Mommy had a baby, 
His name was Tiny Tim!
She put him in the bathtub,
To see if he could swim!

He drank up all the water,
He ate up all the soap!
He tried to eat the bath-tub,
But it got stuck in his throat!

Mommy called the doctor,
The doctor called his nurse,
His nurse called the lady,
With the alligator purse!

‘Measles!’ said the doctor,
‘Mumps!’ said the nurse,
‘Nothing!’ said the lady,
With the alligator purse!

Mommy punched the doctor,
Mommy slapped the nurse,
Mommy thanked the lady,
With the alligator purse!

This kids’ song (usually with the last verse removed!) which dates back to the 1950s is one I fondly remember from my own childhood. It’s funny and it makes you laugh. But it also made me think. It made me think of a facet of social life and history which has almost vanished from modern life.

When is the last time you saw a doctor make a house-call?

In days gone by, if someone was sick, a runner-message, a telegram, or a jingle on the pipe summoned your friendly family physician to your front door. Armed with a smile, a hat and his leather ‘Gladstone‘ bag, he’d treat you for everything from a broken arm to a case of influenza. When’s the last time you remember seeing a doctor walk along a residential street and head into a patient’s house?

Once upon a time, it was normal for a doctor, a general practitioner, a family physician, to make house-calls. Nowadays, this ancient practice has almost ceased to exist in certain countries. Whatever happened to all that?

This posting will look at the history of house-calls. Why they happened, what for, what happened when you got one, and why they’ve almost disappeared in modern society.

Why Did Doctors Make House-Calls?

From the earliest days of professional medicine, until fairly recently, it was common for doctors to make house-calls. I still remember my family physician making house-calls when I was a child, which was not that long ago. It was perfectly normal to call him on the telephone in an emergency, and he’d drive out to see you. It was well-known that you couldn’t reach him at home, or at the office, on certain days of the week (usually the weekend), because he dedicated one day a week to visiting patients at home.

Why?

Why is it that doctors made house-calls? Why were they famous for such attention to their patients? Let’s consider the context…

For much of human history, travel was slow. Most people walked. Owning a horse and carriage, or any other horse-drawn vehicle, was expensive, like owning a car today. Only with much higher maintenance costs. Going to a doctor was not always possible.

If the patient was too ill to walk and no convenient transport could be found, it was completely impossible. Would you chance a ride on a horse in the middle of the night, when you’ve got a brain-splitting fever so bad you can hardly drag yourself to the bathroom?

I’ve had one of those. It’s so bad you can’t even stand up, let alone get on a horse. You’re so dizzy you’d break an ankle falling down the steps just trying to get to the damn stables.

Don’t forget folks…this is before the days of telephones. Before the days of ambulances and 911 and Triple-0, before the days of 999. There was no quick and simple solution back then.

In an emergency, a doctor had to be sent for. And he would have to come. In a hurry! Because a doctor had to treat all sorts of things, most of them were general practitioners, meaning that they studied everything from minor operations and surgeries, to how to deliver babies, how to take your temperature, or how to prescribe medicines for that head-cold you’ve had for four days.

It was this lack of a ‘middle-man’, the emergency-response system, that meant that house-calls were necessary. And doctors training and education, covering a wide range of areas of medicine, reflected this. Even the vehicles the doctors used to get to their patients were specially-made.

The Doctor’s Buggy

In an age when doctors did a lot of travelling around making house-calls, some of them extremely serious, they had to have reliable and safe transportation. It wasn’t safe to ride on horseback to every appointment, especially if you were transporting fragile medical equipment with you. You needed a wheeled vehicle of some kind, which was suitably designed for your purpose.

This is a Victorian-era doctor’s buggy, and it was designed for use by visiting physicians. You’ll notice a few things about it. To begin with, it’s surprisingly large for a vehicle that would carry two people at most. It’s got a wide base and a low center of gravity, and storage in the foot-well behind the dashboard. This is so that the doctor could load his equipment into the front of the buggy, and drive it at high speeds, and take corners with minimal slowing. The low center of gravity prevented rollover accidents while on the way to a medical emergency.

The buggy is simply constructed. It doesn’t have the heavy glass and wood body of a larger carriage or coach. Such extra weight was unnecessary, and only slowed the doctor down in an emergency. These buggies were made to be fast and safe.

The Gladstone Bag

It’s been decades since most physicians ever carried one of these things. But they’re still called ‘doctor’s bags’ to this day. Invented in the mid-1800s by an English bag-manufacturer known only to history as “J. G. Beard”, these leather-sided, gate-mouthed bags were named ‘Gladstones’, after the four-time British Prime Minister William Ewart Gladstone, and of whom Mr. Beard was a supporter.

Gladstone bags were carried by everyone. Tradesmen, businessmen, carpenters and laypeople of all kinds. They were used as weekend-bags and overnight bags by travelers going by train, carriage or ocean-liner, and even as equipment-bags by adventurers and archaeologists. Such a bag wouldn’t be out-of-place in one of Indiana Jones’ adventures through the deserts of Egypt or the wilds of Arabia.

Despite the Gladstone bag’s long history and numerous, numerous uses, in popular culture, it is, has, and always will be, firstly and most commonly associated with physicians. To this day, they’re still called ‘doctor’s bags’. The reason for this probably dates back to the days when they still made house-calls.

Physicians who made house-calls had to be prepared for absolutely anything. Anything. From childbirth to mumps, boils to appendicitis, influenza to rampant diphtheria. Because of this, they had to carry a wide array of equipment in their bags. Not just measuring-tapes, a thermometer and a stethoscope, but most things that doctors today wouldn’t normally carry around – surgical and amputation-kits, bottles of medicine, swabs, measuring-cups, needles, syringes, tourniquets and other nasty and potentially deadly items.

