Wednesday, 23 April 2014

To Honour the Bard: "Send in the Surgeon"

The post’s title is a bit misleading, I admit.  You see, surgeons were never Shakespearean characters.  Todd Pettigrew has argued that was because “because the culturally available narratives surrounding the surgeon were, ideologically speaking, blurry and confused.”[1]  Fair enough, occupational boundaries did put the proverbial “gray area” to shame.

Surgery and surgeons do pop up on occasion in Shakespeare and in various other 17th century plays and prose fiction.  The narrative examples employed by these authors of fiction reflect the beliefs related to surgery and its practitioners.  If the cultural narratives and available literary representations were blurred and confused, it is simply because it is reflective of surgery’s growth in the period. 

The 17th century was one of transition and importance in the professionalization of surgery.  Both guild and individual practitioners sought epistemological legitimacy, and increased occupational and social credit by presenting themselves as similar to physicians.  Contemporary novels, plays, and ballads, can help us gauge how these attempts to increase social and professional credit were perceived by 17th century writers and their audience. 

The physician was a popular character; Thomas Berger and William Bradford’s index of characters in early modern drama lists 104 identified as doctors and a further 68 as physicians.[2] In contrast, they list only 35 plays that include surgeons as characters.[3]  The surgical practitioner in all of these texts was a minor character at best, named rarely, with few lines of speech. 

For a conference paper & thesis chapter I looked at a further 90 items of prose fiction and 30 ballads that revealed similar findings.  Surgery and its practitioners were referred to briefly and in passing; someone would send for the surgeon, he would examine and dress a wound, and promptly exit the scene.

Though the Bard never included surgeons as characters, we do get a sense of his  understanding of surgery/surgeons in both The Merchant of Venice and Macbeth. 

Surgeons treated wounds and were to be fetched immediately!
Portia: Have by some surgeon, Shylock,
on your charge, to stop his wounds,
lest he do bleed to death. 
The Merchant of Venice IV,i.
Captain: But I am faint. My gashes cry for help
Duncan: So well thy words became as thy wounds:
they smack of honour both—go get him surgeons.
Macbeth I,ii.
I find especially telling the portrayal of surgeons in Philip Massinger’s A Very Woman.  He portrays interprofessional (or interoccupational; surgery as a “profession” is much contested) cooperation where an unnamed doctor and two surgeons work together to successfully treat a wounded man.[4] 

This depiction is particularly interesting as it reveals Massinger’s understanding of the role of physicians and surgeons and he uses the moment to reinforce the subordination of surgery to physic. 

The doctor and surgeons disagree over a course of treatment for their wounded and melancholic patient Don Martino Cardenes: 

Doctor: He must take air.
1 Surgeon: Sir, under your correction,
The violence of motion may make
His wounds bleed fresh.
2 Surgeon: And he hath lost already
Too much blood, in my judgment.
Doctor: I allow that;
But to choak up his spirits in a dark room,
Is far more dangerous.  He comes; no questions.[5]

Though important to note, this disagreement is more significant than just a doctor overruling the judgments of two surgeons. 

Rather, the scene also reveals something of the professional boundaries Massinger thought important.  The surgeons’ expertise lay in the treatment of wounds and they are focused on his blood loss.  In contrast, the physician’s knowledge of medical theory meant that he approached the patient with a more holistic view of his wellbeing.  Both Martino’s mental and physical state could be treated with a change of environment; no doubt influenced by the Hippocratic writings universities deemed necessary reading for physicians. 
The doctor’s relationship with the two surgeons is an interesting one.  Though they work together, it is evident that he makes the therapeutic decisions and they act accordingly.  The physician hints at this when he praises their conduct – the surgeons did not use quack medicines, but followed the rules of Chiron and Aesculapius themselves.  As the second surgeon states “we were but his subordinate ministers, and did onely Follow your [the doctor’s] grave directions.”[6] 

The other characters thus heap their praise upon the doctor.  While the surgeons are offered 3000 crowns as a reward, “such petty sums” could not fully thank the doctor and he was offered his choice of the treasury and a castle or city of his choice to rule.[7] 

A noble and humble character, the doctor requests only that a “Colledge for Physitians may be With care and cost erected, in which no man May be admitted to a Fellowship, But such as by their vigilant studies shall Deserve a place there.”[8] 

One of the good doctor’s last actions in the play is to ensure the continued good name of physic and its rank at the top of the medical hierarchy.  In Massinger’s eyes, at least, the manual artist could not compare to the physician with his complex and learned theories.

A fair representation of early modern surgeons and physicians do you think?  Let me know here or on Twitter - I'm @medhistorian. 

p.s. happy birthday Shakespeare!  Still awesome 450 years later.

[1] Todd H.J. Pettigrew, Shakespeare and the Practice of Physic: Medical Narratives on the Early Modern English Stage.  Newark: University of Delaware Press, 2007.
[2] Thomas Berger and William Bradford, An Index of Characters in English Printed Drama to the Restoration. Englewood, Colorado: Microcard Editions Books, 1975.
[3] Berger and Bradford, An Index of Characters in English Printed Drama to the Restoration.
[4] Philip Massinger, Three New Playes. London: Printed for Humphrey Moseley (1655), 46.
[5] Ibid., 46-47.
[6] Ibid., 22.
[7] Ibid., 22-23.
[8] Ibid., 82.

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