DOCTORS’ FEES AND INCOMES.
ANCIENT FEES.—LARGE FEES.—SPANISH PRIEST-DOCTORS.—A PIG ON PENANCE.—SMALL FEES.—A “CHOP” POSTPONED.—LONG FEES.—SHORT FEES.—OLD FEES.—A NIGHT-CAP.—AN OLD SHOE FOR LUCK.—A BLACK FEE.—“HEART’S OFFERING.”—A STUFFED CAT.—THE “GREAT GUNS” OF NEW YORK.—BOSTON.—ROTTEN EGGS.—“CATCH WHAT YOU CAN.”—FEMALE DOCTORS’ FEES.—ABOVE PRICE.—“ASK FOR A FEE.”—“PITCH HIM OVERBOARD.”—DELICATE FEES.—MAKING THE MOST OF THEM. The great German physician who wrote the above died (as he ought, for putting so much truth into four lines) in 1538. He, of all physicians of his day, earned his fees; but it is often the case that the most deserving get the least reward, and Cordus was not an exception to the rule. A good physician, or surgeon, is seldom a sharp financier, and vice versa. “It is hard to serve two masters.” Ancient physicians’ fees were much larger, considering the difference in the value of money, than modern. Erasistratus, in the year 330 B. C., received from General Seleucus, of Alexander’s army, to whom the kingdom of Syria fell at the termination of the Macedonian conquest, the enormous sum of 60,000 crowns as a fee for his discovery of the disorder of the general’s son, Antiochus. The Emperor Augustus employed four physicians, viz., Albutus, Arantius, Calpetanus, and Rubrius, to each of whom he paid Large Fees. French physicians were never very well paid. The surgeons of Charlemagne were tolerably well recompensed. Ambrose Pare, the great surgeon, and inventor of ligatures (for peculiar arteries),—previous to whose time the arteries were seared with a hot iron; otherwise the patient bled to death,—received 5,000 francs for ligaturing one artery. Louis XIV. gave his surgeons 75,000 crowns each for successfully performing upon him a surgical operation. Upon the confinement of Maria Louise, second wife of the great Napoleon, four physicians—Bourdier, Corvisat, Dubois, and Ivan—received the sum of $20,000. Dubois was the principal, and received one half of the amount,—not a very extravagant remuneration; but then Napoleon held a mean opinion of physicians in general, and this fee was not to be wondered at. Dupuytren, the distinguished French surgeon, left a property of $1,580,000. Hahnemann, who, in 1785, at Dresden, abandoned physic in disgust, afterwards went to Paris, and at the time of his death was literally besieged with patients, reaping a reward for his labors of not less than $40,000 per annum. Boerhaave was a successful practitioner, born at Leyden, and left, at his death, $200,000 from private practice. John Stow, the eminent antiquarian writer, whose misfortunes compelled him to beg his daily bread at the age of eighty, informs us that “half a crown (English) was looked upon as a large fee in Holland, while in England, at that same time, a physician scorned to touch any fee but gold, and surgeons were still more exorbitant.” In Spain, until a very remote period, the priests Anthony Gavin, formerly a Catholic priest of Spain, says, “I saw Fran. Alfaro, a Jew, in Lisbon, who told me that he was known to be very rich, when in Seville, where the priests finally stripped him of all his wealth, and cast him into the Inquisition, where they kept him four years, under some pretence, and finally liberated him, that he might accumulate more property. After three years’ trade, having again collected considerable wealth, he was again imprisoned and his wealth confiscated by the priest-doctors, but let off, with the order to wear the mark of San Benito (picture of a man in the midst of the fire of hell) for six months. “But Alfaro fled from the city, and finding a pig near the gate, he slipped the San Benito over the pig’s neck, and, sending him into the town, made his escape. ‘Now I am poor,’ he added, ‘nobody wants to imprison me.’” English Fees and Incomes. In no other country have physicians’ fees varied so much as in England. The Protestant divine and the physician have kept step together to the music of civilization and enlightenment. Both of these professions were held at a low estimation up to the Elizabethan era, when a young, unfledged M. D. from Oxford would gladly accept a situation in a lord’s family for five or ten pounds a year, with his board, and lodgings in the garret, while, in addition to professional services he might act as sort of wise clown, “and be a patient listener, the solver of riddles, and the butt of ridicule for the family and guests. He might save the expense of a gardener—nail up the apricots; or a groom, and sometimes curry down and harness the horses; cast up the farrier’s or butler’s accounts, or carry a parcel or message across the country.” As was said also of the divine, “Not one living in fifty enabled the incumbent to bring up a family comfortably. As the children multiplied, the household became more beggarly. Often it was only by toiling on his glebe, by feeding swine and by loading dung-carts, that he could gain his daily bread.... His sons followed the