For hundreds of years the monks were not allowed to wear a beard; this necessitated the employment of tonsors ("tonsorial-artists" they call themselves to-day) to whom was left also the performance of anything that partook of the nature of an operation, such as bleeding, bandaging, etc. This calling, was however, recognized as a most inferior one, and the barbers, like the bathkeeper, the shepherd and the hangman, were not considered of good repute. Consequently, such an one was not eligible for membership in any other guilds or fraternities. In 1406 the Emperor Wenzel was rescued from prison, in Prague, by the daughter of a bathkeeper; in gratitude he made her his mistress, and declared both barbers and bathkeepers to be respectable; but having lost his position his decree had no weight, and not until 1548, in Augsburg, were they really made eligible to the guilds. At this time their most dignified labor was the sharpening of instruments. In 1696 Leopold I. decreed their profession to be an art, and gave it a position above that of the apothecary so that in their most dignified occupation they were elevated to the making of ointments and plasters.
As surgery has for the profession of barber surgery to thank the existence upon man of a beard, so the European continent may thank the Crusaders of the eleventh century for having necessitated the existence of the bathkeeper, because of the leprosy which they brought home from the East. During the Crusades, as is well known, there were founded numerous Orders having for their original purpose the care and protection of pilgrims and injured soldiers. The three most celebrated Orders were the Knights of St. John, the Knights Templar and the Teutonic Order. Were this the place it would be most interesting to go into a history of these religio-medico-military Orders, and show how from most devout purposes and humble origin they grew into despotic and tyrannical associations of great power, which it finally took all the force of Church and State to suppress. As the then humble and enthusiastic members of these Orders returned from the Holy Land they established hospitals for the care of lepers, who became very numerous in Europe. For instance it is stated that in France, in 1225, there were two thousand hospitals for this purpose, while the King Louis the Great founded, in 1260, a special hospital for those made blind by Egyptian ophthalmia. It is well known also that during the middle ages there was the greatest neglect of the ordinary canons of cleanliness both among the upper and lower classes. The number of hospitals and cloisters dedicated to the lepers being insufficient, bath houses were built and bathkeepers were engaged in order, so far as possible, to prevent the spread of leprosy. At this time the bathkeeper was permitted to bathe and cup, later also to bleed, although the bleeding was required to be done in the bathkeepers' own house, since he was not usually permitted to enter a patient's house. As bathing became less necessary for purposes already mentioned the bathkeeper took to imitating the barber, though much later, and not until about 1750 in some countries, were they permitted to do this publicly, and only after having passed the examinations to which the barber was also subjected. In Prussia they were only allowed to treat wounds and chronic diseases, and so it came about that by the beginning of the eighteenth century a really conscientious and efficient barber surgeon was supposed to have served an apprenticeship in large hospitals, to have witnessed the work of noted surgeons and to have served in the Army or Navy. He was also supposed to be something of a linguist and to know a little botany; particularly was he expected to be conversant with anatomy, although there was a sad lack of cadavers—which was atoned for by the use of carcasses of animals, for the main part swine.
Eckardt, writing at this time of the sixteen different virtues of a barber, enumerated, first of all, fear of God; then that he should be careful, prudent, temperate, and ready to use both hands with equal dexterity; he claimed that "Arrogance seems most prevalent among barbers, as a common saying would imply 'barbers are proud animals.'" He expressed his surprise also at the envy and malice between bathkeepers and barbers, and advised them both to consult physicians and other masters.
The customs of the time must be blamed for this lamentable condition of affairs. The boy who was destined to become a barber was apprenticed at a time when he had scarcely learned to write. If he could write legibly and read a little Latin no one dared refuse him. He learned to shave and went from house to house for this purpose, spending the little time remaining in sharpening knives, spreading plasters, picking lint, taking care of children, doing all menial duties, and using the same light as the housemaid because it would have been disrespectful to his master's wife to use any other. After years of this work he was gradually taken to visit patients and then was taught how to bleed, cup, apply leeches, extract teeth and clysters. His master knowing nothing of anatomy could give him no instruction, though by the laws of apprenticeship he was bound to do so. Before concluding this apprenticeship he was supposed to pass an examination, which his master's laziness usually permitted him to escape. He then presented the master with some silver instruments and was dismissed with an injunction to be thankful that such a miserable specimen of God's creatures had ever been taught to shave a beard or spread a plaster. He now became a journeyman, still living at the house of his master, and was not allowed to marry; after a while he received a paltry sum as wages, got his dinners free and began to dabble on his own account. Study was out of the question; these men could not understand what little they did read and served the community mainly as bearers of tales. After some years of activity as journeyman they could become masters by applying to the authorities, presenting certificates, and passing an examination before the physicians of the district.
