The Coming of the Doctor' As illustrated by the Career of Richard Hope of Cranbrook (d.1725)

‘The Coming of the Doct or’: as illustrated by the career of Richard Hope of Cranbrook (d.1725) peter allen This article will be mainly based on the account book of Richard Hope (d.1725), who in his will describes himself as ‘Chirurgeon and Apothecary’. It will also make reference to what is known about Hope’s life and set him in the context of the small Kent town of Cranbrook where he practised for the 28 years (1688-1716) covered by entries in his account book. Evidence from that book will be used to illustrate Hope’s work as barber, surgeon, apothecary and physician. It will be suggested that it shows Hope had been principally a barber-surgeon in the 1680s, but that by the end of his career he had a substantial apothecary’s business with a clientele including quite wealthy people, as well as holding a licence to practise as a physician and being recognised as such by the parish. A genuinely versatile and apparently able man, he may rightly be regarded as a professional who quite well corresponds with Geoffrey Holmes’ thesis of ‘the coming of the doctor’ – the general practitioner – during the years which were Hope’s working lifetime. Insofar as the evidence permits, his income and social status will be discussed, although the account book offers more on the former than the latter. At the Centre for Kentish Studies, where the account book is lodged, are also Hope’s will and other Hope family documents. Some use has also been made of these family documents and of other traced family material. Unlike the account book, they offer no detail on his professional work, but some information on his possessions and domestic circumstances. Cranbrook’s baptismal and burial registers contain many late seventeenthcentury Hope entries, including several Richard Hopes. However, no baptismal entry appears to relate to the account book’s author, and the assiduous modern Hope family historians have been unable to determine either the date or place of his birth. His 1685 licence to practise as a physician, discussed more fully below, is witnessed by another Richard Hope, ‘Physitian’, which perhaps suggests that the witness was the father PETER ALLEN and the account book’s author had formerly been his apprentice – but no evidence of this has been shown. Possible birthplaces of Richard Hope junior include Horsmonden, where the account book shows that his siblings (at least latterly) lived, and Rye, where in the 1720s there was an MD physician, Mr James Hope, whom Cranbrook’s nineteenth-century historian judged to have been our Richard Hope’s son or brother.1 The date in 1725 of Hope’s death is clear both in the church register and his son’s entry on the cover of the account book. Thomas Hope (b.1693) appears to be one of three sons of Richard junior and his wife Mary to be baptised at Cranbrook. He was later (as a parent) designated as ‘Surgeon’ in the same baptismal register. It was presumably this Thomas Hope to whom our Richard bequeathed his ‘shopp goods’ in his will.2 Clearly this was a family of medical practitioners over two or, more probably, three generations. Late seventeenth-century Cranbrook is the subject of a recent study by Anthony Poole.3 The greatest days of the town’s famed broadcloth industry were past, its terminal decline indeed taking place throughout Richard Hope’s life. Nonetheless, with a population which Poole calculates to be probably in excess of 2,200, it remained a significant Kent town and market centre, with quite diverse local trade and industry in addition to farming. Although Hearth Tax evidence of 1664 shows that Cranbrook had sunk to be one of Kent’s poorest towns,4 there was still a quite substantial ‘middling sort’ which undoubtedly included Hope. Hope certainly enjoyed no monopoly as a medical practitioner in Cranbrook. Barber-surgeons, apothecaries and physicians have been identified there throughout the seventeenth century, including the notable Robert Pemell (d.1653), author of a range of medical publications. In Hope’s lifetime, his fellow Cranbrook apothecary, Thomas Cruttenden, who predeceased him by 21 years, left a house with contents valued at a modest £70 and an apothecary’s shop with contents worth £68.5 Surgeons William Silk and John Betting, or Botting, were Hope’s contemporaries. John Groombridge, an Oxford MA , practised as a physician in Cranbrook; he died in the same year of 1721 as another Cranbrook physician, William Robinson, for whom no degree or licence is recorded.6 When we take into account the existence of various other practitioners, including women, few of whose names have been recorded, it seems likely that the number of Cranbrook inhabitants per practitioner is comparable with – possibly, even lower than – the c.400 found by Pelling and others in larger towns.7 Hope’s leather-bound account book contains writing in at least three hands.8 It seems reasonable to conclude that those in the oldest hand, not easily read, are by Richard Hope himself, while most of the remainder, in ‘THE COMING OF THE DOCTOR’: RICHARD HOPE OF CRANBROOK (D. 1725) a rounder, clearer hand, are by his son, the inheritor of the ‘shopp goods’, Thomas Hope. Two