Tag Archives: surgery

The twenty-eighth of February, 2014: the most unkindest cut of all

In Henry Fielding’s 1749 picaresque History Of Tom Jones, A Foundling, the eponymous hero, laid up in bed having been brained by a bottle in a fight, is attended by the barber Little Benjamin – ‘one of the pleasantest barbers that was ever recorded in history’. First, Benjamin provides Tom with a shave; then, he turns his attention to Tom’s head-wound.

‘I find you have more trades than one,’ Tom exclaims.

‘A surgeon,’ the barber gravely corrects him, ‘is a profession, not a trade.’

Confused, Tom addresses Benjamin as ‘Mr Barber, or Mr Surgeon, or Mr Barber-surgeon’ – to which the anguished Benjamin replies: ‘Infandum, regina, jubes renovare dolorem [You command me, O Queen, to revive unspeakable grief]. You recall to my mind that cruel separation of the united fraternities, so much to the prejudice of both bodies, as all separations must be… What a blow was this to me, who unite both in my own person!’

Little Benjamin’s ‘unspeakable grief’ concerns the events of May 1745, and the sundering of the City of London’s Company of Barber-Surgeons. It was a dissolution that brought to an end the capital’s longest-running odd-couple comedy.

That the surgeons (or chirurgeons, from the Greek for ‘hand’) should have been yoked to the barbers by Act of Parliament was not at first such an impractical proposition as it later came to seem. There were obvious overlaps – not least the use by practitioners in both trades of specialised blades and other instruments – and no self-evident points of division along the continuum of operations that ran from hair-cutting and shaving to the drawing of teeth and the letting of blood. If a man could be trusted to put a razor to one’s throat, why not a thumb-lancet to one’s vein?

Even in the earliest days of this historic mésalliance, however, it was recognised that distinctions between the two specialisations were desirable.

In the landmark 1540 Act that first incorporated the Company of Barber-Surgeons, it was observed that there were in London ‘two severall and distincte companyes of Surgeons, occupyinge and exercisynge the sayde scyence and faculty of surgery, the one company being commonly called the Barbours of London, and the other company called the surgeons of London’. The Barbers had a distinguished history as a City Company, having been incorporated under Edward IV in 1443; the guild of surgeons, by contrast, was something of an upstart rabble, being, as the Act noted, ‘not incorporate, nor hav[ing] any maner corporacion’.

The Act aimed to unite the two bodies in order that both the ‘speculacion’ and ‘practyse’ of surgery might furnish ‘more perfect spedy and effectuall remedy… than it hath ben or should be if the said two companies of barbours and surgeons should contenew severed a sunder’. But there was a catch. It had not escaped the notice of the Royal authorities that surgeons had a tendency to attract ‘perso[n]s… infected with the pestilence great pockes & such other contagious infirmityes’ – that is, ill people. Even in this pre-germ-theory age, it was clear that this presented a risk of infection to those who might later visit the barber-surgeon in search of nothing more drastic than a shave and a haircut.

For this reason, the 1540 Act imposed a prohibition: no-one practising ‘barbery or shaving’ within a three-mile radius of the City of London would be permitted to conduct surgery, blood-letting or any other surgical operation – ‘drawing of teeth only excepte’.

The incorporation of the new Company by the Act was commemorated in a well-known painting, King Henry VIII and the Barber Surgeons, by Hans Holbein the Younger, in which notable barber-surgeons of the time, including sergeant-surgeon to the king Thomas Vicary, are shown crouching in obeisance to the monarch (Holbein’s licence in depicting a sealed Charter in Henry’s hand, rather than an Act of Parliament, has led some to argue that the painting in fact depicts the 1512 granting of a Charter to the Barbers’ Company – but other historical details, including Henry’s apparent age in the painting, tend to discredit this thesis). It was clearly a momentous event in the history of both the barbers and the surgeons. But, in reality, it was the beginning of the end for the barbers’ profession.

By the eighteenth century, the caricatures had hardened. The barber was humble, approachable, uneducated, a craftsman at best; the surgeon, by contrast, was pompous, ambitious, proud of his learning and his Latin, and avaricious in harvesting fees from his wealthy patients. Fielding nails both types in Tom Jones.

Before Little Benjamin’s arrival at his bedside, Tom is attended by an unnamed doctor: ‘though I am afraid the doctor was a little of a coxcomb,’ Fielding notes, ‘he might be nevertheless very much of a surgeon’. After bamboozling the local rustics with medical jargon (‘I was once, I remember, called to a patient who had received a violent contusion in his tibia, by which the exterior cutis was lacerated, so that there was a profuse sanguinary discharge’), the surgeon turns his attention to Tom. But his ministrations are short-lived: after learning that Tom is not, after all, a well-to-do gentleman, he storms out in a fury.

