Virginia was the only colony that tried to draw legislative boundaries around the various aspects of medical practice. The effort came in 1736 in the form of “an Act for Regulating the Fees and Accounts of the Practicers of Phisic.” On two grounds the act deserves to be quoted at some length. For one thing, it throws a good light on the state of medical practice at that time. For another, it affords undeniable parallels to some current problems in the cost of medicines and medical care, and to the role of government in serving the interests of the “consumer.”

The first section of the act recited certain abuses, especially of the surgeons and apothecaries:

I. Whereas the practice of phisic in this colony, is most commonly taken up and followed, by surgeons, apothecaries, or such as have only served apprenticeships to those trades, who often prove very unskilful in the art of a phisician; and yet do demand excessive fees, and exact unreasonable prices for the medicines which they administer, and do too often, for the sake of making up long and expensive bills, load their patients with greater quantities thereof, than are necessary or useful, concealing all their compositions, as well to prevent the discovery of their practice, as of the true value of what they administer: which is become a grievance, dangerous and intolerable, as well to the poorer sort of people as others, & doth require the most effectual remedy that the nature of the thing will admit.

The second section then proceeded to emphasize the chief distinction between the apprentice-trained apothecary-surgeons and the university-educated physicians by allowing the latter to charge twice as much for their services as the former could. If the apothecaries and surgeons felt—as well they might have—that the difference in fees was an insult to them, it did not last long. The law was not renewed at the following session of the Assembly; perhaps its backers, the physicians, had seen their patients flock to the lower-priced practicers.

Although Virginia was the only colony to set medical fees by law, the practice of legislative price fixing in other areas of the economy was as common in colonial America as it was in England. In Virginia, to be specific, not only prices and quantities but in some cases even qualities of goods and services offered to the public by tavernkeepers, shoemakers, millers, and ferrymen were regulated by law. The economic philosophy and terminology of laissez faire were among the alien isms imported after 1776. During the colonial years, government rarely hesitated to act in the economic field where the need was felt.

From this particular Virginia law of 1736 it would appear that some if not all medical charges had gotten well out of line—the correct line, of course, being what the people and their elected representatives thought was reasonable:

II. BE it therefore enacted, ...

That from and after the passing of this act, no practicer in phisic, in any action or suit whatsoever, hereafter to be commenced in any court of record in this colony, shall recover, for visiting any sick person, more than the rates hereafter mentioned: that is to say,

Surgeons and apothecaries, who have served an apprenticeship to those trades, shall be allowed,

	£	s	d
For every visit, and prescription, in town, or within five miles	00	5	00
For every mile, above five, and under ten	00	1	00
For a visit, of ten miles	00	10	00
And for every mile, above ten	00	00	06
With an allowance for all ferriages in their journeys.
To Surgeons, For a simple fracture, and the cure thereof	02	00	00
For a compound fracture, and the cure thereof	04	00	00

But those persons who have studied phisic in any university, and taken any degree therein, shall be allowed,

For every visit, and prescription, in any town, or within five miles	00	10	00
If above five miles, for every mile more, under ten	00	1	00
For a visit, if not above ten miles	1	00	00
And for every mile, above ten	00	1	00
With an allowance of ferriages, as before.

Lest it appear that all Williamsburg “practicers” made a habit of charging excessive fees, the generous treatment an earlier doctor gave at least one of his patients must be set down. George Hume, a Scottish merchant who came to Virginia about 1722 and soon caught all the prevalent ills, found the place “only good for doctors and ministers who have very good encouragem’nt here.” One of the “common distempers” that afflicted Hume was dysentery, then called the flux. He was laid so low that Dr. John Brown all but despaired of his life. Hume’s gratitude for being cured was doubtless enhanced by the fact—carefully reported to his Scottish relatives—that “ye Dr. took nothing for my druggs.”

The third section of the act, specifying exactly what the “practicer of phisic” should set forth in his bill, bears if least a faint augury of modern food-and-drug labeling legislation:

III. And to the end the true value of the medicines administered by any practicer in phisic, may be better known, and judged of, Be it further enacted, by the authority aforesaid, That whenever any pills, bolus, portion, draught, electuary, decoction, or any medicines, in any form whatsoever, shall be administered to any sick person, the person administering the same shall, at the same time, deliver in his bill, expressing every particular thing made up therein; or if the medicine administered, be a simple, or compound, directed in the dispensatories, the true name thereof shall be expressed in the same bill, together with the quantities and prices, in both cases. And in failure thereof, such practicer, or any apothecary, making up the prescription of another, shall be nonsuited, in any action or suit hereafter commenced, which shall be grounded upon such bill or bills: Nor shall any book, or account, of any practicer in phisic, or any apothecary, be permitted to be given in evidence, before a court; unless the articles therein contained, be charged according to the directions of this act.

This final section reveals that some differentiation between the branches of the medical profession had already begun in America. The tip-off is the phrase that imposes on “any apothecary making up the prescription of another” the same requirements as on physicians who make up their own prescriptions.