Historiographies of surgical innovation: endoscopic endonasal pituitary surgery

Abstract

The historiography of medicine has shifted from narratives of inevitable progress, authored mainly by the medical profession, to a more complex, analytical approach in which historians place medicine in its social context. However, the history of surgery has lagged behind somewhat; Christopher Lawrence suggests this is because the recent focus on the construction of medical knowledge does not incorporate the practical aspects of surgery, which are difficult to extract from their previous linear narrative. Thomas Schlich likewise recognises that surgery is both knowledge and skill—therefore more of a ‘craft’ than medicine. A possible solution is aligning the history of surgery with the history of technology: analysing the interplay of instruments and human activity.This case study uses the history of endoscopic endonasal pituitary surgery to explore the historiography of surgical innovation, in the context of its heavy reliance on both technology and interdisciplinary divisions of labour. Re-enactment, evolutionary frameworks and using Social Construction of Technology methods all require close collaboration between historian and surgeon to bridge the gap between scholarship and tacit knowledge.