Insurance against germ theory: Commerce and conservatism in late-Victorianmedicine

This article highlights the role played by commercial life insurance compan ies in determining the response to tuberculosis in Britain between 1865 and 1920. Late-Victorian life offices hired two sorts of physicians to help th em screen out high-risk proposals: provincial medical examiners, who collec ted fees for examining candidates; and salaried medical advisors, who devel oped guidelines for the medical examination and interpreted the examiners' findings for the head office. The latter set of physicians, many of whom wo rked at specialist consumption hospitals in London, established all orthodo xy among life offices that privileged hereditarian explanations for the cau se of tuberculosis. The provincial examiners resisted that orthodoxy, argui ng that advances in public health and treatment rendered irrelevant any app arent correlation between family history and tuberculosis. In adjudicating this internal dispute, life offices stood by their salaried advisors, but i n the process pushed them away from viewing disease in terms of specific ca uses and toward viewing disease in terms of statistical correlation. This v ictory of statistics over etiology preserved, at least for the rest of the twentieth century, the institutional prominence of insurance as a technique for coping with medical uncertainty.