A female surgeon in 17th-century Edinburgh

In April 1633, the Dean of Guild Court in Edinburgh heard a complaint from Johne Spang, Deacon (President) of the Incorporation of Surgeons and Barbers. His grievance concerned one Issobell Cairnie, who had been training apprentice surgeons while ‘unfree’ (unlicensed) in the trade of surgery. Issobell was the widow and second wife of James Henrysoun, burgess, barber-surgeon and three-time Deacon of the Incorporation. 

During his career, Henrysoun oversaw treatment of the city’s poor and was especially renowned for his work attending plague victims, although he was unable to save his first wife from the pestilence. He also ran a private surgical practice, which included training a rotation of apprentices, who boarded with his family. His father and brother were also barber-surgeons, and his son and sons-in-law would likewise follow the trade. 

On marrying into a family of surgeons, it is very plausible that Issobell acquired a comprehensive applied knowledge of surgery, having likely assisted James at their home. After his death in April 1629, she continued her husband’s business and went undetected for four years. 

Issobell’s apprentices included Alexander Henrie, who boarded with her, and although the record is vague, she appears to have supervised the surgical training of her son, Robert Henrysoun. Issobell was reprimanded by the Court “with hard sentence”. She was fined and prohibited from “taking of any prenteissis or [from] useing or exerceing ony payrt of chirurgie”. In addition, Alexander Henrie and Robert Henrysoun were barred from practising surgery while they “remane in Companie with said Issobell”. 

The eminence of her deceased husband may have spared Issobell a spell in the Tolbooth Jail (and a turned blind-eye or two may even have delayed her court summons). Robert Henrysoun continued his apprenticeship elsewhere and was admitted a Fellow of the Incorporation the following year.

Unfortunately, the document concerning Issobell Cairnie’s case does not explicitly indicate the extent of her surgical knowledge or if she physically treated patients, although the implication is there. Nonetheless, it is a fascinating source for its rarity in revealing a snapshot of a shadowy figure in early modern Scottish medicine – the female surgeon. Moreover, an interesting entry in the Incorporation’s minutes suggests a lack of clarity in the regulations may have inadvertently given women the green light to supervise surgical apprentices, if not also practise surgery.

Female surgeons in ancient history 

We often talk of women ‘entering’ medicine and surgery in the late 19th century, when access to medical schools was secured. However, it would be more accurate to mark this period as a ‘return’.  Although the documentary record is fragmentary, funerary monuments, art, papyri and medical texts demonstrate that women have delivered healthcare for thousands of years. They worked as healer priestesses, herbalists and apothecaries, midwives, physicians and – less well known – surgeons. 

Many foundations of modern medicine and surgery can be traced to Ancient Greece, and women were active participants. Female “cord cutters” are referenced in the Hippocratic texts of the fifth century BCE. In the fourth century CE, the Greek physician Aspasia is believed to have pioneered surgical techniques in excising uterine haemorrhoids and her work influenced later male surgeons. In Egypt, women worked as professors at the medical school in Heliopolis as early as 1500 BCE. At Sais there was a medical school for women and the ‘lady overseer of female physicians’ Peseshet is said to have taught there. Illustrations on Egyptian tombs depict women performing surgery, suggesting the practice was common. 

Female surgeons in medieval and early modern Europe

As the influence of the male-dominated Christian Church spread, women found it increasingly difficult to practise openly, with some notable exceptions. The 12th-century abbess Hildegard of Bingen resisted religious patriarchal convention and authored books challenging medical orthodoxies relating to the womb and sexuality. In general, women had more liberty to practise in areas of lesser Church influence. Salerno, a southern Italian coastal town known for its paganism, boasted a medical school with women on its faculty, where the famed 11th-century obstetrician and author Trota practised.

The misogyny of the Church was adopted by the universities, which closed their doors to women from the 13th century. This represented the beginning of a very gradual shift from tolerance to explicit hostility as women were increasingly marginalised from practising medicine officially. In Paris, an ordinance in 1271 allowed male and female surgeons and apothecaries the right to be granted licences yet, in 1481, women were prohibited. There was an exception for surgeons’ widows, who were permitted to assume their spouse’s practice after his death, yet they too were excluded in 1694. Craft guilds, for the most part, barred women from membership. In the 1540 founding charter of the London Company of Barber-Surgeons, King Henry VIII proclaimed: “No … women shall practise surgery”. 

Yet, despite official suppression and exclusion from medical schools, women continued to openly practise surgery and, while some were scorned by male medical professionals, many were respected in their communities. The occupational term ‘chirurgienne’ was not uncommon in France or ‘surgeoness’ in England, where women were occasionally granted ecclesiastical surgical licences and apprentices. While the numbers of English women who obtained a licence was small, it is suggested ‘countless’ unrecorded women practised without the official sanction of a licence. In their studies of English female surgeons, AL Wyman and Doreen Evenden found extensive evidence of women demonstrating the necessary skills to practise surgery, including bone-setting, dentistry, bloodletting and wound-stitching. In 1614, the charter of Salisbury Barber-Surgeons stated: “… there are divers women within this city, altogether unskilful in the art of chirurgery … no such woman … shall meddle with any cure of Chirurgery”. This illustrates not just a strong presence of female surgeons, but that their ubiquity sufficiently concerned male surgeons, who sought to remove them from the marketplace, most likely because women’s lower fees undercut their own. 

