Medicine before the motor car

Introduction

The history of medicine tends to be dominated by stories of famous doctors and great medical discoveries. Much less attention is paid to the ways in which ordinary medicine was practised in the past. This paper is concerned with a small but very important part of ordinary practice: the history of home visits and the part played by horses, carriages and finally the motor car.

In Britain today relatively few home visits are carried out by general practitioners. There are probably wide variations, but overall there are certainly far fewer home visits now than there were when the NHS was introduced. In the 1950s, for instance, it was common for general practitioners to carry out five, 10 and often more home visits every day including nights and weekends. All this is common knowledge. But if you had been practising in the 18th and 19th centuries, apart from a very small number of admissions to hospitals and dispensaries, almost all medical consultations took place in the patient's home. Most medical practitioners were therefore totally dependent on their horses which were much the most expensive item in their practice.

The most striking feature of doctors on horseback was the distances they travelled. Many general practitioners – especially in rural areas – rode 15 or more miles a day on horses which had to be sturdy and reliable rather than elegant. In 1825 John Simpson, a young Bradford physician, was offered a beautiful but frisky horse as a gift. With sadness but common sense the gift was turned down and Simpson bought a strong, reliable animal, calling it ‘Weasel’. It cost him £20.¹

The advantage of horseback riding (as opposed to horse and carriage) was the ability to take short cuts through fields and along narrow bridle paths or deeply rutted farm tracks. Another advantage was that some doctors' horses could be trusted to find their way safely home from a night visit while the exhausted doctor slept in the saddle.² No wonder that doctors often grew fond of their horses and treated them with care and affection. William Carr in Yorkshire built a shed for his horse in the winter, and always carried ‘a pocket-full of corn’ or ‘an oatcake’ to keep his animal happy.³ Matthew Flinders of Donnington in Lincolnshire wrote in his diary in 1798:

My old pony, poor Taffy, died – he shrunk to a skeleton, having for above two months refused hay and corn and would eat only a little grass – he has carried me I think more than 5 years and I feel concerned for his loss.⁴

Early members of the Maurice family (which has provided general practitioners in Marlborough from 1792 to the present) had a practice which covered an area roughly 25 miles wide.⁵ In the 1830s, a Norfolk surgeon, John Greene Crosse, recorded that ‘five times within 10 days I have seen a patient 33 miles off and each day attended an extensive practice in and about Norwich’.⁶

The main snag of horse travel was too little space for carrying medicines and equipment. Through most of the 18th century the awful state of the roads precluded the use of carriages. The famous agriculturist, Arthur Young, wrote in 1790: ‘from Chepstow to the halfway house between Newport and Cardiff [the turnpike] continues as mere lanes of hugeous [sic] stones as big as one's horse and abominable holes’. Another road near Bury St Edmunds consisted of ‘ponds of liquid mud and loose flints just sufficient to lame every horse which moves near them’. And these were the main roads. Side roads were much worse.⁷

It was only in the late 18th century that roads started to improve sufficiently for carriages to appear in large numbers. In the mid-18th century, for example, Thomas Shute, a Bristol physician, bought a small sulky carriage (so called because it would only hold one person).⁸ A Bristol surgeon, John Townsend, famous for his large practice in the late 18th century, had a contract with a firm to supply him with a coachman day or night for £100 a year. He designed a special carriage that had pockets to hold tins of ointment, spatulas, surgical instruments and splints – ‘ready for any emergency’. Working ceaselessly, day and night, he managed to leave £62,000 when he died – a monstrous amount at that time.⁹

Thus, on almost every occasion when illness struck the local squire, farmer, lawyer, vicar, businessman, shopkeeper or persons of independent means, whether their complaint was trivial or grave, they and their families expected and received a home visit and paid the appropriate fee. The term ‘family doctor’, which first appeared around the 1830s, was used to describe the general practitioners who were usually poor but discrete, a bit old-fashioned in their ways (considered an advantage when modern medicines were deeply distrusted) and who nearly always travelled on horseback.¹⁰

The image conveyed by horse and carriage

The social aspects of medical transport were known to be important. General practitioners rode on horseback or came in a small pony and trap. But not all. William (‘Billy’) Broderip of Bristol who liked to be known as an ‘apothecary’, had a very grand ‘equipage’ which cost well over £100. He managed to make the astonishing income of £4000–£5000 a year in the 1790s for which he was heartily loathed by the local physicians.¹¹

The successful consultant surgeons and physicians in London and other large cities would rather have been seen dead than on horseback. Ambitious young physicians favoured light, fast and comfortable carriages, some designed for a single horse, others for a pair. Only an expert on the subject (which the author is not) could nowadays distinguish between the barouche, brougham, britzschka and cabriolet (from which the word ‘cab’ is derived) or the dogcart, gig, landau, governess cart and Victoria.^12,13

The gig and the dogcart were much favoured by the young, but the older well-to-do doctors usually owned (or hired) a four-wheeler such as a brougham or a Victoria ( Figure 1) which needed a coachman, suitably attired, and a groom at the stables. Cabriolets were to the broughams as expensive sports cars to chauffeur-driven limousines – the vehicles of impetuous youth and staid middle age, respectively.

Figure 1.

