Medicine in georgian times was categorised largely by the social class of the practitioner and the scale of fees they charged. Some doctors did tend to focus on one or two main approaches to treatment — sea bathing, for example. Some took appointments that carried with them a limitation on the range of patients, like those who supervised the poor wretches confined in Bedlams or asylums. However, for the most part, all tackled illnesses of the same kind, approaching it via their own area of expertise, and there was little love lost between them.

Apothecaries were not the elite of the profession. Far from it. At the top of the heap were the physicians. Some trained by costly apprenticeships with noted doctors. Most were university men, who completed some kind of medical degree in Scotland or overseas, since English universities did not offer them for most of the century. This made them acceptable socially, like lawyers and clergymen — ‘honorary gentlemen’. All were noted for charging steep fees and dealing mostly with the wealthy, though a few might take on a wider range of patients, especially in rural areas, since buying in to a practice was expensive and setting up your own a long-term risk.

A physician might also become a man-midwife. Childbirth was a hazardous business and local midwives were not always trusted by the upper classes. This too was more a matter of upper-class snobbery than skill. Many midwives came from the lower classes and spent much of their time with the poor. The rich did not want them dealing with the birth of their children.

Surgeons or barber-surgeons carried out operations and amputations, sometimes with a physician present for the most hazardous ones. Some would be ex-military men, for dealing with battle wounds was their province. Their training was based on a practical apprenticeship, though this was often haphazard. Because they worked with their hands, they were considered artisans.

Apothecaries: Retailers or Professional Men?

Apothecaries were classed as tradesmen. For many years, the law saw them as retailers, not medical professionals. Not until a ruling by the House of Lords in 1704, were apothecaries accepted as part of the medical profession and legally allowed to prescribe and dispense medicines. Even then, they were forbidden from charging fees for their services. They had to obtain their whole income from the sale of medicines, bandages and the like, plus general shop items. Like some chemists today, the apothecary’s shop would not just be a dispensary,. They also sold patent medicines, perfumes, spices, herbs and even confectionery.

Adam Smith wrote:

Apothecaries’ profit is become a by-word … the whole drugs which the best employed apothecary in a large market town will sell in a year, may not perhaps cost him above 30 or 40 pounds. Though he should sell this therefore for a three or four hundred percent profit, this may frequently be no more than the reasonable wages of his labour, charged, in the only way in which he can charge them, upon the price of his drugs.

Dr Erasmus Darwin however, more cynically, advised a young man to remember “… at first a parcel of blue and red glasses at the windows might gain part of the retail business on market days … I remember Mr Green of Litchfield once told me his retail business, by means of his show shop, and many coloured windows, produced him £100 a year.”

Apothecaries in London had started out as part of the Grocers’ Company. Only in 1617 was the Society of Apothecaries created by royal charter. It was slow to spread its influence outside the capital, but gradually the standards set by the Society for admission were accepted more widely. These required apothecaries to undertake a lengthy apprenticeship with a final examination, though there were still no legal rules for claiming the title of apothecary before 1815.

Apothecaries as General Practitioners

Over time, apothecaries took on more and more work in dealing directly with patients, not just compounding and dispensing medicines. Some were little more than quacks or men with a sharp eye for high profits. Still, they were the doctors most likely to visit the middling sort and even the poor, riding around a large area with their medicines and tools in knapsacks.

As the poet Crabbe wrote:

Helpers of men they’re called and we confess
Theirs the deep study, theirs the lucky guess,
We own that numbers join with care and skill
A temperate judgement, a devoted will.
Men who suppress their feeling, but who feel
The painful symptoms they delight to heal.
…To the Physician of the soul and these
Turn the distressed for safety, hope and ease.

This is perhaps a rosy view of the group. Others were much less complementary. Lady Eleanor Butler called the apothecary in her locality “a dirty little village quack”.

A manuscript in the library of the University of Melbourne, created in Hampshire, England, between about 1727 and 1740 shows that some apothecaries were certainly men of science, worthy of being set alongside any other kind of doctor.

This unknown owner of an anatomy atlas used the reverse of many of the plates to record a cross between a pharmacopoeia and a prescription book. Unlike most contemporaries, who started from the remedy, he used medical conditions as a basis for his notes, giving a page or more to each of 34 different groups of diseases. After some general comments about drug treatment, he gives a list of remedies, some linked to named patients, with the level of detail typical of a prescription book. The end result was a kind of aide memoire or handbook, linking standard information from the printed book to his own observations and experience.

This is surely not the work of some “dirty little village quack”.

Druggists and Chemists

As apothecaries transitioned into being full-blown doctors, so the necessary work of dispensing attracted its own specialists. Pharmacists (also called chemists or druggists at the time) began to develop a separate area of work, based on the preparation and supply of medicines. Since this put them in competition with the apothecaries, who were also still involved in the same area, tensions rose. The apothecaries attempted to restrict the chemists’ and druggists’ activities in 1748 with a proposed new law to control the supply of medicines to their own advantage, but it failed to make it onto the statute book.

Later in the 1800s, proposals were made to unite apothecaries, surgeon-apothecaries, midwives and dispensing chemists under one examining body. The chemists opposed this and won the argument, so the Apothecaries Act of 1815 did not give apothecaries sole control over making-up medicines. Perhaps as a result, the apothecaries eventually merged with the physicians, leaving the dispensing chemists and pharmacists as a separate profession.