‘Crucial Interventions: An Illustrated Treatise on the Principles and Practice of Nineteenth-Century Surgery’ by Richard Barnett in association with Wellcome Collection (Thames & Hudson, 2015).
Following our initial call for clinical and academic reviews of ‘Crucial Interventions,’ Laura Neff offers her perspective as a junior doctor. You can see the accompanying review offered by Dr Alice McLachlan here.
The history of nineteenth-century surgery had long been constructed as either a ‘narrative of progress’ or a history of ‘great men’ as ‘great discoverers’. Richard Barnett’s latest work, Crucial Interventions: An Illustrated Treatise on the Principles and Practice of Nineteenth-Century Surgery, is beautifully presented and is a companion to his 2014 publication, The Sick Rose: Disease and the Art of Medical Illustration. Barnett addresses the major transformations in surgical practice for the general reader.
Crucial Interventions is divided into sections on specific parts of the body, such as the head and the abdomen, as well as mini-articles on surgical developments, such as anaesthesia and asepsis. Many pages within the text are large illustrations of surgical operations. The reader is drawn to these vivid and explicit illustrations, as would be a nineteenth-century medical student or surgeon preparing for an operation. Many surgical texts from the period lack illustrations, which were too expensive for publication. In Crucial Interventions, these images provide a visual history of surgical operations to the modern reader. In the history of medicine, it is important to engage with images of surgery as part of a wider discourse on surgical practices and standards.
Today, surgery is performed in a sterile environment, in which the patient is either sedated or given a local anaesthetic before the commencement of the operation. Nevertheless, Barnett’s use of images requires further contextualization for the reader to appreciate fully the “transformation” of surgery beyond its graphic medical depiction of historic operations. The discovery of anaesthesia and antiseptics have long dominated the ways in which scholars and the public understand Victorian surgical practices. Prior to these “modern” developments surgery was a semi-skilled craft, performed by men trained as apprentices. Barnett provides a sweeping narrative of medical practices from the classical world of Galen to ship-surgeons of the seventeenth century (pp. 16-45). Yet, this condensed account could have questioned further the ways in which historians, and the public, have understood these practices and methods.
Illustration of the Use of the Lister’s Carbolic Spray, Antiseptic Surgery, 1882. Wellcome Images.
The author poses this essential question: ‘Does what the surgeons know matter more than what they do?’ (p. 18) Nineteenth-century surgeons, such as Robert Lawson Tait, challenged the very concept of Listerism, an antiseptic method associated with
Joseph Lister’s carbolic spray, because it undermined the ways in which they performed surgery. For Tait and his contemporaries, it was crucial that their culture of surgery was based firmly on theories derived from post-operative surgical results. Barnett’s text constructs the mysteries of nineteenth-century surgery through accounts of achievements and discoveries, while posing important questions to the reader. However, to fully appreciate the complexity of nineteenth-century surgery and its “revolutions” required further dissection of how surgeons attempted to create, as Lindsey Granshaw observed, ‘bodies of knowledge’ (p. 258).
Surgery “transformed” during the nineteenth century based on what surgeons knew rather than what they did. Tait, for example, remarked, ‘absolute accuracy of diagnosis in the abdomen is very far from being possible; only the ignorant assert what it is, and only fools wait for it’ (p. 24). The construction of surgical knowledge through skills, methods and techniques was fundamental for any system of surgery to succeed. Listerism has long been understood as a retrospective construction of a surgical system by Lister’s colleagues and followers. Barnett explained that Lister did not spark a “revolution” in surgery simply from his 1867 paper (pp. 90-94); nevertheless, the author could have examined further the competing “antiseptic” or “cleanliness” systems through the “body of knowledge” surgeons used either to defend, accept or reject the notion of antiseptics to demonstrate that surgeons “did what they do” essentially based on ‘what they knew’.
Illustration of an Abdominal Incision for Cecum Surgery (Large Intestine). By Claude Bernard and Charles Huette, 1848. Wellcome Images.
Recently, Medical History published a special issue on ‘Skill in the History of Medicine and Science’ edited by Thomas Schlich and Nicholas Whitfield (pp. 349-510). This volume explored how ‘skill,’ whether surgical, medical or scientific, had been understood within wider historiography. They acknowledge that, ‘skill can prove troublesome to define. The content of what counts as a medical skill ranges widely across different dimensions of the body and self, as through places, disciplines and phases of history’ (p. 349). The images selected for Crucial Interventions exhibited the skill and ability of individual surgeons through their illustrations. Surgeons and others created these images to demonstrate ‘what they did by what they knew’.
Barnett concluded his text with, ‘surgical histories that revolve around great surgeons and their pioneering operations do so at the risk of excluding other stories—most importantly, those of patients and the long aftermath of surgery’ (p. 244). Far beyond the exclusion of patients and their lived experiences, surgical history of the nineteenth century reveals the ways in which surgery “transformed” based on the knowledge and expertise of individual practitioners.
As readers and scholars, we should continue to explore the constructions of surgical knowledge. For example, on 8 December 1890 at the Royal College of Surgeons of England, Thomas Spencer Wells concluded his lecture on “Modern Abdominal Surgery” with, ‘here I am compelled by the hour to close this very hasty and imperfect sketch of what we, the surgeons of the present, have done and are doing, and how we do it’ (p. 33). Barnett’s work provides a valuable contribution to explore surgeons through “what they knew” by “what they did”. Thus, this text offers a visual foundation for further research into the construction of surgical knowledge and practice in the nineteenth century.
Reviewed by Laura R. Neff is a PhD candidate at Royal Holloway, University of London. Her thesis was on the history of abdominal surgery from 1860 to 1890. In 2009, she received a Masters in the History of Medicine at the Wellcome Trust Centre for the History of Medicine at University College London. In 2007, she received a Bachelors Degree in History from American University located in Washington, DC, USA.
Correspondence to Laura Neff.
Granshaw, Lindsay. 1992. Knowledge of Bodies or Bodies of Knowledge? Surgeons, Anatomists and Rectal Surgery, 1830-1985, C. Lawrence (ed), Medical Theories, Surgical Practice: Studies in the History of Surgery. London: Routledge.
Schlich, Thomas, and Nicholas Whitfield. 2015. Skill in the History of Medicine and Science. Medical History, 59(03).
Tait, Robert Lawson. 1888. Lectures on Ectopic Pregnancy and Pelvic Haematocele. Birmingham: The “Journal” Printing Works.
Wells, Thomas Spencer. 1891. Modern Abdominal Surgery: The Bradshaw Lecture delivered at the Royal College of Surgeons on December 18th 1890, with an Appendix on the Castration of Women. London: J & A Churchill.