CLEVELAND DOCTORS AND THEIR FEES
(ABOUT 1840)
By HOWARD
DITTRICK
In determining the period of an undated
Cleveland Fee
Table presented to the Museum of the
Cleveland Medical Library
by Henry Schuman of New York, the writer
became interested
not only in the Table itself, but also
in the signers of this docu-
ment and the conditions under which they
practiced. Some factors
leading to the publication of such a
list of charges are to be dis-
cussed here; an endeavor will be made to
determine the date of
issue; the Fee Table will be reprinted;
and some comment on
Cleveland doctors of the period will be
included.
There are other nineteenth century fee
bills of Ohio in the
collections of the Medical Library. What
brought about their
publication at that particular time? In
an Ohio journal1 of 1838
one finds: "The compensation of the
physician should be liberal.
It ought to bring back with interest,
what had been expended in
the acquisition of elementary knowledge,
and afford compensation
for the tedious years of probation, to
which he was subjected; it
should enable him to procure all the
necessary books, apparatus
and instruments; provide adequately for
the support and educa-
tion of his family; and secure him
against want in his old age."
This editorial was written by Daniel
Drake of Cincinnati, the ag-
gressive and impetuous crusader of a
century ago, who at this par-
ticular time was endeavoring to
establish some uniformity in
medical fees "in the different
States of the West and South
West."
Drake contributed to his journal several
editorials similar to
the above, and as a consequence several
Ohio counties began
deliberations which subsequently
resulted in the publication of
Fee Bills. These framed documents
confronted patients in the
1 Daniel Drake, Western Journal of
Medical and Physical Sciences (Cincinnati),
XII, n. XLV
(1838), 50.
361
362 OHIO ARCHAEOLGICAL AND HISTORICAL
QUARTERLY
typically
austere and redolent offices of physicians of the era.
While
Drake was writing these editorials he was also active in
the
First (1835) and Second (1838) Ohio Medical Conventions.
Another
prominent member of those conventions was Jared Pot-
ter
Kirtland who, in 1837, moved from Poland to Cleveland.2 In
that
same year he received the appointment of Professor of the
Theory
and Practice of Physic in the Medical College of Ohio.
Drake
was a leading figure in this college, as well as in the Ohio
convention.
It is no surprise, therefore, to note Kirtland's name
at
the head of the list of signers of the Fee Table. Probably
through
the influence of Drake, Kirtland initiated this regulation
into
Cleveland. With the sponsorship of
Kirtland the success
of
such a project was assured, for in that year, as will be pointed
out
later, he was elected president of the Ohio Medical Con-
vention.
The
following is a transcript of the brochure:
MEDICAL
FEE
TABLE
FOR
THE
CITY
OF CLEVELAND, OHIO
Bemis'
Job Printing Establishment, No. 1, Superior-Lane
FEE
TABLE
For
the first visit $1
00 to 2
Every
subsequent visit after first, (same day) 1
..
First
consultation visit 5
00
Each do.
do. after first, 2
50
Opinion
in writing, 5
00 10
Visiting
at night, after 10 o'clock, P. M., and before
sunrise, 2
00 3
Detention
in case at patient's house during the night, 5
00 10 00
Advice
and Prescription at Office, 50 1 00
Visiting
out of town, for every mile from the line of the
city,
(night, double) 50
Case
of Midwifery, (natural) 10
00
do. do.
(prenatural) 15
00 50 00
Extracting
placenta, 10
00
2
Howard Dittrick, Pioneer Medicine
in the Western Reserve (Cleveland,
1932),
58.
CLEVELAND DOCTORS' FEES 363
Each necessary subsequent visit after fourth day, 1 00
Venesection or extraction of Tooth, 50 1 00
Vaccination, 2
00 5 00
Cure of Gonorrhcea or Syphilis, 10
00 100 00
Amputation of Leg, 50 00
do. of Arm, 30 00
Amputation of Toes and Fingers, 5
00 10 00
Excision of diseased Joints, 100
00
Operation of Trepaning, 30
00 50 00
Reduction of Dislocation, 10
00 50 00
Adjustment of Fractures, 10
00 30 00
Operation of Lithotomy, 50
00 200 ..
Reduction of Hernia, 5
00 15 ..
Operation for Strangulated Hernia, 50
00
Important operation on the Eye, 50
00
Minor operation on the Eye, 5
00 20 ..
