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A historical perspective

Professsor Chris Lawrence

Professsor Chris Lawrence is Emeritus Professor at the Wellcome Trust Centre for the History of Medicine at University College London. The history of surgery is one of his specialist interests.

Here Chris describes the ancient tradition of performing operations in public and explains how modern medical professionalism has restricted this public access. Chris feels that Surgery Live recovers the old idea of medical practice as a public performance, with a twist.

'Today, almost anywhere that Western medicine is practised, public viewing of a surgical operation as it is happening, especially in a hospital, is an uncommon event. This is because public access is carefully restricted by the medical professions. However, for most of its history much medical practice, including surgery, was a public or at best a semi-private spectacle.'

Ancient Greece

'In ancient Greece, to which we can date modern western medicine, doctors were itinerants. They travelled from town to town and rented a shop in the market place. They unpacked their surgical instruments and drugs, advertised their skills and waited for patients. They might visit rich people in their homes but otherwise operations, such as setting broken bones, reducing dislocations and lancing boils were performed in their shops or even outdoors while relatives and neighbours stood around. Doctors talked about what they were doing as they operated because rhetoric was a very important skill in ancient medicine. They possibly answered questions from onlookers who might even criticise the surgeon.'

Renaissance and beyond

'From what can be gleaned from pictures and other sources medical treatment remained a public or at least family event throughout the Renaissance and beyond. This was in line with many other sorts of performance. Dissection of the dead for the teaching of anatomy was carried out in public in many European countries. Some illustrations suggest people of all sorts gathered in great numbers for these demonstrations. Like public hangings they were often huge occasions pulling massive crowds.'

The 18th century

'Hospitals were rare in the West until the 18th century when large numbers were founded. Major operations, such as amputation, were carried out in special theatres but these would have been packed with medical students and, no doubt, members of the public could surreptitiously gain admission if they wished.'

20th century barriers

'During the twentieth century professionals slowly fenced off a great deal of behaviour that once occurred in public space. In medicine, talk of expertise and discretion turned the doctor-patient relationship into a confidential business. Except for the patient and the surgical team and a strictly regulated number of medical students, the surgical operation was made a private world. The need for asepsis, the practice of reducing or eliminating contaminants, was one of the reasons given for keeping non-participants out of operating theatres but it also gave surgeons a means to exclude outsiders from what was now considered purely professional business.'

TV: A dam is breached

'On February 11, 1958, the dam was breached in the UK when the BBC showed the first episode of Your Life in their Hands, one of 10 live programmes illustrating current medical treatment. Three of these included surgical operations. By today's standards the avoidance of discussion of particularly disagreeable symptoms seems quaint but at the time the series was a dramatic breakthrough. In general the public approved of the series but conservative sections of the medical profession thought the programmes sensationalist and that they would foster hypochondria or pander to morbid interest.'

Surgical broadcasting today

'The latest series, no longer live, was broadcast in 2005 and seems to have given no offence to any interest group. This, however, is not simply the product of familiarity. Today, patients (or their lobby groups) consider they have a right to know what happens behind medicine's formerly closed doors. The medical profession also no longer assumes that it knows best and that patients need only be given the minimum information necessary to manage their condition and treatment. The broadcasting of operations that have already taken place is now quite common, further opening up medical practice to public scrutiny.

'So Surgery Live is in many ways the recovery of the old idea of medical practice as a public performance but with this difference. Today it constitutes public medical education and an attempt to dispel any ideas of professional secrecy that people may have. In the past it was not a public privilege to view an operation; it was an unspoken right based on the assumption that medical knowledge was shared by all members of a community and only medical skill and experience was exclusive to experts.'

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