3.28.2006
Medical Theory, Surgical Practice (History and Theory of the Body)
Title
Lawrence, Christopher (ed.). Medical Theory, Surgical Practice: Studies in the History of Surgery. London: Routledge, 1992.
Field
History and Theory of the Body
Summary
This collection of essays on "the relation of surgical practice to medical theories of the body" (x) is more like a historical corrective on major figures and themes in surgical history. Also of note is the concern that several of the essays pay to the specialization of surgery and its separation from other branches of medicine (and its susequent division into specialities - all this is rather taken for granted in current ideas of medical practice, but it is crucial to see how surgery came to be understood as such from being something affiliated with the barbers guild back in the middle ages.)
"Democratic, Divine and Heoric: The History and Historiography of Surgery" Christopher Lawrence: In this essay, Lawrence examines the way the trope of the Heroic surgeon was developed in Anglo-American history. "Where Renaissance surgeons found the source of their self-esteem and identity in newly translated ancient texts, English surgeons of the Enlightenment grounded their claims for recognition in their recent empirically acquired knowledge of anatomy, of operative techniques and of instrument design." (5) "Victorian histories of surgery began to use the Romantic language of the heroic, individual struggle which had increasingly appeared in the literature of science." (7) The breakthrough usage of antiseptic also expanded the view of the surgeon as hero, allowing him ever more province into the human body. Lawrence also discusses why surgery has eluded serious scholarship - it has been so successful in its teleological philosophy of progress that it doesn't get questioned too much. He brings in Tempkin (a very important figure in the historiography of medicine) who posited in the 50s that the disease doesn't always dictate treatment, but the constructedness that allows the treatment to predicate our understanding of disease. Anyway, by the 19th C, surgery and manliness (like the expansion into the West, so the expansion into the body) became linked. "What is the relation between the rise of surgery and the constitution of the body as an array of objects of surgical knowledge? After all the way in which we know the body in western medicine to a great extent implies the possibility of surgical intervention. Surgical practice is not simply the result of bodily knowledge. Bodily knowledge made by surgeons has built into it the possibility of surgical practice." (34)
"Seventeenth-century English Surgery: The Casebook of Joseph Binns" Lucinda McCray Beier: This essay takes as its source material the clinical notebooks of Joseph Binns, a very unremarkable surgeon in mid-17th Century Britain. It's goal is to examine the day-to-day practice of surgery. He treated rashes, boils, tumors, STDs,set bones, etc. While at this time there was a clear break (enforced by the Guild) between Surgeons and Physicians (who could prescribe internal medicines) these notebooks show that even unremarkable, respectable surgeons like Binns crossed this line all the time. "It clearly demonstrates that, for the most part, Binn's practice did deal with what was designated as the surgeon's domain: external disorders. But, like other surgeons and apothecaries of the day, he was prepared to treat internal diseases. Likewise, the casebook shows that Binns depened upon both theory and epiricism in his approach to treatment. His therapeutic regimes were governed by humoral theory. However, long experience of remedies and surgical procedures, combined with trial and error, influenced the courses of treatment he conducted." (81)
"Surgery and Scrophula" Roger French: This essay examines "what doctors and surgeons say and meant when they used the term 'scrophula' and how their picture of it was constructed." "Scrophula" was a term for tuberculosis used in the 17th-18th C, but disappeared from medical vocabulary and wasn't linked with TB until much later. This essay argues that its identification as the King's Evil (it could be cured by the touch of the King) made it's visibility (referenceability) contingent on anti-regency politics in Britain and France.
"Giovanni Battista Morgagni and Eighteenth-century Physical Examination" Malcolm Nicolson: This essay is another case study of a physician, this time a really famous one, to discuss a particular day-to-day activity - bed side manner. Further, as the previous essay, this contends that the physician also used many of the techniques of the surgeon, in practice, blurring the supposed clear demarcation between the two that existed at the time. This is evinced by the fact that while the physician had to respect the rules of decorum at the time (in terms of touching the body), he did palpate, percuss, and auscultate the body. "The aim of the new diagnostic procedures was to anatomise the living, to see the structural effects of disease at the bedside. The new conception of pathology thus gave physical examination primary significance." (123)
"Physiological Principles in the Surgical Writings of John Hunter" Stephen Jacyna:
This essay looks at the much studied influencial 19th C surgeon, John Hunter, but tries to discuss the undertheorized ways in which Hunter use bio-medical knowledge affected his conception of surgery. First off, for Hunter, "bodily actions [are] pervaded by teleology." (138) "Hunter saw the surgeon as acting - ideally - in co-operation with the body's own intelligence." (141) There is a return to nature and the province of the natural over the body - but a nature that is designed for the healthy progress of the body.
