Part 13

Perhaps regarding nothing connected with the science and practice of medicine, or the lives of its professors, are there more stories told, more curious facts on record, more interesting exhibitions of character and touching displays of generosity to relate, than about the giving and taking--or not taking--of fees. In stringing together some memoranda and anecdotes on this head, it needs only to be said that they are but a few out of a crowd. At the outset, it may be explained that from very early times the fee of the physician (like that of the advocate or the university professor) was regarded in the light of a voluntary recognition or reward for services rendered out of pure love of science or humanity. Dr. Doran alleges, indeed, that "there is a religious reason why fees are supposed not to be taken by physicians. Amongst the Christian martyrs are reckoned the two eastern brothers, Damian and Cosmas. They practised as physicians in Cilicia, and they were the first mortal practitioners who refused to take recompense for their work. Hence they were called Anargyri, or 'without money.' All physicians are pleasantly supposed to follow this example. They never take fees, like Damian and Cosmas; but they meekly receive what they know will be given out of Christian humility, and with a certain or uncertain reluctance, which is the nearest approach that can be made in these times to the two brothers who were in partnership at Egea in Cilicia." It has very naturally, however, been objected that physicians act from no such lofty motives, but merely because they prefer that the gratitude or the fears of the patient should be the measure of their reward. And yet, as Mr. Wadd forcibly remarks, "it is a fact, not less singular than true, that the advancement of surgical science is a benefit conferred on society at the expense of the scientific practitioner, since in proportion as the mode of cure is tuto et celeriter, safe and speedy, remuneration is diminished. Perhaps in no instance is this better exemplified than in the operation of the hydrocele, introduced by my late friend and master, Sir James Earle. Compare the simplicity, safety, and celerity of this, with the bustle and bloody brutality of the old system; the business of six weeks reduced to so many days! But mark the consequence, quâ honorarium: does the patient increase the fee for the pain and misery he is spared? Not a bit of it. Here is little or no work done; no trouble to the doctor; no pain to the patient; therefore, nothing to pay for.... Selden, who understood these failings in mankind vastly well, gives them a sly hit in his Table Talk:--'If a man had a sore leg, and he should go to an honest, judicious chirurgeon, and he should only bid him keep it warm, and anoint it with such an oil (an oil well known) that would do the cure, haply he would not much regard him, because he knows the medicine beforehand, an ordinary medicine. But if he should go to a surgeon that should tell him, your leg will gangrene within three days and it must be cut off, and you will die unless you do something that I could tell you, what listening there would be to this man! Oh, for the Lord's sake, tell me what this is, I will give you any content for your pains!'" Not only has this loss of reward through the devising of new appliances for preventing human suffering, not made medical men, as a rule, one whit less anxious to devise them, or adopt them when devised; but it is in the experience of all, that in many cases physicians can render services gratuitously, which they would never have had the opportunity of rendering if it was not understood, both by themselves and the suffering, that they gave their skill cheerfully for God's sake as for gold's sake, to those who were unable to appeal to the latter power.

Ancient Fees of Magnitude.--Seleucus--the one of Alexander's generals to whom the kingdom of Syria fell at the break-up of the empire of Macedonian conquest--gave to Erasistratus 60,000 crowns "for discovering the disorder of his son Antiochus." Alcon, whose dexterity is celebrated in Martial's Epigrams, was repaid by the public, in the course of a few years' practice, the sum of 10,000,000 sesterces (£80,000) which he had lost by a law-suit. Four Roman physicians, Aruntius, Calpetanus, Rubrius, and Albutius, for their attendance on Augustus and his two immediate successors, enjoyed each an annual salary of 250,000 sesterces, equal to £2000 sterling.

Early English Fees.--In 1345, Edward III. granted to his apothecary, Coursus de Gungeland, a pension of sixpence a-day; and "Ricardus Wye, chirurgicus," had twelve pence per day, and eight marks per year, for his services. Under the same king, "Willielmus Holme, chirurgicus Regis," is rewarded with the permission, during his lifetime, "to hunt, take, and carry off wild animals of all kinds, in any of the royal forests, chases, parks, and warrens." In the Courts of the kings of Wales, the physician or surgeon was the twelfth person in rank, and his fees seem to have been fixed by law. For a flesh wound, not of a dangerous character, he got nothing but such of the wounded man's garments as the blood had stained; but for any of the three classes of dangerous wounds, he had in addition 180 pence, and his maintenance so long as his services might be in requisition.

