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Risk, Responsibility and Surgery in the 1890s and Early 1900s

  • Claire Brock (a1)
Abstract

This article explores the ways in which risk and responsibility were conceptualised in the late nineteenth and early twentieth centuries by surgeons, their patients and the lay public. By this point surgery could be seen, simultaneously, as safe (due to developments in surgical science) and increasingly risky (because such progress allowed for greater experimentation). With the glorification of the heroic surgeon in the late Victorian and early Edwardian period came a corresponding, if grudging, recognition that successful surgery was supported by a team of ancillary professionals. In theory, therefore, blame for mistakes could be shared amongst the team; in practice, this was not always the case. Opening with an examination of the May Thorne negligence case of 1904, I will also, in the latter third of this piece, focus on surgical risks encountered by women surgeons, themselves still relatively new and, therefore, potentially risky individuals. A brief case study of the ways in which one female-run institution, the New Hospital for Women, dealt with debates surrounding risk and responsibility concludes this article. The origin of the risks perceived and the ways in which responsibility was taken (or not) for risky procedures will provide ways of conceptualising what ‘surgical anxiety’ meant in the 1890s and 1900s.

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Copyright
The online version of this article is published within an Open Access environment subject to the conditions of the Creative Commons Attribution licence .
Corresponding author
*Email address for correspondence: cb178@le.ac.uk
References
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1. Accounts of the Thorne trial, from which specific details are taken, can be found in ‘Medico-Legal and Medico-Ethical: An Overlooked Sponge’, BMJ, 1, 2267 (11 June 1904), 1408–9; ‘Medicine and the Law: Byrne v Thorne’, The Lancet, 164, 4223 (6 August 1904), 419–20; ‘The Law Courts’, The Times, 37414 (Tuesday 7 June 1904), 9.

2. Schlich, Thomas, ‘Risk and medical innovation: A historical perspective’, in Schlich, Thomas and Tröhler, Ulrich (eds), The Risks of Medical Innovation: Risk Perception and Assessment in Historical Context (Abingdon and New York: Routledge, 2006), 119: 16.

3. See, for example, Twenty-Ninth (1900) Annual Report of the New Hospital for Women, 144, Euston Road, N.W. Established 1872 (London: Alexander and Shepheard, 1901), 6, where Thorne appears as a ‘Senior Assistant’ and ‘Anaesthetist’.

4. Thomas Annandale, ‘Address in Surgery’, BMJ, 2, 1961 (30 July 1898), 293–7: 295; ‘Count Sponges and Instruments’, BMJ, 1, 2052 (28 April 1900), 1047–8.

5. Christopher Lawrence, ‘Democratic, divine and heroic: the history and historiography of surgery’, in C. Lawrence (ed.), Medical Theory, Surgical Practice: Studies in the History of Surgery (London and New York: Routledge, 1992), 1–47: 7; 32. See also Sally Wilde and Geoffrey Hirst, ‘Learning from Mistakes: Early Twentieth Century Surgical Practice’, Journal of the History of Medicine and Allied Sciences, 64, 1 (2008), 38–77; L.S. Jacyna, ‘The Laboratory and the Clinic: The Impact of Pathology on Surgical Diagnosis in the Glasgow Western Infirmary, 1875–1910’, Bulletin of the History of Medicine, 62, 3 (1988), 384–406.

6. Sally Wilde concludes that, by 1900, the possibility of surgical confidence had been passed to the patient, while Ian Burney notes that there was a ‘confident, professionalised interaction among surgeon, patient and anaesthetist’, which was disrupted by the publicity given to anaesthetic deaths. See Sally Wilde, ‘Truth, Trust, and Confidence in Surgery, 1890–1910: Patient Autonomy, Communication, and Consent’, Bulletin of the History of Medicine, 83, 2 (2009), 302–30; 305: 328; and Ian Burney, Bodies of Evidence: Medicine and the Politics of the English Inquest, 1830–1926 (Baltimore, MD and London: Johns Hopkins University Press, 2000), 153.

