Doctors: Physicians, Surgeons, Dentists and Apothecaries in England

England Occupations

The practice of medicine in Great Britain was, compared with other countries, disorganised and uncontrolled until the middle of the 19th century. Its practitioners were mostly part-time, combining their work with a wide range of other activities. As the historian Margaret Pelling said about membership of the Barber-Surgeons' Company in London in the 17th century, many in that period were actually distillers, innkeepers, hosiers, colourers, pinmakers, hatpressers, musicians, dyers, perfumers, tallowchandlers and tailors. Robert Dimsdale, for example, the first of eighteen 'doctors' in his family, and a barber at Broxbourne in Hertfordshire, was presented in 1629 for keeping an unlicensed alehouse and the following year was fined for trading as a grocer, not having been apprenticed. Formal records of medical qualification are very limited and although there were many practitioners, they were used and accepted not because of any paper qualification but because of the service they offered.

As late as 1856, of the 10,220 persons listed in the Medical Directory with some sort of qualification, only four per cent had a medical degree from an English university. Fifteen years earlier the 1841 Census had listed three times as many (33,339) as practising one or more branches of medicine.

By the middle of the 16th century there were, in broad terms, a very few physicians (mostly with a degree from Oxford or Cambridge) who diagnosed internal problems; barbers who conducted minor surgery such as bloodletting and drawing teeth; surgeons who carried out major surgery in the presence of a physician (both barbers and surgeons had generally been apprenticed); and apothecaries (also apprenticed) who sold drugs and sometimes treated patients. As already indicated, however, the situation was far more complicated than would appear from such a simple statement. There was much overlap and frequent disputes between the various representative bodies that developed.

Physicians
To quote from one reference,
 * "The class of doctors that commanded most prestige in 1800s was the physicians. They were not concerned with the external injuries, nor did they performed surgeries or set bones. Their work was mainly confined to check the pulse and urine of the patients. They were called the physicians because they only administered drugs or physic."

The Royal College of Physicians of London (of England from 1858) had been founded in 1518 and was supposed to have a monopoly in the giving of medical advice within a seven mile radius of the City of London and, from 1522, nationally, a monopoly that was challenged successfully by the apothecaries in 1703. Of the 337 physicians in provincial towns in 1783, very few were members of the Royal College in London. Early physicians working outside London may be found in John H. Raach, A Directory of English Country Physicians 1602-1643 (1962) [FS Library 942 E4r].

The Royal College of Physicians of London has, besides ordinary members, Licentiates and Fellows. Biographies of the last two categories, 1518-1824, were collected by its librarian, William Munk, and printed as The Roll of the Royal College of Physicians of London (2nd edition, 3 vols., 1878) [FS Library 942 U2mw]. Additional volumes on the Fellows only, 1825-1983, have since been published. No printed work deals with the Licentiates after 1824 but from 1845 they can be found (with the Members) in the annual Medical Directory (see below).

There is a separate Royal College of Physicians in Edinburgh, founded in 1681, another in Glasgow for both Physicians and Surgeons, founded in 1599, and another in Dublin for Physicians, founded in 1667. Their Members and Fellows from 1845 appear in the Medical Directory (see below).

Barbers, Surgeons and Dentists
After the physicians, came the surgeons in the medical hierarchy. Their work was to perform surgeries, cut open the chest, deal with fractures and everything that a physician could not perform. The class of surgeons did not command as much respect from the society as the physicians did.

The main reason for that was that until 1745 they were formally linked with barbers and had to get bodies from the graveyard to learn how to perform surgeries. It was as a result of this difference in status, that the physicians were always addressed as Dr. and surgeons as Mr.

The setting of bones or the performance of surgeries fell into the domain of barbers due to their use of very sharp razors, and also to the earliest marine surgeons, who were required to perform these tasks routinely on-board ship. Every ship of the line had a surgeon onboard, as falls and slips were an everyday occurrence, due to the normal weather in and around Britain. It was on board ship that the first indication of the value of citrus fruits in battling scurvy was observed, and the reason that British Naval personnel were called ‘Limeys’.