Fees in the reign of Henry VIII. and Elizabeth.--In the record of expenses of the Earl of Cumberland, it is stated that he paid to a physician of Cambridge £1; but this fee was evidently, as shown by other entries, an exceptionally liberal one, even perhaps for a noble to pay. In the 18th year of Henry VIII., as is mentioned in Burn's History of Westmoreland, Sir Walter Strickland made a bargain with a physician to cure him of an asthma for £20. Stow, in the same reign, complimenting British physicians on their skill and learning, mentions "as the great grievance that the inferior people are undone by the exorbitance of their fees." Half-a-crown, he avers, is in Holland looked on as a large fee; whereas in England "a physician scorns to touch any metal but gold; and our surgeons are still more unreasonable." Queen Elizabeth's physician in ordinary received £100 per annum, besides his sustenance, wine, wax, and other necessaries or perquisites. Her apothecary, Hugo Morgan, for one quarter's bill had £83, 7s. 8d.; but this was not all for medicines, as such entries as this will show:--eleven shillings for a confection shaped like a manus Christi, with bezoar stone and unicorn's horn; sixteenpence for a royal sweetmeat with incised rhubarb; six shillings for "a conserve of barberries, with preserved damascene plums, and other things for Mr. Ralegh;" two shillings and sixpence for sweet scent to be used at the christening of Sir Richard Knightley's son; and so on.

Fees after the Revolution.--At the close of the sixteenth and opening of the seventeenth century, the fee of the physician had tended towards fixity, as regards the minimum at least, which was ten shillings. This appears from several incidental contemporary statements, as in the satirical dialogue of "Physick lies a-bleeding; or the Apothecary turned Doctor" (published in 1697, during the war of the "Dispensary"), in which one of the characters, called on to pay eighteen shillings for medicine for his wife and a crown by way of gratuity to the apothecary, says: "I wish you had called a doctor; perhaps he would have advised her to have forbore taking anything, at least as yet, so I had saved 13s. in my pocket." In 1700, as appears from the Levamen Infirmi, the existence of minimum and maximum fees appears to have been quite recognised:--"To a graduate in physick, his due is about ten shillings, though he commonly expects or demands twenty. Those that are only licensed physicians, their due is no more than six shillings and eightpence, though they commonly demand ten shillings. A surgeon's fee is twelve-pence a mile, be his journey far or near; ten groats to set a bone broke, or out of joint; and for letting blood, one shilling; the cutting off or amputation of any limb is five pounds, but there is no settled price for the cure."

Sir Theodore Mayerne.--This eminent physician, who was a native of Geneva, and attended James I. and the two Charleses, once very neatly and deservedly rebuked a mean and ostentatious friend, who, after consulting him, laid on the table two broad pieces of gold (of the value of 36s. each). Sir Theodore quietly pocketed the fee; and, on his friend expressing or showing himself hurt at thus being taken at his money, said to him: "I made my will this morning; and if it should appear that I had refused a fee, I might be deemed non compos." Mr. Wadd caps this anecdote with another about Dr. Meyer Schomberg, who was much in vogue about the middle of last century. Mr. Martin, the surgeon, used now and then to visit him; and was once shown in when a patient was with him. After the patient was gone, Martin noticed two guineas lying on the table, and asked the doctor how it came that he left his money about in that way? Said Dr. Schomberg: "I always have a couple of guineas before me, as an example, or broad hint, what they (the patients who consulted him) ought to give."

