By Samantha Sandassie
It would be an understatement to say that early modern surgery and its practitioners have a negative reputation. Popular narratives present surgeons as poorly educated men who performed invasive operations on unlucky and unanesthetized patients using unsterilized instruments. In addition, most scholarship has tended to emphasize the differences between learned and professional physicians as opposed to unlearned tradesmen surgeons. In short, scholars have sustained a seventeenth-century hierarchy that devalues surgeons’ importance in contrast with the esteemed natural philosophy model of medicine practiced, supposedly solely, by physicians. In so doing, we imagine historical surgery, and define and limit the early modern surgeon’s practice, in a way (s)he would not recognize.
Notwithstanding the risks of early modern surgery, simple surgical procedures made up a large percentage of in-person, patient-practitioner interactions during the period. Indeed, surgical practitioners provided the bulk of day-to-day medical care and acted as something of a general practitioner. The surgeon’s scope was far wider, and his duties more complex, than incision, extirpation, and suturing. Surgical treatises and casebooks record treatments for everything from cancers, to scrofula, venereal diseases, and even mental illnesses. And in so treating, practitioners used a variety of internal and external remedies, demonstrating that patient care went well beyond the scalpel.
To illustrate this point, I’d like to focus in on three mid-seventeenth century English surgeons who left detailed surgical case records now housed in the British Library. The casebook of Joseph Binns, a mid-seventeenth century London surgeon, is a valuable window through which one may understand the practice of a legally practicing, successful, urban surgeon. John Conny’s medical journals (BL Sloane MS 2766 and 2779) cover his naval practice from 1648-1652 and 1661-1665, and James Molins recorded his anatomical and surgical observations (BL Sloane MS 3293) taken at St. Thomas Hospital in London in 1674. This trio of observations provides fascinating and valuable insight into the nature and scope of early modern surgical practice and support this idea of a surgical-general practitioner.
Taken together, these manuscripts reveal a remarkably wide variety of patients, ailments, and treatments. Joseph Binns, for example, treated patients as varied as the “button maker’s child” for smallpox, Lady Harris for a leg wound, and a physician named Dr. Rodgers for piles. Likewise, John Conny’s naval practice ranged from treating Mary Boone’s seasickness to Edmund Credinge’s abscessed finger and wounded thigh. Indeed, from July 1661 to December 1664, Conny recorded almost 400 receipts; not all unique cases, but he listed receipts for roughly 200 men, 150 women, and almost 20 children. James Molins’ hospital observations likewise demonstrate that patients varied in terms of age and sex. Moreover, his detailed notes reveal a wide range of patient occupations as well – from maids to shoemakers, coachmen’s wives to elderly lawyers and a surgeon of almost 100 years old.
The cases also reveal that surgical practitioners treated an extraordinary variety of ailments in ways that we would not necessarily recognize as “surgical.” Occupational boundaries between physicians and surgeons were blurred during this period. Joseph Binns, for example, frequently treated patients using a combination of surgical intervention and internal medicines. On 22 February 1647, he treated a young butcher who had been gored severely by a bull in a beer garden. To treat the wound, Binns cleaned and dressed the injury, draining it of “stinkinge bloody matter”, and continued to purge the man with enemas and internal medicines. He was demonstrably knowledgeable of, and reliant upon, humoral theory when treating many patients while still tailoring treatment to individual ailments and bodies. As a surgeon, Binns’s practice was supposed to be limited to external treatments and to following physicians’ directives. Physicians, on the other hand, were seen as caretakers of medical knowledge who were privy to the inner workings of the human body. They alone could rightly interpret the body’s signs using their knowledge of Galenic and Hippocratic theories, prognosticate, and treat accordingly.
Physicians saw surgeons’ physick practice as treading dangerously into their own territory. They denounced surgeons as uneducated and their practice of internal medicine as illegitimate. The physician James Primrose, for example, lamented that “in many places Surgeons are wont to arrogate to themselves the function and office of Physicians.” Likewise, tensions steadily rose between London’s Company of Barbers and Surgeons and the College of Physicians as both groups sought to create distinct occupational identities and spaces within the medical marketplace. Here, the College was fighting an uphill battle. With university-trained physicians commanding high fees that made them inaccessible to the typical patient, the surgeon was an able and more affordable alternative.
Interestingly, patients – even those who could afford a prominent physician – still patronized surgeons who practiced internal medicine. Bishop Lancelot Andrewes wrote to surgeon Joseph Fenton (Joseph Binns’s master) for medical advice on 6 August 1624. In his letter, Andrewes inquired specifically for Fenton’s medical knowledge, and described symptoms that were more suited to a physician’s practice than a surgeon’s: lack of appetite, losing taste for drink, and a painful left foot. At the risk of retrospectively diagnosing Andrewes, his symptoms sound very much like gout.
