Smith County, Texas
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In this section, several statistical observations will be made and charts presented that offer quite a clear overview of Dr. Samuel Overton's medical practice in Omen, Texas.
A. Typical Work Schedule
Dr. Overton apparently was on call seven days a week, 365 days a year. There seems to be only a small variation in his office/visitation days, although on Sundays his medical visits were reduced in frequency. Many times on weekends, Dr. Overton combined familial calls with medical necessities. Dr. Sam visited the family of his brother, Colonel John F. Overton, in a professional capacity some twenty different Sundays during a fourteen-year period, often prescribing medication for the entire family in the process. On Sunday, September 1, 1872, the doctor entered into his J.F. Overton account: "To visit family on Sunday." For some reason, he chose to charge his brother nothing for this service.
Saturday was the busiest day (approximately 16% more calls than average) of his medical week, with about the same number of home visits occurring as office visits. Of course, Dr. Overton was on call 24 hours per day. A premium was charged for "night" visits and over the course of the fourteen years covered in the ABC ledgers, about 65 night visits were made, with ten being made in the year 1870, alone.
The good doctor averaged about two charges per day over the years. Some days he spent his time elsewhere, probably overseeing operations on his farm. On other days, however, the medical practice consumed all his attention.
For example, on Tuesday, August 9, 1870, Dr. Overton charged patients a total of eleven times. He called on Meridith Arnald to medicate his wife ($3.50); also Joel Lindsey to medicate his wife ($2.50) and he visited Sam Talley (freed man at Mrs. Bradford's) to medicate two children ($5.00). That same day, Dr. Overton received a total of eight patients in his office, all of whom were freed men except for John Flore who dropped by for two boxes of pills (50 cents). The freed men and women who were treated at his office were John Edmonson, Gerry Williams, Gerry Roberson (living at R. Hamilton's place), John Beck, Holland Johnston (a freed woman), Mary McClelon (a freed woman living at Bob White's place) and Nathan Swan. Total charge for the office visits was $10.50, making his total revenue for the day equal to $21.50.
Holidays meant little to Dr. Overton in the way of a respite from the call for medical attention. He practiced medicine on virtually every holiday, if the occasion called for it. On Christmas Day in 1896, less than a year before his death, Dr. Overton rode out to the home of Mrs. Ama Young to deliver a baby to Leona. That same day, he visited Noah Brown to medicate their ailing son.
B. Home Versus Office Visits
Over a period of about 45 years, Dr. Samuel Overton served his community well. In the 14 years pictured below, he averaged over 500 charges per year, divided between 56% home visits to 44% office visits.
HOME VERSUS OFFICE CALLS
The above chart demonstrates the reduced annual visits made by Dr. Overton in his last decade of life. However, it also is a powerful reminder that the rural doctors of this time period were, indeed, a hardy breed. Dr. Sam made over 200 house calls in his last year, dying on October 22, 1897 at the age of 76, having made at least one house on that very day.
C. Amounts Charged and Received in Payment
The same 14 years noted above are used to display the charges that Dr. Overton levied on his patients, as well as the amounts received, in the following chart.
$ AMOUNTS CHARGED AND RECEIVED
To even the casual observer of the above data, it becomes obvious that Dr. Overton's charges far outstripped his collections. Such was the case with many physicians of that era. Patients frequently would be unable to meet their obligations when bill-collecting time rolled around. Other patients would simply move to another town, county or state, leaving the physician with little hope of ever collecting the debt.
In the chart above, Dr. Overton charged a total of $24,798; he collected $15,710 during the same time period of fourteen years, averaging about 63% conversion of receivables. In the years following his death in 1897, his widow Sarah collected an additional $1,594, bringing the conversion rate up to about 70%. During the entire period of the ABCDE ledgers, 21 years, Dr. Overton charged out $34,465 in services and collected $27,292, equaling a conversion of receivables of 79%. This conversion rate was close to the average of that period. Dr. James Addison Abney, a rural physician in East Texas, described his toils and collection troubles thusly:
" Out of this hard, cheap work, by tact and good management, I collected about fifty to seventy-five percent of the amounts charged on the books. I did a large charity practice that was not on the books." 1.
