Physician, heal thyself: The health and mortality of Victorian doctors

Social History of Medicine

Volumn 9, Issue 1, 1996, Pages 1-30

  Woods, Robert ^a  

^a UNIVERSITY OF LIVERPOOL   (United Kingdom)

Author keywords

Dr William Ogle; Health; Medical profession; Medical statistics; Mortality; Nosology; Victorian England

Indexed keywords

ARTICLE; HISTORY; LONGEVITY; MORBIDITY; MORTALITY; OCCUPATIONAL HEALTH; PHYSICIAN; UNITED KINGDOM; VITAL STATISTICS;

GREAT BRITAIN; HISTORY, 19TH CENTURY; LONGEVITY; MORBIDITY; MORTALITY; OCCUPATIONAL HEALTH; PHYSICIANS; VITAL STATISTICS;

EID: 0030115002     PISSN: 0951631X     EISSN: None     Source Type: Journal    
DOI: 10.1093/shm/9.1.1     Document Type: Article

References (110)

1. William Ogle, 'Statistics of Mortality in the Medical Profession', Medico-Chirurgical Transactions, 69 (1886), pp. 217-37,
2. and for a report of the discussion, see Proceedings of the Royal Medical and Chirurgical Society, New Series, ii (1886), p. 45.
3. The paper and discussion are also reported in the Lancet for 30 January 1886,
4. and the same report is reprinted in Journal of the Statistical Society, 49 (1886), pp. 164-70.
5. The last words of Ogle's paper are 'physician, heal thyself; a proverb with a history even before St Luke. See Stevenson's Book of Proverbs, Maxims and Familiar Phrases (London: Routledge and Kegan Paul, 1949), pp. 598-9.
6. Ogle, 'Statistics', p. 223.
7. Ogle, 'Statistics', pp. 223-4
8. speculates on this point referring to Francis G. P. Neison, Contributions to Vital Statistics (London: Simpkin, Marshall & Co., 1845; third edition, 1857), pp. 121-33
9. (see also 'On the Rate of Mortality in the Medical Profession', Journal of the Statistical Society 15 (1852), pp. 193-222), in which is reported an analysis of mortality among Fellows of the Royal Medical and Chirurgical Society between 1805 and 1849. Neison's work will be discussed again later in the paper (see Table 8).
10. Unfortunately, William A. Guy, 'On the Duration of Life among Medical Men', Journal of the Statistical Society, 17 (1854), pp. 15-23, in considering the same issue was only able to deal with 'the ages at death alone, the element of the ages of the living communities among whom the deaths took place being wanting' (p. 15).
11. Ogle, 'Statistics', p. 231 and p. 230.
12. Ogle, Statistics Ibid., p. 229.
13. 'Mr Camomile' is an idealized country doctor: financially comfortable with £500 to £600 a year and socially respectable, and of whom we shall hear more later. Anon, 'The Income Tax and its Oppressive Effect on General Practitioners', Provincial Medical and Surgical Journal, 11 (1851), pp. 111-12.
14. In respect to the work and living conditions of members of the medical profession, the following are particularly important summaries of our current knowledge: M. Jeanne Peterson, The Medical Profession in Mid-Victorian London (Berkeley: University of California Press, 1978),
15. Irvine Loudon, Medical Care and the General Practitioner, 1750-1850 (Oxford: Clarendon Press, 1986),
16. and Anne Digby, Making a Medical Living: Doctors and Patients in the Market for English Medicine, 1720-1911 (Cambridge: Cambridge University Press, 1994).
17. Only Loudon lists Ogle's 'Statistics' paper in his select bibliography, although he does not refer to it in the text. Neither Peterson nor Loudon or Digby consider the health and mortality of doctors either in their own right, or in terms of their influence on the ability to make a medical living in the nineteenth century.
18. Although this paper deals exclusively with England and Wales, Margurite W. Dupree and M. Anne Crowther, 'A Profile of the Medical Profession in Scotland in the Early Twentieth Century: The Medical Directory as a Historical Source', Bulletin of the History of Medicine, 65 (1991), pp. 209-33 suggest what could be done in Scotland by using medical directories and the civil registration system.
19. The following summarize recent work on the association between sickness and mortality: James C. Riley, 'Disease without Death: New Sources for a History of Sickness', Journal of Interdisciplinary History, 17, 3 (1987), pp. 537-63;
20. 'Ill Health during the English Mortality Decline: The Friendly Societies' Experience', Bulletin of the History of Medicine, 61 (1987), pp. 563-88;