"Practicing on Principle: Joseph Lister and the Germ Theories of Disease" Christopher Lawrence and Richard Dixey: This essay contests the widely held notion that Joseph Lister and his followers represent the sole (or at least) main causes for the revolution of modern surgery through their studies and work on sepsis. The essay maintains that Lister and his group took on the modifications made to their initial theories as their own and posited themselves as the originators of those theories of inflammation and sepsis.
""From Conservative to Radical Surgery in Late Nineteenth-century America" Gert H. Brieger: This essay examines the way conservative surgery became radical surgery (at the expense of heroic surgery). Conservative surgery refers to the preservative nature of surgery - it preserves the body in life. Radical surgery attempts to cure the patient completey of the disease (not really what you thought - see it isn't the procedure that makes it radical - it is the intent - thus, the progression from conservative to radical isn't really that weird). What was shunned was heroic surgery - invasive surgeory to show the surgeon's testing of medicine's limits.
"Knowledge of Bodies or Bodies of Knowledge? Surgeons, Anatomists and Rectal Surgery, 1830-1985" Lindsay Granshaw: This essay is on the history of the growth of a specialty - rectal surgeons actively differentiated themselves as experts in terms of curing fistulas, and advised that patients not go to private physicians or quacks for cures. This was based in part on their insistence that they better knew the anatomy of the rectum than others. As such, this led to quite different envisionings of how the external sphincter worked that wasn't resolved until the mid 19th C. " Anatomists and clinicians both form part of the medical profession, yet, as the case of rectal surgery and anatomy illustrates, their approaches, and their theoretical and practical concerns have always been and in many ways are quite different...Bodies of knowledge did not equate with knowledge of bodies." (258)
"Experiment and Experience in Anaesthesia: Alfred Goodman Levy and Chloroform Death, 1910 - 1960" Christopher Lawrence: Why didn't physcians care that Alfred Levy had discovered that chloroform could cause death? We have again the division across fields of knowledge - clinicians felt that their work "on the ground" was not comparable to work done in labrotories by scientists on cats and dogs. But yeah, the cat dog people were right, it totally killed people and then they had to stop using it.
"The Amibiguous Artifact: Surgical Instruments and the Surgical Past" Ghislane Lawrence: This essay calls for a history of surgical instruments. It warns against relying too much on mere representation of old artifacts as simple, transparent truth - much like Sander Gilman does in his book. An interesting example is given - we shouldn't assume that a blade's purpose is so transparent (it is to cut, right?) but why, how, etc. is it different that a knife (say to cut a turkey?) "A history of surgery more concerned with the everyday practice of users and makers may well prove more productive when the complexity of old instruments as historical resources is recognized." (311)
Lawrence, Christopher (ed.). Medical Theory, Surgical Practice: Studies in the History of Surgery. London: Routledge, 1992.
Field
History and Theory of the Body
Summary
This collection of essays on "the relation of surgical practice to medical theories of the body" (x) is more like a historical corrective on major figures and themes in surgical history. Also of note is the concern that several of the essays pay to the specialization of surgery and its separation from other branches of medicine (and its susequent division into specialities - all this is rather taken for granted in current ideas of medical practice, but it is crucial to see how surgery came to be understood as such from being something affiliated with the barbers guild back in the middle ages.)
"Democratic, Divine and Heoric: The History and Historiography of Surgery" Christopher Lawrence: In this essay, Lawrence examines the way the trope of the Heroic surgeon was developed in Anglo-American history. "Where Renaissance surgeons found the source of their self-esteem and identity in newly translated ancient texts, English surgeons of the Enlightenment grounded their claims for recognition in their recent empirically acquired knowledge of anatomy, of operative techniques and of instrument design." (5) "Victorian histories of surgery began to use the Romantic language of the heroic, individual struggle which had increasingly appeared in the literature of science." (7) The breakthrough usage of antiseptic also expanded the view of the surgeon as hero, allowing him ever more province into the human body. Lawrence also discusses why surgery has eluded serious scholarship - it has been so successful in its teleological philosophy of progress that it doesn't get questioned too much. He brings in Tempkin (a very important figure in the historiography of medicine) who posited in the 50s that the disease doesn't always dictate treatment, but the constructedness that allows the treatment to predicate our understanding of disease. Anyway, by the 19th C, surgery and manliness (like the expansion into the West, so the expansion into the body) became linked. "What is the relation between the rise of surgery and the constitution of the body as an array of objects of surgical knowledge? After all the way in which we know the body in western medicine to a great extent implies the possibility of surgical intervention. Surgical practice is not simply the result of bodily knowledge. Bodily knowledge made by surgeons has built into it the possibility of surgical practice." (34)
"Seventeenth-century English Surgery: The Casebook of Joseph Binns" Lucinda McCray Beier: This essay takes as its source material the clinical notebooks of Joseph Binns, a very unremarkable surgeon in mid-17th Century Britain. It's goal is to examine the day-to-day practice of surgery. He treated rashes, boils, tumors, STDs,set bones, etc. While at this time there was a clear break (enforced by the Guild) between Surgeons and Physicians (who could prescribe internal medicines) these notebooks show that even unremarkable, respectable surgeons like Binns crossed this line all the time. "It clearly demonstrates that, for the most part, Binn's practice did deal with what was designated as the surgeon's domain: external disorders. But, like other surgeons and apothecaries of the day, he was prepared to treat internal diseases. Likewise, the casebook shows that Binns depened upon both theory and epiricism in his approach to treatment. His therapeutic regimes were governed by humoral theory. However, long experience of remedies and surgical procedures, combined with trial and error, influenced the courses of treatment he conducted." (81)
"Surgery and Scrophula" Roger French: This essay examines "what doctors and surgeons say and meant when they used the term 'scrophula' and how their picture of it was constructed." "Scrophula" was a term for tuberculosis used in the 17th-18th C, but disappeared from medical vocabulary and wasn't linked with TB until much later. This essay argues that its identification as the King's Evil (it could be cured by the touch of the King) made it's visibility (referenceability) contingent on anti-regency politics in Britain and France.