Large Royal Fees in Later Times.--Henry Atkins was sent for to Scotland by James the First (of England), to attend to the Prince Charles--afterwards Charles I., but then in his infancy--who lay dangerously sick. For this journey and duty the King gave Atkins the splendid fee of £6000, which he invested in the purchase of the manor of Clapham. In 1685 a very handsome fee was ordered to be paid--but it was never paid--to Dr. King, for a brave breach of Court etiquette that saved the life of Charles II. for a time. Evelyn thus relates the incident, under date 4th February 1685:--"I went to London, hearing his Majesty had been, the Monday before (2 Feb.), surprised in his bed-chamber with an apoplectic fit; so that if, by God's providence, Dr. King (that excellent chirurgeon as well as physician) had not been actually present, to let him blood (having his lancet in his pocket), his Majesty had certainly died that moment, which might have been of direful consequence, there being nobody else present with the king save this doctor and one more, as I am assured. It was a mark of the extraordinary dexterity, resolution, and presence of mind in the Dr. to let him blood in the very paroxysm, without staying the coming of other physicians; which regularly should have been done, and for want of which he must have a regular pardon, as they tell me." The Privy Council ordered £1000 to be given to Dr. King; but he never obtained the money. The physicians who attended Queen Caroline in 1737 had 500 guineas, and the surgeons 300 guineas, apiece. Dr. Willis, for his success in dealing with the malady of George III., received £1500 a-year for twenty years, and £650 was settled on his son for life; the subordinate physicians had thirty guineas for each visit to Windsor, and ten for each visit to Kew. The Empress Catherine of Russia made Dr. Dimsdale--a Hertfordshire physician--who, in 1768, travelled to St. Petersburg to inoculate her and her son, a Baron of the Empire; and presented him with a fee of £12,000, and a life pension of £500. This sum of £12,000 is about the largest ever paid, in ancient times or modern, to one physician for one operation; although there are living surgeons who from private individuals have received fees that dwarf this imperial largess into comparative insignificance. Perhaps even more remarkable, however, than Catherine's liberal payment for good work, was the Emperor Joseph of Austria's reward for bad news. On his deathbed his Majesty asked Quarin his opinion of his case, and was frankly assured, in reply, that he could not expect to live other forty-eight hours. For this uncourtly but really kind affirmation of the truth, the Emperor created Quarin a Baron, and conferred on him an income of £2000. Louis XIV. gave his physician and surgeon 75,000 crowns each, after the successful performance of a painful, and at that time novel, operation. Beside this, the fees paid by Napoleon I. to the Faculty who attended Marie Louise in March 1811, when the Emperor's son was born, are trifling. Dubois, Corvisart, Bourdier, and Ivan, had amongst them a remuneration of £4000, £2000 being the portion assigned to Dubois.

Fee for a Political Consultation.--At the outbreak of the American war, Grenville was desirous to ascertain what was the state of feeling that prevailed among the Quaker colonists in America; and he could hit, as he thought, on no more effectual means of doing this, than by a conversation with Dr. Fothergill, who was a Quaker, and enjoyed the hearty confidence of his brethren of that sect. Fothergill was accordingly summoned to prescribe for the statesman--who, in reality, wanted to feel, through him, the pulse of transatlantic Quakerism; and the visit, of course, was made to take the turn of a vivacious controversy on American politics. At the end, Grenville put five guineas into the doctor's hand, and said to him, "Really, I feel so much better, that I don't think it is necessary for you to prescribe." With a shrewd smile, Fothergill, keeping a good hold of the money, said, "Well, at this rate, friend, I can spare thee an hour now and then."

Generous Refusal of Fees.--There are many anecdotes of refusal of physicians to take fees from persons whom the payment of them would have distressed; but they are all so nobly alike, that we need not quote any here. The benevolent and eccentric Dr. Smith, when established in a practice equal to that of any physician in London, did what perhaps few physicians in great practice would have done. He set apart two days for the poor in each week. From those who were really poor, he never took a fee; and from those who were of the middling ranks in life, he never would take above half a guinea! Yet so great was the resort to him, that he has in one day received fifty guineas, at the rate of half a guinea only from each patient.

Sticklers for Fees.--Sir Richard Jebb was once paid three guineas by a nobleman from whom he had a right to expect five. Sir Richard dropped the coins on the carpet, when a servant picked them up and restored them. Sir Richard continued his search. "Are all the guineas found?" asked his Lordship, looking round. "There must be two still on the floor," was Jebb's answer; "for I have only three." The hint was taken, and the right sum put down. An eminent Bristol doctor coming into his patient's bedroom immediately after death, found the right hand of the deceased tightly clenched. Opening the fingers, he discovered within them a guinea. "Ah! that was for me, clearly," said the doctor, putting the piece into his pocket. A physician, receiving two guineas when he expected three, from an old lady who used to give him the latter fee, had recourse to one part of Sir Richard Jebb's artifice, and, assuming that the third guinea had been dropt through his carelessness on the floor, looked about for it. "Nay, nay," said the lady, "you are not in fault. It is I who dropt it."