21. George Alter and James C. Riley, 'Frailty, Sickness, and Death: Models of Morbidity and Mortality in Historical Populations', Population Studies, 43, 1 (1989), pp. 25-45.
22. See Lives of the Fellows of the Royal College of Physicians of London, 1826-1925 (Munk's Roll, Volume IV) (London: Royal College of Physicians, 1955),
23. and for obituaries: Lancet (27 April 1912), p. 1164
24. and British Medical Journal (20 April 1912), p. 929.
25. William Ogle, 'Suicides in England and Wales in Relation to Age, Sex, Season and Occupation', Journal of the Statistical Society, 49 (1886), pp. 101-35;
26. 'Summary of Several Male Life Tables', Journal of the Royal Statistical Society, 50 (1887), pp. 648-52
27. (see also Public Health, 1 (1888-89), pp. 168-70);
28. 'The Alleged Depopulation of the Rural Districts of England', Journal of the Royal Statistical Society, 52 (1889), pp. 205-32 (the eminent Victorian population geographer, E. G. Ravenstein, was involved in the discussion of this paper.);
29. and 'On Marriage Rates and Marriage Ages with Special Reference to the Growth of Population', Journal of the Royal Statistical Society, 53 (1890), pp. 253-80.
30. Émile Durkheim, Le Suicide Étude de Sociologie (Paris: Félix Alcan, 1897), p. 16.
31. Ogle also made significant contributions to the development of a new aetiology-based cause-of-death classification, to the study of scarlet fever (Forty-ninth Annual Report for 1886)
32. and the study of causes of death among infants (Fifty-fourth Annual Report for 1891).
33. Simon Szreter, 'The GRO and the Public Health Movement in Britain, 1837-1914', Social History of Medicine, 4, 3 (1991), pp. 435-63, quoted from pp. 456-7
34. (see other articles in this special issue devoted to 'The General Register Office of England and Wales and the Public Health Movement 1837-1914: A Comparative Perspective').
35. Ogle's works of Greek translation were: Aristotle on The Parts of Animals (London: Kegan Paul, Trench & Co., 1882),
36. and Aristotle on Youth & Old Age, Life & Death and Respiration (London: Longmans, Green, and Co., 1897).
37. Anne Hardy, '"Death is the Cure of All Diseases": Using the General Register Office Cause of Death Statistics for 1837-1920', Social History of Medicine, 7, 3 (1994), pp. 472-92, takes a more charitable view of Ogle's work.
38. William Farr, 'Medical Profession. Draft Report, as an Example of the Proposed Mode of Describing the Professions (Class 1.) in Connection with the Statistics of the Census, 1861', in Census of England and Wales for 1861, Volume III. General Report (British Parliamentary Papers 1863/LIII, Part 1), pp. 243-8, provides an excellent introductory description of the mid-nineteenth-century medical profession. The material from its Table 5 is incorporated in Table 1 below, but Farr appears to have had reservations about the use of 1860-61 data and 1860-61 with 1871 is preferred here, although 1851 is used in Figure 9.
39. Ogle, 'Statistics', p. 222.
40. The published censuses of 1891 and 1901 also did not distinguish between 'occupied' and 'retired' members of the medical profession. See Edward Higgs, 'Counting Heads and Jobs: Science as an Occupation in the Victorian Census', History of Science, 13 (1985), pp. 335-49,
41. 'The Struggle for the Occupational Census, 1841-1911', in R. M. MacLeod (ed.) Government and Expertise: Specialists, Administrators and Professionals, 1860-1914 (Cambridge: Cambridge University Press, 1988), pp. 73-86,
42. and Making Sense of the Census, Public Record Office Handbooks 23 (London: HMSO, 1989).
43. Ogle, 'Statistics', p. 221, Table 3 for 1880-82 compares the medical profession with 29 other occupations.
44. Robert Woods and Naomi Williams, 'Must the Gap Widen Before it can be Narrowed? Long-term Trends in Social Class Mortality Differentials', Continuity and Change, 10, 1 (1995), pp. 105-37.
45. See also Noel A. Humphreys, 'Class Mortality Statistics', Journal of the Royal Statistical Society, 50 (1887), pp. 255-92, especially p. 280, Table I, for a comparison of adult life expectancies, and further homage to the work of Farr and Ogle;
46. and T. H. C. Stevenson, 'The Social Distribution of Mortality from Different Causes in England and Wales, 1910-12', Biometrika, 15 (1923), pp. 384-8.