Top left: Gig. Top right: Dogcart. Centre: Wolsey 1906 motor car. Bottom left: Brougham. Bottom right: Victoria. Etching by author

For consultant practice, the importance of owning the right sort of carriage could hardly be exaggerated:

The carriage and liveries ought to be of rich colours, so that all the world may know to whom it belongs … You should seat yourself in it in a prominent attitude, and make it a rule to be employed writing … so that when I stop anyone in the street to speak to me, I look like a cabinet minister … the late Dr Heaviside always contended that his cream-coloured carriage picked out with sky blue, and a pair of grey horses, hooked many a patient for him as everybody knew his vehicle, it was so conspicuous.¹⁴

A peer with gout sent for a surgeon who was said to have a certain cure for the disease. When the surgeon arrived, his lordship demanded of his servant, ‘Does this famous doctor come on foot, or in a carriage?’ ‘On foot,’ was the reply and the butler was told to ‘send the scoundrel about his business. Did he possess the secret he pretends to have, he would ride in his coach-and-six and I should have been happy to have entreated him to deliver me from this terrible disease.’¹⁵

The impact of the railways

It might well be thought that the railways dealt a mortal blow to horse transport. Indeed, following the extremely rapid expansion of the railways the stagecoaches had virtually disappeared by 1850.¹⁶ But horse-drawn transport actually increased for the simple reason that ‘without carriages and carts the railways would have been like stranded whales, giants unable to use their strength, for these were the only means of getting goods and people right to the doors of houses, warehouses, markets and factories …’¹⁷ Thus the age of the railways was also the age of the horse and carriage. They needed each other. In England and Wales the total number of large horse-drawn carriages and lorries increased (in round numbers) from 330,000 1831 to 850,000 in 1872. Likewise there was a four-fold increase in the number of light two-wheelers – the vehicles of the middle classes – which had increased to around 320,000 by 1902.¹⁸

The railways had little effect on general practice but they had a profound effect on consulting practice. If, for example, a London consultant was asked to visit a patient in Oxford in the late 1820s, it would have meant a visit by horse and carriage with at least one overnight stop. By the 1850s the same consultation could easily be done in a day by train, with time when he got back to London to see one or two patients before dinner.

The first passenger-carrying train appeared in 1830. Such trains allowed consultants to travel much further and faster, enhancing their reputation and their income. If there was not a convenient train at the right time, a special one-carriage train could be provided. These were rich pickings.¹⁹

Dr CJB Williams, professor of medicine at University College Hospital in London who had a large consulting practice, travelled by train to see patients in Liverpool, Birmingham, Leeds, Marlborough, Torquay and Brighton. Williams' longest journey (which he did on four separate occasions) was to a patient in Cornwall, near Land's End.²⁰

Although the replacement of stagecoaches by trains made travel much easier for out-of-town consultations, within the cities the massive increase in horse-drawn traffic was causing severe problems. In England and Wales by the late 19th century there were more than 100,000 public passenger vehicles and cabs, around half a million trade vehicles, and about half a million private carriages.¹⁶ With numbers such as this, straw had to be scattered on the roads outside hospitals to muffle the clatter of horses' hooves and iron-clad wheels. There were millions of tons of horse droppings. Men wore spats, and Victorian women favoured ankle-length outdoor coats, not out of modesty, but because of the splash of liquified manure. London's transport was grinding to a halt, and it is with the greatest sense of irony that we, today, discover that just over 100 years ago the only remedy for traffic congestion was seen to be the rapid introduction of the motor car. It was a matter of simple arithmetic. Cars took up less road space than a horse and carriage. A single large lorry could pull a load that would require several teams of horses and wagons. And cars did not produce horse dung.

The arrival of the motor car

Bicycles of modern design (pneumatic tyres, a chain drive and two wheels of equal size) first appeared in the 1870s. They were said to be most useful for clergymen and doctors. Motorcycles followed later. The first cars were produced by Benz and Daimler in Germany in the 1870s, but in Britain it was only in the 1890s, when absurdly oppressive speed restrictions (maximum speed of 4 mph in the country, 2 mph in towns) were repealed, that cars began to appear in large numbers.²¹

Was changing to cars economically sound as far as doctors were concerned? The answer was a resounding ‘yes’. In general, a motor car was no more expensive to buy than two horses and a carriage, and much less expensive to run. The running costs of a horse and carriage which included forage, shoeing, stabling and the employment of a groom cost on average about £300 a year. A general practitioner in 1905 could expect to save at least £100 a year by changing to a motor car.

But there was more to it than money. As a correspondent to the British Medical Journal said in the 1890s, ‘the “mechanical horse” is never sick or sorry, never tired. Cars would go on all day, and if need be all night. They did not require a stable, run away, or grow ill or die; and they did not deposit ordure on the roads.’²²

Cars allowed doctors to travel much further with much less fatigue than their predecessors. As early as 1896, Dr Tuke of Harrogate travelled 60 miles and visited 20 to 30 patients a day in his 4.5 horsepower car. All this at an estimated cost of around 1d a mile.²³

The car also came into its own for night visits. In 1899, Dr Stedman of Worcester wrote ‘[my car] stands in the shed, always ready. I can walk up to it in the night and will have driven it out into the road, before the messenger can button up his coat … I could never get my carriage [and groom] at the door under three-quarters of an hour.’²⁴ In 1906 Mr Lockwood, a surgeon, said of one of his patients that: ‘if I had had to rely on horses when called up at night, and turned out the horse and man … (the patient) would possibly have died. I had my motor car which meant the turn of a handle and I was off.’²⁵

The medical journals published numerous articles on the virtue of motor cars in spite of the occasions when they broke down. Apart from breakdowns, however, between the mid-18th century and the beginning of the 20th, the change from horseback to the motor car was the greatest single change in everyday routine medical practice.

Footnotes

DECLARATIONS —

Competing interests None declared

Funding None

Ethical approval Not applicable

Guarantor IL

Contributorship IL is the sole contributor