HCPC Registered Chiropodist Podiatrist
History of Chiropody& Podiatry
chiropody as an area of professional practice within health care concerned with the care and treatment of disorders of the feet,
has had both ancient and modern elements in its development. Whilst
some health care professions (radiography and occupational therapy
amongst others) are products purely of the twentieth century, chiropody,
is best understood as an older health-related craft reformed under
twentieth-century conditions. The forebears of modern-day chiropodists
were the itinerant corn-cutters of past centuries who plied their trade
at fairs, markets, and in the streets. Little is known in detail about
the history of corn-cutters, but by 1845 Lewis Durlacher, a leading
British practitioner, was drawing a distinction between the new
professional chiropodist and the humble journeyman cutter.
Durlacher argued that the treatment of foot conditions should become a firmer part of medical practice of his day, and that in particular those with ‘the requisite surgical information’ after examination should be granted a license to distinguish them from untrained corn-cutters. His attempts to create a trained and recognized new class of practitioner did not come to fruition for nearly half a century, when a ‘Pedic Society’ was founded in New York, followed in Britain in 1912 by the Society of Chiropodists. Foot care at this time was becoming a major business area, which may have stimulated these professional responses. The Scholl remedial footwear firm had developed in the US, successfully responding to market needs, and had opened its first London branch in 1910. British doctors of the day were generally not interested in this area as part of their practice, and only a dedicated few served as mentors, patrons, and examiners for the new Society of Chiropodists. However, by 1923 its journal, The Chiropodist, was presenting the new profession as a collateral branch of medicine in line with Durlacher's earlier ambitions, drawing its scientific principles into a neglected but now crucially important area of health care practice.
The ambitions of the British chiropodists were very much influenced in the 1920s by the general position of dentistry. Dentists were trained, licensed surgical practitioners with a ‘body site’ of their own, separate commercial premises under their own control, and amicable relationships with other medical practitioners. Although previously licensed by the Royal College of Surgeons, they had attained self regulation in 1921 — but attempts by chiropodists to follow this example with a parliamentary bill in 1928 was strongly resisted by organized, professional medical lobbyists. The British Medical Association's position was to oppose any other class of practitioner outside the formal jurisdiction of the medical profession. Chiropody was modestly defined in the bill as ‘the diagnosis and medical, mechanical or surgical treatment of foot ailments such as abnormal nails, bunions, corns, warts and callosities but not the performance of operations for which an anaesthetic is required’, but this was not enough to disarm extensive professional rivalries in the inter-war years.
Nevertheless, after further decades of boundary disputes with medicine, chiropody in Britain finally achieved state registration or licensing in 1960, largely within the terms of the above definition. In the meantime, podiatry had developed within chiropody, as a specialized and more surgically ambitious area of bone surgery. The Canadian province of Ontario, for example, now specifically licenses podiatry as ‘cutting into osseous tissues of the metatarsals and toes of the foot, including osteotomies and joint surgery’ including associated diagnosis. This more advanced type of practice is now internationally common and corresponds with the earlier ambitions of the turn-of-the-century professional modernizers and their vision of a collateral profession. As with other one-time medical auxiliary occupations, chiropody training in recent times has been incorporated into higher education, and now holds a secure place in the broad medical division of labour as one of the preventative and remedial health professions. Students are trained on graduate programmes to offer treatments in the area of biomechanics, sports medicine, and bone surgery under local anaesthesia, in addition to the more traditional concerns with corns, in-growing toenails, veruccas, and local injections. The fully-trained professional group suffers, in its own view, from unfair competition from untrained practitioners, and thus like all professions in such circumstances tries to prohibit their practice, but this claim in Britain at least has not so far been legally successful. Arguably it is more likely that chiropody's next phase of development will lie in even closer links with related medical, surgical, and health professional areas, particularly as health policies try both to contain health care costs and to support increasingly aged populations. Developments in podiatry, however professionally important, may remain a relatively minor part of chiropody's future compared with its wider co-operation with GPs, dieticians, physiotherapists, and others working in primary care services.
Gerry V. Larkin
Larkin, G. V. (1983). Occupational monopoly and modern medicine. Tavistock, London and New York.
The Emergence of Chiropodists
Time progressed, as did the English language. The term ‘Chiropody’ can be traced back to a practitioner of foot care who published a work in 1785 (Chiro [Greek -khier,hand] podos [foot] or Kheirpodes [Greek] chapped feet), (Dagnal 1983). David Low wrote ‘ Chiropodologia or a Scientific Enquiry into the Causes of Corns, Warts, Bunions and Other Painful or Offensive Cutaneous Excrescences.’ Low published his work after translating a 1781 French text by Nicholas-Laurent La Forest entitled ‘L’Art de Soignre les Pieds’ . Unfortunately it does seem that Low plagiarised the French work.
