QUITE A FEW MEDICAL MEN TURN UP IN JANE AUSTEN’S WRITING.

There is mention of medics in all of her mature novels and also in her letters - because of course, she came across real medics in addition to the fictional ones she created. So who were all these people? What sort of training and qualifications did they hold, and what sort of work did they undertake?

In the 21st century in the UK, all doctors are registered and regulated by the General Medical Council. They are the body responsible for ensuring that medical practitioners have obtained a recognised medical degree and recognised postgraduate qualifications, and you can check any person claiming to be a doctor in this country on the publicly available register. However, the body that became the General Medical Council was only established following the first medical act in 1858, long after Jane Austen’s time - so how did people know who was treating them and whether they were quacks?

Most of the medical men we meet in the novels are apothecaries. However Jane Austen also mentions surgeons (Anne calls for one when Louisa falls in Persuasion) and physicians (Mrs Tilney In Northanger Abbey is said to have had three physicians in constant attendance during her final illness) and therefore Jane Austen includes the three main strands of medics in the late 18th/early 19th centuries.

Who’s Who

An apothecary was a trained and (partly) regulated professional. Apothecaries split away from the Company of Grocers in 1615, forming the Worshipful Society of Apothecaries, which exists to this day. Most early medicines derived from herbs and spices, and grocers would have this knowledge, hence the origins of the Company. Apothecaries originally merely ran a shop and dispensed prescriptions issued by physicians, but over time became knowledgeable about the conditions they were dispensing for and, being cheaper than consulting a physician, were often the primary source of medical advice and care. By Jane Austen’s time, and as seen in her novels, they were making house calls and diagnosing and dispensing advice as well as making up medicines, with a work pattern recognisably that of an old fashioned country GP.

Physicians had a university degree and were usually members of the College of Physicians in London which was founded in 1518. It should be noted that not all physicians had studied medicine - because at this time medical degrees could be bought! Edward Jenner, of smallpox vaccination fame, whom we think of as an eminent doctor, was a country apothecary who bought a degree from St Andrews. Physicians’ roles were in history and observation (often they did not touch the patient), making a diagnosis, offering advice, and writing a prescription, which an apothecary would dispense. Physicians were the top of the tree, and it is notable that in Jane Austen’s fiction, physicians are mentioned in connection with characters at the higher end of the social scale (or those with pretensions). When Jane is ill in Pride and Prejudice, the Bingley sisters are not happy with the “country advice” of Mr Jones the apothecary, and suggest sending to town for “an eminent physician”.

Anything requiring “hands on” treatment was dealt with by surgeons. Originally barbers, skilled in dexterity with sharp implements, the surgeons broke away and in 1745 formed the Honourable Company of Surgeons, a City Livery company, which became the Royal College of Surgeons of London in 1800. When we think of 18th-century surgery, we tend to think of gruesome amputations and Fanny Burney’s horrific account of her mastectomy in 1811 - anaesthesia was not successfully demonstrated until 1846. However these major procedures were rare, and due to the high mortality, to be avoided at all costs. Most surgical practice involved more minor work, often not involving an operation at all. Most did not hold hospital appointments, and worked in the community.

It is important to note that by Jane Austen’s time, the boundaries between the different branches of the profession were becoming extremely blurred - the apothecaries were diagnosing, invading the physicians’ turf, and a significant number of them also had some surgical experience as part of their training. A very common practitioner of the time was the surgeon/apothecary - in a survey of English counties in 1783, 82% of practitioners described themselves thus. In other words, they were developing into a skilled generalist.

Below these three recognised groups were large numbers of irregular practitioners. These were people with no qualifications at all - some would be adequate, having picked up expertise as they went along, but many would be dangerous and incompetent.

There was also widespread public confusion about terminology - not excluding Jane Austen. When little Charles Musgrove falls from the tree in Persuasion, he dislocates his collarbone and sustains a back injury. Mr Robinson is sent for, and he is described as an apothecary. Bone setting would normally require a surgeon, but perhaps Mr Robinson is a surgeon/apothecary, and Jane Austen’s contemporaneous readers would have known this without having it spelled out.

