SIR PATRICK. Youre only beginning to giv...

SIR PATRICK. Youre only beginning to give yourself the airs of age. Did you ever see a boy cultivating a moustache? Well, a middle-aged doctor cultivating a grey head is much the same sort of spectacle.

RIDGEON. Good Lord! yes: I suppose so. And I thought that the days of my vanity were past. Tell me at what age does a man leave off being a fool?

SIR PATRICK. Remember the Frenchman who asked his grandmother at what age we get free from the temptations of love. The old woman said she didn't know. [Ridgeon laughs]. Well, I make you the same answer. But the world's growing very interesting to me now, Colly.

RIDGEON. You keep up your interest in science, do you?

SIR PATRICK. Lord! yes. Modern science is a wonderful thing. Look at your great discovery! Look at all the great discoveries! Where are they leading to? Why, right back to my poor dear old father's ideas and discoveries. He's been dead now over forty years. Oh, it's very interesting.

RIDGEON. Well, theres nothing like progress, is there?

SIR PATRICK. Dont 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. Thats something to be proud of. But your discovery's not new. It's only inoculation. My father practised inoculation until it was made criminal in eighteen-forty. That broke the poor old man's heart, Colly: he died of it. And now it turns out that my father was right after all. Youve brought us back to inoculation.

RIDGEON. I know nothing about smallpox. My line is tuberculosis and typhoid and plague. But of course the principle of all vaccines is the same.

SIR PATRICK. Tuberculosis? M-m-m-m! Youve found out how to cure consumption, eh?

RIDGEON. I believe so.

SIR PATRICK. Ah yes. It's very interesting. What is it the old cardinal says in Browning's play? "I have known four and twenty leaders of revolt." Well, Ive known over thirty men that found out how to cure consumption. Why do people go on dying of it, Colly? Devilment, I suppose. There was my father's old friend George Boddington of Sutton Coldfield. He discovered the open-air cure in eighteen-forty. He was ruined and driven out of his practice for only opening the windows; and now we wont let a consumptive patient have as much as a roof over his head. Oh, it's very VERY interesting to an old man.

RIDGEON. You old cynic, you dont believe a bit in my discovery.

SIR PATRICK. No, no: I dont go quite so far as that, Colly. But still, you remember Jane Marsh?

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 a man I should kill him that way.

Citation: George Bernard Shaw, The Doctor’s Dilemma, Project Gutenberg, 1906.

Link: https://www.gutenberg.org/files/5070/5070-h/5070-h.htm