Correspondence

Former Times

N Engl J Med 1995; 333:1084-1085October 19, 1995

Article

To the Editor:

While cleaning out my desk, I found the enclosed bill for my one-day stay at the Children's Hospital for a tonsillectomy when I was 11 years old (Figure 1Figure 1Bill for Tonsillectomy.). Several things struck me about it, especially in comparison with a hospital bill one might receive today. The most obvious is the low cost of service, although $17 was worth much more in 1943. The second is that the bill was paid (in cash) by my father at the time of discharge. There was no health insurance, Medicare, Medicaid, or health maintenance organization then. Most striking, though, is the simplicity of the bill. One glance, and you understand it perfectly. How radically different from today's hospital bills!

Sol Messinger, M.D.
3 Gates Cir., Buffalo, NY 14209

To the Editor:

The man in Figure 1Figure 1Dr. Harvey Winters McNeel. is my grandfather, Harvey Winters McNeel, who received his medical degree from the University of Virginia in 1897 and afterward established a general practice in his birthplace, Hillsboro, West Virginia. He was one of the few doctors in the county then, and his practice covered more than 100 square miles of the surrounding countryside, most of it mountainous wilderness. Bad weather and worse roads often made patients accessible only by horseback. The saddlebags in which he carried his medical gear on such visits can be seen slung over his shoulder in Figure 1.

Figure 2Figure 2Ledger Page. shows a page from Dr. McNeel's ledger for the years 1902, 1903, and 1904 with the accounts of two of his patients. It shows that his fee for a house call, including medication, was typically $2. But not all his patients paid in cash. Frank Scott settled a portion of his account with 10 bushels of corn, which my grandfather, who had a farm on the side, probably used to feed his hogs. J.V. Slaven paid some of his account, according to the ledger, with a “Days work,” after which appears the word “Flues,” presumably meaning that he cleaned the chimneys in my grandfather's house.

Dr. McNeel died in 1948.

David McNeel
Correspondence,