Surgeons and Apothecaries in Suffolk: 1750-1830 City Slickers and Country Bumpkins – Exploring Medical Myths by Sally Irvine, M.A.(Cantab.) Thesis submitted to the University of East Anglia for the degree of Ph.D. School of History April 2011 © This copy of this thesis has been supplied on condition that anyone who consults it is understood to recognise that its copyright rests with the author and that no quotation from the thesis, nor any information derived therefrom, may be published without the author’s prior written consent. ABSTRACT This thesis challenges accepted views of the development of general practice by revealing significant differences between the assumptions which have been made around many aspects of practitioner life and practice. It has achieved this through research into one provincial and rural area of England (the towns and villages of Suffolk), producing data which, while often inconclusive and incomplete, is sufficiently voluminous to raise questions. Where no firm conclusions can be made, it has often been possible to at least challenge those of others based on equally incomplete data. This approach has produced evidence of diverse antecedents and early educational experiences, the continuing use of apprenticeships well into the nineteenth century, and a remarkable number of publications and societies for mutual exchange and development, compensating to some degree for the lack of interchange with leading edge practitioners in London and other metropolitan areas; facts not usually recognised in traditional histories. From this evidence, the lack of availability of and access to the then growing hospital opportunities appears not to have diminished the range of skills and services offered by country practitioners to their community. There is evidence of greater involvement by women in many aspects of practice than is usually recognised in orthodox historiographies; such women having significant status and income relative to the rest of the community they served. All this leads to the tentative conclusion that rural medical practitioners may be a link between the sixteenth century healer and the nineteenth century general practitioner. The hope is that more research into comparable areas of England will establish whether the nature of the country surgeon and apothecary in Suffolk was replicated elsewhere, and therefore that this proposition is generalisable. 2 Table of Contents Page Abstract 2 Table of Contents 3 List of Plates, Tables and Figures 5 Acknowledgements 7 List of Abbreviations Used, Conventions Used 8 Chapter 1: Introduction 9 1.1 Sources and Historiography 14 1.2 The Argument 33 Chapter 2: Suffolk Context 1750-1830 45 2.1 Demography and Economy 45 2.2 The Social Structure 55 2.3 Changing Morbidity and Attitudes to Illness 64 Chapter 3: Titles, Origins and Numbers 72 3.1 Titles 72 3.2 Origins and Dynasties 87 3.3 Numbers 100 Chapter 4: How They Were Educated and Trained 109 4.1 Schooling 109 4.2 Apprenticeship 125 Chapter 5: Further and Higher Education 151 5.1 Hospital and Dispensary Education and Training 152 5.2 Further and Higher Education 168 Chapter 6: What Sort of Medicine - Treatment or Prevention? 181 6.1 Treatment 181 6.2 Preventative Medicine 196 3 Chapter 7: Midwifery and the Role of Women in Medicine 213 7.1 Historiographical Context 213 7.2 Training and Standards 221 7.3 The Suffolk Evidence 224 7.4 Female Midwifery 231 7.5 Women in Other Healthcare Roles 236 Chapter 8: Income and Status 253 8.1 Income 253 8.2 Status and Standing 283 Chapter 9: Conclusions 293 9.1 Key Research Questions 294 9.2 Evidential Strengths and Weaknesses 303 9.3 What Remains to be Done? 305 Appendices 307 Appendix A Suffolk Medical Practitioners and their Antecedents 308 Appendix B Medical Dynasties 309 Appendix C Ratio of Practitioners Identified Against Populations of the Larger Towns and Villages in Suffolk in 1801 and 1831 314 Appendix D Known Schooling of Suffolk Medical Practitioners 317 Appendix E Apprentices by Place of Birth Where Known, Place of Apprenticeship and Place of Practice 319 Appendix F Apprentices by Population Centres 1772-1815 and 1815-1858 333 Appendix G Known Further Training of Surgeons and Apothecaries by Hospital/Dispensary with Dates and Length of Stay 335 Appendix H Known Higher Educational Attainment of Suffolk Medical Practitioners 340 Appendix I Practitioners With ‘Midwife’ in their Preferred Title 343 Appendix J List of Some Doctors Attending Births Between 1750 and 1830 345 Appendix K Social Origins of