Cyrus," have been my favourites for more than half a century. Of the
latter work, John Addington Symonds has finely and truly said, that "the
rarer qualities of Sir Thomas Browne's style (are) here displayed in rich
maturity and heavy-scented blossom. The opening phrase of his dedication
to Sir Thomas Le Gros--'When the funeral pyre was out, and the last
valediction over, men took a lasting adieu of their interred friends,
little expecting the curiosity of future ages should comment on their
ashes;'--this phrase strikes a key-note to the sombre harmonies which
follow, connecting the ossuaries of the dead, the tears quenched in the
dust of countless generations, with the vivid sympathy and scrutinizing
sagacity of the living writer.... I will only call attention to the unique
feeling for verbal tone, for what may be called the musical colour of
words, for crumbling cadences, and the reverberation of stationary sounds
in cavernous recesses, which is discernable at large throughout the
dissertation. How simple, for example, seems the collocation of vocables
in this phrase--'Under the drums and tramplings of three conquests!' And
yet with what impeccable instinct the vowels are arranged; how naturally,
how artfully, the rhythm falls! Take another, and this time a complete
sentence,--'But the iniquity of oblivion blindly scattereth her poppy, and
deals with the memory of men, without distinction to merit of perpetuity.'
Take yet another--'The brother of death daily haunts us with dying
mementoes.'"
I take leave of this, the most notable of English Physicians, by
transcribing the following grand, suggestive, and characteristic passage
from his "Fragment on Mummies":--"Yet in these huge structures and
pyramidial immensities of the builders, whereof so little is known, they
seemed not so much to raise sepulchres or temples to death, as to contemn
and disdain it, astonishing heaven with their audacities, and looking
forward with delight to their interment in those eternal piles. Of their
living habitations they made little account, conceiving of them but as
_hospitia_, or inns, while they adorned the sepulchres of the dead, and
planting them on lasting basis, defied the crumbling touches of time and
the misty vaporousness of oblivion. Yet all were but Babel vanities. Time
sadly overcometh all things, and is now dominant, and sitteth upon a
sphinx, and looketh unto Memphis and old Thebes, while his sister Oblivion
reclineth semisomnous on a pyramid, gloriously triumphing, making puzzles
of Titanian erections, and turning old glories into dreams. History
sinketh beneath her cloud. The traveller, as he paceth amazedly through
those deserts, asketh of her, who builded them? and she mumbleth
something, but what it is he heareth not."
The medical profession is a noble and pleasant one, though laborious and
often full of anxiety, straining mind and body. The good physician is the
sympathizing, confidential, and comforting _friend_ of the family. He
values the humble gifts and testimonials of gratitude from the poor, even
more than the costly presents of the rich.
The virtuous poor are always grateful. It can truly be said of the
physician's kind and often gratuitous services to them, in the language of
scripture:--
"When the ear heard me, then it blessed me; and when the eye saw me it
gave witness to me; because I delivered the poor that cried, and the
fatherless, and him that had none to help him. The blessing of him
that was ready to perish came upon me; and I caused the widow's heart
to sing for joy."
Among savages, sorcerers, and magicians, are the medicine men; these are
still represented, in civilisation, by impostors and quacks. Members of
the profession, as a rule, keep themselves posted up in the medical
science of the day, honestly and unselfishly do everything that can be
done for their patients, and rejoice in being the means of their recovery,
far more than in their fee.
Burton, in his "Anatomy of Melancholy," treating of "Physician, Patient,
and Physick," when astrology, ignorance, and queer nostrums, were then
more in vogue than practical science, says:--"I would require Honesty in
every Physician, that he be not over careless or covetous, Harpylike to
make a prey of his patient, or, as an hungry Chirurgeon, often produce and
wire-draw his cure, so long as there is any hope of pay. Many of them, to
get a fee, will give physic to every one that comes, when there is no
cause, thus, as it often falleth out, stirring up a silent disease, and
making a strong body weak." Burton then quotes the following sensible
Aphorism from Arnoldus:--"A wise physician will not give physick, but
upon necessity, and first try medicinal diet, before he proceedeth to
medicinal cure."
Latimer thus severely censured the mercenary physicians of his day:--"Ye
see by the example of Hezekiah that it is lawful to use physick. But now
in our days physick is a remedy prepared only for rich folks, and not for
the poor, for the poor man is not able to wage the Physician. God indeed
hath made physick for rich and poor, but Physicians in our time seek only
their own profits, how to get money, not how they might do good unto their
poor neighbour. Whereby it appeareth that they be for the most part
without charity, and so consequently not the children of God; and no doubt
but the heavy judgment of God hangeth over their heads, for they are
commonly very wealthy, and ready to purchase lands, but to help their
neighbour, that they cannot do. But God will find them out one day I doubt
not."
"Empirics and charlatans are the excrescences of the medical profession;
they have obtained in all ages, yet the healing art is not necessarily the
occasion for deception; nor the operations of witchcraft, charms, amulets,
astrology, alchemy, necromancy, or magic; although it has its mysteries
like other branches of occult science."
Paracelsus, the prince of charlatans, styled himself "King of Physic,"
but, though he professed to have discovered the _elixir of life_, he
humbly died at the early age of forty-eight years.
