A Directory of Medical Personnel Qualified and Practising in the Diocese of Canterbury, circa 1560-1730
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A Directory of Medical Personnel Qualified and Practising in the Diocese of Canterbury, circa 1560-1730
1
PAPER No. 021
A Directory of Medical Personnel Qualified and Practising
in the Diocese of Canterbury, circa 1560-1730
Ian Mortimer, BA MA PhD FRHistS RMSA
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Introduction
The question of how many medical practitioners served urban and rural communities in the
early modern period has exercised social historians for many years. A century ago, the
seventeenth century provincial practitioner was looked upon as a rare beast, more often than
not a quack or charlatan, with the vast majority of ‘proper’ physicians being resident in
London. This view was strongly reinforced by early historians of medicine, who, as a result of
their eagerness to demonstrate how society had been improved by the profession,
concentrated on applauding the achievements of the great men of science. Of course, many of
these great men emerged from the provinces - Kent’s own William Harvey is a prime example
- but they tended to base themselves either in the university towns or London, and their work
was anything but routine or characteristic of the profession as a whole. Although local records
often revealed practitioners functioning successfully in localities, and evcn gaining wealth,
status and political eminence in towns, the idea that there was a large cardre of provincial
physicians, surgeons and apothecaries was normally dismissed.
This view first came to be challenged in the 1960s. In 1961, McConaghey used
ecclesiastical records (particularly those of the diocese of Exeter) to describe the licensing
system over the period from the mid-sixteenth century to the mid-eighteenth, and
churchwardens’ and municipal accounts to illustrate the medical relief available to the poor.1
In so doing he demonstrated that there were several hundred licensed practitioners in Devon
and Cornwall between the late sixteenth and mid eighteenth centuries. The following year
John Raach’s much more straightforward solution appeared, entitled A Directory of English
Country Physicians 1603-1643.
2
In this he identified a total of 814 'doctors' for the provincial
counties in the period. Unfortunately, his definition of a 'doctor' was influenced heavily by
earlier historians of metropolitan medical practitioners, who had adopted contemporary elitist
terminology to exclude anyone who was not a licensed physician or the holder of a M.D.
degree, and he excluded surgeons, apothecaries, females and unorthodox practitioners.
Nevertheless, it was a good point well-made: London was not the sole source of medical
expertise in the early seventeenth century, nor even the main one for the majority of the
population.
Very soon afterwards, R.S. Roberts shifted the question on to a much more
sophisticated and professional level an influential article in the journal Medical History.
3
In
his opening lines Roberts demonstrated why the history of medicine in the provinces had been
1
R.M.S. McConaghey, 'The history of rural medical practice' in FNL Poynter (ed.), The Evolution of Medical
Practice in Britain (1961), pp. 117-143. 2
John Raach, A Directory of English Country Physicians 1603-1643 (1962). 3
R.S. Roberts, 'The personnel and practice of medicine in Tudor and Stuart England: part 1: the provinces',
Medical History vi, 4 (1962), pp. 363-382.
3
ignored, stating 'the smallness of the number of physicians who belonged to the exclusive
College of Physicians has made it appear that the mass of the people who lived outside
London relied for medical attention on quacks'.4
In the same opening paragraph he drew
attention to the important implications of Raach's work, and moreover demonstrated its
limitations, suggesting that it was wrong for historians to ignore surgeons and apothecaries in
any systematic appraisal of practitioner availability in provincial England. Over the next two
pages he developed this theme, introducing for the first time the key methodological problems
which inform the debate to this day. He questioned the validity of a list along the lines of
Raach's, as the recorded presence of a M.D. or a M.B. in a particular place does not
necessarily imply that he practised there, and many such men indeed had retired. Most
importantly, he questioned the very nature of the provincial physician's training and
occupational identity. In his words:
A directory of physicians implies that the term physician is a fairly distinct type of medical
practitioner performing a function in medicine not carried out by the subordinate
apothecaries or surgeons. This of course has usually been assumed to be so until the
apothecary became a general practitioner some time after the Plague, and contemporary
writers... all believed in such a hierarchical and differentiated professional structure. Thus
there is no hint in the Directory that in fact some of the people listed were surgeons and
apothecaries by training who at this early date took out episcopal licences to establish, or
confirm their practice. This fact is important for when such men became 'physicians' they
did not practise in the same way as the true consultant-like physicians, whose prescribed
treatment was actually carried out by apothecaries and surgeons. This new type of
physician kept his apothecary's or surgeon's shop, run by apprentices, and did all the
treatment himself.5
This is the crux of the problem. What is a medical practitioner? Two or three hundred years
before the advent of the modern Medical Register, it is not easy to say. Is it accurate to call a
grocer who deals in medicinal substances and is occasionally called an apothecary by his
clients a medical practitioner? Should we not refer to an experienced woman whose
profession is nursing the sick and healing children’s ailments also as a medical practitioner?