Some female surgeons from the landed classes treated their less well-heeled neighbours. In the early 1600s, English Puritan diarist Lady Margaret Hoby ran a busy practice performing a variety of operations, some requiring significant skill. For instance, she wrote of “a child brought to me … who had no fundament… I was earnestly entreated to cut the place to see if any passage could be made … I cut deep and searched”. In Scotland, the surgeon Lady Anne Halkett is said to have treated 60 patients wounded in the Battle of Dunbar in 1651. 

Unlike the English bishops, the Church of Scotland did not grant ecclesiastical licences to either sex. This was probably due to the more profound impact of the Protestant Reformation, which resulted in efforts to suppress healers – most commonly women – who continued to use rituals associated with Catholicism. Regardless of the type of work performed by women, allegations of witchcraft became a serious occupational hazard. Between 1563 and 1736, nearly 4,000 people accused under Scotland’s Witchcraft Act were executed, mostly women. This included folk healers and midwives. 

Despite increased malignment and exclusion, women continued to provide healthcare. It is probable Scottish female surgeons outside Edinburgh practised less covertly than Issobell Cairnie. Until the 1770s, the Incorporation held influence only in Edinburgh, with no supervisory powers in the Lothians, Fife or Borders. Medical practitioners outside the city were relatively free to practise in the east and in areas not under the Glasgow Faculty’s control in the west of Scotland. The occupational boundaries between different branches of medicine were also more fluid in rural or remote areas, where physicians and surgeons were not yet organising professionally. Therefore, it would be quite possible for women to extend their more traditional work in midwifery, nursing and medicine dispensing to include minor surgery and dentistry (in effect, similar to the surgeon-apothecary, the predecessor of the general practitioner).  

Importantly, patients were willing to consult a variety of medical practitioners, professional or ‘irregular’.  They were less interested in the gender and professional status of the healthcare provider than in their desire to be cured of disease or treated for an injury. Women offered vital care where the services of a qualified physician or surgeon were unaffordable or, in more remote areas, simply out of reach. Even in a major city like Edinburgh, where the Incorporation guarded its rights and privileges almost to the point of obsession, Helen Dingwall notes: “women participated fully in the unofficial side of medical practice”. 

Women and the Incorporation of Barbers and Surgeons of Edinburgh

With the exception of a midwifery licence granted to Ann Ker in 1752, there is no other record of a woman being admitted to the Incorporation. Women were, therefore, not allowed to practise surgery or train surgeons in the city of Edinburgh. 

However, in common with the other incorporated trades, indigent barbers’ widows were permitted to continue their husband’s shop, where they could work as a barber and train apprentices. In a time before the Widows’ Fund, this released the Incorporation from the responsibility of providing a financial safety net to the wives of deceased members. The earliest example in the College records was in 1590, when barber’s widow Bessie Lundie engaged the apprentice William Wood “to remain in hir household”. 

Crucially, this proviso in the Incorporation’s regulations did not extend to surgeons’ widows. It seems apparent that Issobell Cairnie was not the only widow to flout the rules. Indeed, in the following decade, the problem was deemed acute enough for the Incorporation’s male membership to take action. At a meeting held in 1648, they noted their despair that the regulations had been misinterpreted, and that it had “never been their meaning to extend the samee indeferentilie to all”. An Act was then passed proclaiming: “no widow … shall have liberty of keeping of servantis except … for barborising, excluding heirby all operatiounes in surgery”. It is worth noting that servants and apprentices were two separate classes of trainee, the former bearing no resemblance to the domestic servant. Sadly, the original regulation has not survived. Yet, it is clear the policy had been vague enough that Issobell Cairnie had either misconstrued its meaning, believing widows of both surgeons and barbers could continue their spouse’s business or, alternatively, she was aware that an ambiguity in the law created an unintentional loophole, which she exploited. The latter seems more likely; James Henrysoun was closely connected to the Incorporation so his wife would have been familiar with the regulations.

Conclusions

That Issobell Cairnie was able to secretly operate a private surgical practice for considerable time before being discovered, virtually under the nose of the Incorporation, suggests that outside Edinburgh women would have practised more openly (witchcraft harassment aside). Like Issobell, we can infer women learned the surgical trade by observing and assisting their surgeon husbands, sons and brothers, while others acquired the necessary skills in their homes or publicly in a community where no surgeon was accessible. 

When women gained access to formalised training in the late 19th century, it followed a long and very gradual process of being sidelined. In the face of increasing marginalisation from the late medieval period, female folk healers, midwives and herbalists – whom we know more about – continued to find their place in the medical market. However, we still know comparatively little about female surgeons in early modern Scotland. 

The manuscript relating to Issobell Cairnie is on display in the Surgeons’ Hall Museums’ temporary exhibition, ‘A Fair Field and no Favour: the History of Women in Surgery.’ 

Further reading 

• Evenden DA. Gender differences in the licensing and practice of female and male surgeons in early modern England, Medical History 1998. 42(2): 194–216
• Whaley L. Women and the Practice of Medical Care in Early Modern Europe, 1400–1800. 2011. Basingstoke, Hampshire, Palgrave Macmillan.
• Wyman AL. The surgeoness: the female practitioner of surgery 1400–1800, Medical History 1984. 28(1): 22–41.