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With regard to surgery it was clear that surgeons had operated as an ancient medical art as far back as the physician. The surgeon performed operations, set broken bones, treated accident cases, and much of the surgeon’s work demanded high levels of hand–eye coordination, dexterity, speed, decision‐making, as well as expertise. It was considered a form of skilled manual labor, and the eighteenth century phrase “The Craft of Surgery” still resonates today in the narrative of surgery as a craft specialty.

Since the middle ages, surgeons in the London area had been organized as a guild. Guilds were associations of merchants or artisans with mutual interests. They were organizations that operated like a combination of a trade union and a professional body. It was only in 1540 that they joined with the barbers to form the Barber–Surgeons Company of the City of London. This relationship lasted until 1745 when the surgeons established a separate city company. In 1800 the surgeons received their Charter as the Royal College of Surgeons of London, and then in 1843 they were made the Royal College of Surgeons (RCS) of England, with the establishment of Membership (MRCS) and Fellowship (FRCS) which remains today.

An important distinction between physicians and surgeons at that point was that surgeons were not university educated. They learned their skills through apprenticeships and by practical training, and not in any way theoretical or university‐based.

The RCS was much larger than the RCP. By the mid‐nineteenth century there were over 8000 practitioners with a surgical license, but only 300 of these were Fellows of the College. The FRCS was not an exclusively London license, and those who held it could practice in all parts of England.

In order to make a living, most members of the RCS also began to prescribe and dispense drugs, and in order to qualify themselves for this they took on a second qualification from the Apothecary Society.