Patient Expectations: How Economics, Religion, and Malpractice Shaped Therapeutics in Early America by Catherine L. Thompson (review)

Catherine Thompson’s concise and well-written account of the transformation of Massachusetts medicine in the first half of the nineteenth century focuses on the active roles patients played in determining the types and administration of therapeutics that they were prescribed and that they actually took. Thompson argues that patients were influenced by larger societal changes in religious beliefs, in economic developments, and in legal interpretations that impacted their expectations as to what was appropriate physician care and satisfactory outcome. A documented increase in legal actions filed against practitioners during the time period and thereafter, particularly regarding broken bones, was the product of not only surgical advance and the confidence of practitioners in what they could accomplish but also the public’s understanding of “cure”—which no longer necessarily meant “palliation.”

The author builds upon the work of John Harley Warner and Kenneth De Ville. Warner, in his The Therapeutic Perspective, has shown the influence of the Paris School upon early American medical authors, and he documented through hospital records the decline of heroic therapeutics administered to in-house patients.¹ Thompson provides nuance to these findings by examining physician case books of community-based physicians in Boston and elsewhere in the state. She finds her Boston physician-based data differed somewhat from what Warner found in the wards of the Massachusetts General Hospital, and her research demonstrates rural differences as well. De Ville’s Medical Malpractice in Nineteenth-Century America is the standard resource on the subject, presenting a tightly woven argument as to why there was an upsurge of lawsuits against medical practitioners as the century unfolded.² Thompson expands upon De Ville’s findings by comprehensively compiling a list of Massachusetts cases and offering a nuanced interpretation of their meaning, including interesting speculations regarding the role of changing religious beliefs in impacting patient decision making in filing lawsuits.

One of the virtues of Thompson’s book is its relative brevity and the comparatively low price of the paperback edition. Patient Expectations can serve as an assigned text in introductory courses in American medical history or general medical history courses. The research is evidence-based, the book combines narrative and analytical history methodologies, and the wide range of sources she tapped will be most instructive to both undergraduate and graduate students.