"Giovanni Battista Morgagni and Eighteenth-century Physical Examination" Malcolm Nicolson: This essay is another case study of a physician, this time a really famous one, to discuss a particular day-to-day activity - bed side manner. Further, as the previous essay, this contends that the physician also used many of the techniques of the surgeon, in practice, blurring the supposed clear demarcation between the two that existed at the time. This is evinced by the fact that while the physician had to respect the rules of decorum at the time (in terms of touching the body), he did palpate, percuss, and auscultate the body. "The aim of the new diagnostic procedures was to anatomise the living, to see the structural effects of disease at the bedside. The new conception of pathology thus gave physical examination primary significance." (123)
"Physiological Principles in the Surgical Writings of John Hunter" Stephen Jacyna:
This essay looks at the much studied influencial 19th C surgeon, John Hunter, but tries to discuss the undertheorized ways in which Hunter use bio-medical knowledge affected his conception of surgery. First off, for Hunter, "bodily actions [are] pervaded by teleology." (138) "Hunter saw the surgeon as acting - ideally - in co-operation with the body's own intelligence." (141) There is a return to nature and the province of the natural over the body - but a nature that is designed for the healthy progress of the body.
"Practicing on Principle: Joseph Lister and the Germ Theories of Disease" Christopher Lawrence and Richard Dixey: This essay contests the widely held notion that Joseph Lister and his followers represent the sole (or at least) main causes for the revolution of modern surgery through their studies and work on sepsis. The essay maintains that Lister and his group took on the modifications made to their initial theories as their own and posited themselves as the originators of those theories of inflammation and sepsis.
""From Conservative to Radical Surgery in Late Nineteenth-century America" Gert H. Brieger: This essay examines the way conservative surgery became radical surgery (at the expense of heroic surgery). Conservative surgery refers to the preservative nature of surgery - it preserves the body in life. Radical surgery attempts to cure the patient completey of the disease (not really what you thought - see it isn't the procedure that makes it radical - it is the intent - thus, the progression from conservative to radical isn't really that weird). What was shunned was heroic surgery - invasive surgeory to show the surgeon's testing of medicine's limits.
"Knowledge of Bodies or Bodies of Knowledge? Surgeons, Anatomists and Rectal Surgery, 1830-1985" Lindsay Granshaw: This essay is on the history of the growth of a specialty - rectal surgeons actively differentiated themselves as experts in terms of curing fistulas, and advised that patients not go to private physicians or quacks for cures. This was based in part on their insistence that they better knew the anatomy of the rectum than others. As such, this led to quite different envisionings of how the external sphincter worked that wasn't resolved until the mid 19th C. " Anatomists and clinicians both form part of the medical profession, yet, as the case of rectal surgery and anatomy illustrates, their approaches, and their theoretical and practical concerns have always been and in many ways are quite different...Bodies of knowledge did not equate with knowledge of bodies." (258)
"Experiment and Experience in Anaesthesia: Alfred Goodman Levy and Chloroform Death, 1910 - 1960" Christopher Lawrence: Why didn't physcians care that Alfred Levy had discovered that chloroform could cause death? We have again the division across fields of knowledge - clinicians felt that their work "on the ground" was not comparable to work done in labrotories by scientists on cats and dogs. But yeah, the cat dog people were right, it totally killed people and then they had to stop using it.
"The Amibiguous Artifact: Surgical Instruments and the Surgical Past" Ghislane Lawrence: This essay calls for a history of surgical instruments. It warns against relying too much on mere representation of old artifacts as simple, transparent truth - much like Sander Gilman does in his book. An interesting example is given - we shouldn't assume that a blade's purpose is so transparent (it is to cut, right?) but why, how, etc. is it different that a knife (say to cut a turkey?) "A history of surgery more concerned with the everyday practice of users and makers may well prove more productive when the complexity of old instruments as historical resources is recognized." (311)
# posted by SMRT : 7:05 PM
