Part 20

Dr. Mead, in the time of George the First, was generous to a degree, and like many of his brethren, would not accept fees from curates, half-pay officers, and men of letters. At home his fee was a guinea. When he visited patients of means, in consultation or otherwise, he expected two guineas or more. But to the apothecaries who waited on him at his coffee houses of call he charged only half a guinea for prescriptions, written without his having seen the patient. He had an income one year of L7,000, and for several years received between L5,000 and L6,000, which, considering the value of money at that time, is as much as that of any living physician.

The physicians who attended Queen Caroline had five hundred guineas, and the surgeons three hundred guineas each; Dr. Willis was rewarded for his attendance on George III. by L1,500 per annum for twenty years, and L650 per annum to his son for life. The other physicians, however, had only thirty guineas each visit to Windsor, and ten guineas each visit to Kew.

Dr. Abernethy was annoyed by a lady needlessly consulting him about her tongue. One morning she came, as he was descending the steps from his door and putting on his gloves. She said:--"Doctor, I'm so glad I have caught you!" The doctor asked if it were the old trouble. On her saying "Yes," he told her to put out her tongue. She did so, and he said, "Stand there till I come," and left her so, in the street, setting out on his round of visits.

Once when prescribing nutritious and expensive diet for a young man in consumption, he observed the look of despair on the young wife's face, and the evidence of straitened circumstances around; when the lady appealed to him, asking if there was really nothing else he could suggest for her husband. He replied:--"When I think of it, I'll send along a box of pills in the afternoon!" A messenger brought the box. On the lid was written "One every day," and, on being opened, it was found to contain twenty guineas!

He once bluntly told a bon-vivant gentleman to "Live on sixpence a day, and earn it!"

Long ago, a friend told me of a lady in Devonshire, belonging to a family she knew, who read medical books, and at length imagined she had every disease under the sun. Whenever she discovered what she believed to be a new symptom, she at once went off to consult different medical men regarding it, spending several hundreds a year in this way, and all quite needlessly. At length she confided to her friends that since doctors differed so widely, and she could obtain no satisfaction as to what ailed her, she had resolved to go to town and consult one of the Queen's physicians.

A consultation was held in the family, and her nephew was sent to explain matters to the physician, in the hope of his being able to cure her hypochondria. When she reached town, the street in which the physician lived was blocked with the carriages of patients. After waiting hours, her turn at last came. The physician examined her, asked a few questions, then enquired if she had any friends in town, as he would rather call to see her when under their roof, and there tell her what he had got to say. She protested that she was quite prepared to hear the worst--that she had for long years looked death in the face--that the notices of her death were lying in her desk, all written out and addressed, only requiring the date to be filled in, etc. The physician said he was busy--more than twenty patients were still waiting in the street--he was averse to scenes, and would much prefer to see her at her friend's house. She still persisted, and begged of him to tell her all, there and then, on which he said:--"Madam, it is my melancholy duty to inform you--that there is nothing whatever the matter with you!"

This interview fortunately effected her cure, to the great delight of her friends, who paid the physician a handsome fee.

Sir Astley Cooper one year received in fees L21,000. This sum was exceptional, but for many years his income was over L15,000. His great success was achieved very gradually. "His earnings for the first nine years of his professional career progressed thus:--In the first year he netted five guineas; in the second, twenty-six pounds; in the third, sixty-four pounds; in the fourth, ninety-six pounds; in the fifth, a hundred pounds; in the sixth, two hundred pounds; in the seventh, four hundred pounds; in the eighth, six hundred and ten pounds; and in the ninth--the year in which he secured his hospital appointment--eleven hundred pounds."

On one occasion when he had performed a perilous surgical operation on a rich West Indian merchant, the two physicians who were present were paid three hundred guineas each; but the patient, addressing Sir Astley, said:--"But you, sir, shall have something better. There, sir, take that," upon which he flung his nightcap at the skilful operator. "Sir," replied Sir Astley, picking up the cap, "I'll pocket the affront." On reaching home, he found in the cap a draft for a thousand guineas from the grateful but eccentric old man.

A cynical lawyer once advised a young doctor to collect his fees as he went along, quoting the following verse to back his recommendation:--

"God and the doctor we alike adore, But only when in danger, not before; The danger o'er, both are alike requited-- God is forgotten, and the doctor slighted."

