Some difficulty is occasionally felt by medical men in deciding as to the charges they should make for professional attendance. This arises from several causes. Medical advice, unlike an article of commerce, cannot have a determinate value assigned to it. Relief from pain and restoration to health are priceless boons. It is impossible to place a mere money value on the study, experience and ability the medical attendant brings to bear upon a case during a long and serious illness. Patients, therefore, are expected to pay such fees as their circumstances in life enable them to do. This is both just and necessary. All classes society require medical aid, but all cannot possibly remunerate the doctor sufficiently to enable him to maintain the position he is bound to occupy. Moreover, the time occupied in seeing persons of wealth is much greater than that demanded by the poorer classes. In the former cases visits are often made by appointment - an arrangement frequently creating inconvenience and loss of time; while they are expected to be much protracted beyond the time really necessary for a full investigation of a patient's state. In the latter, the visits are made when the practitioner is going his round, and are limited to the interrogation of the sick.

The customs in various parts of the country differ so widely in the matter of medical fees, that it is almost impossible to make out a scale that shall be suitable for all districts; but the Manchester Medico-Ethical Association has endeavored, and successfully as we think, to form a tariff which will in a large proportion of instances, in country practice at least, be a fair and suitable one to adopt. They gauge the capacity of a patient to remunerate his doctor by the rental he pays for his house. It is easier of discovery than the income, of which, however, it is a fair test. Certain exceptional cases will inevitably arise, where the practitioner must use his discretion.

“Thus, in the case of lodgers, he can only estimate their probable style of life if they were in an establishment of their own, and those who occupy an extensive house for the purpose of letting lodgings must also be left to his discrimination. In the case of notoriously men of penurious wealthy habits, he must decide for himself what class befits them; and in the case of shopkeepers, residing in premises where trade is carried on, a liberal deduction may be made from a rental not incurred solely for personal or family convenience.”

The Association divide the community into four classes:-

This division, though well suited for some country districts, would not be so for Metropolitan practice.

Note. - In New York the rental is much greater, in proportion to the income, than in London. A physician who pays Ł80 ($450) rent for a house in London, would be obliged to pay in this city, for a house as eligibly situated, and equally as commodious, at least $1,500. - Eds. A. H. R.

The tariff as follows: * [Before decimalisation in 1971, there were 20 shillings/pound and 12 pence/shilling, and thus 240 pence/pound.]

Explanatory Notes to Tariff

The numbers refer to the corresponding ones on the condensed tariff.

A. — General Practitioners.

1. Ordinary visit.-Requires no explanation.

2. Special Visit.-This is a visit of which notification is not given before 10 A.M., when the Practitioner has commenced his daily round, such visits almost always involve, increased trouble or expense; also whenever immediate attendance is requested. The latter circumstance often embarrasses the Practitioner, and entitles him to an increased fee.

3. Night Visit. - One made between 10 P.M. and 7 A.M.

4. Mileage. - This commences at two miles from the Practitioner's house, and is added to the visit, according to class.

6. Detention. - When, at the desire of the patient, or from the urgency of the case, the Practitioner is detained more than an hour, he is entitled to additional remuneration, at the rate per hour, or part of an hour, of an ordinary visit. This does not apply to attendance in midwifery

6. Advice at Practitioner's House. - The same charge as for an ordinary visit. The same addition would be applicable for detention beyond an hour.

7. Letter of Advice. - The same as viva voce advice.

8. Consultations. - When the ordinary attendant has to meet another medical man in consultation, he is fully entitled, from loss and disarrangement of time, to double his ordinary fee. If such consultations are very frequent, this may be occasionally remitted his discretion. When a general Practitioner is himself called in consultation, he is entitled to the Consultant's minimum fee of 21s.; but this may be relaxed at the desire of the Practitioner previously in attendance. Midwifery consultation among Class 1 of patients, should be-charged according to arrangement between patient and Practitioners. Among the other classes, the second Practitioner is entitled to the same fee as the first, independently of the length of time he is detained.

9. Attendance on Domestic Servants. When paid for by their employer, they should be charged as per Tariff. When paying for themselves, they may be charged as if belonging to Class 1 or 2. If the employer send for the practitioner himself, or distinctly avails himself of his advice, he is to be considered as the responsible person.

10. Two or more Patients in one House. - When these are member of one family and paid for by one person, a visit chargeable for each beyond the first. When this is not the case, the full charge should be made for each.

11. Midwifery. - From use and wont the fee for Class 1 is generally understood to cover after visits, when those are few and all goes well; also, with those toward the bottom of this class, it may be reduced 15a., if paid within a month. In the other classes the after visits are not included, unless previously arranged otherwise. When operations, such as the use of forceps, turning, etc., are required the Practitioner entitled to an additional half fee. The Tariff allows considerable latitude in the Midwifery fee, owing to the very great diversity of charges hitherto usual with different Practitioners.

12. Abortions. - In ordinary premature labor the same charge is allowable as in midwifery. In attendance on abortions, the visits required should be charged as such plus an additional charge for detention, according to No. 5.

13. Vaccination. - This is not included in the midwifery fee. It may be charged according to the visit or visits required, if performed by the regular medical attendant; otherwise, as a special visit.

14. Certificates. — Simple certificates may be charged as ordinary visits or letters of advice. When special investigation or responsibility is involved, as in Life Assurance or Lunacy Certificates, 10s. 6d. to 42s. should be charged, according to circumstances.

We re-publish this tariff here because we think with those who have issued it that “it may serve as a reference in case of disputed charges, and thus prevent litigation, and promote a friendly settlement. It will also be a useful guide to the junior Practitioner, who is often in doubt as to the proper remuneration to which he is entitled for his services.”

But while it is only just that pecuniary remuneration medical services should be demanded of all who are able to make them, let us, as a profession, never forget that humanity compels us to go as readily and cheerfully to the aid of the sick poor who cannot, as to that of richer man who can pay us. As homoeopathists, it is our duty to spread our system among the poor to the very utmost. To this end our Hospitals and Disgensaries are established. The work they have accomplished is great. More zeal in sustaining them, more care in prescribing at them, may render this work greater still. — Monthly (London) Homoeopathic Review.