Private Practice: In the Early Twentieth-Century Medical Office of Dr. Richard Cabot

Abstract

Richard Cabot (1868–1939), scion of an illustrious Boston family, received his M.D. degree from Harvard Medical School in 1892 and served on the faculty from 1899 to 1933. He created the field of medical social work, popularized the clinico-pathological conference, performed pioneering research on blood chemistry, wrote a textbook on physical diagnosis that went through ten editions, and wrote candidly and critically on physician behavior, medical ethics, patients' rights, and similar subjects. Between 1897 and 1926, Cabot maintained a private practice at his home in Back Bay, a wealthy Boston neighborhood with many physicians' offices. He kept careful records on 5,358 patients and thousands of letters from patients and physicians. Christopher Crenner has drawn a random sample of two hundred cases from 1900–1915, Cabot's most active period, and analyzed them in the context of the contemporary medical literature. At the time a new type of medical practice in physicians' offices was replacing home visits and group consultations of physicians in the patient's home. New office-based diagnostic and therapeutic equipment required patients to come to the primary-care physician's office and be referred to the offices of new kinds of specialists. Cabot provided primary care and received referrals resulting from his popular book on blood chemistry. Cabot's patients varied in their socioeconomic status, with few at the extremes. He showed little concern with their social identities but varied his fees by ability to pay.