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- The Doctor's Dilemma - 5/24 -


B. B. [continuing] I suspected typhoid: the head gardener's boy had it; so I just called at St Anne's one day and got a tube of your very excellent serum. You were out, unfortunately.

RIDGEON. I hope they explained to you carefully--

B. B. [waving away the absurd suggestion] Lord bless you, my dear fellow, I didnt need any explanations. I'd left my wife in the carriage at the door; and I'd no time to be taught my business by your young chaps. I know all about it. Ive handled these anti- toxins ever since they first came out.

RIDGEDN. But theyre not anti-toxins; and theyre dangerous unless you use them at the right time.

B. B. Of course they are. Everything is dangerous unless you take it at the right time. An apple at breakfast does you good: an apple at bedtime upsets you for a week. There are only two rules for anti-toxins. First, dont be afraid of them: second, inject them a quarter of an hour before meals, three times a day.

RIDGEON [appalled] Great heavens, B. B., no, no, no.

B. B. [sweeping on irresistibly] Yes, yes, yes, Colly. The proof of the pudding is in the eating, you know. It was an immense success. It acted like magic on the little prince. Up went his temperature; off to bed I packed him; and in a week he was all right again, and absolutely immune from typhoid for the rest of his life. The family were very nice about it: their gratitude was quite touching; but I said they owed it all to you, Ridgeon; and I am glad to think that your knighthood is the result.

RIDGEON. I am deeply obliged to you. [Overcome, he sits down on the chair near the couch].

B. B. Not at all, not at all. Your own merit. Come! come! come! dont give way.

RIDGEON. It's nothing. I was a little giddy just now. Overwork, I suppose.

WALPOLE. Blood-poisoning.

B. B. Overwork! Theres no such thing. I do the work of ten men. Am I giddy? No. NO. If youre not well, you have a disease. It may be a slight one; but it's a disease. And what is a disease? The lodgment in the system of a pathogenic germ, and the multiplication of that germ. What is the remedy? A very simple one. Find the germ and kill it.

SIR PATRICK. Suppose theres no germ?

B. B. Impossible, Sir Patrick: there must be a germ: else how could the patient be ill?

SIR PATRICK. Can you shew me the germ of overwork?

B. B. No; but why? Why? Because, my dear Sir Patrick, though the germ is there, it's invisible. Nature has given it no danger signal for us. These germs--these bacilli--are translucent bodies, like glass, like water. To make them visible you must stain them. Well, my dear Paddy, do what you will, some of them wont stain. They wont take cochineal: they wont take methylene blue; they wont take gentian violet: they wont take any coloring matter. Consequently, though we know, as scientific men, that they exist, we cannot see them. But can you disprove their existence? Can you conceive the disease existing without them? Can you, for instance, shew me a case of diphtheria without the bacillus?

SIR PATRICK. No; but I'll shew you the same bacillus, without the disease, in your own throat.

B. B. No, not the same, Sir Patrick. It is an entirely different bacillus; only the two are, unfortunately, so exactly alike that you cannot see the difference. You must understand, my dear Sir Patrick, that every one of these interesting little creatures has an imitator. Just as men imitate each other, germs imitate each other. There is the genuine diphtheria bacillus discovered by Loeffler; and there is the pseudo-bacillus, exactly like it, which you could find, as you say, in my own throat.

SIR PATRICK. And how do you tell one from the other?

B. B. Well, obviously, if the bacillus is the genuine Loeffler, you have diphtheria; and if it's the pseudobacillus, youre quite well. Nothing simpler. Science is always simple and always profound. It is only the half-truths that are dangerous. Ignorant faddists pick up some superficial information about germs; and they write to the papers and try to discredit science. They dupe and mislead many honest and worthy people. But science has a perfect answer to them on every point.

A little learning is a dangerous thing; Drink deep; or taste not the Pierian spring.