47. 25-65 is 40 years while values of 25 to 30 years approximate to life expectancies at birth of 40 to 55 years in the West model.
48. The problems associated with using model life tables in this way are considered further in Robert Woods, 'On the Historical Relationship Between Infant and Adult Mortality', Population Studies, 47 (1993), pp. 195-219;
49. and on long-term trends in adult mortality among men, see Woods and Williams, 'Must the Gap Widen'.
50. Dr William Farr, in characteristic vein and referring to his tables for 1860-61 with 1871, put his finger on the point precisely: 'Physicians and surgeons from youth up to the age of 45 experience a mortality much above the average; after that age they do not approach the priesthood in health, but differ little from the average. Many young practitioners have hard struggles to encounter. They are in contact with the sick; are exposed to zymotic disease, and their rest is disturbed. In states of depression deadly poisons are to hand. There is an excess of practitioners in cities. Country practitioners have to visit their patients in all weathers, at all hours. The causes from which medical men suffer demand careful study.' Supplement to the Thirty-fifth Annual Report for 1872 (PP 1875/XVIII, Part 2), p. lv.
51. See also Farr, 'Medical Profession.' In 1930-32 physicians and surgeons were still at the bottom of Social Class I in terms of their overall mortality, but their position relative to all adult men had also slipped.
52. See H. M. Vernon, Health in Relation to Occupation (London: Oxford University Press, 1939), p. 200, also Figures 2 and 9.
53. It should be noted that causes of death for members of the medical profession were not reported in the Supplement covering 1880-82, although data derived from samples of the death certificates for other selected occupations were; see the sources to Table 1. See also John Ashley and Tim Devis, 'Death Certification from the Point of View of the Epidemiologist', Population Trends, 67 (1992), pp. 22-8.
54. This compares with a recommended fee for the delivery of a baby by a member of the medical profession of from 75 to 105 pence, Digby, Making a Medical Living, p. 255, Table 9.1.
55. Dr Thomas Thorne charged 37.5 pence for a home visit within five miles. Anthony Trollope, Dr Thorne (London, 1858; Penguin edition, 1991), p. 31;
56. see also Farr, 'Medical Profession'.
57. Ogle, 'Statistics', p. 227. This is not a straightforward matter. Ideally it requires knowledge of the population at risk of dying distributed by age-groups. Ogle assumed that because the death rate among members of the medical profession in 1880-82 was 25,535 per million, 'We can therefore divide out the 25,535 deaths, which occur annually among a million living medical men, in the proportions given us by the 3,865 deaths of which we have the causes; and by so doing we shall of course have the annual death-rate per million from each separate cause so dealt with'. This ratio method could only be satisfactory if the age structure of the medical profession remained largely unchanged between 1873 and 1882, which it did not (see Table 1).
58. Dr Tercius Lydgate died from diphtheria aged 50; just before the period covered by Table 5, perhaps. See George Eliot, Middlemarch (London, 1871-72; Penguin edition, 1965), p. 892.
59. Dr Arthur Newsholme, 'The Vital Statistics of Peabody Buildings and Other Artisans' and Labourers' Block Dwellings', Journal of the Royal Statistical Society, 54 (1891), pp. 70-97, (pp. 94-6, Table A) used 74 cause-of-death categories for his special tabulation of the 1,143 deaths that occurred in the Peabody Buildings, London, in the years 1888-90.
60. Henry Payne, MD, A Pocket Vocabulary of Medical Terms (With their Pronunciation), For the Use of Registrars, Poor Law Officials, &c (London: Hadden & Co., 1885). Phthisis is otherwise known as 'pulmonary tuberculosis'.
61. Ogle, 'Statistics', p. 229. Ogle's Table 5 (p. 228), which provides evidence for this view, does not distinguish among 'diseases of respiratory system'.
62. Letter to the Registrar-General on the Mortality of Males engaged in certain occupations in the Three Years 1890-92; and on an English Healthy District Life Table for the Ten Years 1881-90, by John Tatham, Esq., M.A., M.D., (27 May 1897) in Supplement to the Fifty-fifth Annual Report of the Registrar General, Part II (British Parliamentary Papers 1897/XXI.I), p. xxlii;
