Sick, Not Dead

Book excerpt: The life expectancy of British workers rose dramatically during the nineteenth century, a period when workingmen routinely began to consult doctors. While rates of sickness fell, the length of episodes of disease and injury became more protracted. Instead of dying at relatively young ages, workingmen survived longer and experienced more sickness. In Sick, Not Dead, James C. Riley traces these developments and examines the arrangements made for providing medical care to workers. Drawing on the work attendance and sick visit records of British friendly societies, Riley explores how these organizations provided workingmen with access to doctors and regulated compensation for wages lost due to sickness. He finds in this period the roots of today's doctor-patient relationship. In the 1870s, when a small number of patients could choose among a relatively large number of doctors, patients demanded and got frequent and convenient consultations for low fees. But in the 1890s, working people sacrificed their advantage: as the number of patients increased, they began accepting their doctors' excuses for care they previously had rejected as inattentive or deficient. In the 1910s and 1920s, the doctors improved their own organization and used it to seize control of the fee schedule. Using the extensive claims records of the societies, Riley also explores the regional patterns of sickness in Britain from 1870 to 1910 and addresses the question of how policies that promoted lower mortality affected rates and duration of sickness.