Practitioners’ Spouses 348 References and Bibliography 350 4 List of Plates, Tables and Figures List of Plates Page 1 George Crabbe 14 2 Abelia chinensis 275 List of Tables Page Table 3.1 Analysis of the Stated Principle Professional Title 78 Table 3.2 Comparison of Foart Simmons’ Figures of Practising Doctors in Suffolk in 1783 and Those Derived from Primary Sources and SMB 79 Table 3.3 Analysis of Changes in Title Use in Suffolk in 1800, 1820 and 1830 85 Table 3.4 Parental Occupation of Medical Practitioners in Bristol and West of England, 1760-1830 90 Table 3.5 Occupation of Fathers of 149 Apprentices in London, 1764-81 91 Table 3.6 Analysis of Occupations of Fathers of Suffolk Practitioners, 1750-1830, Compared to Apprentices, 1815-1858 92 Table 3.7 Doctor-population Ratio in Suffolk Towns with over 2,000 Inhabitants in 1801 and 1831 106 Table 4.1 Types of Schooling from DNB Analyses 110 Table 4.2 Apprentices 1772-1815 and 1815–1858 in Some Centres of Population 143 Table 4.3 Average Premium for Each Length of Apprenticeship for Surgeons and Apothecaries in Suffolk 147 Table 4.4 Analysis of Average Premium for Each Length of Apprenticeship by Decade in Suffolk 1760-1810 148 Table 4.5 Summary of Average Length and Premium by Decade 149 Table 5.1 Facilities for Medical Education in England and Wales up to 1830 156 5 Table 5.2 Distribution Over Hospitals and Dispensaries of Those Suffolk Practitioners Whose Choice is Recorded 157 Table 5.3 Numbers of Known Members by Decades of Suffolk Medical Societies and Book Clubs 174 List of Figures Page Figure 2.1 Map of Suffolk in 1825 Showing Main Towns and Turnpike Roads 48 Figure 3.1 Scatter Diagram of Doctor Ratios Against Population in the 52 Most Populated Suffolk Towns in 1801 105 Figure 3.2 Scatter Diagram of Doctor Ratios Against Population in the 52 Most Populated Suffolk Towns in 1831 105 Figure 7.1 Access to a Man Midwife Locally, 1750-1830, Throughout Suffolk 225 6 ACKNOWLEDGEMENTS I have found the work of Dr David van Zwanenberg and his editor, Eric Cockayne, invaluable in this research. Without their initial work on gazetting all medical practitioners in Suffolk, my task would have been much more difficult and onerous. My attention was drawn to this collection by the staff of the Suffolk Record Office in Ipswich who have been unfailingly helpful and supportive. Their colleagues in the other SRO locations at Bury St. Edmunds and Lowestoft have been similarly knowledgeable and gave freely of their expertise. Staff at the British Library have directed and assisted me in searching out obscure references and I am grateful to them all. My greatest thanks go to my supervisor, Dr. Steven Cherry, who has been supportive throughout and provided me with much need encouragement and positivity, as well as ideas and references. I am also extremely grateful to Rosemary Day who read each chapter as it came ‘off the line’, and provided helpful and constructive feedback. Professor Janet Gale Grant of The Open University read the final draft and commented as to argument and construction, and her ideas and challenges were invaluable. I am most grateful to Dr Carol Varlam who also read the final drafts and spent considerable time giving advice and detailed comment. Support and enthusiasm from Rosemary Carter has also been an essential help throughout. All these have contributed to the end result, but I take full responsibility for the arguments and conclusions reached. 7 List of Abbreviations The following abbreviations have been employed: DNB Dictionary of National Biography LSA Licentiate of the Society of Apothecaries MD Doctor of Medicine MRCS Membership of the Royal College of Surgeons RCP Royal College of Physicians RCS Royal College of Surgeons RHS Royal Humane Society SMB Suffolk Medical Biographies SRO Suffolk Record Office Conventions Employed • Dates given in round brackets for medical practitioners are birth and death, unless they are in italics with curly brackets, in which case they are dates when the practitioner was known to be active. • The use of male forms of pronouns in general text is for convenience and ease of reading, but also reflects the overwhelming predominance of male practitioners at the time. However, evidence shows that there were some female practitioners and, where they are discussed directly, the appropriate pronoun is used. • References prior to and including 1949 are treated in the past tense; all those from 1950 onwards are treated as present. 