The Professionalization of Surgery: An Examination of Surgeon-Patient Encounters in Britain 1745-1858

Abstract

Between 1745 and 1858, surgery in Great Britain developed from a manual craft into a scientific medical discipline and surgeons transformed themselves from the manual workers of medicine into a professional medical elite. The aims of this thesis are to examine this professionalization of surgery and what it meant in practical terms for the relationship between surgeons and patients. A review was undertaken of historical sources in the humanities, medicine, education, art and English literature, and an analysis of patients’ and surgeons’ perspectives. The professionalization of surgery was achieved through the occupation of surgery adopting the characteristics of a profession, and by its practitioners - the surgeons - embracing the attributes of professionalism. Surgeons organised themselves into surgical corporations and focused on learning and enhancing surgical knowledge and skills. They embraced certain attributes and accepted new standards of behaviour and ethical codes to guide their personal conduct and self-regulation. The experiences of six patients who underwent major surgery prior to the advent of anaesthesia, and of fifty-six patients who consulted their surgeon by letter post, revealed the challenges they faced during consultations, diagnosis, and treatment. The surgeons they encountered varied from the few who were domineering and oblivious to their suffering, to the many who were understanding, compassionate and sympathetic. Surgeons experienced emotional distress and disturbed sleep before operating in peacetime and war, but self-control and emotional restraint enabled them to complete surgical procedures. Exploring their emotions helped them articulate their feelings and shape their identities. The desirable attributes of an ideal surgeon were described by them as humanity, compassion, integrity, communication, a scientific approach, and the avoidance of unnecessary surgery. Deficiencies included over-eagerness to operate, poor technical skills, and undue focus on daring and surgical speed. A critical scientific approach to new discoveries was displayed by the many surgeons who advocated further research and experience before acknowledging the safety of anaesthesia. The findings described in this thesis contribute to a better understanding of the professionalization of surgery and how this had an impact on the relationship between surgeons and patients during this period.