Physicians, Surgeons and Apothecaries

When I trained as a doctor there was a definite hierarchy in the profession. Hospital doctors were superior to GPs. They had more knowledge (supposedly) and status. The two types of hospital doctor, physicians and surgeons, were considered equal although physicians thought they had the most brain power, while surgeons thought themselves the most daring and courageous. Physicians might become annoyed when they were accused of being too cerebral, and surgeons were a little sensitive that they had once been the barber surgeons and had a reputation in the past as butchers. GPs were at the bottom, below both, which is actually unfair as GPs have an enormous breadth of knowledge and manage a wide range of conditions from babyhood to old age.

In the past it was a little different. In the late eighteenth and early nineteenth century there were three main groups of medical practitioners.

University-trained physicians treated internal diseases. They weren’t very hands on but might sniff or inspect urine. They prescribed medicines prepared by apothecaries. Physicians were few in number and treated the rich, who might invite them to dine with the family.

Surgeons trained at the London hospitals and were licensed by the Corporation (later Royal College) of Surgeons. Surgeons treated external disorders of teeth, eyes and skin, and venereal disease. If something needed practical interference that was their remit: setting bones, dressing wounds or ulcers, incising abscesses and amputations.

Apothecaries treated the poor. They undertook a five-year apprenticeship but it was unregulated until 1815. Apothecaries could treat people but only charge for the medicines, not the advice. They often had a shop.

There were also unqualified quacks, charlatans, mountebanks, bonesetters and some patients even consulted the horse doctor.

Many “doctors” working in the countryside or outside London were trained as both surgeons and apothecaries as Thomas Hammond, the man who trained John Keats, was. They had the skills and knowledge of the apothecaries but could also undertake many of the practical surgical procedures needed. They often also had obstetric skills and experience. They evolved into the first GPs in England.