Dressing recent Wounds, opening Abscess, and introducing
Seaton or Issue, 1 00 10 00
Each subsequent dressing in addition to visit, (according
to discretion of Physician) 1
00 5 00
Extirpation of Polypus, 10
00 50 00
do. of Tumors, 10
00 100 00
Operation for Fistula in Ano or Perineo, 10
00 50 ..
Passing Catheter or Bougie, 1
.. 5 ..
Paracentesis Abdominis or Thoracis or Vesicae, 10 00 30 00
Operation for Hydrocele, 10
00 30 00
do. Aneurism, 25
00 100 00
do. Hare-Lip, 10
00 30 00
do. Club-Feet
& attendance, (single) 30
00 50 00
do. do. do. (double) 50
00 100 00
Medicine included, except the more common articles that are usually
kept in the family.
In Surgical Operations, attendance, at the ordinary rate, is to be
charged in addition to the operation.
FEE TABLE
For the City of Cleveland, in Cases where the Physician furnishes no
Medicine.
For the first visit, 1 00
For the second visit, (same day) 75
Subsequent ones, do. 50
Visit at night after 10 P. M., (before sunrise) 1
50 2 00
Detention at night, 3 00 10
..
Case of Gonorrhcea or Syphilis, 5
00 100 ..
In all other cases, to conform to the prices established by the other
Table.
364 OHIO ARCHAEOLOGICAL AND HISTORICAL
QUARTERLY
Whereas, the foregoing
"Table of Fees" has been, in fact, practically
in use for a few
years, by the Faculty of Cleveland,
Resolved, That it be adopted by the members of the Medical
Profes-
sion, residing in the
City of Cleveland, whose names are hereunto affixed.
The Fees shall be
increased according to the responsibility or importance
of the case, and
services rendered, when extraordinary. They may be
diminished at the
discretion of the Physician, when he is well convinced of
the inability of the
individual to pay the full charge; but in no instance,
shall a deduction be
made, for the purpose of mercenary competition.
2nd. It is recommended
to present accounts for settlement, quarterly,
and in no instance
shall the account remain without adjustment, longer than
one year; believing
that we are under no obligation to give a longer credit
than does the
merchant, the mechanic, or members of other respectable
professions.
3d. In the above
regulations, it is not intended to prevent gratuitous
services to the poor;
still, we do not believe it the duty of the Physician
(in a country where
ample provision is made by law, for the poor) to
indiscriminately, give
his services and medicines; with equal propriety,
might the merchant be
requested to clothe, and the provision dealer to
feed the poor, in
every instance, gratuitously.
Jared P. Kirtland, Mills
& Inglehart,
Erastus Cushing, Charles
D. Brayton,
Charles A. Terry, H.
A. Ackley,
Geo. Mendenhall, M.
L. Hewitt,
H. Mellen Congar, Edwin
W. Cowles,
J. B. Hutchinson, Robt.
Johnstone,
P. Mathivet.
When was this Fee
Table published? The history of
the
co-signers has been
examined and various incidents associated
with them have been
considered in establishing the period of its
origin. Joshua Mills
died April 29, 1843,3 so it must
have been
before that date. Cowles practiced in Cleveland in 1832,4 but in
1834 moved to Detroit
and did not return to Cleveland until 1838.
Ackley settled
permanently in Cleveland on May 25, 1839, while
still engaged in
teaching anatomy at the medical school in Wil-
loughby. Although
Hutchinson opened an office in Cleveland on
July 24, 1839,5 he had
previously maintained one in the Farmers
3 Annals of Cleveland, 1818-1935. A Digest and Index of
the Newspaper Record
of Events and Opinions (Cleveland, 1938), XXVI, part I, 1843, 66.
4 Samuel P. Orth, History
of Cleveland (Chicago, 1910), I, 186.
5 Annals of Cleveland, XXII, part I, 1839, 117.
CLEVELAND DOCTORS' FEES 365
Block.6
Publication could not have occurred, therefore, earlier
than 1838, nor later than 1843.
The solution of the problem was found in
the advertisements.
Mills and Inglehart advertised their
partnership in 1837,7 1838,8
18399 and in 1840.10 Announcement of
its termination was made
on July 1, 1841,11 which would fix the
publication before that
date. Two other partnerships have a
definite relation to the prob-
lem. The Hewitt-Ackley partnership12 was
formed May 6, 1840,
and the Terry-Brayton partnership was
discontinued on April 5,
1839.13 Such
changes were advertised regularly. Had
these
firms been in existence at the time this
schedule was published it
seems fair to assume that the four
physicians would not have
signed as individuals. Mills and
Inglehart appear under their
firm name. On the other hand, although
Peabody and Mathivet
were partners from January, 1839, to
June, 1840, Mathivet signed
alone. Perhaps his partner was not
willing to cooperate in main-
taining this schedule.
