Surgery,Science and Modernity: Operating Rooms and Laboratories as Spaces of Control

This is not an empirical paper. I am developing the general implications of an empirically oriented case study on the surgical spaces of the Royal Victoria Hospital in Montreal, Adams Annmarie Schlich Thomas , “Design for control: Surgery, science and space at the Royal Victoria Hospital, Montreal, 1893–1956, Medical history, 1 (2006), 73–94.

Galison Peter , “Buildings and the subject of science”, in Galison Peter Thompson Emily (eds), The architecture of science (Cambridge, MA, and London, 1999), 1–25, p. 19.

Livingstone David N. , Putting science in its place: Geographies of scientific knowledge (Chicago and London, 2003); and Ophir Adi Shapin Steven , “The place of knowledge: A methodological survey”, Science in context, iv (1991), 1991–21, p. 14. They included even cathedrals, see Heilbron J. L. , The sun in the church: Cathedrals as solar observatories (Cambridge, MA, 1999).

Shapin Steven , “The house of experiment in seventeenth-century England”, Isis, lxxix (1988), 373–404, p. 373.

Ophir Shapin , op. cit. (ref. 3), 7, 9, 15; and Livingstone , op. cit. (ref. 3), 17–86.

For a survey, see e.g. Jardine Nicholas , The scenes of inquiry: On the reality of questions in the sciences (Oxford, 1991).

As early examples see in particular, Latour Bruno Woolgar Steve , Laboratory life: The social construction of scientific facts (London and Beverly Hills, 1979); Knorr-Cetina Karin , The manufacture of knowledge: Toward a constructionist and contextual theory of science (Oxford, 1981); Lynch Michael , Art and artifacts in laboratory science (London, 1982); and Collins Harry M. , Changing order: Replication and induction in scientific practice (Beverly Hills and London, 1985).

Knorr-Cetina Karin D. , “The ethnographic study of scientific work: Towards a constructivist interpretation of science”, in Knorr-Cetina Karin D. Mulkay Michael (eds), Science observed: Perspectives on the social study of science (London, Beverly Hills and New Delhi, 1983), 115–40, p. 117.

Latour Bruno , “Give me a laboratory and I will raise the world”, in Knorr-Cetina Mulkay (eds), Science observed (ref. 8), 141–70, p. 141.

Lynch Michael , “Laboratory space and the technological complex: An investigation of topical contextures”, in Star Susan Leigh (ed.), Ecologies of knowledge: Work and politics in science and technology (Albany, NY, 1995), 226–56, p. 255. See also Ophir Shapin , op. cit. (ref. 3), 11.

Jewson N. D. , “The disappearance of the sick man from medical cosmology”, Sociology, x (1976), 225–44; Jewson N. D. , “Medical knowledge and the patronage system in eighteenth century England”, Sociology, viii (1974), 1974–85; Ackerknecht Erwin H. , Medicine at the Paris hospital (Baltimore, 1967); and Cunningham Andrew Williams Perry (eds), The laboratory revolution in medicine (Cambridge, 1992).

Brandt Allan M. Sloane David C. , “Of beds and benches: Building the modern American hospital”, in Galison Peter Thompson Emily (eds), The architecture of science (Cambridge, MA, and London, 1999), 281–305, p. 281.

See e.g. Pevsner Nikolaus , A history of building types (Princeton, NJ, 1976), 138–58; Sloane David Charles , “Scientific paragon to hospital mall: The evolving design of the hospital”, Journal of architectural education, xlviii (1994), 82–98.

Prior Lindsay , “The architecture of the hospital: A study of spatial organization and medical knowledge”, The British journal of sociology, xxxix (1988), 86–113, p. 93.

Brandt Sloane , op. cit. (ref. 12), 281.

Cf. Galison , op. cit. (ref. 12), 11–12.

Brandt Sloane , op. cit. (ref. 12).

Sloane , op. cit. (ref. 13).

Foucault Michel , Discipline and punish: The birth of the prison (New York, 1995; French original, Paris, 1975), 170–7; see also Foucault Michel , Les machines à guérir: Aux origines de l'hôpital moderne (Brussels, 1979).

Ophir Shapin , op. cit. (ref. 3), 12.

Prior , op. cit. (ref. 14), 92.

Markus Thomas A. , Buildings and power: Freedom and control in the origin of modern building types (London and New York, 1993), 22.

Markus , op. cit. (ref. 22), p. xix.

Levin Miriam R. , “Contexts of control”, in Levin Miriam R. (ed.), Cultures of control (Amsterdam, 2000), 13–39, p. 14.

