Part 19

While no one may see far into the future, the maxim, "In time of peace prepare for war," is as true of the medical department as of any. Were it a state secret no one would breathe it here, but it is lamentably true and publicly known that even now we are not prepared as we should be. The awful lessons of the Spanish War have been forgotten. West Point officers have until comparatively recently received no instruction in camp sanitation. Some of us worked hard a while ago to have at least elementary instruction in it introduced into their curriculum. As an illustration I believe that to-day they are taught more about horse's feet and how to keep them in good condition, than about those of their men. Line officers, especially volunteer, have never been too ready to locate their camps where water and drainage were the best, and the awful mortality of the Spanish War was mainly due to preventable disease, while this was due to stupid and inexcusable disregard, on the part of officers of the line (mainly volunteer) of the advice of their medical officers.

But, after all, gentlemen, the discouragements you will meet with will be far fewer than those with which your predecessors had to contend, while the pleasant side of your lives will be far pleasanter than was theirs. In fact, I think your lives have in many respects fallen in pleasanter places than have ours. Discipline and order protect you to a large extent from quackery and idiocy. The fads of the day disappear before the appearance of the flag and the sound of the drum. So-called Christian Science finds no place in your curriculum, and it will be long, I trust, before the army chaplain tinctures the military hospital with sectarian therapeutics or an Emanuel church cult. If by entering the army one may escape disgusting influences of this character, then it may become such a refuge that it shall thereby be made both inviting and invincible.

It is pleasing to those of us who co-operated in the movement, to have the assurances of the Surgeon General that the establishment of the Medical Reserve Corps has been of actual benefit to the regular Army Medical Department. While the military rank to which its members found themselves suddenly elevated was not so lofty as to cause any attacks of vertigo, none having been up to the present day reported, it at least gives us satisfaction to realize that help may thus be afforded from private life, and that a closer rapport has been effected.

And now it is well nigh as difficult a task to appropriately conclude these remarks as to begin them. Men come and go; a few leave imprints of their footsteps; the vast majority make no impression that lingers.

"Some when they die, die all; their mouldering clay Is but an emblem of their memories; The space quite closes up through which they passed."

Fain would I believe that many of you would make enduring records. Yet each can do his best, and I doubt not each will do it. You have so much to encourage you, so comparatively little to hamper or hold back. Glorious is your work, glorious may be your fulfillment of it. We have lived in a goodly time; you will enjoy one still more goodly. With scientific progress, whose like the world has never known, and with an altruism which makes the world constantly better, you will be able to do things never done by your predecessors.

"'Tis coming up the steeps of time, And this old world is growing brighter! We may not see its dawn sublime, Yet high hopes make the heart throb lighter! Our dust may slumber underground When it awakens the world in wonder; But we have felt it gathering 'round! We have heard its voice of distant thunder. 'Tis coming! Yes, 'tis coming!

"'Tis coming now, that glorious time Foretold by seers and sung in story, For which, when thinking was a crime, Souls leaped to heaven from scaffolds gory! They passed. But lo! the work they wrought! Now the crowned hopes of centuries blossom, The lightning of their living thought Is flashing through us, brain and bosom; 'Tis coming! Yes, 'tis coming."

XI

THE EVOLUTION OF THE SURGEON FROM THE BARBER

If one attempt to scan the field of the history of medicine, to take note of all the fallacies and superstitions which have befogged men's minds, and brought about what _now_ seem to be the most absurd and revolting views and practices of times gone by, and if one search deliberately for that which is of curious nature, or calculated to serve as a riddle difficult of solution, he will scarcely in the tomes which he may consult find anything stranger than the close connection, nay, even the identity maintained for centuries, between the trade of the barber and the craft of the surgeon. Even after having studied history and the various laws passed at different times, he will still miss the predominant yet concealed reason for this state of affairs. This will be found to be, in the words of Paget, the "maintenance of vested rights as if they were better than the promotion of knowledge." He will wonder also why women were licensed to practise surgery in the fourteenth century and prevented in the nineteenth, or why specialties were legally recognized in the sixteenth century only to lose their dignity and identity a little later.

In thus attempting to consider the relations which have existed in time past between barbers and surgeons I must ask you to remember that there was a time when bleeding was deemed necessary for the cure of almost all ailments, and that after the Church had condemned the shedding of blood by any of her officials it was most natural to turn for assistance to the barbers, who were supposed to be dexterous with sharp instruments, with basins and with towels. Thus it happened that when the barbers found themselves permitted to perform this sole act they naturally ventured further and practised many parts of minor surgery independently of the ecclesiastics.

