Barber Surgeons Research Articles

John Ranby FRS, William Hogarth and the Barber Surgeons.

The progress of dentistry towards a profession allied to medicine and surgery was incremental, and a most important step in that process was the separation of the surgeons from the barbers in 1745. Hogarth's illustration of a dentally active barber has been discussed previously in the British Dental Journal. In this paper, his probable contribution to the campaign for separation led successfully by his friend, surgeon John Ranby FRS (1703-1773), through the dramatic and much analysed painting The death of the countess (1743), is analysed. In this paper, it is suggested that William Hogarth was not only aware of the tensions between the physicians, surgeons and barbers that had come to a head, but that he modified the first thoughts, seen in a sketch (now at the Ashmolean, Oxford), to incorporate in this painting, and the print made from it a conspicuous sub-scene, almost central in a composition where the dying countess would be expected to be the only subject, as a satirical comment on that internal conflict.

10 Historic Events That Shaped the Face of Modern Surgery “The Craft of Surgery is as old as Mankind”

Evidence of the practice of surgical procedures has been found in ancient civilizations. Various books have documented surgeries being done in ancient Egypt, India and Greece. Modern practices of anaesthesia, blood transfusion, antisepsis and nursing have helped to improve the outcomes and comfort of Surgery. The two World Wars played an important role in creating condition which were conducive to the rapid development of modern technology and improvement in Surgical techniques. In this article, we examine the various milestone events that have led to the development of modern Surgical practice. Keywords: History, Surgery, Ancient Civilizations, Barber surgeons, World wars.

Ocular and eyelid surgical anatomy in Georg Bartisch's "Ophthalmodouleia"

Georg Bartisch, a 16th century barber surgeon, published in 1583 his treatise entitled "Ophthalmodouleia" (Greek term meaning eye service), a work in German to promote ophthalmology for his countrymen barber surgeons. He did not have an academic education nor knew classical languages, he had used a triplet in terminology by using German, Hellenic and Latin nomination in his anatomical descriptions. Various accurate illustrations and a peculiar system of presentation with flap to liken an in-depth presentation were demonstrated to add prestige in his work. This raises concerns for another medical surgeon to have helped for this publication. Bartisch innovative approaches introduced various surgical tools. Cataract surgery was the epitome of his work. Anatomy of both the eye and the eyelids was there for only to serve the operation. Religion, magic and Galenic views presented barriers for Bartisch's scientific development. However, he is considered as the patron of German School of Ophthalmology.

14세기 기 드 숄리악의 '대외과술'에 나타난 아랍 의학의 영향

This paper aims to examine the influence of Arab medicine as seen in Guy de Chauliac's Chirurgia magna written in the 14th century. Western European medicine in the 14th century focused on internal medicine theories centered on Galenic medicine, and surgery was neglected. On the other hand, practical aspects of daily life and warfare heightened interest in surgery. However, surgeons and barber surgeons in the 14th century had a lot of surgical experience, they often caused problems because they lacked an understanding of the theory. Accordingly, Guy de Chauliac believed that they should also receive theoretical education. At that time, there were no books written specifically on surgery. Therefore, Guy de Chauliac wrote Chirurgia magna which included his own experience and Arabic medical books that described medicine more advanced than those in Western Europe. Through this study, I found that Arab medicine not only had a significant influence on the writing of Chirurgia magna, but also greatly contributed to the development of Western European medicine as Chirurgia magna continued to be compiled until the 18th century.

Parks retractor.