Fees collectively Irresistible.--Radcliffe attended a friend for a twelvemonth gratuitously. On his last visit his friend said, "Doctor, here is a purse in which I have put every day's fee; and your goodness must not get the better of my gratitude. Take your money." Radcliffe steeled himself to persevere in benevolence, just touched the purse to reject it, heard the chink of the gold, and put it into his pocket, saying "Singly, Sir, I could have refused them for a twelvemonth; but, all together, they are irresistible."

PALEY'S ECONOMY OF CONSCIENCE.

The great controversy on the propriety of requiring a subscription to articles of faith, as practised by the Church of England, excited in 1772 a very strong sensation amongst the members of the two universities. Paley, when pressed to sign the clerical petition which was presented to the House of Commons for relief, excused himself, saying, "He could not afford to keep a conscience."

DIFFIDENCE IN THE PULPIT.

Izaak Walton relates about Bishop Sanderson, that once "his dear and most intimate friend, the learned Dr. Hammond, came to enjoy a quiet rest and conversation with him for some days at Boothby Pannel, and did so, and having formerly persuaded him to trust his excellent memory, and not read, but try to speak a sermon as he had writ it; Dr. Sanderson became so compliant as to promise that he would. And to that end they two went early the Sunday following to a neighbour minister, and requested to exchange a sermon; and they did so. And at Dr. Sanderson's going into the pulpit, he gave his sermon (which was a very short one) into the hands of Dr. Hammond, intending to preach it as it was writ; but before he had preached a third part, Dr. Hammond (looking on his sermon as written) observed him to be out, and so lost as to the matter, especially the method, that he also became afraid for him; for it was discernible to many of that plain auditory. But when he had ended this short sermon, as they two walked homeward, Dr. Sanderson said with much earnestness, 'Good Doctor, give me my sermon, and know that neither you, nor any man living, shall ever persuade me to preach again without my books.' To which the reply was, 'Good Doctor, be not angry; for if ever I persuade you to preach again without book, I will give you leave to burn all the books that I am master of.'" Elsewhere Walton says:--"Though they were much esteemed by them that procured and were fit to judge them, yet (Dr. Sanderson's sermons) were the less valued because he read them, which he was forced to do; for though he had an extraordinary memory (even the art of it), yet he was punished with such an innate, invincible fear and bashfulness, that his memory was wholly useless as to the repetition of his sermons, so as he had writ them; which gave occasion to say, when some of them were first printed and exposed to censure (which was in the year 1632), that the best sermons that ever were read were never preached." Aubrey says, that when he was a freshman at college, and heard Dr. Sanderson read his first lecture, he was out in the Lord's Prayer.

CHRISTIAN NAMES AMONG THE PURITANS.

In his Church History, Collins says:--"Under the article of Baptism, the Book of Discipline runs thus: 'Let persuasions be used that such names that do savour either of Paganism or Popery be not given to children at their baptism, but principally those whereof there are examples in the Scriptures.' The Puritans were strict in keeping close to this rule, as may be collected from the odd names they gave their children; such as, 'The Lord is Near,' 'More Trial,' 'Reformation,' 'Discipline,' 'Joy Again,' 'Sufficient from Above,' 'Free-Gifts,' 'More Fruit,' 'Dust,' etc. And here Snape was remarkably scrupulous; for this minister refused to baptize one Christopher Hodgkinson's child, because he would have it christened Richard. Snape acquainted Hodgkinson with his opinion beforehand. He told him he must change the name, and look out for one in the Scripture; but the father, not thinking this fancy would be so strongly insisted on, brought his son to church. Snape proceeded in the solemnity till he came to naming the child; but not being able to prevail for any other name than Richard, refused to administer the sacrament, and thus the child was carried away, and afterwards baptized by a conforming clergyman."

"WHAT IS AN ARCHDEACON?"

Lord Althorp, when Chancellor of the Exchequer, having to propose to the House of Commons a vote of £400 a year for the salary of the Archdeacon of Bengal, was puzzled by a question from Mr. Hume, "What are the duties of an archdeacon?" So he sent one of the subordinate occupants of the Treasury Bench to the other House to obtain an answer to the question from one of the bishops. To Dr. Blomfield accordingly the messenger went, and repeated the question, "What is an archdeacon?" "An archdeacon," replied the bishop, in his quick way, "an archdeacon is an ecclesiastical officer, who performs archidiaconal functions;" and with this reply Lord Althorp and the House were perfectly satisfied.

