No consideration should render man more thankful to his Creator, and
justly proud of the progress of human intellect, than the perfection to
which the art of surgery has been carried. In its present improved
condition, we are struck with horror at the perusal of the ancient
practice, and marvel that its barbarity did not sooner induce its
professors to diminish the sum of misery it inflicted on their victims.
Ignorance, and its offspring Superstition, seemed to sanctify this
darkness. Improvement was considered as impious and unnecessary; and to
deny the powers of the chirurgical art, heresy against the holy men, who
alone were permitted to exercise it.
This supposed divine attribute of the priesthood can be traced to remote
ages: Aesculapius was son of Apollo, and princes and heroes did not
consider the art of surgery beneath their dignity. Homer has illustrated
the skill of Podalirius and Chiron; and Idomeneus bids Nestor to mount his
chariot with Machaon, who alone was more precious than a thousand
warriors; while we find Podalirius, wrecked and forlorn on the Carian
coast, leading to the altar the daughter of the monarch whom he cured, and
whose subjects raised a temple to his memory, and paid him divine honours.
Tradition informs us, that in the infancy of the art all its branches were
exercised indiscriminately by the medical practitioners. It was not then
supposed that the human body was subject to distinct affections, external
and internal; yet, as its study advanced, the ancients were led into an
opposite extreme, and we find that in Egypt each disease became the
province of a special attendant, regulated in his treatment by the sacred
records handed down by their hierarchy.
Herodotus informs us, that "so wisely was medicine managed by the
Egyptians, that no physician was allowed to practise any but his own
peculiar branch." Accouchments were exclusively the province of females.
These practitioners were remunerated by the state; and they were severely
punished, when, by any experimental trials, they deviated from the
prescribed rules imposed upon them, and, in the event of any patient
dying under a treatment differing from the established practice, the
medical attendant was considered guilty of a capital offence. These wise
provisions were made, says Diodorus, in the full conviction that few
persons were capable of introducing any new treatment superior to that
which had been sanctioned and approved by old practitioners.
Pliny complains that no such laws existed in Rome, where a physician was
the only man who could commit murder with impunity; "Nulla praeterea lex,"
he says, "quae puniat inscitium capitalem, nullum exemplum vindictae.
Discunt periculis nostris, et experimenta per mortes agunt: medicoque
tantum hominem occidisse impunitas summa est."
By one of these singular anomalies in public opinion, this supposed divine
science was soon considered an ignoble profession. In Rome it was chiefly
practised by slaves, freedmen, or foreigners. From the overthrow of the
Roman empire till the revival of literature and the arts in Europe,
medicine and surgery sought a refuge amongst the Arabians, who studied
both branches in common; for, though exiled to the coast of Africa in
point of scientific cultivation, it was necessarily cultivated in other
countries, and in the greater part of Europe became the exclusive right of
ecclesiastics. In time, however, it was gradually wrested from their hands
by daily necessities; and every one, even amongst the lowest classes,
professed himself a surgeon, and the cure of the hurt and the lame was
intrusted to menials and women.
As the church could no longer monopolize the art of healing, it became
expedient to stigmatize it, although that very faculty had but lately been
their boast; but it had fallen within the powers of vulgar and profane
comprehension, and therefore was useless to maintain sacerdotal
pre-eminence. In 1163, the Council of Tours, held by Pope Alexander III.,
maintained that the devil, to seduce the priesthood from the duties of the
altar, involved them in mundane occupations, which, under the plea of
humanity, exposed them to constant and perilous temptations. The edict not
only prohibited the study both of medicine and law amongst all that had
taken religious vows, but actually excommunicated every ecclesiastic who
might infringe the decree. It appears, however, that the temptations of
the evil one were still attractive, as Pope Honorius III., in 1215, was
obliged to fulminate a fresh anathema on transgressors, with an additional
canon, ordaining that, as the church abhorred all cruel or sanguinary
practices, not only no priest should be allowed the practice of surgery,
but should refuse their benediction to all who professed it.[26]
The practice then fell into the hands of laymen, although priests, still
regretting the advantages that it formerly had yielded them, were
consulted in their convents or houses; and when patients could not visit
them without exposing them to clerical censure, they asserted their
ability to cure diseases by the mere inspection of the patient's
dejections; and so much faith was reposed in this filthy practice, that
Henry II. decreed that upon the complaints of the heirs of persons who
died through the fault of their physicians, the latter should suffer
capital punishment, as having been the cause of their patient's death,
unless they had scientifically examined what was submitted to their
investigation by the deceased's relatives or domestics: and then proceeded
to prescribe for the malady.
