My third novel, A Notable Occupation, features an English army medic stationed with the British troops in Newport, Rhode Island during the American Revolutionary War. As I did some editing this weekend, I noticed that my editor removed all instances where I'd written 'doctor' and replaced them with 'physician. While I was happy enough to bow to her greater knowledge, I wondered why 'physician' was more accurate than 'doctor'.
So I did what all good historical novelists do: research.
It turns out that 'doctor' is a term used by American colonists to refer to men of medicine. Back in England, the term 'physician' was used. But it's not as simple as a difference between American English and British English. In England, as in many European nations in the 18th century, the practice of medicine was divided among men of various training and skills.
|Dr. Benjamin Rush trained at|
Princeton University and at
Edinburgh's Medical School
A physician was university-trained. He might have studied at a medical school on the continent or in Scotland. The Royal College of Physicians of London had been established in the 16th century, but it had in its own words "a turbulent history" until the 19th century.
Physicians had to pass exams in classical education (Latin and Greek) as well as medical exams. However, classes were theoretical. Medical students in England did not dissect cadavers or even the corpses of small animals. Medical students at that time generally apprenticed with a established physician. The job of a physician was to diagnose ailments. He often bled patients to balance the humors. Sometimes he recommended changes in diet or ingestion of a tonic made either by himself or an apothecary. Some of the more skilled physicians could set bones.
Most of a physician's patients were people who could afford their services. During times of epidemics, like the London plague of 1665, most physicians left town. Those that stayed infrequently treated the poor. In any case, there was little they could do for them anyway. Physicians at that time did not have the knowledge of germ theory. They knew something was in the air and they knew people in close quarters were more likely to sicken and die, but they did not know to clean instruments between patients.
|Early 18th Century trepanning instruments|
Just as they do today, surgeons in the 18th century did the cutting. Sometimes they worked with or even
under the direction of physicians, but they also just as frequently worked alone. Surgeons had to complete an apprenticeship and be accepted into the Barber-Surgeon's Guild. A law in 1629 required all ships sailing from British ports to employ a surgeon. Surgeons did not have to have university training, but by 1800, the guild enforced strict rules about their skill set, refusing to allow a surgeon to practice in London if he did not satisfy the guild.
A note on barbers - after their merger with the surgeons in a guild in 1540, they were only licensed to pull teeth. They are precursors to modern dentists.
|Colonial Williamsburg apothecary|
The Society of Apothecaries was granted a charter in London in 1617. They compounded medicines, both ingested and topical. Originally grocers, apothecaries sold many products we would not recognize as medicines today such as tobacco, perfumes, and aphrodisiacs.
In the American colonies there were simply not enough people with the above skill sets to treat everyone. Most women passed on the knowledge of herb-craft to their daughters and most settlements had at least one midwife. Americans also benefited from the vast knowledge of their native neighbors, who knew the roots and plants best suited for healing. African slaves also brought the medical knowledge of their shamans and wise women to the Americas. Medical men in the colonies often combined these skills, not always with great competency.
|Dr. Joseph Warren|
The term 'doctor' long referred to university graduates of disciplines in the liberal arts. PhD literally means philosophiae doctor or doctor of philosophy. 'Doctor' is a Latin word that comes from the verb 'to teach'. In 18th-century Europe, it did not refer to medical men. However, by the 18th century, 'doctor' was a title used to address physicians. In Europe, doctor was not a noun. But in the American colonies, the term was used as a noun and referred to men with various backgrounds in medicine. Being a doctor in the colonies was often a matter of practice, not of education.
Dr. Joseph Warren, a Son of Liberty from Boston, was the epitome of a colonial doctor who performed surgery, compounded medicines, and diagnosed internal complaints. He did not hold a medical degree, but earned the title 'doctor' through an apprenticeship and through experience.
I found this brief essay from the Foundation of the American Academy of Ophthalmology very useful in understanding the differences between physicians and doctors in the colonial era.
18th Century American Medicine
In 18th Century England, there were three main classes of medical men: physicians, surgeons and apothecaries. Physicians were considered the elite among the three groups, holding medical degrees from universities and serving mainly the upper classes. In contrast, English surgeons and apothecaries rarely held medical degrees and often gained their training through apprenticeship. By and large the doctors of early colonial America were not English physicians but “ship’s surgeons”. They had learned their trade through apprenticeship or hospitals and often took on their own apprentices in America, which became the chief means of medical education at the time. While referred to as physicians or doctors, most colonists practicing medicine did not qualify as such back in England.
Colonial “physicians” practiced medicine, surgery and apothecary together as needed. As the colonies grew and prospered, some could afford to be trained at the universities abroad and earn their medical degree. Upon their return, however, colonists expected even European trained physicians to open the same general practices as their untrained countrymen. As might be expected, colonial physicians with formal degrees were often more prosperous and enjoyed greater prestige, but these were few and far between. On the eve of the Revolutionary War it has been estimated that the colonies contained 3,500 physicians, only 400 of whom had undergone some sort of training, and about 200 of these actually held medical degrees.
In 1751, American medical education took a leap forward when Dr. Thomas Bond and Benjamin Franklin established the Pennsylvania Hospital, the first formal institution of its kind. Fifteen years later, medical schools in Philadelphia and New York were established. These institutions offered training and lectures to colonial medical practitioners. Despite the presence of these institutions, the American colonies did not have formal policing of the medical profession. Those rules and regulations enforced in England were not carried across the Atlantic and few colonial cities had the wherewithal to create their own licensing or examinations.
EARLY MEDICAL EDUCATION IN ENGLAND IN RELATION TO THE PRE-HISTORY OF LONDON UNIVERSITY by CHARLES SINGER and S. W. F. HOLLOWAY
The Foundation of the American Academy of Ophthalmology, "18th Century American Medicine"
Brandywine Battle Historic Site, "Surgeons and Butchers"
The Royal College of Physicians, "History"