Such is the perversity of our nature, that the remuneration given with the
greatest reluctance is the reward of those who restore us, or who
conscientiously endeavour to restore us to health. The daily fees, it is
true, are not handed with regret, for the patient is still suffering; but
if they were to be allowed to accumulate to a considerable amount, they
would be parted with, with a lingering look. The lawyer's charges for a
ruinous litigation, the architect's demands for an uncomfortable house,
are freely disbursed, though if exorbitant they may be taxed; but the
doctor's--a guinea a visit!--is sheer extortion. 'Send for the apothecary:
the physician merely gives me advice; the apothecary will send me plenty
of physic: at any rate I shall have something for my money.'
To what can this unjust, this illiberal feeling be attributed? Simply to
vanity and pride. Illness and death level all mankind. The haughty
nobleman, who conceives himself contaminated by vulgar touch, can scarcely
bring himself to believe that he is placed upon the same footing as a
shoe-black. All _prestiges_ of grandeur and worldly pomp vanish round the
bed of sickness; and the suffering peer would kneel before the humblest
peasant for relief. Then it is that money would be cheerfully lavished to
mitigate his sufferings. But how soon the scene is changed! The patient is
well, thrown once more in the busy vortex of business or of pleasure. He
had been slightly indisposed; his natural constitution is excellent: the
doctors mistook his case; thought him very ill, forsooth; but nature cured
him.
Could the ambitious mother admit for one moment that her daughter had been
seriously ill?--a sick wife is an expensive article! If her medical
attendant unfortunately hinted that the young lady had been in danger, he
is considered a busy old woman, exaggerating the most trifling ailment to
obtain increase of business; in fact, a dangerous man in a family where
there are young persons--to be provided for. Nor can we marvel at this. No
one likes to be considered morally or physically weak, excepting
hypochondriacs, who live upon groans, and feel offended if you tell them
that they do not look miserable. The soldier will describe the slightest
wound he received in battle as most severe and dangerous; a feeling of
pride is associated with the relation. The bold hunter will boast of a
fractured limb; the accident showed that he was a daring horseman. Nay,
the agonizing gout is a fashionable disease, which seems to proclaim good
living, good fellowship, and luxury: it is, in short, a gentlemanly
disease. But the slow ravages of hereditary ailments, transmitted from
generation to generation with armorial bearings, the development of which
may be averted by proper care, or hurried on by fashionable imprudence!
how difficult even to hint to a family the presence of the scourge, when,
through the transparent bloom of youth and beauty, our experienced eye
reads the fierce characters of death in the prime of years. The aerial
coronet floats in fond visions before the doting mother's ambitious eyes.
A man would be a barbarian, nay, a very brute, to deprive the darling girl
of the chances of Almacks, the delights of the pestiferous ball-room, or
the galaxy of court or opera!
To attend the great is deemed the first stepping-stone to fortune, and
patronage is considered as more than an equivalent of remuneration. Too
frequently does the physician placed in that desirable situation forget
what Hippocrates said of the profession. "The physician stands before his
patient in the light of a demi-god, since life and death are in his
hands."
Curious anecdotes are related of this unbecoming subserviency. A courtly
doctor, when attending one of the princesses, was asked by George III. if
he did not think a little ice might benefit her. "Your majesty is right,"
was the reply; "I shall order some forthwith." "But perhaps it might be
too cold," added the kind monarch. "Perhaps your majesty is right again;
therefore her royal highness had better get it warmed."
This absurd deference to rank and etiquette by a physician who at the
moment is superior to all around him, reminds one of an account given by
Champfort of a fashionable doctor. "D'Alembert was spending the evening at
Madame Du Deffand's, where were also President Henault and M. Pont de
Vesle. On this flexible physician's entering the room, he bowed to the
lady with the formal salutation, '_Madame, je vous presente mes tres
humbles respects_.' Then, addressing M. Henault, '_J'ai bien l'honneur de
vous saluer_.' Turning round to M. de Vesle he obsequiously said,
'_Monsieur, je suis votre tres humble serviteur_;' and at last,
condescending to speak to D'Alembert, he nodded to him with a '_Bonjour,
Monsieur_!'" On such occasions a condescending smile from power is
considered a fee.