In this work Roberts singlehandedly showed the weaknesses of the traditional approach and
opened the gate to the modern study of the social history of medicine.
The identification of practitioners by name continues to have validity, however,
especially when combined with more recent numerical modelling and sampling techniques.
Perhaps the most influential essay on the social history of medicine yet published, by
Margaret Pelling and Charles Webster’s 1979 essay, ‘Medical Practitioners’, used a very
similar methodology, ennumerating the numbers of practitioners active in a locality at a
4
Roberts, 'Personnel and practice', p. 363.
5
Roberts, 'Personnel and practice', pp. 364-5.
4
specific time and comparing this with the local population.6
They identified sufficient
‘practitioners’ (defined as anyone who was practising medicine, excluding nurses and
midwives) to suggest practitioner:population ratios of 1:400 in London at the end of the
sixteenth century and 1:220 in Norwich (a figure later revised by Pelling to 1:200).7
Although
they found it difficult to expand on this and suggest how many practitioners were operating in
rural areas, the point had been emphatically made. In 1600 there were more practitioners per
head of the urban population than there were in a twentieth-century city.
No real advance on this position was made until recently. In 2002 the present writer
examined the probate accounts for the dioceses of Canterbury, Salisbury (including the
archdeaconry of Berkshire) and Chichester in order to quantify changes in medical assistance
purchased on behalf of the seriously ill and dying in the seventeenth century. The Canterbury
collections proved extraordinarily rewarding. They suggest that between c.1590 and c.1710
there was an increase of between 360% and 1,130% in the use of medicine and medical
advice by the seriously ill and dying (depending on social status and geographical location,
the rural poor seeing the greatest change). As a result, there may be no doubt that the
seventeenth century saw the medicalisation of society in East Kent, in the sense that at the
start of the period few individuals except the rich sought the help of occupationally-defined
medical practitioners when seriously ill - most relied on amateur, family and local help -
whereas by 1700 almost all non-destitute people had access to medical practitioners or
specially prepared apothecarial wares deemed suitable for their needs.8
This massive increase in the use of medical strategies to cope with illness and injury
begs one very important question. How was this possible? Traditionally the answer has been
the assumption that more competition must mean more business, which in turn must mean
more businessmen or practitioners. But as Pelling and Webster’s essay suggests, there were
many practitioners operating in London and Norwich c.1600, so where would be the evidence
for a massive increase in their numbers?
Fortunately, in East Kent it is possible to answer this question in detail, partly using the
probate accounts themselves. This is because one may determine reasonably accurately how
many practitioners were operating in c.1690 compared to c.1620. The details of payments to
named practitioners allow us to calculate how deficient a directory of names built up from
licensing and similar records may be. The result is that the numbers of occupationally-defined
medical practitioners (excluding nurses) in East Kent was an average of about 191 in the
6
Margaret Pelling and Charles Webster, 'Medical Practitioners' in Charles Webster (ed.), Health, medicine and
morality in the sixteenth century (Cambridge, 1979), pp. 165-236. 7
Margaret Pelling, 'Tradition and diversity: medical practice in Norwich 1550-1640' in Instituto Nazionale de
Studi sul Rinascimento, Scienze Credenze Occulte Livelli di Cultura, Convegno Internazionale 1980 (Florence,
1982), pp. 159-171.
