'Nobody is healthy in London, nobody can be'
At the Cheltenham Literature Festival this coming Sunday (14 October) I’ll be taking part in a discussion on surgical ethics, chaired by the polymathic Raymond Tallis, and also featuring the ethicist Hugh Davies, the clinical researcher Laura Coates, and the clinician and educator Roger Kneebone. This is part of ‘The Power of Surgery’ – a strand of events within the festival curated by Roger Kneebone. Roger is perhaps best known for his surgical simulations, which have given audiences around the country an opportunity to step inside the operating theatre and witness the kinds of skills and decisions involved in modern surgery. In ‘The Power of Surgery’ he turns his surgical gaze on the profession itself, exploring the aesthetic, creative, ethical and intellectual aspects of this ancient craft. Tickets are available here, and to whet your appetites here’s a short piece on the history of surgery I wrote for The Litmus Paper, a free newspaper published especially for the festival:
‘Surgery’ comes from two Greek words: cheiron and ergon, literally ‘hand-work’. The exercise of surgical power has always been characterised by a tension between learning and craft, the lecture room and the butchers’ block – in short, between the head and the hand.
Until well into the eighteenth century surgery was a trade with a desperately poor reputation. Physicians, the ‘head’ of the orthodox ‘medical body’, sought to develop a holistic perspective on each patient’s life, while mere mechanical knowledge of flesh and bones could be left to vulgar tradesmen like surgeons – the ‘hands’ of the medical body.
In the age of Enlightenment surgeons began to develop a distinctively ‘surgical’ view of the body. Disease was not an imbalance but a lesion, a localised, physical defect that could be identified and treated through surgical intervention. In the secularised hospitals of the French Revolution doctors, too, acquired this surgical gaze. But in doing so the notion of the patient as an autonomous individual dissolved, to be reconstituted as the ‘case’ – a new entity subject, in every sense, to expert clinicians.
Technical developments in the nineteenth century – anaesthesia, antisepsis – helped surgeons to consolidate their new position as the leaders of medical thought. The ennoblement of Joseph Lister, the pioneer of antiseptic surgery, in 1897 became a symbol of how far surgery had come in the nineteenth century, and how far it would go in the twentieth.
But a powerful demographic shift towards the chronic diseases of old age – conditions less susceptible to surgical intervention – has created new challenges for contemporary surgical power, and for the regimes of state-funded healthcare in which it is embedded. To the head and the hands we must now add the ballot-box and the purse.