“Dr. Mortimer?”
“Mister, sir, Mister! A humble MRCS!”

And so…’Doctor’ James Mortimer is introduced to the reader at the start of one of Sherlock Holmes’s most famous cases: The Hound of the Baskervilles. But what’s all the fuss about ‘doctor’ and ‘mister’ and what the hell is an ‘MRCS’, anyway?

Anyone who’s spent enough time around the medical profession, either as a medical professional themselves, or maybe just someone who spends a lot of time visiting doctors, surgeons and hospitals, will probably know that physician is addressed as ‘doctor’, while a surgeon is always addressed as ‘Mister’. Why is this? A surgeon deals in medicine as well, so surely he deserves the title of ‘doctor’ along with his other colleagues, right?

Well no, actually. From the earliest days of medical history, right up to the 21st century, surgeons were not, could not, still are not, addressed as ‘doctor’ and are not awarded or given the title of ‘doctor’. This article will explain why.

Titles

To begin at the beginning, with titles. A medical doctor is given the prefix “Dr.”, which stands for “Doctor”, or the suffixes “M.D” or “G.P”, which stand, respectively, for “Medical Doctor” or “General Practicioner [of medicine]”.

By contrast, a SURGEON is always given the title of “Mr.”, that is, “Mister”.

The reasons for this are several, and they come from traditions started centuries ago.

The Doctor

The job of a doctor, or a physician, was to prescribe medicines. A doctor’s job was to examine, diagnose and treat illnesses and to cure the sick. This was considered a respectable and honorable occupation. The saver of people’s lives was therefore given the title of “doctor”. A physician was above the level of a surgeon. He had a greater degree of medical knowledge and skill. He was not the one with the dreaded hacksaw, forceps, tonsil-knife or the red-hot poker which was used to cauterise bleeding stumps after the completion of an amputation. A physician was an entirely different kind of person. One with REAL medical knowledge.

Sherlock Holmes’s friend and colleague, John Watson, M.D., graduated from the University of London 1878 with the degree of Doctor of Medicine. This grants him the title of “Doctor” before his name and he was, by the standards of the day, a fully-qualified doctor, who could prescribe medication, treat injuries and diagnose ailments. Back then, to call a physician ‘mister’ was considered an insult, as it implied he had not the proper medical kowledge or skill to hold his title. On the other hand, calling a surgeon ‘doctor’ was to suggest that the surgeon was standing above his station and expertise.

The Surgeon

The job of a surgeon in the Victorian era (1837-1901), and even before then, during the Regency and Georgian eras, was to perform surgery. While the job-description may not have changed, the manner in which it is carried out, certainly has, and when you see how surgery was carried out, you’ll understand why nobody thought a surgeon should be called a ‘doctor’.

In the 18th and 19th centuries, the mainstay of the surgeon’s occupation, was performing amputations and removing foreign bodies from injured persons. Such things could be bullets, arrows, lead shot and splinters of wood (which caused a great deal of injuries onboard wooden battleships at sea). Another job of the surgeon was to remove various stones from the kidneys, bladder and liver.

While operations such as these are perfectly safe today, in the Victorian Era and Georgian eras, surgery was risky, uncertain and extremely painful. Anasthetics had not yet been discovered, and any operation would have been incredibly painful, with the patient wide awake. Imagine, if you will, being fully concious while a surgeon dug around in your ribcage with a pair of tweezers, trying to pull out a bullet, or had a tourniquet tied around your arm while he sawed your limb off at the elbow, with you being as just awake as he is. Amputations were what surgeons were ‘famous’ for. Sawing off infected, broken or gangrenous limbs with hacksaws, when recovery or treatment had proved ineffective. The only painkiller you would have would have been laudanum or morphine, both of which were of questionable effectiveness in alleviating the considerable pain of having the teeth of a hacksaw slicing through your arm.

Because of the painful and dangerous nature of their work, it’s probably not surprising that surgeons were greatly despised by society. People would not look the same way at a surgeon that they did with a doctor. Surgeons caused pain and suffering, even though they were medical people. Their operations, even if successful, would cause death by infection. And if unsuccessful, would cause the patient to die a painful and fully-concious death, still lying on the operating table.

While these days, a surgeon may be seen to be on equal footing with a physican, one must remember that once upon a time, “surgeon” was not the person’s full title. In medieval and early modern times, they were called “barber-surgeons”. A barber, then, as now, is a person who cuts your hair. Only back then, it wasn’t just hair that they cut off you. The famous “barber-pole”, of red and white diagonal, spiralling stripes, which are sometimes found outside barbershops, are descendant from this time. They represent the white of bandages and the redness of dripping blood, from the days when a barber-surgeon would just as likely saw off your arm as he would give you a shave and a new hairdo. The slang-name for a surgeon, a “sawbones”, comes from the days when a surgeon’s main occupation was chopping off limbs.

It is for these reasons that surgeons, such as “Doctor” Mortimer, were denied the rank of “Doctor” before their names. Such men were seen as being unworthy of holding the rank and title since, while they worked for good, they caused so much pain and suffering to their patients. By the way, ‘MRCS’ stands for a MEMBER of the ROYAL COLLEGE of SURGEONS. This is why Mortimer cannot actually be called a ‘doctor’, because he is in fact a surgeon.

Amputation-kit, possibly belonging to a ship’s surgeon. Note the presence of the two hacksaws, used for sawing off patients limbs and the knives and probes for removing bullets and other foreign bodies from patients’ bodies. The two long knives at the bottom of the medical case are Liston knives (invented by Dr. Liston in the Crimean War of the 1850s). They are used for cutting through flesh and muscle. Hacksaws are used for cutting through the patient’s bones.