Special Issue of Medical History on Skill in Medicine & Science

MDHThe new issue of Medical History  (guest edited by Nicholas Whitfield and Thomas Schlich at the Social Studies of Medicine program at McGill) is focused on the theme of skill in the history of medicine and science. The editorial is historiographically interesting as a survey of skill as an historical category (among many relevant to both the histories of medicine and psychology, including the history of observation, objectivity, emotion, and the senses).

Additionally, articles of interest include those about: Adolf Meyer’s influence on 20th century psychiatric clinical skills; the “discourse of skills” used to establish post-War British neuropathology; the norms of conduct within the first generation of neurosurgeons 1900-1930; and the debates between animal behaviorists and molecular biologists on best practices in the experimental manipulation of mouse DNA  (and the interpretation thereof). There are also a number of pertinent reviews on books about: insanity and colonialism in post-emancipation Caribbean; gender and class in turn of the 20th century British asylums; and the analysis of Nazi psychology at Nuremberg.


Selected abstracts read as follows:

A Knockout Experiment: Disciplinary Divides and Experimental Skill in Animal Behaviour Genetics. By Nicole C. Nelson

In the early 1990s, a set of new techniques for manipulating mouse DNA allowed researchers to ‘knock out’ specific genes and observe the effects of removing them on a live mouse. In animal behaviour genetics, questions about how to deploy these techniques to study the molecular basis of behaviour became quite controversial, with a number of key methodological issues dissecting the interdisciplinary research field along disciplinary lines. This paper examines debates that took place during the 1990s between a predominately North American group of molecular biologists and animal behaviourists around how to design, conduct, and interpret behavioural knockout experiments. Drawing from and extending Harry Collins’s work on how research communities negotiate what counts as a ‘well-done experiment,’ I argue that the positions practitioners took on questions of experimental skill reflected not only the experimental traditions they were trained in but also their differing ontological and epistemological commitments. Different assumptions about the nature of gene action, eg., were tied to different positions in the knockout mouse debates on how to implement experimental controls. I conclude by showing that examining representations of skill in the context of a community’s knowledge commitments sheds light on some of the contradictory ways in which contemporary animal behaviour geneticists talk about their own laboratory work as a highly skilled endeavour that also could be mechanised, as easy to perform and yet difficult to perform well.


Social Skills: Adolph Meyer’s Revision of Clinical Skill for the New Psychiatry of the Twentieth Century. By Susan Lamb.

dolf Meyer (1866–1950) exercised considerable influence over the development of Anglo-American psychiatry during the first half of the twentieth century. The concepts and techniques he implemented at his prominent Phipps Psychiatric Clinic at Johns Hopkins remain important to psychiatric practice and neuro-scientific research today. In the 1890s, Meyer revised scientific medicine’s traditional notion of clinical skill to serve what he called the ‘New Psychiatry’, a clinical discipline that embodied social and scientific ideals shared with other ‘new’ progressive reform movements in the United States. This revision conformed to his concept of psychobiology – his biological theory of mind and mental disorders – and accorded with his definition of scientific medicine as a unity of clinical–pathological methods and therapeutics. Combining insights from evolutionary biology, neuron theory and American pragmatist philosophy, Meyer concluded that subjective experience and social behaviour were functions of human biology. In addition to the time-honoured techniques devised to exploit the material data of the diseased body – observing and recording in the clinic, dissecting in the morgue and conducting histological experiments in the laboratory – he insisted that psychiatrists must also be skilled at wielding social interaction and interpersonal relationships as investigative and therapeutic tools in order to conceptualise, collect, analyse and apply the ephemeral data of ‘social adaptation’. An examination of his clinical practices and teaching at Johns Hopkins between 1913 and 1917 shows how particular historical and intellectual contexts shaped Meyer’s conceptualisation of social behaviour as a biological function and, subsequently, his new vision of clinical skill for twentieth-century psychiatry.


Neither Physicians Nor Surgeons: Whither Neuropathological Skill in Post-War England? By Anna Kathryn Schoefert

Neuropathologists constituted a small field in post-war England, perched between neurology, psychiatry, neurosurgery and pathology, but recognised as a discrete field of expertise. Despite this recognition, the success of the neighbouring fields of neurosurgery, psychosurgery and neurobiology, and the consultant status granted to pathologists in the National Health Service, neuropathologists struggled to stabilise their field. A discourse of skills, acquired and acquirable, became central to their attempts to situate the field in relation to surgeons’ handicraft, physicians’ diagnostic acumen and the technologies of the biological sciences.


Skill, Judgement and Conduct for the First Generation of Neurosurgeons, 1900-1930. By Delia Gavrus.

Historical contingency complicates a reading of skill as a self-explanatory and always positive attribute. By focusing on the attempts of the first generation of neurosurgeons to build a community and fashion a collective neurosurgical self, this article highlights the extent to which the relationship between surgical skill and professional judgement is reflected in broader concerns that shape the landscape of medicine at a given time. Some early twentieth-century surgeons expressed concern about the spectacularisation of surgery and the skilful but problematic work of ‘brilliant operators’. The neurosurgeons’ policies of inclusion and exclusion show that in the process of fashioning a neurosurgical persona, this first generation sanctioned specific norms of conduct underwritten by similar moral imperatives, such as self-control. These norms governed the doctors’ work both in the operating room and on the public stage (in their engagement with the press). The meetings of the first neurosurgical society staged a critical encounter between the host neurosurgeon and the members who watched him perform surgery. These technical performances in the operating theatre, followed by discussions, were designed to encourage particular norms, to negotiate surgical knowledge, and to demonstrate the skills and character of the neurosurgeon. The performances acted as a technology of the self that aligned the operator to a community and helped that community refine its norms of surgical conduct. The awkward surgeon with inferior technical ability was preferable to the brilliant but vain operator who lacked the capacity to judge when he should not deploy his spectacular skills.