The use of a surgical speculum (latin for mirror, from specere: to watch) or retractor has been described since ancient times. An anal speculum (catopter) for haemorrhoids, abscesses, and fistulas was mentioned in Hippocrates’ dissertations from around 400 BC1. Many years followed without further advances in transanal surgery owing to pain, limited anaesthesia, morbidity, and even death2. Perhaps the most famous fistulotomy in history (1685) necessitated the development of new instruments, when King Louis XIV had an anal fistula treated by the ‘barber surgeon’ Charles-Francois Felix. He spent months developing new instruments and refining his technique by undertaking ‘surgical training’ on guinea pigs and less well-to-do patients. Among these instruments was a three-bladed self-retaining anal retractor (Fig. 1a), a predecessor of the retractor described in this article. The evolving interest in, and optimization of, transanal excisions of anal and rectal tumours at the beginning of the 20th century demanded improved access to, and visualization of, the rectum. In Benign Tumours of the Rectum3, Alan Guyatt Parks (1920–1988) described and illustrated the use of a two-bladed self-retaining speculum for excision of rectal adenomas. A three-bladed version (Parks retractor) (Fig. 1b) was described in a later article in 19734. It formed the basis of two principles essential for peranal excision: that the anal canal could be opened to achieve exposure with the retractor, and that submucosal injection facilitated dissection. As Parks stated, the key to optimal surgery is ‘good exposure, good exposure, good exposure’5. Parks had many other innovations and contributions from the aetiology and classification of anal fistula to pelvic floor physiology, haemorrhoid surgery, and ileal reservoir with ileoanal anastomosis6.

Medieval surgery (eleventh-thirteenth century): barber surgeons and warfare surgeons in France.

From the eleventh to the thirteenth century, three major events marked surgery in France: the appearance of an epidemic linked to ergotism which led to numerous amputations, the emergence of barber surgeons for civilian practice, and the organization of war surgery for the First Crusade. If a certain separation between medicine and surgery had appeared at the beginning of the Middle Ages, it would have been from 1215 (at the time of the Lateran Council) that the real separation between medicine and surgery was made. Before this date, the surgery was done by the clergy (monks) who had some experience of surgical practice. After the Council de Lateran, the barbers will take charge of the surgery. In the Middle Ages, the first cause of amputation was linked to poisoning by ergot of rye, intoxication due to the ingestion of contaminated bread. Due to ergotamine-related vasoconstriction, many patients will die with a frequency ranging from 10 to 20% in times of starvation. For survivors, gangrenes will lead to amputations made at the beginning by monks, then by the barber surgeons after 1215. With the name of barber surgeon, barbers are initially responsible for small surgical procedures, then for amputations given the epidemics linked to ergotism which led to numerous amputations. By this practice, they will acquire the knowledge of anatomy and the knowledge of the surgery. Apart from this civilian practice of surgery carried out by barber surgeons, the military practice of surgery will appear with the conquests of England and the start of the crusades which will require a more professional organization of surgery. After 1371, as only barbers surgeons had some surgical practice, their knowledge surpassed knowledge of the university. This supremacy of the barber surgeon over the surgeons of the university will be demonstrated by Ambroise Paré.

Revisiting the Plague in the Age of Galileo

Revisiting the Plague in the Age of Galileo

Subspecialization, a Cause of Concern for Neurosurgeons in Pakistan, an Opinion Piece and Open Discussion

Specialization is a process of becoming an expert. In medicine, it was a long and gruelling journey that medical graduates embarked upon in their chosen field with pride and enthusiasm to become leaders. The specialists seen as the culmination of years of hard work and the marker of prestige. In the old days this distinction was very apparent between the barber surgeons who had little to no formal education and trained as an apprentice and the physicians, who had a university education, went on to become fellows of one of the Royal Colleges and were treated as experts. Eventually, as knowledge expanded, 65 specialities fragmented from medicine and surgery and as of today 31 subspecialties are recognized by the general medical council in the UK.1

RCGP William Pickles Lecture 2019: Training tomorrow's doctors, 1851-2051.

