Most physicians wonder occasionally about the practice of medicine in days gone by. What sort of relationship did their forebears have with their patients? Did they have to cope with paperwork? What was life like for the average doctor of the time? I recently obtained, for a few dollars at a stamp collectors' auction, a life insurance questionnaire that affords a fascinating glimpse into medical practice in rural Canada more than 150 years ago.
Photo by: Courtesy Joseph Caplan
The Canada Life Assurance Company was founded in 1847. The following year their agent in Hamilton, Canada West (now Ontario), paid 41/2 pence (about $5.00 in today's currency) to send a single foolscap-sized page from Hamilton about 50 km to Niagara (now Niagara-on-the-Lake). It was mailed May 27, 1848, to Henry Melville, MD, who received it on May 28 and completed it the next day. A brisk, professional gentleman, he was no procrastinator.
Melville was born in Barbados on July 7, 1816, and obtained his medical degree from the University of Edinburgh. He returned to practise in the West Indies in St. Vincent and eventually moved to Canada. He was an Anglican and must have had some standing in the little county town of Niagara, as he was one of the founders of Trinity College, Toronto, in 1852. He returned to England and died in London March 27, 1868, at the early age of 51.
Ralph M. Clement, the applicant, lived about 30 km away in St. Catharines. He was 36 and, I surmise, fairly wealthy. At a time when barter was common in rural Canada, he had adequate funds available to pay a regular insurance premium. Melville noted that 6 months previously he had “attended him once in consultation” when he was “labouring under a bilious type of fever with considerable disturbance of the urinary organs” (possibly an acute pyelonephritis). To obtain a consultation from that distance in early winter would have been expensive. Melville also noted that he saw him occasionally socially, but not as a physician. They were about the same age and probably moved in the same circles.
The 14 questions on the insurance company's form are a snapshot of the life hazards of the era. It is not surprising to find a question about vaccination at a time when smallpox was rife. The inquiry about hernia reflects an occupational hazard of the heavy physical labour of the time. Oddly, there is no reference to urine, although diabetes mellitus was known. (Perhaps diabetics died too young to take out life insurance.) The remaining enquiries would not be out of place on a modern insurance form, allowing for the rather stilted language. We might grimace, though, at the apparent lack of written patient consent as the insurer requests an account of the applicant's past and present health, family history, recent illness and use of alcohol. It is also interesting that no specific medical examination is suggested.
Melville's remarks are written in the clear, flowing hand of the classically educated gentleman of the late 18th century, rather than the spiky semi-legible script that became common in the later Victorian era. His replies are frank and blunt to the point of tactlessness. He makes it clear that he is not Clement's regular medical attendant and has seen him only once professionally. He responds “I don't know” to basically everything. This was probably true, but it is painful to read some of his remarks; from their curtness one wonders if he suspected a degree of chicanery.
My guess is that Clement was not well and suspected it. He did what many people in similar circumstances do today: he asked a medical acquaintance who knew him only slightly to complete a life insurance form. Melville's reputation was probably good enough that a reasonably favourable report would have been acceptable to the insurers. For whatever reason, Melville did not provide one. We can only wonder what his reponses did to Clement's premiums, or if he was even accepted at all.
This simple document tells a story of a practice that is still fairly familiar to patients and their physicians. Allowing for changing lifestyles and technologies, there has been surprisingly little alteration in this relationship.
Footnotes
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Acknowledgements: My thanks to the staff, Department of History of Medicine, University of Toronto, and Mr. Henri Pilion, Archivist, Trinity College, Toronto, for biographical data.