Within my circle of friends, there have been two surgeons. I say ‘have been’ because one has sadly recently died and the other is in hospital, receiving palliative care and slowly fading away. Both were orthopaedic consultants (one even had the gallantry to operate on me) and both were highly respected in their profession and worshipped by their staff. In short, if they so much as requested, “Scalpel, please”, even the handyman in the workshop would start rummaging through his toolbox. The pronouncements of Mr Smith or Mr Jones (they are not their real names, obviously) were received with something akin to reverence.
But why the plain honorific ‘Mr’, not ‘Doctor’ or ‘Professor’, as in other branches of medicine? First, it should be pointed out that ‘mister’ was never plain, old ‘mister’. The word comes from the Latin ‘magister’, meaning ‘master’. In Anglo-Saxon it became ‘maegister’, in Middle English it was ‘maister’ and then shortened to the modern ‘mister’. So, let’s have a bit of respect here for Mr Murtagh.
But I am not a doctor, with years of training and a long list of abbreviations after my name. Why therefore should a superbly qualified surgeon be put on the same footing as someone who has frequently been under the knife but never wielded it himself? The answer is rooted in ancient snobbery.
The ‘father’ of medicine is generally held to be Hippocrates (born 460 BC), who had the insight into the fact that disease could have natural, rather than supernatural, causes. Even today, the Hippocratic Oath (“First, do no harm”) is still used worldwide. Yet for the next 2,000 years, not a lot happened in the progress of our understanding of the human body and how it works (and sometimes doesn’t). In fact, that is not strictly true. A lot went on, but it all led up one gigantic cul-de-sac, one that was anything but scientific, more a conspiracy of superstition, myth, and fallacy.
Up until the late Middle Ages, most people were illiterate. Only in monasteries, home to cohorts of scribes, copyists, scholars and academics, devoted to a simple life of worshipping God and preserving the ancient texts, could an education be pursued. The Church was a pivotal influence in everyday life and therefore much of what was considered to be sound medical practice was based on prayer, potions, spells, incantations and spurious theology. In fact, the origin of the word ‘doctor’ comes from the Latin docere, ‘to teach’, so original doctors were academics, not medical practitioners. Even today, if you gain a PhD (Doctor of Philosophy) at university, you are entitled to use the honorific ‘Dr’. A friend of mine, with a PhD to his name, delighted in placing a note on his dashboard when parking illegally, “Doctor on call’. On whom he was calling a discreet veil shall be drawn. The use of the term ‘doctor’, referring to a person licensed to practise medicine did not come about until the 16th century. Even then, the mysteries of the human body remained the sole preserve of an exclusive and self-regarding cadre of academics who upheld a philosophy and practice that was at best totally erroneous and at worst downright hazardous. Medicine was a learned, scholarly, erudite discipline that was nothing much more than hocus-pocus quackery, utter bunkum. The cure was more likely to kill you than the ailment. The best that can be said in their favour is that the doctors of the day were ignorant, not malevolent.
Surgeons were a completely different kettle of fish. Since earliest Man, there has always been a need for a spot of impromptu handiwork with blade, saw, hammer and chisel on the human body at times of accident or injury. The people best placed to hack off an unsalvageable limb or sew up torn tissue or remove a pesky arrow or bullet would be those who possessed the necessary tools for the job, namely butchers and barbers. And in the earliest days of basic surgery, that is what surgeons essentially were – butchers. It was rarely in jest that a commander following battle would demand to know ‘the butcher’s bill’, in other words, the number of dead and wounded.
In nearby Worcester, there is an area called The Shambles. (There are similar areas in many other cities and towns.) The word ‘shambles’ was used to denote an open-air slaughterhouse and meat market where butchers killed and chopped up animals for consumption. Hence the modern interpretation of the word. I would often describe some of the bed-studies of adolescent boys in my House at Malvern College as “a shambles”. Never a pretty sight. Even worse in The Shambles in Worcester in the immediate aftermath of the Battle of Worcester in the Civil War. The butchers had their work cut out that day.
Thus, surgeons were traditionally the poor cousins of physicians. They had no academic training. They had studied no learned texts. They hadn’t read the ancients. They knew no Latin or Greek. They had no understanding of the complex humours that make up the human body. My God, they were no better than butchers! Certainly, they had no right to be called doctors. It was plain ‘Mr Sawbones’ for them.
But the wheel inexorably turned. At the dawn of the Age of Enlightenment, when reason started to usurp superstition,when science replaced assumption, when evidence took the place of blind belief, the stock of the surgeon began to rise as their knowledge and understanding of medical procedures grew. The founding of the Royal College of Surgeons in 1800 put them on an equal footing with the Royal College of Physicians – admittedly 300 years later – and in subsequentyears, there were some who claimed that surgery was the more important discipline. Certainly, it became more ‘sexy’. Everybody can remember the rock star that was Christiaan Barnard, pioneer of the first heart transplant. Can anybody call to mind a household name who was a urologist or a gastroenterologist?
It's a nonsense, of course, to compare apples and pears. Today, both surgeons and physicians possess medical degrees and their standing in the medical world as well as the forum of public opinion is comparable and commensurate. But still doctors who are surgeons prefer to be known as ‘Mr’ and not ‘Dr’. So proud of their distinction from physicians that the title ‘Mr’ has become something of a badge of honour. Inverse snobbery, you might say. But who can blame them, having suffered so much discrimination and condescension over the centuries?