"TAPPING" A TOPER.

A man who had never drunk water enough to warrant the disease, was reduced to such a state by dropsy, that the physicians decided that tapping was necessary; and the poor patient was invited to submit to the operation, which he seemed inclined to do, in spite of the entreaties of his son. "Oh! father, father, do not let them tap you," screamed the boy, in an agony of tears; "do anything, but do not let them tap you!" "Why, my dear?" inquired the afflicted parent. "It will do me good, and I shall live long in health to make you happy." "No, father, no, you will not: there never was anything tapped in our house that lasted longer than a week!"

THE CAPACITY OF AN ABBE.

When the diminutive Abbé de Voisenon was ordered by his physician to drink a quart of ptisan per hour, he was horrified. On his next visit the doctor asked, "What effect has the ptisan produced?" "Not any," answered the little Abbé. "Have you taken it all?" "I could not take more than half of it." The physician was angry that his directions had not been carried out, and frankly said so. "Ah! my friend," pleaded the Abbé, "how could you desire me to swallow a quart an hour? I hold but a pint!"

BENEFIT OF CLERGY.

In Burnet's History of the Reformation, we find it stated that "a law of Henry VII. for burning in the hand clerks convicted of felony, did not prove a sufficient restraint. And when, in the fourth year of the following reign, it was enacted that all murderers and robbers should be denied the benefit of their clergy, two provisos were added to make the bill pass through the House of Lords, the one for excepting all such as were within the holy orders of bishop, priest, or deacon, and the other, that the Act should only be in force till the next Parliament. Pursuant to this Act many murderers and felons were denied their clergy, and the law passed on them to the great satisfaction of the nation; but this gave great offence to the clergy, and the Abbot of Winchelcont said, in a sermon at Paul's Cross, that the Act was contrary to the law of God, and to the liberties of the holy Church, and that all who assented to it had by so doing incurred the censures of the Church."

DEAN SWIFT'S CONTRIBUTORY DINNER.

Dean Swift once invited to dinner several of the first noblemen and gentlemen in Dublin. A servant announced the dinner, and the Dean led the way to the dining-room. To each chair was a servant, a bottle of wine, a roll, and an inverted plate. On taking his seat, the Dean desired the guests to arrange themselves according to their own ideas of precedence, and fall to. The company were astonished to find the table without a dish, or any provisions. The Lord Chancellor, who was present, said, "Mr. Dean, we do not see the joke." "Then I will show it you," answered the Dean, turning up his plate, under which was half-a-crown, and a bill of fare from a neighbouring tavern. "Here, sir," said he, to his servant, "bring me a plate of goose." The company caught the idea, and each man sent his plate and half-a-crown. Covers, with everything that the appetites of the moment dictated, soon appeared. The novelty, the peculiarity of the manner, and the unexpected circumstances, altogether excited the plaudits of the noble guests, who declared themselves particularly gratified by the Dean's entertainment. "Well," said the Dean, "gentlemen, if you have dined, I will order the dessert." A large roll of paper, presenting the particulars of a splendid dinner, was produced, with an estimate of the expense. The Dean requested the accountant-general to deduct the half-crowns from the amount, observing, "that as his noble guests were pleased to express their satisfaction with the dinner, he begged their advice and assistance in disposing of the fragments and crumbs," as he termed the balance mentioned by the accountant-general--which was two hundred and fifty pounds. The company said, that no person was capable of instructing the Dean in things of that nature. After the circulation of the finest wines, the most judicious remarks on charity and its abuse were introduced, and it was agreed that the proper objects of liberal relief were well-educated families, who from affluence, or the expectation of it, were reduced through misfortune to silent despair. The Dean then divided the sum by the number of his guests, and addressed them according to their respective private characters, with which no one was perhaps better acquainted. "You, my Lords," said the Dean to several young noblemen, "I wish to introduce to some new acquaintance, who will at least make their acknowledgment for your favours with sincerity." "You, my reverend Lords," addressing the bishops present, "adhere so closely to the spirit of the Scriptures, that your left hands are literally ignorant of the beneficence of your right. You, my Lord of Kildare, and the two noble lords near you, I will not entrust with any part of this money, as you have been long in the usurious habits of lending your own on such occasions; but your assistance, my Lord of Kerry, I must entreat, as charity covereth a multitude of sins."

"BREAKING UP" BEFORE THE HOLIDAYS.