“Detachment is not the eternal emotional disposition of the surgical operator.” So concludes Michael Brown in Emotions and Surgery in Britain, 1793-1912. Brown is a historian at Lancaster University, England, specialising in analysing the complex, and often intertwined, histories of medicine, emotions, gender and war. Brown has published widely, including on martial masculinities and visualities of aged veterans in the long nineteenth century. Between 2016 and 2002, Brown was Principal Investigator of the Wellcome Trust’s Emotions of Surgery study.
In Emotions and Surgery in Britain, 1793-1912, Brown examines surgical emotions, placing them in the broader context of the affective turn, in 19th Century British Surgery. In doing so, he uncovers the compassion and care that informed the development of the practical craft of surgery in the pre-anaesthetic era, thereby delineating this era as the time when surgical professional identity took shape. By reconstructing the history of how emotions informed and often guided surgical decisions, he thoroughly dismantles any notion of the cold-hearted surgeon. Furthermore, he demonstrates how coldness was seen as abhorrent then as now.
This book’s dedication and the often epistolary introduction read a like a love letter from Brown to his wife, setting the emotional tone for a book that is as much a history of surgeons’ compassionate hearts as it is of their scientific minds. But this love story matters even more than that. Brown’s wife, Professor Joanne Begiato, is a historian of emotions, family and masculinities. In this unique romantic-academic context, Brown has studied the histories of surgical emotion and of surgery, histories so entwined, they are like a pair of conjoined, only fatally separable, twins.
For example, Brown pays detailed attention to the history of the discovery and development of anaesthesia, questioning why the palliative properties of gases were only realised relatively late in the 1840s. In his detailed considerations of the emotional repercussions of removing a conscious individual, in obvious fear and pain, from the operation, Brown asserts that surgeons in the Romantic period were, “powerfully alive to the sufferings of their patients and were concerned to do what they could to ease them where possible.” Brown identifies two opposing narratives on the role of pain, one focussed on patient suffering, the other conceptualising pain as a test of patient character. Brown explains that pain was culturally understood as a productive emotion, one capable of prompting personal reflection. These seemingly contradictory, parallel models of pain were often held simultaneously by surgical practitioners.
Alongside the rich source material that scaffolds Brown’s arguments, there are other passages (and this is no complaint) where Emotions and Surgery in Britain, 1793-1912 reads like a Who’s Who in the history of surgery. Brown introduces readers not only to the surgeons who would send their former housemen to the back of the operating theatre, but also to the men after whom ligaments, surgical instruments and operative procedures are named. Almost as a sidenote, Brown tells a gripping and important history of the Lancet, highlighting the influence and legacy of the first editor Thomas Wakley, a radical whose reforming voice echoes through the writing of the current incumbent, Richard Horton. There is gossip too: as a former London medical student, I loved reading about the inter-hospital rivalries and enjoyed Brown’s lively account of the merger, and subsequent severance, of the medical schools of Guys and St Thomas’. I was similarly intrigued by Brown’s descriptions of the politics of the organisation, the Provincial Medical and Surgical Association, that was to become the British Medical Association (BMA).
Jut as it would feel incomplete to review this book without referring to the marriage between Brown and Begiato, it would be remiss of me to ignore the political context. As I write this review, junior doctors in England have announced a second round of strikes in their pay dispute with the government. There is a comparable crisis in higher education, blighted by redundancies, precarious contracts and decimated pensions. Perhaps precisely because of this context, as he casts his historian’s eye to the present, Brown is at his most pessimistic. He notes the rise in compassion fatigue and burnout and rightly draws attention to the fact that today’s surgeons have few places of emotional refuge.
Brown writes that he hopes this history will interest contemporary surgeons. I am sure it will. It can be read – as is no doubt intended- chapter by chapter, as a scholarly work, but on second reading, I found delight in dipping in and savouring snippets of surgical trivia. Entertainment aside, this is, above all, a captivating and compassionate account of the remarkable emotional legacies that shaped and still today inform surgical craft, surgical careers and professional surgical identity.