16th Century Maritime Medicine Part 2:
Evolution of the Barber-Surgeon

Anatomic dissection at the Barber-Surgeon’s Hall, 1581. (Dobson and Milnes-Walker 40)

            To trace the history of the barber-surgeon, one must begin in the early Middle Ages, before the foundation of the great universities.  At this time the surgical arts, and the medical arts in general, were typically the province of the monks and priests.  However, the Church was uneasy with this arrangement.  Increasing hierarchical disapproval of exposure to others’ blood led improvising monks to teach laypeople the skills of surgery.  The ideal laity for this task were the barbers, who were already familiar with the handling of razors and knives. Pope Innocent III provided the final impetus for the development of these barber-surgeons at the Fourth Lateran Council of 1215, when he declared that involvement of any priest or member of the Holy Orders in surgery was an unforgivable sin (Keevil 13).  This cemented the demand for barber-surgeons.

    In England the guild structure that regulated tradesmen was established starting around the time of the Norman Conquest, with the establishment of the Saddler’s Guild (Dobson and Milnes-Walker 1).  Guilds gave structure and precedence to the various crafts, and barber-surgeons were treated no differently than other trades. The first reference to what would later become the Worshipful Company of Barber-Surgeons of London (1), the 17^th guild in the order of precedence for the city, occurs in 1308 when Richard le Barbour was admitted as the Master of the Barbers by the Court of Alderman of London.  Some of his tasks were enumerated in his warrant:

“Richard le Barbour dwelling opposite to the Church of Allhallows the Less, was chosen and presented by the Barbers of London…to have supervision over the trade of the Barbers.  And he was admitted and made oath that every month he would make scrutiny throughout the whole of his trade, and if he should find any among them keeping brothels, or acting unseemly in any other way, and to the scandal of the trade, he was to distrain upon them and cause the distress to be taken into the Chamber of London.”  (Dobson and Milnes-Walker 10)

 
    The guild of barbers makes intermittent appearances in the London records over the next century, but its position in England’s medical establishment was fully realized in the late 15^th century.  In 1451, the Company was given its first grant of arms, on a field sable, a chevron between three fleams argent by the Clarenceux King of Arms (Dobson and Milnes-Walker 17). Eleven years later, King Edward IV issued the first Charter of Incorporation for the Company.  The main focus of the Company, in keeping with Richard le Barbour’s mandate above, was to govern the training, certification, and good conduct of its members.  Individuals hoping to become barber-surgeons were required to complete a seven-year apprenticeship under an admitted freeman of the Company.  The bonds between master and apprentice were close, with some apprentices receiving significant bequests of surgical texts and equipment in their master’s wills (Getz 13).  Foreigners were to be admitted to the company only if they were of great skill and willing to abide by all the stated rules.  Guild rules were enforced by fines, for such infractions as taking too many apprentices, teaching the skills of surgery to non-apprentices, or stealing an apprentice away from another practitioner.  Thus by the dawn of the 16^th century, the structure and authority of the barber-surgeons’ guild was firmly established.
   
    The late 15^th century and early 16^th century evolution of regulated groups such as the Worshipful Company of Barbers, charged with certification and oversight of their profession, was at least partially a response to the fragmented nature of medieval medical care.  A local practitioner might be a University-trained physician, an apothecary, a barber-surgeon, or a local tradesman independently practicing medicine.  Furthermore, the terms themselves were frequently interchangeable; a single individual is listed in fifteenth century records as having variously been called a physician, a surgeon, and a dog doctor (Getz 7). 

The Charter granted to the barber-surgeons by Edward IV demonstrates the progressive trend during the late 15^th century towards regulated specialties in medicine.  The physicians served in the capacity of what would now be called internists.  They prescribed medications to be taken internally (orally), and did not perform invasive procedures.  Physicians admitted to the Royal College of Physicians were required to have a university degree.  On the other hand, the barber-surgeons who performed bloodletting and surgical procedures were generally trained following the apprenticeship model.  Apprentices were required to serve seven years before they were accepted as a freeman of the Company and could practice independently.  Competing with the barber-surgeons were the surgeons, university-trained professionals who would never perform the basic grooming functions of a barber.  As one might imagine, there was considerable professional tension between the barber-surgeons and the surgeons.  However, the number of university-trained surgeons admitted to the Fellowship of Surgeons was never more than two dozen during the early 16^th century, as opposed to the Worshipful Company of Barber-Surgeons who numbered over 150.  Thus when Henry VIII required the services of surgeons for his navy, it was to the Worshipful Company of Barber-Surgeons that he made his request (Dobson and Milnes-Walker 47).

Following the uneasy merger of the Worshipful Company of Barbers and the Fellowship of Surgeons in 1540 (which lasted until 1745), formal surgical education was increasingly emphasized.  In the Act of Parliament announcing the merger, the combined Company was given the right to collect the bodies of four executed prisoners per year for anatomic dissections to be held publicly for all surgeons (Dobson and Milnes-Walker 39) (see figure at top of page).  The 16^th century barber-surgeon would also have access to a number of texts to bolster the knowledge gained during apprenticeship.  Although the foundation of medical knowledge remained the ancient authorities such as Galen and Hippocrates, the printing press allowed wider dissemination of a number of popular texts on ‘modern’ surgery, such as those by Guy de Chauliac (d. 1368), John de Vigo (1450-1525), and Hieronymus von Braunchsweig (mid 16^th C) (Gardner 172).  The Tudor era sailor could therefore expect the shipboard barber-surgeon to be a learned man trained in the preparations of common unguents and balms for open wounds and illnesses such as the pox (see Medicinals below).  He would possess a variety of tools for specialized purposes, such as bleeding bowls, amputation knives, and urethral syringes (all these were found on the Mary Rose, although only the wooden handle of the conjectural knife survived; see also the surgical instrument cabinet in Figure 5.  He would be familiar with immobilization and splinting of the dislocations and fractures common to shipboard life. More severe and potentially lethal open fractures resulting from gunshot wounds and other trauma during battle might be treated with rapid amputation, first formally described in 1517 (Gardner 179).  Amputation had to be undertaken with great speed due to the lack of anesthesia, and life threatening hemorrhage was the greatest risk followed by postoperative infection (2).  Because flap amputations had not yet been developed, the healing stump was often problematic and infection-prone during recovery .  Although hemorrhage or infection led to the death of virtually all who received internal injuries in combat, the barber-surgeon was familiar with suturing intestines and on occasion elevating depressed skull fractures .