Leeches and Barbers: The Changing Meanings of Medical Personnel Terminology

All those familiar with Romeo and Juliet know of the role the apothecary plays in the lovers’ demise; we also laugh at the kindly nurse.  In The Merchant of Venice, Portia masquerades as a “most reverend doctor” and commands Shylock to “have by some surgeon […] on your charge / To stop his wounds” (4.1.221, 252-253).  Speakers of modern English recognize all these words and, most often, will associate them with terms used for medical personnel.  However, few of Shakespeare’s contemporaries would define apothecary, nurse, doctor, or surgeon in quite the same way.  Similarly, speakers in medieval England would also have their own conceptions of what these words mean. 

This paper aims to explore such past conceptions of terminology for medical personnel.   Although I will mainly focus on terms for primary caregivers such as doctors and nurses (and their earlier counterparts), some brief discussion of peripheral terms will also occur.  I will first consider each word in isolation and explore its change in meaning over time and then examine the words collectively to see how the meanings interact to create change and usage variations.

           Following this analysis, I will also briefly discuss limitations of my study and suggestions for further research. 

Exploration of Individual Terms^[1]
“More needs she the divine than the physician.” (MacBeth, 5.1.64)

          Although physician now refers to any medical doctor, physician at one point had other concurrent meanings.  The general usage of physician to refer to doctors has been documented since at least 1225, but from roughly 1400 to 1833, the term also designated any person who studied natural science or physics.^[2]  In the period from 1400-1895, another narrowed meaning existed; the term physician did not include those who practice surgery.  According to Nuland (1988) in his description of the medical field in fifteen century Paris, physicians were those practitioners who had received a university degree.^[3]  Such physicians studied Greek and Latin and healed with medicines and advice.  In the hierarchy of the field, physicians possessed both the highest levels of knowledge and the greatest socioeconomic status.  Haggard (1929) confirms that similar conditions existed in Great Britain.  He notes that during the Middle Ages and the Renaissance, physicians performed no surgery due to lasting influence of the manuscripts of Galen, who claimed that surgery was a baser form of treatment.^[4] 

          Although at one point physician did have narrowed meanings in comparison to its current usage, it is difficult to determine when narrowing or widening occurred.  The three meanings existed concurrently for a period of roughly four hundred years.  Traugott and Dasher (2002) refer to this type of semantic phenomena as polysemy.  With physician, a “layering” of meaning occurs as “older meanings coexist with new meanings” (p. 12). 

“Have by some surgeon …” (Merchant of Venice, 4.1.252)

 
^[1] In Great Britain, some vestiges of this distinction between surgeons and physicians still exist.  According to the OED, most medical practitioners describe themselves as “Physician and Surgeon.”
            
           Of all the terms for medical personnel, surgeon has remained relatively stable.  From its first documented use in the early fourteenth century, surgeon in its most basic conception has always referred to one who uses surgery to treat wounds, fractures, and other illnesses. However, the connotations associated with surgeon have gradually shifted.  One major shift has been in the public perceptions of surgeons.  For many years, surgeons were held in less esteem than physicians; they were not required to have a medical degree and often competed with barbers (see following section for further explanation of barber).  At one point during the fifteenth century, according to Gottfried (1986), surgeons were eclipsed in number and political clout by the barbers.  Another major shift is the type of practice performed by surgeons. Skinner (1949) claims that originally surgeons were restricted to using surgery for external disorders while internal problems were the realm of physicians.  Of course, in the twenty-first century the roles of surgeons have gained greater respect.  Surgeons today receive more training, not less, than the average general practitioner and are generally granted greater respect by the general public.  It is unclear when these shifts began, though it is possible that the distinction existed as late as 1813. 

           These earlier distinctions between surgeon and physician might possibly explain the use of surgeon to designate medical officers, a trend that eventually culminates in titles such as surgeon-general.  According to the OED, this usage was first documented in 1591.  In war, physicians, with their attention to internal maladies and veneration of Galen, would have been little use to soldiers with festering wounds and limbs needing setting or amputation.  Surgeons, though, would have been a necessary part of any military unit, whether on land or ship.^[1]

“You whoreson cullionly barber-monger, draw.” (King Lear, 2.2.29-30)

 


