A Question of Identity: Women, Science, and Literature (review)

Anne Digby. Making a Medical Living: Doctors and Patients in the English Market for Medicine, 1720-1911. Cambridge Studies in Population, Economy, and Society in Past Time, no. 24. Cambridge: Cambridge University Press, 1994. xix + 348 pp. Ill. $64.95.

Anne Digby reminds us that while physicians in the past treated patients, invented new medical theories, compounded medicines, and made discoveries about the human body, they also made a living. One hundred and fifty years ago, that last was not an easy task. For some practitioners who managed to capture a wealthy set of patients, the living was plentiful: for attending Harriet Brudenell, daughter of the Earl of Cardigan, during her fatal illness in 1767, Dr. Addington charged £100. Most practitioners, however, scraped by, perhaps earning even less money than that stereotype of Victorian literature, the impoverished clergyman.

Digby's story is persuasive on many levels. She has cast her net wide in terms of evidence, combing twenty-one provincial record offices and libraries for the nitty-gritty of account books, medical bills in family papers, correspondence, and poor-law overseers' accounts. She has also employed a wide range of periodical literature--including some wonderful cartoons from Punch, as well as metropolitan sources more familiar to us.

The emergence of professional structures in the Victorian period looks different when pounds, shillings, and pence are taken into account. Some medical men's strategies are familiar to us from Irvine Loudon's account of the rise of the general practitioner, ¹ but others are less so. Digby shows how physicians used a variety of techniques to try to increase the size of their practices. For example, they were very keen to treat mothers and children, since a child might be the key to enrolling the whole family as patients. More specifically, Digby shows that midwifery was an especially important part of general practice, ranging from 10 percent of a successful physician's income to 30 percent for a struggling medic. Physicians also expanded their practices by seeing the poor under the auspices of the Old and New Poor Laws, dispensaries, and workingmen's associations. However, this scramble for patients meant that doctors were extremely unwelcoming to anyone whom they perceived as an outsider, whether a woman physician or an alternative practitioner.

Common sense tells us that economics was at the heart of medical professionalization, but Digby's book is refreshing in its down-to-earth explication of how and why this was so. As late as 1907, Punch printed a cartoon of a figure sitting by the roadside--he is, the caption explains, an unemployed doctor waiting in hopes that an automobile crash will provide him with patients; the stereotyped ambulance chaser is too poor to afford to chase anyone! Digby suggests that it was not until the state started paying physicians via National Insurance in 1911 that most practitioners could be sure that they would be able to make a decent living.

Digby also reframes the story of the rise of the Victorian medical profession by her attention to patients. She points out that the patient-practitioner relationship was always at least two relationships: therapeutic, and economic. For the poor, the advent of the New Poor Law in 1834 seems to have made medical care much less generous. For middling sorts, domestic medical manuals constantly urged the money-saving values of self-treatment. Nor were practitioners as confident of medicine's powers as they might wish, and consequently they often made dreadful patients. Edward Jenner, for example, moaned bitterly when his physician was unable to cup or bleed him--his cups were broken, his lancets were dull, and his leeches had perished in the cold of winter. While the 1911 insurance act was criticized because panel physicians ended up seeing office patients for an average of only three and...