Medicine before the motor car
Authors: Irvine Loudon
Journal: Journal of the Royal Society of Medicine (2009)

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