^[1] According to Skinner (1949), modern barber poles date back to barbers’ former role.  Blood-stained bandages wrapped around a staff would be set outside the barbers’ shops.  A basin for bleeding would sit on top of the staff. 
          Although the OED indicates that barber first appeared around 1380, Skinner (1949) suggests the term has an earlier origin.  He notes that barbers owe their beginnings to a 1092 degree forbidding monks to wear beards; the barbers were first trained to shave the monks and bleed them.  Nuland (1988) comments that in some areas, physicians would prescribe procedures such as bleeding for barbers to perform.^[1]  Gottfried (1986) notes that the barbers organized around 1300 and received a charter in 1376.  Eventually, barbers would split into two groups: the barber-surgeons and the barber-tonsors, who provided dentistry services.  However, as Skinner (1949) points out, no distinction existed between the surgeons and barber-surgeons until roughly 1745.  At this point, barbers began to restrict their activities to cutting hair, trimming beards, and possibly pulling teeth.^[2]  Such changes in barber are an example of subreption.  The meaning of barber changed because the barbers assumed different cultural roles. 

“Shall I lose my doctor? No, he gives me the potions…” (Merry Wives of Windsor, 3.2.85-86)
 

 
          According to Skinner (1949), doctor was first applied to those who had earned master’s degrees and were also teachers.  In the twelfth century, the first degree of doctor, meaning a degree advanced beyond the master’s level, was conferred in Italy, and this use of doctor eventually traveled to England, where the OED documents it as first being used in 1377. This use of doctor incorporates both the meanings of “teacher” and “extensive knowledge and learning.”  Eventually, Skinner notes, the faculties of law, medicine, and divinity in English universities all granted students the rank of “doctor.”  After the fifteenth century, though, doctor became more and more associated with the medical profession because only the doctors of medicine went out and practiced among common people, while doctors of law and divinity were more likely to remain in the universities and socialize with those of their own status.  For doctor, then, three main meanings have existed: doctor as teacher, doctor as learned scholar with a degree of doctor, and doctor as medical practitioner.^[1]  Doctor is also an example of polysemy, though the first use of doctor has largely diminished. 

^[1] The OED gives the earlier date of 1684 for the last documented usage of barber-surgeon.  Most likely, the shift occurred somewhere in the middle of these two dates. 

“Many skilfull leaches him abide /To salve his hurts” (The Faerie Queen, 1.5.17).

          Leech, as Skinner notes, derives from the Anglo-Saxon term laece, which means healer.  In its earliest uses, which the OED documents beginning in 900 A.D., leech referred to any who practiced healing.  In a case of probable metaphorical extension, leech became transferred to the blood-sucking worms typically used by such practitioners as a common form of treatment.  In such a sense, the worms were “healers” just as the men who controlled them were.  This transfer also possibly arose because of a shift; the worms became leeches because of their close proximity to the healers. 

^[1] Doctor at one point was also used to refer to an assistant-master in a school, but it is only documented for a period of sixty-five years from 1630-1695.  I treat this usage as part of the general meaning of doctor as teacher. 

           One of the earliest documented medical personnel terms, leech experienced subtle transformations in meaning.  By the medieval period, Gottfried (1986) suggests that leech was beginning to assume a derisive connotation.  Leech was used to describe country practitioners with no formal training who relied largely on folk medicine.  Such a shift, which Traugott and Dasher (2002) call a pejoration, was probably due to the emergence of barbers’ guilds and university-trained physicians.  In the seventeenth century, the OED claims that leech applied only in every day prose to veterinarians, a meaning that still exists in some dialects.  Of course, leech as a term for medical practitioners did not disappear completely and is still recognized by many speakers today, but usually only in a historical context.

“Throw physic to the dogs; I’ll none of it.” (Macbeth, 5.3.49)

 ^[1] The OED also suggests another possibility.  It speculates that the Old English form lyce and the early Middle English form liche refer to the worms and could have assimilated to laece or leech through popular etymology. 

Few sources discuss physic, as it referred to medical practitioners, in great detail.  The OED cites the first documented usage of physic referring to a doctor as being in 1362; the last reference occurred in 1764.  In these usages, physic seems to mean a doctor personified, as in the sentence “‘Lord, sister,’ says Physic to Law.”  Physic also referred to the practice of healing, medical science, and curative medicines, but these usages now are archaic. 