After considering all these facts, it
seems highly probable
that publication of the Table hinges
still more upon Ackley's
activities. As will be pointed out
later, Ackley took an active
part in setting up the surgical fees,
and he would more likely
have done that after he had made
Cleveland his permanent loca-
tion. This occurred on May 25, 1839. These
deductions place
the publication of the Fee Table between
that date and May 6,
1840, the date when he entered into
partnership with Hewitt. All
those who signed the document were in
active practice in Cleve-
land at that time.
In searching directories and historical
sketches of Cleveland
at the time when the Fee Table was
published, some facts con-
nected with the signers have seemed
worth recalling. For ex-
ample, it would seem that many
physicians did not settle in prac-
6 Ibid., XXI, part I, 1838, 170.
7 Ibid., XX, part I, 1837, 180.
8 Ibid., XXI, part I, 1838, 170.
9 Ibid., XXII, part I, 1839, 116.
10 Ibid., XXIII, part I, 1840, 142.
11 Ibid., XXIV, part I, 1841, 126.
12 Ibid., XXIII, part I, 1840, 143.
13 Ibid., XXII, part I, 1839, 117.
366
OHIO ARCHAEOLOGICAL AND HISTORICAL QUARTERLY
tice. There were peripatetic
practitioners as well as professors.
Kirtland moved from Poland to Cleveland,
and later to Rockport,
just west of Cleveland. Ackley had taught or practiced in
Rochester, in Akron and in Willoughby
before locating per-
manently in Cleveland. His
Cleveland home on Prospect
Avenue is now the club house of the
Rowfant Club. The roving
of Cowles, the pioneer homeopath, has
already been noted. George
Mendenhall, after graduating from the
University of Pennsyl-
vania, entered practice in Cleveland,
returned to Philadelphia for
more training, then went back to
Cleveland. Later he developed
a pulmonary affection and moved to
Cincinnati. These changes
in location seem considerable when one
recalls the limited number
of physicians practicing in Cleveland
over a hundred years ago.
A similar tendency to change is seen in
business methods
connected with medical practice. Many
physicians' offices were
operated on a partnership basis. More
striking is the ephemeral
nature of such partnerships. Ackley, for
instance, while living
and teaching in Willoughby entered into
partnership with Mills
on March 22, 1837.14 This arrangement
lasted only until Sep-
tember 30 of that same year. This may
have been an effort on the
part of Ackley to make use of Mills'
office to build up a practice,
without establishing a residence in
Cleveland. In 1840, the firm
of Hewitt and Ackley was announced.15 This still existed in
1846.16 In 1850, however, Theodatus
Garlick replaced Hewitt in
the partnership.17 Mills, directly after the partnership
with
Ackley was dissolved in 1837, formed a
new one with Inglehart,
which lasted, as is indicated above,
until 1841. This was a nec-
essary measure for Mills because, as
will be pointed out later, he
was occupied with municipal affairs.
Peabody and Mathivet were
partners from January, 1839, to June 16,
1840.18 A partnership
of Brayton and Terry was dissolved on
April 5, 1839.19 In 1840,
Congar and Mendenhall were announced as
partners,20 but they
14 Ibid., XX, part I, 1837, 180.
15 Ibid., XXIII,
part I, 1840, 143..
16 Ibid., XXIX, part I, 1846, 143.
17
Dittrick, Pioneer Medicine, 58.
18 Annals of Cleveland, XXII, part
I, 1839, 116.
19 Ibid., XXII,
part I, 1839, 117.
20 Ibid., XXIII,
part I, 1840, 142.
CLEVELAND DOCTORS' FEES 367
evidently dissolved partnership before
July 1, 1841. Medical
teaching, public office and commercial
ventures were part-time
activities which accounted for many of
these business alignments.