7. See note 1 for sources.

8. BMJ, op. cit. (note 1), 1409.

9. BMJ, op. cit. (note 1), 1409.

10. The Times, op. cit. (note 1).

11. Frederick Treves, Manual of Operative Surgery, Vol. II (London: Cassell & Company, 1892), 234.

12. Lancet, op. cit. (note 1), 420.

13. Lancet, op. cit. (note 1), 420.

14. For a history of the Medical Defence Union, see Clifford Hawkins, Mishap or Malpractice? (Oxford: Blackwell/Medical Defence Union, 1985).

15. See BMJ, 2, 2271 (9 July 1904), 100; The Lancet, 164, 4219 (9 July 1904), 122.

16. ‘Correspondence: Thorne Defence Fund’, BMJ, 1,2268 (18 June 1904), 1462; also in The Lancet, 163, 4216 (18 June 1904), 1750.

17. ‘The Responsibility of a Surgeon for His Assistants’, BMJ, 1, 2268 (18 June 1904), 1446–7: 1446.

18. Ibid., 1447.

19. BMJ, op.cit. (note 17).

20. Printed in BMJ, 2, 2272 (16 July 1904), 153; and The Lancet, 2, 4220 (16 July 1904), 173.

21. ‘Room for the Ladies!’, BMJ, 1, 119 (9 April 1859), 292-4: 293.

22. Thomas Schlich, ‘Surgery, Science and Modernity: Operating Rooms and Laboratories as Spaces of Control’, History of Science, 45 (2007), 231–56: 236.

23. Stefan Hirschauer, ‘The Manufacture of Bodies in Surgery’, Social Studies of Science, 21, 2 (1991), 279–319: 297.

24. Treves, op. cit. (note 11), 237.

25. Treves, op. cit. (note 11), Vol. I, 36–7.

26. Ghislaine Lawrence, ‘The ambiguous artifact: surgical instruments and the surgical past’, in Christopher Lawrence (ed.), op. cit. (note 5), 295–314: 310–11.

27. Treves, op. cit. (note 11), 29. This is not to suggest that Treves’s statement is contradictory; rather, the ‘brilliance’ of early nineteenth-century speed and sang froid have been replaced, in his eyes, by the splendour of intricacy, precision and the possibility of replication.

28. A. Marmaduke Sheild, ‘Sponges and Forceps Left in the Abdominal Cavity’, The Lancet, 163, 4215 (11 June 1904), 1684. All quotations in this paragraph are from the letter, which was dated 6 June 1904, the final day of the Thorne trial.

29. The Lancet, op. cit. (note 1), 419–20: 417. For ongoing tensions between standardisation and individual surgical skill, see Thomas Schlich, ‘The Art and Science of Surgery: Innovation and Concepts of Medical Practice in Operative Fracture Care, 1960s–1970s’, Science, Technology, & Human Values, 32, 1 (2007), 65–87.

30. Keir Waddington, ‘Unsuitable Cases: The Debate over Outpatient Admissions, the Medical Profession and late-Victorian London Hospitals’, Medical History, 42 (1998), 26–46: 29.

31. Letter from John Campbell, dated 8 August, 1904, ‘Free Operations’, The Lancet, 164, 4224 (13 August 1904), 491. All quotations in this paragraph are from this letter.

32. See, for example, Sally Wilde, The History of Surgery: Trust, Patient Autonomy, Medical Dominance and Australian Surgery, 1890–1940 (e-book at: www.thehistoryofsurgery.com); Wilde, op. cit. (note 6); Wilde and Hirst, op. cit. (note 5); Sally Wilde, ‘The Elephants in the Doctor–Patient Relationship: Patients’ Clinical Interactions and the Changing Surgical Landscape of the 1890s’, Health and History, 9, 1 (2007), 2–27.

33. Wilde, op. cit. (note 6), 219.

34. Thomas Schlich, The Origins of Organ Transplantation: Surgery and Laboratory Science, 1880–1930 (Rochester, NY: University of Rochester Press, 2010), 9–10; Lawrence, op. cit. (note 5), especially 10–15.

35. Richard D. French notes that the Daily Chronicle was one of the most consistent backers of the anti-vivisection movement. See Antivivisection and Medical Science in Victorian Society (Princeton, NJ: Princeton University Press, 1975), 267.

36. For an account of the reaction against medical intervention during this period, see, for example, Nadia Durbach, Bodily Matters: The Anti-Vaccination Movement in England, 1853–1907 (Durham, NC and London: Duke University Press, 2005).

