'The illusion of an explanation': The concept of hereditary disease, 1770-1870

Journal of the History of Medicine and Allied Sciences

Volumn 57, Issue 4, 2002, Pages 410-448

  Waller, John C ^a  

^a NONE

Author keywords

[No Author keywords available]

Indexed keywords

ARTICLE; ATTITUDE TO HEALTH; GENETIC DISORDER; GENETICS; HISTORY; HUMAN; MARRIAGE; PEDIGREE; RISK FACTOR;

ATTITUDE TO HEALTH; GENETIC DISEASES, INBORN; HISTORY, 18TH CENTURY; HISTORY, 19TH CENTURY; HUMANS; MARRIAGE; PEDIGREE; RISK FACTORS;

EID: 3042769486     PISSN: 00225045     EISSN: None     Source Type: Journal    
DOI: 10.1093/jhmas/57.4.410     Document Type: Review

References (179)

1. Alexander Tweedie, "Hereditary Transmission of Disease," in Tweedie, Cyclopaedia of Practice Medicine, 7 vols. (London, 1847), II, 443-46, p. 444.
2. Diathesis was conventionally defined as a constitutional predisposition to a narrow range of chronic diseases. For representative nineteenth-century discussions of the diathesis, and hereditarian thought in general, see Joseph Adams, A Treatise on the Supposed Hereditary Properties of Diseases . . . (New York: Garland Press, 1984 ed.);
3. William Sedgwick, "Sexual Limitation in Hereditary Disease," Br. Foreign Med.-Chirug. Rev., 1861, 26, 198-214 and
4. William Sedgwick, "Sexual Limitation in Hereditary Disease," Br. Foreign Med.-Chirug. Rev., 27, 477-89;
5. William Sedgwick, "Sexual Limitation in Hereditary Disease," Br. Foreign Med.-Chirug. Rev., 1863, 30, 159-97
6. William Sedgwick, "Sexual Limitation in Hereditary Disease," Br. Foreign Med.-Chirug. Rev., and 31, 445-78;
7. Julius Steinau, Pathological and Philosophical Essay on Hereditary Diseases (London: Simpkin, 1843);
8. and James Whitehead, On the Transmission, front Parent to Offspring, of Some Forms of Disease, and of Morbid Taints and Tendencies (London: J. Churchill, 1851).
9. Sir James Clark, A Treatise on Tubercular Phthisis, or Pulmonary Consumption. Reprinted front the Cyclopaedia of Practical Medicine (London: Marchant, 1834), p. 52.
10. See Pliny Earle, "On the Causes of Insanity," Am. J. Insanity, 1848, 4, 185-211, pp. 186-93;
11. Edward Jarvis, On the Comparable Liability of Males and Females to Insanity, and Their Comparative Curability and Mortality When Insane (New York: Utica, 1850), p. 15;
12. Hugh Grainger Stewart, "On Hereditary Insanity," J. Mental Sci., 1864, 10, 50-66;
13. D. H. Tuke and J. C. Bucknill, A Manual of Psychological Medicine (London: J. Churchill, 1862), p. 264.
14. Andrew Combe, Observations on Mental Derangement (London: Longman, Rees, Orme, Brown, & Green, 1831), p. 4.
15. See Roy Porter and G. S. Rousseau, Gout: The Patrician Malady (New Haven, Conn.: Yale University Press, 1998);
16. Alexander Macaulay, "Gout," in A Dictionary of Mediane, Designed for Popular Use (Edinburgh: Adam and Charles Black, 1834), p. 285.
17. See Henry Percy, Advice to His Son, by Henry Percy, Ninth Earl of Northumberland (1609) ed. with a biographical introduction by G. B. Harrison (London: E. Benn, 1930), p. 12;
18. John Gregory, A Father's Legacy to His Daughters (Dublin: Thomas Ewing and Caleb Jenkin, 1774), p. 9.
19. James King, William Cowper: A Biography (Durham, N.C.: Duke University Press, 1986), p. 24.
20. Wilkie Collins, The Queen of Hearts: A Novel (New York: Harpers and Brothers, 1857);
21. Oliver Wendell Holmes, Elsie V̇enner: A Romance of Destiny (London: Routledge, Warne, and Routledge, 1861);
22. George Gissing, The Unclassed (London: Lawrence and Bullen, 1895);
23. see also J. M. Winnard, The House of Raby or, Our Lady of Darkness (London: Chapman and Hall, 1854);
24. Anon., The. Lancashire Wedding, or Darwin Moralized (London: Houlston and Wright, 1867).