We are told of a patient who, instead of the medicine prescribed,
swallowed the prescription! and _Punch_ records an extraordinary case of a
voracious individual who bolted a door, and threw up a window!
Sydney Smith, on being told by his doctor to take a walk on an empty
stomach, asked--"Upon whose!" But a truce to stories suggested by the
queer nostrums of quacks.
Empirics, however, often believed in their nostrums, and were, sometimes,
amiable and unselfish.
In the year 1776, we are told, there lived a German doctor, who styled
himself, or was called, "the Rain-water doctor;" all the diseases to which
flesh is heir he professed to cure by this simple agent. Some wonderful
cures were, it is said, achieved by means of his application of this
fluid, and his reputation spread far and wide; crowds of maimed and
sickly folk flocked to him, seeking relief at his hands. What is yet more
remarkable still, he declined to accept any fee from his patients!
Dr. Haygarth, of Bath, had a pair of wooden tractors made in precisely the
same shape and appearance as Perkin's metallic ones; and the same results
followed as when the others, which cost five guineas a pair, were used.
The story is well known of the condemned criminal in Paris, who was laid
on a dissecting table, strapped down, with his eyes bandaged, and slightly
pricked, when streamlets of water set a-trickling made him think, as he
had been told, that he was being bled to death. His strength gradually
ebbed away, and he actually died, although he did not lose a drop of
blood.
I knew of a gentleman who, when pills to procure sleep were ordered to be
discontinued, lay awake. The doctor made up a box of bread pills, which
were administered as the others had been, and the patient slept, and
recovered rapidly.
A young medical man fell in love with a young lady patient, and, when he
had no longer any pretext for continuing his visits, he sent her a present
of a pair of spring ducks. Not reciprocating his attentions, she did not
acknowledge the present, upon which he ventured to call, asking if the
birds had reached her. Her reply was--"Quack, quack!"
Dr. Lettsom, a quaker in the time of George III., near the close of the
last century, had such an extensive practice that his receipts in some
years were as much as L12,000; and this although half his services were
entirely gratuitous, and rendered with unusual solicitude and care to
necessitous clergymen and literary men. Generosity was the ruling feature
of his life. On one occasion he attended an old American merchant whose
affairs had gone wrong, and who grieved over leaving the trees he had
planted. The kind hearted doctor purchased the place from the creditors,
and presented it to his patient for life.
Pope, a few days before his decease, bore the following cordial testimony
to the urbanity and courtesy of his medical friends:--"There is no end of
my kind treatment from the Faculty; they are in general the most amiable
companions, and the best friends, as well as the most learned men I know."
And Dryden, in the postscript to his translation of Virgil, speaks in the
same way of the profession. "That I have recovered," says he, "in some
measure the health which I had lost by too much application to this work,
is owing, next to God's mercy, to the skill and care of Dr. Guibbons and
Dr. Hobbs, the two ornaments of their profession, whom I can only pay by
this acknowledgment."
When Dr. Dimsdale, a Hertford physician and member of Parliament, went
over to Russia to inoculate the Empress Catherine and her son, in the year
1768, he received a fee of L12,000, a pension for life of L500 per annum,
and the rank of Baron of the Empire.
Dr. Henry Atkins was sent for to Scotland by James the Sixth to attend
Charles the First (then an infant), ill of a dangerous fever. The King
gave him a fee of L6000, with which he purchased the manor of Clapham.
Louis XIV. after undergoing an operation, gave his physician and his
surgeon 75,000 crowns each.
Dr. Glynn once attended the only son of a poor peasant woman, ministering
to his wants with port wine, bark, and delicacies. After the lad's
recovery, his mother waited on the doctor, bringing a large wicker basket
with an enormous magpie, which was her son's pet, as a fee to show their
gratitude.
A thousand pounds were ordered to be paid to Sir Edmund King for promptly
bleeding Charles the Second, but he never received this fee.
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."
It has been my privilege to know several doctors intimately. Our family
doctor when I was a boy in Paisley, was Dr. Kerr, a man far in advance of
his day. He was the means of introducing a pure water supply to the town
of Paisley, always strenuously urging the importance of sanitary matters
and good drainage, when such things were then but little understood, and
greatly neglected. Shortly after the water had been introduced to the
houses, from Stanley, an old man--who had been accustomed to purchase
water from a cart which went through the streets selling it from a
barrel--on being asked how he liked the new water, replied indignantly,
"Wha's going to pay good siller for water that has neither smell nor
taste?"
On one occasion, an elderly gentleman, who was slightly hypochondriac,
consulted Dr. Kerr about his clothing, saying that he regulated the
thickness of his flannels by the thermometer. Dr. Kerr, losing patience,
said, "Can you not use the thermometer your Maker has put in your inside,
and put on clothes when you are cold?"
Dr. Kerr's son and assistant, whom we then called "the young doctor," died
a few years ago in Canada, over eighty years of age. No man could
possibly have been more considerately kind, gentle, and tender-hearted. On
one occasion, in 1841, when, in typhus fever, I was struggling for my
life, he sat up with me for three whole consecutive nights, and brought me
through. He ever kept himself abreast of the science of the day, and
devoted his abilities and energies, _con amore_, to the benefitting of
men's souls as well as their bodies.