In Regency England, the medical field consisted of apothecaries, surgeons, and physicians. Only physicians could call themselves “Doctor.”
The physicians were essentially the internists. They were men of the “gentleman” class – from the gentry or, perhaps, even the younger sons of an aristocrat. They did not “soil” their hands by tending a wounds or doing some sort of surgery. They would have had a university education, as did all “gentlemen” of the gentry or the aristocracy, but did not take any courses in the few medical schools available. At Oxford or Cambridge, they would study Greek and Latin. Chances were he received his license without ever having had any clinical experience at all. At the most, they would have observed medical procedures in a lecture hall. They had never dissected a cadaver or performed an autopsy or practiced on patients in any form. As a “gentleman” they might watch over the procedure performed by a surgeon, but they did not participate beyond, mayhap, a bit of curiosity. A physician might dine with the family while he was in attendance in the home, while a surgeon or apothecary would eat with the servants. Also, a doctor would not be paid his fee directly, for such would mean he “worked” for a living.
After medical school, a physician could take further training and become a “consulting physician,” brought in by other doctors to diagnose and recommend treatment in complicated cases.
A surgeon would train at as an apprentice with another surgeon. “Surgeon” in those days did not mean the same as we think of it today. In truth, they rarely performed surgery beyond setting broken bones, etc. No open heart procedures or cancer treatments. No eye surgeries. They were more of the nature of what we would call a “general practitioner” in our time. They treated common ailments – coughs, colds, blisters, influenza, etc. In order to become a surgeon, the man was expected to serve as an intern to an older, more established surgeon. What we would now call “on the job training.” Even the poet, John Keats, began such an internship at the age of 16. He was assigned to one Mr. Thomas Hammond. Before begin the internship, Keats was educated beyond grammar school. He was not a “gentleman,” as I discussed earlier. His grandfather owned a livery. He performed menial jobs such as cleaning the examining room and tending to the surgeon’s horses. Ironically, he left the internship after two years and set himself up as a surgeon. Unfortunately for Keats, the law overseeing surgical procedures changed the following year. Then it was set at a FIVE-year apprenticeship and a six-months training course to maintain a license as a surgeon.
Keats was not completely discouraged. He applied to medical school and was located in London, where he (for the sake of all of us who love poetry) took the acquaintance of Leigh Hunt, the person who first published Keats’s poems. Alicia Rasley tells us, “From Keats’s experience, we can learn a lot about Regency-era medical education. For example, (Dr. Arpan K.)Banerjee writes that Keats paid 25 pounds 4 shillings (a considerable sum equivalent to about six months wages for many workers) for a 12-month course of study at Guy’s Hospital in Southwark (just south of the Thames, very close to the site of Shakespeare’s Globe Theater). Guy’s was, and is now, one of the more prestigious of medical schools.
“Keats took anatomy, physiology, and surgery, and to earn more money became a “dresser” at the hospital. This job appears to have little to do with dressing the doctors, but much to do with applying dressings to wounds. Dressers were doctors’ assistants, performing minor surgical tasks and taking notes. After a year of schooling, Keats qualified to take the apothecary exam and passed. Apothecaries were pharmacists, mixing medications to sell to the public. Keats could have continued with his education to become a physician, or stopped then and set up shop as an apothecary. But—the writers among us might recognize this sequence of events—he got his first acceptance letter (for a sonnet), and quit medicine forever.
“Banerjee concludes, ‘John Keats is surely the only Licentiate of the Society of Apothecaries to be a member of the select pantheon of great poets of the English language. Few others in this pantheon lived a shorter life than he, yet Keats managed to qualify as a doctor in this time in addition to producing a prolific poetic output.””