25. Of course, family health would remain an issue of considerable actuarial concern during the twentieth century; but, at least until recent years, its importance has been of a rather lower order of magnitude than when endemic maladies such as gout, scrofula, and phthisis were believed to be strongly inherited conditions. See, for example, Anon., [Review of James Begbie's Observations on the Mortality of the Scottish Widow's Fund and Life Assurance Society], Edinburgh Med, Surg. J., 1854, 49, 111-19.
26. Anon., "The Disease of Drunkenness," The Insurance Monitor, January-June 1871, p. 38;
27. Anon., "Indication of Impaired Life for Medical Examiners," The Insurance Monitor, January-June 1874, p. 390;
28. Anon., "An Analysis of Three Hundred and Twelve Rejections," N.Y. Med. Rec., 1873, 8, 525-26;
29. Edward Henry Sieveking, The Medical Adviser in Life Assurance (London: J. & A. Churchill, 1874).
30. See C. L. Robertson and Henry Maudsley, Insanity and Crime: Medico-Legal Commentary on the Case of George Victor Townley (London, John Churchill and Sons, 1864), p. 7.
31. Cited in Anon., [Review] "Moral Mania," Am, J. Insanity, 1871, 27, 455.
32. See also Anon., "Trial of a Question of Insanity," Am. J. Insanity, 1853, 9, 62-67;
33. Charles Rosenberg, The Trial of the Assassin Guiteau (Chicago: University of Chicago Press, 1974).
34. See, for example, Charles Rosenberg, "The Bitter Fruit: Heredity, Disease, and Social Thought in Nineteenth-Century America," in D. Fleming and B. Bailyn, eds., Perspectives in American History, vol. 3 (Cambridge, Mass.: Harvard University Press, 1974), pp. 189-235, p. 201.
35. For the cultural associations of tuberculosis, see David S. Barnes, The Making of a Social Disease: Tuberculosis in Nineteenth-Century France (Berkeley: University of California Press, 1995);
36. and Clark Lawlor and Akihito Suzuki, "The Disease of the Self: Representing Consumption," Bull. Hist. Med., 2000, 74, 458-94.
37. By the early nineteenth century, several widely reported attempts to induce the illness with the tubercles of sufferers had failed, discouraging the idea that tuberculous diseases were contagious. See Benjamin Phillips, Scrofula; Its Nature, Its Causes, Its Prevalence, and the Principles of Treatment (London: Bailliere, 1846), p. 158;
38. Elizabeth Lomax, "Hereditary or Acquired Disease? Early Nineteenth-Century Debates on the Cause of Infantile Scrofula and Tuberculosis," J. Hist. Med. Allied Sci., 1977, 32, 356-74, p. 366.
39. Erwin Ackerknecht, "Diathesis: The Word and the Concept in Medical History," Bull, Hist, Med., 1982, 56, 317-25;
40. see also, George B. Wood, "Constitutional diseases," in A Treatise on the Practice of Medicine (Philadelphia: J. B. Lippincott and Co., 1858), p. 468. Ackerknecht also linked the success of essentialistic medical theories to the dislike of contagionist etiologies among a medical profession hostile to infringements of personal and mercantile freedom of movement.
41. See Ackerknecht, "Anticontagionism between 1821 and 1867," Bull. Hist. Med., 1948, 22, 562-93.
42. Christopher Hamlin has lodged strong caveats against this thesis; see Hamlin, "Predisposing Causes and Public Health in Early Nineteenth-Century Medical Thought," Soc. Hist. Med., 1992, 5, 43-70.
43. Rosenberg, "Bitter Fruit," pp. 200-201.
44. Jarvis, Comparative. Liability, p. 20.
45. See also Daniel Noble, The Human Mind in Its Relations with the Brain and Nervous System (London: Churchill, 1858), pp. 239-42.
46. See, for example, James Cowles Prichard, A Treatise, on Insanity and Other Disorders Affecting the Mind (Philadelphia: E. L. Carey and A. Hart, 1837), PP. 136-39;
47. John Webster, "Remarks on the Causes and Morbid Anatomy of Mental Diseases," Med.-Chirurg. Trans., 1849, 32, 115-40, p. 116.
