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
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.
Croft is Consultant Surgeon at North Middlesex University Hospital