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Langstaff: A Nineteenth-Century Medical Life

Jacalyn Duffin
Copyright Date: 1993
Pages: 383
  • Book Info
    Book Description:

    A unique and readable microhistory of an ordinary physician and his community during a period of revolutionary medical change. Duffin bases her insights on a detailed computer-assisted analysis of 40 years of extant daybooks of James Langstaff (1825-1889).

    eISBN: 978-1-4426-7638-1
    Subjects: History

Table of Contents

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  1. Front Matter
    (pp. i-vi)
  2. Table of Contents
    (pp. vii-x)
  3. Tables, Figures, and Maps
    (pp. xi-xii)
  4. Acknowledgments
    (pp. xiii-2)
  5. Introduction
    (pp. 3-7)

    Medicine was transformed during the nineteenth century by the revolutionary principles of physical diagnosis, anaesthesia, antisepsis, germ theory, and public health. These developments and the technological changes that accompanied them led to profound alterations in concepts of disease, in diagnostic and therapeutic modalities, and in the structure and function of the profession; they laid the foundations of modern practice. A great deal of attention has been given to the discoveries and their associated protagonists or ‘heroes’ the well-known men and women whose contributions fostered these changes. More recently, historians have examined the contextual origins and products of these changes as...

  6. CHAPTER ONE The Making of a Doctor
    (pp. 8-25)

    On 3 October 1864 James Miles Langstaff began his day by attending Mrs Scheel during the unassisted birth of her healthy baby boy at five minutes past midnight. Within the hour, he washed and packed away his unused tools and rode home over the hard-packed country road for a few hours’ sleep. He rose early to make rounds, beginning with Mrs Scheel, who did not look well and seemed to be developing the fever that would keep him coming back for another three weeks.¹

    Langstaff then went to see the other sick people in his fifteen-year-old Richmond Hill practice, most...

  7. CHAPTER TWO The Professional and Social World of a Nineteenth-Century Doctor
    (pp. 26-58)

    In May 1849, one month after receiving his licence, Langstaff set up a medical practice in Unionville, a village five miles east of his home. That slow summer he made seventy visits in four months, to a score of different people, giving out advice and medicines, attending deliveries, and pulling teeth. He saw no patients at all from 23 August to 8 September 1849, when he moved back to Richmond Hill and purchased the practice of Dr John Reid, including house, lot, horse, and buggy, for the considerable sum of £500 and an extra ‘£30 for the good will.’¹


  8. CHAPTER THREE Medical Knowledge in Diagnosis: Physical Signs at the Bedside
    (pp. 59-72)

    Whenever Langstaff visited sick people, he tried to find an organic diagnosis for their ailments. Commonplace as this statement may appear, he was among a generation of physicians for whom ‘physical’ diagnosis was an increasingly important part of disease recognition or the process of conceiving of, naming, and classifying patterns of illness. In the eighteenth century, diseases were recognized usually by symptoms, the subjective aspects of illness, as obvious to the patients as they were to their doctors. The change in diagnostic emphasis took place at the beginning of the nineteenth century and resulted from a variety of social, political,...

  9. CHAPTER FOUR Medical Knowledge in Therapy: Old Stand-bys, Innovations, and Intangibles
    (pp. 73-91)

    The history of medical therapeutics was long ignored by medical historians, partly because much of the therapy given by doctors in the previous century was considered to be worthless or even harmful in the present. Only recently have scholars sought to understand the social and medical reasons why dangerous drugs and practices were commonly used and to document the extent of their use.¹ An image of the caring, patient pioneer-doctor, who had little to offer but his presence, has been dispelled by studies of prescribing practice that show nineteenth-century doctors tended to use large numbers of different medications, sometimes several...

  10. CHAPTER FIVE Patients and Their Diseases: Morbidity and Mortality in Children and Adults
    (pp. 92-125)

    Sickness, injury, birth, and death were intimately woven into the social and cultural fabric of nineteenth-century Ontario life, and virtually all persons in the community – regardless of age, sex, or economic status – found they had need of the doctor at one time or another. In studying the diseases that afflicted any population, historians are not obliged to forget what they know now, but they must come to terms with the definitions and categories of illness used in the records of the past. Classification, or the grouping of diseases, tells us a great deal about the presumed causes of illness. Over...