Unable to quit their cloisters, in surgical cases, which could not be so
easily cured at a distance, sooner than lose the emoluments of the
profession, they sent their servants, or rather the barbers of the
community, who shaved, and bled, and drew teeth in their neighbourhood
ever since the clergy could no longer perform these operations, on the
plea of the maxim "_Ecclesia abhorret a sanguine_;" bleeding and
tooth-drawing being, I believe, the only cases where this maxim was
noticed. From this circumstance arose the barber craft or barber-surgeons.
These practitioners, from their various avocations, were necessarily
dexterous; for, in addition to the skill required for good shaving,
tonsurating the crowns of clerical heads was a delicate operation; and it
was about this period that Pope Alexander III. revised the canon issued by
the synod of Carthage respecting the tonsure of the clergy. Surgery being
thus degraded, the separation between its practice and that of medicine
became unavoidable, and the two branches were formally made distinct by
bulls of Boniface VI. and Clement V.
St. Louis, who had witnessed the services of surgeons in the field of
battle during the crusades, had formed a college or _confrerie_ of
surgeons, in honour of St. Cosme and St. Damian, in 1268; and wounds and
sores were dressed _gratis_ in the churches dedicated to those saints on
the first Monday of every month. To this body, of course, the
barber-surgeons, or _fraters_ of the priests, who had not received any
regular education, did not belong. Hence arose the distinction, which even
to the present day obtains in various parts of the Continent, where
surgeons are divided into two classes,--those who had gone through a
regular course of studies, and those who, without any academical
education, were originally employed as the servants of the priests and
barbers. So late as the year 1809, one of my assistants in the Portuguese
army felt much hurt at my declining his offer to shave me; and in 1801,
some British assistant-surgeons, who had entered the Swedish navy, were
ordered to shave the ship's company, and were dismissed the service in
consequence of their refusal to comply with this command.
But to return to our barbers.--These ambitious shavers gradually attempted
to glean in the footsteps of the regular chirurgeons, and even to encroach
upon their domain, by performing more important operations than phlebotomy
and tooth-drawing; the audacious intruders were therefore very properly
brought up _ex officio_ by the attorney-general of France, and forbidden
to transgress the boundaries of their art, until they had been duly
examined by master chirurgeons; although these said masters were not
better qualified than many of the barbers. Such was their ignorance
indeed, that Pitard, an able practitioner, who had successively been the
surgeon of St. Louis, Philip the Brave, and Philip the Fair, obtained a
privilege to examine and grant licences to such of these masters who were
fit to practise, without which licence all practitioners were liable to be
punished by the provost of Paris; and in 1372 barbers were only allowed to
dress boils, bruises, and open wounds.
Although this account chiefly refers to France and its capital, yet the
same distinction and division between surgeons and barbers prevailed in
almost every other country; and privileges were maintained with as much
virulence and absurdity as the present controversial bickerings between
physicians and surgeons.
In 1355 these master-surgeons constituted a faculty, which pocketed
one-half of the penalties imposed upon the unlucky wights who had not the
honour of belonging to their body. They also enjoyed various immunities
and exemptions; amongst others, that of not keeping guard and watch in the
city of Paris. To increase their emoluments, they granted as many honorary
distinctions as they could in decency devise, and introduced the
categories of bachelors, licentiates, masters, graduates, and
non-graduates of surgery. The medical faculty now began to complain of the
encroachments of the master-surgeons on their internal domain of poor
mortality with as much bitterness as the masters complained of the
impertinent invasion on the part of the barbers, of their external
dominion. To court the powerful protection of the university against these
interlopers, the surgeons consented to be considered as the scholars of
the medical faculty, chiefly governed by clerical physicians.