D. Total Annual Income
During the entire period covered by the ledgers, Dr. Samuel Overton annually averaged about $1,800 in service charges and likely collected about $1,400. Using figures based on the consumer price indices (www.westegg.com/inflation/), the present value (1999 dollars) of a dollar in 1869 today would be about $12.15; for 1872, $13.51 and for 1895, $18.95. Thus, in 1999 dollars, Dr. Samuel Overton would show a present day annual income of approximately $28,500 to $30,000 and collections of about $23,000. This level of income hardly would be enough to feed a family of thirteen without the supplemental income and foods generated by his farming operation.
Dr. Overton's estimated average income of $1,800 also was typical for physicians of his era, and likely even above average, considering the fact that his income for the last decade of his life is included in the average figure.
"Toward the end of the century (19th), generally speaking, physicians made an annual income of around $1,000. Two thousand dollars was considered quite a large income; only doctors in the larger cities could claim such figures In a survey of 3,317 physicians in seventy-five counties, physicians' incomes at the turn of the century ranged between $40,000, the highest figure, to $1,873, an average figure." 2.
E. Fees for Services and Traveling
Dr. Overton's fees were very much in line with the average fees of his era. What is surprising about his fee structure is the minimal change in the fees from the one of the earliest entries office visits recorded in the oldest ledger (Wednesday, January 24, 1866 - To med and pres wife, W.D. Baitman, $1.50) to the last office call Dr. Overton took thirty one years later (Friday, October 22, 1897 - To med and pres wife, James Warren, $1).
Part of the explanation may be found in the consumer price index noted above. Tremendous turmoil in the financial markets during the Reconstruction period drove the value of the dollar down. Hence, the deflationary forces made the earlier dollars (i.e.; 1869 $ with a value at $12.15 in 1999 $) less valuable in current dollars than later dollars (i.e.; 1895 $ with a value of $18.95 in 1999 $). Even so, Dr. Overton's charges remained remarkable stable during the entire span of his career.
Generally speaking, his charges for services were as follows (trailing numbers approximately equivalent to 1999 dollar):
Prescriptions and Medicine - $1.50 and up ($27+)
(Regarding the practice of dentistry, during the 21 years covered by the medical ledgers, Dr. Sam Overton extracted a tooth, or teeth, on 222 occasions, nearly always charging $1 for the procedure.)
The above charges in Omen may be compared to the following schedule 3. of charges set by a group of doctors in Tyler in 1857:
Prescription and Medicine - $2.00 and up
F. Unusual Visits and/or Charges
Like every other physician in any time period, Dr. Overton had his share of unusual visits and/or emergencies. In the 11,550 entries in the six medical journals, however, he attended only one recorded abortion, that occurring on May 1, 1872, for which he charged $11, the same fee as for the birth of a child. He also recorded only one post mortem examination, that of James Allen on Thursday, November 18, the day following Allen's death in 1871. Mr. Allen was a fellow member of the Masonic Lodge #98 in Canton, so perhaps the doctor undertook the examination out of courtesy to Mr. Allen's next of kin.
In October 1871, Dr. Overton visited the home of Charley Brown, a freed man, charging him $5 for tending to his wife, who had suffered a pistol shot. About a year earlier, on Saturday, February 5, 1870, Dr. Overton charged Bill Moore $5 for looking after a pistol wound Mr. Moore suffered. Several years later, on Friday, October 1, 1886, a "Mrs. Clemants" was the victim of a gunshot, but was only charged $2.00 for the doctor's time and attention.
Broken bones were commonplace back in the early days of horses, buggies and wide-open spaces. Dr. Overton tended to numerous broken arms, legs and other extremities. On July 11, 1872, he visited "Miller" whom he identified in his ledger as "half Cherokee Indian." Mr. Miller had his broken jaw set for a price of $5. In 1882, Dr. Overton visited and set the leg of Jacob Malone for $8. Several years later in September 1890, Dr. Overton visited Abe Adams to set a broken elbow, once again charging $8.