Timmermans Stefan Berg Marc , The gold standard: The challenge of evidence-based medicine and the standardization in health care (Philadelphia, 2003), 8.

Levin , op. cit. (ref. 24), 22.

Levin , op. cit. (ref. 24), 21.

Beniger James E. , The control revolution: Technological and economic origins of the information society (Cambridge, MA, 1986).

As Peter Galison has rightly emphasized, there is “no single trans-temporal, trans-cultural entity that is ‘the laboratory’ that would include all spaces from the alchemist's secretive basements array of furnaces through the clinical research hospital to the $10 billion Large Hadron Collider outside Geneva”, Galison , op. cit. (ref. 2), 1.

Bernard Claude , An introduction to the study of experimental medicine (French original, 1865; transl. by Green Henry Copley , New York, 1957), 5.

Bernard , op. cit. (ref. 30), 6, 75. Bernard kept reiterating this important point throughout the book, see e.g. similarly pp. 67–68, 156.

Bernard , op. cit. (ref. 30), 82.

Foucault , op. cit. (ref. 19), 26 and 194. As characterized by Foucault, power is something that is “not possessed but exercised”, it is “the overall effect of strategic positions”, it is fluent with “innumerable points confrontation, focuses of instability” etc., ibid., 25–27. On science and power in a Foucauldian mould see Rouse Joseph , Knowledge and power (Ithaca and London, 1987), 209–47.

Foucault , op. cit. (ref. 19), 202.

Bernard , op. cit. (ref. 30), 146.

Bynum William F. , Science and the practice of medicine in the nineteenth century (Cambridge, 1994), 106.

Bernard , op. cit. (ref. 30), 147.

Bernard , op. cit. (ref. 30), 140.

Rouse , op. cit. (ref. 33), 95–111.

Rouse , op. cit. (ref. 33), 221–2.

Latour , op. cit. (ref. 9), 164.

Latour , op. cit. (ref. 9). See also Pickstone John V. , ‘Ways of knowing: Towards a historical sociology of science, technology and medicine’, The British journal for the history of science, xxvi (1993), 433–58, p. 437.

Latour Bruno , “Visualization and cognition: Thinking with eyes and hands”, in Knowledge and society: Studies in the sociology of culture past and present, vi (1986), 1–40.

Latour , op. cit. (ref. 9), 163.

On that aspect of the laboratory, see Latour , op. cit. (ref. 9). Also, inscription devices do not have the same crucial role in surgery as in science, although one could interpret the inscription of normal anatomy into the living body as a similar process to inscription in science, cf. Stefan Hirschauer, “The manufacture of bodies in surgery”, Social studies of science, xxi (1991), 279–319.

See e.g. Schlich Thomas , Surgery, science and industry: A revolution in fracture care, 1950–1990s (Basingstoke, 2002), 240.

Kirschner Martin , Operative surgery: General and special considerations, transl. by Ravdin I. S. (Philadelphia and London, 1931), 229–349.

Foucault , op. cit. (ref. 19), 135–40. The patient is disciplined for being turned into an object while the surgeon is disciplined to become an instrument, see Hirschauer , op. cit. (ref. 45), 280,284–9; on docility in the context of surgery, see ibid., 309.

Hirschauer , op. cit. (ref. 45), 307–13, quote on p. 310.

On the historiography of surgical instruments and its problems, see Lawrence Ghislaine , “The ambiguous artifact: Surgical instruments and the surgical past”, in Lawrence Christopher (ed.), Medical theory, surgical practice: Studies in the history of surgery (London and New York, 1992), 295–314.

See Hirschauer , op. cit. (ref. 45), 286–93.

Rouse , op. cit. (ref. 33), 231.

Rouse , op. cit. (ref. 33), 233–4.

Mörgeli Christoph , The surgeon's stage: A history of the operating room (Basel, 1999), 159–83.

Mörgeli , op. cit. (ref. 54), 172–4.

Rosenberg Charles E. , The care of strangers: The rise of America's hospital system (New York, 1987), 144.

Brandt Sloane , op. cit. (ref. 12), 288.

Brandt Sloane , op. cit. (ref. 12), 288–9.

Sloane , op. cit. (ref. 13), 82.

Prior , op. cit. (ref. 14), 92.

Livingstone , op. cit. (ref. 3), 64.

Donzé Pierre-Yves , “L'ombre de César: Les chirurgiens et la construction du système hospitalier vaudois (1840–1960)”, Ph.D. thesis, University of Neuchâtel, 2004, 111.