Shakespeare even quoted foot ailments that surely may have needed the services of a chiropodist. Romeo and Juliet, Act 1, Sc.5:
‘Cap welcome, gentlemen!
Ladies that have their toes unplagued with corns,
will have a bout with you.
Ah ha my mistress!
Which of you will now deny to dance?
She that makes daintily,
she I’ll swear hath corns!
Am I come near you now?
And on it goes. Hindley c1884 documents the History of the Cries of London heard in the mid-1600’s, probably composed by the celebrated Orlando Gibbons. Ben Johnson (1563-1637) in his play Bartholomew Fair (1614) also depicts a character at a fair-ground entering the scene with a cry of his advertisement:
”Here’s fine herrings, eight a groat,
Hot cordilines, pies and tarts.
New mackerel I have to sell,
come buy my well fed and oysters ho!
Come buy my whitings fine and new.
Wives, shall I mend your husbands horns?
I’ll grind your knives to please your wives
and very nicely cut your corns.
Maids have you any hair to sell?
Either flaxen, black or brown?
Let none despise the merry, merry cries,
of famous London Town.”
It appears that the services of a chiropodist became necessary to serve the aristocracy and the well-off. The Seventeenth Century saw the advent of ‘Corn-cutters’. Such practitioners became respectable, enough for one, John Hardman, to have his portrait painted by Caulfield in the 1700’s. A sure testament to his fame and fortune. John Hardman became the chiropodist to the then King William of Orange. Respectability beckoned at his doorstep.
Portrait of John Hardman
1734 saw other revelations. Reed’s Weekly Journal announced that ‘Mr March, a famous corn cutter became the nail cutter to His Royal Highness the Prince of Wales.’ An annual salary of 50 guineas.’ Other practitioners were charging up to 1 guinea for an individual treatment. A guinea in the mid 1700’s was worth £150 in today’s terms (2015).
Corn cutter, or the preferred term corn operator, probably emerged as a professional title in the 1700’s. Certainly by 1750 such practitioners were being documented pictorially. Around 1750 an engraver by the name of Funney created an illustration of a corn cutter at work. The picture shows an early chiropodist complete with wig and spectacles and before him an array of surgical instruments. The mode of dress and the mere fact that such work was worthy of an illustration, suggests very strongly that this corn cutter was highly regarded. Through advertising and word of mouth, particularly in coffee and bathhouses, high society now welcomed a reputable practitioner to relieve them of their painful foot conditions. If it was good enough for the reigning monarch to have such a person in his employ, fashion dictated that everyone with money should follow suit.
The Corn Cutter, made by Bob Funney, published by Jackson, 1735-1765 (engraving)
Yet still the profession was somewhat dogged by the fact that corn cutters could be seen plying their trade on street corners. Over the next fifty years or so the chiropody ‘street traders’ gradually disappeared and were replaced by more respectable practitioners. Now they worked from their own premises and even circulated business cards.
In the 1800 London Kelly’s Directory there was one entry listing a chiropodist. By 1840 there were three and by 1880 forty such people registered themselves as practitioners, many offering other services, most notably tooth-pulling.
Textbooks started to be written and published. Hyman Lion, a chiropodist in Edinburgh wrote a Treatise on Corns in 1802 and in 1845 Lewis Durlacher penned the first complete text describing the treatment and care of foot conditions. Hyman Lion was an enterprising practitioner and aspired to further himself to the pinnacle of his profession. He studied medicine at Edinburgh University and graduated with a distinction, his ultimate ambition being to practise as a doctor specialising in foot conditions – perhaps one of the first attempts by a chiropodist to gain acknowledgement from the medical profession. However, he was prevented by the fact that his first calling had been as a corn-cutter, an occupation not considered worthy of the attention of medical and surgical practitioners of the time.
Chiropody/Podiatry as a Profession.
The first person to formally suggest that chiropodists should be regulated and their title protected was Lewis Durlacher, a London chiropodist in 1854. He was practitioner to George IV, William IV and Queen Victoria. He also attempted to establish ‘a dispensary for diseases incidental to feet … for the gratuitous treatment of the needy’ which, in 1913, would become the London Foot Hospital.