63. and Letter to the Registrar-General on the Mortality in certain Occupations in the Three Years 1900, 1901, 1902, by John Tatham, Esq., M.A., M.D., Fellow of the Royal College of Physicians (June 1908), in Supplement to the Sixty-fifth Annual Report of the Registrar-General, Part II (PP 1908 Cd. 2619), p. xxxi.
64. For men in England and Wales, George Gregory Kayne, Walter Pagel and Laurence O'Shaughnessy, Pulmonary Tuberculosis: Pathology, Diagnosis and Prevention (London: Oxford University Press, 1939), especially Figure 258, p. 520, illustrates the distinctive age profile of mortality from pulmonary tuberculosis, its decline and change between the 1850s (highest mortality ages 20-40) and the 1900s (ages 45-55).
65. The figures for 1900-02 and 1910-12 come from the Decennial Supplements, see Table 1.
66. Ogle, 'Statistics', p. 230;
67. Tatham's Letter to the Registrar-General (27 May 1897), p. xxlii.
68. Vernon, Health, p. 200 offers the following explanation: 'doctors' meal times are frequently irregular, and urgent cases may have to be attended without any rest after meals. In consequence, there is a high mortality rate from diseases of the digestive system'.
69. Ogle, 'Suicides', see note 9.
70. Ogle, Suicides Ibid., p. 108, Table IV.
71. Ogle, Suicides Ibid., p. 110.
72. Ogle, Suicides Ibid., p. 111.
73. Peterson, Medical Profession, p. 226;
74. Loudon, Medical Care, p. 199. Dr Thorne, 'might constantly be seen compounding medicines in the shop, at the left hand of his front door, . . . positively putting together common powders for rural bowels, or spreading vulgar ointments for agricultural ailments.'
75. Trollope, Dr Thorne, p. 32.
76. Although Olive Anderson, Suicide in Victorian and Edwardian England (Oxford: Clarendon Press, 1987), p. 364 also notes this point, as well as reproducing Ogle's table of occupation-specific suicide rates (p. 95), she makes no further mention of the position of doctors as victims. Rather, her Chapter 11 is entitled 'The Role of Medical Men in Preventing Suicide'.
77. Riley, 'Ill health', p. 564.
78. Alfred W. Watson, An Account of an Investigation of the Sickness and Mortality Experience of the I.O.O.F. Manchester Unity During the Five Years 1893-1897 (Manchester: IOOF, 1903).
79. Alfred W. Watson, An Account of an Investigation of the Sickness and Mortality Experience of the I.O.O.F. Manchester Unity During the Five Years 1893-1897 Ibid., p. 20.
80. Alfred W. Watson, An Account of an Investigation of the Sickness and Mortality Experience of the I.O.O.F. Manchester Unity During the Five Years 1893-1897 Ibid., p. 39.
81. See also Riley, 'Disease without Death', p. 562,
82. and for the case of a particular occupation, Humphrey Southall and Eilidh Garrett, 'Morbidity and Mortality among Early Nineteenth Century Engineering Workers', Social History of Medicine, 4 (1991), pp. 231-52.
83. Jacques Bertillon, 'Morbidity and Mortality according to Occupation', Journal of the Royal Statistical Society, 55 (1892), pp. 559-600
84. (Translated from Journal de la Société de Statistique de Paris, October-November, 1892). In contrast to the English experience, Bertillon was able to report that, 'At Paris the mortality of doctors is, on the contrary, very low'. He ascribed this excess to the predominance of country practitioners in England who are 'obliged to go long distances in the most severe weather, in small open carriages, which they generally drive themselves . . . The Paris doctors lead quite a different life, and are much less exposed to the severity of the weather.' (p. 585)
85. Journal de la Société de Statistique de Paris, Ibid., p. 559.
86. Journal de la Société de Statistique de Paris, Ibid., p. 561.
87. Influential in the sense that its findings were used as the basis for actuarial calculations under the National Health Insurance Act of 1911. See L. G. Chiozza Money, Insurance versus Poverty (London: Methuen, 1912), pp. 165-70;
88. also E. P. Hennock, British Social Reform and German decedents: The Case of Social Insurance, 1880-1914 (Oxford: Clarendon Press, 1987).
89. 2 + 12.827x + 0.635.