For Britain, see Granshaw Lindsay : “The rise of the modern hospital in Britain”, in Wear Andrew (ed.), Medicine in society: Historical essays (Cambridge, 1992), 197–218, see pp. 211–12. For North America, see Rosenberg , op. cit. (ref. 56), and Howell Joel D. , Technology in the hospital: Transforming patient care in the early twentieth century (Baltimore and London, 1995), 30–68.

Hirschauer , op. cit. (ref. 45), 297–303.

Howell , op. cit. (ref. 63), 58.

Kirschner , op. cit. (ref. 47), 55.

Howell , op. cit. (ref. 63), 59.

Rosenberg , op. cit. (ref. 56), 149.

Rosenberg , op. cit. (ref. 56), 149.

Cf. Smith Dale D. , “Appendicitis, appendectomy, and the surgeon”, Bulletin of the history of medicine, lxx (1996), 414–41.

See e.g. Schlich , op. cit. (ref. 46); Howell , op. cit. (ref. 63), 57–68; Reverby Susan , “Stealing the golden eggs: Ernest Amory Codman and the science and management of medicine”, Bulletin for the history of medicine, lv (1981), 156–71; Wilde Sally , “See one, do one, modify one: Prostate surgery in the 1930s”, Medical history, xlviii (2004), 2004–66; and Smith , op. cit. (ref. 70).

Weisz George , The medical mandarins: The French academy of medicine in the nineteenth and early twentieth centuries (Oxford, 1995), 162.

Lesch John E. , Science and medicine in France: The emergence of experimental physiology, 1790–1844 (Cambridge, MA, 1984), 5–8, 12–14, 50–124, 199–218.

Warner John Harley , “The history of science and the sciences of medicine”, Osiris, x (1995), 164–93, p. 186.

Bernard , op. cit. (ref. 30), 99.

Bernard , op. cit. (ref. 30), 104.

Bernard , op. cit. (ref. 30), 65.

Bernard , op. cit. (ref. 30), 197.

“A surgeon, a physiologist and Nero give themselves up alike to mutilation of living beings. What differentiates them also, if not ideas?”, Bernard , op. cit. (ref. 30), 102. According to Bernard, physiologists and surgeons also share a particular morally high-standing emotional asceticism towards their work. The physiologist “no longer hears the cry of animals, he no longer sees the blood that flows, he sees only the idea and perceives only organisms concealing problems which he intends to solve”. Similarly, “no surgeon is stopped by the most moving cries and sobs, because he sees only his idea and the purpose of his operation”, ibid., 103.

Bernard , op. cit. (ref. 30), 8–9.

Bernard , op. cit. (ref. 30), 102; Bernard stressed this communality when he wrote that”…surgeons perform vivisections daily on their subjects”, ibid., 101.

Richard Stewart , “Anaesthetics, ethics and aesthetics: Vivisection in the late nineteenth-century British laboratory”, in Cunningham Williams (eds), op. cit. (ref. 11), 142–69, p. 147.

Richard , op. cit. (ref. 82), 147.

Richard , op. cit. (ref. 82), 150.

Richard After , op. cit. (ref. 82), 155.

Richard , op. cit. (ref. 82), 163.

Richard , op. cit. (ref. 82), 155.

Kocher Emil Theodor , “Concerning pathological manifestations in low-grade thyroid diseases”, Nobel lecture, 11 December 1909, in Nobel Lectures physiology or medicine, 1901–1921 (Amsterdam, 1967), 330–83, p. 331. This also raises the issue of the use of animals in modern health care and the variations in the animal's status according to the context, see Rock Melanie Mikhalovskiy Eric Schlich Thomas , “People, other animals and health knowledges: Toward a research agenda”, Social science and medicine, lxiv (2007), 1970–6.

Prior , op. cit. (ref. 14), 86.

Cunningham Williams , op. cit. (ref. 11); Pickstone , op. cit. (ref. 42), 449–52; and Warner , op. cit. (ref. 75).

Warner , op. cit. (ref. 74), 182.

Howell , op. cit. (ref. 63), 62.

Ibid., 62.

Warner , op. cit. (ref. 74), 178.

Sturdy Steve Cooter Roger , “Science, scientific management, and the transformation of Britain c. 1870–1950”, History of science, xxxvi (1998), 421–66, p. 449. Cf. Howell , op. cit. (ref. 63), 2: “Rather than simply attributing change to the march of science, it is far more interesting for the historian and valuable for the policy maker to examine when and how the appeal to science derived its current power”.

Tröhler Ulrich , “Surgery (modern)”, in Bynum William F. Porter Roy (eds), Companion encyclopedia of the history of medicine (2 vols, London and New York, 1993), ii, 984–1028, see pp. 993–9.

