William Birnie investigates the story of a surgeon who sought to elevate the status of his profession…
William Cheselden (1688-1752) is remembered as the only eminent surgeon of the first half of the eighteenth century. This picture depicts him giving an anatomical demonstration in the anatomy-theatre of the Barber-Surgeons’ Company, which he joined in 1710 after completing his apprenticeship.
The Barber-Surgeons’ Company had been formed under Henry VIII in 1540 after the Fellowship of Surgeons was united with the Company of Barbers. For us today this may seem an odd thing to do, however, back then, it was fairly understandable as during the sixteenth and seventeenth centuries the degree of surgical intervention was limited.
In Cheselden’s time, surgeons trained through an apprenticeship during which, they would attend private anatomy lessons. Before the Anatomy Act of 1832, the only legal supply of bodies for anatomical purposes where those of criminals condemned by the courts. The Barber-Surgeons’ Company kept scrupulous control over the use of bodies dissected in their hall, with the macabre ritual of often later displaying the dissected bodies of executed criminals in niches around the walls. Cheselden himself was fined by the Company in 1714 for carrying out dissections without permission, which drew away audience members from regular lectures at the Company. With students having little opportunity to take part in dissections themselves, teachers would rely on models or anatomical preparations for class.
At just twenty-three years of age, Cheselden drew up a detailed syllabus of a course of lectures on anatomy that he would deliver three times a year. Cheselden was an extremely good anatomist and draughtsman, and it was his aim to publish an atlas of the body that was both artistic and accurate. At this time there was no small suitable manual of anatomy in English, and so, in 1713, Cheselden published his lectures, illustrated with twenty-six plates as The Anatomy of the Humane Body.
He insisted on the importance of medical students having meticulous knowledge of anatomy, and on practical dissection as the basis of this knowledge. The Anatomy of the Humane Body was a handy manual for the student, and complemented his practical dissections. It contained everything a student of medicine and surgery needed to know and, more importantly, was readable, with Cheselden himself commenting: ‘truth, brevity, and plainness of description being all I aim at.’ This book remained popular among medical students for over a century, with the title page bearing the intriguing quotation: ‘of all God’s work that do this world adorn, there is not one more fair and excellent than is man’s body both for power and form’.
He joined the staff of St. Thomas’s in 1718, and during the 17 years that he stayed there, Cheselden became the best known surgeon in Great Britain. His book published in 1733, titled Osteographiaor the Anatomy of the Bones, offered specimens that he, as England’s top surgeon and anatomist, judged to be the most representative cases. In order to capture these innovative and beautiful images, he used a camera obscura, the first time this had been attempted for medical imagery. The outlines were sketched first, with assistants later reworking the drawings and adding detail. Interestingly, the first page of this book shows a self-portrait sketch of Cheselden drawing with the aid of the camera obscura.
By the 1720s there were calls from a few London surgeons to separate the Barber-Surgeons’ Company, in order to reflect the professional ambitions of the surgeons more accurately. There was an important distinction to make between the two; surgeons would perform trephining, drilling into the skull to lift depressed fractures, and lithotomy, cutting for bladder stones. Interestingly, Cheselden was capable of removing bladder stones in under a minute. Barbers would perform bleeding, tooth extraction and minor surgery. Another reason given for the dissolution of the Company was to allow greater freedom for anatomical training, with Cheselden aiming to free the surgeons from what he felt to be annoying restrictions put upon them by the regulations of the Company. He felt that surgeons, as a professional body, could not develop while tied to the barbers. The century in which he lived saw the development of an erudite underpinning for surgical practice through teaching and publications. Writing four years after the split, he said the rulers of the Barber-Surgeons’ Company had prevented the spread of knowledge about anatomy and ‘the improvements in anatomy since their restraints have been removed will sufficiently convince the world of the unfitness of them.’ This all coincided at a time when charitable hospitals were allowing surgeons to build a greater social status by working for them, albeit unpaid, with the additional benefit of allowing surgeons to build private practices among wealthier patrons.
This campaign for separation, led by Cheselden and his surgeon friend John Ranby (1703-1773), resulted in the split of the Company and the formation of the Company of Surgeons, in 1745. This would later become the Royal College of Surgeons of England which is still in existence today. It is interesting to note that Ranby had been surgeon to the Royal Household, and having attended to George II, held much influence with him. This new company could stage dissections at a new theatre located at the Old Bailey, next to Newgate Prison, where prisoners’ bodies would be bought straight from the gallows. The late 1740s saw surgeons openly advertising anatomical classes in ‘practical anatomy’, adding to a wide range of medical lectures already available in London.
William Cheselden was a true pioneer, he saw the need for scientific surgical education, and actively promoted publications and the methodical teaching of pre-clinical sciences. The first surgeon of his age and among the chief agents in separating the surgeons from the barbers, with a view to better training for surgeons, Cheselden deserves to be remembered for his superb skill and far seeing views on medical education.
William Birnie is a Visitor Service Assistant at Wellcome Collection. You can contact him at W.Birnie@wellcome.ac.uk.