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Published online by Cambridge University Press: 26 July 2012
The licensing of provincial surgeons and physicians in the post-Restoration period has proved an awkward subject for medical historians. It has divided writers between those who regard the possession of a local licence as a mark of professionalism or proficiency, those who see the existence of diocesan licences as a mark of an essentially unregulated and decentralized trade, and those who discount the distinction of licensing in assessing medical expertise availability in a given region. Such a diversity of interpretations has meant that the very descriptors by which practitioners were known to their contemporaries (and are referred to by historians) have become fragmented and difficult to use without a specific context. As David Harley has pointed out in his study of licensed physicians in the north-west of England, “historians often define eighteenth-century physicians as men with medical degrees, thus ignoring … the many licensed physicians throughout the country”. One could similarly draw attention to the inadequacy of the word “surgeon” to cover licensed and unlicensed practitioners, barber-surgeons, Company members in towns, self-taught practitioners using surgical manuals, and procedural specialists whose work came under the umbrella of surgery, such as bonesetters, midwives and phlebotomists. Although such fragmentation of meaning reflects a diversity of practices carried on under the same occupational descriptors in early modern England, the result is an imprecise historical literature in which the importance of licensing, and especially local licensing, is either ignored as a delimiter or viewed as an inaccurate gauge of medical proficiency.
1 For example, J H Raach, A directory of English country physicians, 1603–1643, London, Dawsons of Pall Mall, 1962; R M S McConaghey, ‘The history of rural medical practice’, in F N L Poynter (ed.), The evolution of medical practice in Britain, London, Pitman Medical Publishing, 1961, pp. 117–44.
2 For example, Irvine Loudon, Medical care and the general practitioner, 1750–1850, Oxford, Clarendon Press, 1986.
3 For example, Margaret Pelling and Charles Webster, ‘Medical practitioners’, in Charles Webster (ed.), Health, medicine and mortality in the sixteenth century, Cambridge University Press, 1979, pp. 165–236. The authors provide a basis for quantifying practioner/patient ratios, without breaking down those ratios into the more subtle strata of licensed practitioner/patient ratios.
4 David Harley, ‘“Bred up in the study of that faculty”: licensed physicians in north-west England, 1660–1760’, Med. Hist., 1994, 38: 398–420, p. 399.
5 Doreen Evenden, ‘Mothers and their midwives in seventeenth-century London’, David Harley, ‘Provincial midwives in England: Lancashire and Cheshire, 1660–1760’, and Ann Giardina Hess, ‘Midwifery practice among the Quakers in southern rural England in the late seventeenth century’, all in Hilary Marland (ed.), The art of midwifery, London, Routledge, 1993. D A Beaufort, ‘The medical practitioners of western Sussex in the early modern period: a preliminary survey’, Sussex Archaeological Collections, 1993, 131: 139–51. Doreen Evenden, The midwives of seventeenth-century London, Cambridge University Press, 2000. Adrian Wilson, A safe deliverance: childbirth in seventeenth-century England, London, UCL Press, 1998.
6 These are the parishes of Bradford and Somerton, which were peculiars of the Bishop of Exeter. Chardstock, which is also included, is now in Somerset but in the early modern period was in Devon.
7 See, for example, John R Guy, ‘The episcopal licensing of physicians, surgeons and midwives’, Bull. Hist. Med., 1982, 56: 528–42; R S Roberts, ‘The personnel and practice of medicine in Tudor and Stuart England. Part 1: the provinces’, Med. Hist., 1962, 6: 363–82.
8 Technically the legislation granting bishops the right to license practitioners was not repealed until 1948. See Guy, op. cit., note 7 above, p. 542.
9 It was not purely at a local level that one could be licensed. The universities, the Archbishop of Canterbury, other ecclesiastical authorities and the Privy Council could all license a physician or surgeon. Records relating to diocesan licensing should therefore not be taken to reflect all licensed practitioners, nor should they be seen as wholly representative of medical activities in a particular vicinity.
10 Jonathan Barry, ‘Population distribution and growth in the early modern period’, in Roger Kain and William Ravenhill (eds), Historical atlas of south-west England, Exeter University Press, 1999, pp. 116–17, on p. 116.
11 Pelling and Webster, op. cit., note 3 above, pp. 227, 233.
12 Devon Record Office, Exeter (hereafter DRO): Chanter 42–49; Roberts, op. cit., note 7 above, p. 369; McConaghey, op. cit., note 1 above, p. 129. In addition, 38 were granted in the period 1568–97. The Act Book for the years 1597–1610 is only extant in a few fragments. McConaghey's figure of 288 grants is difficult to account for; it is suspected that he listed all the applications he found as well as all licence grants recorded.