How did surgeons justify this broad scope of practice? Ancient Greeks and Romans saw medicine, they argued, as a single practice made up of three related parts: diet, surgery, and physick or pharmacy. Each was valuable and distinct: “there be 3 parts of that Phisick which at this time we professe, Chirurgery which by the use of the hand, Diet which with a convenient manner of feed and & ordering the body, Pharmacy that by medicines attempt to expel diseases, & preserve health.” The separation of the three parts into three occupations was thought an artificial interpretation of medicine. John Knight, the Serjeant-Surgeon under Charles II, in his lecture “Signa Prognostica Medicinae” quoted Scribonius Largus saying that the work of physicians, surgeons, and apothecaries was so intertwined that “they cannot but to the Detriment of the professions and man kinde be well separated.” Despite pressure from the College of Physicians, the Company of Barbers and Surgeons turned a blind eye to those practicing internal medicine, and stepped up when necessary to defend them from legal prosecution. On 12 December 1690, the Company declared it would cover the cost of Fenton Binns’s – Joseph’s son – legal fees if he was arrested by the College “for giving internall medicines in a case of Surgery.”
So, perhaps, it may be time to revisit our popular ideas about the nature and scope of early modern surgery. As the surgical practice of both Binns’, John Conny, and James Molins demonstrate, both individual practitioners and the Company of Barbers and Surgeons acknowledged, and actively defended, the surgeons’ right to a general practice beyond the operating table. It is necessary to step away from the characterization of early modern surgeons as purely ill-educated manual artists and recognize the fluidity of occupational boundaries during the period. The medical field was in a state of flux for the three hundred years typically considered “early modern.” Definitions, professional boundaries, the nature of the body and disease were consistently negotiated, renegotiated, and redefined in the period. The surgical practitioner was a key part of this process as he negotiated the medical marketplace and sought to increase his occupational and social status.
Samantha Sandassie is an early modernist and historian of surgery whose research and teaching interests range widely from the history of medicine and early modern Europe to the history of science and environment. You can find her at www.medhistorian.com and on Twitter @medhistorian.
 See for example: Louise Noble, Medical Cannibalism in Early Modern English Literature and Culture (New York: Palgrave MacMillan, 2011), 52-53. Sir George Norman Clark, A History of the Royal College of Physicians in London (Oxford: Oxford University Press, 1964). Vivian McAllster also stresses the differences between surgeons and physicians in “William Harvey, Fabricius ab Acquapendente and the Divide Between Medicine and Surgery,” Canadian Journal of Surgery 50,1 (February 2007), 8.
 Most characterized surgery as an art or trade as opposed to the science of professional physic: A.M. Carr-Saunders and P.A. Wilson, The Professions. (Oxford: Oxford University Press, 1933); Toby Gelfand, Professionalizing Modern Medicine: Paris Surgeons and Medical Science and Institutions in the 18th Century (Westport, Connecticut: Greenwood Press, 1980).
 Christopher Lawrence, Medical Theory, Surgical Practice (New York: Routledge, 1992), 10; Irvine Loundon, “Leg Ulcers in the Eighteenth and Early Nineteenth Centuries,” Journal of the Royal College of General Practitioners part I, vol. 31 (1981), 263-273 and part II, vol. 32 (1982), 301-309; Robert Jutte, “A Seventeenth-Century German Barber-Surgeon and his Patients,” Medical History 33 (1989), 189; Mary Lindemann, Medicine and Society in Early Modern Europe, (Cambridge: Cambridge University Press, 1999), 216.
 BL Sloane MS 153. Joseph Binns, Surgeon to St. Bartholomew’s Hospital, Medical case-book, 1633-63. Binns’s casebook covers his practice from 1633-1663 and has been examined thoroughly by Lucinda McCray Beier in Lucinda McCray Beier, “A London Surgeon’s Career: Joseph Binns,” in Sufferers and Healers: The Experience of Illness in Seventeenth-Century England (London: Routledge & Kegan Paul, 1987), 51-96 and “Seventeenth-Century English Surgery: The Casebook of Joseph Binns,” in Christopher Lawrence (ed), Surgical Theory, Medical Practice: Studies in the History of Surgery (London: Routledge, 1992), 48-84.
 BL Sloane MS 153 f. 12, 32, 49.
 BL Sloane MS 2779 f.1b, f.5-6.
 BL Sloane MS 2766 f. 2-32b.
 BL Sloane MS 3293 f. 242, 242b, 245, 245b, and 250b.
 BL Sloane MS 153, f. 18b.
 James Primrose, Popular Errours, trans. Robert Wittie (London: printed by W. Wilson for Nicholas Bourne, 1651), 36-39.
 BL Sloane MS 118, f. 29.
 Ambroise Paré, The Works of that Famous Chirurgion Ambose Parey, trans. Thomas Johnson (London: Thomas Cotes and R. Young, 1634), preface unpaginated. See also: Thomas Vicary, The English-mans Treasure (London: B Alsop and Thomas Fawcet, 1641), 2-3.
 BL Sloane MS 211, f. 1.
 Sidney Young, The Annals of the Barber-Surgeons of London (London: Blades, East & Blades, 1890), 345.