The barbers and surgeons had been united in 1540 to form the Barber-Surgeons Company of London, but from that date the surgeons could not act as barbers, and barbers could not be involved in any form of surgery "excepting only the drawing of teeth". By a charter of 1629 all ships sailing from British ports were required to have on board a surgeon approved by the Company. The surgeons broke away in 1745 but their Company of Surgeons failed in 1796 and was re-founded as the College of Surgeons in 1800, with an initial 300 Fellows, receiving royal status in 1843. No person could practise as a surgeon within seven miles of the City of London unless examined by the College. There were companies of Barber Surgeons in some provincial towns, for example at Chester, Newcastle-on-Tyne and Shrewsbury.

The records of the Barber Surgeons' Company of London remain with the Barbers' Company at Barber-Surgeons' Hall, Monkwell Square, London EC2Y 5BL, but the registers of apprentices 1657-1786 [FS Library film 1648287-90] and of admissions to freedom 1522-1801 [FS Library film (1522-1757) 1648286], together with lists of the Navy surgeons and surgeons' mates examined 1734-45 [FS Library film 1648285], are available on microfilm at Guildhall Library, Aldermanbury, London EC2P 2EJ.

The admission registers of the former Company of Surgeons 1745-1796 remain with the Royal College of Surgeons of England, 35-43 Lincoln's Inn Fields, London WC2A 3PN. Written enquiries only should be addressed to the Librarian.

Biographies of the Fellows of the Royal College of Surgeons of England 1800-1930 have been published as Plarr's Lives of the Fellows of the Royal College of Surgeons of England (2 vols., 1930) [not in FS Library] and there are additional volumes covering the years 1930-1982.

There is a separate Royal College of Surgeons in Edinburgh, founded in 1505, another in Glasgow for both Surgeons and Physicians, founded in 1599, and another in Dublin for Surgeons, founded in 1786. Their Members and Fellows from 1845 appear in the annual Medical Directory (see below).

For the development of dentistry see Christine Hillam, Brass plate and brazen impudence: dental practice in the provinces 1755-1855 (Liverpool University Press, 1991) [FS Library 942 U2hc] which includes a list of practising dentists taken from 19th century directories. It developed within the Royal College of Surgeons in the 19th century and its practitioners appear in the annual Medical Directory after 1866 and in the separate annual Dentists Register from 1888 [not in FS Library]. This shows place of education and qualification but not age or parentage.

Apothecaries
The apothecaries in London were originally members of the Grocers' Company but were formed into the Society of Apothecaries by royal charter in 1617. Their stock, as listed in probate inventories, is indicative of their activities, being summarised by David Hey as "medicines, perfumes, spices, herbs, comfits, antidotes, aphrodisiacs, antiseptics, tonics, purgatives, laxatives, emetics, astringents and general cure-alls". The Society of Apothecaries was one of the City Livery Companies and in 1774 limited its membership to persons who were actually practising apothecaries. By Act of Parliament in 1815 its authority was extended to the whole of England and Wales, the qualification of Licenciateship (LSA) being obtained by a five-year apprenticeship (after 1856 more often by studentship) and examination.

The records of the Society of Apothecaries are deposited at the Guildhall Library (address above) and include complete runs of apprentice-bindings 1617-1836 (that show the child's date of baptism), freedom admission registers 1617-1890, and Court of Examiners' candidates' qualification books 1815-1939 [many records 1617-1900 have been filmed by FS Library, see Author Catalogue 'Society of Apothecaries'].

Abstracts of the apprenticeship books 1617-1669 have been printed in the series London Apprentices, vol. 32 [FS Library 942.1/L1 U25w v.32]. An alphabetical list of the Licentiates, 1815-1840, showing their addresses and the dates they qualified, was printed by the Society of Apothecaries and has been republished on microfiche by the Society of Genealogists, London [not in FS Library].