13 These are the applications of Peter Classen, surgeon, of Exeter, 1665; Thomas Bryant, surgeon, of Endellion, 1717; Joseph Hemminge, physician and surgeon of Liskeard, 1723; William Gayer, surgeon of Okehampton, 1731, and John Palfreman, physician and surgeon of Molland, 1783.
14 DRO: Chanter 151–167. The missing volumes include the period 1682–91. Also the problems are compounded by the fact that no single subscription book was authoritative, and various volumes overlap. The Act Books are thus considered more authoritative, despite their lacunae.
15 DRO: Chanter 41–49 (Diocesan Act Books, 1568–97, 1610–46, 1661–1734). These are continued by separate registers of grants for the period after 1734, in Chanter 87 and 88. Where available, the Act books' indexes, compiled by Mr Chanter, were used (1568–97; 1610–78). Two of the fifty licences granted noted by Chanter in his indexes were not found, although a thorough search was made. One was due to his failure to note the page number, and another due to the illegibility of the page number in his index. One entry not indexed by Chanter was found. It is unlikely that a great many entries were missed by Chanter: thirty pages were scrutinized to check his indexing. His greatest failing was palaeography, misreading several names. All entries found and used here were newly transcribed.
16 Joan Lane, ‘The medical practitioners of provincial England in 1783’, Med. Hist., 1984, 28: 353–71.
17 Evenden, ‘Mothers and their midwives’, op. cit., note 5 above, p. 9.
18 David Harley has noticed a similar rise in the 1750s for Lancashire and Cheshire, and attributed it to the rise of man-midwifery and practitioners' need to justify “their expanding practices”. It may also have acted as a religious safeguard of their intrusion into what was traditionally seen as women's affairs. See Harley, op. cit., note 5 above, pp. 38–9.
19 By comparison, in the diocese in 1568–97, 38 applications were recorded as being granted to 35 individuals (some were granted only temporarily), an unadjusted rate of 1.3 per year. In 1610–27, 50 were granted (2.8 per year) and in 1628–41, 36 were granted (2.6 per year). DRO, Chanter 41–43.
20 Harley, op. cit., note 4 above, p. 401.
21 Margaret Pelling, The common lot: sickness, medical occupations and the urban poor in early modern England, London, Longman, 1998, p. 33.
22 There is one exception to this: a certificate of competence dated 1659 whose bearer, Abraham Haward, obtained his licence in 1665 after obtaining a second certificate. The 1659 certificate is discussed later.
23 DRO: Moger II, ‘surgeons' licences’. This total includes letters relating to applications but does not include multiple documents relating to a single application.
24 Harley, op. cit., note 5 above, p. 30.
25 DRO: Chanter 47.
26 DRO: Moger II/surgeons' licences/Devon/Topsham.
27 Call Books with wardens' presentments at visitations survive for Totnes and Exeter from 1744, and for the rest of the diocese from 1768. DRO: Chanter 292–321.
28 DRO: Chanter 218.
29 DRO: Moger II/surgeons' licences/Devon/Instow.
30 The percentage of the year's applications falling in the months before, of, and after the visitation remains at 75 per cent.
31 DRO: Moger II/surgeons' licences/Cornwall/Endellion.
32 This grant was not recorded in the Act Book. The length of time taken varied greatly. Jonathan Edwards' certificate was dated 8 November 1661 but his licence not granted until 17 September the following year. Tubb Jewell's petition was dated 27 August 1668 in Bodmin and his licence granted within the week, on 3 September 1668. The delay with regard to Abraham Harward is noted later in the text. Six months passed between John Blight's certificate and licence in 1673. Three and a half months passed between Joshua Smith's petition and his licence in 1662.
33Statutes of the Realm, London, 1810–28, vol. 3, p. 31 (quoted in Lucinda Beier, Sufferers and Healers, Routledge & Kegan Paul, 1987, pp. 12–13).
34 A good example is that of Alexander Wolcott of Fowey. DRO: Moger II/surgeons' licences/Cornwall/Fowey.
35 DRO: Moger II/surgeons' licences/Devon/Colyton.
36 See Evenden, ‘Mothers and their midwives’, op. cit., note 5 above, p. 21. Examples include: DRO: Moger II/surgeons' licences/Devon/Sidmouth, Exeter (Edward Bury) and Honiton (Wm Richards).
37 For example, William Durston specifies examinations of candidates from Plymouth and Kingsbridge; Thomas Pyne and Ellis Veryard examined candidates from both Devon and Cornwall. John Osmond examined candidates from Crediton, Rewe, Aylesbeare and Bradninch.
38 DRO: Moger II/surgeons' licences/Cornwall/Endellion. This certificate of medical competence upon examination is accompanied by a character reference signed by five parish officials and two others.