Many early physicians found it necessary
to supplement in-
come from practice by engaging in
commercial pursuits. In all
probability David Long, Cleveland's
first physician, was more
occupied at this time in the sale of bar
iron and castings than in
the care of the sick, so that his name
does not appear on the Fee
Table. Kirtland became almost as deeply
interested in horticul-
ture and geology as in medicine, and
became even more famous
in those fields. Mendenhall, in 1837,
was associated with his
brother in the coal business, and in
1839 was selling trees in quan-
tities. Mills was engaged in another
occupation, but one closely
allied to medicine. He operated a drug
store on Superior Street.
On May 30, 1842, he was appointed Custom
House Physician.
Did not the physicians of the nineteenth
century take a more
active part in social and political
economics than do the medical
men of today? The Cleveland medical
group of the period under
discussion would seem to have assumed
fully its civic obligations.
David Long had been in turn trustee of
the village, county com-
missioner, and president of the village
corporation. In 1832,
Cowles and Mills were both members of
the Board of Health.21
Joshua Mills was also elected alderman
in 1836, president of the
City Council in 1837, and mayor in 1838
and 1839.22 He was
reelected mayor in 1842,23 and died
in office. In 1838, Menden-
hall was appointed a delegate to the
Whig County Convention.
David Long was elected president of the
Home League in 1842,
and Mendenhall elected secretary.
Mendenhall was also nomi-
nated for councilman in 1842. Kirtland
served three terms in
the Ohio legislature, and was chairman
of the committee which
built the Ohio penitentiary. The
physician held a position of
esteem and respect in the community, and
had a large part in
forming public opinion and in solving
civic problems.
It has been frequently noted that
physicians of the thirties
21 Orth, History of Cleveland, I,
133.
22 Ibid., 186.
23 Annals of Cleveland, XXV,
part I, 1842, 257.
368
OHIO ARCHAEOLOOGICAL AND HISTORICAL
QUARTERLY
and forties advertised. This was done
commonly in the public
press. Delilah's name was not yet
associated with those who
consorted with the newspapers.
Announcements of opening or
removal of the physician's office, the
formation or dissolution of
partnerships, and occasionally a
statement of the physician's spe-
cial field of practice were made in the
newspaper. The notices
of partnership and opening of offices
have already been discussed.
Some interesting sidelights on practice
may be discovered from
other advertisements. In 1839 such items
were inserted by W. H.
Bond24 and C. A. Mills,25 botanic
physicians, offering botanic
medicines at wholesale and retail
prices. Thomsonian medicine
had come to Cleveland. This firm of
doctors was an agency for
'Thompson's new patent truss and
Resurrection and Persian Pills,
a family medicine that is
unequalled." Mathivet also
advertised
these same pills for sale, and in 1837
Erastus Cushing and Men-
denhall advertised trusses for rupture.
In August, 1837, a printed
recommendation of Cleveland's pioneer
dentist, Benjamin Strick-
land,26 appeared and was
signed by most of the signers of the
Fee Table.
Other items in the papers indicate
special qualifications of
practitioners. Mendenhall, in 1840,
after two years of hospital
training in Philadelphia, announced that
he and Congar were
prepared to operate for club foot. This
fact is reflected in the
Fee Table, where the charge for the
operation for double club
foot was as high as $100.00.
Incidentally, during that training
in Philadelphia Mendenhall had an attack
of a malignant form
of petechial typhus fever. Kirtland, in
1843, announced that he
could be seen for consultation only at
Mendenhall's office on two
days a week, when examination of
physical signs was determined
by the stethoscope.
As late as 1876, Samuel D. Gross of
Philadelphia said,27 "It
is safe to affirm that there is not a
medical man on this continent
who devotes himself exclusively to the
practice of surgery." As
24 Ibid., XX, part I, 1837, 181; Orth, History of
Cleveland, I, 189.
25 Annals of Cleveland, XXII, part I, 1839, 116.
26 Ibid., XX,
part I, 1837, 93.
27 J. H. Baas, Outlines of the
History of Medicine, translated by H. E. Handerson
(New York, 1889), 1054.
CLEVELAND DOCTORS' FEES 369
early as 1839, however, Horace Ackley
announced that he in-
tended to confine his work to surgical
operations and that he was
prepared to attend surgical cases in the
immediate vicinity of his
residence. As a special inducement,
"Persons wishing to stop
with Dr. Ackley for surgical attention
can be furnished accom-
modations in the vicinity of his office
in the Mechanics Block."28
If the charges for surgical procedures
listed in the Fee Table
are examined critically, the influence
of Ackley is readily seen.