While researching William Pickles, famous for his 1939 book on epidemiology and for being the first president of the RCGP, I came across his article ‘Trends of general practice: a hundred years in a Yorkshire dale’ published in the Practitioner , 1951.1 I thought it might be of interest to look at changes in medical education over those 100 years and, potentially, the subsequent 100 years. In 1851, medical education in the UK was in a mess. The training of a practitioner in Britain in 1850 could vary from university study, to a series of courses in a provincial hospital, to broom-and-apron apprenticeship in an apothecary’s shop. The Victorian public were confused as to who was a doctor, a general practitioner (the term ‘general practitioner’ was unknown before 1800 but was firmly established by 1840), a physician, a surgeon, a barber surgeon, an apothecary, a druggist, or a snake oil merchant! The competing tensions between these conflicting practitioners are vividly drawn out in George Eliot’s novel Middlemarch , set in 1832. Dr Tertius Lydgate, who has radical ideas about infectious diseases from his overseas education, manages to fall out with both the local practitioners and the physicians brought from London. It took 16 bills and two select committees over 18 years for the 1858 Medical Act to be passed. Lord Cohen, writing in the BMJ in 1968, said that the 1858 act was the ‘pivotal event in the history of medical education in Great Britain and Ireland’ .2 The act enabled the public to distinguish between qualified and unqualified practitioners, and every organisation that granted medical qualifications was represented on the new General Medical Council. Dr Pickles entered practice in Wensleydale in 1913 and practised there for 50 years. His 1951 article hints at the very comprehensive medical …

Shakespeare and the Practice of Physic: Medical Narratives on the Early Modern English Stage by Todd H. J. Pettigrew

Reviewed by: Shakespeare and the Practice of Physic: Medical Narratives on the Early Modern English Stage by Todd H. J. Pettigrew Carol F. Heffernan (bio) Todd H. J. Pettigrew. Shakespeare and the Practice of Physic: Medical Narratives on the Early Modern English Stage. Newark: University of Delaware Press, 2007. 197 pages. $85.00. Todd Pettigrew's Shakespeare and the Practice of Physic studies the medical practitioners that appear in Shakespeare's plays in the context of tracts and vernacular medical texts that were part of the debate on medical practice sparked by the establishment of the College of Physicians of London in the early sixteenth century. The College of Physicians attempted to establish a hierarchy of medical practitioners with themselves at the top. Pettigrew argues that "Shakespeare's drama consistently questions and challenges the elite physicians' claim on absolute authority in medical matters" (30). His introductory chapter (chapter 1) focuses on the rhetorical question the king in Cymbeline puts to the physician who delivers the news of his wife's death, "Who worse than a physician/Would this report become?" (5.5.27-28). Pettigrew suggests that the question "is the subtle medical refrain of the most sophisticated drama of the age" (30). The next five chapters each takes up one kind of practitioner of the healing arts: "the empiric," with no formal training but with practical experience (usually a woman); the university-trained physician; apothecaries and friars; surgeons; and, finally, those who heal with magic. Left unsaid is that most of the sick in Shakespeare's day, as in the late fourteenth and early fifteenth centuries, did not have the good fortune to be treated by a doctor of physic such as Richard Napier, mentioned several times by Pettigrew. Napier was a physician and clergyman whose medical records, kept from 1597–1634, are the source of Michael MacDonald's study of madness in seventeenth-century England, Mystical Bedlam. Napier's patients were exclusively dukes and duchesses and other members of the highest ranks of [End Page 161] the aristocracy. Patients were usually treated by barber surgeons who performed such operations as bleeding, tooth-drawing, and cauterization; midwives; apothecaries; and members of the clergy who were long in the habit of curing men's bodies together with their souls. Except for the clergy, these other leeches were unlatined and, therefore, unversed in the Latin medical authorities that formed the basis of university medical training. This reality makes more striking Pettigrew's assertion that Shakespeare challenges the establishment physicians. Chapter 2 presents Helena's cure of an ailing king in All's Well that Ends Well as Shakespeare's "case for greater tolerance in medical practice" (60). The king at first rejects Helena's offer of help because, as a woman, she lacks the formal training of the "learned doctors" of "the congregated college" (2.1.115-16) and, therefore, he groups her with "empirics" (2.1.121) who were thought to privilege experience over formal training. Helena, however, is no mere female empiric; she has inherited remedies from her father, Gerard de Narbon, a famous physician. In the end, the king calls Helena a "sweet practiser" of "physic" (2.1.183-84) and declares himself her "resolved patient" (2.1.203). Chapter 3 is primarily concerned with Macbeth and demonstrates the powerlessness of physicians—the establishment practitioners—to heal conditions beyond the physiological. Called in to treat the madness of Lady Macbeth, the physician seems to judge her condition in need of spiritual rather than medical treatment: "This disease is beyond my practice" (5.1.60). Timothy Bright's A Treatise of Melancholie would seem to concur: "the affliction of soul through conscience is quite another thing than melancholy." Chapter 4 takes up marginal practitioners: the apothecary and friar who appear in Romeo and Juliet, the one play that does not challenge the elite physicians' claim to absolute authority in medical matters. Both the apothecary and the friar exceed the limits of their profession, and thus lead to disaster. The apothecary breaks the laws of Mantua when he sells Romeo the poison because of his poverty; Friar Laurence's potion concocted for Juliet would have been forbidden by the College...

