Physician Price Fixing in 19th Century Virginia

We, physicians, practicing in Charlottesville, mutually agree, to charge and require fees not less than the following, in the cases hereinafter specified. June 9^th. 1848. (Click here to convert the currency from 1848 dollars to modern values.)

Twelve physicians in Charlottesville, Virginia, agreed with each other to have minimal charges for an extensive array of medical services in June of 1848. Higher charges were not forbidden, only those that were deemed too low. Who were these doctors? And what was it like to live in Charlottesville in the middle of the nineteenth century?

At least nine of the twelve signers of the Agreed Rate of Medical Charges, or the fee bill, had strong ties to the University of Virginia, founded several decades earlier in 1819. It appears that seven were students at the University, starting as early as the 1829-1830 session and ending as late as 1843-1844. Two studied for only one year, three for four years.  At a minimum, the seven studied Medicine, Anatomy & Surgery, and Chemistry, but some took additional classes or a particular class more than once. Several students registered for nearly all the courses offered at the University at the time. Most notably, John S. Davis, the son of a faculty member, in addition to medically related classes, studied Ancient Languages, Modern Languages, Mathematics, Natural Philosophy, Moral Philosophy, and Law.¹ Davis became the demonstrator in anatomy and eventually a professor at the University. Another student, James L. Cabell, joined the faculty as a young man before he had even had a chance to demonstrate his expertise in actual medical practice.² Four–Cabell, Leitch, Minor, and Poindexter–were enrolled in classes the same year, 1833.³ Signers Henry Howard and Robert E. Rogers did not attend the University but were faculty members. It is worth noting that these four, Drs. Davis, Cabell, Howard, and Rogers, were the only teachers in the medical school in 1848 (and would remain so for another four years). Consequently, each person connected with the University of Virginia medical department signed the fee bill.

The physicians ranged in age from 24 to 57 at the time they signed the fee bill. They lived an average of about 65 years with a range from 49 to 82, possibly older, as death dates for two of the physicians are difficult to locate. All the signers of the fee bill were married, but given the state of medicine in the middle of the nineteenth century, the physicians were not spared the early loss of family members. Five of the physicians lost wives who were in their thirties or forties. Drs. Davis, Howard, and Leitch each remarried after their wives died in their thirties. Dr. Rogers remarried after his wife passed away when she was 43. Dr. Gooch’s wife died at 45; it is not clear if he ever remarried. Most were fathers though possibly not Dr. Rogers. Two of the signers who had no biological children, Dr. Hargrave and Dr. Cabell, either legally or for all practical purposes, adopted nieces. Those who had children were often not spared the grief of outliving them. Peter Heiskell buried at least four daughters though seven children survived him. Charles Minor was the father of thirteen children, four did not live to adulthood. One of William Gooch’s two daughters died the same year as his wife. John Staige Davis lost a daughter, two years before her mother. One of Dr. Carter’s two children was killed in the Mexican War. Dr. Leitch did not have to grieve the loss of his 24 year old son, but only because he died himself at 47.

An illustrious and respectable group, the signers were involved in other activities and enterprises not related to practicing medicine or teaching at the University. One was a member of the House of Delegates, five were on the vestry of the Episcopal Church, one was a director of an insurance company and on the Board of Overseers of the Poor, another founded and was the principal of a large boarding school, one became president of a bank, another was a trustee for a carriage shop, another a county magistrate.

The nineteenth century saw the beginning of medical associations in Virginia with the founding of the state Medical Society of Virginia in 1820. City and county societies came later: Petersburg in 1846, Clarke County around 1851, Louisa in 1851, and Richmond in 1852. Also in 1852 the Medical Society of Virginia was reorganized, and the formation of many additional county societies took place.⁴ What about Charlottesville? In the January 1851 issue of The Stethoscope and Virginia Monthly Gazette, mention is made of a medical society at the University of Virginia.⁵ Was an official medical organization behind the creation of the fee bill, or were the signers independent physicians who joined forces to assure sufficient remuneration? It is not clear which was first to arrive on the scene, the fee bill or the medical society, but possibly the two are correlated since the society was specifically tied to the University, and the fee bill was signed by all three members of the medical faculty and the anatomy demonstrator.

