The Surgical Profession

by

Peter Kernahan

• LAST MODIFIED: 17 April 2025
• DOI: 10.1093/obo/9780197768723-0015

Introduction

The surgical profession—the body of medical practitioners recognized as surgeons—is distinct from surgery as a therapeutic technique or a system of knowledge. The manual treatment of wounds and diseases dates back to prehistoric times. Descriptions of operative procedures appear in texts from Antiquity—for example, the Sushruta Samhita and the Edwin Smith papyrus. However, the surgeon as an occupational category only begins to appear in Europe during the Middle Ages. To greatly simplify, university-educated physicians were members of the learned professions and dealt with internal disease. Surgeons, on the other hand, trained through apprenticeship and were numbered among the skilled trades, a category that included other healers like barbers and apothecaries. Surgical work, which encompassed manipulation and dressings as well as cutting, was largely confined to the surface of the body and the extremities. Trephining and lithotomy were exceptions. By the late eighteenth century, surgeons—aided by advances in anatomy and surgical technique—had risen in status and separated occupationally and administratively from the barbers. Broadly speaking, during the early nineteenth century, physicians and surgeons began to receive a common medical education, creating a unified medical profession. At mid-century, anesthesia and antisepsis/asepsis helped make the exploration of the body technically feasible, while ideas about disease as a local process made its exploration intellectually coherent. So by the late nineteenth century, surgeons had expanded into previously closed areas of the body, including the abdomen, chest, and brain. With these developments, the status and prestige of the surgeon rose further. As full-time surgical practice became economically viable, surgery became a distinct specialty. This process included the creation of societies, journals, educational programs, and certifying bodies. Subsequently, the specialty of surgery itself has fragmented into various specialties and subspecialties. Culturally, at the beginning of the twentieth century, the surgeon came to epitomize modern, scientific medicine and its therapeutic potential. Throughout its history, however, the craft tradition has remained an important part of the professional identity of the surgeon regardless of specialty. This entry introduces a bibliography of surgery as a profession/specialty. As an Oxford Bibliography, the majority of citations, although international in scope, are in English with particular attention to the United States and United Kingdom. Further, given the origins of modern biomedicine of which surgery is a key part, much of the existing literature on the surgical profession’s history reflects a broadly Eurocentric perspective. Finally, there are many areas in the history of the surgical profession that remain to be explored.

General Overviews

Book-length surgical histories remain a popular genre, and there are many titles from which to choose. They can be divided broadly into two overlapping categories: histories of the field that foreground biography and procedures, and those that locate surgery and surgeons within broader epistemological, social, and cultural contexts. Of the former, Wangensteen and Wangensteen 1978 provides an encyclopedic history of the development of surgery from prehistoric times onward. Ellis and Abdalla 2018 covers much the same ground in a shorter fashion. While Rutkow 2022 follows a similar chronology, it also expands the traditional surgical history to cover themes like professionalization. In the second category, two books stand out. The multiauthored volume Schlich 2018b is the most comprehensive thematic survey to date. The twenty-six chapters, all written by historians with a strong interest in the field, review the history and historiography of surgery from a variety of perspectives. A comprehensive introduction, Schlich 2018a, discusses what distinguishes surgical history. An earlier work, Lawrence 1992, represents one of the first forays by historians into a field that had largely been the province of surgeons themselves. The essays in that collection, particularly those on the historiography of surgery, reassessments of anesthesia and antisepsis, and the culture of American surgery in the late nineteenth century, remain foundational over thirty years later. For a quick overview, Tröhler 1993 and Schlich 2004 provide concise outlines of surgical history and historiography. Finally, Lawrence and Treasure 2020 examines the 20th-century profession through a series of linked biographical sketches.

• Ellis, Harold, and Sala Abdalla. A History of Surgery. 3d ed. Boca Raton, FL: CRC Press, 2018.