Important Dates in the Reform of Medicine

Jane Austen (1775 - 1817) lived through an interesting time in the history of medicine, roughly coinciding with what is sometimes called “the great period of medical reform”, during which the profession began to assume the form we would recognise today. The first significant date is well before Jane’s time, but is important as it shaped the way we see practice being conducted in the novels. In 1704, what is known as the Rose case was ruled upon by the House of Lords which recognised that the practice of apothecaries visiting and diagnosing patients, while technically illegal, was widespread and should not be banned. It did not reverse the existing law, but gave apothecaries some degree of protection for their custom and practice, thereby paving the way for their transformation into the modern GP.

The next date we need to consider is 1815, towards the end of Jane Austen’s life, when the Apothecaries’ Act became law. For the first time, apothecaries needed to sit an examination and be granted a licence to practice by the Society of Apothecaries. The legislation was not retrospective, so those already in practice were not required to gain the licence. One of the successful candidates in 1816, the second year, was John Keats. This was the first time there had been any attempt to regulate the training and check the credentials of medical care providers. The LSA (Licentiate of the Society) remained a recognised qualification until 2003, and many older GPs will have LSA among their qualifications.

And finally some years after Jane Austen’s death, the first Medical Act of 1858 established the Medical Council, defined what was and was not a recognised medical qualification, and established a register of qualified doctors. There had been fifteen previous unsuccessful bills brought before parliament, and there were years of bitter turf wars during this time between different branches of the profession as everyone fought for position and recognition.

Apothecaries

Since most of the characters we meet in Jane Austen’s works are apothecaries, I want to go into them in some more detail. Apothecaries served a seven year apprenticeship. An apprentice was essential for a busy apothecary - while he was on his rounds, he needed someone to be back at the shop, making and dispensing medicines. They might accompany the master on his rounds and perhaps later even treat some patients themselves. There’s a sighting of an apprentice in Pride and Prejudice, when Aunt Phillips mentions Mr Jones’ “shop boy”.

Most apprentices had some sort of school education until the ages of twelve to fifteen, when they would start the apprenticeship. Around this time it was starting to be viewed as a respectable employment, and a way to rise. A survey from Bristol covering the period of 1760 to 1830 shows apothecaries are drawn mainly from the families of the more respectable professions. A significant premium was required to buy your son’s apprenticeship - these varied, particularly between London and the provinces. John Keats paid £210 in London in 1810, but in rural areas £50 - £100 was more usual, yet still a significant sum.

Pinning down the income of an apothecary is extremely difficult, with huge variability, again particularly between London and rural areas. An average income of £400pa has been suggested in rural areas. In the city, incomes were much higher and could be in excess of £1000. Apothecaries had a monopoly on drugs and could out-earn their physician colleagues. We think over-prescribing is a modern phenomenon, but the Georgians loved their medicines - it was part of the consumer society which was developing at this time.

In Emma, Frank Churchill blunders by mentioning Mr Perry’s carriage. A carriage indicates a certain income level (at least £700pa, Edward Copeland suggests) so Mr Perry is doing rather well for himself. However, most country apothecaries would rather rely on a good steady horse. Carriages would be more common in towns, and a practitioner with many wealthy patients would have a carriage to arrive in style and demonstrate the trappings of success.

The social standing of apothecaries was changing at the end of the 18th century, and they were beginning to be viewed as skilled professionals - but they ran a shop, and were in trade. Everybody in Highbury speaks well of Mr Perry - but he is not at the Coles’ dinner party. Jane Austen’s own social standing is a little lower than that of her characters, and in her letters she describes an occasion when Mr Lyford, the Steventon surgeon/apothecary arrives to visit her mother at dinner time, and is invited to sit down and join the family meal. However some years later, when advising her niece Anna, an aspiring author, about the book she is writing and Aunt Jane is picking up points that she doesn’t think work, she says ”A country surgeon … would not be introduced to men of their rank”.