“I do remember an apothecary…” (Romeo and Juliet, 5.1.37)

           Originally, an apothecary was a person who stored non-perishable items in a warehouse or shop.  These items might happen to include drugs.  According to Skinner (1949), apothecary first became associated with medicine in England in 1302, and in 1606 the Society of Apothecaries was created in London.  The OED claims that in 1617 the Apothecaries Company of London became a separate entity from the Grocers.  Such a transfer might represent a subreption, or simply a change in the role of apothecaries due to historical conditions.

            Another subreption occurs when apothecaries were outlawed from prescribing drugs in 1866.  Before this time, according to Haggard (1929), apothecaries not only dispensed drugs, but also diagnosed diseases and prescribed drugs.  Of course, physicians, who viewed the apothecaries as uneducated and usurpers to the roles of physicians, tried to restrict such activities.  However, public sympathy remained on the side of the apothecaries, which Haggard claims is the result of the apothecaries’ willingness to remain at their posts during the plague while physicians fled.  Only in 1866 did the English government pass a law requiring a person have a medical degree to prescribe drugs.  At this time, the meaning of apothecary changed because of what Traugott and Dasher (2002) call an “institutional fiat” (p. 4).  The meaning created by the 1866 law is still recognized by speakers today, but it is considered archaic and has largely been replaced with chemist, druggist, and pharmacist.     

“Time is the nurse and breeder of all good.” (Two Gentlemen of Verona, 3.1.242)

Nurse originally designated a wet-nurse; the last documented usage of this meaning occurred in 1529.  The term eventually widened to encompass any woman who cared for young children, and even though this use sounds quaint to American English speakers’ ears, this sense of nurse still exists.  Metonymy is evident in the creation of the last meaning of nurse, one who cares for the injured and ill.  Part of the meaning of nurse—a woman who cared for children unable to care for themselves—was a person who cared for the helpless.  This segment of meaning transferred to form the basis for the modern usage of nurse.

Midwife has experienced little change in its meaning since its first documented usage in 1300.  Then, as now, a midwife was a woman who helped other women in childbirth.  The profession of the midwife has remained largely the realm of women.  Haggard (1929) notes that society considered men delivering babies to be scandalous.  He describes the 1745 obituary of a physician who “had the hardihood to proclaim himself a man midwife; it was deemed scandal to some delicate ears” (p. 70).  However, as it became gradually more acceptable for physicians to deliver children, the status and roles of midwives lessened.  Today, midwives still exist but are seen as an alternative to the more popular option of using a physician.  In the past several years, a new nursing specialization, that of the nurse-midwife, has also arisen.  Nurse-midwives have nursing degrees and an additional certificate qualifying them to provide prenatal and postnatal care.   

“One Isabel, a sister, desires access to you” (Measure for Measure, 2.4.18)
           

          

                    Predictably, the earliest meaning of sister refers to a female who has the same parents as the person in question.  The OED first documents this usage in 900 A.D. Another meaning of sister designates females of religious groups such as nuns.  Although it is possible that this second meaning arose because the nuns were as sisters to each other, the OED documents the religious sister as also appearing around 900 AD, and so it is difficult to make any firm conclusions about the relationship of the two meanings.  The last meaning of sister important to my discussion of medical terms refers to medical nurses and does not appear until significantly later in 1860.  The medical sister can refer either to nurses in general or specifically to charge or head nurses, creating polysemy between the two terms.  Though it may at one point have been used by U.S. nurses, today this meaning of sister seems to be limited to British English. 

            It is unclear how sister became transferred to refer to nurses.  Of course, the sisters of religious orders often engaged in charitable works and probably were practiced in caring for the sick.  This aspect of the sisters’ lives could have served as the impetus for such a transfer when the nursing profession became organized in the mid-eighteenth century.      

Interactions

            To demonstrate the interactions of medical personnel terms over time, I will examine the semantic field at three times: 1400, 1700, and 2000.  Although I choose these dates somewhat arbitrarily, I begin with 1400 because before this time, many of my terms were not in use.  More complex interactions also begin to occur around this date. 

