PHYSICIANS AND THEIR FEES.
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."