The Doctor’s Dilemma

for only opening the windows; and now we won’t 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 don’t believe a bit in my discovery. Sir Patrick No, no: I don’t go quite so far as that, Colly. But still, you remember Jane Marsh? Ridgeon Jane Marsh? No. Sir Patrick You don’t! Ridgeon No. Sir Patrick You mean to tell me you don’t 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 you’ve 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 showing it at medical lectures. Sir Patrick Still, that wasn’t 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. I’ve tried these modern inoculations a bit myself. I’ve killed people with them; and I’ve 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 you’ll find out why. Sir Patrick Grumbling and fumbling for his spectacles. Oh, bother your pamphlets. What’s 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 That’s not new. I’ve heard this notion that the white corpuscles⁠—what is it that what’s 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 don’t 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 won’t 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 upgrade, we should have cured her arm. But we got in on the downgrade and lost her arm for her. I call the upgrade the positive phase and the downgrade 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. That’s my discovery: the most important that has been made since Harvey discovered the circulation of the blood. My tuberculosis patients don’t 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. Emmy Looking in. Will you see a lady that wants her husband’s lungs cured? Ridgeon Impatiently. No. Haven’t 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. Don’t 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. You’ll tell her I can’t see her, and send her away: do you hear? Emmy Unmoved. Well, will you see Mr. Cutler Walpole? He don’t want a cure: he only wants to congratulate you. Ridgeon Of course. Show 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 Don’t laugh at me. I want your advice. Sir Patrick Professional advice? Ridgeon Yes. There’s something the matter with me. I don’t know what it is. Sir Patrick Neither do I. I suppose you’ve been sounded. Ridgeon Yes, of course. There’s nothing wrong with any of the organs: nothing special, anyhow. But I have a curious aching: I don’t know where: I can’t localize it. Sometimes I think it’s my heart: sometimes I suspect my spine. It doesn’t 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 they’re quite commonplace. Sir Patrick Do you hear voices? Ridgeon No. Sir