JF Ptak Science Books   Post 1659 (expanded)

When you think of expense and medical care, why on Earth should any of it cost so much?  Well, that question would make more sense if asked in the year 1819, because–according to the make-believe history of Medical Billing Capacity– the need for compensation for knowledge or spent stores or supplies or whatever was not very great, at all. 

E(ward) Cutbush, a very capable naval surgeon (and noted as the father of modern American naval medicine) attests to this, and did so in this report on the status and expense of the hospitals and medical care facilities available to the U.S. Navy (and which was published in 1819). He didn’t of course know necessarily that health care wasn’t very expensive at all–especially if relation to the price of wine–Cutbush just reported the numbers. 

And the numbers are interesting:  in 1814, for the U.S. Naval Hospital in Washington, D.C., for the 116 inpatients and 86 outpatients seen during the year, a total of $344.74 was spent on “medicines, instruments and dressings”, $1,166.30 on “support of patients, nurses and attendants” (which really meant food and sundries),  and another $180.00 in wages for  “nurses and attendants”.  By comparison, $79.70 was spent on soap and candles, $334.52 on replacement furniture, and $368.40 on fuel. $50.56 was spent of fruits and vegetables.

And somewhere in there, we are shown that about $30 was spent on “clothing of an insane pensioner”, which I guess must mean that some old Seamen were judged to be “insane”, and needed clothing, before they were sent off and away from the hospital. 

[This image is clear once enlarged.]

A little bit further on, Cutbsuh tells of the more exact expenses on food/”support” for the folks at the  D.C. hospital  in 1814.  By far the leading expense (in the total of $1,166.30 3/4) was meat, meaty fresh meat, which accounted for nearly half of the total outlay ($439.88).  Bread was next ($179) followed by Madeira wine ($108).  Actually all of the alcoholic beverages–which included Madeira, brandy, sherry, port and whiskey) added up to $153.00, almost as much as bread.  Meat, bread and booze then accounted for $726, or 62% of the food budget (less the minimal cost of fresh veggies).  Milk, tea and coffee weighed in at $92, which means the drinking-goods totaled $245, or 21% of the food outlay.  Barley, rice, oat meal corn meal and “biscuit” came in at $24; vinegar, molasses and brown sugar surpassed those staples at $97.

We don’t get any information on the surgeon’s pay, unless we look at the stats for the naval hospital at Baltimore.  There, for 1814, we see that $352.00 was spent on medicine, $80 on surgeon’s instruments, $231 on fuel, $1645 on provisions, $18 for nurses, $18 for cooks, and $1282 on surgeon pay.  Unfortunately, I cannot find how many surgeons were called to receive this compensation, but we can see that their pay consumed 26% of the hospital expenses while caring for a total of 244 sailors over the run of one year.  It is not impossible that there was one surgeon on hand, and one nurse.  So, each sailor getting care from Baltimore received about $1.44 worth of medicine for their stay; the nurse and cook each got about 7 cents for each of the patients receiving care there, and the doctor picked up about $5.25 per sailor.

Of course there wasn’t much in the way of surgical tools when compared with even the late 19th century to spend money on–ditto medicine.  Stand-alone hospital machinery was virtually non-existent in 1814, and so the major factor upon which all hopes were laid was the surgeon, a sort of walking hospital–a job of superior messiness and long and lonely responsibility.

These numbers were for the late period of the War of 1812, when more than 2,650 servicemen were killed and 4,500 wounded.I could not in a cursory effort find the number of surgeons serving or employed during 1814, nor an overall figure on total medical care cost for seamen.  But it does seem likely that more was spent on milk, bread and booze than on medicine and surgical instruments.  And certainly the doctor cost far more than any other single unit int he medical care scheme–and, given that the greatest part of all care necessary resided with the physician, it was probably worth every penny (or fourth thereof.)

Notes:

1.  Cutbush at this time was given the direction of the “Marine and Navy Hospital establishment and of the medical and hospital Stores, which may from time to time be required for the use of the hospitals, or for the vessels of the United States equipped at this place.”-–Dudley, William S.. The Naval War of 1812, a documentary history, Volume 3.. Naval Historical Center, 1985.