48. Sir Henry Holland, Medical Notes and Refections (Philadelphia: Haswell, Barrington and Haswell, 1839), p. 10.
49. Jacob Bigelow, [Comments on a paper delivered by Professor Bowen], Proc. Am. Acad. Arts Sci., 1861, 5, 110.
50. Anon., [Review of Phillips' Scrofula; its Nature, its Causes, its Prevalence, and the Principles of Treatment], Br. Foreign Med.-Chirurg. Rev., 1846, 22, 124-55.
51. See Abraham M. Lilienfeld, "Ceteris Paribus: The Evolution of the Clinical Trial," Bull, Hist, Med., 1982, 56, 1-15.
52. For examples in the nineteenth century, see S. M. Bemiss, "Report on the Influence of Marriages of Consanguinity upon Offspring," Trans, Med. Assoc., 1858, 2, 320-460;
53. Arthur Mitchell, "On the Influence which Consanguinity in the Parentage Exercises upon the Offspring," Edinburgh Med. J., 1865, 10, 781-909;
54. George Darwin, "Marriages between First Cousins in England and Their Effects," Fortnightly Rev., 1875, 24, 22-41.
55. John Haslam, Observations on Madness and Melancholy (London: J. Callow, 1809), p. 231.
56. See Adams, Treatise, p. 41
57. Noble, On the Brain, p. 231;
58. W. R. Wilde, "Statistics of the Deaf and Dumb in Ireland," J. Stat. Soc. London, 1853, 10, 69-74, p. 70;
59. George Robinson, On the Prevention of Mental Disorders (London: Longman, Brown and Green, 1859), p. 81.
60. Thomas White, A Treatise on Struma or Scrofula, Commonly Called the King's Evil; in which the Impropriety of Considering It as an Hereditary Disease Is Pointed Out; More Rational Causes are. Assigned; and a Successful Method of Treatment Is Recommended (London: J. Murray arid R. Turner, 1784), p. 10.
61. George Henning, A Critical Inquiry into the Pathology of Scrofula, in which the Origin of that Disease Is Accounted for on New Principles; and a New and Much Improved Method Is Recommended and Explained for the Treatment (London: Callow, 1815), p. 19.
62. Quoted in Carlos López-Beltrán, "Human Heredity 1750-1870: The Construction of a Domain," (Ph.D. thesis, King's College London, 1992), p. 49.
63. William Cadogan, A Dissertation on the Gout, and All Chronic Diseases, Jointly Considered, as Proceeding from the Same Causes; What Those Causes Are; and a Rational and Natural Method of Cure Proposed (London: J. Boyles, 1772), p. 19.
64. White, A Treatise on Struma, p. 12.
65. Ibid., p. 10.
66. Henry Ancell, A Treatise on Tuberculosis: The Constitutional Origin of Consumption and Scrofula (London: Longman, Brown, Green & Longmans, 1852), p. 373.
67. López-Beltrán, "Human Heredity," chapter 2, pp. 35-60.
68. Adams, Treatise, pp. 16-17.
69. Caleb Ticknor, A Guide, for Mothers and Nurses in the Management of Young Children; with Reference to Hereditary, or Family Diseases; and Advice to the Pregnant, and Lying-in Female (New York: Taylor & Dodd, 1839), p. 202.
70. See Sir Thomas Watson, Lectures on the Principles and Practice of Physic: Delivered at King's College, London (Philadelphia: Lea and Blanchard, 1844), p. 718;
71. Edward Jarvis, [excerpt from letter to Robert Newman], Am. J. Insanity, 1870, 26, 110-13.
72. Phillips, Scrofula, p. 124.
73. Henning, A Critical Inquiry, p. 56.
74. Anon, [review] "Scrofula; Its Nature, its Causes, its Prevalence, and the Principles of Treatment," Edinburgh Med. Surg. J., 1846, 66, 117-58, p. 137.
75. Allen Thomson, "On the Nature, the Causes, and the Prevention of Consumption," The. New Monthly Magazine, 1840, 51, 108-19, pp. 227-39, pp. 506-16, quote on p. 111.
76. See, for example, White, A Treatise an Struma;
77. Henning, A Critical Inquiry, p. 56;
78. Anon., "Review of Phillips' Scrofula", p. 142.
79. Phillips, Scrofula, p. 113;
80. John Hunter, A Treatise on the Venereal Disease (Philadelphia: Charles Cist, 1787);