entries in this later hand use the pronoun ‘we’, which may suggest that father and son (presumably formerly apprenticed to Richard) were latterly working in some sort of partnership. In all, the book contains over 400 records of sums owed or paid, many covering several pharmaceutical products – the precise number depending on the way that double entries or unclear entries are counted. The order of entries is quite confusing, both because the book has been started at each end and also because the later entries are interspersed between older, as remaining page-space permits. Of those which are dated (the majority), those in the older hand run – not in sequence – from 1688 to 1708 and those in the later hands from 1705 to 1716. About half the total entries cover 1709-16, and a further third cover 1688-93, facilitating comparison between Hope’s earlier and later years of practice, but providing rather scanty evidence on the middle years. There is a definite change in the type of transaction most often recorded towards the end of the account book’s 28-year period as compared with that at the beginning. When Hope in 1685 (three years before the account book’s first entries) obtained a diocesan licence to practice as a physician, it was given to Richard Hope, ‘Surgeon’,9 and the early (1688-93) entries do give the impression that Hope was then primarily a barber-surgeon although he was also already earning as an apothecary and physician. In the post-1708 period, on the other hand, Hope was doing less (though still some) barbery, and still a good deal of surgeon’s work, but he had apparently expanded his physician’s role and definitely increased and diversified his pharmaceutical supplies in the apothecary’s role which appears to have been his main source of income. Richard Hope as Barber-Surgeon The 1688-96 ‘triming’ of hair entries – all of them at one end of the book and in the hand presumed to be Richard Hope’s – are payments for a whole quarter’s trimming, or even a year’s. Some record payment in advance; some are records of sums owed. (It seems likely that most trims were paid for immediately in cash, and are therefore unrecorded.) A quarter’s trimming might cost anything from one shilling to ten shillings, though in most cases it was between 1s. 3d. and 2s. 6d. The sole 10s. entry was for Mr Cooke, the enormously wealthy lawyer who lived at Great Swifts in Cranbrook, so that it may be reasonably supposed (and supported by some non-barbering entries) that Hope considerably varied his charges according to customers’ wealth. The only two barbery entries after 1708 relate to money owed for work done. The account book’s entries for surgeon’s work, though fewer than the pharmaceutical entries, are as numerous in the post-1708 period as in the PETER ALLEN pre-1694 one. Evidently Hope, though more of an apothecary-doctor in the later period, continued doing that for which he had presumably been apprenticed. The surgeon’s work, in the words of Thomas Ross (1519), was ‘principally in manuall applicacon of medicines’.10 Those words remained valid into the eighteenth century, when according to Dr Loudon the practice of surgery included operations, the reduction of fractures and dislocations, the dressing of wounds and ulcers, the removal of teeth and virtually all treatment of venereal disease.11 The most obvious and common of the surgeon’s treatments, carried out for numerous different reasons, was to bleed the patient, and over thirty of Hope’s account book entries are for bleeding (‘blouding’ and, twice, ‘phlebotomy’). Surprisingly, the account book contains no clear reference to the alternative of cupping, but ‘vesicatories’ were sold (to bring about blistering), as were ‘cerecloths’, ‘plasters’ and ‘cataplasms’ (poultices), any of which were likely to be coated with ointment or other remedies, whether to deliberately open up wounds, or otherwise. Another example of long-established surgeon’s practice was the application of two ‘leaches’ for 1s., while (in another undated, but also early, entry) Elizabeth Shoosmith evidently preferred to buy her leech for 3d. A surgeon’s apprenticeship had for centuries included some study of anatomy, though as late as 1674 John Locke, himself a bachelor of medicine, thought that study to be of limited use, and what has been termed the ‘great revival’ of anatomical teaching began only after 1700.12 Hope’s account book refers to operations on broken bones and the treatment of dislocations, but these total barely ten of the account book’s approximately 400 entries. The definite impression gained is that the surgeon was consulted most often for relatively minor ailments requiring modest payment for items such as ointments, bandages, plasters and clysters, though some of the pharmaceutical sales undoubtedly were to treat venereal disease. Perhaps surprisingly, tooth extractions, always associated with barber-surgeons, account for only three of the entries. Apothecary By far the greatest number of entries in the account book relate to pharmaceutical sales, and it therefore is appropriate to write at greater length on Hope as the apothecary which he became. Many of the sales, as has been indicated, arose from his surgeon’s work, but others were more relevant