            1400: Perhaps one useful way of examining the semantic field of medical personnel terms is through the hierarchy suggested by Gottfried (1986).  Gottfried states the following hierarchy, beginning with the most powerful, existed during this time period: physicians, surgeons, barbers, apothecaries, leeches, quacks and charlatans, and women, which would have included midwives.^[1]  Another useful way of examining medical personnel terminology in 1400 is to consider how each term divided up the responsibilities of the field.  As seen in the diagram, midwives, for example, would have been solely responsible for providing any prenatal and postnatal care, since men were typically not allowed to deliver children.  Physicians, also referred to as doctors and physics, occupy most of the part of the field that deals with diagnosis and prescription, although apothecaries also at times diagnosed diseases and prescribed medication.  Sharing the responsibility for surgery were surgeons and barbers, though country leeches also probably were required to perform surgeries.  This diagram also shows how two meanings of physician also existed.  Physician₁ was probably more widely used, while physician₂  had a broader meaning. 

 

^[1] To avoid making my discussion too complex and unmanageable, in this paper, I do not discuss quack and charlatan as they seem to be more
peripheral terms.  A more extended study, though, would include further investigation of these words. 

            Of course, a diagram cannot show all the interactions occurring at this time.  One important issue that does not appear on the diagram is the pejorative tone that leech was starting to acquire in 1400.  It is also difficult to determine the usage rates of some of these terms.  For example, was physician used more than doctor?  Also missing from the diagram are terms that in 1400 had not yet moved into this particular semantic field.  At this time, sister and nurse did not refer to any medical practitioners. 

            1700:  By 1700, several changes would have occurred.  Physic was no longer is use, and the use of barber was diminishing as a rivalry with surgeons ensued.  Apothecaries were slowly losing the ability to prescribe medicine.  A new meaning for surgeon also arose: the term was used to refer to medical officers in military units.  At this time, another word joined the semantic field as well when nurse was transferred to those who take care of the ill and injured.  Physicians and doctors were also beginning to branch into obstetrics, though only in progressive wealthy families.        

            2000:  By 2000, the semantic field of medical personnel terminology had changed considerably.  Terms such as barber have disappeared from this field, and leech and apothecary will most likely soon be gone.  Surgeon is now a subset of physician and doctor, and several new words, including pharmacist, chemist, druggist, sister, and nurse-midwife have been added to the field.  Also important is the diminished presence of midwife; although midwifes still exist and even experience a resurge in popularity in the past few decades, they perform a much smaller role now that physicians deliver most children. 

Limitations and Suggestions for Further Study

            Although my study of medical personnel terms provided interesting insight into this particular semantic field, some limitations existed.  Numerous terms existed that I could not cover because of time limitations and the increasing complexity implicit with adding more terms.  For example, I did not cover many terms that referred to doctor such as quack, charlatan, sawbones, medic, and healer.  I also hesitated to cover newer terms such as pharmacist, chemist, druggist, orderly, paramedic, nurse practitioner, and physician’s assistant.  Because these terms as they refer to the medical profession have been in use a relatively short time, they haven’t experienced very interesting semantic changes yet.  Furthering studying these terms would create a fuller vision of the semantic field. 

            Another limitation of my study was my lack of resources on the nursing and pharmaceutical professions.  All of my sources focused primarily on the history of physicians, and so what I learned about sister, nurse, and pharmacist I found in the OED.  Further research would hopefully uncover more information. 

            Overall, though, the semantic field of medical personnel terminology offers interesting examples of semantic change.  Polysemy, metonymy, shifts, metaphorical extensions, and subreptions are all present.  The field also provides an illustration of how culture and history interact to create change in word meaning and usage, whether through the feuds of apothecaries and surgeons or the demise of the barbers. 

References

Gottfried, R.S. (1986).  Doctors and Medicine in Medieval England,
            1340-1530.  Princeton, NJ: Princeton UP.

Greenblatt, S., Cohen, W., Howard, J.E., and Maus, K.E.  (1997).  The
            Norton Shakespeare.  New York: Norton.   

Haggard, H.W. (1929).  Devils, Drugs, and Doctors: The Story of the
           Science of Healing from Medicine-Man to Doctor.  New York:
           Blue Ribbon Books. 

Hensyl, W.R., Ed. (1982).  Illustrated Stedman’s Medical Dictionary. 
           24^th Ed.  Baltimore:  Williams and Wilkins. 

Nuland, S.B. (1988).  Doctors: The Biography of Medicine.  New York:
           Knopf. Oxford English Dictionary Online. (2002). 2^nd ed. Oxford,
           Oxford UP. Retrieved on May 3, 2004 from
           http://dictionary.oed.com.

 Skinner, H.A. (1949).  The Origin of Medical Terms.  Baltimore:
           Williams and Wilkins.