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- The Doctor's Dilemma - 3/24 -


RIDGEON. Jane Marsh? No.

SIR PATRICK. You dont!

RIDGEON. No.

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?

RIDGEON. Phagocytes.

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.

SIR PATRICK. And mine do when my inoculation catches them in the negative phase, as you call it. Eh?

RIDGEON. Precisely. To inject a vaccine into a patient without first testing his opsonin is as near murder as a respectable practitioner can get. If I wanted to kill s man I should kill him that way.

EMMY [looking in] Will you see a lady that wants her husband's lungs cured?

RIDGEON [impatiently] No. Havnt I told you I will see nobody?[To Sir Patrick] I live in a state of siege ever since it got about that I'm a magician who can cure consumption with a drop of serum. [To Emmy] Dont come to me again about people who have no appointments. I tell you I can see nobody.

EMMY. Well, I'll tell her to wait a bit.

RIDGEON [furious] Youll tell her I cant see her, and send her away: do you hear?

EMMY [unmoved] Well, will you see Mr Cutler Walpole? He dont want a cure: he only wants to congratulate you.

RIDGEON. Of course. Shew him up. [She turns to go]. Stop. [To Sir Patrick] I want two minutes more with you between ourselves. [To Emmy] Emmy: ask Mr. Walpole to wait just two minutes, while I finish a consultation.

EMMY. Oh, he'll wait all right. He's talking to the poor lady. [She goes out].

SIR PATRICK. Well? what is it?

RIDGEON. Dont laugh at me. I want your advice.

SIR PATRICK. Professional advice?

RIDGEON. Yes. Theres something the matter with me. I dont know what it is.

SIR PATRICK. Neither do I. I suppose youve been sounded.

RIDGEON. Yes, of course. Theres nothing wrong with any of the organs: nothing special, anyhow. But I have a curious aching: I dont know where: I cant localize it. Sometimes I think it's my heart: sometimes I suspect my spine. It doesnt exactly hurt me; but it unsettles me completely. I feel that something is going to happen. And there are other symptoms. Scraps of tunes come into my head that seem to me very pretty, though theyre quite commonplace.

SIR PATRICK. Do you hear voices?

RIDGEON. No.

SIR PATRICK. I'm glad of that. When my patients tell me that theyve made a greater discovery than Harvey, and that they hear voices, I lock them up.

RIDGEON. You think I'm mad! Thats just the suspicion that has come across me once or twice. Tell me the truth: I can bear it.

SIR PATRICK. Youre sure there are no voices?

RIDGEON. Quite sure.

SIR PATRICK. Then it's only foolishness.

RIDGEON. Have you ever met anything like it before in your practice?

SIR PATRICK. Oh, yes: often. It's very common between the ages of seventeen and twenty-two. It sometimes comes on again at forty or thereabouts. Youre a bachelor, you see. It's not serious--if youre careful.

RIDGEON. About my food?

SIR PATRICK. No: about your behavior. Theres nothing wrong with your spine; and theres nothing wrong with your heart; but theres something wrong with your common sense. Youre not going to die; but you may be going to make a fool of yourself. So be careful.

RIDGEON. I sec you dont believe in my discovery. Well, sometimes I dont believe in it myself. Thank you all the same. Shall we have Walpole up?

SIR PATRICK. Oh, have him up. [Ridgeon rings]. 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 youve taken your cheque and rolled up your bag and left the house. I tell you, Colly, chloroform has done a lot of mischief. It's enabled every fool to be a surgeon.

RIDGEON [to Emmy, who answers the bell] Shew Mr Walpole up.

EMMY. He's talking to the lady.

RIDGEON [exasperated] Did I not tell you--

Emmy goes out without heeding him. He gives it up, with a shrug, and plants himself with his back to the console, leaning resignedly against it.


The Doctor's Dilemma - 3/24

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