In 1452 a fresh source of dissension arose amongst clerical physicians,
lay physicians, master surgeons, and barbers. Cardinal Etoutville
abolished the law which bound the physicians of the university to
celibacy, when, to use the historian's words, "many of the clerical
physicians, thinking there was more comfort to be found in a wife without
a benefice than could be expected in a benefice without a wife, abandoned
the priesthood, and were then permitted to visit their patients at their
own houses." Thus thrown into the uncontrolled practice of medicine, these
physicians became jealous of the influence of the surgeons, to whom they
had been so much indebted; and they had recourse to every art and
manoeuvre that priestcraft could devise to oppress and degrade them. To
aid this purpose, they resorted to the barbers, whom they instructed in
private, to enable them to oppose the master-surgeons more effectually.
The surgeons, indignant at this protection, had recourse to the medical
faculty, supplicating them to have the barbers shorn of their rising
dignity. Thus for mere motives of pecuniary interest, and the evident
detriment of society, did these intriguing practitioners struggle for
power and consequent fees; and, according to the vacillation of their
interests, the barbers became alternately the allies of the physicians or
the mercenary skirmishers of the surgeons.
From this oppression of the art, for nearly three centuries surgery was
considered a degrading profession. Excluded from the university, not only
were surgeons deprived of all academic honours and privileges, but
subjected to those taxes and public burdens from which the members of the
university, being of the clerical order, were exempted. This persecution
not only strove to injure them in a worldly point of view, but the priests
carried their vindictive feelings to such a point of malignity that when
Charles IX. was about to confer the rites of apostolical benediction upon
the surgeons of the long robe, the medical faculty interposed on the plea
of their not being qualified to receive this benediction, as they did not
belong to any of the four faculties of the university; and as the
chancellor, or any other man, had not the power of conferring a blessing
without the pope's permission and special mandate, both surgeons and
barbers ought to be irrevocably damned. The apostolical benediction in
those days was considered of great value, since it exempted all candidates
from examination in anatomy, medicine, surgery, or any other
qualification, when they applied for a degree.
Ever since the healing art ceased to be a clerical privilege, and a state
of rivalry prevailed between spiritual and corporeal doctors, the former
have sought to represent their opponents as infidels and atheists--the
unbelief of physicians became prevalent, and to this day medical men are
generally considered freethinkers;--an appellation which in a strictly
correct acceptation might be considered more complimentary than
opprobrious, since it designates a man, who extricating his intellectual
faculties from the meshes of ignorance or prejudices, takes the liberty of
thinking for himself.
Sir Thomas Brown in his "Religio Medici," alludes to this injurious
opinion entertained of medical men, when he says, "For my religion, though
there be several circumstances that might persuade the world I have none
at all, _as the general scandal of my profession_, the natural course of
my studies, the indifferency of my behaviour and discourse in matters of
religion--yet in despite thereof, I dare, without usurpation, assume the
honourable style of Christian."
Sir Kenelm Digby in his observations on the work from which the above is
extracted, entertains a similar opinion, and quotes Friar Bacon in support
of it. The following are his words: "Those students who busy themselves
much with such notions as reside wholly in the fantasy, do hardly ever
become idoneous for abstracted metaphysical speculations; the one having
bulky foundations of matter, or of the accidents of it, to settle upon--at
the least with one foot; the other flying continually, even to a lessening
pitch in the subtile air. And accordingly it hath been generally noted,
that the excellent mathematicians, who converse altogether with lines,
figures, and other differences of quantity, have seldom proved eminent in
metaphysics or speculative divinity. Nor again, the profession of their
sciences in other arts, much less can it be expected that an excellent
physician, whose fancy is always fraught with the material drugs that he
prescribeth his apothecary to compound his medicines of, and whose hands
are inured to the cutting up, and eyes to the inspection of anatomized
bodies, should easily and with success ply his thoughts at so towering a
game, as a pure intellect, or separated and unbodied soul."
