Insurance against germ theory: commerce and conservatism in late-Victorian medicine

This article highlights the role played by commercial life insurance companies in determining the response to tuberculosis in Britain between 1865 and 1920. Late-Victorian life offices hired two sorts of physicians to help them screen out high-risk proposals: provincial medical examiners, who collected fees for examining candidates; and salaried medical advisors, who developed guidelines for the medical examination and interpreted the examiners' findings for the head office. The latter set of physicians, many of whom worked at specialist consumption hospitals in London, established an orthodoxy among life offices that privileged hereditarian explanations for the cause of tuberculosis. The provincial examiners resisted that orthodoxy, arguing that advances in public health and treatment rendered irrelevant any apparent correlation between family history and tuberculosis. In adjudicating this internal dispute, life offices stood by their salaried advisors, but in the process pushed them away from viewing disease in terms of specific causes and toward viewing disease in terms of statistical correlation. This victory 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.