8 CHAPTER 1: INTRODUCTION “The country doctor, such as we know him – a well-read and observant man, skilful in his art, with a liberal love of science, and in every respect a gentleman – is so recent a creation that he may almost be spoken of as a production of the present century”.1 In 2000, Steven King and Alan Weaver described as ‘valuable’ the broad brush generalisations that resulted from the attempts of previous historians to provide an overview of the struggle between established medical theory and the rise of empiricism. At the same time, they warn that such generalisations were leading to an emphasis on national, largely London-based, developments to the detriment of regional and more local research.2 Irvine Loudon recognised this when he wrote that: “[the] perception of medical man in the eighteenth century was perhaps inevitably based on a small and highly literate elite of practitioners, most of whom practised in London”.3 Similarly, Mary Fissell admits that “the historiography of English medicine has been strongly weighted towards the metropolis”.4 This continuing emphasis is not surprising, as the evidential base for describing medical practice in the late eighteenth and early nineteenth centuries came to a large extent from London or other major cities such as Edinburgh, because the most successful doctors (socially, financially and professionally) worked in such large cities. Moreover, most British medical advances either started or were developed there, together with the growth of largely metropolitan hospital-based medicine which was such an important factor in the changing relationship between doctor and society in this period. However, this has sometimes led to an underestimation of provincial features and developments. Accordingly, this thesis seeks to address a number of apparent distortions concerning the history of medical practice in the late eighteenth and early 1 John Cordy Jeaffreson, A Book About Doctors, Vol. 11, (London, 1860), p.276. 2 Steven King & Alan Weaver, “Lives in their hands: the medical landscape in Lancashire, 1700- 1820”, Medical History, 45, (2000), pp.173-200. 3 Irvine Loudon, Medical Care and the General Practitioner 1750-1850, (Oxford, 1986), p.11. 4 Mary Fissell, Patients, Power and the Poor in Eighteenth Century Bristol, (Cambridge, 1991), p.194. 9 nineteenth centuries, by considering the example of the rural county of Suffolk. A review of the areas of agreement and conflict amongst modern writers, when tested against Suffolk evidence, raised doubts about current conclusions covering many aspects of a doctor’s life, suggesting the need for revisions and further research. Also, in some respects the primary evidence presented here reinforces current thinking; for example, in relation to the type and range of medical practice on offer. In other respects, it points to a need for revised interpretations of, for example, the educational background of surgeons and apothecaries, the prevalence of hospital training before 1830, and the influence and role of women. The research has provided new narratives about the lives of surgeons and apothecaries, sufficient to suggest that an approach based primarily on London and provincial cities like Birmingham or Bristol, may be distorting the picture of healthcare delivery in the country as a whole. The rural medical practitioner who emerges from the Suffolk evidence is a more complete entity than just a ‘poor cousin’ of the metropolitan or even large town doctors, a possible new link in the emergence of the general medical practitioner from the healer of the sixteenth and seventeenth centuries. This inquiry is significant because only one in five of the population lived in major cities and towns in 1800, with the majority living in the countryside until about 1850.5 Evidence concerning this majority should therefore feature within any depiction of medical care. A county-wide survey has value in its own right, but the advantage lies not only in the amount of data available, but its consistency across a large tract of inhabited land. Any conclusions reached have legitimacy which is not achievable if based on a smaller research area. For example, histories at the local or parish level are generally based on evidence that is too narrow to allow generalisation.6 Conversely, national studies tend to be skewed towards urban experience where data are 5 Phillip J. Waller, Town, City and Nation – England 1850-1914, (Oxford, 1983), p.2. 6 Joseph L. Barona & Steven Cherry (eds.), Health and Medicine in Rural Europe 1830-1945, (Valencia, 2005), p.20. 10