Daily Business: The Organization and Finances of Doctors' Practices.

Abstract

During the night of 6 December 1826, Franziska Gross, a midwife in the Austrian town of Innsbruck, was called to a heavily pregnant woman who had just gone into labour. When the woman, after suffering severe convulsions, lost consciousness the midwife sent two messengers to the nearby physician. But because ‘there was no bell’,1 the attempt to find immediate help in the middle of the night failed. Driven by despair, the two messengers hurried on to the nearby military hospital where they were given tea and ointment for the dangerously ill woman. She died in the evening of the following day. This example of a failure to establish contact between a physician and a patient or her relatives, tragic as it was, holds important clues as to how physicians organized their availability outside the usual practice hours. Ringing the night-bell should have woken the doctor. The search for medical help often ended outside the physician’s house, however, as in the case above, when there was no bell, when no bell could be found or when the residents could not be aroused from their deep sleep. The physician, on the other hand, could not – when packing his instrument bag and saddling his horse – be sure that he would still find an acute case of emergency at the house he was led to by the messenger that the distraught relatives had sent. In many cases medical intervention had become obsolete after the many hours taken to travel to some remote village. On 26 October 1889 the South Tyrolean country physician Franz von Ottenthal arrived in a farmhouse in Luttach in the Ahrn Valley, a village, which had 400 inhabitants at the time. He went there every day to see a 73-year-old man who had, for