Schlich Thomas , Die Erfindung der Organtransplantation: Erfolg und Scheitern des chirurgischen Organersatzes (1880–1930) (Frankfurt am Main, 1998), 35–90.

Schlich , op. cit. (ref. 97), 52–54.

Schlich , op. cit. (ref. 97), 53–57.

von Eiselsberg Anton , “Zur Frage der dauernden Einheilung verpflanzter Schilddrüsen und Nebenschilddrüsen”, Verhandlungen der Deutschen Gesellschaft für Chirurgie, xliii (1914), 655–69, see p. 656; see also Schlich , op. cit. (ref. 97), 226–30.

Schlich , op. cit. (ref. 97), 226–30; Tröhler , op. cit. (ref. 96); Schlich Thomas , “The emergence of modern surgery”, in Brunton Deborah (ed.), Medicine transformed: Health, disease and society in Europe, 1800–1939 (Manchester, 2004), 61–91.

Schlich , op. cit. (ref. 97), 58–69.

Horsley Victor , “Remarks on the function of the thyroid gland: A critical and historical review”, British medical journal, 1892, i, 215–19, 265–8, see p. 216. Horsley did thyroid ablation experiments on apes to explore the role of the organ in a “scientific way”. In 1885 Horsley was the first investigator who could offer a really convincing animal model of a lack of thyroid function, Schlich , op. cit. (ref. 97), 58, 61–62.

Schlich , op. cit. (ref. 97), 75–80.

Ibid., 226–36. On the close relationships and overlapping research of surgeons and physiologists see in more detail Schlich , Ibid., 91–198, 233–4.

For examples from the second half of the twentieth century see Schlich , op. cit. (ref. 46), 86–109.

Kocher , op. cit. (ref. 88), 335; Schlich , op. cit. (ref. 97), 75.

Kirschner , op. cit. (ref. 47), 1.

Kirschner , op. cit. (ref. 47), 244. On the isolation of the operating room from its environment, see Hirschauer , op. cit. (ref. 45), 283–4.

Markus , op. cit. (ref. 22), 229–40.

Wangensteen Owen H. Wangensteen Sarah D. , The rise of surgery: From empiric craft to scientific discipline (Folkstone, 1978), 464. Interestingly, this development parallels similar changes in the design of laboratories, which at times could also assume the role of theatre, since “as knowledge moved from its point of origin to public disclosure it frequently had to be dramatized in order to be stabilized”, see Livingstone , op. cit. (ref. 3), 27.

Wangensteen Wangensteen , op. cit. (ref. 111), 465–70.

Kirschner , op. cit. (ref. 47), 245.

Kirschner , op. cit. (ref. 47), 250.

Donzé , op. cit. (ref. 62), 113.

Pite William A. , “Hospital operating theatres”, The architect's journal, lxi (1925), 968–72, see p. 970.

On places of knowledge and their urban environment, see Dierig Sven Lachmund Jens Mendelsohn J. Andrew , “Introduction: Toward an urban history of science”, Osiris, xviii (2003), 1–19, see pp. 13–16.

Kirschner , op. cit. (ref. 47), 250.

Adams Schlich , op. cit. (ref. 1), 320–4.

Mörgeli , op. cit. (ref. 54), 244. For a more detailed discussion on doctors as architects, see Adams Annmarie , Architecture in the family way: Doctors, houses and women, 1870–1900 (Montreal and Kingston, 1996), 36–72.

Mörgeli , op. cit. (ref. 54), 234.

Pickstone , op. cit. (ref. 42), 437.

Latour , op. cit. (ref. 9), 141–70.

Rouse , op. cit. (ref. 33), 226–36.

Kirschner , op. cit. (ref. 47), 230.

Hirschauer , op. cit. (ref. 45), 283–90.

Kocher , “wollte jede Operation zu einem bakteriologischen Experiment ausgestalten”, quoted after Tröhler Ulrich , Auf dem Weg zur physiologischen Chirurgie: Der Nobelpreisträger Theodor Kocher (1841–1917) (Basel, 1984), 37.

The translation is taken from Absolon Karel B. Absolon Mary J. Zientek Ralph , “From antisepsis to asepsis: Louis Pasteur's publication on ‘The germ theory and its application to medicine and surgery’”, Review of surgery, xxvii (1970), 245–58. The original quote can be found in Pasteur L. , Théorie des germes et ses applications: Lecture faite à l'Académie de Médecine (Paris, 1878), 16–17.

This relationship between laboratory and operating room has been spelled out for another example by Fitzgerald Gerard J. , “Constructing the cradle: Instrumental and architectural responses to airborn infection, 1935–45”, paper presented at “Form and function: The hospital”, 3rd international conference of the International Network for the History of Hospitals, Montreal, 21 June 2003.

