While surgeons carry the appellation “Dr.” in the USA and other parts of the world, in the UK they are referred to as “Mr.” How has this anomaly arisen?

Academically, in order to be called “Dr.” one must hold a doctoral degree (the highest academic degree in any field of knowledge), such as Doctor of Medicine, M.D., or Doctor of any other discipline. In the USA, an M.D. is a licensing qualification to practice medicine, whereas in Britain, an M.D. is a postgraduate thesis degree. In order to practice medicine in Britain, students must attain a Bachelor of Medicine and a Bachelor of Surgery degree (MB and BS). Therefore they are not, in the strictest sense, “doctors.” However, once graduated in Britain, all graduates are referred to as Doctor, as are consultant and trainee physicians and other specialists––all except surgeons.

The word “doctor” is derived from the Latin doctor-oris, meaning teacher or instructor, and in Middle English (c. 1150-1500) it became used for any learned man or medical practitioner. The title “Mr.” is a 16th century English variant of Master, derived from the Latin Magister, which means master or teacher.

Following the fall of the Roman Empire, most surgery in Europe was performed in monasteries by monks and their assistants, the barbers. As well as cutting hair and shaving, barbers helped with blood-letting.

The Medieval Universities were founded to teach subjects, including medicine, which had no place in the ecclesiastical curriculum. Salerno was one of the first medical schools and was established by the middle of the 11th century. Courses were initially available to physicians and surgeons, but not to apothecaries.

In 1123 CE, Pope Calistas II decreed that monks must not shed blood, and it was this ruling that resulted in the teaching of surgeons being forbidden in church-dominated universities. Surgeons, therefore, served an apprenticeship, whilst physicians spent four years at university, leading to a Bachelor of Medicine degree and a possible further thesis leading to a Doctorate. The Pope’s ruling also resulted in a great boost to the barbers, who now performed dental extractions and fracture treatments as well as blood-letting. Because of their increased role, they became known as the barber-surgeons, and monks then administered only to the spiritual needs of patients.

At this time, true surgeons also developed. They were more skilled than the barber-surgeons, but were apprenticed and not university trained, and therefore could not style themselves as “doctors.”

In 1493 English surgeons decided to enter a working agreement with the barber-surgeons, and this association was given Royal assent in 1540 when Henry VIII, by Act of Parliament, united the two groups under the name of “Masters, Governors of the Mystery and Commonalty of Barbers and Surgery of London.” From this time, by Royal edict the barbers could only perform barbery and extraction of teeth, and the surgeons had to refrain from cutting hair and shaving people! King Henry VIII gave each member of this newly formed group the right to be addressed as “Master,” and in time “Master” was pronounced “Mr.” So when a British Surgeon is addressed as “Mr.” he is actually being honoured, as in reality he is being called “Master.” Female surgeons are called Miss, Ms. or Mrs.

The association of surgeons and barber-surgeons lasted until 1745, when the surgeons petitioned the English parliament for a separation that lasts to this day. The barber-surgeons are now represented by the Benevolent Barbers’ City Livery Company.

Mr. Croft is Consultant Surgeon at North Middlesex University Hospital in London.