Even Little Benjamin, when called on to assume the mantle of ‘surgeon’, feels compelled to adopt ‘so different an air and aspect from that which he wore when his basin was under his arm, that he could scarce be known to be the same person’.

‘A man is obliged to keep up some dignity in his countenance whilst he is performing these operations, or the world will not submit to be handled by him,’ Benjamin explains. ‘You can’t imagine, sir, of how much consequence a grave aspect is to a grave character. A barber may make you laugh, but a surgeon ought rather to make you cry.’

The surgeons’ sense of professional pride – or self-importance – was central to the break-up of their ill-made marriage with the barbers. With surgery becoming increasingly advanced (the removal of bladder-stones, for instance, had been refined to a fine art by John Douglas and William Cheselden), many surgeons grew impatient with rules such as that requiring each surgeon’s diploma to be signed by the Company’s governors, two of whom would be barbers or other non-surgeons. The surgeons chafed at the limitations they believed the barbers represented to the advancement of their science; as early as 1684, a petition to the King had been submitted by some surgeons regarding their incorporation as a distinct company, although nothing came of it.

The barbers, for their part, were largely content, secure and perhaps complacent in their occupation of a time-honoured (if minor) place in the City’s complex web of guilds, companies and corporations; what value the advancement of surgery, when weighed against the weight of history, prestige, pageantry and liveried ceremony? It is illustrative of how widely the two factions had diverged that the barbers’ professional worries concerned not any rivalry with the  surgeons but the increasing competition offered to their trade by the burgeoning fashion for the small wigs known as perukes; the barbers spent much of the first decade of the eighteenth century attempting – without success – to absorb the peruke-makers into the Barber-Surgeons’ Company.

What did provoke the barbers into something like conflict with the surgeons was the suspicion that their prestige within the Company was being undermined – that they were being accorded less than complete respect by their ambitious partners. A 1699-1700 dispute – won by the barbers – over the election of a disproportionate number of surgeons to the offices of Warden and Master sounded the first rumblings of a serious rift.

The politicking that led up to the ’45 rupture is opaque, but the identity of the prime mover is in little doubt: William Cheselden, a man seemingly as adept at pulling strings as at excising stones. Cheselden is a complex figure. A gifted and bold surgeon, he achieved renown as an eye surgeon as well as a lithotomist. Despite his fame, he appears to have been initially reluctant to accept high office in the Company. Not until 1738, after his retirement, was he elected to the Company’s Court of Assistants; in 1739, he became Examiner (amid some controversy, as the incumbent, Mr Myddleton, was paid to step aside). His election in absentia to the post of Renter Warden in August 1744 adds to the impression of manoeuvres being executed with an eye on the long game.

Not that Cheselden’s elevation necessarily put him on cosy terms with the Company authorities. Indeed, in 1741, he was censured by the Company for ‘frequently procur[ing] the dead bodies of malefactors from the place of execution and dissect[ing] same at his own house’ in Cheapside at the same time as Company anatomists were struggling to attract students to their own demonstrations at Old Bailey.

The surgeons fired the first shot in December 1744, announcing their desire to be divorced from the barbers. The announcement seems to have been abrupt and unexpected, although the details of any preliminaries may have been lost to us as a result of a tacit agreement between the two factions to keep their disagreements ‘off the books’. On December 20, five delegates from each side convened at the King’s Arms tavern in St Paul’s Churchyard (among those on the surgeons’ side was John Freke, a friend of Henry Fielding’s whom Fielding mentions twice in Tom Jones). The surgeons presented their case. The writing was on the wall for the barbers from this point on.

In their subsequent petition to a Parliamentary Committee convened to consider the matter, the surgeons made great play of their having, ‘from their sole and constant study of, and application to [surgery], rendered the profession and practice thereof of great and public benefit and utility to this Kingdom’, and noted that the barbers were – as they long had been – ‘employed in a business foreign to and independent of the practice of Surgery’; the union of the two was ‘in no degree conducive to the progress or improvement of the art of Surgery’.

In their earnest and rather hurt response, the barbers expressed surprise that the surgeons should want to dissolve the 200-year-old marriage. They contended, in essence, that the barbers, even in Henry VIII’s day, had never been up to much with regard to the practice of surgery, and that the two factions had never had a great deal of professional common ground – so why should the surgeons suddenly find the union inconvenient? The ‘present flourishing Condition of the Surgeons’ was ‘the only real Alteration in the Circumstances of Things’.

Of course, the principal sentiment behind the barbers’ submission was alarm that the wealthy surgeons might make off with the better part of the Company’s assets and resources, leaving the penurious barbers  – ‘their less happy brethren’ – in dire financial straits.