The following story illustrates the too frequent weary waiting, when hope makes the heart sick, and also shows on what curious casual incidents the success of a career may sometimes turn. It has been told in different ways, and attributed to different men, such as to Dr. Freind, and others; but, quite possibly, the same or a similar incident may have repeatedly occurred. I simply give it as it was narrated to me. A young doctor having graduated with honours, took a house at a high rent in Harley Street, London. The brass plate attracted no patients; months passed idly and drearily, and the poor fellow took to drink. One night the door-bell rang--a servant man, from a lady of title round the corner, begged him to come at once, as his mistress was dangerously ill, lying on the floor; her own doctor was out, and he was sent to fetch the first doctor he could find. The young doctor regretfully thought what a fool he was, for here was his chance, when he could not avail himself of it; but he would go, and try hard to pull himself together.

When he reached the room, he had enough conscience or sense left to know that he was not in a fit state to prescribe, and exclaiming, "Drunk, by George!" took his hat and bolted from the house. Next morning he received a scented note from the lady, entreating him not to expose her, inviting him to call, and offering to introduce him professionally to her circle! Before the season was ended, his practice was yielding him at the rate of some L1500 a year!

Curiously enough, it is recorded of a British doctor that he once actually took a fee from a dead patient. Entering the bedroom immediately after death had taken place, he observed the right hand tightly clenched. Opening the fingers, he found in them a guinea. "Ah, that was clearly for me," said the doctor, putting the gold into his pocket.

It may be remembered here, that the Royal College of Physicians, London, was founded by Thomas Linacre, physician to Henry VIII., in 1518; and that the Royal College of Physicians of Edinburgh was incorporated by Charter of Charles II., November 20th, 1681.

As to the fees paid to physicians, we find that Dr. Edward Browne, the son of Sir Thomas Browne, who became a distinguished physician in London, in his Journal, under the date of February 16th, 1664, records: "I went to visit Mr. Edward Ward, an old man in a feaver, when Mrs. Anne Ward gave me my first fee, 10 shillings."

In a work entitled "Levamen Infirmi," published in the year 1700, we find that the scale of remuneration to surgeons and physicians was as follows:--"To a graduate in physic, his due is about ten shillings, though he commonly expects or demands twenty. Those that are only licenced physicians, their due is no more than six shillings and eightpence, though they commonly demand ten shillings. A surgeon's fee is twelvepence 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."

Till recent times neither barristers nor physicians could recover their fees by legal proceedings against their clients or patients unless a special contract had been made. In the case of lawyers this custom can be traced back to the days of ancient Rome. Their services were regarded as being gratuitously rendered in the interests of friendship and justice, and of a value no money could buy. The acknowledgment given them by clients was regarded as an honorarium, and paid in advance, so that all pecuniary interest in the issue of the suit was removed, thus preserving the independence and respectability of the bar.

Equity draftsmen, conveyancers, and such like, however, could recover reasonable charges for work done.

So in the medical profession, surgeons, dentists, cuppers, and the like were always entitled to sue for their fees; but the valuable services of a consulting physician were of a different kind, not rendered for payment but acknowledged by the gratitude and honour of his patients.

But this code of honour was modified when all medical practitioners were relieved by the Act of 21 and 22 Vict. 90, which applied to the United Kingdom, and enabled them to recover in any court of law their reasonable charges as well as costs of medicines and medical appliances used. This rule applies to physicians, surgeons, and apothecaries as defined by the statute.

The following information is taken from "Everybody's Pocket Cyclopaedia" (Saxon & Co.).

LONDON MEDICAL FEES.

"Patients are charged according to their supposed income, the income being indicated by the rental of the house in which they reside. The following are the charges usually made by medical practitioners:--

----------------------------------------------------------------------- | Rentals. |------------------------------------------------ | L10 to L25 | L25 to L50 | L50 to L100 ----------------------|----------------|----------------|-------------- Ordinary Visit | 2s 6d to 3s 6d | 3s 6d to 5s | 5s to 7s 6d Night Visit | Double an | Ordinary | Visit Mileage beyond two | | | miles from home | 1s 6d | 2s | 2s 6d Detention per hour | 2s 6d to 3s 6d | 3s 6d to 5s | 5s to 7s 6d Letters of Advice | Same charge as | for an Or- | dinary Visit Attendance on Servants| 2s 6d | 2s 6d to 3s 6d | 3s 6d to 5s Midwifery | 21s | 21s to 30s | 42s to 105s | | | CONSULTANTS. | | | | | | Advice or visit alone | 21s | 21s | 21s Advice or visit with | | | another Practitioner| 21s | 21s to 42s | 21s to 42s Mileage beyond two | | | miles from home | 10s 6d | 10s 6d | 10s 6d -----------------------------------------------------------------------

"Special visits, i.e., of which due notice has not been given before the practitioner starts on his daily round, are charged at the rate of a visit and a half. Patients calling on the doctor are charged at the same rate as if visited by him.

"There are about 23,000 physicians and surgeons in the United Kingdom, or one to every 1,600 inhabitants."