[History of medicine].

A HEAVY old-fashioned leatherbound ledger, with the initials 'G. P." stamped on its front cover, was handed in to the Cleveland County Archivist's office by the Clerk to the Parish Council of Yarm in the 1970s. The ledger records a doctor's practice over two short periods in the 1880s. The initials 'G. P.' seem unlikely to mean general practitioner, although that title was in use in the nineteenth century. At that time, there was a doctor in practice locally called George Pilkington. So the ledger has been studied and the known facts on Pilkington's career compared to determine if the initials 'G. P.' could be those of George Pilkington. The first half of the ledger concerned general practice in the area around Yarm, and ran from November 1879 until May 1881. The rest of the ledger entries concerned a practice based four miles distant at Stockton-from June 1882 until February 1884. Yarm is now a smaller town than Stockton, higher up the river Tees. In the seventeenth century, the days of sail, it was an active port, thriving on imports and exports of agricultural and mining produce from south Durham and north Yorkshire. At Yarm, there were three categories of entry: those of visits, marked 'VIS' or 'ITER'; those entered 'MED'; and miscellaneous services. The entry VIS in the ledger meant a nearby visit, while ITER denoted a journey of over one mile, customarily charged according to its distance. The nature of the miscellaneous services is stated, but there is no abbreviation to suggest the location of any such service. While 'accouchement' would take place in the home, bandaging or vaccination could have been undertaken at home or at surgery. (As their number is not large, this analysis has assumed miscellaneous services to have taken place at the surgery.) The notable omission in his abbreviations is any contraction indicative of surgery attendance at Yarm. © Journal of the Royal College of General Practitioners, 1984, 34, 223-225. Superficially the contraction MED implies the dispensing of a prescription. Most doctors had a small surgery dispensary-some employing a dispenser during surgery hours to make up standard mixtures, pills or ointments. The habit of sending patients to a pharmacist was uncommon-mostly confined to physicians. Patients attending the surgery might have been charged for 'medicines only', without a specific charge for 'advice'-almost an echo of the pre-1815 Apothecaries Act situation. Does the abbreviation MED imply dispensing only, or does it cover that missing service in these accounts-a service crucial to general practice-the surgery consultation? At Stockton, his work pattern underwent a radical change, in that 92 per cent of his recorded services were for visits. He also showed the time of late requests for visits. A new abbreviation appeared in a few cases: 'CONS', charged at the same rate as MED. This contraction would seem to mean a surgery consultation. The increase in his visits at Stockton may be interpreted as a failure on his part to attract patients to his surgery.