to a physician’s. Joan Lane has written that, ‘The early eighteenth century saw the gradual disappearance of the barber-surgeon … and the emergence of the surgeon-apothecary, separate from the apothecary’.13 As already ‘THE COMING OF THE DOCTOR’: RICHARD HOPE OF CRANBROOK (D. 1725) indicated, it seems probable that Hope metamorphosed over time from versatile barber-surgeon to the more prestigious general practitioner who styled himself, as in his will, ‘chirurgeon and apothecary’. On account partly of the old link with barbery, most late seventeenth-century country surgeons, Geoffrey Holmes tells us, ‘rated little higher in common esteem than good craftsmen, if as high’,14 whereas apothecaries – many of them, such as Hope, ‘pothecary doctors’ – were fast rising in numbers, prosperity and status, the profession attracting many apprentices from families of a markedly higher social rank than thitherto. Julia Burnby analysed 223 apothecary apprenticeships between 1710 and 1713, and of the 187 where parental occupation could be identified she found that only 66 were craftsman/shopkeeper/yeoman as against 11 2 in the professional/ merchant/gentleman class.15 In status terms, Hope’s transformation from barber-surgeon to surgeon-apothecary would undoubtedly have been an upward move. Under the tripartite structure set up by the early seventeenth-century, physicians were broadly supposed to deal with patients’ internal maladies, surgeons to perform external treatments, and apothecaries to store, sell and make up products prescribed. The senior profession was that of the physicians, and their relationship with the apothecaries had always been two-sided. On the one hand there was cooperation, allegedly often collusion, as the physician advocated the purchase of sometimes costly medicines and restorative preparations; on the other, there were many attempts by the physicians to prevent presumptuous apothecaries from prescribing and practising on their own account. Under Henry VIII the Royal College of Physicians had been given licensing and inspection authority over apothecaries in London, but outside London both regular supervision and strict separation of functions were frequently impracticable, particularly where there were hardly any local universityeducated physicians. In London during Hope’s period physicians and apothecaries tended to be at daggers drawn, as the Royal College of Physicians denigrated apothecaries and fiercely opposed their edging into general medical practice. Ultimately in the notable case of apothecary Rose (1704), the House of Lords established apothecaries’ right to prescribe medicines and to charge for the preliminary consultation involved. But such battles had little or no effect in the provinces, where ‘unofficial usurpation of the physician’s role by the apothecaries’, in Holmes’ phrase,16 had long been a fact and was willingly accepted by a number of university-educated physicians. As already mentioned, Cranbrook had such a physician, John Groombridge, during Hope’s time, and there is neither surviving record of hostility nor evidence to suggest it in the account book. Irrespective of this issue, what do the account book’s pharmaceutical sales tell us about Hope primarily as an apothecary? There is certainly PETER ALLEN ample indication, throughout the whole period covered by the account book, that Hope was following the classical Galenic principles, with their heavy emphasis on the importance of ‘evacuation’ when there was an excess of one of the four humours: there are repeated references to diaphoretics and sudorifics (to encourage perspiration), to diuretics, to purgatives and cathartics, and to emetics. The appropriate pharmaceutical product was still frequently the medieval one, whether taught by the Arabs or older than this: Hope’s sales included those of English herbs such as elder, hyssop, melilot and liverwort, but they are outnumbered by entries for electuaries, much favoured by the medieval Arabs and more profitable to the dispenser; they included two for ‘Venice Treacle’, generally associated with a large number of components, mostly from overseas. Plants from the Spanish colonies had widened the range of pharmaceutical products by Tudor times, while English settlements in North America had led to further innovations; these too, including guaiacum, the antisyphilitic sudorific from the Caribbean, and mechoacan, the purgative from Mexico, were sold by Hope. In the seventeenth century the primacy of existing pharmaceuticals, detailed in the physicians’ pharmacopoeias, was challenged by the ‘chemical’ approach, advocating new cures (as well as some older ones), including much more use of minerals. In France, the new teaching gained considerable ground when in 1658 Louis XIV’s life was apparently saved by the vomiting occasioned by the irritant mineral antimony. In England, Charles II was a keen patron, though his own life may have been shortened by his years of experimenting with mercury cures. Hope’s account book has three entries for antimony, one for ‘brimstone’ (i.e. sulphur), one each for arsenic and ratsbane (arsenic oxide – though possibly used against rats). One account book entry is for a chalybeate electuary – the local chalybeate