One must keep the terms straight when writing about medical care in the Regency. There were surgeons, apothecaries, and physician. All three could be referred to as “doctor.” This sometimes throws me off when writing such a scene. In my novella, “The Earl’s English Rose,” the heroine’s Indian man servant is shot in a highway robbery. At first, I called the man who treated him, “doctor.” Though he was most assuredly a surgeon, I hesitated in calling him such, but finally realized “doctor” might confuse some of the readers, because they were associating “doctor” and “physician” as one and the same. One distinction which helps in writing such scenes is a physician would be called “Doctor,” while a surgeon or apothecary was addressed as “Mister.”
“Guy’s (which united with St. Thomas during Keats’s years) was probably the most prestigious of medical schools in the kingdom. However, Edinburgh was also known for giving an exceptional medical education, and many of the most prominent 19th Century physicians (including Conan Doyle) trained there.” (Doctors in the Regency)
Apothecaries were supposed only to be the “pharmacists,” but often acted as general practitioners in lieu of other medical help. They would be one step above a tradesperson on the social ladder. Like surgeons, they customarily learned their trade during their tenure as apprentices. They were the alternative for those who could not afford a physician’s fees. Generally, they were only paid for the drugs and lotions and mixtures they sold, not for any advice they dispensed along the way.
These men were educated in the use and composition of herbs, potions, and medicines, and were usually found more in rural areas.
An apothecary shop offered a customer herbs, panaceas, poultices, etc. Herbs grew in an adjacent garden and were stored in apothecary jars and drawers and pouches made of linen or even cotton.
As a group they “seceded from the Worshipful Company of Grocers, and were incorporated as a separate city livery company in 1617, [and] were supposed to stay in their shops and dispense the prescriptions written by the physicians.” (A Primer on Regency Era Doctors)
In Jane Austen’s Pride and Prejudice, we learn Mr. Jones, would have traveled to Netherfield Hall and dispensed his advice without recompense. But he recommended his draughts, which enabled him to earn some money, and instructed Elizabeth on how to use them:
The apothecary came and having examined his patient said as might be supposed that she had caught a violent cold and that they must endeavor to get the better of it advised her to return to bed and promised her some draughts. The advice was followed readily for the feverish symptoms increased and her head ached acutely.
My own piece on Medical Professions in the Georgian Era
Plus, these excellent articles . . .
- The Physician in the 19th Century
- A Triple Tragedy: How Princess Charlotte’s Death Changed Obstetrics
- Doctors and Medical Care in the Regency Era
- Doctors in the Regency
- The Apothecary’s Prayer
- Jane Bennet’s Apothecary in Pride and Prejudice
- Mister, Doctor, or Hey You: Medical Personnel in the Regency
- Regency England and Medical Care
- A Primer on Regency Era Doctors
- Physicians, Surgeons and Apothecaries
Fascinating article. Question would any of the above mentioned be present during a birth or would it strictly be the midwife only.
If any were present, Diane, it would have to be a surgeon. A “doctor” would be equivalent to a pharmacist in today’s terms. However, a midwife was, for the most part, the way of things in those days. The article I did previously on 19th Century Childbirth, Before and After Princess Charlotte’s Death might be useful in answering some of your questions: https://reginajeffers.blog/2016/06/07/19th-century-childbirth-before-and-after-princess-charlottes-death/#:~:text=Nihell%20claimed%20that%20few%20deliveries%20required%20the%20use%20of%20forceps.&text=But%20forceps%20were%20not%20the,delivery%20of%20her%20fifteen%20children.
Phew! I wouldn’t have stood much of a chance of surviving my two cancers in Regency times! Whereas hopefully the three operations I’ve had have eliminated them today. Obviously some of them were better than nothing (at least when they stopped believing that bleeding was the answer to most things)
Me either, Glynis. I am thankfully healthier than many my age, but I have had my trials and would not have survived cancer. For another example, I had an ectopic pregnancy which was not diagnosed right away. My tube ruptured.
Great post. Love to dream of living in Jane Austen time but not willing to trade our modern medical care (or indoor plumbing lol)
Or air conditioning. Or comfortable clothing. Or proper care of female issues. Or … etc. etc. etc.