  11. CHAPTER SIX Lunatics, Dreamers, and Drunks
    (pp. 126-144)

    Over the course of the nineteenth century, physicians increasingly viewed mental illness as the product of ‘moral’ or emotional causes, amenable to ‘moral’ or emotion-based therapy; specialized hospitals or asylums were founded to provide such treatment. In the past, historians of medicine portrayed these changes as laudable, but recently others have challenged this assessment. Taking their lead from Michel Foucault’s revisionist analysis of insanity and without necessarily embracing all his interpretations, the newer studies suggest that the impulse to ‘medicalize’ (i.e., diagnose, isolate, and treat) the mentally abnormal may have been neither benevolent nor effective.¹ Most of these studies have...

  12. [Illustrations]
    (pp. None)
  13. CHAPTER SEVEN Accidents, Injuries, and Operations: Langstaff’s Practice of Surgery
    (pp. 145-177)

    Surgical advances of the second half of the nineteenth century led to several changes in the practice of medicine, including increased specialization and a shift in the role of the hospital. The advent of anaesthesia in the late 1840s and antisepsis in the late 1860s fostered these changes by making it possible to perform previously inconceivable operations on the thorax and abdomen, without pain or fear of infection. The resultant flurry of surgical activity led to an increase in the rate of operative intervention and to the heady optimism that would characterize early twentieth-century medical endeavour.¹ The Langstaff records provide...

  14. CHAPTER EIGHT Birthing and Its Problems in Langstaff’s Practice of Obstetrics
    (pp. 178-217)

    Over the course of the nineteenth century birthing was ‘medicalized’ – it ceased to be perceived as an entirely natural process and the exclusive domain of midwives or other women attendants and was increasingly viewed as a potentially dangerous, almost disease-like condition amenable to a variety of treatments, involving special instruments and medication that properly belonged in the hands of doctors. Historians have been divided over the question, to whom was the change more beneficial – the birthing women or their male physicians?¹ Those emphasizing the benefits to women refer to the ghastly agonies of an earlier period and contrast them with...

  15. CHAPTER NINE Therapy through Social Action: Lawyers, Politics, and Public Health
    (pp. 218-250)

    The last two decades of the nineteenth century saw increasing agitation for sanitary reform and public health throughout the western world; Ontario was no exception.¹ In 1882 Robert Koch’s proof that tuberculosis was caused by a bacterium added to the growing evidence for the germ theory of disease, recently endorsed by the work of Louis Pasteur and Joseph Lister, and gave a final ‘scientific’ boost to the sanitary movement that had originated in older theories of noxious airs (or miasmata). In the past, sanitarians have been portrayed as opponents of the more ‘scientific’ theory of micro-organisms, but Nancy Tomes has...

  16. Conclusion
    (pp. 251-256)

    For forty years in a century of important change, James Miles Langstaff practised in a semi-rural setting, usually alone, with few vacations, and without having attended a medical conference; nevertheless, he was far from isolated and kept abreast of innovation. The science of his early training seems to have stayed with him like an intellectual touchstone and was present in his references to anatomy and physiology in the explanation of symptoms. Examples include his observations on the incongruously deeper breathing of a person recovering from pneumonia, the relationship between function and healing in women with breast cancer, and the mechanism...

  17. Appendix A A Note on Method
    (pp. 257-259)
  18. Appendix B Professional Associates of James Miles Langstaff
    (pp. 260-266)
  19. Appendix C Langstaff’s Personal Library and Charities
    (pp. 267-271)
  20. Appendix D Langstaff’s Properties
    (pp. 272-272)
  21. Appendix E Therapies in Langstaff’s Daybooks
    (pp. 273-276)
  22. Appendix F Medical Diagnoses in Langstaff’s Daybooks
    (pp. 277-280)
  23. Notes
    (pp. 281-356)
  24. List of Manuscript and Printed Sources
    (pp. 357-360)
  25. Select Bibliography
    (pp. 361-370)
  26. Illustration Credits
    (pp. 371-372)
  27. Index
    (pp. 373-383)