Dr. Overton recorded several surgical "operations" in his ledgers, as follow:
Abe Adams - October 7, 1885, "To operation (October 7 & 8)," $10
Then there were those visits that surely grieved Dr. Overton almost as much as the family of the patient. On July 21, 1871 a visit was made to the home of Neal Shelby, a freed man, to attend to a "burnt child," quite possibly associated with the huge kettles of lye and water used in periodic washings.
While the diagnosis of the illnesses were rarely noted in the medical journals kept by the doctor, one can imagine the setting-in of a serious illness when numerous, sequential visits to an individual were noted in the journals by Dr. Overton - particularly when the visits abruptly terminated. The doctor visited Mrs. Mosley's son on 23 occasions from January 14 through March 8, 1887. Likewise, Mrs. Nancy Lindsey was visited 28 times from December 1 through December 31, 1884. The ultimate disposition of the patients is unknown to this writer.
On several occasions, however, there was nothing a doctor could do for the afflicted. Usually, Dr. Overton charged only for attending to living beings, and nothing for those already on the path to the Hereafter. For Ben Malone, Junior, the visit on Saturday, November 11, 1888 was noted by the doctor simply as "Dead, no charge."
G. Types of Payments Received
Certainly, Dr. Overton would have preferred to be paid in cash, at the time of the medical service. That rarity occurred no more than a dozen times during the entire span of these medical ledgers. On all the other medical services, payment was received sometime around the end of the current year, or as soon as the patient's family could get together some sort of payment. The following chart demonstrates the types of payments that Dr. Sam Overton received over the 21 years of the entire set of ledgers.
Generally speaking, the following rates of exchange were assigned to the commodities most often received by Dr. Overton, given that the prices varied slightly over the time period covered by the medical ledgers:
Corn - 75 cents to $1.25 per bushel
(According to the web site for the Progressive Farmer periodical , September 2000 delivery for corn is priced at approximately $1.94 per bushel. It seems remarkable that Dr. Overton put a 1999 value on a bushel of corn at approximately $18, more than nine times the value that is attached to that same bushel of corn in today's market! Likewise a bushel of oats delivered in September 2000 will cost $1.08 per bushel, compared to the 1999 value of $9 per bushel in Dr. Overton's books. Perhaps this is a testament to today's modern farm practices.)
H. "Other" Type Payments
As noted above, approximately 13.4%, or $3,553, of the pay received by Dr. Overton in the fourteen years covered by the ABC ledgers was in the form of "Other." This category of pay evidently was centered on whatever good, commodity or service the doctor wanted and/or needed, versus whatever might have been at the disposal of the patient.
Examples of "other" type payments are:
1. Washing of Clothes
2. Day Labor
3. Semi-skilled Labor
4. Consumable Items
As of May 6, 1894, Mr. Pollite, a local shoemaker, owed Dr. Overton $49.50. Part of this debt was associated with the Pollite family renting a house from Dr. Overton, for which the owner charged the renter $24 per month (about $432 in 1999 dollars). After not receiving any payment on this outstanding debt for two years, Dr. Overton wrote the following note to Mr. Pollite:
Omen, Texas March 2, 1896
Sir, I am very much in kneed of a good par of Shoose of your make, you know how to fit my foot. If you will make them, send me word when you can do it,
5. Balancing Accounts
6. Miscellaneous Items
Of course, patients could hope for forgetfulness to set in with the doctor, as exemplified by an 1886 entry into a ledger in the behalf of Jesse Hodge, wherein Dr. Overton records: "Settled, I recon as I forgot it", 35 cents.
I. Livestock taken in Trade
13 hogs/4 pigs, $84.42
J. Interest Charged
1. Sylvia Van Voast Ferris and Eleanor Sellers Hoppe, Scalpels and Sabers, Nineteenth Century Medicine in Texas (Eakin Press, Austin, Texas), p. 48.
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