81. F. Oppert, Visceral and Hereditary Syphilis, with Special Reference to Measures of Public Hygiene (London: John Churchill & Sons, 1868), pp. 93-95.
82. López-Beltrán, "Human Heredity," pp. 143-44.
83. Professor Bowen, [Summary of paper and discussion], Proc. Am. Acad. Arts Sci., 1861, 5, 102-11, p. 103.
84. See also Henry T. Buckle, History of Civilization in England, vol. 1 (London: J. W. Parker and Son, 1857), 177.
85. William Brinton, On the Medical Selection of Lives for Assurance (New York: John Hopper), pp. 19-21, p. 19.
86. The only statistical study undertaken by a medical hereditarian that embraced the ceteris paribus method and still managed to provide support for the concept of hereditary malady was James Paget's article, "On the Hereditary Transmission of Tendencies to Cancerous and Other Tumours," Medical Times Gazette, 1857, 2, 191-93.
87. See Theodore Porter, The Rise of Statistical Thinking, 1820-1900 (Princeton, N.J.: Princeton University Press, 1986).
88. John Galt, "Fragments on Insanity," Am. J. Insanity, 1844, 1, 122-31, p. 123.
89. Stewart, "On Hereditary Insanity," p. 51.
90. Sieveking, The Medical Adviser.
91. Anon., "Review of James Begbie's Observations," p. 526.
92. Cadogan, A Dissertation on the Gout, p. 18. Having cited evidence for the curability of gout, Cadogan also noted, "this is another strong argument that proves it not hereditary" (p. 7).
93. William Stevenson, A Successful Method of Treating the Gout by Blistering: With an Introduction, Consisting of Miscellaneous Matter (Bath: R. Cruttwell, 1779), p. 6-7.
94. Sir James Jay, Reflections and Observations on the Gout (London: Kearsly, 1772), pp. 43-44;
95. Marmaduke Berdoe, An Essay on the Nature and Causes of the Gout (Bath: S. Hazard, 1772), p. 9.
96. Both cited in Porter and Rousseau, Gout, pp. 111-13.
97. William Charles Ellis, A Treatise on the Nature, Symptoms, Causes and Treatment of Insanity (London: Samuel Holdsworth, 1838), p. 45.
98. George Man Burrows, Commentaries on the Causes, Forms, Symptoms and Treatments, Moral and Medical, of Insanity (London: Thomas and George Underwood, 1828), p. 568.
99. George B. Wood, A Treatise on the Practice of Medicine (Philadelphia: Grigg and Elliot, 1847), p. 759.
100. Isaac Ray, A Treatise on the Medical Jurisprudence of Insanity (Boston: Charles C. Little arid James Brown, 1838), p. 310.
101. Cited in Pliny Earle, The Curability of Insanity. A Series of Studies (Philadelphia: J. B. Lippincott Co., 1887), p. 40.
102. Haslam, Madness and Melancholy, p. 229.
103. Burrows, Commentaries, pp. 107-8.
104. Combe, Mental Derangement, p. 17.
105. See Norman Dain, Concepts of Insanity in the United States, 1769-186; (New Brunswick, N.J.: Rutgers University Press, 1964), especially chapter 4.
106. I b i d.
107. L. S. Jacyna, "Somatic Theories of Mind and the Interests of Medicine in Britain, 1850-1879," Med. Hist., 1982, 26, 233-58.
108. William Aitken, The Science and Practice of Medicine (London: C. Griffin, 1863), pp.141, p.410.
109. Bucknill and Tuke, Psychological Medicine, p. 647.
110. See John C. Waller, "Heredity, Reproduction and Eugenics: From the Early Nineteenth Century to Francis Galton," Stud. Hist. Phil. Biol. Biomedical Sci., 2001, 32, 20-52.
111. Christoph Hufeland, A Treatise on the Scrofulous Disease, Translated from the French of M. Bousquet by Charles D. Meigs (Philadelphia, Carey, Lea & Carey, 1829), p. 37.
112. White, Treatise, on Struma, p. 12.
113. Ibid., p. 14.
114. Henning, A Critical Enquiry, p. 49.
115. Cadogan, A Dissertation on the Gout, p. 19.
116. See, for example, Francis Hopkins Ramadge, Consumption Curable: and the Manner in which Nature as well as Remedial Art Operates in Effecting a Healing Process in Cases (New York: J.M. Howe, 1839).
117. See Edward H. Dixon, Scenes in the Practice of a New York Surgeon (New York: De Witt and Davenport, 1855), p. 161-62.