water of Tunbridge Wells and Cranbrook, with its iron salts, being highly regarded as a versatile cure. A few other entries seem likely to be those which a traditional herbalist (or reader of Culpeper) might prescribe: lavender compress, radishes, elder, honey, saffron, ‘herbs’, garlic and liverwort, for examples. Holmes has suggested that demand for apothecaries’ services, especially after the 1660s, was increased by the availability of opiates and other pain-killing drugs, importation of which hugely increased during the seventeenth century.17 The most striking example in Hope’s account book is that of ‘Richard Dan’s wife’, for whom no fewer than fourteen purchases of laudanum, at 6d. each, were made from March 23 to April 30, 1709. The overall picture, then, is that Hope was a genuinely knowledgeable apothecary, very eclectic in his approach, and well up-to-date with contemporary practice. The eclecticism, embracing both Galen and ‘THE COMING OF THE DOCTOR’: RICHARD HOPE OF CRANBROOK (D. 1725) Paracelsus, also went so far as to accommodate some native herbal remedies, in addition to the regular sale of more profitable pharmaceutical products. Account book entries in Hope’s own hand, despite erratic spellings in English, included at least a little Latin, though it is striking that his son’s neater hand, perhaps with the advantage of Cranbrook’s grammar school education (as the account book mentions that another son, Francis, attended it), reveals more careful English and more Latin. Local Physician Finally we come to the question as to the extent that this all-round practitioner acted also as local physician. By an Act of 1511 bishops might license practitioners such as apothecaries or surgeons also to practise as physicians, and it was such a diocesan licence that Hope, of whose early education and training as a surgeon nothing is known, obtained in 1685. Two of the three witnesses signing the testimonial supporting the application of ‘Mr Richard Hope Junr of Cranbrooke’ were Charles Buck, who was Cranbrook’s vicar, and Thomas Bliss, a Maidstone surgeon who himself had obtained a diocesan licence nine years earlier.18 The third, in whose hand the document appears to be written, was none other than ‘Richard Hope Physitian’ who may very well have been both father of the account book’s author and also the same ‘Chirurgeon’ whom the document refers to as having ‘instructed & tutoured’ Richard Junior ‘in the Theory & practise’ of chirurgery. If this indeed is correct, the account book’s author came from a family in which the surgeon father, Richard Senior, trained Richard Junior as apprentice – and also, perhaps, a brother, the James of Rye who was mentioned earlier in this account. On that hypothesis, either two or three Hopes would have exemplified the seventeenth-century tendency for surgeons to obtain licences to practise as physicians. The 1680s have been noted by Holmes as a decade of unprecedented pressure on ecclesiastical authorities to grant such licences, as surging demand for medical services was not matched, especially in the remoter dioceses, by supply of physicians.19 Richard Hope senior evidently had obtained his licence a generation earlier, however, and Cranbrook surgeons of his vintage who did likewise included John Relfe, licensed in 1662 although his funerary inscription of 1683 calls him a ‘practitioner of Physicke in Cranbrook for the space of 33 years’, and William Silke, surgeon, also licensed in 1662, who is known to have administered physic to Cranbrook patients for four decades ending in 1698.20 The account book itself does not indicate that Hope charged for consultation and prescribing (which at least before the Rose verdict of 1704 would have been illegal on the part of an apothecary who, unlike Hope, had no licence to do so), and it is just possible that he did not. As PETER ALLEN already mentioned, Cranbrook throughout the seventeenth century had been well familiar with all the various medical practitioners working side by side, and during Hope’s time at least one physician, the Oxford-educated John Groombridge, his more or less exact contemporary, appears to have been practising in Cranbrook. The absence of consultation charges from Hope’s account book makes it possible that most drug sales arising from the practice of physic came from prescriptions by Groombridge or others. It may well be that for Hope, a university-educated physician was not a higher-status rival who might restrict his practice, but a welcome fellowprofessional whose practice increased Hope’s pharmaceutical sales. This would correspond with Holmes’ comment that, ‘whatever feelings of social and professional superiority country physicians may have cherished towards the local apothecaries, there appears to be extraordinarily little evidence of animosity between them’.21 Nevertheless, despite the absence of consultation fees in the account book, it is very unlikely that Hope was only a surgeon-apothecary (as he called himself), rather than one of the many ‘pothecary doctors’ of the period. We know that his licensed Cranbrook medici predecessors or younger contemporaries had been fully recognised as physicians, visiting the sick, and there can be little doubt that Hope was