The sponsors of the Fee Table were
prominent in medical
organization. In the year in which it
was probably published, at
a meeting of the Ohio Medical
Convention,29 Kirtland was elected
president and Mendenhall was elected
recording secretary. On
April 28 of the following year, a county
medical society was
organized30 and the following officers
were elected: J. P. Kirt-
land, president; H. A. Ackley and C. A.
Terry, vice-presidents;
J. B.
Hutchinson, recording secretary; C. D. Brayton, correspond-
ing secretary. Another prominent Cleveland physician, John
Delamater, was president of Willoughby
Medical College in 1839.
He did not come to Cleveland until 1843,
and therefore his name
does not appear in the Fee Table.
Mendenhall was elected an
honorary member of the Philadelphia
Medical Society.
Much has been written of the personal
side of Kirtland and
Ackley. Cushing and Terry were courtly
and polished men of
the highest culture. Cushing was reputed
to have had "the silver
doorbell" practice of Cleveland.
Mendenhall's departure was a
great loss to Cleveland medicine. He
subsequently wrote a "Vade
Mecum for Medical Students" and was
very active in medical edu-
cation. Dr. Robert Johnstone "fell
in the prime of life, a victim
of ship fever."
Other fee bills, one from Columbiana
County and another
from Medina County, are discussed in an
article which is now in
press for the Bulletin of the History
of Medicine. As Dr. Jona-
than Forman has intimated in a personal
communication, should
a medical society attempt to regulate
fees in such a manner today,
28 Annals of
Cleveland, XXII, part I, 1839, 117.
29 Orth, History
of Cleveland, I, 190.
30 Annals of
Cleveland, XXIII, part I, 1840,
143.
370 OHIO ARCHAEOLOGICAL AND HISTORICAL
QUARTERLY
the
officers would be summoned forthwith to appear before a
federal
court to answer a charge of using measures in restraint
of
trade.
But a
State can use a Fee Schedule. A few weeks ago the
State
of Ohio mailed to Ohio physicians a little red book in which
the
Industrial Commission set forth its regulation of procedure,
with an
accompanying schedule of fees. Comparison of some of
these
fees with those of 1839 is enlightening.
1839
Opinion
in writing ........................ $5.00 to $10.00
Visiting
out of town, per mile (night double).
.50
Operation
for hydrocele .................. 10.00 to 30.00
Operation
for trepaning ................ 30.00 to 50.00
Paracentesis
thoracis ...................... 10.00 to 30.00
Lithotomy
............................... 50.00
to 200.00
1945
Affidavits upon
request .............................. $3.00
Mileage
outside corporation limits, per mile............ .50
Hydrocele radical
removal ........................... 50.00
Trephine of skull
................................... 25.00
Thoracic paracentesis ............................... 10.00
Nephrectomy
...................................... 150.00
CLEVELAND DOCTORS AND THEIR FEES
(ABOUT 1840)
By HOWARD
DITTRICK
In determining the period of an undated
Cleveland Fee
Table presented to the Museum of the
Cleveland Medical Library
by Henry Schuman of New York, the writer
became interested
not only in the Table itself, but also
in the signers of this docu-
ment and the conditions under which they
practiced. Some factors
leading to the publication of such a
list of charges are to be dis-
cussed here; an endeavor will be made to
determine the date of
issue; the Fee Table will be reprinted;
and some comment on
Cleveland doctors of the period will be
included.
There are other nineteenth century fee
bills of Ohio in the
collections of the Medical Library. What
brought about their
publication at that particular time? In
an Ohio journal1 of 1838
one finds: "The compensation of the
physician should be liberal.
It ought to bring back with interest,
what had been expended in
the acquisition of elementary knowledge,
and afford compensation
for the tedious years of probation, to
which he was subjected; it
should enable him to procure all the
necessary books, apparatus
and instruments; provide adequately for
the support and educa-
tion of his family; and secure him
against want in his old age."
This editorial was written by Daniel
Drake of Cincinnati, the ag-
gressive and impetuous crusader of a
century ago, who at this par-
ticular time was endeavoring to
establish some uniformity in
medical fees "in the different
States of the West and South
West."
Drake contributed to his journal several
editorials similar to
the above, and as a consequence several
Ohio counties began
deliberations which subsequently
resulted in the publication of
Fee Bills. These framed documents
confronted patients in the
1 Daniel Drake, Western Journal of
Medical and Physical Sciences (Cincinnati),
XII, n. XLV
(1838), 50.
361