The nature of provincial medical practice in eighteenth-century England.

When one looks at the history of the medical profession in eighteenth-century England, the striking feature is the extent to which historians have concentrated on the minority of famous and distinguished medical men, mostly in London, and how little is known of the much more numerous rank-and-file practitioners of provincial England. This paper is part of a study that attempts to redress the balance by an examination of the clinical practice, the social status, and the economic rewards of ordinary provincial medical men. The reason for their neglect is partly the obvious one that the famous tend to leave copious records, the obscure very few and those few that survive are usually scattered and incomplete. It is, nevertheless, possible, on the basis of such records as exist, to offer and test certain hypotheses; for example, that the surgeon-apothecary of the eighteenth century was first and foremost a businessman, and often a very successful one, motivated by a hard sense of commercialism; and that the divisions of medical men suggested by the variety of titles and designations found in the eighteenth century meant very little because the type of practice adopted by an individual was dictated most of all by the competition and opportunities for business in his chosen area of practice. It will also be suggested that eighteenth-century medical practitioners were employed on a large scale not just for the treatment of serious life-threatening illness, but for minor self-limiting conditions; and that they were employed in this way not solely by an upper class well able to pay for medical care, but by a wide range of social classes. Surgery, in particular, has been too often portrayed as an agonizing business of "heroic" and desperate capital operations; here it will be shown that such operations were rare events, and over ninety-five per cent of country surgical practice consisted of simple, but often effective, procedures. There also seems to be evidence that the first half of the century witnessed a significant rise in the prosperity of ordinary practitioners and that the second half was, in the words of Richard Smith junior, "The Golden Age of Physic". Most accounts of provincial practice in the eighteenth century suggest that the ordinary practitioners, the apothecaries and surgeon-apothecaries, advanced little if at all in competence or prosperity throughout the century. Such advances in medical knowledge as occurred in British medicine were largely confined to London and