In the University of Virginia Catalogue for the 1844-45 session there is a report that includes a section on the “alleged extravagant incomes of the professors.” The average for the nine professors, including Drs. Cabell, Howard, and Rogers, for the four years up to and including 1844-45 was $2300 per nine-month session.  The author of the report argued that the compensation was not excessive and would “scarcely vie with those of the middle class of lawyers, physicians, and merchants in any of the thriving communities of our country.”⁶ Sara Pryor, the niece of one of the signers who was not associated with the University, wrote that the professors could live “upon their modest salaries, and have something to spare for entertaining.”⁷

The Charlottesville Twelve who signed the Agreed Rate of Medical Charges were not the only physicians in the Charlottesville area. The federal census records of 1850 for Albemarle, the county surrounding Charlottesville, include each of the signers as physicians as well as another 34 men. Albemarle had a population of 25,800 in 1850 which provided one doctor for approximately every 560 people, or 178 doctors per 100,000 people, very close to the 1850 national average of 176 physicians for every 100,000.⁸  Assuming the census occupations were self-reported, it is reasonable to suppose that some of these “physicians” were “non-regularly trained healers” or “irregular practitioners” as Todd Savitt describes in his essay.

At least two of the signers, John Hughes and James Poindexter, were regularly trained physicians who also had ties to Thomsonianism. (Hughes received his M.D. degree from the University of Virginia. Poindexter took medical classes at the University of Virginia and then earned his M.D. degree from the University of Maryland.⁹ Founded by Samuel Thomson (1769-1843), this alternative practice opposed the treatments of regular or allopathic medicine of the day such as: “bleeding, poisoning, blistering, physicking, freezing, starving, &c.”¹⁰ Thomson thought it was critical to maintain the body’s digestive powers and its natural or “inward heat.” ¹¹ To maintain or restore these properties he placed a heavy reliance on botanic remedies and exposure to steam. Virginia proved to be a state containing many converts to Thomsonianism or to one of its offshoots, with its influence peaking in the 1830s and 1840s.¹² Letters to the Botanico-Medical Recorder were written from practitioners in almost half of Virginia’s counties, with a particularly high 66 percent from the Piedmont region which included Albemarle County and the city of Charlottesville.¹³ The struggles between, and oftentimes among, the Thomsonians and regular doctors were sometimes fierce as each accused the other of inhumane or ineffectual practices while claiming his own success.¹⁴

An incident that occurred five years after the signing of the fee bill involved at least four of our doctors. John S. Mosby, the famous Confederate cavalry ranger, was sentenced to a year in the Charlottesville jail after shooting and injuring a fellow university student, George R. Turpin. Letters and petitions were sent to the Governor of Virginia asking for Mosby’s pardon, due to the unhealthy conditions at the jail. Three physicians who had signed the fee bill, Drs. Poindexter, Carter, and Hughes, asked for his early release, while Dr. Leitch suggested that Mosby serve his sentence. Mosby was pardoned two days before Christmas 1853, survived the Civil War in spite of his daring exploits, and lived well into the twentieth century, dying in 1916.¹⁵

What was Charlottesville like in 1848? In the 1840s, it was a small town surrounded by mountains, streams, forests, and fields.  Sara Pryor moved to Charlottesville around 1839 with her aunt and uncle, Samuel Pleasants Hargrave, one of the signers of the fee bill. In her autobiography, My Day; Reminiscences of a Long Life, she described the town as “refined, amiable, and intelligent,” lacking a circulating library but with “four churches, two book-stores, several dry-goods stores, and a female seminary.”¹⁶ There were many more churches in the county. From 1825 to 1837 at least twenty-one church buildings were constructed in the area, and by the middle of the nineteenth century there were forty-five churches serving five denominations.¹⁷ Pryor wrote that Charlottesville “society” in the 1840s consisted of professors from the University of Virginia as well as families descended from the early settlers.  According to Pryor, “The absence of all the hurry and fever of life made the little town of Charlottesville an ideal home before the cataclysm of 1861.”¹⁸

