Skill, Judgement and Conduct for the First Generation of Neurosurgeons, 1900–1930

Abstract

Historical contingency complicates a reading of skill as a self-explanatory and always positive attribute. By focusing on the attempts of the first generation of neurosurgeons to build a community and fashion a collective neurosurgical self, this article highlights the extent to which the relationship between surgical skill and professional judgement is reflected in broader concerns that shape the landscape of medicine at a given time. Some early twentieth-century surgeons expressed concern about the spectacularisation of surgery and the skilful but problematic work of 'brilliant operators'. The neurosurgeons' policies of inclusion and exclusion show that in the process of fashioning a neurosurgical persona, this first generation sanctioned specific norms of conduct underwritten by similar moral imperatives, such as self-control. These norms governed the doctors' work both in the operating room and on the public stage (in their engagement with the press). The meetings of the first neurosurgical society staged a critical encounter between the host neurosurgeon and the members who watched him perform surgery. These technical performances in the operating theatre, followed by discussions, were designed to encourage particular norms, to negotiate surgical knowledge, and to demonstrate the skills and character of the neurosurgeon. The performances acted as a technology of the self that aligned the operator to a community and helped that community refine its norms of surgical conduct. The awkward surgeon with inferior technical ability was preferable to the brilliant but vain operator who lacked the capacity to judge when he should not deploy his spectacular skills.

A Scoping Review of Professionalism in Neurosurgery

“…Publications that addressed professional identity were sometimes philosophical and sometimes practical. 10,15-65 Several articles addressed the concept of excellence in neurosurgery, 31-33,35,36 while others addressed the personality of a neurosurgeon. 20,61,62 Twelve of the indexed publications were presidential speeches from past presidents of the Congress of Neurological Surgeons (CNS), American Association of Neurological Surgeons (AANS), and several international neurosurgery societies.…”

Neurosurgery in Aberdeen Royal Infirmary C. 1920– C.1940: Knowledge, Skills and Styles

“…This was advocated by Cushing who had argued that 'every young surgeon should begin to acquire his operative training in a series of operations on lower animals'. 36 In 1924 Learmonth was elected to a Rockefeller fellowship at the Mayo Clinic, Minnesota, and came under the supervision of Alfred Adson (1887-1951). 53 Adson was interested in the sympathetic nervous system, 56 the spine and the spinal cord, 57 and was regarded as an innovator in the fi eld.…”

“…65 The vision of this society was to create a specialised association for surgeons dedicated to neurosurgery, to establish standards for neurosurgical procedures and to foster certain surgical styles. 36 Similar to the SNS, the SBNS was a small scientifi c club and the criterion for membership was an interest in neurosurgery. 66 Learmonth was a founding member alongside other men including Jefferson, Dott and Cairns.…”

“…Although this was regarded as a 'tedious and dull show', it meant that this slow, careful performance with delicate tissue handling led to a reduction in mortality. 36 The way to acquire a surgical technique was through the imitation of others and by operative experience. 37 During the 1920s three British men had become interested in surgery on the nervous system and had appreciated the importance of learning this technique directly from the innovators.…”

Commentary: A Scoping Review of Professionalism in Neurosurgery

“…12,13,16,18 Its culture was driven by contemporary advances in science and technology, together with an emphasis on technique, training, and innovation. 8,[20][21][22][23][24] From the perspective of professional norms, cognitive qualities were given primacy. Nevertheless, individual contributions by neurosurgeons to the care of the wounded in the First World War showed that the human side was equally well represented.…”