Complete Lower Lip Reconstruction with a Large Lip Switch Flap and a Composite Modiolus Advancement Flap.

Summary:Total loss of the lower lip is debilitating and poses a reconstructive challenge. Aiming to restore oral continence and function and also cosmetic appearance, a successful reconstruction has a huge impact on the quality of life for the individual patient. Early sources of local tissue rearrangement for lip reconstruction date back 3000 years, with earliest reports of lip switch procedures more than 2 centuries ago in Europe, when noma was still endemic in Europe, indicating that the anatomy was better understood by the barber surgeons of the past than we like to acknowledge. We are still faced with such challenging cases all over the world where resources are limited. Our current understanding of perforator anatomy and blood supply makes more frequent revisits to flaps of the past with modern advances. Innovative solutions are imperative for salvage, and old ideas tend to reappear when they prove to be useful. Herein, we describe in open access a new reconstructive method where we combined a large lip switch flap together with a composite advancement modiolus flap to reconstruct a whole lower lip and the donor defect of the upper lip all at once, a procedure that is simple to perform and works in settings where it is greatly needed.

Cadaveric Oath: The need of the hour

In today’s scenario the doctor –patient relationship is getting from bad to worse because of the lack of communication skills in undergraduate students pursuing medicine. Acquiring knowledge through dissection of human body is an age old concept started in 15th century by barber surgeons to demonstrate the structures of human body. Importance of cadaveric dissection for learning anatomy helps the students in developing spatial and tactile appreciation of the structures which cannot be obtained by prosected specimens or computerised learning aids. Cadaver being their first teacher, students should be imbibed with the moral values and have gratitude towards the cadaver for helping them understand the structures of the body by way of dissection. Cadaveric oath recitation will help the students in developing empathy with the cadaver as a “SILENT TEACHER” and in the long run with the patients while serving the humanity by way of medical practice. Keywords: Cadaveric oath, Doctor-patient relationship, Silent teacher, Anatomy teaching, Cadaveric dissection

I Jornada de Historia de la Enfermería: Retrato de la Enfermería en el Ocaso del Siglo XVI

In this brief review, the author informs us about what happened in the course of the first day of History of Nursing in Alava, which focused on nursing in the late sixteenth century and especially in the presentation of the book: Herrera, a barber surgeon in the plague of 1599 in Vitoria.