Bishops' Licences
In 1511 an Act of Parliament (repealed only in 1948) had required physicians and surgeons to be licensed by the bishops of the dioceses in which they practised and both geographically and administratively this was the most comprehensive system of qualification in England and Wales, though it had fallen into disuse by 1750 and licences are rarely found after that date. The issuing of a licence depended on mature experience and good character. Testimonials and proof of formal training were only occasionally filed.

Most of the known bishops' licences were listed by A.W.J. Haggis in seven typescript volumes, Index of Episcopal Medical Licentiates, now at the Wellcome Institute for the History of Medicine, 183 Euston Road, London NW1 2BE, and although many of the entries relate to the period before 1700 they were all included in Eighteenth Century Medics (see below) which indicates those medics for whom Letters Testimonial survive.

The licences for some dioceses have been printed, e.g. A.J. Willis, Canterbury Licences (General) 1568-1646 (1972) [FS Library 942.23 N2w]; J.H. Bloom &amp; R.R. James, Medical Practitioners in the Diocese of London 1529-1725 (1935) [not in FS Library] and F.C. Morgan, Lists of Schoolmasters and Surgeons Licensed by the Bishop of Hereford 1683-1835 (Transactions of the Woolhope Naturalists' Field Club, vol. xxxiv.2 (1953), pages 135-9; not in FS Library]. Those who were licensed also subscribed to the Thirty Nine Articles (of the Christian religion) and may appear in Subscription Books such as those for the Diocese of Norwich, printed 1637-1800 (1937) [FS Library 942.61 H2n; index of names FS Library film 453023.6]. All these books are indexed in Eighteenth Century Medics.

Apprenticeship
In the 18th century more than half of all practising "doctors" seem to have been men who had served an apprenticeship. Apothecaries began to train as surgeons and surgeons to take university degrees, qualifying as physicians. Many apothecaries were Members of the Royal College of Surgeons and these doubly qualified (MRCS, LSA) surgeon-apothecaries were the forerunners of general practitioners. The successful surgeon-apothecary, Alexander Nisbet, in Edinburgh, had three apprentices at a time, taking sixteen between 1711 and 1731, each for three or five years. William Ostler at Barton-upon-Humber had eight apprentices over the long period 1731-84, each for seven years and probably one at a time. However, these numbers are quite exceptional and so far as one can see (in the 18th century at least) two-thirds of masters took only one apprentice.

Juanita Burnby went laboriously through the records of the tax on apprenticeship indentures, 1710-1808, at The National Archives, Kew, and extracted all those relating to a wide variety of medical men. The names of the apprentices and of their parents and masters for the whole period are indexed in Eighteenth Century Medics. These records, it must always be noted, are far from complete.

Eighteenth Century Medics
The majority of the above- and below-mentioned sources, both published and unpublished, which relate to the 18th century are indexed in the most valuable Eighteenth Century Medics: A Register by P.J. and R.V. Wallis, published by the Project for Historical Bibibliography at Newcastle-upon-Tyne (2nd edition, 1988) [FS Library 942 U24w]. The 35,000 highly abbreviated entries need careful study and comparison with the list of abbreviations. The volume includes not only the physicians, surgeons and apothecaries but also many pharmacists, distillers, chemists, druggists, dentists, opticians, midwives and patent-medicine sellers.

Medical Schools and Degrees
During the Victorian era, there was no system of training by the medical schools. There were only a handful of hospitals that existed during the early Victorian era. Many of the physicians believed that medicine ought to be taught by books and antiques. So even if there existed a large number of medical schools during the Victorian era, they wouldn’t have been successful.

Towards the end of the 18th century a number of provincial medical schools were established and after about 1780 the proportion of doctors being trained at university increased. Of those who had degrees at this time about 30% had been to Edinburgh, twice as many as to any other university. Aberdeen and Cambridge were next in the popularity lists, followed by Oxford, Leyden, Rheims, Glasgow and Dublin. Many Irish men went to Scotland for their degrees but medical graduates at Trinity College, Dublin, increased in number in the early 19th century. Many a Nonconformist clergyman was also involved in medicine.