37. ‘The Daily Chronicle on Human Vivisection’, BMJ, 1, 1743 (26 May 1894), 1143–4: 1143.

38. ‘The Renaissance of Surgery in the Victorian Age: Abdominal Surgery, 1837–1897’, Queen’s Commemoration Number, BMJ, 1, 1903 (19 June 1897); 1527–31: 1527; 1530.

39. Aesculapius Scalpel [Edward Berdoe], St Bernard’s. The Romance of a Medical Student (London: Swan Sonnenschein & Co., 1888), 88.

40. Ibid., 61.

41. Scalpel, op. cit. (note 39), 92. ‘Dying Scientifically’ was an alternative title for what appears to have been a pamphlet form of the novel, published by the Society for the Protection of Hospital Patients. See ‘Hospital Scandals’, Reynolds’s Newspaper, 2456 (Sunday 5 September 1897), 2.

42. Anon., Experiments on Patients by Two Hospital Physicians, 2nd edn, with additions (London: Pickering & Co., 1884), 17.

43. ‘The Chelsea Hospital for Women’, BMJ, 2, 1756 (25 August 1894), 429-36: 431.

44. ‘Experiments on Patients’, BMJ, 1, 1745 (9 June 1894), 1262.

45. Scalpel, op. cit. (note 39), 88-9: 92.

46. Annandale, op. cit. (note 4), 293-7: 294; 295–6. For the context of Annandale’s comments about ‘historical’ antisepsis and the rise of asepsis in the 1890s, see Michael Worboys, Spreading Germs: Disease Theories and Medical Practice in Britain, 1865–1900 (Cambridge: Cambridge University Press, 2000), 150–92.

47. ‘Obituary: Sir William Bennett, KCVO, FRCS’, BMJ, 1, 3705 (9 January 1932), 80–1: 81.

48. Sir William Henry Bennett, ‘The Ethics of Operating’, BMJ, 1, 2212 (23 May 1903), 1222. See David S. Jones, ‘Visions of a Cure: Visualization, Clinical Trials and Controversies in Cardiac Therapeutics, 1968–1998’, Isis, 91, 3 (Sept 2000), 504–41 for a more recent example of professional differences over the interpretation of surgical success. For the performance of surgical identity, see Delia Gavrus, ‘Men of Dreams and Men of Action: Neurologists, Neurosurgeons, and the Performance of Professional Identity, 1920–1950’, Bulletin of the History of Medicine, 85, 1 (2011), 57–92.

49. Bennett, op. cit. (note 48).

50. For more on late nineteenth century fears of anaesthetic death, see Stephanie J. Snow, Operations Without Pain: The Practice and Science of Anaesthesia in Victorian Britain (Basingstoke: Palgrave Macmillan, 2006) and Burney, op. cit. (note 6) and ‘Anaesthesia and the evaluation of surgical risk in mid-nineteenth-century Britain’, in Schlich and Tröhler (eds), op. cit. (note 2), 38–52.

51. Hawkins, op. cit. (note 14), 12. Hawkins suggests that this is because surgical negligence could be ‘seen, such as the failure of a wound to heal, whereas physicians’ mistakes could easily be attributed to nature’.

52. Lawson Tait, ‘The Modern Treatment of Myomatous Disease of the Uterus’, BMJ, 1,1891 (27 March 1897), 779–80 780.

53. See, for example, Anna Davin, ‘Imperialism and Motherhood’, History Workshop Journal, 5 (1978), 9–65.

54. The following account of the case is taken from ‘Beatty v Cullingworth’, BMJ, 2, 1873 (21 November 1896), 1525–6 and ‘Medico-Legal. Beatty v Cullingworth: Times Report’, ibid., 1546–8.

55. ‘Medico-Legal. Beatty v Cullingworth’, op. cit. (note 54), 1547.

56. Medico-Legal. Beatty v Cullingworth’, op. cit. (note 54), 1548.

57. Medico-Legal. Beatty v Cullingworth’, op. cit. (note 54). Beatty would later publish two books which stemmed from her encounter with Dr Cullingworth: Unjust Judges (London: Judicial Injustice Redress Society, 1911) and the self-published Medical Tyranny: A Personal Experience (London: A.J. Beatty, 1912).