Doctors required a bag to store all these important items in. The bag had to be large, easily-opened, securely locked to prevent tampering and theft, and with an easy grab-and-carry design. The upright, gate-mouthed opening of the Gladstone Bag made it ideally suited for this purpose. Not having to fumble around with a saggy, soft-mouthed bag (for example, a haversack or a duffel-bag) made the doctor’s job easier when he had to reach inside his bag in an emergency, to find some vital piece of equipment.

Being able to open the bag, have it stay open, close the bag, lock it, pick it up and walk with it without the contents inside (which could be sharp, fragile or poisonous) shifting and breaking, was the deciding factor in why physicians carried Gladstone bags. They were simply safer to transport their dangerous equipment around, than other bag-designs of the era.

Don’t forget that until fairly recently, thermometers were still fragile glass tubes filled with mercury. Or that doctors used to carry poisonous drugs like chloroform or ether with them, if they had to sedate a patient during an operation. You wouldn’t put stuff like that in a briefcase, close the lid, lock it, pick it up, tip the contents sideways all over each other in the process, only to have the lock fail and suddenly have everything spill out onto the floor and shatter into a million pieces! The design of the Gladstone bag made such an occurrence impossible.

What Was Involved in a House-Call?

Absolutely anything, short of a heart-transplant.

In the days when it was not practical for most people to visit a doctor, and when the doctor came to the patient, the physician had to be prepared for absolutely anything that his training covered. It’s one reason why he carried his Gladstone bag with him – it was one of the few practical luggage-types of the era that could hold so many different and dangerous objects with relative safety.

Physicians called out to a patient’s home could be expected to do anything from listening to a heart-beat, taking temperatures, prescribing medicines, and checking pulses, to more serious stuff, like childbirth, re-setting broken bones, stitching up wounds, or even minor surgery, like removing a patient’s appendix!

I’m old enough that I still remember a time when doctors made house-calls. Three house-calls I remember my family physician making when I was a child, tackled everything from broken bones, to stitching up a gash to the head, and one particularly memorable house-call which involved the removal of a fish-bone from my throat…to this day I can’t stand eating fish with bones in it.

The Golden Age of the House-Call

House-calls were common throughout history, but peaked during the 19th and 20th centuries. Advances in medicine, communications and transportation made it easier and safer for physicians to make house-calls. Telephones, bicycles and motor-cars made calling a doctor faster and safer.

House-calls began to fall steadily as a medical priority, after the end of the Second World War. This is matched by a steady decline in the number of general practitioners, among other contributing factors.

The End of the House-Call?

In an age when medicine was far more hands-on and personal, a physician had to cover a wide range of skills, since he had no idea what he might be called out to attend to, at any hour of the day, or night. Such physicians were called ‘general practitioners’ because they did not specialise in one particular area; they covered a ‘general’ field of medicine, learning the basics of every field, to serve them in their profession.

These days, there is a much higher number of specialists than general practitioners – physicians who will concentrate on one part of the human body. Eye-doctors, hearing specialists, Ear-Nose-&-Throat doctors, cardiologists who look into heart-conditions, podiatrists, who handle your feet, dermatologists who handle skin-issues and so-forth.

This spreading-out of knowledge means that there are fewer and fewer doctors who can handle a wider range of diseases and illnesses. And this means, fewer doctors who can handle house-calls, with their unpredictable natures.

In the 1920s in the United States, three-quarters of physicians were general practitioners. By the 1980s, that had dropped to less than 1%! With so few general practitioners around, it’s hardly surprising that house-calls are rapidly becoming a thing of the past! In the 1930s, 40% of patient-physician interactions happened through house-calls. In the 2010s, that’s dropped to less than 1%.

By the 21st century, the house-call is something almost consigned to history. When’s the last time you remember a doctor making a house-call? Most physicians work in their clinics or surgeries, most specialise in one area or another, of medicine. Not all of them have the skills necessary to carry out varied demands required of an unexpected house-call. With modern emergency services and improved communications and transportation, there’s less need for physicians to make house-calls. In our increasingly litigious society, some physicians have stopped giving house-calls over fears of being sued! And yet…

The Future of House-Calls?

House-calls have never really gone away. While it’s true a smaller number of doctors still carry out house-calls, there are some physicians, such as in the United States, who are trying to revive the practice. They believe it’s beneficial for a number of reasons. It gives reassurance to the elderly, or those living alone, or who can’t travel easily. For parents, it gives them comfort to know that their family doctor can check on their children if they should fall ill in the middle of the night. Doctors enjoy the personal time spent with patients. Not being slotted into an appointment-gap means that the physician can take his time with the patient and discuss their condition in detail, without the pressure of another patient waiting for treatment.

House-calls are being carried out these days, by more people than just doctors. Nurses and some paramedics also conduct house-calls, or conduct regular house-visits to elderly, infirm or otherwise house-bound patients. It provides comfort as well as medical care, and professional treatment for non-emergency medical conditions. In the United States, there’s even the Visiting Physicians Association, providing house-calls to the elderly and infirm.

Some doctors think that making house-calls is actually more cost-effective. Not having to maintain a professional premises and being able to work out of their own home (or the homes of others, in the case of house-calls!) makes reviving this ancient practice more attractive in the 21st century. On top of that, easier access to medical care in the home makes things more comfortable for those who have transport issues. Non-emergency medical problems can be treated at home, before they deteriorate and an ambulance has to be called, instead of a doctor!

Want to know more about the history of house-calls?

History of Medicine – House-Calls

‘Healthy Debate’ article about House-Calls (2011)

Doctors Reviving House-Calls

The Benefits of House-Calls

Modern Technology and the House-Call