E.g. Kirschner , op. cit. (ref. 47), 263–71, and Felter R. K. Miss , Nurse in Charge, Royal Hospital, Montreal, “Operating room technic in the Royal Victoria Hospital”, The modern hospital, iii/1 (1914), 28–32, p. 28. On the “aseptic disciplining of the surgeon-body”, Hirschauer , op. cit. (ref. 45), 283–6.

See on Robert Koch's experiments, e.g Schlich Thomas , “Repräsentationen von Krankheitserregern: Wie Robert Koch Bakterien als Krankheitsursache dargestellt hat”, in Rheinberger Hans-Jörg Hagner Michael Wahrig-Schmidt Bettina (eds), Räume des Wissens: Spur, Codierung, Repräsentation (Berlin, 1997), 165–90.

Rouse , op. cit. (ref. 33), 237.

Tröhler , op. cit. (ref. 96), 991.

I thank Rachel Prentice for making me aware of this aspect.

In this sense, the modern operating room is part of the “transformation of the whole of society according to laboratory experiments”, see Latour , op. cit. (ref. 9), 167.

Mörgeli , op. cit. (ref. 54), 254.

For the notion of cleanliness as a form of control, see Douglas Mary , Purity and danger: An analysis of the concepts of pollution and taboo (New York, 1966).

Lawrence Ghislaine , op. cit. (ref. 50), 299–300.

Schlich , op. cit. (ref. 46), 214–17.

Lawrence Ghislaine , op. cit. (ref. 50), 308.

Markus , op. cit. (ref. 22), 9.

Livingstone , op. cit. (ref. 3), 27.

Hirschauer Stefan , “Towards a methodology of investigations into the strangeness of one's own culture: A response to Collins”, Social studies of science, xxiv (1994), 335–46, see pp. 342–3.

Rosenberg , op. cit. (ref. 56), 149.

Markus , op. cit. (ref. 22), 35.

The practice of surgery was seen as a particularly “scientific” feature of hospitals, see Adams Annmarie , “Modernism and medicine: The hospitals of Stevens and Lee, 1916–1932”, Journal of the Society of Architectural Historians, lviii (1999), 42–61, p. 42.

Sloane , op. cit. (ref. 13), 82.

Collins H. M. , “Dissecting surgery: Forms of life depersonalized”, Social studies of science, xxiv (1994), 311–33.

Lynch Michael , “Collins, Hirschauer and Winch: Ethnography, exoticism, surgery, antisepsis and dehorsification”, Social studies of science, xxiv (1994), 354–69, p. 364.

Lynch , op. cit. (ref. 149), 364.

Lawrence Christopher , “Democratic, divine and heroic: The history and historiography of surgery”, in Lawrence Christopher (ed.), Medical theory, surgical practice: Studies in the history of surgery (London and New York, 1992), 1–47, p. 32.

John Pickstone has argued for an integration of the history of science and medicine with the history of modes of production, see e.g. his Ways of knowing: A new history of science, technology and medicine (Manchester, 2000).

Donzé , op. cit. (ref. 62), 94–119.

Latour Bruno , “The costly ghastly kitchen”, in Cunningham Williams (eds), op. cit. (ref. 11), 295–303.

Galison Peter , “Objectivity is romantic”, American Council of Learned Societies, Occasional paper no. 47, 1999, http://acls.org/op47–3.htm#galison), 19.

Dierig Sven , “Engines for experiment: Laboratory revolution and industrial labor in the nineteenth-century city”, Osiris, xviii (2003), 116–24, p. 116.

Dierig , op. cit. (ref. 156), 125.

Rouse , op. cit. (ref. 33), 212.

Rouse , op. cit. (ref. 33), 221. Moreover, the laboratory “represents a mature form, not the origin of the gradually emerging project of remaking the world to make it knowable”, see ibid., 229.

Rouse , op. cit. (ref. 33), 216.

Rouse , op. cit. (ref. 33), 230.

Rouse , op. cit. (ref. 33), 239–40.

Rouse , op. cit. (ref. 33), 227.

Rouse , op. cit. (ref. 33), 212.

Rouse , op. cit. (ref. 33), 217.

Rouse , op. cit. (ref. 33), 241.

Cunningham Williams , op. cit. (ref. 11), 12.

Cunningham Williams , op. cit. (ref. 11), 12.

Rouse , op. cit. (ref. 33), 241–2, and the emergence of an information society, see Beniger , op. cit. (ref. 28).

For more about the laboratory in terms of the emergence of modern societies see Rouse , op. cit. (ref. 33), 226–47.