History of Medicine Book of the Week: Cases in Surgery (1770)
Safar Saydshoev May 22, 2020
From Barber Surgeon to Medical Profession: Dr. White and the Adaptation of Surgeons in 1700
By Patrick Gauthier
Even in the past decade, medicine has evolved into something that is nothing short of extraordinary. As treatments and cases in surgery continue to revolutionize the world in innovations, the origins, concepts, and implementation of the surgical forefathers plays a crucial role in discovering our roots. Not only does it show where we have been, but it also gives us a greater appreciation for where we are going. Dr. White’s book, which was originally published in 1770, now resides in Leo J. McCarthy, MD, History of Medicine Room and Collection at the Ruth Lilly Medical Library.
While Dr. Charles White’s book, Cases in Surgery, may be seen as unremarkable when viewed in the large scope of medicine, it still plays an important role in understanding the foundation of surgery and the shift from early forms of medical practice. Dr. White’s book showcases the crucial role of surgery in a hospital setting in the mid-to-late 1700s.[ii] This perspective on surgery was vastly different from popular belief of previous centuries, when surgery was considered to be an undesirable profession among the various fields of medicine when compared to the more prestigious and scholarly physicians.[iii]
However, in White’s book, one of the most persistent goals throughout is that of educating people, especially younger surgeons, in not only how to perform operations, but also how surgery is used in healing.[iv] As White endorsed the clinical use of surgery, he also stressed the importance of combining physicians’ scholarly learning with hands on experience seen in barber surgeons. This view is a dynamic shift of perspective from the lowly barber surgeon to the beginnings of prestige in surgery as it is seen today.[v] White’s book shows the early transformation of surgery to the modern form of medical practice we see today. This is largely due to how White was trained and the experience he had through his education.
Like most surgeons White began as an apprentice to his father, Thomas White. After his apprenticeship was over, he went to study in London, where he received his degree, under William Hunter. In his time of study White became close friends with Williams brother, John. John and White became close working colleagues that revolutionized the way hospitals functioned across England. What he had experienced in his formal education inspired him to take part in the founding of the Manchester Infirmary at the age of 24.[vi]
Throughout his career, White maintained an interest in anatomical dissection in relation to the human body. White began to teach these anatomical findings by facilitating and starting the first public lectures in the area of Manchester. White understood the importance of surgery and the need to have a basic education to be able to be an expert in it. White then wrote down each surgical case, eventually publishing them as a teaching tool for young practicing professionals. Cases in Surgery allowed aspiring surgeons to understand how each operation could be used as a treatment to attempt to save a patient’s life.[vii]
The standard way of teaching at this time was to illustrate and explain each historical case. In his book, a detailed illustration of what was wrong or the treatment that was used is included along with the discussion of each case.[viii] These principles shown throughout the book are best seen in the opening case of the book, a patient known as William Slater. On August 10th, 1761, Slater was amputated from the knee down. White states the surgical procedure used, amputation flap principle, and also includes diagrams of what the stump and cast should look like post-surgery. Along with this information, White also stated how this case impacted future surgeries in that all patients from this surgery complained of diseased joints that may require further treatment and that he needed to do a double incision rather than a single incision near the head of amputation. Although Slater later died of consumption, also known as tuberculosis, White continued to use what he has learned in his first case with three other patients needing similar operations seen in various stages of his career.[ix]
White saw the need for improving surgery within the hospital by combining the skills of barber-surgeons with medical education to develop a well-rounded medical professional. While Cases in Surgery was simply a book to teach and train younger surgeons it came at a crucial moment in the history as the field of surgery was developing. Its author was at the center of a developing surgical field whose practitioners were crucial in propelling surgery to its prominence today. Understanding this book and its author is understanding the roots of the modern surgeon.
This post was written for the course HIST H364/H546 The History of Medicine and Public Health (Instructor: Elizabeth Nelson, IUPUI School of Liberal Arts).
[i] Leo J. McCarthy, MD History of Medicine Room and Collection, Ruth Lilly Medical Library, photograph by Patrick Gauthier.
[ii] Charles White, Cases in Surgery, with Remarks. Part the First (London: Printed for W. Johnston, 1770), 1-40.
[iii] Owsei Temkin, "The Role of Surgery in the Rise of Modern Medical Thought,” Bulletin of the History of Medicine 25, no. 3 (1951): 248-59, http://www.jstor.org/stable/44443639
[iv] White, Cases in Surgery, 20.
[v] William R. Le Fanu, “The Lost Half-Century in English Medicine,” Bulletin of the History of Medicine 46, no. 4 (1972): 319-48, http://www.jstor.org/stable/44450817
[vi] Behr, G. "Charles White Of Manchester: The 250th Anniversary of His Birth," The British Medical Journal 2, no. 6153 (1978): 1699-700, http://www.jstor.org/stable/25430372.