That such ideas should be maintained in former days, when bigotry and
prejudice reigned paramount, we cannot be surprised; but one must marvel
to see a modern and intelligent annotator of Brown's work,[27] coincide in
this illiberal opinion, in the following terms:
"Imaginative men, that is, persons in whom the higher attributes of genius
are found, seldom delight in the sciences conversant with mere matter or
form; least of all in medicine, the object of which is the derangement, or
imperfection of nature, and the endeavour to substitute order and harmony
in the place of their opposites. Brought thus chiefly into contact with
diseased organization, surrounded by the worst elements of civil society,
(for their experience must in general be among the intemperate and the
vicious,) they may be said to exist in an infected moral atmosphere, and
it is therefore not greatly to be wondered at that among such persons a
highly religious frame of mind should be the exception and not the rule."
The absurdity of this observation can only be equalled by its extreme
illiberality. Can it be for one moment entertained, that the physician who
gives his care to every class of society and at all ages "exists in an
infected moral atmosphere?" Supposing that he is not fortunate enough to
attend upon the opulent and the great, and is limited to a pauper or an
hospital practice, does Mr. St. John mean to say that instances of
intemperance and vice are confined to the indigent, although want of
education, and poverty may degrade them in crapulous pursuits? If there
does exist a profession pre-eminent for its philanthropic character, and
the power of discrimination between good and evil, and right and wrong, it
is undoubtedly that of medicine. The finest feelings of humanity are
constantly brought to bear, both in seeking to relieve bodily sufferings
and solacing an afflicted mind--whether it be with the scalpel in hand in
an anatomical theatre, or by the bedside of an agonized sufferer, whom he
hopes, under Providence, to restore to health and to his family, the
physician has daily opportunities of beholding the wonders of the creation
and the benevolence of the Creator--he is a constant witness of the
fervent supplication of the unfortunate and the heartfelt gratitude of
those suppliants at the throne of mercy, whose prayers have been heard. A
man of exalted benevolence (and such a physician ought to be), he must be
alive to all the generous feelings of humanity, and he is doomed more
frequently to move in an _infected moral atmosphere_, when gratuitously
attending some of the troublesome and pedantic legislators of the republic
of letters, than when exerting his skill to relieve the grateful poor who
may fall under his care.
It has been maintained that the physician seeking in the arcana of nature
the causes of every vital phenomenon becomes a materialist: nothing can be
more unjust, nay, more absurd, than such a supposition. The study of
physiology teaches us, more perhaps then any other pursuit, to admire the
wonderful works of our Creator, and Voltaire has beautifully illustrated
the fact in the following lines:
Demandez a Sylva par quel secret mystere
Ce pain, cet aliment dans mon corps digere,
Se transforme en un lait doucement prepare;
Comment, toujours filtre dans des routes certaines,
En longs ruisseaux de pourpre il court enfler mes veines;
A mon corps languissant donne un pouvoir nouveau,
Fait palpiter mon coeur et penser mon cerveau;
Il leve au ciel les yeux, il s'incline, il s'ecrie
Demandez le a CE DIEU qui m'a donnez la vie.
Broeseche has justly said, _Tanta est inter deum, religionem, et medicum
connexio, ut sine Deo et religione nullus exactus medicus esse queat_; and
it has truly been said by a later writer, "that a philosophic physician
must seek in religion, strength of mind to support the painful exertions
of his profession, and some consolation for the ingratitude of mankind."
Amongst the many glaring absurdities which retarded the progress of
medical studies, one cannot but notice the presumptuous claims of the
physicians to the exclusive privilege of teaching surgery to their pupils,
while anatomy was solely professed by surgeons, and not considered
necessary in the instruction of a physician. All these anomalies can be
easily traced to that spirit of dominion, exclusion, and monopoly, which
invariably characterized clerical bodies. To such a pitch was this
destructive practice carried, that surgeons were only allowed to perform
operations in the presence of one or more physicians: nor were they
permitted to publish any work on their profession until it had been
licensed by a faculty who were utterly ignorant of the matter of which it
treated. The celebrated Ambrose Pare could only obtain as a special favour
from his sovereign, the permission to give to the world one of its most
valuable sources of information.