likewise. The limited evidence in the account book does include the following entries: 1708 to Mrs Bonner: ‘diligent care & pains; 1713 to James Bridgland: ‘curing your son’s head’, 7s/6d; 1715 ‘Sent for to Mercy Mills’ and ‘Cured her’: £1-5-0; 1716 ‘Received £6-15-4 of Parish’. It will be noted that all four, which appear to refer to cases that might well fall to physician rather than surgeon or apothecary, date from the later years of Hope’s practice, by which time it is probable that his status as a ‘doctor’ (the word is known, in the seventeenth century already, to have been widely used in popular reference to licensed apothecaries and surgeons) had long been established. The 1716 entry showing his employment by the parish authorities, presumably for services to the poor, may suggest their recognition of his physician’s status. ‘The coming of the Doctor’ is the memorable title of a chapter by Geoffrey Holmes in which he argues that ‘between 1660 and 1740 ‘the doctor’ truly arrives in English society’.22 Holmes sees the ‘Augustan profession’ of medicine as in an ‘active state of flux’, in which by 1730 the process of fusion between different types of practitioner had much advanced. The evidence of Richard Hope’s account book, displaying his versatility as a truly general practitioner, and strongly suggesting that in his later years his barber-surgeon’s work took second place to his apothecary-doctor role, recognised by the parish, appears well to fit with ‘THE COMING OF THE DOCTOR’: RICHARD HOPE OF CRANBROOK (D. 1725) Holmes’ thesis. Ian Mortimer has written of ‘this new type of physician (who) kept his apothecary’s or surgeon’s shop, run by apprentices, and did all the treatment himself’.23 So far as one can tell, this description seems to fit Hope precisely. Much debate has taken place as to the extent or indeed reality of medical professionalism in the early modern period. On considering what contribution Richard Hope’s account book might make to that debate, a reasonable conclusion may be that he himself should be regarded as a professional, no matter what reservations may remain as to whether medicine itself can be regarded as a single profession in his lifetime. Such a conclusion might follow from using Rosemary O’Day’s suggested checklist for defining a profession.24 Its six criteria are: 1. A body of people offering service on the basis of expertise; 2. E xpertise and authority grounded on theoretical knowledge as well as practical skill; 3. A claim of monopoly; 4. A dherence to a code of ethics; 5. S ubjection to an internal organisation able to discipline members; 6. A mple autonomy in working. Using this list, Hope appears on the whole to qualify as a ‘professional’ practitioner by virtue of fulfilling the first, second, sixth and perhaps fourth criteria. As to No. 1, the expertise is apparent in the entries (with the Latin) in the account book. As to No. 2, the fact that his knowledge is theoretical as well as practical is testified in the extract from his licence testimonial already quoted, and, in his apothecary’s role, is amply evidenced in respect not only of his most frequent Galenic remedies but also of his use of ‘chemical’ alternatives as well as laudanum and other relatively new drugs. As to No. 6, he is manifestly his own master. Of the remaining three criteria, No. 4 would hardly be much apparent in an account book, but the striking entry, already cited, of a charge for ‘diligent care & pains’, already quoted, at least suggests an ethical approach. As to criteria Nos 3 and 5, the account book can furnish no evidence on either, but any claim of monopoly or subjection to a disciplinary organisation is unlikely in reality, although, as regards No. 5, Hope’s licence as a medicus was presumably revocable in theory. However, the significance of No. 5 in particular is at least open to debate: Marjorie Pelling has questioned the significance given by ‘some authors’ to institutional developments as a basis for professional achievement – especially for the 80 per cent of the population in 1700 who did not live in towns of around 4,000 or more inhabitants.25 PETER ALLEN 10 In sum, the account book indicates that Hope fulfilled a high proportion of the criteria which may reasonably be applied to judge professionalism in the provincial England of his day, no matter how difficult it is to identify a single medical profession during his lifetime. Two further issues much discussed in the history of the professions are income and status. In small towns, such as Cranbrook, medical practitioners’ income was always likely to be lower, but social standing quite possibly higher, than in London or other big towns. The account book of course furnishes more information about income than about local status, and this will be reflected in what follows. The book’s approximately 400 entries extend across 28 years, so that, since it is inconceivable that Hope should serve little over a dozen customers per year, the entries must represent only a tiny fraction of his business – perhaps primarily dispensing and treatments supplied on credit instead of immediate cash payment. Despite this severe limitation to the value of the evidence, a number of details at least give clues as to his