Moreover there persist to-day in Europe many relics of the old customs, and the barber surgeon is still a common figure in Germany, and particularly in Russia, where the really educated surgeons are still too few for a vast and widespread population. It must be remembered also that the Church gradually imbued men's minds with a horror of a dead body, and of the profanation which followed having anything to do with it, and surrounded the study of anatomy with every possible obstacle and obloquy; even to such an extent that to be known as having dissected a human body was to be exposed to indignity, assault and even death. It was, therefore only intense yearning for knowledge, on the part of earnest men, which then permitted anatomical instruction to be given or encouraged.

During the middle ages the greatest medical school in the world was situated at Salernum (or Salerno), but a short distance from Naples. This is not the place in which to discuss its history, although it became famous above almost every other institution of learning of any kind, and though, by one of the freaks of history, even the site of the buildings is now lost and no one seems to know just where they stood. In his time, namely, in 1240, the Emperor Frederick II was the great patron of this college; his decrees concerning the regulation of the study and practice of medicine deserve attention to-day. A part of one of his enactments reads as follows: "Since it is possible for a man to understand medical science only if he has previously learned something of logic, we ordain that no one shall be permitted to study medicine until he has given his attention to logic for three years. After these three years he may if he wishes proceed to the study of medicine." And again: "No surgeon shall be allowed to practise until he has submitted certificates in writing, of the teachers of the faculty of medicine, that he has spent at least one year in that part of medical science which gives skill in the practice of surgery, that in the college he has diligently and especially studied the anatomy of the human body, and is also thoroughly experienced in the way in which operations are successfully performed and healing afterwards brought about."

When first we hear of medical men in Great Britain they were commonly spoken of as _leeches_, as among the Danes and Saxons; later the clergy introduced books from Rome, and almost every Monastery had some brother possessed of more or less knowledge of the medicine of the day. The College of Salernum later gave great impetus to the study of medicine, even before the days of William the Conqueror, which was strengthened by the influence emanating from Naples, and particularly from Montpellier. For centuries the Catholic clergy were almost the only persons with sufficient education to study and practise physic; which profession became in time so lucrative that many of the monks abandoned their monasteries, neglecting their religious duties, and applied themselves to the study of medicine. To such an extent was this true that in 1163 the Council of Tours forbade monks staying out of the monastery for more than two months at a time, or teaching or practising physic. In taking this action the Council only repeated what had been ordained by decree of Henry III in 1216, and by the second Council of Lateran in 1139. No restraint was at first placed upon the secular clergy, and many of the Bishops and other church dignitaries gained both money and honor by acting as physicians to Kings and Princesses.

Next to the clergy the Jews possessed the largest share of learning. Their nomadic life permitted an intercourse with the different nations of the world, which was denied to most others, and there were many who studied medicine and practised, not only among those of their own race but amongst Moors and Christians alike. The priests became extremely jealous of Jewish physicians and of lay surgeons, and endeavored to secure through Rome a formal excommunication of all who committed themselves to the care of a Jew, while by canon law no Jew might give medicine to a Christian. But so celebrated were the Jewish physicians, and so superior to everything else was men's desire for life and strength, that even the power of Rome could not exclude them from practice. Still less could the clergy restrain the lay surgeons from the performance of their craft, and though it would appear that at first, in England, the priests were not disposed to separate surgery from medicine, the Pope became jealous of so much interruption to the duties of the clergy and looked upon the manual part of surgery as detracting from clerical dignity. Accordingly were made numerous attempts to debar priests from the performance of surgical operations. In 1215 the ecclesiastics were prohibited by Pope Innocent III from undertaking any operation involving the shedding of blood, while by Boniface VIII at the close of the thirteenth century, and Clement V, about the beginning of the fourteenth century, surgery was formally separated from physic and the priests positively forbidden to practice it. It is to the Church then that we owe this absolute abandonment of surgery to an illiterate and grasping laity. For some time, however, the priests kept their hold upon surgery by instructing their servants, the barbers, who were employed to shave their own priestly beards, in the performance of minor operations. It was these men, who were in some degree qualified by the instruction of the clergy, who first assumed the title of barber surgeons, and who gradually formed a great fraternity.