So late as 1726 we find the medical faculty of Paris making a formal
representation to Cardinal de Noailles and the curates of that capital to
prevent surgeons from granting certificates of health or of disease, and
this application was grounded on the pious motive of enforcing a more
rigid observance of Lent! They further insisted that this indispensable
mortification was eluded in consequence of the facility of obtaining
certificates that permitted persons stated to be indisposed to eat animal
food, eggs, and butter, whence infidelity was making a most alarming
progress, threatening the very existence of church and state, and the
overthrow of every ancient and glorious institution. The faculty were
formally thanked for their pious zeal in the true interests of religion,
and the spiritual welfare of their patients; and orders were affixed upon
the door of every church, anathematizing all certificates that emanated
from the unholy hands of surgeons and barbers.
These unfortunate barbers, although they humbly submitted to the sway of
both physicians and surgeons when it suited their purpose, were in turn
persecuted by both their allies and alternate protectors; so much so, that
the clerical practitioners at one time prohibited them from bleeding, and
conferred this privilege upon the bagnio-keepers. From the well-known
nature of these establishments, various may be the reasons that led to
this patronage, which was clearly an attempt to qualify bagnio-keepers to
extend their convenient trade.
At last, in the year 1505, barbers were dignified with the name of
surgeons. Their instructions were delivered in their vernacular tongue,
until the university again interfered, and ordered that lectures should be
delivered in Latin; once more closing alma-mater against illiterate
shavers, who were, however, obliged to give a smattering of classical
education to their sons destined to wield alternately the razor and the
lancet. In 1655, surgeons and barber-surgeons were incorporated in one
college; a union which was further confirmed, in 1660, by royal
ordonnance, under some limitations, whereby the barbers should not assume
the title of licentiates, bachelors, or professors, nor be allowed to wear
the honourable gown and cap that distinguished the higher grades of
learning. Red caps were in former times given by each barber to his
teacher on his being qualified, and gloves to all his fellow-students.
Thus we find that the high state of perfection which the surgical art has
attained is solely due to the efforts of industry to free itself from the
ignoble trammels of bigotry and prejudice. Intellectual progress has
invariably been opposed in every country by those powerful and interested
individuals who derived their wealth and influence from the ignorance of
society. Corporate bodies monopolizing the exercise of any profession will
invariably retard instruction and shackle the energies of the student. It
is, no doubt, indispensable that the practice of medicine in all its
branches should only be allowed to such persons as are duly qualified; but
whenever pecuniary advantages are derived from the grant of the
permission, abuses as dishonourable as they are injurious to society will
infallibly prevail. In Great Britain the period of study required in
medical candidates is by no means sufficient. Five or six years is the
very lowest period that should be insisted on; and, when duly instructed,
degrees and licences should be conferred without fee, on all applicants,
by a board of examiners unprejudiced and disinterested. This mode of
granting licences would add to the respectability of the profession, while
it would ensure proper attendance to the public. Physicians and surgeons
would then become (what to a certain extent the latter are at present,
though illegally as far as the laws of the college go), general
practitioners, and society would no longer be infested by the swarms of
practising apothecaries, who, from the very nature of their education, can
only be skilled in making up medicines, or who must have obtained
experience in the lessons taught by repeated failures in their early
practice, unless perchance they have stepped beyond the usual confined
instruction of their class. The consequences that arise from this fatal
system are but too obvious. These men live by selling drugs, which they
unmercifully supply, to the material injury of the patient's constitution.
If, after ringing all the changes of their materia medica without causing
the church-bell to toll, they find themselves puzzled and bewildered, a
physician or a surgeon is called in, and too frequently these
practitioners are bound by tacit agreement not to diminish the revenue
that the shop produces. If it were necessary to prove the evils that
result from the monopolizing powers vested in corporate institutions, the
proof might be sought and found in the virulence and jealousy which they
evince in resisting reform, from whatever quarter it may be dreaded; and
it may be said that too many of the practising apothecaries of the present
day stand in the same relative situation in the medical profession as the
barbers of olden times.
This faculty of exercising every branch of the profession, however
qualified, is of olden date, and we find on the subject the following
lines in the writings of Alcuin in the time of Charlemagne:
Accurrunt medici mox Hippocratica tecta:
Hic venas findit, herbas hic miscet in olla;
Ille coquit pultes, alter sed pocula perfert.