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.

Historians of medicine have tended to be preoccupied primarily with scientific research, the development of therapeutically significant medicines, and ethical business practice. Roy Porter, however, adopted a wider conception. Referring to the eighteenth and early nineteenth century, he redefined the role of “the vile race of quacks” (so described by their own contemporaries) as a manifestation of a burgeoning medical entrepreneurship in an emerging consumer society. He maintained that “Irregular medicine … mobilised the growth of medicine as business”, an aspect of medical history which he believed to have been largely ignored hitherto and one which requires of historians an understanding of the market for pharmaceuticals. Anne Digby has examined the market for medical services during the nineteenth century in an analysis of interactions between doctors and patients at a time when self-dosing was prevalent. However, interactions between medical practitioners and suppliers of medicines in Britain for most of this period remain largely unexplored (with the significant exception of the work by Jonathan Liebenau) and as a result, it will be argued, have been misunderstood.

This article examines the material culture of neuroscientist Vilayanur S. Ramachandran’s research into phantom limbs. In the 1990s Ramachandran used a ‘mirror box’ to ‘resurrect’ phantom limbs and thus to treat the pain that often accompanied them. The experimental success of his mirror therapy led Ramachandran to see mirrors as a useful model of brain function, a tendency that explains his attraction to work on ‘mirror neurons’. I argue that Ramachandran’s fascination with and repeated appeal to the mirror can be explained by the way it allowed him to confront a perennial problem in the mind and brain sciences, that of the relationship between a supposedly immaterial mind and a material brain. By producing what Ramachandran called a ‘virtual reality’, relating in varied and complex ways to the material world, the mirror reproduced a form of psycho-physical parallelism and dualistic ontology, while conforming to the materialist norms of neuroscience today.

Seeking to align psychiatric practice with general medicine following the inauguration of the National Health Service, psychiatric hospitals in post-war Britain deployed new treatments designed to induce somatic change, such as ECT, leucotomy and sedatives. Advocates of these treatments, often grouped together under the term ‘physical therapies’, expressed relief that the social problems encountered by patients could now be interpreted as symptomatic of underlying biological malfunction rather than as a cause of disorder that required treatment. Drawing on the British Journal of Psychiatric Social Work, this article analyses the critique articulated by psychiatric social workers based within hospitals who sought to facilitate the social reintegration of patients following treatment. It explores the development of ‘psychiatric social treatment’, an approach devised by psychiatric social workers to meet the needs of people with enduring mental health problems in hospital and community settings that sought to alleviate distress and improve social functioning by changing an individual’s social environment and interpersonal relationships. ‘Physical’ and ‘social’ models of psychiatric treatment, this article argues, contested not only the aetiology of mental illness but also the nature of care, treatment and cure.

This article contributes to the literature on the history of medico-legal practice by using a survey of 535 poisoning cases to examine the emergence of forensic toxicological expertise in nineteenth-century English criminal trials. In emphasizing chemical expertise, it seeks both to expand upon a limited literature on the history of the subject, and to offer a contrast to studies of criminal poisoning that have tended to focus primarily on medical expertise. Poisoning itself is a topic of abiding interest to historians of forensic medicine and science because (together with insanity) it long tended to attract the greatest attention (and often confrontation) in criminal proceedings. In looking at a wide number of cases, however, it becomes apparent that few aroused true medico-legal controversy. Rather, the evidence from several hundred cases tried as felonies during the eighteenth and nineteenth centuries indicates that prior to the 1830s few presented any opportunity for “a battle of experts”. While Ian Burney and Tal Golan have shown that this was certainly not the case during the mid and late nineteenth century, this paper goes further by dividing the period under study into three distinct phases in order to show how expert testimony (and experts themselves) changed during the course of the century, and why this process opened a door to the potential for formalized controversy.