The sheer numbers of people who practised medicine in some form or other during the medieval and early modern periods are overwhelming. Medical practitioners were, quite literally, everywhere. From ‘formal’ trained and licensed physicians across to the village blacksmith who might perform a secondary role as tooth-drawer, the types of practitioner are also legion. All of the terms below can be found in early modern sources as descriptive terms for practitioners, including their various derivatives and alternative spellings) and this list is by no means exhaustive.
Physic (Phisic, Physick, Phisique, Fisick(e)), Physician, Doctor (of medicine), licentiate, Practicer, Practitioner, Apothecary (pothecary, poticary), Surgeon, Chirurgeon (Chirurgion), Barber, Barber-Surgeon, Mounteban(c)k, Druggist, Chemist, Midwife, Peruke-maker.
It is important to note, too, that these terms do not necessarily imply specific groups or trades. Much depends not only on how practitioners identified and described themselves, how others described them, and in what contexts. For example, it is not unusual to find a man described as a surgeon in one source, and then as a ‘gentleman’ in another. Neither are the terms mutually exclusive. An apothecary might also act as a surgeon or a barber (or both), whilst a physician might run an apothecary business. Many practitioners also carried on unconnected trades, with medicine forming only a part of what they did. The terminologies themselves, therefore, are unreliable in assuming wither any homogeneity within, or differentiation between, medical ‘trades’. This was a world of medical practice where many individuals provided medical services to a greater or lesser extent. But this is not to say that we should therefore regard medicine as a completely unstructured free-for-all. There were certainly general categories into which practitioners could, at least nominally, be fitted.
The provision of medicine in the early modern period has often been depicted in terms of a tripartite structure – a pyramid of practitioners consisting of Physicians, surgeons and apothecaries, with a base layer of ‘unorthodox’ practitioners (quacks, cunning folk, wise-women etc). This is partly based on the corporate structure of medicine in Medieval Britain where, by 1550, there were three separate medical corporations: the Society of Apothecaries, the Barber-Surgeon’s company and the College of Physicians (later changed to the Royal College of Physicians). The effect of recent scholarship has eroded the barriers between these practitioner types to the extent where the divisions can no longer be seen as reliable. Nevertheless, it is still useful to pick out some broad characteristics.
Early modern physicians – doctors –might be used to apply to ‘professional’ medical practitioners who had perhaps undertaken formal medical training, at a university or hospital, achieved a medical degree from Oxford or Cambridge, or from one of the many European universities offering MDs, or had been granted a license to practice from the Royal Colleges in London or a diocesan license from the Archbishop of Canterbury or regional Archbishops. In a formal sense these were ‘orthodox’ practitioners insofar as they regarded themselves as elite medical practitioners, and therefore superior to unlicensed ‘empiricks’ – untrained and unlicensed doctors who they regarded as dangerous quacks. In London there was some regulation of practice, due to the presence of the College of Physicians, and some prosecutions for those operating without a licence. Away from London, however, there was little enforcement or regulation of practice.
The assumption of the term ‘doctor’, for example, is not a marker of either training or qualification. In fact even the use of apparently specific terms or titles, such as ‘MD’ cannot be relied upon since it is already clear that many ‘unorthodox’ practitioners simply assumed title or mantle as they pleased, especially if it made them appear more important or able. ‘Doctor’ was a generic term used interchangeably with other titles by practitioners, and as a title by which others referred to them.
One key aim of this project is to explore the spectrum of ‘doctors’ across medieval and early modern Britain, to establish what functions they performed within their communities (i.e. not just in terms of their medical practice), how this changed over time, and what sorts of networks they belonged to.
A similarly difficult situation arises in trying to exactly define the surgeon or barber-surgeon. Self-evidently their function was to perform surgical techniques from minor operations to (much more rarely) amputations and more complex procedures. As with physicians, the Barber-surgeons’ company required training and qualification for membership and this could again be obtained through universities or training hospitals. Again, too, regulation was somewhat limited to London.
The training of surgeons varied markedly. At a hospital prospective surgeons might benefit from more practical training, whilst a university might give them a focus on broader holistic bodily theories. By the eighteenth century some European universities such as Württemburg, were including things like musculature, the nervous system and even obstetrics as part of the surgeon’s training.
Barber-surgeons provided a range of what might be thought of as ‘running repairs’, from lancing boils and setting bones to bodily maintenance such as bloodletting, hair cutting and shaving. In this sense, the local barber was an important type of practitioner as they too often undertook a general practice role, as well as catering for routine matters of appearance.
In the provinces and rural areas training was far less defined. It might take the form of a formal or informal apprenticeship, perhaps even more so for barber-surgeons, or even ad hoc, ‘on the job’ experience.
The apothecary was a ubiquitous figure across early modern Britain. Apothecaries were medical retailers. Often (but not always) running a shop, they supplied a range of medical (and often non-medical) goods from drugs and compound remedies to herbs, spices, ointments and powders to plasters and unguents.
By law, the apothecary was supposed to supply medicines, rather than prescribe them. As today, the sick person was expected to take their doctor’s receipt to the apothecary, who would make up the necessary substance. Likewise, people could buy medicines ready-prepared in case of need, or could purchase individual ingredients to make their own favourite preparations. It was from the apothecary that a person might buy paper – perhaps to write their own remedy collections – along with other household items. Some apothecaries also acted as a sort of general store.
It is also important to note that the apothecary was not supposed to physically treat sick people, nor to undertake surgery. At least in theory, apothecaries who broke this rule could be prosecuted, although relatively few actually did. In fact, especially in rural areas, an apothecary might well prove to be the only source of medical provision and therefore effectively be a general practitioner.
What was the apothecary’s shop like? In London, and other large towns, apothecary businesses could be large, while country premises might have little more than a desk and a couple of shelves to display goods. In better-equipped shops, visitors might well be greeted by shelves with row upon row of painted majolica drug jars and glass vials filled with exotic-coloured liquids. A large counter might contain scales and weights, and a pestle and mortar to grind up ingredients. In order to entice people to buy, some apothecaries tried to create a sensory experience to make their shop and themselves appear mysterious and arcane. The smells of exotic spices would have assailed the nostrils of customers, while the sight of hundreds of strange jars and brightly-coloured substances would have occupied the eye. It is easy to imagine the astonishment that seeing a stuffed crocodile hanging from the ceiling might cause to an unsuspecting shopper. Some London retailers used tricks such as these, while the premises of rural apothecaries might be more austere.
To return to the point made earlier, the number of prospective practitioners was legion. There were, for example, many types of ‘informal’ medical practitioners who specialised in certain conditions or parts of the body. Occulists might undertake treatment of eye complaints, ‘cooching’ cataracts or treating sore eyes. Tooth-drawers and bonesetters might perform their services ad hoc, rather than operating from fixed premises.
From the latter half of the seventeenth century, and especially into the eighteenth as the ‘medical marketplace seemingly expanded’, quack doctors, travelling ‘mountebanks’ and other vendors of cheap if not dubious preparations criss-crossed Britain selling their wares and increasingly took to newspapers to advertise goods and services.
Magical healing was doubtless popular, and attested to by the ready survival of healing charms, prayers and remedies often categorised as ‘folkloric’, but often no different to those of ‘orthodox’ practitioners. Figures like cunning folk, wise women and village white witches or wizards often relied upon reputation, performing an important role in offering choices and alternatives to those seeking medical services.