House-Surgeon and not House-Physician?

Where the Term ‘House Surgeon’ Comes From

Q: “Why is an intern called a house-surgeon and not a house-physician?”

This is a very interesting question, and I had to dig really deep to find the answer. We’ve all heard this term being used for interns in India, but the matter was complicated by the term having different meanings in India and the UK.

To understand where the term ‘house surgeon’ came from, we need to first understand who a ‘surgeon’ is.

Who is a ‘surgeon’?

The word ‘surgeon’ today refers to a doctor who specialises in the treatment of injuries or disorders of the body by incision or manipulation, especially with instruments.

When you think of the word ‘surgeon’, I bet you think of someone like this:

And not someone like this:

Surprised?

The English word ‘surgery’ comes from Latin ‘chirurgiae’, which in turn is derived from a Greek word meaning ‘the work of hand’. In medieval Europe, there used to be a huge divide between ‘physicians’ and ‘surgeons’. In mediaeval Europe, the practice of ‘surgery’ was not generally not carried out by medical practitioners (who were typically formally educated and known as ‘physicians’) but by hairdressers or ‘barbers’, who were trained by apprenticeship and not formally educated in medicine, and were known as ‘barber surgeons’.

Because barbers used instruments like razors, they were frequently called upon to use them for procedures like blood-letting, pulling teeth to amputations; and would frequently serve at the battlefield as well.

A barber-surgeon extracting stones from a woman's head; symbolising the expulsion of 'folly'(insanity). Watercolour by J. Cats, 1787.

The Company of Barber-Surgeons was one of the many ‘livery companies’ (associations of people belonging to a particular profession) of the City of London, since 1540 – when the Fellowship of Surgeons had merged with the Company of Barbers.

The 1700s saw the age of ‘enlightenment’ – when traditional arguments in various fields were retired after having failed the test to empirical science. Newer discoveries in the field of medicine led to a growing movement in England and other parts of Europe for surgery to be practiced by those with medical experience. In 1745, the Company of Barber-Surgeons split to form the Barbers’ Company (which still exists today) and the Company of Surgeons. In 1800, a Royal Charter was granted to the Company of Surgeons, and the Royal College of Surgeons was established in London.

Hospitals & House Surgeons

In the early 1800s, both physicians and surgeons used to work at hospitals. And although surgeons now belonged to the medical fraternity, there was still a large professional ‘gap’ between the two – with a physician being considered the ‘real doctor’ and a surgeon was between a physician and a barber in professional hierarchy.

As physicians were elite and more expensive, it was difficult for hospitals to make them stay in the hospital premises and would typically be called only on rare occasions. Surgeons however were more dispensable and would stay at the hospital, and hence came to be known as “house surgeons”. According to Dictionary.com, the earliest use of the term “house surgeon” dates between 1815 and 1825. Because these doctors were often young and in the early phases of their careers, it is likely that this term was used in India for the youngest doctors working in a hospital – the interns, and it’s likely that it is for this reason that medical internship after MBBS is still known as ‘housemanship’ in many circles. In the UK, however, the term ‘house surgeon’ has evolved to mean a first-year surgical resident.

Acknowledgements

A lot of hours were spent researching for this piece, and it could not have been possible without the help of Gp Capt Anurakshat Gupta –  surgeon, medical history pundit and co-founder of the International Quiz Association.

By Dr Anmol Dhawan