Private Practice: In the Early Twentieth-Century Medical Office of Dr. Richard Cabot (review)

In 1896, Richard C. Cabot opened a private office in Boston's Back Bay neighborhood. A year later, he published A Guide to the Clinical Examination of the Blood for Diagnostic Purposes. After this work came dozens more. Cabot's specialized studies were soon joined by more general writings. His scope then broadened beyond medical subjects in works such as The Christian Approach to Social Morality (1913) and What Men Live By: Work, Play, Love, Worship (1914). In the 1920s, he abandoned private practice for work as a professor of social ethics at Harvard College. He continued to write on medical practice and ethics, for major publishers such as Houghton Mifflin, Macmillan, and Harper & Brothers. He also wrote for medical journals and magazines. Confident in his ability and duty to reprobate error, Cabot established a controversial prominence in American medicine.

His publications exhibit two facts about Cabot's place in the history of medicine. First, historians should know him better. Oxford University Press's American National Biography, a standard historical reference, has no entry for him. Yet it features 229 biographies of other Americans, all eminent in the fields of health and medicine, and all born between 1858 and 1878. Though Private Practice claims not to be "a book about the character, personality, or life of Richard Cabot, except in a tangential sense" (14), it will be, for the immediate future at least, the book about this important figure in American medical history.

Second, Cabot's bibliography suggests that he was a most thoughtful observer of medical practice during this important transitional period. That Cabot took writing so seriously improves the historical value of his medical writings. He clearly studied the craft of writing and learned to choose his words with increasing accuracy. Even his patient records and correspondence invite study, through their evident care with words.

Appropriately, Private Practice is also distinguished for its respect for language. Not ambitious in style, the prose is careful and scholarly but not tedious. It does not compete with quoted material and thus presents the words of Cabot and his contemporaries in their own quiet elegance. Private Practice also examines a surprisingly large body of medical writings by Cabot's contemporaries. A respect for the language of the time may be most evident, however, in Chapter 6, which describes Cabot's role in his brother's 1893 euthanasia. Here Cabot's own voice, through select quotations, expresses the immense emotional content of this story. The chapter then tours old medical dictionaries to trace the evolution of the meanings of "euthanasia."

This chapter highlights another virtue of Cabot as a historical subject: he was unusually honest. As both he and his brother, Hugh the surgeon, reported in interviews, "doctors not infrequently practiced euthanasia but rarely discussed it" (195). Cabot discussed it. And he annotated a transcript of the discussion for clarity. In a 1938 Macmillan book, Cabot presents honesty, "next to food and shelter," as "one of our greatest needs." And he claims to have been studying honesty for "at least half a century" (Honesty, iii). As Private Practice documents, an attention to honesty characterized his practice. He is remembered, as Chapter 1 reports, "for chiding the American medical profession about the covert use of placebo strategies" (12). And as Chapter 4 documents and Chapter 7 emphasizes, Cabot was distinguished by his reluctance to withhold or manipulate diagnostic and prognostic information. It may be naïve to assume that his patient records and correspondence are perfectly honest, but their candor is manifest. And this quality also makes Cabot an excellent choice for an in-depth study.

The first six chapters of Private Practice organize the details of Cabot's medical practice around topics of established and enduring interest to scholars on the history of medicine. For this, Private Practice contributes much to the broader history of medicine by presenting its specific subject with reference to...