In 1848 Charlottesville had a courthouse and offices in the vicinity of the courthouse. A pillory and stocks were not mentioned after 1820, but a whipping post was “repaired” in 1807, “restored” in 1820, and referred to again in 1857.¹⁹ In his lists of county officers for the mid 1840s, Mr. Woods gives the names of county magistrates, a Commonwealth attorney, a sheriff, a jailor, and fifteen attorneys of the Albemarle Bar.²⁰ The town had two newspapers, the Jeffersonian Republican and the Virginia Advocate, and several banking establishments. These banks and newspapers ceased functioning during the Civil War.²¹

The University of Virginia Cemetery was founded in 1828 as a result of a typhoid epidemic in Charlottesville. Years later it became the final resting place for Drs. Davis, Cabell, and Howard. Maplewood Cemetery, the earliest public cemetery to still be in existence, was established in 1831.²² Drs. Carter, Hughes, Leitch and Poindexter are interred there. Prior to that time, most families buried their dead on their own property.

In 1796 the Virginia Legislature passed an act to establish a process for taxing the populace to provide for public school houses and teachers. Thomas Jefferson supported the concept but local support was insufficient at that time.²³ In 1811 the Legislature created the Literary Fund which granted loans to localities for the construction of school buildings. In 1840 there were “eighteen academies or grammar schools and twenty-one primary schools, with about 400 students in each system” in Albemarle County.²⁴ While numerous, these did not fulfill Jefferson’s ideal of universal public education. In 1849 a debate concerning free schools was held. In spite of Dr. William H. McGuffey, of McGuffey Reader fame, promoting the cause, public schools failed to win the necessary support.²⁵ Universal education was not to become a reality until after the Civil War.²⁶

The first turnpike was built in Albemarle County in 1806 with more to follow. Crops were moved by wagon in the early part of the nineteenth century until the formation of the Rivanna Navigation Company which fostered the use of the river to carry freight on flat-bottomed boats.²⁷  The railroad extended to Albemarle County and was within seven miles of town by 1848, finally reaching Charlottesville in 1850. As it neared the town it “helped businesses to flourish, boosted the economy, and introduced new consumer goods into Charlottesville.”²⁸  In 1850 with the labor of over 400 slaves, Charlottesville was connected to Richmond by the Virginia Central Railroad, formerly the Louisa Railroad.²⁹

Charlottesville and Albemarle County were “refined” and “amiable” in Sara Pryor’s words for some inhabitants but not for the majority. Census returns from 1850 show that of the 25,800 residents in Albemarle County, roughly 52 percent were enslaved blacks, 46 percent were white, and two percent were free blacks. In addition to laboring at area homes and farms, where 78 percent of the 943 county farmers owned slaves, slaves were critical to the running of the University of Virginia. They maintained University buildings and grounds, worked for the professors, and cared for students.³⁰  Students were not permitted to bring their own personal slaves, but in 1842 the governing board of the University stated that slaves were to have no more than twenty young men assigned to them.³¹

According to the 1850 census, of the 89 people associated with the ten professors, 41 were enslaved. It appears that “domestics” were housed in the cellars of Pavilion homes in which the professors lived as well as in structures added behind the Pavilions.³²  The slave schedule from the 1850 census is only partially transcribed online, but it shows that six of the fee bill signers owned slaves: Charles Carter, ten slaves; James A. Leitch, six; James W. Poindexter, John C. Hughes, and James L. Cabell, five each; and Henry Howard, three. Robert Rogers did not have slaves but lived with his brother William who owned six.³³ John S. Davis does not appear in the portion of the slave schedule that is transcribed online, but historian Moore states that he had two slaves according to the census.³⁴ Peter Heiskell also does not appear in the slave schedule online, however the 1850 U.S. Census shows that he had an 18 year old mulatto male in his household.³⁵ The earlier 1840 federal census indicates that Charles Minor was in a household with nine slaves, three under the age of ten.³⁶  According to his niece, Dr. Hargrave freed his inherited slaves.³⁷

This gives an introductory glimpse of Charlottesville and the fee bill physicians. For an essay by medical historian Todd L. Savitt about fee bills in general and the Charlottesville fee bill in particular, go to Essay. For more details about the individual physicians, go to Signers of the Bill.

