There is a large middle class, able and willing to render a compensation for medical services, who cannot pay such fees as those services are entitled to, especially for long sicknesses. If dependent on such as these only, the income of physicians would not be sufficient to attract to their ranks men of talents, nor such as are able to devote much time and money to their preliminary education.

In all large cities there are multitudes of men whose wealth enables them to pay for the best services from medical men, and who will not be satisfied unless they obtain what they consider as such. Boston has its full share of these wealthy men. A reliance on the support to be derived from them encourages the student to resort to all proper means to qualify himself for their service.

Under the circumstances here stated, the proper course seems to be to make a discrimination in the recompense demanded for medical services. Such a result must probably be brought about in all instances, more or less perfectly, by the necessity of the case, without any special arrangement. In the fee-table adopted in Boston in 1808, and in that which has now been adopted, and which here follows, the principle is openly recognized and acted upon. This fee-table does not state absolutely what the full fee shall be in any case. The general plan of it is to state a minimum in each case. In the table of 1808, a minimum was stated for the charge; but it was provided that a deduction of one-third might be made from the amount of a bill, whenever the circumstances of the patient seemed to require it. In the present table, there is named for each service the limits within which the fee shall be placed, though not designing to prohibit a higher charge where the time devoted, or the great importance of the service rendered, should call for it; nor, on the other hand, to forbid a deduction to those in limited circumstances, in proportion to the exigencies of the case.

RULES AND REGULATIONS.

At the Annual Meeting of the BOSTON MEDICAL ASSOCIATION, held May 2, 1864,

Drs. J. MASON WARREN, GEORGE BARTLETT, CHARLES E. BUCKINGHAM, GEORGE H. GAY, CHARLES D. HOMANS, and JAMES C. WHITE were appointed a Committee to revise the Rules and Regulations and Fee-Table of the Association, and to report upon the same at a special meeting.

At a special meeting of the Association, held June 13, 1864,

The above-appointed Committee submitted the following report, which was accepted, and ordered to be printed.

IT WAS ALSO VOTED, That a new edition be printed of the Medical Police and Rules and Regulations of the Association, as amended by the Special Committee, together with a Catalogue of the Officers and Members.

REPORT.

IN pursuance of their duty, your Committee would briefly refer to some of the successive phases through which the Fee-Table has passed during the last seventy or eighty years. In 1788, as stated in the letter appended to the Rules and Regulations, the fee for an ordinary visit was four shillings, which in 1800 was raised to one dollar. In 1808 it was again raised to a dollar and a half, with the right reserved to the petitioner to make a discount of one-third in cases of necessity. Thirteen years ago it was raised again to two dollars; but, in view of the fact that such a fee would be beyond the means of many patients to pay, a sliding scale was adopted, by which it was provided, that, in such cases, a minimum fee might be charged of one dollar. It was also further provided, that, "in every case, in settling his account, the practitioner might make any deduction which he conscientiously believed that the circumstances of the patient rendered necessary."

It is now thought necessary, in view of the recent great increase in the expenses of living, that the fee be again raised, making it three dollars instead of two, subject as heretofore to any deduction which may be rendered necessary by the pecuniary circumstances of the patient. It has been thought best to substitute a single fixed fee for the visit, in place of the sliding scale adopted in the last Fee-Table, for reasons which have been fully discussed at the annual meeting.

At the annual meeting of the BOSTON MEDICAL ASSOCIATION, held May 5, 1884, Drs. HENRY W. WILLIAMS, C. B. PORTER, and E. N. WHITTIER, were appointed a committee to revise the Fee-Table of the Association, and to report upon the same at a special meeting.

At a special meeting of the Association, held Dec. 18, 1884, the abovementioned committee presented their report, which was accepted.

IT WAS VOTED, That a new edition of the Rules and Regulations and Fee-Table of the Association, together with a revised catalogue of the officers and members, be printed, and sent to the present members of the Society.