In George Bernard Shaw’s play The Doctor’s Dilemma, written early last century, the knife-happy surgeon invents a nut-shaped abdominal organ, the ‘nuciform sac’. It is situated near the appendix, ‘full of decaying matter’, and requires removal, assuming the patient can afford the fee. The surgeon, Cutler Walpole, has the line: ‘The operation ought to be compulsory.’
Bernard Shaw labours the point that removal of the nuciform sac equals 500 guineas, and not removing it equals nought guineas. He then suggests, wickedly, that we want our surgeons to be mortal, ‘quite as honest as most of us’, not God-like. Which of us, he asks, would not be influenced by the financial equation, if it is impossible to prove that this organ might be better left in situ? Add in the need to pay for a Harley Street consulting room, school fees, and a wife with expensive tastes and the choice is self-evident.