Regency History

Physician, Surgeon, or Apothecary?

“A surgeon!” said Anne.

He caught the word: it seemed to rouse him at once; and saying only: “True, true, a surgeon this instant,” was darting away, when Anne eagerly suggested:

“Captain Benwick, would not it be better for Captain Benwick? He knows where a surgeon is to be found.”

Persuasion by Jane Austen, p. 50

If you’ve read this book, or seen the excellent adaptation starring Amanda Root and Ciaran Hinds, you’ll recognize this scene as the one in which Louisa Musgrove has fallen and hit her head, and been rendered unconscious. Now, today, if this were to happen, none of us would call for a surgeon, because surgery is something that takes place in a hospital and involves cutting and stitching together again and, especially in the case of head injury, is hopefully the last resort to recovery.

However, in Jane Austen’s day, “surgeon” was what people called a general practice doctor, who might also be the apothecary, depending on the size of the town or the availability of medical professionals in the area. A surgeon in the Regency era was simply a self-taught or non-degree-holding medical man who knew enough to treat you when you were ill, and would also perform surgery if necessary.

Medicine has always been an evolving art, and its designations have necessarily evolved with it. As early as the 16th century, England had organized medicine into what was called a tripartite system, with strict definitions of each of the three recognized areas of medicine.

The apothecaries were chemists, who concocted drugs or medicines for people to take when ill. They were learned in use of herbs and plants as well as various minerals and chemicals, and were primarily concerned with correctly mixing medicines and selling their wares, not advising customers on how to treat illnesses (very much like modern-day pharmacists).

Physicians were perhaps the “highest” of the three divisions, simply because they had the most formal education and catered almost exclusively to the wealthy. To become a physician, one had to receive a degree in medicine from a recognized institution, like Oxford or Cambridge. A physician would diagnose, treat, and advise patients regarding their maladies, and would prescribe medications.

Surgeons were a bit more complicated. They performed any invasive treatment (surgery), including amputation and bloodletting, but also cutting hair. The Guild of Surgeons was officially combined with the Company of Barbers during the reign of King Henry VIII, perhaps because there wasn’t enough work for two separate men in every town, or because people who like to cut things ought to be contained—who knows? But barber-surgeons were common for a long while.

During the 18th century, however, the boundaries between these three designations began to be blurred, mostly because there weren’t enough physicians to go around, and even if there were, the poor could not afford them. Surgeons and apothecaries began to step into the gap, using their applied experience in working beside physicians to advise and treat any who needed their help.

The Apothecaries’ act, 1815: A Reinterpretation, by S.W.F. Holloway, p. 1

By the time of the Regency, the surgeon-apothecary had become common, performing surgeries alongside treating illnesses and prescribing drugs, but they at least generally became licensed through the College of Surgeons in order to do so. A new group called chemists managed the compounding of the drugs to be dispensed, while physicians still were the acknowledged gods of medicine, but simply were not a practical solution to the general populace.

The Apothecaries’ Act of 1815 officially regulated the practice of apothecary-surgeons, requiring a 5-year apprenticeship and an examination before candidates would be permitted to hang up their shingle. It is hoped that this increase in education and experience made a difference, as the reigning medical theory—of the need to bring the body into balance by stimulant or depressant use—was not much of an improvement from that of the middle ages.

Incidentally, or logically, because of the distinction of education, only physicians were referred to as Doctor So-and-so, while apothecaries and surgeons were merely Mister.