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: Æsculapius 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 prÆterea lex,” he says, “quÆ puniat inscitium capitalem, nullum exemplum vindictÆ. 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 À 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 confrÉrie 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 À Sylva par quel secret mystÈre
Ce pain, cet aliment dans mon corps digÉrÉ,
Se transforme en un lait doucement prÉparÉ;
Comment, toujours filtrÉ 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 lÈve au ciel les yeux, il s’incline, il s’Écrie
Demandez le À ce Dieu qui m’a donnez la vie.

BroËseche 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 ParÉ 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.