118. George Gregory, Elements of the Theory and Practice of Physic, Designed for the Use of Students (New York: M. Sherman, 1830), p. 207.
119. Anon., [Review of Sir James Clarks A Treatise on Pulmonary Consumption], Br. Foreign Med.-Chirurg. Rev, January 1836, I, 70-84, p. 71.
120. Clark, Treatise on Tubercular Phthisis, p. 63.
121. William Stokes, A Treatise on the Diagnosis and Treatment of Diseases of the Chest. Diseases of the Lung and Windpipe (Philadelphia: E. Barrington & G. D. Haswell, 1844), pp. 417-19, p. 418.
122. Richard Payne Cotton, On Consumption: Its Nature., Symptoms and Treatment (London: John Churchill, 1858), p. 86.
123. Horatio Prater, "Suggestions for the Prevention of Hereditary Diseases," The Lancet, 1842-43, 2, 500-6; 546-53, p. 502.
124. Whitehead, On the Transmission, p. 66.
125. Anon., [Review of Sir James Clark's A Treatise on Pulmonary Consumption], Edinburgh Med. Surg. J., 1836, 45, 226-37, p. 233.
126. Prater, "Suggestions for the Prevention," p. 551.
127. See also Robert James Culverwell, On Single and Married Life; or, the Institutes of Marriage; Its Intent, Obligations, and Physical and Constitutional Disqualifications . . . (London: published by and for the author, at his residence, 1848), p. 134.
128. Adams, Treatise, p. v.
129. Phillips, Scrofula, p. 121.
130. B. Lincoln Ray, "Hereditary Transmission," An Address Read before the Rhode Island Medical Society, at the Semi-Annual Meeting, Dec. 18, 1861, pp. 138-58, pp. 155, 157.
131. See also Ticknor, A Guide for Mothers, p. 155.
132. William Gairdner, On Gout; Its History, Its Causes, and Its Cure (London: J. Churchill, 1851), p. 45.
133. As a medical reviewer in the American Quarterly Review noted in 1830, "Acquired defects... are not so apt to be propagated; and happily for us. Were it otherwise, we should have the most singular and innumerable varieties of races. Where a limb had been amputated, a stock of one-limbed animals would be formed." Anon. "Longevity," Am. Q. Rev., 1830, 33, 401.
134. Adams, Treatise, pp. 32-3.
135. Montrose A. Pollen, "Heritage, or Hereditary Transmission," St. Louis Med. Surg. J., 1856, 14, 490-505, p. 491.
136. Allen Thomson, "Generation," in R. B. Todd & W. Bowman, eds., Cyclopaedia of Anatomy and Physiology (London: Longman, Brown, Green, Longmans, & Roberts, 1836-39), pp. 468-80, p. 473.
137. Holland, Medical Notes, p. 36.
138. See also W. B. Carpenter, "Varieties of Mankind," in R. B. Todd, ed., Cyclopedia of Anatomy and Physiology, vol. 4 (London: Longman, Brown, Green, Longmans and Roberts, 1849-52), 1302-6, p. 1305;
139. Paget, "On the Hereditary Transmission," p. 192.
140. Prosper Lucas, Traité Philosophique et Physiologique de L'hérédité Naturelle dans les Etats de Santé et de Maladie du Système Nerveux, avec L'application Méthodique des Lois de la Procréation au Traitement Général des Affections dont Elle Est le Principe (Paris: Chez J. B. Baillière, 1847), pp. 92-96.
141. Ray, "Hereditary Transmission," p. 141;
142. see also H. A. Carrington, "Heredity," Communications Conn. Med. Soc., 1870, 79, 365-76, p. 366.
143. John Adams, Memoirs of the Life and Doctrines of the Late John Hunter (London: J. Callow, 1818), p. 212;
144. Whitehead, On the Transmission, p. 21.
145. Daniel Haynes, "Address delivered before the Rensselaer County Medical Society . . .June 3, 1838," New York State Med. Soc., 1838, 4, 196-204, p. 198.
146. Robert Bentley Todd, "Temperament," in Todd, ed., The Cyclopaedia of Anatomy and Physiology, vol. 4 (London: Longman, Brown, Green, Longmans, & Roberts, 1835-59), 935-37, p. 935. Todd wrote that "we have so little chance of superseding a connate disease, or of preventing one to which there is a constitutional disposition" (ibid.).