1. University of Virginia, Catalogue of the Officers and Students of the University of Virginia (1829-1830 – 1843-1844). [↩]
2. Philip Alexander Bruce, History of the University of Virginia, 1819-1919; The Lengthened Shadow of One Man, vol. 2 (New York: Macmillan, 1920), 176. [↩]
3. University of Virginia, Catalogue of the Officers and Students of the University of Virginia (1832-1833. [↩]
4. Wyndham Bolling Blanton, Medicine in Virginia in the Nineteenth Century (Richmond: Garrett & Massie, 1933), 75-95. [↩]
5. “Medical Societies,” The Stethoscope, and Virginia Medical Gazette 1 (1851): 46. [↩]
6. University of Virginia, Catalogue (1844-1845): 45. [↩]
7. Sara Pryor, My Day: Reminiscences of a Long Life (New York: Macmillan, 1909), 73. [↩]
8. U.S. Census: Albemarle, Virginia, 1850, accessed 23 March 2011; Leo F. Schnore, “Statistical Indicators of Medical Care: An Historical Note,” Journal of Health and Human Behavior 3, no. 2 (Summer 1962): 133, accessed 23 March 2011. [↩]
9. Robley Dunglison, An Address, Delivered to the Graduates in Medicine, at the Annual Commencement of the University of Maryland, On Wednesday, March 19th, 1834, Baltimore: William Wooddy, 1834, 23. [↩]
10. Botanico-Medical Recorder 7, no. 11 (February 23, 1839): 169. [↩]
11. Samuel Thomson, New Guide to Health or Botanic Family Physician (London: Simpkin, Marshall & Co., 1849), 7, 62. [↩]
12. James O. Breeden, “Thomasonianism in Virginia,” The Virginia Magazine of History and Biography 82, no. 2 (April 1974): 162. [↩]
13. Breeden, 162. [↩]
14. Breeden, 164. [↩]
15. William M.E. Rachal, “Petitions Concerning the Pardon of John S. Mosby in 1853,” The Magazine of Albemarle County History 9 (1948-1949): 22-23. [↩]
16. Pryor, 43, 73. [↩]
17. Edgar Woods, Albemarle County in Virginia (Bridgewater, Va.: C.J. Carrier Co., [1956?]), 136; K. Edward Lay, The Architecture of Jefferson Country, Charlottesville and Albemarle County, Virginia (Charlottesville: University Press of Virginia, 2000), 17. [↩]
18. Pryor, 54, 73. [↩]
19. Woods, 82. [↩]
20. Woods, 379-380, 383. [↩]
21. Woods, 100, 107-108. [↩]
22. Woods, 49. [↩]
23. Woods, 89-90. [↩]
24. Lay, 17. [↩]
25. Woods, 89-90. [↩]
26. Lay, 17. [↩]
27. Woods, 69, 84-85. [↩]
28. Newton Bond Jones, Charlottesville and Albemarle County, Virginia 1819-1860, A Dissertation Presented to the Graduate Faculty of the University of Virginia in Candidacy for the Degree of Doctor of Philosophy (1950), 172; Charlottesville Area Transit, accessed 23 March 2011. [↩]
29. Charlottesville Area Transit. [↩]
30. John Hammond Moore, Albemarle, Jefferson’s County, 1727-1976 (Charlottesville: University Press of Virginia, 1976), 124; Gayle M. Schulman, “Slaves at the University of Virginia,” (May 2003): 3, accessed 23 March 2011. [↩]
31. Schulman, 6. [↩]
32. Schulman, 4, 6. [↩]
33. Slave Schedule, 1850, Federal Census, Albemarle, Virginia (Charlottesville), accessed 23 March 2011. [↩]
34. Moore, 142. [↩]
35. U.S. Census: Albemarle, Virginia, 1850. [↩]
36. U.S. Federal Census, 1840. [↩]
37. Pryor, 38. [↩]