And where, in all this, was the illustrious Cheselden? Out of public view, the wily surgeon was quietly ensuring the demise of the Company of which he was an Examiner. It is surely no coincidence that the Parliamentary Committee was chaired by one Charles Cotes, a relatively undistinguished young physician from Westminster Infirmary, and the husband of Wilhelmina Cheselden, William’s daughter – nor that Cheselden is known to have been circulating backstage at Parliament immediately prior to the Committee delivering its verdict.

Unsurprisingly, the Committee’s conclusion was a death warrant for the Company of Barber-Surgeons. It found, in short, that ‘the separation was desirable’. The Bill to effect the dissolution passed swiftly through Parliament. All that was required now was Royal Assent. Again, the surgeons had a man on the inside.

Cheselden wasn’t the only Company surgeon with influential connections. Also ranged against the barbers was John Rainby (sometimes spelt Ranby). If Cheselden was the strategist, Rainby was the man to lead the charge. Described by a contemporary as ‘harsh of voice with inelegant manners’, Rainby nevertheless moved in circles of high culture. He was on good terms with Hogarth, and sat for the figure of Tom Rakewell in The Rake’s Progress. He had accompanied George II as sergeant-surgeon at the battle of Dettingen, and was physician to Queen Caroline, who customarily referred to him as ‘Blockhead’. The surgeon Messenger Monsey noted with distaste that ‘Rainby was the only man I ever heard coolly defend the use of laudanum in effecting his designs on women, which he confessed he had practised with success’ (Rainby countered this allegation not with a rebuttal but with a crisp ad hominem swipe: Monsey, he said, was ‘a nasty dog in a dirty shirt’).

The King approved the Bill. The union was dissolved on June 25, 1745. John Rainby was elected the first Master of the Company of Surgeons.

The barbers – at first under the leadership of the aptly named Richard le Barber – reluctantly went their own way as ‘The Master, Governors and Commonalty of the Mystery of Barbers of London’.

What had begun with Henry VIII and Holbein ended, ignominiously, with a cruel lampooning by the hard-drinking cartoonist Isaac Cruikshank. In a typically monstrous scene, Cruikshank depicted aproned barbers and well-dressed surgeons locked in brutal hand-to-hand combat. ‘Take care of my Wig I had it new to go down to the House’, one surgeon wails to his assailant; a barber, bending over a cowering surgeon, yells: ‘I’ll teach you to despise Gentlemen Barbers you pitiful Pill monger’; another surgeon, belabouring a barber with his cane, cries: ‘I’ll teach you, you beggarly Scoundrel to call yourself Barber-surgeon’.

The cartoon’s title pretty well sums up the welter of professional pride, culture-clash and mismatched ambition that ultimately strained the Company to breaking-point and beyond. Cruikshank called it ‘The Battle Of The Barbers And Surgeons’.

The fifteenth of September, 2011: a nasty dog in a dirty shirt

Rootling about in the annals of eighteenth-century surgery (preparing an article for History Today magazine), I came across the lavishly disturbing surgeon John Rainby, and, as a corollary, the circumstances of the horrid death of Queen Caroline.

Rainby – a man “harsh of voice with inelegant manners” (inelegant manners not being the half of it, as we shall see) – was surgeon to Caroline, wife of George II. She was fond of him, or at least she was familiar enough with him to routinely address him as ‘Blockhead’.

In 1737, she suffered an internal rupture.

Queen Caroline to Rainby: ‘I am sure now, Blockhead, you are telling the King I have a rupture.’

Rainby to Queen Caroline: ‘I am so, and there is no more time to be lost – your Majesty has concealed it for too long already.’

She would not conceal it for much longer. But despite her sufferings, Caroline retained that delightful sense of humour with which one will always associate the English aristocracy. When a visiting surgeon, bending to tend the Queen’s needs, inadvertently brushed a lit candle and set his wig on fire, the Queen begged Rainby to hold her hand, so that she could laugh.

Five days before her death, the Queen’s intestine ruptured completely. “The putrefying contents of her belly soaked through the sheets and over the floor,” one historian reports.

The incident provoked a merciless couplet from Alexander Pope:

Here lies, wrapped in towels,

The only proof that Caroline had bowels.

Nice. Back to Rainby. Here’s a rather chilling analysis of his character by a professional rival, the splendidly named Messenger Monsey:

Rainby was the only man I ever heard coolly defend the use of laudanum in effecting his designs on women, which he confessed he had practised with success.

Rainby countered this distasteful allegation not with a rebuttal but with a crisp ad hominem swipe: Monsey, he said, was “a nasty dog in a dirty shirt”.