90. Richard Cobb, Death in Paris (Oxford: Oxford University Press, 1978), p. 102.
91. See note 6, but also, for example: Noel Parry and José Parry, The Rise of the Medical Profession (London: Croom Helm, 1976),
92. Ivan Waddington, The Medical Profession in the Industrial Revolution (Dublin: Gill and Macmillan, 1984),
93. W. F. Bynum, Science and the Practice of Medicine in the Nineteenth Century (Cambridge: Cambridge University Press, 1994).
94. Jane Austen, Persuasion (London, 1818; Oxford University Press edition, 1980), pp. 55 and 107. There are many other examples, although Dr Lydgate and Dr Thorne are perhaps the best known.
95. Farr's, 'Medical Profession', also provides a valuable account of the distinctions between apothecaries, surgeons, physicians and general practitioners, but these distinctions were never precise.
96. In the discussion which followed the 'Statistics' paper a Dr C. T. Williams asked Ogle if he could 'give any information as to the relative value of a medical man's life according as he was resident in town or country'. Dr Ogle had 'no information' on this matter. Williams' point is an important one, however. Of the 768 'physicians, surgeons and apothecaries' enumerated in London in 1861, 45 per cent lived in only three West End registration districts - all with relatively low mortality. See Robert Woods and P. R. Andrew Hinde, 'Mortality in Victorian England: Models and Patterns', Journal of Interdisciplinary History, 18, 1 (1987), pp. 27-54, especially pp. 50-51 on the relative distribution of doctors in England and Wales.
97. The databases for both FRCPs and FRCSs contained year of birth, year of election to fellowship, year of death for all those elected between 1825 and 1911 (FRCP, N = 778) or 1843 and 1911 (FRCS, N = 3,587, but for only 3,094 were year of birth and year of death given). For the RCS, year of membership was also included but this was not given in Munk's Rolls. The mean ages at death were FRCP = 71.36 and FRCS = 70.40; and the median, FRCP = 73.00 and FRCS = 72.00. For FRCPs the mean and median ages at election to fellowship were 41.46 and 39.00, and for MRCSs 24.08 and 23.00 with 36.87 and 33.00 for FRCSs, respectively. There was very little overlap in terms of fellowship. See Peterson, The Medical Profession, for a guide to the biographical uses of Plan's Lives and Munk's Rolls and the social and academic backgrounds of Fellows,
98. and again Farr's, 'Medical Profession'.
99. 25-65 reported in Table 8 were estimated directly from age at death and years of life distributions equivalent to those shown in Table 1. The resulting life table functions were smoothed to correct for irregularities in the survivorship curves. The estimates in italics in Table 3 were derived in similar fashion. Neison, Contributions to Vital Statistics, p. 130
100. (also Journal of the Statistical Society 15 (1852), p. 216), provides the appropriate age at death and years of life data for Fellows of the Royal Medical and Chirurgical Society (see note 3).
101. Anon, 'The Income Tax', p. 112.
102. Registrar General's Decennial Supplement for England and Wales, Occupational Health, OPCS Series DS No. 10 (London: HMSO, 1995), p. 31;
103. see also Registrar General's Decennial Supplement for Great Britain, 1979-80, 1982-83, OPCS Series DS No. 6, Part 1 Commentary (London: HMSO, 1986), p. 85,
104. John Charlton et al., 'Trends in Suicide Deaths in England and Wales', Population Trends, 69 (1992), pp. 10-16,
105. and on suicide among young doctors, J. C. Richings, G. S. Khara and M. McDowell, 'Suicide in Young Doctors', British Journal of Psychiatry, 149 (1986), pp. 475-78.
106. Richard Doll et al., 'Mortality in Relation to Smoking: 40 Years' Observations on Male British Doctors', British Medical Journal, 309 (6959), (1994), pp. 901-11;
107. and Richard Doll et al., 'Mortality in Relation to Consumption of Alcohol: 13 years' Observations on Male British Doctors', British Medical Journal, 309 (6959), (1994), pp. 911-18.
108. The two Whitehall studies and the general susceptibility hypothesis are summarized in Michael G. Marmot, 'Social Differentials in Health Within and Between Populations', Daedalus, 123 (4), (1994), pp. 197-216.
109. Ogle, 'Statistics', p. 229.
110. For example, Digby, Making a Medical Living.