The Rise of British Surgery in the Eighteenth Century

THE RISE OF BRITISH SURGERY IN THE EIGHTEENTH CENTURY By FENWICK BEEKMAN, M.D. NEW YORK CITY HE eighteenth century saw the young man who wished to learn the changes in the educational sys- curing art could obtain little knowl- tem in England that were re- edge at home, inasmuch as the universi- flected not only by a renewed ties of England and Scotland did not participation in literature and includestates- in their curricula practical Tmanship, but which also provoked in- methods of teaching either medicine or terest in the study of science. In speak- surgery. Consequently, the aspirant to ing of this period we are told by medicine, following a classical educa- Buckle, in his “History of English Civ- tion at one of the universities, sought ilization”: the facilities offered to study medicine . an immense change had begun, not on the Continent, in Italy, France or only among speculative minds, but also Holland. On the other hand, the young among the people themselves. The in- man who wished to become a surgeon crease of scepticism stimulated their curi- seldom obtained a university degree, osity; and the diffusion of education sup- but at the age of fifteen or sixteen in- plied the means of gratifying it. Hence, dentured himself as apprentice to some we find that one of the leading character- practicing surgeon for a period of seven istics of the eighteenth century, and one years. If successful, he obtained his free- which preeminently distinguished it from dom at the end of that period from the all that preceded, was a craving after Barber-Surgeons Company and was al- knowledge on the part of those classes lowed to practice his art under certain from whom knowledge had hitherto been restrictions of the Company. The shut out.1 young surgeon’s knowledge of the This was an age in which for the first human body, as we shall see, was mea- time primary schools were provided for ger and his further qualifications to the lower classes, circulating libraries practice, depending as they did to so were established, newspapers com- large an extent upon the conscientious- menced to be generally read, printing ness of the surgeon to whom he was ap- which had been confined to London prenticed, were frequently lacking, as began to be practiced in other cities of teaching the pupil was often neglected the British Isles, and finally efforts were by the unscrupulous master and the ap- made to popularize science through prentice merely acted as a servant. treatises written in untechnical style. The physicians, because of their uni- It is of this period that I wish to versity education, looked down upon write, concerning changes which oc- the surgeons and, through their associ- curred in the teaching and practice of ations, restricted the practice of the sur- surgery. geon to manipulative therapy, bleed- Previous to the birth of the century, ing, small operations, the treatment of wounds, and the reduction of fractures From this time on, for two hundred and dislocations. The freedom of the years, until 1745, when the surgeons Barber-Surgeons Company did not of finally separated themselves from the necessity permit the cutting for stone, barbers and formed their own corpora- for there was further training de- tion, four public anatomies were held manded of those who wished to be annually at Barbers Hall in Monkwell qualified to perform this operation. Street, London. Dissection outside the After receiving their freedom, some Hall was forbidden and infringement of these young men joined the army or of the law was dealt with severely; to navy and, as war was ever present in wit: those days, the experience they ac- 21st May 1573. Here was John Deane quired did much to further the knowl- and appoynted to brynge in his fyneX2i edge of their profession. One need but for havinge an Anathomye in his howse read “Severall Chirurgical Treatises” contrary to an order in that behalf be- (1676) by Richard Wiseman, Ser- tween this and mydsomer next.3 geant-Chirurgeon to Charles 11, to learn of the variety of surgical condi- These public anatomies were per- tions he was called upon to treat while functory demonstrations upon a pre- serving in the army or at sea. Wiseman pared dissection; the pupils, freemen was a keen observer and kept a record of the craft and apprentices sat on of the course and outcome of each pa- benches far removed from the cadaver, tient he treated. Consequently, he was while the Master of Anatomy read a able to produce a treatise which stood didactic lecture during which his asso- far above all other works on surgery up ciate, the Steward of Anatomy, demon- to that time, with the exception of strated the part under discussion. those of Ambroise Pare. Frequently the