plough, and his daughters went out to service.” Queen Elizabeth’s physician in ordinary received one hundred pounds per annum and perquisites—“sustenance, wine, wax, and etceteras.” Morgan, her apothecary, for one quarter’s bill was paid £18 7s. 8d. A one pound fee, paid by the Earl of Cumberland to a Cambridge physician, was considered as exceptionally liberal, even for a nobleman to pay. Edward III. granted to his apothecary, who acted in the capacity of physician in those days, a salary amounting to six pence a day, and to Ricardus Wye, his surgeon, twelve pence per day, besides eight marks. (A mark was 13s. 4d.) In the courts of the kings of Wales, the A parsimonious friend, consulting Mayerne, laid two broad pieces of gold (sixty shillings) on the doctor’s table, to express his generosity, as he felt safe that they would be immediately returned to him. But Mayerne quietly pocketed them, saying,— “I made my will this morning, and if it became known that I had refused a fee, I might be deemed non compos mentis.” Anecdote of James Coythier. This jolly doctor was employed by Louis XI., and was said to have sponged immense sums from his royal master, beyond a regular salary. “He wrung favor upon favor from the king, and if he resisted the modest demands of his physician, the latter threatened him with speedy dissolution. On this menace, the king, succumbing to the fear of death, which weakness characterized his family, would at once surrender at discretion.” Finally, to rid himself of such despotic demands, the king ordered the executioner to behead the physician. The requisite officer waited on Coythier, and in a courteous and considerate manner, as became the occasion, said to him,— “I deeply regret, my dear sir, the circumstance, but I must kill you. The king can stand you no longer, and here are my orders.” “All right,” replied the doctor, with surprising unconcern; “I am ready whenever you are. What time would you find it most convenient to perform the little operation?” While the officer was trying to decide, Coythier continued,— The officer stood struck with amazement, but finally returned and imparted the astounding information to the king. “O, liberate him instantly. Hurt not a hair of his head,” exclaimed the terrified monarch. Coythier was of course speedily restored to his place in the king’s confidence—and treasury. A Long Fee. Here is what may be called a long fee:— An English surgeon, named Broughton, had the good fortune to open the commerce of the East Indies to his countrymen through a medical fee. Having been sent from Surat to Agra, in the year 1636, to treat a daughter of the emperor Shah Jehan, he had the great fortune to restore the princess. Beyond the present reward to the physician for his great services, the emperor gave him the privilege of a free commerce throughout the whole extent of his domains. Scarcely had Broughton returned than the favorite nabob of the province—Bengal—sent for the doctor to treat him for a very dangerous disease. Having fortunately restored this patient also, the nabob settled a pension upon the physician, and confirmed the privilege of the emperor, extending it to all Englishmen who should come to Bengal. Broughton at once communicated this important treaty, as it was, to the English governor at Surat, and, by the advice of the latter, the company sent from England, in 1640, the first ship to trade at Bengal. Such was the origin of the great Indian commerce, which has been continued to the present day,—the longest continued doctor’s fee ever given. Another long fee was that given to Dr. Th. Dinsdale, who travelled from England to St. Petersburg by order of A Short Fee. This is how a physician fell short of his fee. Charles II. was taken suddenly and dangerously ill with apoplexy. The court physician being out of town, Dr. King, who only being present, with one attendant, instantly bled his majesty, to which “breach of court etiquette” John Evelyn attributes his salvation for the time; for he would certainly have died, had Dr. King staid the coming of the regular physician—for which act he must have a regular pardon! The privy council ordered a handsome fee to be paid Dr. King for his great presence of mind and prompt action, but it never was paid. Charles died soon afterwards, and poor King fell short of a fat fee. Odd Fees. Amongst the many funny things told about Sir Astley Cooper, the eminent English surgeon, none is better authenticated than that respecting the “night-cap fee.” In his earlier practice, he had to pass through all the trials and tribulations, “anxious and ill-rewarded waitings,” that lesser stars have before and since, and ever will, before he became “established.” In his first year’s practice in London, his profits were but five guineas; his second reached the encouraging sum of twenty-five pounds, and increased in this ratio till the ninth year, when it was one thousand pounds. In one year he made twenty-one thousand guineas. It is said that