To think about: Have things changed? How many animals die for medical progress each year? 

After a scathing discussion on the difference between the Public Health Service and the Private Illness Service, Shaw finishes up with some numbered conclusions: against vested interests in ill health, and for a coroner’s enquiry into every death where doctors have been sniffing about. His twelfth rule is my favourite: ‘Do not try to live forever. You will not succeed.’

 

The Play 

O’Donovan argues that in The Doctor’s Dilemma ‘the concerto grosso passages for the doctors constitute scenes of delectable high comedy that age cannot wither nor custom stale.’ 

It opens with Dr Ridgeon being congratulated on his knighthood. It is not long before doctors are discussing opposing treatment methods and their personal ideas of disease causation: 

SIR PATRICK Don’t 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.

SIR PATRICK…He’s a clever operator, is Walpole, though he’s only one of your chloroform surgeons. In my early days, you made your man drunk; and the porters and students held him down; and you had to set your teeth and finish the job fast. Nowadays you work at your ease; and the pain doesn’t come until afterwards, when you’ve taken your cheque and rolled up your bag and left he house. I tell you, Colly, chloroform has done a lot of mischief. It’s enabled any fool to be a surgeon.

WALPOLE I tell you this: in an intelligently governed country people wouldn’t be allowed to go about with nuciform sacs, making themselves centres of infection. The operation ought to be compulsory: it’s ten times more important than vaccination. 

BB (Sadly) Walpole has no intellect. A mere surgeon. Wonderful operator; but, after all, what is operating? Only manual labour. Brain- BRAIN remains master of the situation. The nuciform sac is utter nonsense: there’s no such organ. It’s a mere accidental kink in the membrane, occurring in perhaps two-and-a-half percent of the population. Of course, I’m glad for Walpole’s sake that the operation is fashionable; for he’s a dear good fellow; and after all, as I always tell people, the operation does no harm: indeed, I’ve known the nervous shake-up and the fortnight in bed do people a lot of good after a hard London season; but still it’s a shocking fraud.

 

The doctors must decide on whether to treat TB in an artist who is a cad but talented, or a fellow doctor who has no money. Dubedat, the artist, suggests he should be paid to undergo Walpole’s operation, rather than the other way about…to an amusing outrage of the medical characters. 

Eventually they decide on who and what will treat him. He dies of the vaccination therapy of Sir BB: 

BB Poor young fellow! How well he died! I feel a better man, really.

SIR PATRICK When you’re as old as I am, you’ll know that it matters very little how a man dies. What matters is, how he lives. Every fool that runs his nose against a bullet is a hero nowadays, because he dies for his country. Why don’t he live for it to some purpose? 

Consider: I suspect not even Bernard Shaw would have written this line ten years later. Why?

 

Finally Ridgeon confesses his love for Jennifer the widow of Dubedat, and also confesses to her he killed Dubedat by letting his colleague Sir BB treat him. She is aghast: 

JENNIFER I shall remember you always as a little man who tried to kill a great one.

RIDGEON Pardon me. I succeeded. 

 

References and Further Reading 

The play can be read online via Project Gutenberg: 

http://isis.library.adelaide.edu.au/pg/etext04/dcdlm10.txt 

O’Donovan J (1983) G.B.Shaw            Gill and McMillan