39 DRO: Moger II/surgeons' licences/Cornwall/Liskeard.
40 DRO: Moger II/surgeons' licences/Devon/Unplaced.
41 DRO: Moger II/surgeons' licences/Devon/Unplaced.
42 DRO: Moger II/surgeons' licences/Devon/Cullompton.
43 DRO: Moger II/surgeons' licences/Devon/Wembworthy.
44 One other female surgeon was licensed in the diocese in 1568 (DRO: Chanter 41).
45 DRO: Moger II/surgeons' licences/Cornwall/Falmouth.
46 DRO: Moger II/surgeons' licences/Cornwall/ Liskeard (John Lyne).
47 DRO: Moger II/surgeons' licences/Devon/unplaced (Edward Manninge).
48 DRO: Moger II/surgeons' licences/Devon/unplaced (Anthony Norris of Inwardleigh).
49 For example, Mr George Trewicke had served an apprenticeship in “His Majesty's Hospital at Plymouth for sick and wounded seamen and prisoners of the late war”; in 1667 John Stavely claimed service “in the late engagements” to his credit; and William Wyatt “served as chirurgeon att sea in his voyages to the Straights and other places, as chirurgeon to a regiment of foote and also as chyrurgeon to their Majesties Hospitall at Plymouth”. (DRO: Moger II/surgeons' licences/Cornwall/Roche, and Devon/Kingsbridge and Plymouth.)
50 DRO: Chanter 44; John Venn, Alumni Cantabrigienses, Cambridge University Press, 1922–54.
51 DRO: Moger II/surgeons' licences/Devon/unplaced (Gray Holland). His application was probably dismissed as unnecessary, as his services in examining candidates were called upon several times in subsequent years. He advanced MD by 1669.
52 For example, John Evans spent sixteen years practising under his father, “a professed and licensed surgeon”; John Tossell of Burrington spent three years apprenticed to his grandfather; and Peter Blackaller, son of an eminent Canterbury licentiate, Thomas Blackaller, stated as his qualification his upbringing and education in his father's household “for twenty years and more” (DRO: Moger II/surgeons' licences/Devon/Kingsbridge, Burrington and Colyton).
53 For other localities, see Harley, op. cit., note 5 above, p. 31; Hess, op. cit. note 5 above, p. 55.
54 DRO: Moger II/surgeons' licences/Cornwall/Minster.
55 DRO: Moger II/surgeons' licences/Somerset/unidentified.
56 DRO: Moger II/surgeons' licences/Devon/Dartmouth.
57 Harley, op. cit., note 5 above, p. 31.
58 See, for example, Guy, op. cit., note 7 above, p. 528. A local example also is that of William Cowan of Moretonhampstead, who was described as a licentiate when he signed a fellow practitioner's statement on 3 June 1704, but who did not apply for his own licence until 20 June 1704, seventeen days later. DRO: Moger II/surgeons' licences/Devon/ Sheepwash.
59 Loudon, op. cit., note 2 above, p. 22.
60 DRO: Moger II/surgeons' licences/Devon/Harberton.
61 The apothecary's name is given as “George Demon Fryart”. Since this petition shows Hoskyn to have been hoodwinked time and again, this might not be the genuine name of a genuine apothecary.
62 DRO: Moger II/surgeons' licences/Devon/Dartmouth.
63 Rosemary O'Day, The professions in early modern England, 1450–1800, London, Longman, 2000, especially ch. 2, pp. 18–43.
64 See, for example, DRO: Moger II/surgeons' licences/Devon/Hennock and Harberton. The application of John Colwell of Harberton also stresses that for eight years he had followed the “practice and calling” of a physician.
65 Harley, op. cit., note 4 above, p. 398.
66 DRO: Moger II/surgeons' licences/Cornwall/Morwenstow. Sealing was the method used also by examiners of practitioners in physic in Plymouth in the 1660s.
67 It seems Harward did not submit this document to the ecclesiastical authorities for a few years, and was granted a licence only in 1675.
68 Loudon, op. cit., note 2 above, p. 17.
69 See, for example, DRO: Moger II/surgeons' licences/Cornwall/Launceston (letter from John Ruddle to Francis Cooke, 1673), and Moger II/surgeons' licences/unplaced (letter from Dr Oxenden to Mr Cooke, 1699).
70 See, for example (in addition to those quoted in the text), the petitions for the parishes of Tiverton (1689), Great Torrington (1685–6), Dartmouth (1724), Colyton and Seaton (1697), and Winkleigh (1705).
71 DRO: Moger II/surgeons' licences/Cornwall/Marazion.
72 DRO: Moger II/surgeons' licences/Cornwall/ St Martin in Meneage.
73 For examples, see DRO: Moger II/surgeons' licences/Denbury, Winkleigh, Hennock, Harberton.
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