Naval Maritime Physician : Roles and Challenges

Background: Naval maritime physician is a trained doctor who is responsible for providing promotive, preventive and curative health care to the ship's crew. Injuries and sickness of seafarer's has existed since the time man learned sea travel In earlier day the duties of maritime physician were performed by the captain or barber surgeons who used archaic remedies such as treating sores from the ropes on sailors' hands with sufferer's urine, turpentine for rheumatic pains, limb injuries were frequently treated with amputation and most popular cure for all ailments was always gin, rum or whiskey. Then came the diplomed physicians and trained medical officers on war ships who were wardroom warrant officers and it was only in 1808 that the medical officers were given commissioned ranks. Over the centuries the role of naval maritime physicians has evolved to provide high standards of care even in adverse conditions and with minimal support. Roles and challenges: Good maritime medicalpractice involves meeting numerous challenges of clinical, occupational, emergency, trauma and psychiatric medicine, in addition on board physicians must also have, in depth knowledge of pschycosomatic conditions due to stress andfatigue of crew and special conditions such as diving accidents and accidents involving aquatic animals. The situation on board requires extraordinary skills as interventions are difficult, both physically and technically, because the conditions at sea are often acrobatic and at certain times evacuation is also not possible due to weather and operational constraints. Thus the role naval doctor on board ships is truly of an all round physicians, a team mate and a good leader. Conclusion: In conclusion, responsibilities of Naval Maritime Physician is not limited to clinical activities but is multifaceted and objective training about the specifics of warships' environment and related health problems is the key to achieve professional excellence in every sphere.

Journalism’s practitioners and the academy: Must they eternally live in different universes?

Abstract Journalism and the media have a direct impact for both good and ill on the health of the public discourse, yet practitioners and the academy are as divided as were late medieval barber surgeons from those who studied the relationship between practice and the health of patients. There are both valid and invalid reasons for this – the valid reasons derive from the simple fact journalists and scholars have different roles in the public sphere; and the invalid reasons derive from stubbornness bordering on arrogance on both sides of the divide. Few practitioners see the academy as relevant to them; few accept the need to listen to, understand and perhaps act on informed critique. Few scholars are either prepared to make their work timely and relevant to current issues or to abandon the intimidating formats and incomprehensible language that alienates practitioners. Yet there are numerous examples, including the Public Journalism movement in the United States, the Reuters Institute in Oxford and even the BBC’s review system that demonstrate how practitioners and scholars can be persuaded to inhabit – even briefly – the same universe.

The symbolic meaning shown in the portraits of King Henry Ⅷ

The purpose of this study is to examine symbolic meanings of costumes shown by portraits of King Henry VIII and use them as basic data for research on costume design of historical dramas in the Renaissance or on King Henry VIII's costume. This study attempted analysis of symbolic meanings from the paintings-related various domestic and overseas literatures, preliminary study paper, and web sites etc. The symbolic meanings expressed by the portraits of King Henry VIII are characterized by authority, innovation performance, authority, masculinity, innovation performance, artistic taste, intellectual charm, intrepidity and benevolence. Especially, the portraits of King Henry VIII symbolized his masculine beauty by emphasizing sexual attractiveness that cannot be seen in portraits of other kings through broad shoulders and exaggerated codpiece which are the zenith of masculine beauty during the Renaissance age. Through the image of King Henry VIII which was painted with jester or barber surgeons, his characteristic and open mind thinking highly of the technique and human life was also expressed. In the portrait of King Henry VIII, various images set in knights' tournament, playing a musical instrument and reading a book as well as the image of wearing a parliament costume were shown, highlighting King Henry VIII as a person good at both literary and martial arts with open and innovative personality than any other kings in history.

Human cadaveric dissection: a historical account from ancient Greece to the modern era.

The review article attempts to focus on the practice of human cadaveric dissection during its inception in ancient Greece in 3rd century BC, revival in medieval Italy at the beginning of 14th century and subsequent evolution in Europe and the United States of America over the centuries. The article highlights on the gradual change in attitude of religious authorities towards human dissection, the shift in the practice of human dissection being performed by barber surgeons to the anatomist himself dissecting the human body and the enactment of prominent legislations which proved to be crucial milestones during the course of the history of human cadaveric dissection. It particularly emphasizes on the different means of procuring human bodies which changed over the centuries in accordance with the increasing demand due to the rise in popularity of human dissection as a tool for teaching anatomy. Finally, it documents the rise of body donation programs as the source of human cadavers for anatomical dissection from the second half of the 20th century. Presently innovative measures are being introduced within the body donation programs by medical schools across the world to sensitize medical students such that they maintain a respectful, compassionate and empathetic attitude towards the human cadaver while dissecting the same. Human dissection is indispensable for a sound knowledge in anatomy which can ensure safe as well as efficient clinical practice and the human dissection lab could possibly be the ideal place to cultivate humanistic qualities among future physicians in the 21st century.