58. ‘Medico-Legal: Beatty v Cullingworth’, BMJ, 1, 1881 (16 Jan 1897), 178.

59. ‘London Week by Week: Miscellaneous’, Reynolds’s Newspaper, 2426 (Sunday 7 February 1897), 1.

60. ‘Notes and Gossip’, Reynolds’s Newspaper, 2423 (Sunday 17 January 1897), 1.

61. ‘Sunday’s Survey’, Lloyd’s Weekly Newspaper, 2844 (Sunday 23 May 1897), 10.

62. ‘Signals from Our Watch Tower’, Woman’s Signal, 165 (Thursday 25 February 1897), 120.

63. ’Hospital Scandals’, Reynolds’s Newspaper, 2456 (Sunday 5 September 1897), 2.

64. ‘The Chelsea Hospital for Women’, BMJ, 2, 1756 (25 August 1894), 429–36: 431. Edward Berdoe would later become ‘Aesculapius Scalpel’ and was responsible for the Daily Chronicle piece on ‘Human Vivisection’ quoted in this article.

65. Ibid.

66. For more on this scandal, see Ornella Moscucci, The Science of Woman: Gynaecology and Gender in England, 1800–1929 (Cambridge: Cambridge University Press, 1990), 92–101.

67. BMJ, op. cit. (note 61), 431.

68. ‘Human Vivisection: Interview with Dr Elizabeth Blackwell’, Daily Chronicle, 22 May 1894, Newspaper Cuttings: New Hospital for Women, 1871–1968, H13/EGA/144 (London Metropolitan Archives).

69. Blackwell, Dr Elizabeth, Pioneer Work in Opening the Medical Profession to Women. Autobiographical Sketches (London and New York: Longmans, Green and Co, 1895), 154; 157.

70. Minute Books of the Management Committee of the New Hospital for Women, II: May 1882–March 1895, H13/EGA/20 (London Metropolitan Archives).

71. See Claire Brock, ‘Surgical Controversy at the New Hospital for Women, 1872–1892’, Social History of Medicine, 24, 3 (December 2011), 608–23.

72. Minute Books, op. cit. (note 70), 1 December 1892.

73. Ibid., 6 December 1894.

74. See, for example, A. Gordon Pollock’s letter to the Hon. Secretaries of King Edward’s Hospital Fund, dated 27 July 1905, where he states that the hospital is not one solely for the ‘special diseases of women’, but a ‘general Hospital for women desiring to be attended by physicians and surgeons of their own sex’, King Edward’s Hospital Fund for London Correspondence with the New Hospital for Women, A/KE/248/4 (London Metropolitan Archives).

75. See Annual Reports of the New Hospital for Women (London: Alexander and Shepheard), published between 1894 and 1903.

76. Scharlieb, Mary, Reminiscences (London: Williams and Norgate, 1924), 167169.

77. See, for example, Scharlieb’s article ‘Surgery at the New Hospital for Women in 1896’, BMJ, 2, 1910 (7 August 1897), 338–9.

78. Ibid., 338, where pathologist’s reports prevent the carrying out of a wrong diagnosis into surgical errors.

79. See Annual Reports of the New Hospital for Women between 1901 and 1903.

80. May Thorne, ‘After-Effects of Abdominal Section’, BMJ, 1, 1988 (4 February 1899), 264–5. Even nearly a decade later, following up patients, either by letter or in person, was only carried in post-operative cancer cases at the New Hospital. See Louisa Garrett Anderson and Kate Platt, ‘Malignant Disease of the Uterus. A Digest of 265 Cases Treated in the New Hospital for Women’, Journal of Obstetrics and Gynaecology of the British Empire, 14, 6 (December 1908), 381–92: 381.

81. Wilde, op. cit. (note 6), 328.

82. Tait, op. cit. (note 51), 780.

83. ‘Overlooked Forceps’, BMJ, 1, 2263 (19 May 1904), 1147.

I would like to thank Ben Dew and my family for helping me to refine my ideas about risk and responsibility; the Wellcome Trust for awarding me a Research Leave Award (WT096499AIA), which has allowed me to develop my work on women and surgery; the audience at Bart’s Hospital Pathology Museum Seminar Series, where an earlier, shorter version of this research was presented; and the insight and acuity of the Medical History reviewer, whose kind encouragement is very much appreciated.

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