In France it was in the reign of Louis XIV that the hairdressers were formally separated from the barber-surgeons, the latter being incorporated as a distinct medical body. In London it was in 1375 that the Company of Barbers were practically divided into two sections, containing respectively those who practiced shaving, and those who practiced surgery. In 1460 the surgeons were finally incorporated by themselves as the Guild of Surgeons and took their place as one of the liveried companies of the city of London. Similar separation occurred in the original great Guild of Weavers, who divided into the Woollen Drapers and Linen Armourers, the latter afterwards becoming the wealthy and powerful Company of Merchant Tailors.

To trace the history of the London Company of Barbers a little more fully, it was first formed in 1308 and incorporated in 1462 by a charter. In one of the statutes of Henry VIII it was enacted that: "No person using any shaving or barbery in London shall occult (i. e. practise) any surgery, letting of blood or other matter except only drawing of teeth." In 1540 Parliament passed an act allowing the United Companies of Barbers and Surgeons each to have yearly the bodies of four criminals for dissection. In 1518 the barbers and surgeons were united in one company; the former being restricted from all operations except tooth drawing, and the latter having to abandon shaving and hair dressing.

It is interesting also to note that in Oxford, for instance, the Barbers, Surgeons, Waferers and Makers of "Singing bread" were all of the same fellowship, from 1348 to 1500; when, at last, the Cappers, or knitters of caps, were united to them, in 1551, the barbers and waferers abrogated their charter and took one in the name of the city, until 1675, when they received a charter from the University.

The London Guild of Surgeons appears to have been first a mere fraternity which had incorporated itself, and to have originated from an association of the military barber surgeons who had been trained in the hundred years war with France, 1337 to 1444. Its membership, however, was select, and when the physicians declined an alliance with it, it amalgamated with the barber companies in 1540. The United Company of Barbers and Surgeons was peculiar in that strangers and those who were not free men were admitted, while the journeymen of the craft formed a subordinate body within the company. In 1745 the surgeons separated from the barbers and formed a surgeon's company which rapidly acquired influence. By a foolish blunder it forfeited its charter in 1796 but was subsequently incorporated by George III, in 1800, as the Royal College of Surgeons in London; a body which has since maintained its identity, grown tremendously in wealth and strength, and having become one of the licensing bodies of England, has acquired the finest collection of books and specimens in the world and has numbered the brightest intellects which the English surgical profession has contained.

In Dublin the Barber Surgeons were incorporated as a guild by charter granted by Henry VI, in 1446. In 1576 they were amalgamated with the independent surgeons, and by Queen Elizabeth with the barber surgeons and wig-makers. This confraternity was dissolved in 1784 and the College of Surgeons founded immediately afterwards. In Edinburgh the barbers and surgeons were united in 1505, to be separated at about the same time as elsewhere in Great Britain.

During the eighteenth and nineteenth centuries on the continent medicine and surgery were abruptly separated, and the latter was almost entirely in the hands of the barbers. For hundreds of years the dissection of corpses and the embalming of those who could afford it, were in the hands of first the butchers and later of the barbers. The greatest contempt was everywhere shown for one who attempted any surgery. If for instance a nobleman while being bled by a barber received the slightest harm the poor barber was heavily fined, while, should the gentleman die, the culprit was given into the hands of the dead man's relatives to be dealt with as they desired. Throughout the monasteries and whenever the influence of the Church was felt it was forbidden to the monks, who had the monopoly of knowledge, to perform any surgical operation since the Church abhorred the shedding of blood.[8]

[8] I leave it to defenders of the Faith to reconcile this abhorrence with the persecutions of heretics and the tortures of the Inquisition permitted by the same Church.

For hundreds of years the monks were not allowed to wear a beard; this necessitated the employment of tonsors ("tonsorial-artists" they call themselves to-day) to whom was left also the performance of anything that partook of the nature of an operation, such as bleeding, bandaging, etc. This calling, was however, recognized as a most inferior one, and the barbers, like the bathkeeper, the shepherd and the hangman, were not considered of good repute. Consequently, such an one was not eligible for membership in any other guilds or fraternities. In 1406 the Emperor Wenzel was rescued from prison, in Prague, by the daughter of a bathkeeper; in gratitude he made her his mistress, and declared both barbers and bathkeepers to be respectable; but having lost his position his decree had no weight, and not until 1548, in Augsburg, were they really made eligible to the guilds. At this time their most dignified labor was the sharpening of instruments. In 1696 Leopold I. decreed their profession to be an art, and gave it a position above that of the apothecary so that in their most dignified occupation they were elevated to the making of ointments and plasters.

