|The Sick Child [with TB] by Edvard Munch; from Wikipedia|
|George Bernard Shaw|
In 1906, there were no treatments for Tuberculosis [TB] except for isolation, fresh air, and a tuberculin inoculation. What if you were a doctor/scientist at this time, such as Sir Almroth Edward Wright, who knew how to inoculate more safely; you knew that lives could be saved this way, but you could take on only one more patient. Who do you save? Who is worthy of your discovery? That is The Doctor’s Dilemma [Sir Colenso Ridgeon’s dilemma, that is] in George Bernard Shaw’s play.
In the 1966 Tyrone Guthrie Theatre edition of The Doctor’s Dilemma, Shaw’s 1911 Preface on Doctors exposes his views—somewhat paradoxical views when read in 2011. Back in the early 1900’s, in England, there wasn’t a National Health Service. In addition, doctors were paid per smallpox vaccination, and under the Vaccination Act, it was compulsory. Shaw was very outspoken about this; he thought that smallpox severity was lessening, and that it would go away without intervention--the vaccine had nothing to do with the decrease in deaths. This is an interesting position from a man that supposedly held science in high regard. In the play he takes recent scientific findings on opsonic theory and builds a smart exploit—of different kinds of people, of science in the wrong hands, of journalists who don’t understand science, of medical ethics, and places them before us. There is high regard for the science, but little for the people using it.
His 1911 preface exposes [in his view] bacteriology as a superstition, germ theory as farce, and likens vaccines to homeopathy [which he despised]. He also was against vivisection and despised all doctors [GPs and surgeons]. His science loving yet science denying views are his paradox. Of smallpox vaccination he says:
“…Such monstrosities as vaccinations are, as we have seen, founded, not on science, but on half-crowns. If the Vaccination Acts, instead of being wholly repealed as they are already half repealed, were strengthened by compelling every parent to have his child vaccinated by a public officer whose salary was completely independent of the number of vaccinations performed by him, and for whom there was plenty of alternative public health work waiting, vaccination would be dead in two years, as the vaccinator would not only not gain by it, but would lose credit through the depressing effects on the vital statistics of his district of the illness and deaths it causes, whilst it would take from him all the credit of that freedom from smallpox which is the result of good sanitary administration and vigilant prevention of infection…”
His preface, seen with a modern scientific eye, is nearly funny--until you realize that similar diatribes exist today. Perhaps with better understanding of the science of vaccinations today, he would have had a different opinion.
Shaw’s answer to the dilemma is given by the preface: that doctors should be paid by the nation and paid bonuses when their individual district’s death rate decreases, and he offers this advice:
“Take the utmost care to get well born and well brought up. This means that your mother must have a good doctor. Be careful to go to a school where there is what they call a school clinic where your nutrition and teeth and eyesight and other matters of importance to you will be attended to. Be particularly careful to have all this done at the expense of the nation, as otherwise it will not be done at all, the chances being about 40 to one against your being able to pay for it directly yourself, even if you know how to set about it. Otherwise you will be what most people are at present: an unsound citizen of an unsound nation, without sense enough to be ashamed or unhappy about it.”
He seems to have followed his own advice. He was 94 years old when he died following an accident in his garden…and it wasn’t an infection.
Millions of lives have been saved by vaccination. Shaw would have liked to have seen this [would he have seen this?] as well as the formation of the NHS in 1948.
The BCG vaccine [used to prevent TB, and used in countries with high rate of infection] became available in 1921.
For information about modern-day vaccines, visit either The CDC vaccine, the NHS vaccine, or WHO vaccine websites.
An early 1900 article in NYT about using opsonic theory to treat TB.