Although the Crown did not follow the lead of the Company in providing
care for the sick and unsheltered, the authorities after 1624 did have
the state take an interest in medicine to the extent of passing laws
dealing with medical problems and situations. These laws were primarily
concerned with the collection and charging of fees, but also provided
for the censure of the physician or surgeon neglecting his patient.
On four occasions during the century the Assembly attempted to regulate
the excessive and immoderate rates of physicians and surgeons. The
chief example used to convey the injustice of fees for visits and drugs
was that many colonists preferred to allow their servants to hazard a
recovery than to call a medical man. Although an inhumane attitude, the
colonists reasoned that the physician or surgeon would charge more than
the purchase price of the servant.
The act of 1657-58 reveals this attitude and throws some light on the
medical practice of the century. (Similar acts had been passed in 1639
and in 1645 and would be passed in 1661-62.) By the will of the
Assembly, the layman had the right to bring the physician or surgeon
into court if the charge for "paines, druggs or medicines" was thought
to be unreasonable. The surgeon or physician had in court to declare
under oath the true value of drugs and medicines administered, and then
the court decided the just compensation.
The law went on to declare that:
Where it shall be sufficiently proved in any of the said courts
that a phisitian or chirurgeon hath neglected his patient, or that
he hath refused (being thereunto required) his helpe and assistance
to any person or persons in sicknes or extremitie, that the said
phisitian or chirurgeon shall be censured by the court for such his
neglect or refusall.
The legislators also gave the physician or surgeon protection by
providing that their accounts could be pleaded against and recovered
from the estate of a deceased patient--suggesting that patients were
not prompt enough in paying their bills (or perhaps did not survive
treatment long enough to do so). Court records show that the medical
men often took advantage of this provision for collection.
A measure enacted in 1692 indicated a more sympathetic attitude on the
part of the legislators toward the physicians and surgeons. While in
the earlier acts preventing exorbitant fees the court had been ordered
to decide upon just compensation, the later act allowed the physician
or surgeon to charge whatever he declared under oath in court to be
just for medicines. Nor did the act of 1692 make reference to "rigorous
though unskilful" or "griping and avaricious" physicians and surgeons
as had the earlier laws.
References by the colonial Assembly to exorbitant fees were not without
a basis in fact. The conventional charge for the physician's visit,
according to Dr. Wyndham Blanton, was thirty-five to fifty pounds of
tobacco and on occasions the physician, or surgeon, must have exceeded
this fee. An approximate estimate of the value of these visits in
present-day terms would be between twenty and twenty-five dollars. The
cost of medical care was even greater when an unusually large amount of
drugs was dispensed. It is not surprising that many masters did not
provide the services of a physician or surgeon for their servants; nor
that medical attention was given by persons without professional
status. Although these charges seem high, it must be taken into account
that because of the great distances between communities and even
between homes, the physician or surgeon could make only a small number
of visits each week.
County records give many examples of the fees of physicians and
surgeons. Of 145 medical bills entered in the York County records
between 1637 and 1700, the average bill was for 752 pounds of tobacco,
or a little less than one laborer could produce in a year. Other fees
were: 400 pounds of tobacco for six visits; 300 pounds of tobacco for
three visits and five days attendance; 1,000 pounds of tobacco for
twenty days of attendance "going ounce a weeke ... being fourteen
miles"; and 600 pounds for twelve daily visits. At the time these
charges were made, tobacco brought between two and three cents per
pound, or the equivalent of approximately fifty cents today.
The surgeon administering the clyster or phlebotomy, those commonly
resorted to "remedies," could be expected to charge thirty pounds of
tobacco for the first and twenty pounds for the second. The surgeon,
and the physician, often charged from twenty to fifty pounds of tobacco
for a drug prescription.
In 1658, Dr. John Clulo presented a bill to John Gosling in York County
which he itemized as follows (in pounds of tobacco):
For 2 glisters [clysters] 040
For a glister 030
For a potion cord.[ial] 036
For an astringent potion 035
For my visitts paines & attendance ...
For a glistere 030
For an astringent potion 035
For a cord. astringent bole 036
For a bole as before 036
For a purging potion 050
For a [cordial julep] 120
For a potion as before 036
Not only does Dr. Clulo's bill give examples of fees charged, but it
supports the contention that the substance of medical treatment during
the century was bloodletting, purging, and prescribing drugs.
Although the physicians of colonial Virginia did charge well for their
services, it should be noted that they were in demand. Their patients,
this would indicate, considered their services of great value, any
subsequent protests notwithstanding.