one merchant of London paid him annually six hundred pounds. It wouldn’t require but a few such A West India millionnaire, named Hyatt, had been to London, and undergone a severe and dangerous surgical operation at the hands of Sir Astley, assisted by Drs. Lettsom and Nelson. The operation proved a success, and the grateful patient only waited till he could sit up in bed a little while at a time before expressing in some measure his gratitude to the physicians. All three being present one day, Hyatt arose in bed and presented the two physicians with a fee of three hundred gold guineas, and, turning to Sir Astley, who seemed for a moment to have been slighted, the millionnaire said,— “And as for you, Sir Astley, you shall have nothing better than that,” catching off his night-cap, and flinging it almost into Sir Astley’s handsome face—he was said to be the handsomest man in England; “there, take it, sir.” “Sir,” exclaimed the surgeon, with a smile, “I pocket the affront.” On reaching home, and examining the night-cap, he found it contained one thousand guineas—nearly five thousand dollars. An Old Shoe. Quite as odd a fee was that presented to a celebrated New York surgeon about the year 1845. An eccentric old merchant, a descendant of one of the early Dutch families of Manhattan Island, was sick at his summer residence on the Hudson, where his family physician attended him. The doctor gave him no encouragement that he ever would recover. A most celebrated surgeon, since deceased, was called as counsel, who, after careful examination of the case, and considering the merchant’s age, coincided with the opinion of the family physician, and so expressed himself to the patient. “Here, throw this old shoe after him, telling him that I wish him better luck on the next patient;” and drawing off his embroidered slipper, he gave it to the servant, who, well used to his master’s whims, as well as confident of his generosity, ran after the doctor, flinging the shoe, and giving the message, as directed. The surgeon felt sure of his fee, well knowing the ability of the eccentric merchant; but he picked up the shoe, and placing it in his coat pocket, said to his brother physician, who accompanied him, “I’ll keep it, and I may get something, to boot.” It contained, stuffed into the toe, a draft for five hundred dollars. A Black Fee. Dr. Robert Glynn, of Cambridge, England, who died nearly eighty years ago, was a most benevolent man, as well “On one occasion a poor peasant woman, the widowed mother of an only son, trudged from the heart of the fens (ten miles) into Cambridge, to consult the good doctor about her boy, who was very sick with the ague. Her manner so interested the doctor that, though it was during an inclement winter, and the roads almost impassable by carriages, he ordered horses harnessed, and taking in the old lady, went to see the sick lad. “After a tedious attendance, and the exhibition of much port wine and bark, bought at the physician’s expense, the patient recovered. A few days after the doctor had taken his discharge, without fees, the poor woman presented herself at the consulting-room, bearing in her hands a large basket. “‘I hope, my good woman, your son is not ill again,’ said the doctor. “‘O, no, sir; he was never better,’ replied the woman, her face beaming with gratitude; ‘but he can’t rest quiet for thinking of all the trouble you have had, and so he resolved this morning to send you this;’ and she began undoing the cover of the large wicker basket which she had set on the floor. The doctor stood overlooking the transaction in no little concern. Egress being afforded, out hopped an enormous magpie, that strutted around the room, chattering away as independent as a lord. “‘There, doctor, it is his favorite magpie he has sent you,’ exclaimed the woman, looking proudly upon the piece of chattering ebony. It was a fee to be proud of.” A Heart’s Offering. The gratitude of the poor country lad for his recovery did not exceed, probably, that of a young girl, as related “A young girl, fourteen years of age, named Celia ——, called at the hotel to-day where Dr. C., with his family, is stopping, and presenting him with a bouquet of Mayflowers, said, ‘I have no money to pay you for curing my head of scrofula, and I thought these flowers might please you.’ This was truly the offering of a grateful heart; for her head had been entirely covered by sores, from her birth, and the doctor had cured it. Another journal said, in commenting upon it, ‘This heart’s offering deeply affected the doctor, to whom it was a greater reward than any money recompense could have been.’ The doctor has the withered and blackened flowers and leaves pressed, and hung in a frame in his A Stuffed Cat-skin. An eccentric and parsimonious old lady, who died in a small village in the State of Maine, some twenty years ago, always kept a half dozen cats about the house. She was a dried-up-looking old crone, and some ill-minded people had gone so far as to call her a witch, doubtless because of her The woman paid no bills that she could avoid, always pleading poverty as her excuse for the non-fulfilment of her responsibilities. One dark and stormy night she was taken very sick, and by a preconcerted signal to a neighbor,—the placing of a light in a certain window,—help was summoned, including the village doctor, to whom she owed a fee for each visit he had ever made her. But this was fated to be the doctor’s last call to that patient. “O, doctor, then I am dying at last—am I?” The physician assured her such was the case. “Then, doctor, I must tell you that you’ve been very patient with me, and have hastened day or night to see me, in my whims, as well as my real sickness, and you shall be rewarded. I have no money, but you see all my treasures arranged along on the mantel-piece there?” “What!” exclaimed the doctor; “you don’t call those cats treasures, I hope!” “Yes, they are my only treasures, doctor. Now, I want to be just to you, above all others, because you’ve not only served me as I said, but you’ve often sent me wood and provisions during the cold winters—” Here she became too feeble to go on, and the doctor revived her with some cordial from his saddle-bags, when she took breath, and continued,— “See them, doctor; eleven of them. Which will you choose?” Her dying words so impressed him, that he took the cat home, and, on opening her,—for it was very heavy,—he found that the skin contained nearly a hundred dollars, in gold. American Fees and Incomes. There is a surgeon in New York city whose income from practice outside of the hospital is said to be twenty-five thousand dollars per annum. Dr. Valentine Mott, the celebrated New York surgeon, who died April 26, 1865, at the age of eighty-one years, had a very large income, but less than that enjoyed by several surgeons in the metropolis at the present time. There are some specialists in New York, Philadelphia, and Boston, who receive greater sums annually than the regular medical or surgical practitioners. There is no law particularly controlling the prices of the former. The fee for a visit, by the established usage of the medical societies in these cities, is from three to ten dollars. A specialist sometimes receives fifty to one hundred dollars for prescribing in a case, for which another physician, in ordinary practice, would charge but an office fee of two to ten dollars. A quack specialist—and an impostor—in the latter city makes his brags that he has received twelve hundred dollars for one prescription. But then this same lying braggadocio says he has read medicine with Ricard, and had various honors conferred upon him. Dr. Pulte, of Ohio, one of the western pioneers in homeopathy, who has often been greeted, in his earlier professional rounds, by a shower of dirt, rotten eggs, stones, Dr. Bigelow, the very celebrated surgeon of Harvard College, has probably received the largest fee for a surgical operation of any New England practitioner. He is said to be worth nearly a million. Dr. Buckingham, the eminent medical practitioner, of Boston, who probably earns as much as any physician in the city, a few years ago stated to the graduating class of Harvard College—so I am informed by a physician then present—that he received for his first year’s practice in Boston “Catch what you can.”—There is a class of wretches in every city who have no established fee for prescribing for the sick. They go on the principle of “catch what I can.” If they cannot get a fee of twenty dollars, they will take two, provided the patient has no more. A young man who visited one of these medical shave-shops was charged a fee of thirty-five dollars in a very simple case; but the benevolent doctor concluded to accept two dollars and a half instead, since the man had no more money. The shamefulness of such Jewing reminds one of the story of a negro trading off a worn-out old mule:— “I say, dar, what will you take for dat yer mule, Cuffy?” “O, I axes thirty-five dollars for him, Mr. Sambo.” “O, go way, dar. I gibs you five dollars for him,” said the first. “Well, you can take him, Sambo. I won’t stand for thirty dollars on a mule trade, nohow.” There is a female practitioner in St. Louis who earns above ten thousand dollars a year, and her individual fees are moderate at that. Another doctress, Mrs. Ormsby, of Orange, N. J., accumulates some fifteen thousand a year, and is in turn outstripped by another woman practising in New York, who gets nearly twenty thousand dollars a year. Such certainly possess great business tact, with or without professional merit, and for such let all men give them credit. Several female doctors in Boston receive from three to five thousand dollars each, yearly. I presume nearly every physician who has experienced a dozen years in practice has some mementos of his poor patients’ gratitude, in the form, if not of an ebony bird, or a black cat-skin, of something possessing more beauty, and, “Who