Although he was unsuccessful in organising a regulatory body, he wrote various texts which were far ahead of their time. In particular his ‘Treatise on Corns, Bunions, the Diseases of Nails and the General Management of the Feet’ was considered a definitive work and used by chiropodists throughout England.
Elsewhere, dignitaries in Europe employed their own chiropodists. The King of France had a personal chiropodist, as did Napoleon. Perhaps one of the most enterprising practitioners of the day was Isachar Zacharie, chiropodist to President Abraham Lincoln in the USA.
Zacharie was born in England of Jewish parents and travelled to the USA in the mid 1800’s, starting a practice in New York and later Washington. In order to promote his business he would treat civic dignitaries with no charge in exchange for worthy testimonials. President Lincoln wrote in 1862 ‘Dr Zacharie has operated on my feet with good success and considerable addition to my comfort.’
It appears that Zacharie enjoyed the respect and confidence of the President, so much so that the he was asked to act as an unofficial emissary and travel to the south, in particular New Orleans, to help stabilise Jewish support and encourage Jewish loyalty to the Union. Zacharie carried out this onerous task, whilst at the same time still practising as a chiropodist. Whether it was an unwritten request or a misunderstanding, Zacharie managed to treat 15,000 civil war soldiers, their feet suffering the ravages of ill-fitting footwear. After the war he submitted a bill for $45,000 to the War Department which was not paid. He died in 1897 in England and was buried with other persons of note in Highgate Cemetery, London.
The USA took the global lead in officially recognising chiropody as a profession requiring a collective representation when, in 1895, the Society of Chiropodists was founded in New York. Its first official Journal was published in 1907.
Five years later in the United Kingdom, Ernest George Virgo Runting (1861-1954), a one-time chiropodist to Queen Alexandra and Queen Mary collaborated with Dr Arnold Whittaker of Oxford. Together, they formed the British Chiropodial Society in 1912. Runtling was a prolific author on the subject of chiropody. His works include ‘Battalion Chiropody’ (1918), ‘Chiropody Jottings’ (1932) and ‘Practical Chiropody’ (1937).
In 1913 The Pedic Clinic was established in Bloomsbury, London. Here, premises were opened to treat the feet of the poor, it was even dedicated by the Bishop of Willesden, all treatment provided was free of charge. It was also hoped to provide training for aspiring chiropodists but with the advent of World War One this was delayed until 1919, when evening courses were offered on five nights a week.
In 1924 the clinic was renamed The London Foot Hospital. In 1940, during World War Two, the premises were bombed and the Hospital moved to Paddington. The advent of the National Health Service and further moves allowed the State system for training of chiropodists to be firmly established. In 2003, largely due to a dispute over funding of the hospital it was decided to close the establishment (Dagnal, 1988).
A Treatment Room at the London Foot Hospital circa 1939
The Second World War created a hiatus that affected everyone’s lives in the United Kingdom. For years after the conflict the shadow caused difficulties for any aspiring practitioner of chiropody due to such circumstances as closure of training establishments, shortage of raw materials for the manufacture of consumables and conscription. However, in an undated publication ‘Chiropody as a Career’, whose contents suggest that it was published post-1945 but pre-1948 and the advent of the National Health Service (NHS), Christina Cudworth, highlights some of the necessities required to set up in practice:
Chiropody Chair £22
Foot rest £3
Operators chair £3
Chiropody table £5
Nail drill £11
Floor lamp £4
Infra-red foot bath £10
instruments and jars
So for a total of £62 along with a training fee for two years at £42 to £94 and 2 guineas for the examination, one could set up in practice. Annual earnings would be anticipated at between £200 to £400, (£6,000-£13,000 in 2014) the average treatment fees being 3/6d, 5/6d, 7/6d, (£6-£13 in 2014), with the addition of 33% for a domiciliary visit.
Evolutionary evidence strongly suggests that man walking bipedally,
living longer or squeezing feet into inappropriate footwear, has created
the need for skilled professional intervention. This piece shows that
while chiropody as a profession has only been represented by a
professional body in the USA since 1895 and in the UK 1912, with the
SMAE Institute being established in 1919, chiropodists/podiatrists have
been practising for around 4,500 years. It would therefore seem that
chiropody has a secure future.
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Cudworth CC. Circa 1945-1947. 12. Vawser & Wiles, London.
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Dagnal J C. 1988. The London Foot Hospital. British Journal of Chiropody. 53: 185-199.
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Cudworth CC. Circa 1945-1947. 32-33. Vawser & Wiles, London.