The Preface to the play – typically, as long as the drama itself – is an extensive tirade against the professions, and in particular the medical profession, as being excessively given to protestations of the public good and the actual pursuit of private interest. As a founding member of the Fabian movement in 1884, Shaw – a school drop-out who had used the British Library to achieve a massive self-education programme in his 20s and was active in local politics in the deprived London area of St Pancras – was a passionate critic of the huge disparities between the wealthy and the poor, and his unique combination of prodigious intellect and panoramic knowledge meant that he was seldom intimidated in his mission for fairness and truth (a substantial part of the Preface, however, is given over to a glittering harangue against vivisection). At the time of this play he was a highly successful dramatist, with works such as Man and Superman and Major Barbara enjoying international acclaim. The Doctor's Dilemma would come to be seen as the greatest satire on the medical profession since Molière's Malade Imaginaire.[2]
Shaw credits Almroth Wright as the source of his information on medical science: "It will be evident to all experts that my play could not have been written but for the work done by Sir Alm[r]oth Wright on the theory and practice of securing immunization from bacterial diseases by the inoculation of vaccines made of their own bacteria."[3] This remark is characteristically ironical. Wright was knighted shortly before this play was written, and Shaw was suspicious of Wright's high reputation (the latter was also known by the nickname Sir Almost Right). The two men met in 1905, and engaged in a long series of robust discussions, involving at one point a challenge from the medical audience that they had "too many patients on our hands already". Shaw's response was to ask what would be done if there was more demand from patients than could be satisfied, and Wright answered: "We should have to consider which life was worth saving." This became the "dilemma" of the play.[4]
The preface mentions that there is another dilemma: poor doctors are easily tempted to perform costly but useless (and in the best case harmless) operations or treatments on their patients for personal gain. "Could I not make a better use of a pocketful of guineas than this man is making of his leg?" This was reportedly inspired by the behaviour of a prominent Ear Nose and Throat specialist in London who had developed a simple and almost harmless operation to remove the uvula, which did no benefit to his patients but made the surgeon a great deal of money.
