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 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.