8
See Ian Mortimer, ‘The Triumph of the Doctors’, Transactions of the Royal Historical Society, sixth series, xv
(2005), pp. 97-116.
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period 1620-40 and about 195 in the period 1670-1710.9
These figures imply
practitioner:population ratios for the diocese of about 1:370 for the earlier decades and 1:410
for the later, commensurate with the 1:400 proposed by Pelling and Webster for sixteenth
century London in ‘Medical Practitioners’.10
So who were they, these medical practitioners who provided this medical revolution to
the people of East Kent? While we cannot answer this question in every case, it is possible to
give an indication for the majority. Just as the probate accounts for the diocese of Canterbury
are without parallel, the records of diocesan licensing are very good indeed, including not
only grants of licences but (after 1660) applications to obtain licences to practise medicine.
The records of Canterbury freemen are also available, so too the records of those from Oxford
and Cambridge for those who obtained medical degrees and/or licenses to practise medicine.
Raach’s directory is not without its uses, and the indexes at the Centre for Kentish Studies of
probate material - such as wills and inventories - give many more references to medical men.
All these sources were used for compiling this directory.
The most important source by far for this directory, however, is the collection of
probate accounts. There are three crucial reasons why this is so. The first has already been
alluded to: by comparing the qualified practitioners with the active ones, we can work out the
proportions of active practitioners who had no qualification and who would otherwise not
appear in such a directory (and make allowance for them in quantifying their numbers). The
second reason follows on from this: we can also often name and locate these ‘unqualified’
individuals on the basis of their records of activity, allowing us systematically to amplify this
directory in a way possible for no other diocese in England. This is important, for it reveals
that many well-established practitioners were operating with no known official identity with
the acquiesence (tacit or otherwise) of the local authorities. Although in order to charge for
performing medical services, any practitioner was legally required to hold a licence or a
medical degree, at least forty per cent of Kentish practitioners had no such qualification.
Some of these were apothecaries who only supplied medicines, and did not prescribe them,
but many ‘physicians’ and ‘surgeons’ were sanctioned only by local trust. As the present
writer has argued elsewhere, this suggests that although the licensing system was deficient in
many respects, it formed part of a local means of medical control.11 Lack of a licence could be
used as a means of controlling those practitioners who fell foul of local trust, or moved their
practices into a locality against the interests of a trusted practitioner, or without the
9
Ian Mortimer, ‘Medical Assistance to the Dying in Provincial Southern England, c.1570-1720’ (PhD thesis, 2
vols, University of Exeter, 2004), i, pp. 157-8. It should be noted that the number is not static, due to the
cessation of ecclesiastical licences during the Commonwealth. It is perhaps most likely that the number of
practitioners was declining by c.1680.
10 This is based on an estimate of the population of the diocese derived from parish returns for the Compton
Census of 1676. See Mortimer,’Medical Assistance to the Dying’, I 129-30 ; Peter Brandon and Brian Short,
The South East from AD 1000 (1990), pp. 190-6.’
11 Ian Mortimer, ‘Diocesan licensing and medical practitioners in South-West England, 1660-1780’, Medical
History, 48, 1 (January 2004), pp. 49-68.
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acquiesence of the local gentry. Otherwise local support was sufficient licence in itself. Thus,
although Kent shows a higher preportion of licentiates among its practitioners than elsewhere
in southern England, it also shows a high toleration of unlicensed practitioners and a
commensurate high level of trust in their services.
