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.

This paper examines how, over the course of the nineteenth and early twentieth centuries, the appreciation of skill in surgery shifted in characteristic ways. Skill is a problematic category in surgery. Its evaluation is embedded into wider cultural expectations and evaluations, which changed over time. The paper examines the discussions about surgical skill in a variety of contexts: the highly competitive environment of celebrity practitioners in the amphitheatres of early nineteenth-century Britain; the science-oriented, technocratic German-language university hospitals later in the century; and the elitist surgeons of late nineteenth and early twentieth-century United States with their concerns about distancing themselves from commercialism and cheap showmanship. For analysing the interaction of surgical practices with their various contexts the paper makes use of the concept of ‘performance’ and examines how the rules of surgical performance varied according to the prevailing technical, social, and moral conditions. Over the course of the century, surgical performance looked more and more recognisably modern, increasingly following the ideals of replicability, universality and standardisation. The changing ideals of surgical skill are a crucial element of the complex history of the emergence of modern surgery, but also an illuminating example of the history of skill in modern medicine.

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.

During the Great War, the French surgeon Alexis Carrel, in collaboration with the English chemist Henry Dakin, devised an antiseptic treatment for infected wounds. This paper focuses on Carrel’s attempt to standardise knowledge of infected wounds and their treatment, and looks closely at the vision of surgical skill he espoused and its difference from those associated with the doctrines of scientific management. Examining contemporary claims that the Carrel–Dakin method increased rather than diminished demands on surgical work, this paper further shows how debates about antiseptic wound treatment opened up a critical space for considering the nature of skill as a vital dynamic in surgical innovation and practice.

Adolf 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.

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.