The Evolution of British General Practice 1850-1948

By Anne Digby | Go to book overview

8
Medical Investigation and Treatment

'THERE are no real standards for general practice. What the doctor does and how he does it, depends almost wholly on his own conscience.'1 This critical comment followed from an examination of GP's surgeries shortly after the inception of the NHS. To what extent is it valid? The following analysis discusses the methods of general practitioners in their clinical work. A sustained attempt has been made to locate clinical records from past GP's practices, although their cryptic entries, incomplete series, and cross-referencing to records no longer extant, can make their contents elusive. To the breadth of the chapter's general analysis I have added several case studies of individual doctors or practices to illustrate the diversity of general practice in greater depth.

The period from 1850 to 1948 straddles the traditional and the modern in medicine, and the considerable overlap between the two means that it is not possible to make a clear divide between them. Traditional medicine was cenhtred in symptomatic diagnosis and a humane interaction with the patient, whilst modern medicine relied to a much greater extent on precise and mechanistic measurements achieved with instruments, together with powerful pharmaceuticals that cured rather than palliated disease. A portrait contrasting medicine in 1948 with that eighty years before, emphasized that then the:

Science of clinical observation stood high, but that pathology was confined to what is now known as morbid anatomy. Little was known of the causation of disease, and therapeutic blood-letting and the polypharmacy of the alchemist still persisted. Since that day the science of bacteriology has appeared, and the control of sepsis has enabled surgery to take over the treatment of many diseases . . . Precision methods of many kinds have made diagnosis more exact.2

Charting the adoption of modern instrumentation in general practitioners' surgeries is problematical, not least because there was substantial variety between individual doctors. Advances in instrumentation meant that even specialists, let alone GPs, found it difficult to accommodate the pace of new methods of measuring vital physical indicators. Even the eminent clinical physician and tutor at Guys, W. W. Gull ( 1815- 1890), commented in 1872,

____________________
1
J. S. Collings, "General Practice in England Today. A Reconnaissance" in Lancet, i ( 1950), 555.
2
Sir Henry Ogilvie, "Then and Now", Practitioner, 161 ( July to Dec. 1948), 1-2.

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The Evolution of British General Practice 1850-1948
Table of contents

Table of contents

  • Title Page iii
  • Acknowledgements vii
  • Contents ix
  • List of Plates, Maps, and Figures xi
  • List of Tables xiii
  • Abbreviations xiv
  • 1 - Constructing General Practice 1
  • PART I - Careers 21
  • 3 - Recruitment, Education, and Training 40
  • 4 - Reinventing Roles 66
  • PART II - In Practice 91
  • The Medical Market 93
  • 6 - Organizing A Practice 126
  • 7 - Women Practitioners 154
  • 8 - Medical Investigation and Treatment 187
  • 9 - Patients 224
  • PART III - A Wider World 257
  • 10 - Public Duties and Private Lives 259
  • 11 - Generalists, Specialists, and Others 287
  • 12 - National Health Insurance 306
  • 13 - The National Health Service 325
  • Select Bibliography 343
  • Index of Medical Names 365
  • General Index 369
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