In the UK and Ireland, and sometimes in Australia and New Zealand, qualified surgeons take the title of ‘Mr’, ‘Miss’, ‘Mrs’ or ‘Ms’ rather than ‘Dr’.  This tradition arose before 1800 A.D. when physicians were by definition doctors who held a University medical degree (MD), whereas surgeons seldom had any formal qualifications.  Surgeons often worked as assistants to physicians visiting patients at their homes.  Hospital surgical practice became increasingly more important in the 18^th and 19^th centuries and the wealthiest and most famous medics became surgeons rather than physicians.  After the founding of the Royal College of Surgeons of London in 1800 A.D. surgeons gained a formal medical qualification on membership of the college (MRCS).  However, surgeons were now so proud to be distinguished from physicians that the title of ‘Mr’ had become a badge of honour.  Although surgeons in 1730 A.D. had no right to be called ‘Dr’, hospital surgeons in 1830 A.D. had no wish to be.  This tradition has lasted till the present day and sometimes acts as a great source of confusion for patients and foreign doctors!