This is my first post on Romancing the Past, and I'm so pleased to be joining the authors here! Since my first two regencies won't be coming out until 2012, I thought I might tackle a general topic today. Have you ever wondered why some medical men in historical romances (and during the regency, they were uniformly men) are referred to as "Doctor," and some are called just plain "Mister"? I'd like to discuss the differences between the three major medical practitioners working in nineteenth century England: physicians, surgeons, and apothecaries.
But first, a word about the state of medicine during the regency. Doctors had no sonograms, no X-rays, no MRIs; they didn't even have a germ theory of disease. Hippocrates had theorized centuries before that poor health stemmed from an imbalance of bodily humors, so doctors routinely bled or cupped their patients. Illness was also attributed to unhealthy vapors, leading medical practitioners to prescribe "a change of air." Because antibiotics were still unknown, compound fractures and other serious wounds usually meant either amputation or death, and frequently both. Childbirth, too, was often fatal, especially in maternity wards, where hospital-acquired infection drove the mortality rate as high as forty percent. Operations were performed only as a last resort, not only because of the high risk of sepsis, but also because the poor understanding of blood group compatibility made transfusions so risky they were not even attempted successfully until 1818. The use of modern anesthetics was still decades away. Want to read something harrowing? Try novelist Fanny Burney's letter to her older sister, in which she gives a first-hand account of her 1811 mastectomy. The operation required seven men and a nurse, most of whom were needed just to hold the patient down.
But if medicine was more art than science, the artists at the top of the professional ladder were physicians. Distinguished and expensive, they were socially respected figures who hailed from genteel backgrounds and obtained their educations at universities like Edinburgh, Oxford, and Cambridge.
Surgeons were not nearly so well regarded. Though respected today, in the early 1800s they had yet to live down their origins as medieval barbers. More numerous than doctors—in 1815, there were only 14 physicians attached to the Royal Navy, compared to 850 surgeons and 500 assistant surgeons—they were looked on not as true professionals but as technicians, sawbones who treated the distasteful aftermath of accident and infection.Blood and Guts: A History of Surgery how the famous surgeon Robert Liston could remove a limb in under thirty seconds—but once accidentally sawed off his assistant's fingers in the process. "The patient died of infection, as did the assistant, and an observer died of shock. It was the only operation in surgical history with a 300 percent mortality rate." In the face of such bold measures, cleanliness was considered an affectation; Liston reportedly operated in Wellington boots, and to free his hands when switching between the scalpel and the bone saw, he clamped the bloody knife between his teeth.
So physicians were for the rich, and surgeons were for the desperate, but for most everyday medical complaints, patients consulted an apothecary. Apothecaries could trace their origins back to medieval grocers, who in turn grew out of the Guild of Pepperers. They were the nineteenth century equivalent of pharmacists (or chemists, if you're British), only they dispensed medical advice along with their pills. Up until 1704, apothecaries were supposed to know their place—namely, behind the counter of a shop, keeping their opinions to themselves and concocting remedies prescribed by a real physician. Then a disgruntled patient named John Seale sued his apothecary, William Rose, for "practicing physic"—that is, for charging the staggering sum of fifty pounds to sell Seale medicines that left him "never the better but much worse."
Throughout the nineteenth century, the accelerating pace of scientific advances changed medicine profoundly. The social and legal distinctions between the professions evolved, until by 1900 they had assumed much the forms they have today. Sterile operating conditions and the advent of anesthesia reduced mortality rates considerably, raising the surgeon's prestige, while the apothecary's role narrowed to the more limited duties of the modern-day pharmacist. Physicians, meanwhile, remained as pleased with themselves as ever.
Alyssa Everett is married to a handsome doctor with an excellent sense of humor. Her debut regency, A Tryst With Trouble, is available now for pre-order from Amazon. She hopes you'll visit her website and follow her on Twitter, where she promises not to spam you relentlessly.