departed on his round of calls, he may have been called to the country, or in some way he is prevented from attending.

As a rule you will attend to the urgent message at once and do your best for the patient until his own medical attendant is able to take up the case. On his return, you must acquaint him at once with the fact of your having been called, and at the same time tell him what you have done for the patient. On no account continue to visit the patient after his own doctor is available.

In such cases it is desirable that you should not commence any new line of treatment or alter the medicine which his own doctor has been giving unless there is a very good and decided reason.

It is almost needless to state that you must act in the most honourable manner towards your brother practitioner; make no comments to the patient or his relatives on his mode of treatment, even though you may disagree with it, and utter no remarks which might in the slightest degree reflect on his conduct of the case.

The patient may request you to continue your attendance until his present illness has terminated, but on no account do so; it would be most dishonourable and would land you in conflict with his own medical attendant.

You are really entitled to half the fees payable during your attendance, but it is very seldom asked, as most likely you will find yourself under a similar obligation to the same doctor at another time. If you have been called to a midwifery case in the absence of the family practitioner, you are

entitled to, and should usually ask for, half the fee agreed on between the patient and her doctor. If the case has been tedious and has occupied much of your time, or if it has required more than the usual skill (forceps, turning, etc.), then you should get more than half the fee-most probably twothirds.

Fees. The fee which a doctor will charge for his professional services will naturally vary with the social position of the patients whom he attends. Of late years the relative value of money has undergone a great change, and what was formerly reckoned an adequate fee is by no means the case now. Likewise, the distribution of money has undergone change also. Previous to the War the wage-earning classes were considered amongst the poorer classes, and those of them who were not insured persons were charged low fees by their medical attendants. Now the wage-earning classes might almost be considered wealthy, as their expenditure is very small compared to that which the middle classes are called upon to disburse. It seems almost ridiculous that men earning from £4 to £8 per week should still get medical attention practically free, being insured persons under the National Insurance Act.

While one might very reasonably charge a working man earning, say, £4 per week, 3s. to 4s. per visit to the members of his family, one might be inclined to reduce this in the case of a bank or insurance clerk earning a like salary, seeing that he has to live in a good house, dress well and pay for the education of his family. It might be stated, however, that as a rule the working man has a larger

family and that the doctor's fees for professional services might press hardly upon him; to this objection we rejoin that he lives in a much cheaper house, his family is educated gratuitously, their clothing need not be expensive, and if they are ill they can be treated in the hospital or infirmary. With patients in the middle or upper classes one must exercise his own judgment, but fees may vary from 5s. to 21s. per visit.

In cases of prolonged illness it is usual to make a reduction in the total amount. When daily visits are paid over an extended period, the fees accumulate to a large sum and, in the case of widows or of persons whom you know are not well off, this sum ought to be modified accordingly. He may be an excellent doctor in a professional sense, but a poor one in sympathy and brotherly feeling who will not reduce, or in certain cases dispense entirely with fees in cases of known ill-fortune.

As a rule, double fees are charged for night visits, and a fee and a half for special visits, e.g., passing catheter, opening abscess, etc. If a visit lasts longer than half an hour an extra fee is charged, and if the employer requests one to attend his servant a fee of 3s. 6d. is usually charged for each visit. The fee for consultation at one's own home, by letter or telephone, are all chargeable at the same rate, but most practitioners make a modification in fee for advice given by telephone.

When one sees more than one patient in the same house it is usual to charge only half the fee for each of the succeeding invalids.

Patients suffering from venereal diseases are

often crafty and endeavour to get your advice and treatment and then depart without paying. As the cost of material for the modern treatment of syphilis is expensive, it is wise to get the prospective patient to pay a sum in advance before you commence, to cover the whole cost of drugs and of your professional services in connection therewith.

In the case of patients who call casually for advice, either get payment from them at the time or secure their name and address.

Midwifery Fees. As a rule an inclusive fee is charged for attendance at the confinement and during the puerperium. In simple, uncomplicated cases fees vary from three to twenty guineas, depending on the social position of the patient, but in complicated cases (forceps, version, etc.) you are at liberty to increase these considerably.

Specialists' Fees.-It is well known that surgeons and specialists are in the habit of charging very high fees for operations. It is only right and just that they should be paid well for their skill, but as a rule the sum charged is out of all proportion to the services rendered or the amount of skill displayed. The common argument in their favour is, that for several years they earned little or nothing and yet worked hard at infirmaries or hospitals. They must remember, however, that they were then serving their apprenticeship as surgeons, and it is unusual for learners in any branch to receive payment. There is nothing special about surgical handicraft, and, given opportunity, a large proportion of medical practitioners would turn out excellent surgeons.

The leading surgeons are perhaps justified in

charging large fees for consultations and operations, because only by so doing are they enabled to limit their work.

It is the younger surgeons who err in making exorbitant demands, and it is very largely owing to them that the medical profession is threatened with the imposition of a State medical and surgical service.

The general practitioner knows only too well the financial straits into which families are cast by the illness of and subsequent operation on the head of the house. In my opinion it is scandalous that the unfortunate sufferer has either to make choice of receiving gratuitous services in a hospital or having to pay large sums to the surgeon as well as to the nursing home, because it is seldom that a surgeon will operate at the patient's own home. The unhappy medical attendant has often to forego his fees altogether so that the surgeon and the nursing home may be paid.

Junior surgeons charge, as a rule, but little less than that asked by operators of repute. It would be well, therefore, that surgeons should look into this, and revise their scale of charges, making their fees more suited to the nature of the operation as well as to the class of patient.

Gratuitous Services.-Every medical man attends a large number of persons from whom he neither expects nor gets any fee or reward. Amongst this class will be the widows or orphans of former medical colleagues, patients who were once able to pay, but have become very reduced in circumstances, etc.

It is usual to attend the clergyman (and his family) of the church you attend without presenting