Overview of English medical practice between 1700 and 1850

Except in obstetrics, medical care did not change in any fundamental way during the 150 years between 1700 and 1850.  There were inventions, such as the stethoscope invented by the French physician Laennec in 1819, which altered how patients were examined, but until the acceptance of the concept of infectious disease in the second half of the 19th Century, the theory of medical treatments remained essentially unchanged.  This stagnation was worsened by the Napoleonic Wars, which significantly decreased travel in continental Europe by English physicians and so limited the transmission of medical knowledge from Paris and Vienna, major centers of medical advancement of the time.

Physicians were trained in England at medical schools; the only requirement for admission was the ability to pay the tuition and learning was limited to attending lectures.  There were few or no practical or hand-on teaching sessions as physicians did not perform any procedures or surgeries.  In some cities in Scotland and on the Continent a medical diploma could be obtained by mail order.  This separation of medical and surgical treatment was the result of societal mores which prevented “gentlemen” from working with their hands, a situation that began in the middle ages (when the only surgeons were barbers, who had the sharp knives).

Surgeons in the Georgian Era had long been separated from barbers, but they continued to be a completely separate branch of medical care from the physicians.  Surgeons were not required to go to medical school, but were trained by apprenticeship like any other trade.  For this reason, professional surgeons have always been called “Mr.” in England, unlike physicians, who are called “Dr.”  This has translated in modern practice to an English surgeon attending medical school and being called “Dr.” until he finishes his surgical training, at which time he goes back to “Mr.”  As the 18th Century progressed, more and more surgeons attended lectures in medical schools and gradually became more professional about their field, but until the development of anesthesia (ether) and sterile technique in the second half-centurythey were limited in what they could do.

Most of the practice of surgeons was in setting bones, removing bullets, stitching up wounds, and bleeding patients.  An important part of the practice in the first half of the 18th Century was in obstetrics; when a midwife gave up on a difficult case and either the mother or child was going to die the surgeon was called in to try and save one of them.  Not surprisingly, the association in the minds of the public between surgeons and obstetrics was that of death.

Apothecaries, or pharmacists as they are now known, were not legal practitioners of medicine, but they were the people who had the drugs and common usage in the 18th and 19th Centuries was for people who did not have a physician, or who could not afford a physician, to ask the apothecary for advice.  As time went on he was called to peoples’ houses to prescribe for those who were ill, and many upper class households used an apothecary for the servants and a physician for the family.  The apothecary could not legally charge for his advice, but only for the drugs which he prescribed.  It was not until 1815 that a law was passed requiring licensing of apothecaries, but the law was universally despised by medical practitioners and was rarely enforced because of the great confusion of responsibility for the enforcement of the law.

Midwives, until the second half of the 18th Century, were almost always women who gained some experience delivering babies and who gained their job by default of other practitioners.  Then male surgeons, who were already considered tradesmen, began infringing on this all-female monopoly and brought medical science (such as it was) into the practice of what is now known as obstetrics.  This change was largely brought about by the demands of the gentry and peers for healthy heirs to their estates.  This was so important in the smooth inheritance of vast amounts of English land that the man-midwives, or accoucheurs, were actually accepted into the upper echelons of society in a way that no other surgeons had been.  No accoucheur would have been invited to dinner by the haute ton, but one, William Knightley, was knighted for his service to the crown (he was the Prince Regent’s personal practitioner at the time) and was actually given a post as advisor to the Regent in government matters.  Clearly, he was seen by the Regent as a man of acumen and wisdom.