earnings. They may be separately considered, as barbering services, surgical and other medical services, and pharmaceutical products sold. The majority of the ‘triming’ entries are per quarter or half-year, with no indication as to the number of trims entailed; as stated already, payment for the quarter in the years before 1700 ranged between 1s. and 2s. 6d. (with the striking exception of the wealthy Mr Cooke). While the limited number of entries makes it impossible to estimate annual income from barbering, it is probably safe to say that it was below £100 in those early years when barbery was clearly a significant part of Hope’s business. The many sales recorded of items such as vesicatories, plasters/ plaisters, cataplasms and cerecloths, at prices generally between 6d. and 1s. 6d., might relate either to surgeon’s or physician’s treatments. Of the charges for the surgical treatment itself, bleeding (the most frequent entry) most often cost 6d. but occasionally 1s. or (jugular bleeding) even 1s. 6d. The rare drawing of a tooth was 6d. Charges for less simple surgical remedies naturally were higher, and from the limited evidence did not appear greatly to vary as between richer and poorer patients. Reducing a ‘luxated’ (dislocated) wrist twice cost 10s., as did putting an arm in plaster. Richard Robins’ broken leg cost him £4 6s. 0d., almost the highest figure in the account book, possibly representing repeated visits to Hartley, Robins’ home a mile or two from central Cranbrook. Robins appears also to have contributed hops in payment, while the only other such evidence of payment in kind is of four consecutive contributions of cherries and two of fish for setting a fractured clavicle. However, most payments of this nature might well be not recorded in an account book. The relatively few entries apparently showing Hope in the role of physician included ‘curing’ a head (7s. 6d.), ‘curing’ a parotus (7s. 6d.) ‘THE COMING OF THE DOCTOR’: RICHARD HOPE OF CRANBROOK (D. 1725) 11 and ‘curing’ two legs (10s. and 2s. 6d.). Mrs Bonner was charged 10s. for the ‘diligent care & pains’ in 1708. Mainly in the later years, the entries include such as ‘We began our journeys to old Bate’ in 1713: Bate faced total charges of £2 16s. 6d., for drugs and treatment as well as travel expense presumably, but the component for travel cannot be determined from the entry. The bill for ‘Jeremy Dibly’s child’ was much lower: only 6s., although it included six journeys. It is almost certainly the case that Hope’s bread and butter earnings over the years came from pharmaceutical sales, even though the barbersurgeon work was also an important source of income particularly before 1700, as was the physician’s work particularly after 1700. As already stated, pharmaceutical entries are by far the most numerous in the account book. Some charges, especially for non-imported drugs, in most cases as sold also by herbalists, were very low: they include saffron and garlic at 1d. each, ‘elder-flow’ at 2d., and a ‘lavender comp’ at 3d. The made-up decoctions and electuaries, even including ‘Venice Treacle’ (notoriously costly elsewhere, with a huge number of imported components blended by the apothecary), cost in the order of 6d. generally, as did the sudorifics, cathartics and suppositories prescribed to promote ‘evacuation’. Rather more expensive were the imported drugs of mechoacan at 1s. or 1s. 6d. and ‘Cort Peruv’ (presumably Peruvian bark, containing quinine) at 1s. Apothecaries elsewhere are known to have made grossly high profits by charging many times what they had paid when purchasing their drugs; Hope appears to have done nothing of the sort. Joan Lane has drawn an interesting distinction between surgeonapothecaries (as Hope described himself, though he was medicus also) and apothecaries. The latter in the eighteenth century quite often experienced bankruptcies, whereas the more secure surgeon-apothecaries typically had a fairly small stock of goods, with low-risk capital, and in non-inflationary times were not seriously damaged by quite lengthy delays in payment.26 The credit offered, and the modest charges made by Hope for fairly common pharmaceuticals – with even his Venice Treacle so cheap – seem quite well to correspond with this. Two notable features of the many pharmaceutical entries in the years after about 1708 are the evidently quite high social status of many of the clients, and the increased frequency of women clients, sometimes with long lists of purchases. The former is indicated by the frequency of ‘Mr’ and ‘Mrs’ (as well as a ‘Madam Broughton’) in the entries, although ‘Goodman’ and ‘Goody’ entries remain alongside; it is enough at least to suggest that the reputable apothecary-doctor was now readily patronised by the higher elements of local society as well as the middling to humbler ones with whom treatment by apothecary or surgeon rather than old-style physician has more generally been associated. Over the 28 years covered by the account book, Hope’s practice had developed from what had been PETER ALLEN 12 primarily a traditional barber-surgeon’s business to the more sophisticated one where ladies regularly bought pharmaceutical products and enjoyed up to several months of credit before