Some biographical details of doctors educated at Oxford and Cambridge will be found in Joseph Foster, Alumni Oxonienses 1500-1886 (8 volumes, 1891-2) [FS Library 942 57/O1 J2ox] and J. and J.A. Venn, Alumni Cantabrigienses from the earliest times to 1900 (10 volumes, 1922-54) [FS Library 942 49/C1 J2c]. The records of the individual colleges may contain further information and include those who did not matriculate or graduate. Those who went to Edinburgh are in the List of Graduates in Medicine in the University 1705-1866 (Edinburgh, 1867) [FS Library fiche 6203960] and those at other Scottish universities are listed in W.I. Addison, A Roll of the Graduates of the University of Glasgow 1727-1897 (1898) [FS Library 941.43/G1 J2g; film 994098.4]; P.J. Anderson, Officers and Graduates of University and King's College, Aberdeen, 1495-1860 (1893) [FS Library 941.25/A1 J2a; film 924643.2; fiche 6066902] and T. Watt, Roll of the Graduates of the University of Aberdeen 1860-1925 [FS Library 941.25/A1 J2u]; and, for St Andrew's University, J.M. Anderson, Matriculation Roll 1747-1897 (1905) [FS Library 941.33/S2 J2an; film 908801.1].

Those who went to Trinity College Dublin are in G.D. Burtchaell and T.U. Sadleir, Alumni Dublinenses 1593-1860 (2nd edition, 1935) [FS Library (1924 edition only) 941.83/D1 J2v; film 990388.2]. The 2,500 students who were at Leyden, 1575-1875, are listed in R.W. Innes Smith, English-Speaking Students of Medicine at the University of Leyden (Edinburgh, 1932) [not in FS Library].

Professionalism and Registration
The first Medical Registers were printed in the years 1779, 1780 and 1783, and are now very scarce but the entries are included in Eighteenth Century Medics. That for 1779 has been published on microfiche [FS Library fiche 6202652].

The privately funded weekly medical journal The Lancet was first published in 1823 and the British Medical Association was formed in 1832 to promote medical science and maintain the honour of the profession. Its publication developed into the British Medical Journal in 1853. Major regulation of the profession came with the Medical Act of 1858 that established the Medical Council "to regulate the qualifications of practitioners in medicine and surgery". It was charged with drawing up and publishing an annual register of those with specified qualifications who would be entitled to practise medicine or surgery. Those who had been practising since before 1815 were allowed to be included. The first official annual Medical Register was printed in July 1859 and shows place of education and qualification but not age or parentage. Any person not on the Register and practising as a physician, surgeon, doctor or apothecary is liable to heavy penalty.

An unofficial Medical Directory for England and Wales had been published in 1845, also showing place of education and qualification but not age or parentage, and continues to this day. Its annual volumes contain much fuller biographies and details of the doctors' publications but, unlike the Register, may include doctors who have allowed their registration fees to lapse. A Directory for 1847 has been published on microfiche [FS Library fiche 6202653]. Both the Register and the Directory now cover all the British Isles.

The first woman to be admitted to a degree in medicine (at Geneva, New York, in 1849), Elizabeth Blackwell, was placed on the Register in 1859, but Elizabeth Garrett, afterwards Mrs Anderson, who was licensed as an apothecary in 1865, was the first registered woman to have an English qualification. The first woman surgeon on the Register, Mrs Mary Emily Dowson, was approved by the Royal College of Surgeons in Dublin in 1886.

General
There are numerous published biographies and obituaries of doctors. References to many will be found in the Wellcome Institute's Subject Catalogue of the History of Medicine and Related Sciences (18 vols. 1980) [not in FS Library] or in its library catalogue, available at the Wellcome Library in the UK or in the "Deaddocs" database 1750-1850.

There is an excellent summary of the various available websites in the article 'Website focus on medical ancestors' in $ Practical Family History UK; no. 121 (January 2008), pages 64-65.

Related Wiki Articles

 * England Medical Occupations (National Institute)
 * England Occupations Medicine (National Institute))
 * England Occupations, Nurses, Midwives, Veterinarians (National Institute)