doctor's bill at the close of a season of domestic
suffering.

As I have just been sending out my bills,
including not a few fresh copies of old accounts,
I, Alexis Pildraught, speak with a very lively
sense of the uncomfortable working of the present
system. Here are a few hundred names upon my
ledger, names of people who are my friends, who
trust their lives to me; they have looked to me
for human help and solace in their hours of suffering
or peril; for which reason I send in my bill.

That poor sensitive curate, Snovels, whose
wife died when July was blossoming, and when
he sat upon one side of the bed, I on the other,
will avoid me proudly if I put him under obligation
by not charging for eight months' attendance
upon the lost mother of the little ones left
to his charge. But I am miserable at the sight
of the bill in which I have had to reduce my
help and sympathy to figures, and I have not
yet dared to send it in.

There is to Anne Baugh a bill delivered,
seventeen and sixpence. Three years ago upon
a winter night, she worshipped me with gratitude,
because, at the cost of a night's rest and
active personal attention in her cottage, I was
so happy as to save the slender thread of her
child's life from snapping. For a week she
would have given me all she possessed. When
Christmas came I charged for the whole attendance
on that little patient seventeen shillings
and sixpence. The bill has remained three
years unpaid. I am an easy creditor, and she
has always some more pressing claim; but she
associates my help rendered to her that night
with the idea of seventeen and sixpence. I associate
her seventeen and sixpence with the idea of
that human service rendered. She is embarrassed
when she meets me. We are friends, with a
vexatious cloud between us.

Sir John Dunderhead gave me last year a
great deal of trouble. When first he met me
after he had received my Christmas bill, he
contrived coarsely to remind me that I knew he
had a purse. My landlord has been, this year,
among my patients; my bill has suggested to
him the impression that I have a mind to give
him a set off against my rent. I could seize the
buttons of a dozen tradesmen who believe that
I had their bills against me in mind when I made
out the amount of mine to them. Nobody likes
paying the doctor. Sickness itself has very
likely made expenses during the past year
unusually heavy or the earnings light, and then
comes at the year's end a doctor's bill as extra
charge from which it is but natural that most
people should flinch.

Then, too, the doctor's charges being beyond
ordinary housekeeping calculations, and coming
usually from a gentleman who is not likely to
descend to the form of a dun, are often the last
to be paid. Very long credit, three and four
years' credit, is taken of me even by rich and
titled patients. But, when Alexis Pildraught
started in the world, he found it hard to live
for the first few years of his professional life
mainly on book debts.

The change I have to propose is nothing very
startling. It is only the practical encouragement
of an idea frequently occurring to the
minds of many people. Let a consulting physician
or surgeon and the operator take his fees,
but let us consider whether it be necessary or
desirable that the general practitioner in
medicine–the family attendant who is the friend of
the house–should depend for his income on the
money he can make of its misfortune. Let me
look at home. The names of some three hundred
friends who trust my skill are on my books.
When any one of them over my dinner-table
wishes me a prosperous and happy year, he
wishes that some of my friends may catch fevers
and small-poxes, that consumption may show
itself, and that there may be one or two good
lingering illnesses among the richer of them.

But suppose that, upon an understanding
between me and my friends, each of them agreed
to pay, according to his means, his family, and
the average health of it, a fixed annual sum of
two, or three, or five, or ten pounds for my
services, then, without pressing hardly upon
any one, I should have an income probably a
little ampler than I have at present, and to wish
me prosperity would be to wish that there might
be the least possible illness among my friends.
My list of patients would be as a comfortable
little rent-roll from which some names would be
erased from time to time and to which constant
additions would be made. My private interest,
as well as my good will, would make me active
to prevent approach of sickness, or to meet it,
when it is most easily subdued, at the first hour
of its appearance. At present, sickness is
commonly several days' march in advance of the
doctor before he is called in to overtake and conquer
it. Materfamilias has aggravated it too often
with domestic physicking, out of her laudable
desire to save the household funds from galloping
consumption.

There could be no surer blow dealt against
quackery–domestic and well meant, or of the
shop fraudulent–than to remove the fear of
doctors' bills and all check on the impulse to
seek, in the first moment of doubt about health,
competent advice. Costly as quackery is, its
bait is cheapness.

Heads of families, unless they have obtained
special instruction for themselves, are constantly
in want of some small morsels of the counsel
that a well-educated practitioner of medicine can
give. Science is now applied to the art of preserving
health, and the business relations between
doctor and patient do not yet recognise thought
for the maintenance of health as any part at all–
still less as the chief part–of the medical
practitioner's real business in life. But let him be
paid by a fixed annual fee, and left unshackled
by the dread of appearing to obtrude advice or
medicine for the sake of the money it will bring
him, and he will naturally fall into his right
place as maintainer of health. Sanitary science
will be the most profitable to him of all his
studies. He will be quietly observant of the
sources of disease in every house under his care,