THE CRAFT OF SURGERY.*
Manua the editor of this volume is modestly reticent about his share in its production, it is not difficult to see that it has received from him much more than ordinary editorial care. Only a few pages were left ready for the press by Mr. South, and " a vast mass of materials" has had to be reduced into form, though we gather that here and there, there were portions for which something of the kind had been already done. It is quite clear that the public owes much to the industry and good judgment of Mr. D'Arcy Power.
It may be as well to explain that the word "craft" is need in what may be called its objective sense. This book is not a history of the surgical art; had it been so, it would have been beyond the competence of the present writer to criticise it. It relates how the professors and practisers of surgery reached the organisa- tion which they now possess, "craft" being the translation of the word "mystery," or, as it was once and more properly spelt, " mistery,"—more properly, as its connection is with magieterium, not mysteriurn. Still, as Sir James Paget remarks in his admir- able introduction, "it may help to the understanding of this [i.e., the scientific and technical] part of its history, if read together with the writings of the successively contemporary surgeons." And, indeed, one of the most interesting passages in the book— interesting both to professional and lay readers—is John of Arderne's account of his cure of fistula. John of Arderne was a specialist for this disease, and according to his own account a highly successful one, working cures in cases which the surgeons of great Continental schools had abandoned as hopeless. He had a high standard of attainment and conduct for the practiser of the surgical art,—a standard which he seta forth in his chapter, "On ye llianere of the Leche," and he had also a high, we may say, a very high, standard of fees. For the cure of fistula in its most aggravated and dangerous form, he used to • Memorials of the Craft of Surgery in Ragland. From Materials Collected by John Flint South. Edited by D Amy Power. M.d. With Introduction by Sir James Paget, Bert. Londcm Cassell and Co. MK ask "of a worthie man and a gret" forty pounds, and "robes and fees of a hundred shillings for the term of life, by the year." Translating this into modern value, we get a sum of nearly £500, with a farther annuity of £60; making, if the latter be capitalised, a quite magnificent fee of twelve or thirteen hundred pounds. The most successful and fashionable operators of later times have hardly improved upon this. His smallest fee was "a hundred shillings," so that a cure was evidently a luxury in which only the well-to-do could indulge. It is in- teresting to note that this great man practised during the greater part of his life in Newark, a place that could never have been of much importance, though late in life he removed to London. He died somewhere about the end of the fourteenth century. Of his successors, the most famous was Thomas Morstede, who was Surgeon-General to the Army in the Agin- court campaign. His skill also seems to have been fairly remunerated, as he received not much lees than £300 a year in the money of that time, while he was dignified with a guard of three archers. His subordinates, however, seem to have had not more than 6d. per diem, a curiously disproportionate sum, unless we suppose that their superior kept a table for them. The ambulance consisted of " a chariot and two waggons,"—as Mr. Power remarks, "not an overwhelming surgical staff for an army of 30,000 men." There was but one physician who received as much as the Surgeon-in-Chief. As security for their pay, they were permitted to take certain of his Majesty's jewels. As the army was reduced to less than 6,000 when it fought the Battle of Agincourt, it is clear that the physician and the surgeons mast have had plenty to do for their money.
One of the chief difficulties which the author and editor of The Craft of Surgery have had to encounter is the task of dis- entangling the relations between the barbers and the surgeons. Sir James Paget is very anxious to show that the pedigree of the surgeon is not to be traced up to so humble an ancestry as the barber's. "The surgeons from whom we and our College can trace an uninterrupted descent were not barbers." "From first to last, even daring their temporary conjunction with the Barbers' Company, the real surgeons held themselves apart as a distinct body." The separation becomes clearer as time goes on, and is, indeed, distinctly laid down in the Bill by which the two crafts were united in 1540. Then it was enacted that no barber in the City of London " shall occupy any surgery
except drawing of teeth, nor any practiser of surgery shall use shaving." But as late as 1409, the barbers bad had formally confirmed to them by the Court of Aldermen the right of practising surgery. Probably while there were always pure surgeons of the type of John of Arderne and Morstede, the general practitioner commonly united with his profession the barber's occupation, just as now he sometimes keeps a chemist's shop. It is curious to observe that this union of the surgeons with the barbers was partly forced upon them by the jealousy and hostility of the physicians, who seem to have been very anxious to keep their surgical brethren, or rather rivals, at arm's-length. This hostility sometimes burets out into very sharp contentions. The physi- cians were extremely jealous of any encroachment on their pro. vince, and the surgeon who presumed to administer any drug to his patient did so at his peril. In 1632, they even went so far as to procure an Order of Council that no surgeon should perform any of the greater operations without the presence of " a learned physician." This, however, was too much to endure, and the order was recalled or suffered to lapse. Towards the end of this century, the physicians refused to consult with " barber-surgeons ;" but from this position also they were compelled to recede. Judge Jeffreys on this occasion seems to have acted as the surgeons' friend.
The history of the United Company presents many interesting incidents. The incessant exactions of the Crown in the arbi. trary days of Stuart role brought it to the brink of bankruptcy, and even beyond it. In 1641, it was only just saved from the indignity of selling its plate by the liberality of Mr. Alderman Arris, founder of the lecture which still bears his name. Two years afterwards, it declared itself by a solemn instrument unable to pay its debts, and a fortiori to lend. In spite of this, it found money to take part in a speculation in Irish land, and, indeed, the Barbers' Company possesses to this day some Irish property which was then acquired. In 1745, the Barbers and the Surgeons were separated by Ad of Parliament, the Surgeons taking nothing with them except two bequests which had been made for purely surgical purposes. Still they prospered in their separate con- dition, though not till they had passed through a time of depression. The great surgeon, Gunning, had the principal part in restoring their credit. His allocution, delivered at the end of his year of office as Master, is a model of good sense and practical wisdom. By various retrenchments, chiefly in the matter of dinners (in which a saving of 2150 per annum was effected), he brought the finances of the Company into a condition of pros- perity. This was in 1790. Six years afterwards, the charter was forfeited by illegal holdings of meetings, and the opposition of Lord Tharlow (caused, it is said, by his hatred of Gunning), prevented the passing of an Act of Indemnity. However, all ended well. Merges profundo, pidchrior event. Oat of the dis- solved Company of Surgeons rose the Royal College of Surgeons, whose fellowships are among the most honourable of medical distinctions.
We have said enough to show that readers will not be losing their time if they make themselves acquainted with The Craft of Surgery.
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