Mining the Numbers in a Medical Ledger

Bloggers at Past is Present have previously written about the recent donation of Pike-Wright Family papers in posts about the family’s photographs, Dr. Nathan Pike’s medical tools, and Nathan’s trips to the 1850s South. The following post is from AAS member (elected 2002) and volunteer Sande Bishop, who researched Nathan’s medical education and practice.

Among the many papers in the Nathan Staples Pike collection are two leather ledgers, embossed N. S. Pike, in which Dr. Pike diligently recorded his financial life.  The accounts of his patients are scattered throughout the ledgers, wherever they fit.  Many pages contain two, three or even four different accounts. It was through a carefully alphabetized index in the opening pages that the Doctor kept track of the balances. Each time a patient visited, he listed the page number where the latest charges and payments were recorded – for example, Benjamin Clark’s account is indexed as being on pages 244, 293, and 218.  In all there are 534 patients in the first ledger and 538 in the second.  There are, of course, some names listed in both ledgers, but surprisingly few.

 Dr. Pike used double entry bookkeeping, recording his fee and the payment when it was made, sometimes quite a bit later. The majority of ledger listings are “calls” (probably an office visit when he typically billed either 25 or 34 cents) and “visits” (likely house calls, costing 50 cents). These charges included medicine. Most prescriptions have no description, but fall under the general term “med.” A few prescriptions, including paregoric, laudanum, opium, and castor oil, are sometimes identified. Those cost from 12 ½ to 21 cents. Obstetrical delivery is typically $3, more for a breach presentation or use of forceps. Both tooth extractions and vaccinations cost 25 cents. He listed “surgery by cataract needle,” a craniotomy, treatment for dog bites, fractures, draining fluid from hydroceles, and a chest exam “by percussion and auscultation.”

Like a paint-by-numbers canvas, these pages of numbers, beyond his professional fees, capture snippets of the daily life of Dr. Pike—and by extension, physicians of the 1840s. From his canvas of numbers, we can sum up much of his daily professional life.

We learn Nathan treated a wide variety of patients: He doctored workers at the local mills. He signed contracts with several towns to “doctor the town paupers” for a fixed annual charge. He agreed to care for specific individuals, for example, “Widow Burdick at the expense of the town.” In 1851, he itemized “5 people examined for Conn. Mutual Life Insurance.” A few families negotiated a fixed amount for all their care over a year’s time.

He purchased an “amputating knife” for $1, various scalpels, and in 1842 he wrote that he was “learning Galvanic Battery” for 75 cents. A month later he wrote, “I bought home the G. Battery” for another 75 cents. He paid $3 for Webster’s Dictionary.

Many of the accounts have some payment in kind, especially hay, oats, cord wood, and upkeep of his horse, wagon, and sleigh. Several include personal items, such as clothing. To a few, he gave discounts for prompt payment and to others charged interest for late payments. He was aggressive in pursuing unpaid debts, sometimes tracking clients who had moved to out of town or even state.

When the ledgers are read in conjunction with the family genealogy, we learn that Dr. Pike treated a large extended family. Accounts list his siblings, their families, and the related Dixon, Kies, and Hammett families. He charged them as he would any patient, but showed compassion to those who were apparently struggling financially. In the account of his brother-in-law Erastus Hammett Jr., we learn Erastus paid half the balance in kind, with 20 bushels of oats, valued at 42 cents a bushel, totaling $8.40. Dr. Pike apparently forgave the balance, writing, “Let this remain unsettled unless he calls.” Nathan covered the cost of lace and spinning supplies purchased by his mother and sister Mary.

The accounts reveal a supportive family network, in which Nathan repaid debts, especially to his brother Thomas and cousin Eleazer Kies. Nathan documents a number of payments to Thomas, starting with a payment of $41.50 in 1842, the year he graduated from New York University Medical School. Further payments totaling more than $300 follow. In 1848, Nathan repaid Eleazer “By note for tuition previous to this date $90.”

His records likewise present mysteries. One name in particular recurs—Archibald Thomas Douglas—in various roles. Archibald Thomas Douglas is listed as Professor of Obstetrics and Diseases of Women and Children in the catalog from New York University Medical Department. In his ledger a few years after Nathan was a student there, Dr. Pike recorded payments for tuition to Archibald Douglas in 1847 and again 1849. Later, in the 1850s, both served on the Committee on Exams at the Yale Medical School.

In the 1850s, the relationship between Dr. Pike and an Archibald Douglas appears non-medical. In 1852 he paid Archibald T. Douglas for the administration of his estate and in 1855 Douglas signed a note to pay Nathan $58 and interest. And finally, Archibald Douglas signed Nathan’s will as Justice of the Peace and as Judge of Sterling Probate District Court. The relationship of these gentlemen remains a mystery to be solved.