The third reason why the probate accounts are the most important single source
underlying this directory is the question of practitioner identities. Hitherto practitioners have
tended to be described as falling into one of three camps: the physicians (those who advised
and prescribed), the surgeons (those who cut into the body and attended to the outer skin), and
the apothecaries (those who supplied medicines). Historians have realised for a long time that
this is too rigid an understanding to be applied in every case, but only through a study of the
probate accounts has it become apparent how loosely it applied. Many practitioners who
obtained a licence to practise surgery were described as ‘doctor’ by their patients, especially
after 1660. Many apothecaries who were supplying physic were also supplying advice, and
performing the role of a physician, often with the result that they were called ‘physician’ or
‘doctor’ by their clients. In the modern, qualification-dominated world, we would normally
say that a man licensed to practise surgery was a surgeon, or a freeman apothecary was an
apothecary and not a physician, but this was not necessarily so in the seventeenth century. If a
man had a shop from which he sold medicines, he was an apothecary to his clients, regardless
of whether he held a licence to perform surgery and regardless of whether he was officially a
freeman or not. Alternatively, a physician who practised surgery on occasion was no less a
physician for the diversity of his trade, although it would not be incorrect for the beneficiaries
of his surgery to describe him as a surgeon. In some cases a practitioner was described as an
apothecary and as a physician and also held a licence to practise surgery. In short, practitioner
identities were very loose, and as our evidence is so often directly contradictory, it is clear
that most medical practitioners were fulfilling a range of medical roles, especially after 1660.
Format
The following directory includes a total of 832 entries to named practitioners, plus a few
'supplementary' entries (included on account of the difficulty in determining to which
practitioner they relate). All of these were working - and almost all were also resident - in the
diocese of Canterbury. Practitioners noted as resident elsewhere have only been included if
they are known to have practised within the diocese on the evidence of payments, e.g. John
Kevell of Rye, Sussex. Famous practitioners who were born or grew up in Kent have not been
included unless there is evidence of their practising within the diocese. Thus this list does not
include such Kentish medical illuminaries as William Harvey, Robert Sprackling, Thomas
Hall, Edward Bodenham, Robert Conny or Robert Fludd. Fifty-three names have been
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included without a very firm foundation for regarding them as practitioners; these have been
included on the strength of a payment to them in the probate accounts for providing medicines
or physic. Some of these will be references to apothecaries, but others will be reimbursements
to non-medical people for obtaining medicines on behalf of the dying person. Nevertheless,
even if all fifty-three entries relate to reimbursements, it is by far the most complete directory
of practitioners for early modern England yet compiled, with 779 names for 170 years.
Entries here appear in two parts. The first part, headed by the name of the practitioner,
includes the official details about the practitioner derived (on the whole) from sources
associated directly with an official act, e.g. licensing, grants of probate, degrees etc. Within
the first part of the entry, the first line (in bold) is given over to the name of the practitioner
and his vital dates (where known); the second line is his professional identity and place of
residence (and/or place of practice, where an alternative is known); the third and fourth lines
include details of qualifications, and finally personal details (such as a grant of the
practitioner’s own probate) appear in the last line.
The second part of each entry relates to specific instances of medical assistance
payments, and are all taken from the Canterbury diocesan and archdeaconry probate accounts,
held in the Centre for Kentish Studies, Maidstone (CKS). These follow the following form:
Year: [Name of deceased] of [parish], [occupation, if known] ([gross value of the
deceased’s estate]) ‘transcript of entry’ [cause of death, if known; or ‘Multiple infection’
if more than one died of an unknown disease] (doc. reference),
for example:
1610: John Dunckin of Canterbury, Mr (£732) "Item paide unto Mr Charles Annot of
Canterburie chirurgion for medycine for the famylie of the said deceassed visited and
infected as afore is saide with the plawge and for his paines and diligence in attending on
the said famylie divers weekes together verie carefully" [Plague] (CKS PRC20/2/122).
In most cases, specific amounts paid have not been given as these tend to be confusing: in
some cases it is not possible to separate the medical payment here cited from other payments;
in other cases payments might include transport and thus be totally uncomparable with other
entries which list transport separately but which do not specify the practitioner’s name. Thus
almost all have been dropped, and researchers will need to consult the original documents (or
the microfilms of them). As for identifications, many of these are very tentative. The most
tentative are indicated by the entries being italicised. With regard to the date, it is important to
remember that the date prefixing each payment is the date of the account, which may be only
a few months after the death but which might be as much as ten or more years. Most entries,
however, will relate to medical help within the previous four years.