paying. The ‘shopp’ in Cranbrook’s main street holding the goods which Richard Hope bequeathed to his son Thomas must surely have been a significant retailing establishment, perhaps run by Thomas or apprentices (one of whom indeed may have been Thomas), as well as the consulting and treatment premises where Richard worked. The account book can give us no more than approximate indications as to what Richard Hope’s total income as a practitioner might have been, and it tells us almost nothing about his outgoings, but the figures above would probably suggest that latterly his gross income would run to several hundred pounds a year – far more than the vicar or the grammar school master earned, and certainly enough to make him one of the richest men in a Cranbrook still impoverished by the broadcloth industry’s collapse. As to supplementary income from non-medical enterprises, the account book does contain two entries where Hope hired out horses to take to London (5s. 6d.) and Rochester (price not entered), and two entries recording a lodger. There is no further evidence to indicate that either was a regular source of supplementary income for Hope, but they at least suggest that this many-sided practitioner was additionally something of a many-sided entrepreneur – an impression strengthened by the knowledge that after his death litigation occurred in relation to a property, other than his shop, which he had owned.27 The documentary evidence does not make it clear whether this was Coldharbour Farm, Horsmonden, but this farm too was bequeathed to Thomas, virtually the sole beneficiary, in his father’s will. Richard Hope had been very comfortably off. Finally, and briefly, as to social status – on which the account book itself can tell us nothing, other than indicating the growing clientele of better-off patients or customers. Existing research evidence on the town also seems to yield little on Hope’s social standing there. Cranbrook was distinctive for its remarkably high proportion of Dissenters and the gulf between them and the Anglicans. If indeed it was our Richard Hope’s children who were baptised in the Anglican church in the 1690s, it suggests, but does not definitely establish, that their father was an Anglican. Anglican conformity would have meant that he was the more likely to play some official role in the parish, and his professional employment by the parish has already been mentioned. However, we know that, unlike several of the Cranbrook doctors in the nineteenth century, he was not a governor of the grammar school – a role reserved in Hope’s time and long afterwards for Anglicans only. Nor did he serve the parish as a churchwarden or overseer. It seems possible that he was a member of the sizeable Presbyterian congregation of his lifetime, but no evidence for or against this has been found. ‘THE COMING OF THE DOCTOR’: RICHARD HOPE OF CRANBROOK (D. 1725) 13 Nor is it clear, though quite possible, that Hope attained gentry status. In his lifetime, the two traditionally leading local gentry families were the Bakers and Robertses, though both happened to be undergoing very difficult times. Along with them, one or two local lawyers and probably the vicar were recognised as gentry, and it is known that some of the wealthiest clothiers or ex-clothiers of mid-to-late seventeenth century attained the same status – aided by more liberal use of the title ‘Mr’ or ‘gentleman’ after 1660.28 The baptismal, marriage and burial records, in which many Hopes figure, defy an easy conclusion as to their evidence on Richard. If, as is probable, he was the father of sons (including Thomas) born in the 1690s, the baptismal records show him as plain ‘Richard Hope’, married to Mary, at a time when a few other entries were honoured by a ‘Mr’ or ‘Gent’. However, in the 1690s Hope had not very long been apothecarydoctor as distinct from barber-surgeon: it seems very likely that, if the entries had been post-1700, in the years when he was doing doctor’s work for the parish and had a clearly flourishing general practice, his status in the town would have been considerably higher. In 1725 the burial register at least elevates him to ‘Mr Richard Hope, Surgeon’. The evidence of the account book, in conjunction with the limited other information which we have on Richard Hope, appears to illustrate the emergence of the general practitioner as an accepted professional. It is essentially provincial, small town (albeit recently important manufacturing town) evidence: findings as to degree of specialisation, control over practitioners, income and status may well be quite different from those prevailing in larger towns or indeed other provincial regions. It seems to be the case that Hope was originally surgeon or barbersurgeon, presumably after apprenticeship, and that, like many another, he seized the chance of a bishop’s licence in 1685 to become what was sometimes termed a medicus – the relatively new type of physician, though by no means new to Cranbrook. The evidence, including the visiting of patients, the ‘diligent care & pains’ charged for, the employment by the parish, and certain medical cases mentioned in the account book, indicates that he indeed did a good deal of physician’s work, particularly