I mean no disrespect to your generation, Sir Patrick: some of you old stagers did marvels through sheer professional intuition and clinical experience; but when I think of the average men of your day, ignorantly bleeding and cupping and purging, and scattering germs over their patients from their clothes and instruments, and contrast all that with the scientific certainty and simplicity of my treatment of the little prince the other day, I cant help being proud of my own generation: the men who were trained on the germ theory, the veterans of the great struggle over Evolution in the seventies. We may have our faults; but at least we are men of science. That is why I am taking up your treatment, Ridgeon, and pushing it. It's scientific. [He sits down on the chair near the couch].

EMMY [at the door, announcing] Dr Blenkinsop.

Dr Blenkinsop is a very different case from the others. He is clearly not a prosperous man. He is flabby and shabby, cheaply fed and cheaply clothed. He has the lines made by a conscience between his eyes, and the lines made by continual money worries all over his face, cut all the deeper as he has seen better days, and hails his well-to-do colleagues as their contemporary and old hospital friend, though even in this he has to struggle with the diffidence of poverty and relegation to the poorer middle class.

RIDGEON. How are you, Blenkinsop?

BLENKINSOP. Ive come to offer my humble congratulations. Oh dear! all the great guns are before me.

B. B. [patronizing, but charming] How d'ye do Blenkinsop? How d'ye do?

BLENKINSOP. And Sir Patrick, too [Sir Patrick grunts].

RIDGEON. Youve met Walpole, of course?

WALPOLE. How d'ye do?

BLENKINSOP. It's the first time Ive had that honor. In my poor little practice there are no chances of meeting you great men. I know nobody but the St Anne's men of my own day. [To Ridgeon] And so youre Sir Colenso. How does it feel?

RIDGEON. Foolish at first. Dont take any notice of it.

BLENKINSOP. I'm ashamed to say I havnt a notion what your great discovery is; but I congratulate you all the same for the sake of old times.

B. B. [shocked] But, my dear Blenkinsop, you used to be rather keen on science.

BLENKINSOP. Ah, I used to be a lot of things. I used to have two or three decent suits of clothes, and flannels to go up the river on Sundays. Look at me now: this is my best; and it must last till Christmas. What can I do? Ive never opened a book since I was qualified thirty years ago. I used to read the medical papers at first; but you know how soon a man drops that; besides, I cant afford them; and what are they after all but trade papers, full of advertisements? Ive forgotten all my science: whats the use of my pretending I havnt? But I have great experience: clinical experience; and bedside experience is the main thing, isn't it?

B. B. No doubt; always provided, mind you, that you have a sound scientific theory to correlate your observations at the bedside. Mere experience by itself is nothing. If I take my dog to the bedside with me, he sees what I see. But he learns nothing from it. Why? Because he's not a scientific dog.

WALPOLE. It amuses me to hear you physicians and general practitioners talking about clinical experience. What do you see at the bedside but the outside of the patient? Well: it isnt his outside thats wrong, except perhaps in skin cases. What you want is a daily familiarity with people's insides; and that you can only get at the operating table. I know what I'm talking about: Ive been a surgeon and a consultant for twenty years; and Ive never known a general practitioner right in his diagnosis yet. Bring them a perfectly simple case; and they diagnose cancer, and arthritis, and appendicitis, and every other itis, when any really experienced surgeon can see that it's a plain case of blood-poisoning.

BLENKINSOP. Ah, it's easy for you gentlemen to talk; but what would you say if you had my practice? Except for the workmen's clubs, my patients are all clerks and shopmen. They darent be ill: they cant afford it. And when they break down, what can I do for them? You can send your people to St Moritz or to Egypt, or recommend horse exercise or motoring or champagne jelly or complete change and rest for six months. I might as well order my people a slice of the moon. And the worst of it is, I'm too poor to keep well myself on the cooking I have to put up with. Ive such a wretched digestion; and I look it. How am I to inspire confidence? [He sits disconsolately on the couch].

RIDGEON [restlessly] Dont, Blenkinsop: its too painful. The most tragic thing in the world is a sick doctor.

WALPOLE. Yes, by George: its like a bald-headed man trying to sell a hair restorer. Thank God I'm a surgeon!

B. B. [sunnily] I am never sick. Never had a day's illness in my life. Thats what enables me to sympathize with my patients.


The Doctor's Dilemma - 5/24

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