Reluctance in remunerating medical attendants was also manifested by the
ancients; and Seneca has treated the subject at some length. The
difficulty in obtaining remuneration has unfortunately rendered many
physicians somewhat sordid, and loth to give an opinion unless paid for.
In this they are unquestionably right, as gratuitous advice is seldom
heeded; and one of the most distinguished practitioners used to say, that
he considered a fee so necessary to give weight to an opinion, that, when
he looked at his own tongue in the glass, he slipped a guinea from one
pocket into another.
To consider themselves in proper hands, patients must incur expenses, and
as much physic as possible be poured down. Malouin, physician to the Queen
of France, was so fond of drugging, that it is told of him, that once
having a most patient patient, who diligently and punctually swallowed all
the stuff he ordered, he was so delighted in seeing all the phials and
pill-boxes cleaned out, that he shook him cordially by the hand,
exclaiming, "My dear sir, it really affords me pleasure to attend you, and
you _deserve_ to be ill." Our apothecaries must surely meet with incessant
delight!
The most extraordinary remuneration was that received by Levett, Dr.
Johnson's friend and frequent companion. It was observed of him that he
was the only man who ever became intoxicated from motives of prudence. His
patients, knowing his irregular habits, used frequently to substitute a
glass of spirits for a fee; and Levett reflected that if he did not accept
the gin or brandy offered to him, he could have been no gainer by their
cure, as they most probably had nothing else to give him. Dr. Johnson says
"that this habit of taking a fee in whatever shape it was exhibited, could
not be put off by advice or admonition of any kind. He would swallow what
he did not like, nay, what he knew would injure him, rather than go home
with an idea that his skill had been exerted without recompence; and had
his patients," continues Johnson, "maliciously combined to reward him with
meat and strong liquors, instead of money, he would either have burst,
like the dragon in the Apocrypha, through repletion, or been scorched up,
like Portia, by swallowing fire." But though this worthy was thus
rapacious, he never demanded any thing from the poor, and was remarked for
his charitable conduct towards them.
Various professional persons have sometimes endeavoured to remunerate
their medical attendants by reciprocal services: thus an opera-dancer
offered to give lessons to a physician's daughters for their father's
attendance upon him; and a dentist has been known to propose to take care
of the jaws of a whole family to liquidate his wine bill. One of the
wealthiest merchants of Bordeaux wanted to reduce the price of a
drawing-master's lessons, on the score of his taking his children's daubs
with him to sell them _on account_. This arrangement, however, did not
suit the indignant artist, who left the Croesus in disgust.
A singular charge for medical attendance was lately brought before the
court of requests of Calcutta, by a native practitioner. He demanded 314
rupees for medicine alone, and in the items of drugs appeared pearls, gold
leaf, and monkeys' navels!
In one of the old French farces there is an absurd scene between Harlequin
and his physician. The motley hero had been cured, but refused to
remunerate his Esculapius, who brought an action for his fees, when
Harlequin declares to the judge that he would rather be sick again; and he
therefore offers to return his health to the doctor, provided he would
give him back his ailments, that each party might thus recover their own
property. This incident was perhaps founded on an ancient opinion of
Hippocrates, who frequently mentioned salutary diseases. In 1729, a Dr.
Villars supported a thesis on this subject, entitled "_Dantur-ne morbi
salutares?_" and Theodore Van Ween has also written a learned dissertation
on the same subject.
A celebrated Dublin surgeon was once known to give a lesson of economy to
a wealthy and fashionable young man remarkably fond of his handsome face
and person. He was sent for, and found the patient seated by a table,
resting his cheek upon his hand, whilst before him was displayed a
five-pound note. After some little hesitation he removed his hand, and
displayed a small mole on the cheek. "Do you observe this mark,
doctor?"--"Yes, sir, I do."--"I wish to have it removed."--"Does it
inconvenience you?"--"Not in the least."--"Then why wish for its
extirpation?"--"I do not like the look of it."--"Sir," replied the
surgeon, "I am not in the habit of being disturbed for such trifles;
moreover, I think that that little excrescence had better remain
untouched, since it gives you no uneasiness; and I make it a rule only to
take from my patients what is troublesome to them." So saying, he took the
five-pound note, slipped it into his pocket, and walked out of the room,
leaving the patient in a state of perfect astonishment.