This list omits signatories of licence applications unless their presence and medical
qualifications (in the broadest sense) are confirmed, either by a by-line alongside the signature
on a licence application, or medical payments mentioned in the accounts. For example,
8
Nicholas and Robert Day are not included on this list, although they signed medical licence
applications. This is on the grounds that often signatories were men from outside the diocese,
especially London physicians.
This list also omits female practitioners. This is not due to a prejudice but rather to
reflect that in East Kent in the seventeenth century there was a striking line of demarcation
between male and female practitioners serving the seriously ill and dying in a paid medical (as
opposed to nursing) capacity. The medical identities which people here would recognise (e.g.
doctor, physician, surgeon, apothecary) were almost exclusively male. The only instances of
female surgeons specified in the probate accounts are two unnamed women. With regard to
female physicians, in all these thirteen thousand five hundred accounts, there are only two
unambiguous references to a woman being paid for giving medical advice to a seriously ill or
dying person (except to children, and with regard to midwifery and females’ skin complaints,
which lay outside the scope of the study for which this index was created). The first is a
payment of 32s on behalf of a man from Postling, ‘to one Mrs [blank] Wright of or about
Canterbury for phisick by her ministred to the said testator in the time of his sicknes and for
her advise thereabouts and her paynes and charges in coming and horsehire in fetching her
twise from Canterbury to Postling to doo the same’, in an account dated 1635 (CKS
PRC2/33/12.). The second is Mrs Jacob of Canterbury, who was almost certainly a member of
the very extensive family of practitioners based in that city, multitudes of references to whom
are included in this directory. In 1639 10s was paid on behalf of one William Maxted, ‘to Mrs
Jacob for her directions in physic’ (CKS PRC1/3/14). This Mrs Jacob was probably the same
as the Mrs Jacob mentioned in a 1649 account giving advice in conjunction with her son, 14s
being paid on behalf of a Canterbury man, ‘to Mrs Jacob and her son for their advice and
counsell and for physick had of them in the time of the said deceased's last sickness whereof
he died’ (CKS PRC1/8/36).12
With regard to sources: all references to Canterbury freemen have been taken from
Stella Corpe’s lists of the Freemen of Canterbury. It is not presumed that apprentices became
practitioners; and apprentices have been excluded from this list unless there is some other
evidence of service. All references to archiepiscopal licences which do not have a specific
reference to Haggis or Raach (see list of abbreviations) or a similar source have been taken
from the freely available indexes to the registers at Lambeth Palace
(http://www.lambethpalacelibrary.org/holdings/Catalogues/medics/medics_abc.html). The
original registers were not consulted. Similarly, references to degrees and licences from the
universities have been taken from the appropriate Alumni volume for each university. All
other sources have been cited in full or abbreviated form.
12 For further information about the medical roles of women in giving help to the dying and their children, and an
extensive discussion of the nursing roles of women in the period, see Mortimer, ‘Medical Assistance to the
Dying’, i, pp.241-2, and Chapter Five of the same thesis.
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Abbreviations
App. Apprentice of, or apprenticed to
Arch. Archiepiscopal
B.D. Bachelor of Divinity
CKS Centre for Kentish Studies, Maidstone
D.D. Doctor of Divinity
Diocesan applicant Application for a diocesan licence to practise medicine or surgery
Haggis: Haggis MSS in the Welcome Library, London, MS 5341. The references such
as ‘'Liber G'’ refer to the original volume from which Haggis wook his information in
the diocesan collection (currently at Canterbury Cathedral Archives). The references
to page numbers are to the relevant archiepiscopal section of his index.
Jun. Junior
Lic. med. university or college licence to practise medicine
Matric. matriculated
M.B. Bachelor of Medicine
M.D. Doctor of Medicine
ODNB Oxford Dictionary of National Biography (Oxford, 2004)
Raach: J Raach, 'A Directory of English Country Physicians 1603-43' (1962)
RCP Royal College of Physicians
Reg. Register
Sen. senior
Signatory Signed an application for a licence to practise medicine or surgery on behalf
of another practitioner.
Conventions
• Square [brackets] denoted editorial insertions, italic within these brackets being
editorial comment.
• Angled
