Image Credit : Wellcome Library , London . Wellcome Images images @ wellcome . ac . uk http :// wellcomeimages . org A travelling barber-surgeon examining a man ' s head : a group of locals watch with interest . Etching .
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at the universities . 6 They performed a wide variety of procedures as well as barbering : caring for traumatic wounds and burns , and draining abscesses and the buboes of the plague . A German poem by Hans-Sachs ( 1494-1576 ) documented the care of fractures , syphilis and cataracts by barber-surgeons . 1 , 7 In contrast , untrained , self-appointed traveling “ surgeons ” performed more involved procedures ( e . g ., hernia repairs ), often moving from village to village to avoid retribution for the inevitable complications from rudimentary , unsanitary procedures . Turmoil thus arose between the barber-surgeons and these traveling types , mostly over patient and practice ownership , 3 until in 1540 , King Henry VIII settled the dispute with the formation of the Guild of Barbers and Surgeons . 3 This act legitimized the study of surgical skills by the government and united the two groups in training and practice .
One of the most common procedures performed by barber-surgeons was bloodletting . The origins of this practice date back several thousand years to the ancient Greeks . In 500 B . C ., Hippocrates wrote “ venesection holds first place in conducting the treatment of [ various illnesses ].” 4 Later in 200 B . C ., the Greek physician Galen prescribed bloodletting for almost every disease . 4 Galen , whose written teachings were regarded as truth for nearly one thousand years , believed a person ’ s health was dependent on the four “ humors ”: blood , phlegm , yellow bile and black bile . 3 He taught that illness arose from an imbalance of these four humors , and that the process of bloodletting could restore this balance . Despite the now apparent complications of continual blood loss ( scholars now opine that George Washington died from excessive bloodletting ! 8 ) the practice did not completely disappear from hospitals until the 1860s . 4
The practice of bloodletting , curiously , explains the modern-day barber pole . Barber-surgeons used a tall pole with two containers on either end while bloodletting . The top container was a reservoir for leeches , sometimes used for bloodletting instead of cutting a patient ’ s vasculature , while the bottom container was a reservoir for blood . 9 When applying leeches or performing venesection or arteriosection , the patient would wrap his arm around the pole , allowing the blood to collect in the bottom basin . The present-day white stripes around the barber pole represent either the tourniquet or bandages , while the red and blue stripes resemble the patient ’ s bloody arm wrapped around a pole . 4 , 9 Some speculate that the bottom bleeding bowl was the predecessor to the present-day kidney basin .
In the 16th century , barber-surgeons had highly prominent and developed practices that influenced physicians for many years ahead . One was Ambroise Paré , a French man who trained in Paris ’ s Hotel Dieu , founded nearly 1500 years ago . Because he could not afford his surgical licensure fee , he served as a barber-surgeon for the armies of France . 3 When Paré ’ s supply of wound-cleaning boiling oil ran out , he created a gentler treatment made of egg yolks , rose oil and turpentine . 6 , 11 To everyone ’ s astonishment , patients treated with his new solution fared much better postoperatively than patients treated with the cauterizing oil . 6 , 12 Furthermore , by focusing on procedures he personally observed and performed , Paré constructed a series of monumental medical texts based on experiment rather than theory , serving as a foundation for surgical practice today .
Barbers and surgeons continued to train together for nearly 200 years . As time went on , the number and training of the surgeons slowly surmounted that of the barber-surgeons . By the mid 18th century , the surgeons had become a professional scientific body . 6 In 1745 , the two groups officially separated , causing the barber-surgeons to lose their credibility , prestige and practices . 5 The Royal College of Surgeons flourished , and barbers returned to grooming . Despite their eventual fall , their dedication to hands-on and empirically-based practice revolutionized the field of surgery . Today , the discipline of surgery still uses this observation-based approach to research and training . As they say , “ See one , do one , teach one .”
References
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Ackerknecht EH . From barber-surgeon to modern doctor . Bull Hist Med . Winter 1984 ; 58 ( 4 ): 545-53 .
2
Lyons AS , Petrucelli RJ , Petrucelli JA , Bosch J . Medicine : An Illustrated History . Abradale Press / Abrams ; 1987 .
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Bagwell CE . “ Respectful image ”: revenge of the barber surgeon . Ann Surg . Jun 2005 ; 241 ( 6 ): 872-8 ; discussion 878 . doi : 10.1097 / 01 . sla . 0000165185.88634 . d0
4
Abel AL . Blood letting . Barber-surgeons ’ shaving and bleeding bowls . JAMA . Nov 2 1970 ; 214 ( 5 ): 900-1 . doi : 10.1001 / jama . 214.5.900
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Dobson J . Barber into surgeon . Ann R Coll Surg Engl . Feb 1974 ; 54 ( 2 ): 84-91 .
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Drucker CB . Ambroise Pare and the birth of the gentle art of surgery . Yale J Biol Med . Dec 2008 ; 81 ( 4 ): 199-202 .
7
Sachs H , Amman J , Graul R . Das Ständebuch : 114 Holzschnitte . Im Insel-Verlag ; 1934 .
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Witt CB , Jr . The health and controversial death of George Washington . Ear Nose Throat J . Feb 2001 ; 80 ( 2 ): 102-5 .
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Weinberg F . Bloodletting . Can Fam Physician . Jan 1994 ; 40:131-4 .
10
Santoni-Rugiu P , Sykes PJ . A History of Plastic Surgery . Springer Berlin Heidelberg ; 2007 .
TRANSCENDING TRAUMA
11
Neligan P , Warren RJ , Van Beek A . Plastic surgery . 4th ed . / editor in chief , Peter C . Neligan ; volume editor , Richard J . Warren ; video editor , Allen 1 . van Beek . ed . Elsevier ; 2018 .
12
Broughton G , 2nd , Janis JE , Attinger CE . A brief history of wound care . Plast Reconstr Surg . Jun 2006 ; 117 ( 7 Suppl ): 6S-11S . doi : 10.1097 / 01 . prs . 0000225429.76355 . dd
Brooke Barrow is a fourth-year medical student at the University of Louisville School of Medicine .
Abhi Alur is a fourth-year medical student at the University of Louisville School of Medicine .
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