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

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.

Men of dreams and men of action: neurologists, neurosurgeons, and the performance of professional identity, 1920-1950.

In the 1930s and 1940s, neurosurgeons and clinical neurologists engaged in a fierce exchange on the scope of their specialties. Neurosurgeon Wilder Penfield's rhetoric of therapeutic superiority had a strong impact both on the Rockefeller Foundation's support for his institute and on the self-fashioning of neurologists. Neurologists articulated their identity in spirited performances at the meetings of specialist societies, their response shifting from a combative approach to a focus on internal organization. In light of the neurosurgeons' discourse, by the 1950s a new generation of neurologists created a revisionist narrative that inaccurately portrayed the clinical neurologists of the past as having been uninterested in therapeutics.

Envisioning cyclopropane: scientific product or medical technology?

In the late 1920s, V.E. Henderson and his team at the University of Toronto discovered the anaesthetic properties of cyclopropane. For a number of reasons, Henderson did not envision cyclopropane as a useful technology: to him it was simply a gas that possessed anaesthetic properties, rather than a potential clinical product, and this explains why cyclopropane was not first introduced into Toronto hospitals. In contrast, the practicing anaesthesiologist Ralph M. Waters envisioned cyclopropane as a medical technology, partly because it could assist his effort to professionalize anaesthesiology in the 1930s. This paper argues that it is useful to make a historically-informed distinction between cyclopropane the experimental laboratory gas and cyclopropane the medical anaesthetic because such a distinction highlights the social dimensions of the process of scientific discovery and helps illuminate the relationship between scientific production and medical technology.