In the Middle Ages across much of Europe, the above scenario was not uncommon. In fact, it was often the only option. This is because formal medical education was only accessible to aristocrats and clergy, and the general sentiment of the time held that it was “unclean” for the hand of a gentleman or noble to be tainted with blood. This belief went so far that the Church, in the Council of Tours in 1163, forbade clergymen from performing surgery. Furthermore, a papal decree in 1215 expressly prohibited members of the priesthood from surgery, as it was an act that shed blood. As such, physicians of the day rarely performed procedures or surgery of any kind, preferring the role of diagnosis by observation and treatment via chemical cocktails and counseling. This left a vacuum in procedural and surgical medicine, and a dearth of trained professionals that could address the ills of society that required the knife.
Barbers of the day filled this void, in an interesting tradition spawning out of monasteries. Medieval monks classically shaved their scalps (called a tonsure) as a sign of religious devotion. To address this need, many monasteries trained and housed their own live-in barbers. Since traditional physicians and clergymen shied away from surgery, and barbers in monasteries were skilled with the blade, the barbers did more than simply cut hair. They routinely extracted teeth, sutured wounds, did blood letting (widely believed at the time to cure illness), and even performed cataract surgery and limb amputations. Barbers trained in this fashion eventually came to be known as barber surgeons. They set up shop throughout medieval cities, and were even employed by regional armies during battle to treat the wounded.
The schism between respected physicians of the day and the barber-surgeons went further than just non-surgical medicine versus surgery. Classically trained physicians were often highborn, educated in formal academic centers with a focus on rigorous research and study. Barber surgeons, in contrast, hailed from the ranks of common folk, and attained their skills through a guild-like apprenticeship model. Even as time progressed and the necessity of formal surgical training was gradually recognized, medical institutions held distinctions between their physician and surgeon cohorts. Physicians were given long robes as a sign of respect, whereas surgeons were relegated to short robes. Professional societies and memberships were also segregated, with surgeons often seeking training outside of formal medical establishments and belonging to private groups, such as the London-based Company of Barbers. Official titles were also different. In England, the respected title of “Doctor” was reserved for physicians, while surgeons were referred to as “Mister”. Eventually, the importance and legitimacy of surgery could not remain sidelined. Throughout the seventeenth and eighteenth centuries the distinctions gradually diminished. Formal surgical training was properly incorporated into the traditional medical education system. In fact, modern-day residency training bears more resemblance to the apprentice-like surgical training model than that of primarily academic-based education. Professional surgical societies promoting excellence and peer scrutiny became properly established, culminating with the royal charter creating the Royal College of Surgeons in England and its territories in the early 1800s. Yet even today, British surgeons prefer the title of “Mr” rather than “Dr”, a sign of homage to the barber surgeons and the historical roots of the trade of surgery.
So now when you pass by a barbershop, contemplate the question that many in the Middle Ages had to ponder: “would you let your barber perform surgery on you?” Gaze again at the calmly rotating pole of red and white stripes. In the days of old, the pole stood as an advertisement from the barber surgeons, the red and white stripes symbolizing the blood and bandages of their ancient trade. A trade that treated far more than just a bad hair day.
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