The licensing of provincial surgeons and physicians in the post-Restoration period has proved an awkward subject for medical historians. It has divided writers between those who regard the possession of a local licence as a mark of professionalism or proficiency, those who see the existence of diocesan licences as a mark of an essentially unregulated and decentralized trade, and those who discount the distinction of licensing in assessing medical expertise availability in a given region. Such a diversity of interpretations has meant that the very descriptors by which practitioners were known to their contemporaries (and are referred to by historians) have become fragmented and difficult to use without a specific context. As David Harley has pointed out in his study of licensed physicians in the north-west of England, “historians often define eighteenth-century physicians as men with medical degrees, thus ignoring … the many licensed physicians throughout the country”. One could similarly draw attention to the inadequacy of the word “surgeon” to cover licensed and unlicensed practitioners, barber-surgeons, Company members in towns, self-taught practitioners using surgical manuals, and procedural specialists whose work came under the umbrella of surgery, such as bonesetters, midwives and phlebotomists. Although such fragmentation of meaning reflects a diversity of practices carried on under the same occupational descriptors in early modern England, the result is an imprecise historical literature in which the importance of licensing, and especially local licensing, is either ignored as a delimiter or viewed as an inaccurate gauge of medical proficiency.
Countervailing power? Collusion in markets with decentralized trade