has not kept some trifling thing, A very benevolent physician, and a sexagenarian, of New York city, wrote, twenty years ago, “I even yet enjoy a sort of melancholy satisfaction in hastening to relieve the suffering poor of my neighborhood, though I know that my reward will be very small, or, what is far more frequent, that I shall be paid with ingratitude, if not slander. “Sometimes there are bright spots in my horizon, and I think myself more than repaid by a new shirt, or a couple of handkerchiefs—the gift of some poor, though grateful sewing girl. A few of these little treasures I prize with peculiar tenderness.” “A tress of hair and a faded leaf Asking for a Fee. A Boston M. D., who had been in practice fourteen years without accumulating any property, was about to abandon the profession, and, with this view, he applied to Fowler, the phrenologist, with the question, “What pursuit am I best adapted to follow?” Mr. Fowler, with whom he was unacquainted, said, “The practice of medicine;” but, at the same time, he assured the doctor that he ought to do business on a cash principle,—“accipe dum dolet,”—or employ a collector, as he would never collect his fees. Acting on this hint, the doctor returned to his practice, and in a few years was out of debt, and owned a fine residence. A New York student—if report is true—began earlier to be impressed with the propriety of getting his fee in advance, as the following will show. He went before the censors for examination. One of the board was a well-known penurious, fee-loving doctor, who, looking over the list of names of the applicants, said,— “Mr. ——, if a patient came to your office, what would you first do?” “I would ask him for a fee, sir,” was the prompt reply. An old navy surgeon relates the following regarding examinations:— “I was shown into the examining-room. Large table, and a half dozen old gentlemen at it. ‘Big wigs, no doubt,’ I thought, ‘and, sure as my name is Symonds, they’ll pluck me like a pigeon.’ “‘Well, sir, what do you know about the science of medicine?’ asked the stout man in the head seat. “‘More than he does of the practice, I’ll be bound,’ tittered a little wasp-like dandy—a West End ladies’ doctor. “I trembled in my shoes. “‘Well, sir,’ continued the first, ‘what would you do if during an action a man was brought to you with both arms and legs shot off? Now, sir, speak out; don’t keep the board waiting. What would you do?’ “‘By Jove, sir,’ I answered, ‘I would pitch him overboard, and go on to some one else to whom I could be of more service.’ “By thunder! every one present burst out laughing, and they passed me directly—passed me directly.” Delicate Fees. There are certain delicate cases, usually terminating in “good news,” in which it has long been an established custom for the physician to receive a double fee. “A father just We insert the following poetry (!) for the fun of the thing; nevertheless, it is within the experience of more than one physician, who, after doing his duty, exhibiting his best professional ability, and saving the wife of some miserable, worthless fellow, who never deserved such a godsend for a companion, has cheated the doctor out of his fees from spite, when, if the poor woman had died, he would have liberally paid the physician. Let no man take this to himself. “A woman who scolded one day so long “Make the most of him.” It has been said that physicians have been known to benevolently play a fee into a brother’s hand when their own palm failed to be broad enough to hold them all. Perhaps the reader may derive amusement or instruction from the following, in which case the writer is well repaid for their insertion:— “A wealthy tradesman, after drinking the waters of the “‘I wonder what Dr. —— has advised the Bristol physician respecting my case;’ and giving way to his curiosity, or anxiety, he opened the letter, and read,— “‘Dear Doctor: The bearer is a fat Wiltshire clothier; make the most of him. Yours, professionally, ——.’” Clutterbuck, the historian, and a pleasant writer, tells the following of his uncle, who was a physician:— “A nervous old lady, a patient of his, took it into her crotchety old head to try the Bath waters, and applied to her physician for permission. “‘The very thing I have been thinking to recommend,’ he replied; ‘and I know an excellent physician at the wells, to whom I will give you a letter of introduction.’” With her letter and a companion, she started for the springs. En route she took out the letter, and, after looking at the address some time, her curiosity overcame her, and she said to her friend, “So long as the doctor has treated me, he has never told me what my case is, and I have a mind to just look into this letter and see what he has told the Bath physician about it.” In vain her friend remonstrated against such a breach of trust. The old lady opened the epistle, and read the following instructive words:— “Dear Sir: Keep the old woman three weeks, and send her back.” |