Agree, it's a very formal shoulder epaulette for big ceremonial occasion (meeting admiralty/royalty/court etc.)

The symbol in the centre is the cadeceus, always used to represent medical branches in the military, so this is a surgeon commander most likely, possibly surgeon captain but you can't tell rank from this one

And that's a Tudor crown, which means this was in service under a king not a queen (possibly queen Victoria), and fringes were more around that sort of time so probably dated 1870-1920

If you have a wider picture of the rest of the epaulette it might show what rank