Children and Surgery

by

Salim Al-Gailani

• LAST MODIFIED: 17 April 2025
• DOI: 10.1093/obo/9780197768723-0020

Introduction

There are to date few studies by historians of medicine on children as subjects of surgical intervention, with writing on the topic dispersed among general histories of surgery and allied fields, disease, disability, pain and, most prolifically in recent years, intersex and transgender. There is also an established tradition of historical writing by practitioners themselves. Many pediatric surgeons have documented the development of their specialism, with professional journals carrying informative historical articles on key individuals, institutions, and techniques. These are useful sources of information and worthwhile starting points for further research. However, in common with much traditional medical history, these typically triumphalist accounts privilege the perspective of specialist groups, pioneers, and innovations, and have less to say about patient perspectives or the wider social context in which surgery on children has historically taken place. While there is significant literature on surgery within the social history of medicine and allied fields, few scholars writing on surgical topics have considered the implications of focusing on children, specifically, in historical research. Moreover, the development of pediatrics as a surgical sub-specialism, part of a larger trend toward medical specialization, also awaits its historian. While pediatric surgery came to be recognized as a formal, independent medical discipline only in the mid-twentieth century, there is of course a longer history of surgery on children. Historians agree that the availability of reliable anesthetics and antisepsis in the later nineteenth century encouraged more and new kinds of surgery—elective, corrective, and reconstructive—including on children. Research on earlier periods has suggested that operative interventions were usually reserved for adults, as surgery was typically thought to be too dangerous for children’s bodies. However, more systematic historical work is needed to test this hypothesis. Historians of childhood have long asserted the need for, as well as the challenges involved with, accessing the voices and experiences of children in the past. Drawing on a broader scholarship on the history of the patient, scholars have similarly debated the extent to which patients were able to exercise agency in surgical encounters. Yet only very recently have historians begun to approach the child surgical patient as a historical subject or consider the extent to which children were able to influence clinical decision-making independently of their parents or other adult influences. Much research remains to be done, especially beyond the most intensively studied American and British contexts.

Overviews and Approaches

There are to date no overviews focusing specifically on the history of children and surgery, though Brock 2023, on the period around 1900, discusses the operative treatment of the child in theory and in practice, and essays in Parens 2006 place early-21st-century debates over the ethics of the surgical “normalization” of children in historical perspective. Much valuable information on important themes in and approaches to the history of surgery can be gained from Lawrence 1992 and Schlich 2018. Essays in the latter volume represent the state of the historical art and offer essential context for researching the history of children and surgery. Schlich 2004 provides a more general and highly accessible entry point into the history of modern surgery. Of the more general approaches to the history of child health, Viner and Golden 2000 and Linker 2017 highlight the opportunities and methodological challenges of recovering historical experiences of children’s encounters with illness, while Prescott 1998 offers a rare consideration of the adolescent as a special category of pediatric patient. McCray Beier 2008 and Gleason 2013 use mixed methods, including oral history, to place such encounters in the context of everyday cultures of health and healthcare in Britain and Canada, respectively. Newton 2012 is a pioneering study of the perception, treatment, and experience of childhood illness in early modern England, but argues that surgery seems to have been comparatively uncommon in child patients in this period, owing to concerns about safety.

• Brock, Claire. “The Child Surgical Patient in the Early Twentieth Century.” Journal of the History of Medicine and Allied Sciences 78.2 (2023): 149–170.

  DOI: 10.1093/jhmas/jrad005

  Analyzes surgical textbooks and case notes at a London general hospital, exploring the framing of children as a special class of surgical patient around 1900. Compares the surgical treatment of children in theory and in practice and shows innovatively how the child patient could disrupt and affect modern surgical treatment. An essential entry point into the topic.

• Gleason, Mona Lee. Small Matters: Canadian Children in Sickness and Health, 1900–1940. Montreal: McGill-Queen’s University Press, 2013.

  DOI: 10.1515/9780773588547

  A general history of children’s health in early-20th-century Canada, exploring how medical professionals, lay practitioners, and parents understood young patients and how children responded. One of few such studies to highlight children’s experiences of surgery.

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

  An influential collection examining key themes in the history of surgery.

• Linker, Beth. “Confectionery Care: The Child as a Category of Historical Analysis.” Nursing History Review 25.1 (2017): 82–85.

  DOI: 10.1891/1062-8061.25.1.82

  A short introduction to a special issue on the history of children and healthcare; Linker reflects on the need to recover stories of children as both patients and consumers of healthcare goods.

• McCray Beier, Lucinda. For Their Own Good: The Transformation of English Working-Class Health Culture, 1880–1970. Columbus: Ohio State University Press, 2008.

  An investigation of working-class health culture in England, making use of oral history to highlight among many other things instances of children’s encounters with surgery.

• Newton, Hannah. The Sick Child in Early Modern England, 1580–1720. Oxford: Oxford University Press, 2012.

  DOI: 10.1093/acprof:oso/9780199650491.001.0001

  Innovative for its focus on children’s health and illness in early modern England. Posits that surgery on children was considered too dangerous and mostly avoided in this period.

• Parens, Erik, ed. Surgically Shaping Children: Technology, Ethics, and the Pursuit of Normality. Baltimore: Johns Hopkins University Press, 2006.

  An interdisciplinary collection of essays exploring the ethical and social issues raised by the proliferation of surgeries designed to “normalize” children born with physical differences: cleft palate, ambiguous genitalia, and dwarfism. Includes both historical reflections and the perspectives of affected children and their parents.

• Prescott, Heather M. A Doctor of Their Own: The History of Adolescent Medicine. Cambridge, MA: Harvard University Press, 1998.

  A pioneering history of American adolescent medicine in the second half of the twentieth century, using patient records, oral testimonies from physicians, letters from patients and their parents, and advice literature. Analyzes the interplay between adolescent medicine and broader social change, including an emerging “youth culture” and concepts of the family.

• Schlich, Thomas. “The Emergence of Modern Surgery.” In Medicine Transformed: Health, Disease and Society in Europe: 1800–1930. Edited by Deborah Brunton, 61–91. Manchester, UK: Manchester University Press, 2004.

  Discussion of major issues in history of modern surgery, focusing on the interrelationship between professional, conceptual, and technical developments.

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

  An essential collection representing cutting-edge work in the history of surgery. Although few essays mention children, all are valuable entry points into key themes and the wider literature.

• Viner, Russell, and Janet Golden. “Children’s Experiences of Illness.” In Companion to Medicine in the Twentieth Century. Edited by Roger Cooter and John Pickstone, 575–587. London: Routledge, 2000.

  Introduces child health, and children’s experiences of illness, as a topic for historical research.