The Barber-Surgeon

Thoughts and input on anything related to wet shaving or men's grooming.
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drmoss_ca
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The Barber-Surgeon

Post by drmoss_ca »

It might not be generally known, but the Hippocratic Oath* in its original form, which survived up to the 1960s, included this:
I will not use the knife, not even, verily, on sufferers from stone, but I will give place to such as are craftsmen therein.
Perhaps you ought to read the Wikipedia page on lithotomy before proceeding. Such ingenuity towards solving a problem no one seems to have these days. Except, they do, and they have it dealt with humanely. But it's not as common as it once was, and that is undoubtedly due to the fact we can treat gout (so no uric acid stones) and also since we treat urinary tract infections, so far fewer triple phosphate stones, each of which is said to be the tombstone of a dead bacterium.

I see two lines of thought here. Firstly there is a clue in 'craftsmen', who though skilled, and who required a guild and an apprenticeship in the middle ages, were not professionals. Physicians desperately wanted to be professionals, even though they could do little with what knowledge they had, and the few herbal remedies on hand. At one time, actually physically touching a patient was regarded as unprofessional, and even today, examining a patient is a 'physical exam' to emphasise the fact it involves touching. No doubt there was a time when touching was unwise, as no one knew how disease was transmitted, nor even which diseases were transmissable. Better be safe, observe, pronounce and charge a fee, but don't touch the dirty buggers. So there's a class-based, snobbish professional-versus-tradesman aspect to this. That's not new, and is famously celebrated by the UK Royal College of Surgeons. When you gain membership, you are entitled to be known as 'Mister' rather than as 'Doctor'. Inverse snobbery for the win!

But there is a side to this relevant to those of us who hone. Why were barbers the ones to become 'barber-surgeons'? Why not, for example, 'blacksmith-surgeons'? I think the answer is in the honing. The barbers were the ones with the sharp edges. A sharp edge hurts less when it cuts flesh, maybe doesn't even hurt at all. If you read up on a transperineal lithotomy and imagine, if you can, how miserable you must have been to consent to it, and then try to imagine the experience itself - well, goodness, better with someone who can sharpen a scythe or someone who can sharpen a razor? I'm not daft, and neither are you: we want the barber to do it! Remember, or go and read about it, the fact that Samuel Pepys held a dinner each year to honour the anniversary of him surviving being 'cut for the stone'. Maybe, in the light of all this, we should pay barbers more!

My first post after qualifying was to work for Sir Arnold Elton, a urologist who was an excellent surgeon (I recall a senior registrar saying 'he operates on tissues, not on anatomy'), but was otherwise uninterested in forwarding knowledge. I learned more than I ever wanted to know about removing stones from bladders, ureters, and kidneys. Sir Arnold (appointed consultant almost immediately after qualifying in an era when no one did much postgrad training), was a consultant at the old Harrow Hospital. When the NHS decided to replace it with the landmark exemplary Northwick Park Hospital, he was given a consultancy there, to the horror of the high-flying academic wunderkind who filled the other posts. He was best known for having the most lucrative private practice in Harley Street, which happened by accident. He had some heart issues, and a cardiologist by the name of Rafferty told him to cut back. So he doubled his prices, thinking that would both cut back the workload and minimise the financial loss. Well poor Arnie got a lesson in economics. The phenomenally rich sheiks with big prostates who wanted private medicine in Harley Street did some comparison shopping, and all decided the surgeon with the steepest prices must be the best! Poor Arnie saw his private practice workload triple. When I worked for him he actually had a Daimler and a chauffeur in unform. Poor fellow! His knighthood was simple repayment for massive contributions to Margaret Thatcher's Conservative Party. He introduced me to the world of London clubland, and I was grateful to him for showing a young goy what the RAC and the RSM could offer. RIP, Arnie.

Anyway, like a barber, he had the sharpest edges, and that's what counts!

C.
*I was surprised to discover the Oath is some kind of a shibboleth in north America. No one takes it on graduating from medical school in the UK, nor in the rest of Europe as far as I can tell, including Greece. There are far more relevant systems of ethics for modern medicine, most of which get enforced by licensing bodies. Apollo and Asclepius, Hygieia and Panacea, and all the gods and goddesses appear to be asleep at the wheel when it comes to enforcing oaths.
"Je n'ai pas besoin de cette hypothèse."
Pierre-Simon de Laplace
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