  DOI: 10.1201/9780429461743

  A well-illustrated, highly readable survey of the development of surgery from prehistoric times to the twentieth century, with a focus on famous surgeons and operations. The first eight chapters move chronologically. The later chapters cover the surgery of selected conditions.

• Lawrence, Christopher, ed. Medical Theory, Surgical Practice: Studies in the History of Surgery. London: Routledge, 1992.

  The product of a 1985 Wellcome Institute symposium on the history of surgery. This was one of the first books to bring the social historian’s perspective to the study of surgical history. It remains a valuable resource.

• Lawrence, Christopher, and Tom Treasure. “Surgeons.” In Medicine in the Twentieth Century. Edited by Roger Cooter and John Pickstone, 653–670. London: Taylor & Francis, 2020.

  The chapter begins with Harvey Cushing visiting England in 1900 and ends with a discussion of the changes surgeons have faced in recent decades, including specialization and increased public scrutiny. Featured biographies include Daniel Hale Williams, Louisa Martindale, Dwight Harken, and Denton Cooley.

• Rutkow, Ira. Empire of the Scalpel: The History of Surgery. New York: Scribner, 2022.

  Written for a popular audience, this is a concise, chronological history of surgery from prehistory to the present. Notably, it goes beyond a purely internal history to discuss the relationship between surgery and society, including topics like professionalization in the American context.

• Schlich, Thomas. “The Emergence of Modern Surgery.” In Medicine Transformed: Health, Disease and Society in Europe, 1800–1930. Edited by Deborah Brunton, 61–92. Manchester, UK: University of Manchester Press, 2004.

  An excellent overview of surgical history from the 1700s to the present. Schlich emphasizes contingency and that the development of surgery is not a simple technology-driven process. Develops the periodization of surgical history proposed by Tröhler 1993. Medicine Transformed was prepared for Britain’s Open University and is well suited to a high school or introductory college course on the history of medicine.

• Schlich, Thomas. “What Is Special about the History of Surgery?” In The Palgrave Handbook of the History of Surgery. Edited by Thomas Schlich, 1–24. London: Palgrave Macmillan, 2018a.

  DOI: 10.1057/978-1-349-95260-1_1

  The introductory chapter to the Palgrave Handbook. Schlich makes several arguments. Surgery as the discipline is understood today developed first in the West. Its combination of manual intervention, intimacy and invasion, and the vulnerability of both the patient and the surgeon distinguish the history of surgery from that of medicine in general. Surgical history is at once a history of technology, an intellectual history, and a social history.

• Schlich, Thomas, ed. The Palgrave Handbook of the History of Surgery. London: Palgrave Macmillan, 2018b.

  A comprehensive, multiauthored volume that covers the social and cultural history of surgery as well as its technologies and epistemology. Each chapter reviews a particular subject area and has an extensive bibliography. An excellent starting point for research projects and a guide to understanding the scope of surgical history and its historiography.

• Tröhler, Ulrich. “Surgery (Modern).” In Companion Encyclopaedia of the History of Medicine. Edited by W. F. Bynum and Roy Porter, Vol. 2, 924–1028. New York: Routledge, 1993.

  A short, clear overview of the subject. Tröhler usefully divides modern surgery into three conceptual periods. First, from 1860 to around World War I is surgery as applied anatomy characterized by resection. Second, from World War I to the 1950s, is surgery as physiology epitomized by operations to restore function. Third, from the 1950s onward, surgery has a systematic orientation characterized by replacement of organs, joints etc.

• Wangensteen, Owen H., and Sarah Wangensteen. The Rise of Surgery: From Empiric Craft to Scientific Discipline. Minneapolis: University of Minnesota Press, 1978.

  At 753 pages, The Rise of Surgery remains the most comprehensive available reference on the technical and biographical history of surgery. Written from the perspective of a leading mid-20th-century American academic surgeon, the work includes some of the historical context of surgery’s development.