147. See also Adams, Treatise, p. 30.
148. John Mason Good, The Book of Nature (Hartford, Conn.: Belknap and Hamersley, 1837) p. 422.
149. George Bancroft, "Doctrine of Temperaments," Am, Q. Rev., 1829, 5, 118-43, p. 142.
150. nd 1861, pp. 87-105, p. 96.
151. See also Anon. [Review of Henry Belinaye's The Sources of Health and Disease], Am, Q. Rev., 1833, 14, 120-23, p. 122.
152. See Philips, Scrofula, p. 10. "The condition most liable to reappear in the offspring is that disposition of organic arrangement which we denominate temperament," commented Whitehead in 1861;
153. see Whitehead, On the Transmission, p. 14.
154. Ackerknecht, "Diathesis," p. 318.
155. William Lawrence, Lectures on Physiology, Zoology & Natural History of Man (London: Watson, 1822), p. 441.
156. James Cowles Prichard, The Natural History of Man: Comprising Inquiries into the Modifying Influence, of Physical and Moral Agencies on the Different Tribes of the Human Family (London: H. Bailliere, 3rd ed., 1848), p. 100.
157. S. N. Harris, "Hereditary Transmission," S. J. Med. Pharmacy, 1847, 2, 516-27, p. 521.
158. See John Hunter, A Treatise on the Venereal Disease by John Hunter; with an Introduction and Commentary by Joseph Adams . . . (Philadelphia: J. Webster, 1818);
159. William Heberden, Commentaries on the History and Cure of Diseases (London: T. Payne, by S. Hamilton, 1802), pp. 441-42.
160. Adams, Treatise, p. 63. Similarly, Julius Steinau distinguished between "morbus hereditarius seu congenitus," or properly hereditary diseases, and "morbid connati seu adnati," or diseases that were present in parents and passed onto the foetus in utero;
161. see Steinau, Essay on Hereditary Diseases, p. 4.
162. William Buchan, Domestic Medicine: or, a Treatise on the Prevention and Cure of Diseases by Regimen and Simple Medicines (London: A. Strahan, T. Cadell and J. Balfour, 1791), p. 9.
163. William Grant, Observations on the Origin, Progress, and Method of Treating the Atrabilious Temperament and Gout (London, 1779), pp. 25-26.
164. Quoted in Porter and Rousseau, Gout, pp. 114-15.
165. Prater, "Suggestions for the Prevention," p. 503.
166. James Bower Harrison, "Selections from a Series of Essays on General Pathology," The Lancet, 1844, 2, 37-39, p. 38.
167. Isaac Ray, "Statistics of Insanity in Massachusetts," N. Am. Rev., 1856, 82, 78-100, p. 97.
168. Carpenter, "Varieties of Mankind," p. 1304.
169. T. L. Ogier, "Hereditary Predisposition," Charleston Med. J. Rev., 1848, 3, 261-67, p. 264.
170. Also published in Boston Med. Surg. J., 1848-49, 39, 1115.
171. George Henry Lewes, The Physiology of Common Life, vol. II (Edinburgh: William Blackwood & Sons, 1860), 320.
172. The American alienist Isaac Ray avowed the same principle, "the longer the cerebral trouble has existed in the family, and the more decided its action has been on the nervous system, the more likely it is to be transmitted." See Isaac Ray, [Review of Moreau's La Psychologie. Morbide], N. Am. Rev., 1869, 224, 1-29, p. 14.
173. Thomas Trotter, A View of the Nervous Temperament (London: Longman, Hurst, Rees, and Orme, 1807), p. 231.
174. White, A Treatise on Struma, pp. 15-16.
175. John Byrom, "Drink," in A. W. Ward, ed., The Poems of John Byrom (Manchester: The Chetham Society 1899 ed.), p. 70.
176. Henning, A Critical Inquiry, p. 58.
177. Stevenson, Treating the. Gout, p. 87.
178. See, for example, Irvine Loudon, Medical Care and the General Practitioner, 1750-1850 (Oxford: Clarendon Press, 1986), especially chapter 10.
179. See Worthington Hooker, Physician and Patient; or, A Practical View of the Mutual Duties, Relations and Interests of the Medical Profession and the Community (New York: Baker and Scribner, 1849), p. 442.