The Real Doctors

Jane Austen’s paternal grandfather William Austen was a surgeon in Tonbridge, but died when George Austen was around five years old, who thereafter was brought up by an uncle. Tysoe Saul Hancock, who married Jane Austen’s aunt Philadelphia, was nominally employed as a surgeon by the East India company, but was more interested in trading. We know little about the medical activities of either of these gentlemen.

Medicine tended to run in families, as it still does, and Mr Lyford who stayed for dinner was a member of a medical dynasty. We first come across him in 1798 when Jane is 23 and the family are living at Steventon. Another Mr Lyford is mentioned in 1808 when Jane is living with Cassandra and their mother in Southampton. And finally there’s the Mr Lyford who treated Jane Austen during her final illness in Winchester. Deirdre Le Faye identifies the Steventon Lyford as John Lyford, a surgeon in Basingstoke. His daughter Mary was a friend of Jane Austen. The Winchester Lyford is Giles-King Lyford, a surgeon ordinary at the County Hospital, Winchester, nephew of John senior. The Southampton Lyford is thought to be Charles Lyford, an apothecary in Southampton, possibly the brother of Giles.

Edward Knight, Jane Austen’s wealthy brother, goes to Bath for his health in 1799. Jane is of the party, and her letters home mention numerous doctors, with their various pros and cons. Of a Dr Mapleton she comments “there is not a physician in the place who writes so many prescriptions as he does”. I’m not sure whether this is a compliment or not! Dr Mapleton is another who started his career as an apothecary, and obtained a degree “by attestation” from Marischal College Aberdeen, which seems to have been a common and reasonably respectable route at the time.

The first mention of Jane Austen’s own illness was in a letter to Cassandra in September 1816, when she was forty. She has been complaining of back pain, and mentions that Dr White means to call before he leaves the country. This is John White, a surgeon who practised in Hampshire. He was the nephew of Gilbert White of Selbourne, the nature writer. She clearly remained unwell over the following winter, with mention of various non-specific symptoms. There’s no mention of attendance by any medics over the winter, but in April 1817, she mentions having seen Mr Curtis. William Curtis was an Alton apothecary who subsequently served as Mayor of Alton. In a letter in May 1817, she gives her friend Anne Sharp fuller details of the seriousness of the symptoms and how unwell she has been - although, once again she puts on a brave front and claims she is much better. She mentions the Alton apothecary has run out of ideas and suggested better advice. She writes:

“The consequence is, that instead of going to Town to put myself in the hands of some Physician as I shd otherwise have done, I am going to Winchester instead, for some weeks to see what Mr Lyford can do….”

So there had clearly been some idea of Jane’s going to London to receive medical care, but in a change of plan she chose Winchester instead, and one of the Lyfords, a medical family known to her for many years. In her next couple of letters from Winchester at the end of May, she remains positive, as does Mr Lyford, but we know how this ends - these were her last two known letters, after which she falls silent, and she died there on July 18th. Cassandra later wrote that Mr Lyford attended during her last hours and applied something which gave her ease - probably laudanum, and the only useful thing to be done at that point.

The limitations of early 19th century medicine are all too clear - there were no investigations, nobody really knew what the diagnosis was, and there were no effective treatments.

I hope I’ve given you a better understanding of who all these people mentioned in Jane Austen’s novels are. When you go looking for them you’ll find there are quite a few, so I hope the next time you’re reading your Jane Austen, you’ll give Mr Donavan, Mr Robinson, or Mr Harris a little nod, and appreciate who they are.

© Dr Hilary Aitken - retired NHS Consultant. Committee member and speaker to The Jane Austen Society Scottish Branch.

References:

Loudon, I. (1987). Medical care and the general practitioner 1750 - 1850. Oxford University Press

Irvine, S. (2011). Surgeons and apothecaries in Suffolk 1750 - 1830. City slickers and country bumpkins - exploring medical myths. PhD thesis, University of East Anglia

Le Faye, D. (Ed.). (2011). Jane Austen’s Letters (4th ed.). Oxford University Press.

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