The Doctors Dilemma: Preface | Page 5

nineteenth century a London evening paper sent round a
journalist-patient to all the great consultants of that day, and published
their advice and prescriptions; a proceeding passionately denounced by
the medical papers as a breach of confidence of these eminent
physicians. The case was the same; but the prescriptions were different,
and so was the advice. Now a doctor cannot think his own treatment
right and at the same time think his colleague right in prescribing a
different treatment when the patient is the same. Anyone who has ever
known doctors well enough to hear medical shop talked without reserve
knows that they are full of stories about each other's blunders and errors,
and that the theory of their omniscience and omnipotence no more
holds good among themselves than it did with Moliere and Napoleon.
But for this very reason no doctor dare accuse another of malpractice.
He is not sure enough of his own opinion to ruin another man by it. He
knows that if such conduct were tolerated in his profession no doctor's
livelihood or reputation would be worth a year's purchase. I do not
blame him: I would do the same myself. But the effect of this state of
things is to make the medical profession a conspiracy to hide its own
shortcomings. No doubt the same may be said of all professions. They
are all conspiracies against the laity; and I do not suggest that the
medical conspiracy is either better or worse than the military
conspiracy, the legal conspiracy, the sacerdotal conspiracy, the
pedagogic conspiracy, the royal and aristocratic conspiracy, the literary
and artistic conspiracy, and the innumerable industrial, commercial,
and financial conspiracies, from the trade unions to the great exchanges,
which make up the huge conflict which we call society. But it is less
suspected. The Radicals who used to advocate, as an indispensable
preliminary to social reform, the strangling of the last king with the
entrails of the last priest, substituted compulsory vaccination for

compulsory baptism without a murmur.
THE CRAZE FOR OPERATIONS
Thus everything is on the side of the doctor. When men die of disease
they are said to die from natural causes. When they recover (and they
mostly do) the doctor gets the credit of curing them. In surgery all
operations are recorded as successful if the patient can be got out of the
hospital or nursing home alive, though the subsequent history of the
case may be such as would make an honest surgeon vow never to
recommend or perform the operation again. The large range of
operations which consist of amputating limbs and extirpating organs
admits of no direct verification of their necessity. There is a fashion in
operations as there is in sleeves and skirts: the triumph of some surgeon
who has at last found out how to make a once desperate operation fairly
safe is usually followed by a rage for that operation not only among the
doctors, but actually among their patients. There are men and women
whom the operating table seems to fascinate; half-alive people who
through vanity, or hypochondria, or a craving to be the constant objects
of anxious attention or what not, lose such feeble sense as they ever had
of the value of their own organs and limbs. They seem to care as little
for mutilation as lobsters or lizards, which at least have the excuse that
they grow new claws and new tails if they lose the old ones. Whilst this
book was being prepared for the press a case was tried in the Courts, of
a man who sued a railway company for damages because a train had
run over him and amputated both his legs. He lost his case because it
was proved that he had deliberately contrived the occurrence himself
for the sake of getting an idler's pension at the expense of the railway
company, being too dull to realize how much more he had to lose than
to gain by the bargain even if he had won his case and received
damages above his utmost hopes.
Thus amazing case makes it possible to say, with some prospect of
being believed, that there is in the classes who can afford to pay for
fashionable operations a sprinkling of persons so incapable of
appreciating the relative importance of preserving their bodily integrity,
(including the capacity for parentage) and the pleasure of talking about
themselves and hearing themselves talked about as the heroes and
heroines of sensational operations, that they tempt surgeons to operate
on them not only with large fees, but with personal solicitation. Now it

cannot be too often repeated that when an operation is once performed,
nobody can ever prove that it was unnecessary. If I refuse to allow my
leg to be amputated, its mortification and my