It is related of a physician who received his daily fee from a rich old
miser, who had it clenched in his fist when he arrived, and turned his
head away when he opened his hand for the doctor to take it, that, on
being informed his patient had died in the morning, not in the least
disconcerted he walked up to the dead man's chamber, and found his
clenched fist stretched out as usual; presuming that it still grasped the
accustomed remuneration, with some difficulty he opened the fingers, took
out the guinea, and departed.
The Egyptian physicians of old were paid by the state, but they were not
prevented from accepting remuneration from individuals, and they were
allowed to make demands for their attendance except on a foreign journey,
and during military services.
When we compare the value of money it appears probable that the fees of
olden practitioners were more considerable than the remuneration of the
present day. Attendance upon royalty and the court seems also to have been
more profitable. Dr. Radcliffe says, that he received from King William
200_l._ a year more than any other physician in ordinary--this monarch
upon his appointment, gave him moreover, 500 guineas out of the privy
purse for his attendance on the Earl of Portland, and the Earl of
Rochford. When the same physician went to Hanau to attend Lord Albemarle,
he received 1200_l._ from the king, with 400 guineas from his patient,
besides a valuable diamond ring.
Dr. Radcliffe's fortune must have been considerable, as appears from his
legacies, bequeathing 5000_l._ for the improvements of University
College--4000_l._ for the building of a library at Oxford--and 500_l._
yearly for the amelioration of the diet of St. Bartholomew's hospital.
Radcliffe had not been a year in London when he received 20 guineas daily,
and he mentions that his fee for a visit from Bloomsbury Square to Bow,
was five guineas.
We do not exactly know what was the exact honorarium of Doctors in former
days, yet Baldwin Hammey informs us that in 1644, Dr. Robert Wright who
had only been settled three years in London, was in the habit of receiving
a thousand broad pieces (22 shillings) in the course of the year.
The following is a curious account of a puritan's consultation with Dr.
Hammey.
"It was in the time of the civil wars when it pleased God to visit him
with a severe fit of sickness, or peripneumonia, which confined him a
great while to his chamber, and to the more than ordinary care of his
tender spouse. During this time he was disabled from practice; but the
very first time he dined in his parlour afterwards, a certain great man in
high station came to consult him on an indisposition--(_ratione vagi sui
amoris_,) and he was one of the godly ones too of those times. After the
doctor had received him in his study, and modestly attended to his long
religious preface, with which he introduced his ignominious circumstances,
and Dr. Hammey had assured him of his fidelity, and gave him hopes of
success in his affair, the generous soldier (for such he was) drew out of
his pocket a bag of gold and offered it all at a lump to his physician.
Dr. Hammey, surprised at so extraordinary a fee, modestly declined the
acceptance of it; upon which the great man, dipping his hand into the bag
himself, grasped up as much of his coin as his fist could hold, and
generously put it into the doctor's coat-pocket, and so took his leave.
Dr. Hammey, returned into his parlour to dinner, which had waited for him
all that time, and smiling (whilst his lady was discomposed at his being
absent so long), emptied his pocket into her lap. This soon altered the
features of her countenance, who telling the money over, found it to be
thirty-six broad pieces of gold: at which she being greatly surprised,
confessed to the doctor that surely this was the most providential fee he
ever received; and declared to him that during the height of his severe
illness, she had paid away (unknown to him) on a state levy towards a
public supply, the like sum in number and value of pieces of gold; lest
under the lowness of his spirits, it should have proved a matter of
vexation, unequal to his strength at that time to bear; which being thus
so remarkably reimbursed to him by Providence, it was the properest
juncture she could lay hold on to let him into the truth of it." It has
been supposed, that the sanctimonious sufferer was no other than Ireton,
Cromwell's son-in-law.
During the imprisonment of Dr. Friend in the tower, Dr. Head attended his
patients, and on his liberation he presented him with 5000_l._ the amount
of the fees received on his account. Dr. Meade's practice averaged from
5000_l._ to 6000_l._ per annum. It is somewhat strange, that this
celebrated physician whose evenings were generally spent in convivial
meetings at Batson's Coffee-house, used in the forenoon to receive
consulting apothecaries at a tavern near Covent-garden, prescribing for
the patients without seeing them at half-a-crown fee.