Dr. Kevin D Halow MD MBA RVT FACS
I cannot say that I have ever been a big fan of haircuts; maybe I was traumatized as a child. Having been in the military for over 20 years, you would think that I would have gotten used to getting my hair cut. I had to get a haircut about every 2 weeks. Over 20 years, that is a lot of haircuts!! Certainly, it is not that I do not like my barber. My barber, Nick, gives an excellent haircut, but even with Nick at the scissors I am still not a fan. Ironically, I am sure that Nick has no interest in having a surgery either. Yet Nick and I have more in common than simply not wanting to be the subject of each other’s profession. We share a similar history. In fact, our forefathers started out in the same profession. This discussion is less about my haircut phobias and more about this history of surgery and my surgical ancestry; from haircuts to hernia repairs and even some history of the barber pole itself. The origins of surgery began with the “Barber-Surgeon”.
In order to understand the history of surgery, it is best to begin with the history of medicine. Prior to the 14th century A.D., the practice of medicine was dominated by the original works of the Greek physicians, Galen (129–216 BCE) and Hippocrates (460–370 BCE). (1) The human body was thought to be made up of four humors known as “Biles”: Red Bile (Blood), White/Clear Bile (Phlegm/Sweat), Yellow Bile (Urine), and Black Bile (Clots).(2) It gets even a bit more complicated because these “biles” were related to the four basic elements: Air (Red Bile), Water (Clear Bile), Fire (Yellow Bile), Earth (Black Bile).(2) Add another layer to that, the zodiac signs and astrological events, and you have the everything that you need to diagnose and treat disease.
Zodiac Man ( homo signorum)- late medieval depictions the body linked with an astrological sign (3)
This was the practice of medicine prior to the 16th century. It probably comes as no surprise that patient outcomes were marginal at best. Patients often succumbed to diseases that, today, would be easily treatable. Quality of life was poor and the average life expectancy was 31 years old; as opposed to 78 years old today. (4) The practice of medicine was not based upon scientific data. There was no clear knowledge of human anatomy because anatomic dissection of human cadavers was forbidden. Most importantly, surgeons were not part of the medical profession. They were barbers. Barber-surgeons were medical practitioners in medieval Europe. They cut hair, drained abcesses, drilled holes in the skull (Trephination) to let out the evil humors, and, of course, drained blood.(5) Barber-Surgeons would normally learn their trade as an apprentice to a more experienced colleague with no formal education; most were illiterate. (5) As an aside, they always say that surgeons are not hired for their brains, maybe we now know why—just kidding.
This brings us to the well-known and clear identifiable icon for barbers; the barber pole. The barber pole signified the bleeding that occurred during blood-letting and the bandages used to clean up the blood. A patient of the Barber-Surgeon would grab a rod tightly, in order to make the veins protrude, and the Barber-Surgeon would open the vein and drain the blood. Doctors, at the time, did not practice blood-letting, only the Barber-Surgeons performed this treatment.(6) As expected, the treatment was actually worse than the disease.
In England barbers and surgeons originally had separate guilds, but these were merged by Henry VIII in 1540 as the United Barber-Surgeons Company.(5) However, beginning in the 16th century, medicine began to change. Anatomic dissection was revived in the late 15th century. Originally carried out on executed criminals, anatomic dissection of human cadavers became increasingly accepted as part of medical education.(7) In fact, it was so accepted that family members had to stay at the gravesite of the freshly buried corpse in order to prevent grave robbery.(6) Digging up corpses for university medical education was so lucrative that the gravesite had to be guarded by the family for a minimum of a week until the corpse had decayed enough to make it unusable for dissection.(6) As medical education became more scientific, the diagnosis and treatment of disease rapidly changed. The Physician anatomist, Andreas Vesalius (1514-1564), investigated the human body by means of dissection and changed doctors’ attitudes towards the role of observation in medicine. (8) Vesalius, who was made Professor of Surgery and Anatomy at the University of Padua, was instrumental in describing the circulatory system and urged doctors to conduct systematic dissections of human corpses themselves.(8) The innovative French Surgeon, Ambroise Paré (1510-1590), the royal surgeon for a number of French kings, including Henri II, discovered that sealing soldier’s wounds with a tincture of egg yolk, turpentine and oil of roses was more effective method than the common practice of cauterization.(9) . He was also accredited with first using ligatures to tie off bleeding vessels.(9) As more and more discoveries were made through observation and application of the scientific process to medicine, the separation of England’s barbers and surgeons continued. Eventually, barbers were forbidden to carry out any surgical procedures except for teeth-pulling and blood-letting. In 1745 the two professions were separated by King George II, who established the London College of Surgeons. By this time surgeons were now university educated.(5)
While I may not like getting a haircut, I can take comfort in knowing that the only thing that I will get when I visit my barber, Nick, is a shave and a haircut; there will be no blood-letting, teeth pulling, or any other surgical procedure. Thanks to King George II, barbers and surgeons remain in their separate fields. As a patient, you can rest assured that your surgeon is a highly educated physician, has post-doctorate specialty training, is licensed by the state, and is board certified. In the 21st century, the only haircut and shave that you will get from your surgeon is a prep of your surgical site.
- Exhibition of the Barber-surgeon. The Surgeon’s Museum. Edinburgh, Scotland
- Ghosh SK. Human cadaveric dissection: a historical account from ancient Greece to the modern era Anat Cell Biol. 2015 Sep; 48(3): 153–169. Published online 2015 Sep 22. doi: 10.5115/acb.2015.48.3.153