Anatomy was con- ducted by a fellow from the Royal The method of teaching anatomy College of Physicians, because of the throughout the British Isles at the end inability of the Barber-Surgeons Com- of the seventeenth century had changed pany to produce a qualified demon- but little from 1540, when the Barber- strator from its own ranks. Besides Surgeons Company received its charter these demonstrations, charts and mod- from Henry vm. By that charter: els were used extensively for the in- . The sayd maysters or governours of struction of apprentices. the mistery and comminaltie of harbours The Barber-Surgeons Company, like and surgeons of Londo, and their succes- other guilds of the City, was a liveried sours yerely for ever after their sayd dicre- company for the mutual protection of cions at their free liberte and pleasure its members and, like others of its kind, shal and maie have and take without co- required its members to wear liveries tradiction foure persons condempned ad- on days of festivity or when on public judged and put to death for feloni by the due order of the kynges lawe of thys business. The governing body consisted realme for anatomies. And to make of a Master, three Wardens and twenty incision of the same deade bodies . Assistants, the Court of Assistants. The for their further and better knowledge in- members were of two kinds: those who struction in sight learnyng and experi- practiced as barbers and those whose ence in the sayd scyence or facultie of duties were confined to surgery. Be- surgery. .2 sides these an occasional dentist was ad- First figure on the left of the picture is Thomas Alsop, the King’s Apothecary, who is next to Dr. Wm. Butts and Dr. John Chambre. In the group on the right of the picture (kneeling) from left to right; the first is Thos. Vicary, Master of the Barbers 1530 and of the Barber-Surgeons 1541, 1546, 1548 and 1557, Surgeon to St. Bartholomew’s Hospi- tal and Sergeant-Surgeon to Henry vm, Edward vi, Mary and Elizabeth. Next comes Sir John Ayleff, Master of the Barbers 1538 and Surgeon to the King. Next to Ayleff is Nich- olas Simpson, “King’s Barber” and Master of the Barbers in 1537. Edmund Harman, “King’s Barber,” is next. He was Master in 1540. James Monforde (or Mumford) is next to Harmon, he was “King’s Surgeon.” Then comes John Pen, “King’s Barber,” and Groom of the Privy Chamber. The seventh figure is Nicholas Alcocke who later became Surgeon to Edward vi. The kneeling figure on the extreme right of the picture is Richard Ferris, Master in 1563 and Sergeant-Surgeon to Queen Elizabeth. In the back row' (those stand- ing) the names of only two are known; Wm. Tyllev, Upper Warden 1546 and Chris- topher Samon, Master in 1553. mitted, as shown in this early record. better in other parts of the British Isles. “10th September, 1551. John Bryckett, There is no doubt that English surgery ‘toothe drawer’ was admitted ‘a brother at this time was a mere trade, com- into this house’ and paid £1.” It was a pletely controlled by the jealously custom to have the office of Master held guarded rules of the craft, which on alternate years by a barber and a frowned upon individuality in its mem- surgeon. bers and, consequently, thwarted any The Company’s control of the indi- improvements in the practice of sur- vidual was absolute. In addition to its gery. The methods used in the treat- control over all available dissecting ma- ment of surgical conditions were em- terial, there were laws which covered pirical, for the surgeon had little if any the behavior of its members in all knowledge of physiology or pathology phases of their lives. Only a few can be and the treatment he gave was merely mentioned; attendance at meetings of by manipulative methods, which had the Company or at the anatomies was been handed down from one genera- compulsory; a brother of the craft, tion to another, from which he chose under pain of fine or expulsion, was re- the proper one for the condition he was quired to present to the Court of As- called upon to treat. sistants all patients in danger of death; With the beginning of the new cen- nor was a surgeon allowed to sue at law tury a decided change occurred; signs for the recovery of his fee, without first of unrest appeared; a restlessness among obtaining permission. The surgeon was a few to throw off the yoke placed upon called before the Court for failure in them by the archaic rules and regula- obtaining a cure, in case he had ob- tions of the barber-surgeons companies tained his fee in advance and, if found of the larger centers; a wish to improve guilty, was fined, imprisoned, or was their own knowledge of surgery, and to ordered to make due compensation to better the educational system.

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