after 1700. Yet it is striking that in his will he preferred to be named as a chirurgeon and apothecary, and overall the account book evidence would appear to indicate that in practice – very general practitioner though he certainly was – he latterly was more apothecary than barber, surgeon or physician. Though the status of the successful apothecary (such as Hope evidently was) remained below that of the traditional university-educated physician, it had markedly risen in the Augustan period and normally exceeded that of a surgeon, though not necessarily that of a licensed medicus, such as Hope also was. PETER ALLEN 14 As to professionalism, it is argued above that, no matter what view is taken to whether a single medical profession existed in his period, Richard Hope himself fully warrants being recognised as a genuine professional. He was his own master, possessing formal qualifications, and the account book certainly suggests that he was an eclectic and knowledgeable practitioner as an apothecary particularly, but also an example of Holmes’ ‘coming of the doctor’ type of general practitioner. According to Holmes, ‘by 1730 the transmutation of the apothecary into the family doctor had become irreversible’.29 Hope appears to illustrate that transmutation particularly well. endnotes 1 W. Tarbutt, The Annals of Cranbrook Church, Second Lecture, Mr Dennett, Cranbrook, 1870, p. 62. 2 Centre for Kentish Studies (CKS ), 442 F 5/2. 3 A . Poole, A Market Town and its surrounding villages: Cranbrook, Kent in the later 17th century, Phillimore, 2005, p. 25. 4 Ibid., p. 39. 5 G . Cousins, ‘Apothecaries and Surgeons’, The Cranbrook Journal, No. 5, Cranbrook Local History Society, 1992, 8-9. 6 I . Mortimer, ‘A Directory of Medical Personnel qualifying and practising in the Diocese of Canterbury, c.1560-1730’, Archaeologia Cantiana, cxxvi (2006), 153-162. 7 M . Pelling, ‘Trade or Profession? Medical practice in early modern England’, in The Common Lot, Harlow, Addison Wesley Longman, 1998, p. 249. 8 CKS , 442 F 5/3. 9 Canterbury Cathedral Archives: DCb – L/B/361. 10 C. Rawcliffe, Medicine & Society in later medieval England, Sutton, 1995, p. 125. 11 I . Loudon, ‘The nature of provincial medical practice in eighteenth-century England’, Medical History, vol. 29, Wellcome Institute, 1985, p. 8. 12 G . Holmes, Augustan England: Professions, State and Society 1680-1730, Allen & Unwin, 1982, p. 195. 13 J. Lane, ‘The role of apprenticeship in eighteenth-century medical education in England’, in W.F. Bynum and R. Porter (eds), William Hunter and the eighteenth-century medical world, Cambridge, Cambridge University Press, 1985, p. 57. 14 H olmes, Augustan England, p. 193. 15 J.G.L. Burnby, ‘A Study of the English Apothecary from 1660 to 1760’, Medical History, Supplement No. 3, 1983, Wellcome Institute, London, p. 96. 16 H olmes, Augustan England, p. 188. 17 Ibid., p. 184. 18 S ee endnote 9. 19 H olmes, Augustan England, p. 172. 20 P oole, A Market Town, pp. 131-2. 21 H olmes, Augustan England, p. 188. 22 Ibid., p. 167. 23 M ortimer, A Directory of Medical Personnel, p. 137. 24 R . O’Day, The Professions in Early Modern England, 1450-1800, Harlow, Pearson Education, 2000, p. 9. ‘THE COMING OF THE DOCTOR’: RICHARD HOPE OF CRANBROOK (D. 1725) 15 25 P elling, The Common Lot, pp. 248-9. 26 L ane, William Hunter, p. 97. 27 CKS , 442 F 5/2. 28 P oole, A Market Town, pp. 11 8-121. 29 Holmes, Augustan England, p. 184. bibliography Primary Sources Centre for Kentish Studies, Maidstone; 442 F 5/3; Account Book of Richard Hope. Centre for Kentish Studies, Maidstone; 442 F 5/2; Will of Richard Hope, and detail on property settlement after his death. Canterbury Cathedral Archives; DCb-L/B; Richard Hope’s episcopal licence. Secondary Sources Burnby, J.G.L., A Study of the English Apothecary from 1660 to 1760, Medical History, Supplement No.3, 1983, Wellcome Institute, London. Cousins, G., ‘Apothecaries and Surgeons’, The Cranbrook Journal, No. 5, Cranbrook Local History Society, 1992. Grell, O., ‘The Medical Profession’, in A433: The Professions in Early Modern England, 1450-1800, Open University, 2003. Holmes, G., Augustan England: Professions, State and Society 1680-1730, Allen & Unwin, 1982. Lane, J., ‘The role of apprenticeship in eighteenth-century medical education in England’, in W.F. Bynum and R. Porter (eds), William Hunter and the eighteenth-century medical world, Cambridge, Cambridge University Press, 1985. Loudon, I., ‘The nature of provincial medical practice in eighteenth-century England’, Medical History, vol. 29, Wellcome Institute, 1985. Mortimer, I., ‘A Directory of Medical Personnel qualifying and practising in the Diocese of Canterbury, c.1560-1730’, Archaeologia Cantiana, cxxvi, 2006. O’Day, R., The Professions in Early Modern England, 1450-1800, Harlow, Pearson Education, 2000. Pelling, M., ‘Trade or profession? Medical practice in early modern England’ in The Common Lot, Harlow, Addison Wesley Longman, 1998. Poole, A., A Market Town and its surrounding villages: Cranbrook, Kent in the later 17th century, Phillimore, 2005. Rawcliffe, C., Medicine & Society in later medieval England, Sutton, 1995. Tarbutt, W., The Annals of Cranbrook Church, Second Lecture, Mr Dennett, Cranbrook, 1870.