A Brief History of the Royal College of Surgeons of Edinburgh

The Royal College of Surgeons of Edinburgh has enjoyed a continuous existence as a corporate body since 1505. It may justly claim to be one of the oldest surgical corporations in the world. The Barber Surgeons of Edinburgh were formally incorporated as a Craft Guild of the city and this recognition is embodied in the Seal of Cause or Charter of Privileges which was granted to the Barber Surgeons by the Town Council of Edinburgh on 1st July 1505. The Seal of Cause is a remarkable document. It clearly established the role of the Incorporation of Barber Surgeons as a body concerned with the maintenance and promotion of the highest standards of surgical practice and this remains the prime purpose of the great international surgical brotherhood of the Royal College which has developed from the Incorporation. The Seal of Cause conferred various privileges upon the Incorporation, including the exclusive right of its members to practise surgery in Edinburgh and surrounding districts, but in return for these privileges, it imposed certain crucially important duties and obligations. The most important of these, which remains entirely appropriate to this day, is stated very clearly in the Seal of Cause, “that na maner of persoun occupie nor vse ony poyntis of our said craftis of Surregenie ... bott gif he be first frieman and burges of the samyn, and that he be worthy and expert in all the poyntis belangand the saidis craftis diligentlie and avysitly examinit and admittit be the maisters of the said mcraft ... that he knaw anotamell, nature and complexion of euery member humanis bodie, and inlykewayes he knaw all the vaynis of the samyn ... for euery man aucht to knaw the nature and substance of euery thing that he werkis, or ellis he is negligent.” From its earliest origins the College has been an examining body principally concerned with the setting and maintenance of professional standards. Another vitally important obligation laid upon the Barber Surgeons was that of ensuring that all who practise the craft should be able to read and write and this literacy requirement is the earliest of any comparable professional body.

Guy de Chauliac: pre‐eminent surgeon of the Middle Ages

Guy de Chauliac (c1300-1368) trained in Toulouse and the University of Montpellier from where he achieved the highest possible degree of Master of medicine. He undertook fellowships in Bologna (anatomical dissection) and Paris (surgery) and was qualified as a physician not a Barber Surgeon. He took Holy Orders and was appointed as physician to three Avignon-based Popes. He survived an epidemic of the Black Death (1348-1350), suffering an axillary bubo. His book Chirugia Magna was written in medieval Latin in 1363, then circulated in manuscript form before its first printing in 1478. There were 70 editions as it became the most influential surgical text for over 200 years, particularly in France, spanning the period from the late 14th century until Paré (1510-1590). He divided surgery into swellings, wounds, ulcers, fractures and dislocations, and special diseases. Well researched and referenced, based on evidence and experience, he succeeded in incorporating antiquarian and contemporary thinking from French, Arabian, Italian (Bologna), Egyptian and Greek scholars about anatomy, surgical disease and treatment. He was a strong advocate for evaluating outcomes, knowing when not to operate, professionalism and the non-technical competencies. His framework of professionalism was based on four domains: being learned, expert, ingenious and adaptable. The surgical aspirants and leaders of the following two centuries recognized the academic, professional and practical value of his teaching through their reference to and use of Chirugia Magna. The Cowlishaw collection in the Royal Australasian College of Surgeons' library contains four French copies, under the title La Grande Chirugie.

Straßennamen des städtischen Randes

This text contains a comparative evaluation of street names of the urban periphery. Starting with Erfurt, street names of other Thuringian and German cities of the late Middle Ages and the early modern period are examined. In doing so, different groups of people are contemplated, such as prostitutes, barber surgeons and knackers, whose appellatives finally found their way into street names. The focus is on accumulations of such names in certain areas of a city; differences between large and small cities are illustrated as well. In the end, the conclusion highlights the hitherto underutilised significance of these street names.