Doctor's Review: Medicine on the Move

November 29, 2021
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Mad men and barbershops

In medieval times, a bowl of blood advertised an unusual assortment of services

As the butt of countless jokes, lawyers who advertise on TV may or may not belong in one of Dante’s circles of hell, but ambulance-chasers of ill repute certainly weren’t the first professionals to, er, lower the bar by employing somewhat lurid methods to reel in clients. The history of medicine is, in fact, rife with snake-oil salesmen who used fear and trickery to play to the insecurities of potential patients. In some ways it was a necessary evil, and perhaps it still is.

Before newspapers and pop-up ads, before junk mail and Madison Avenue, the service-providers, healers and merchants of the Middle Ages were forced to get creative when it came to advertising their skills and products. Nobody could read and with most forms of effective public communication centuries away, the options for getting the word out were extremely limited. Basically, there was word of mouth, the town crier (if one could afford it) and that good old standby, the shop window. Barber-surgeons – those medieval hybrid healers with a penchant for slicing and dicing – had the most sensational, macabre window displays of all. But first, a little backstory...

Old-school phlebotomy

Bloodletting was the Tylenol of times past: a panacea for virtually every ailment doctors could diagnose – and especially for those they couldn’t. Some 3000 years ago, in the cradle of civilization, the Mesopotamians were the first known people to drain blood therapeutically. The ancient Egyptians took up the tools too, as did the Greeks under Hippocrates. Ancient Ayurvedic texts describe bloodletting practices in great detail, as did Chinese and Islamic sources. Even the Talmud references the many wonderful, curative ways that blood could be drained from patients.

But nobody was more enthusiastic about purgative phlebotomy that the Romans. Galen (AD 129-c. 210) – the humour-obsessed darling of all things medicinal and philosophical – ensured that bloodletting became so deeply ensconced within the medical and lay communities that his influence in this matter endured for some 15 centuries after his demise. There was no questioning the value of phlebotomy; to argue against its usefulness was tantamount to apostasy.

During the plague-infested centuries of the medieval era that stretched roughly between 400 and 1400, medicine was basically devoid of logic in all its forms. These Middle Ages, also more aptly referred to as Dark, were among the very worst times in human history that one could have had the misfortune of being born into. Disease, famine, war and the fallout of feudalism meant that people (including the one percent) lived short, painful lives filled with work for very little consideration except the hope of cosmic reward in the sweet hereafter. It was, however, the Golden Age of bloodletting.

So while bloodletting was everywhere – vigorously employed to drain the body of the wrong humours, “excessive” blood, evil spirits and virtually anything a doctor or patient could imagine – not everyone was willing to do it. Many physicians, in fact, considered it beneath them to do the cutting themselves, and so referred their patients to the so-called barber-surgeons.

The Ancient Egyptians viewed barbering as a noble art, one usually reserved to priests or doctors, since the pharaohs’ hairstyle – shaved with only a ponytail on top – was intimately connected to their worship of the sun-god, Ra. This likely derives from various tribes’ notions that the hair was a portal to bad spirits, a way for an imp or devil to sneak into the body and take hold of the mind. Proper haircuts ensured protection as well as kept the good spirits from leaving. Later the barbershops of Ancient Greece and Rome became social gathering places too, and the ceremony surrounding a young boy’s first shave was an important part of his coming of age.

Shave and haircut: 10 florins

Fast-forward a few hundred years to after the fall of Rome, when the once-glorious public medical system was in ruins and there were no rock-star doctors to build healing temples or publish materias medicae. The responsibility of healing was about to fall into the hands of the barber, as akin in skills and responsibility to a physician as a hair stylist.

This shift came about in large part because of the rise in monastic medicine. As focal points for education, religion and public care, monasteries were literally the centre of the action during the early Middle Ages. Only one problem: Papal decrees prohibited monks from spilling blood, a rather inconvenient glitch since monks were usually the ones practicing medicine at the time. The solution? Barbers were enlisted; besides their actual hair-cutting duties, part of their job was to get their hands dirty cutting and stitching, bleeding and cupping.

Medicine evolved slowly but surely, thanks in part to a sort of mini Renaissance during the 12th century when medical texts from the ancient Greeks, Romans and Arabs were translated into the languages of the day. Healing returned to the hands of trained physicians, at least in theory. Before too long, the guilds – powerful political associations of tradesmen with common tools and practices – were naturally lumping barbers and surgeons together. Not only did they use the same tools, but their history was intricately intertwined.

It was the birth of the barber-surgeon – ready, willing and able to use his blade to free your blood from its veins for a few florins. There was no problem too intimate or too complicated for one’s barber-surgeon to attend to. On a good day, you might go in for a shave and an enema. On another, you might need to have a cyst lanced, a rotten tooth extracted, a fistula repaired or just a good old-fashioned vein drain, either by blade or by leech. There was no anesthesia, of course, but there was always that strap the barber used to hone his blade – a good choice for biting down on while the master practiced his craft.

With no secretary up front to place calls to patients reminding them to come in for an annual draining, the barber-surgeon used the art of advertising to drum up business. The hallmark of his window display was a bowl of fresh blood, recently culled and glistening suggestively for all passersby to see. Londoners eventually recoiled from the sight, and petitioned the city to take care of the problem. In 1307, the blood bowls were banned: “No barbers shall be so bold or so hardy as to put blood in their windows.”

Pole positioned

The pole was devised as a reinterpretation of the bloody and clean rags that were hung outside the barber’s shop to dry; the white stripe now would indicate the service of barbering, while the red denoted the master’s surgical skills. Alternately, some scholars believe the red and white simply represent bloody and clean bandages. On the tops of these first poles was a copper washbasin, of the kind that was used to hold leaches; on the bottom, another bowl of the sort used to collect blood. (Eventually the bowls were replaced with balls.) The pole itself was chosen as a fitting symbol since patients were traditionally handed a pole to squeeze against the pain – and to encourage veins to swell up – while they were being bled.

As the centuries wore on and life retreated somewhat from the country to the burgeoning cities, livery companies took the place of many medieval guilds, though they had similar raisons d’etre. The Worshipful Company of Barbers was formed in London in 1308, and governed the laws and rules surrounding barbering and surgery. Since barbering was such a desirable and often lucrative profession, failed surgeons often tried to join their ranks.

But by 1368, everyone had had enough, so the surgeons were granted permission to form their own association, though barbers still had the authority to oversee them. An Act of Parliament saw the two guilds merge once again in 1540 into the Company of Barbers and Surgeons, though someone had the good sense to provide that barbers stick to hair while surgeons were to do all the slicing. Naturally, they were both allowed to pull teeth.

It was the death knoll for the once-mighty barber-surgeon. Surgery was quickly evolving into a real medical discipline, and they broke away from their hair-cutting counterparts in 1745 to form what would soon become the Royal College of Surgeons.

So what of the Worshipful Company of Barbers? It still exists, though no members cut hair. Most liverymen among its ranks are, in fact, medical professionals, and the historical guild’s modern mandate is now to raise money for surgical and medical charities. (It remains unknown whether, in turn, any trained barbers are members of the Royal College.)

The next time you go to get a haircut, ask your barber or hairdresser if they might be willing to lance that boil while they’re at it, or get rid of a little extra yellow bile. Even better – assuming you’re not too worried about drumming up some competition – suggest they take down that silly red-and-white spinner and put a nice fresh bowl of blood in the window instead. It would be sure to attract attention, though perhaps unlikely to garner them any new clients.

This article was accurate when it was published. Please confirm rates and details directly with the companies in question.


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