The Doctors Dilemma: Preface | Page 6

death may prove that I
was wrong; but if I let the leg go, nobody can ever prove that it would
not have mortified had I been obstinate. Operation is therefore the safe
side for the surgeon as well as the lucrative side. The result is that we
hear of "conservative surgeons" as a distinct class of practitioners who
make it a rule not to operate if they can possibly help it, and who are
sought after by the people who have vitality enough to regard an
operation as a last resort. But no surgeon is bound to take the
conservative view. If he believes that an organ is at best a useless
survival, and that if he extirpates it the patient will be well and none the
worse in a fortnight, whereas to await the natural cure would mean a
month's illness, then he is clearly justified in recommending the
operation even if the cure without operation is as certain as anything of
the kind ever can be. Thus the conservative surgeon and the radical or
extirpatory surgeon may both be right as far as the ultimate cure is
concerned; so that their consciences do not help them out of their
differences.
CREDULITY AND CHLOROFORM
There is no harder scientific fact in the world than the fact that belief
can be produced in practically unlimited quantity and intensity, without
observation or reasoning, and even in defiance of both, by the simple
desire to believe founded on a strong interest in believing. Everybody
recognizes this in the case of the amatory infatuations of the
adolescents who see angels and heroes in obviously (to others)
commonplace and even objectionable maidens and youths. But it holds
good over the entire field of human activity. The hardest-headed
materialist will become a consulter of table-rappers and slate-writers if
he loses a child or a wife so beloved that the desire to revive and
communicate with them becomes irresistible. The cobbler believes that
there is nothing like leather. The Imperialist who regards the conquest
of England by a foreign power as the worst of political misfortunes
believes that the conquest of a foreign power by England would be a
boon to the conquered. Doctors are no more proof against such
illusions than other men. Can anyone then doubt that under existing
conditions a great deal of unnecessary and mischievous operating is

bound to go on, and that patients are encouraged to imagine that
modern surgery and anesthesia have made operations much less serious
matters than they really are? When doctors write or speak to the public
about operations, they imply, and often say in so many words, that
chloroform has made surgery painless. People who have been operated
on know better. The patient does not feel the knife, and the operation is
therefore enormously facilitated for the surgeon; but the patient pays
for the anesthesia with hours of wretched sickness; and when that is
over there is the pain of the wound made by the surgeon, which has to
heal like any other wound. This is why operating surgeons, who are
usually out of the house with their fee in their pockets before the
patient has recovered consciousness, and who therefore see nothing of
the suffering witnessed by the general practitioner and the nurse,
occasionally talk of operations very much as the hangman in Barnaby
Rudge talked of executions, as if being operated on were a luxury in
sensation as well as in price.
MEDICAL POVERTY
To make matters worse, doctors are hideously poor. The Irish
gentleman doctor of my boyhood, who took nothing less than a guinea,
though he might pay you four visits for it, seems to have no equivalent
nowadays in English society. Better be a railway porter than an
ordinary English general practitioner. A railway porter has from
eighteen to twenty-three shillings a week from the Company merely as
a retainer; and his additional fees from the public, if we leave the
third-class twopenny tip out of account (and I am by no means sure that
even this reservation need be made), are equivalent to doctor's fees in
the case of second-class passengers, and double doctor's fees in the case
of first. Any class of educated men thus treated tends to become a
brigand class, and doctors are no exception to the rule. They are offered
disgraceful prices for advice and medicine. Their patients are for the
most part so poor and so ignorant that good advice would be resented
as impracticable and wounding. When you are so poor that you cannot
afford to refuse eighteenpence from a man who is too poor to pay you
any more, it is useless to tell him that what he or his sick child needs is
not medicine, but more leisure, better clothes, better food,