As surgery has for the profession of barber surgery to thank the existence upon man of a beard, so the European continent may thank the Crusaders of the eleventh century for having necessitated the existence of the bathkeeper, because of the leprosy which they brought home from the East. During the Crusades, as is well known, there were founded numerous Orders having for their original purpose the care and protection of pilgrims and injured soldiers. The three most celebrated Orders were the Knights of St. John, the Knights Templar and the Teutonic Order. Were this the place it would be most interesting to go into a history of these religio-medico-military Orders, and show how from most devout purposes and humble origin they grew into despotic and tyrannical associations of great power, which it finally took all the force of Church and State to suppress. As the then humble and enthusiastic members of these Orders returned from the Holy Land they established hospitals for the care of lepers, who became very numerous in Europe. For instance it is stated that in France, in 1225, there were two thousand hospitals for this purpose, while the King Louis the Great founded, in 1260, a special hospital for those made blind by Egyptian ophthalmia. It is well known also that during the middle ages there was the greatest neglect of the ordinary canons of cleanliness both among the upper and lower classes. The number of hospitals and cloisters dedicated to the lepers being insufficient, bath houses were built and bathkeepers were engaged in order, so far as possible, to prevent the spread of leprosy. At this time the bathkeeper was permitted to bathe and cup, later also to bleed, although the bleeding was required to be done in the bathkeepers' own house, since he was not usually permitted to enter a patient's house. As bathing became less necessary for purposes already mentioned the bathkeeper took to imitating the barber, though much later, and not until about 1750 in some countries, were they permitted to do this publicly, and only after having passed the examinations to which the barber was also subjected. In Prussia they were only allowed to treat wounds and chronic diseases, and so it came about that by the beginning of the eighteenth century a really conscientious and efficient barber surgeon was supposed to have served an apprenticeship in large hospitals, to have witnessed the work of noted surgeons and to have served in the Army or Navy. He was also supposed to be something of a linguist and to know a little botany; particularly was he expected to be conversant with anatomy, although there was a sad lack of cadavers--which was atoned for by the use of carcasses of animals, for the main part swine.

Eckardt, writing at this time of the sixteen different virtues of a barber, enumerated, first of all, fear of God; then that he should be careful, prudent, temperate, and ready to use both hands with equal dexterity; he claimed that "Arrogance seems most prevalent among barbers, as a common saying would imply 'barbers are proud animals.'" He expressed his surprise also at the envy and malice between bathkeepers and barbers, and advised them both to consult physicians and other masters.

The customs of the time must be blamed for this lamentable condition of affairs. The boy who was destined to become a barber was apprenticed at a time when he had scarcely learned to write. If he could write legibly and read a little Latin no one dared refuse him. He learned to shave and went from house to house for this purpose, spending the little time remaining in sharpening knives, spreading plasters, picking lint, taking care of children, doing all menial duties, and using the same light as the housemaid because it would have been disrespectful to his master's wife to use any other. After years of this work he was gradually taken to visit patients and then was taught how to bleed, cup, apply leeches, extract teeth and clysters. His master knowing nothing of anatomy could give him no instruction, though by the laws of apprenticeship he was bound to do so. Before concluding this apprenticeship he was supposed to pass an examination, which his master's laziness usually permitted him to escape. He then presented the master with some silver instruments and was dismissed with an injunction to be thankful that such a miserable specimen of God's creatures had ever been taught to shave a beard or spread a plaster. He now became a journeyman, still living at the house of his master, and was not allowed to marry; after a while he received a paltry sum as wages, got his dinners free and began to dabble on his own account. Study was out of the question; these men could not understand what little they did read and served the community mainly as bearers of tales. After some years of activity as journeyman they could become masters by applying to the authorities, presenting certificates, and passing an examination before the physicians of the district.

Prussia was the first country to appreciate the necessity of regulating medical practice, and the barbers and bathkeepers were placed under the control of the Medical College founded, in 1685, by Prince Frederick William. In 1724 this institution attained its greatest activity, having a subordinate school in each province. In 1725 King Frederick William issued a famous edict which did much to regulate medical affairs throughout the kingdom, and directed among other things that barbers and bathkeepers should "lead a religious, temperate, retired and sober life, in order to be at their best whenever their services were required." When their business was not sufficiently good they assumed other cares, as, for instance, one man was surgeon, municipal judge and post-master all at once. They were extremely envious of each other and often dabbled in medicine without permission. It was not until 1779 that the bathkeepers were permitted to rank in Prussia with the barbers, and were allowed to use more than four basins, the bathkeepers' guild being incorporated with that of the barber.