Prussia was the first country to appreciate the necessity of regulating medical practice, and the barbers and bathkeepers were placed under the control of the Medical College founded, in 1685, by Prince Frederick William. In 1724 this institution attained its greatest activity, having a subordinate school in each province. In 1725 King Frederick William issued a famous edict which did much to regulate medical affairs throughout the kingdom, and directed among other things that barbers and bathkeepers should "lead a religious, temperate, retired and sober life, in order to be at their best whenever their services were required." When their business was not sufficiently good they assumed other cares, as, for instance, one man was surgeon, municipal judge and post-master all at once. They were extremely envious of each other and often dabbled in medicine without permission. It was not until 1779 that the bathkeepers were permitted to rank in Prussia with the barbers, and were allowed to use more than four basins, the bathkeepers' guild being incorporated with that of the barber.
There being no temptation to enter these ranks it is not strange that so late even as 1790 good surgeons were rare in Germany; not one in fifty of the barbers really knowing the first principles of the work they were supposed to perform. It came to such a pass that surgeons were compelled to shave and perform other duties of the hairdresser, for no surgeon, however skilled, was allowed to practice as such, unless he was the proprietor of a head-shaving and bathing establishment, with assistants and apprentices, and belonged to the barbers' guild, or unless he was favored by Royal exemption. It was the general lament in Germany, all through the 18th century, that German surgeons were educated in barber shops. Even by the middle of that century the practice of surgery was not considered an honorable business, and those who practiced it were not permitted to carry a sword, neither was a surgeon admitted into society nor tolerated among physicians; moreover when unsuccessful he was bitterly and relentlessly pursued. Under existing conditions the Reichstag either could or would do nothing to alleviate the distressing condition. The physician boasted of his education and treated the surgeon and his craft with disdain, holding that surgery sustained the same relation to medicine that geometry does to higher mathematics and physics. All this time, however, while the physician contented himself with disdaining surgeons he made no attempt to elevate the craft nor to himself study and adorn it. Even by the beginning of the nineteenth century there were scarcely any physicians in Europe who could diagnose a surgical case, while dentistry they claimed called for no more skill than that sufficient for tooth extraction. It was even claimed that so long as the people generally were neglectful of their teeth the physician, or even the surgeon, should be ashamed to concern himself with dentistry.
Von Siebold, in his day, deplored the position of the surgeon; his large military experience had shown him the difficulties with which he had to contend before he could enter society, while his ambitions and high motives were scorned. Even the peasantry were bitterly opposed to all operations. So intense were their feelings that he repeatedly removed his patients to other towns before performing operations. Nevertheless it was true that there were the best of reasons for lack of confidence in any barber who dropped his razor for the purpose of treating a fracture, a hernia or an obstetric case. The State required a barber surgeon to call in a physician in all complicated surgical cases. In such a case the physician demanded the control of the case and reserved to himself the right to judge of what was required. He would not even consider a surgeon who had obtained the doctorate as his equal. Such consultations resulted in little but quarrels and disagreeable scenes. If a village contained no physician the surgeon treated also internal diseases, though he was not allowed to use strong medicines. Every district had its special surgeon who, alone, had charge of several villages where he had the right to keep journeymen and apprentices and to do shaving and cupping. In the Prussian capital city only twenty German and six French surgeons were allowed to practice in 1725, besides the court and private surgeons.
Until 1808 every German surgeon carried on a medico-legal business which was later separated from his surgery. In 1782 there were three classes of surgeons; from the lower one might be promoted to a higher after an examination. In Austria, in 1805, there were doctors of surgery who were required to show a general knowledge of medicine and who had the same rights as the physicians; there were also medical surgeons who could practice under restrictions, and bathkeepers for minor surgery. After the year 1773 barbers and bathkeepers were both spoken of in Austria as surgeons; this was to break up the disputes between them. According to an official feebill holding good in Prussia in 1815, the highest fee that could be charged for an operation was for lithotomy in adults, the maximum limit being about M. 140 ($35), while the majority of operations ranged from M. 20 to M. 50 ($5.00 to $13.00 expressed in U. S. money). Of course this was at a time when the value of money was much greater than now.
As already made plain, it was the Church which by its decrees brought about the separation of surgery from medicine, a condition not existing during the palmy days of Greece and Rome. Even the University of Paris at one time refused to admit a student who had not foresworn the study of surgery, while the denouncement of anatomy and surgery alike was promulgated by both papal bulls and clerical decrees. While many of the physicians considered surgery too burdensome a study, and many others had a severe prejudice against it, the principal cause operating to keep them apart was probably the fact that for surgeons there was absolutely no social position. In 1774 Mederer was made Professor of Surgery in Freiburg, in Breisgau; he delivered his opening address on the wisdom and necessity of combining medicine and surgery. As a result he was persecuted by the public, insulted by students, abused by surgeons and constantly threatened with personal assault. He maintained his position, however, and fought against the prejudice. Twenty-two years later, when he left Freiburg, he referred in his last lecture to his early experience. By this time public opinion had been so changed that the students serenaded him and humbly apologized for what their predecessors had done. Mederer could then see the success of his efforts in that the constitution of France contained a clause combining medicine and surgery, and the Royal Sanitary Commissioners of Vienna had unanimously resolved in favor of such union.