Around a third of patients have drug-resistant epilepsy (DRE). This is crucially and easily determined if a patient continues to have seizures after being on two adequately dosed and appropriately selected antiseizure medicines (ASMs). For these patients, your initial efforts to make a specific and localized diagnosis will inform next treatment decisions. If a patient presents suddenly with DRE, it is key to assess for a possible autoimmune cause, as a separate treatment pathway should be considered. Otherwise, consider epilepsy surgery as an effective treatment. These treatments include brain resections and neuromodulation. Minimally invasive techniques have recently become more common, including laser surgery as well as stereotactically placed depth electrodes. Given the prevalence of neurostimulators, consideration for obtaining MRIs in patients with these devices is addressed, as pathways exist for all of these patients to safely undergo MRI testing.

This chapter explores the practice of dissection in the first and second centuries AD, based largely on the evidence of Galen but drawing a picture beyond his activities alone. Divided into sections according to the contexts of and motivations for dissection, it begins with private dissections for practice and research. It next turns to performative dissections, beginning with those for public display. These public dissections occurred at different scales, and this section considers their contents, their diverse practitioners, and the size and make-up of their various audiences, including a discussion of venues, such as auditoria, and their capacities. The chapter then turns to examples of dissection specifically for medical advertisement, including evidence for public surgery, and then to two instances of dissection in the context of formal competition, one attested textually, the other epigraphically. Finally, it zeroes in on the competitive motivations of Roman dissection and its use in the adjudication of medical and philosophical debates, as well as in the jockeying between rivals.

This chapter establishes the core concept of ‘Romantic surgery’ by exploring the distinctive emotional, intellectual, and performative dimensions of late eighteenth- and early nineteenth-century British surgery. It opens by considering how, building on the legacy of John Hunter, Romantic surgeons constructed their practice as ‘scientific’, grounded in the study of anatomy and physiology. This allegedly more scientific approach to surgery encouraged greater operative restraint, but so too did the emotional regime of Romantic sensibility, which valorised the feelings of the patient and stressed the need to temper personal ambition with emotional sensitivity. This had profound implications for the performance of surgery, as surgeons were encouraged to eschew operative bravura in favour of a more considered deportment. As this chapter demonstrates, such emotional considerations also extended to the spectacle of surgery, as surgeons were expected to manage not only their patients and themselves, but also their audience. The performative persona of the Romantic surgeon was not without ambiguities, however, and this chapter therefore concludes with a study of perhaps the era’s most contested figure, Robert Liston.

This chapter explores the beginning of the end of the emotional regime of Romantic sensibility and the origins of surgical scientific modernity. It illuminates this crucial period of transition through the juxtaposition of two distinct but conceptually and ideologically intertwined moments in surgical history. These are, firstly, the debates surrounding the practice of anatomical dissection that came to the fore in the 1820s and culminated in the passage of the Anatomy Act in 1832, and, secondly, the introduction and early use of inhalation anaesthesia in the later 1840s. In both instances it highlights the powerful influence of utilitarian thought in divesting the body, both as object and subject, of emotional meaning and agency. In the former instance it demonstrates how an ultra-rationalist understanding of sentiment was set in opposition to popular ‘sentimentalism’ in order to divest the dead bodies of the poor of emotional value. Meanwhile, in the latter, it considers how the emotional subjectivity of the newly anaesthetised patient was swiftly tamed by the operations of a techno-scientific rationale.

This chapter charts the ultimate triumph of the emotional regime of scientific modernity in the form of antisepsis, Joseph Lister’s application of germ theory to surgical practice. It begins by exploring the ways in which antisepsis eliminated the patient as an emotional agent in surgery. The 1860s saw profound concern within surgery about the devastating impact of sepsis on post-operative mortality. Many of the explanations provided for this phenomenon rested on long-standing ideas about the role of the patient’s constitution and emotional state in regulating their post-operative health. However, by focusing purely on the condition of the wound, and the need to keep it free of ‘germs’, Lister’s antisepsis effectively overwrote these explanations, rendering patient subjectivity largely meaningless. At the same time, however, if emotions no longer possessed any ontological significance in surgery, the second part of this chapter demonstrates that they nonetheless played a powerful rhetorical function, as this ‘new world of surgery’ was configured in highly sentimentalised terms. This sentimentality not only served to counter widespread popular anxieties about surgery’s moral character, but also constructed Lister, the ultimate scientific surgeon and the emotional template for surgical modernity, as a quasi-divine saviour.

What can the emotions add to our understanding of the history of surgery? Opening with George Wilson’s account of the amputation of his foot in 1842, this Introduction suggests that ‘the black whirlwind of emotion’ that defined his experience of pre-anaesthetic operative surgery should prompt us to take the place of emotions in surgery seriously. It provides a brief account of the argument advanced by the book, the historiographical context in which it is situated, the theoretical framework it employs, the chronological and conceptual parameters that determine its focus, and the rich body of source material on which it draws. It also provides an overview of the chapters that follow in terms of content and argument. Overall, it establishes how Emotions and Surgery charts the changing place of emotions within British surgery across the long nineteenth century, from an emotional regime of Romantic sensibility to one of scientific modernity, demonstrating the ways in which emotions shaped surgeons’ and patients’ experiences and identities.

This chapter uses a close reading of The Lancet medical journal, and its radical, charismatic editor Thomas Wakley, to delineate the ‘high-water mark’ of Romantic sensibility as an emotional regime. It explores the ways in which Wakley and The Lancet leveraged the emotional politics of contemporary melodrama to critique the alleged nepotism and corruption of the London surgical elites. More especially, it analyses their campaign to expose instances of surgical incompetence at the city’s leading teaching hospitals, demonstrating the ways in which this strategy weaponised the emotions of anger, pity, and sympathy, and considering its implications for the cultural norms of an inchoate profession and for the ultimate stability of the emotional regime of Romantic sensibility.

This chapter considers the emotional interiorities and intersubjectivities of Romantic surgery. It challenges the well-established stereotype of the pre-anaesthetic surgeon as dispassionate butcher by demonstrating the ways in which surgical identities and subjectivities were shaped by a culture of emotional expression and reflection. The emotional ‘authenticity’ of pre-anaesthetic surgery was rooted in the embodied experience of operative practice, and the huge challenges that came from dealing with death, disease, and disfigurement on a daily basis. But as well as encouraging emotional introspection, the experience of pre-anaesthetic surgery also demanded that the surgeon manage his patients’ emotions. After all, in this period, fear, despondency, and other states of mind were regarded as an immediate cause of death. For this reason, surgeons needed to monitor their patients’ moods and imagine themselves into their position in order to regulate their own conduct and promote optimal operative outcomes. These relations between surgeons and patients were structured by a range of factors, notably gender. For that reason, this chapter concludes with a consideration of Romantic surgical intersubjectivity in practice, utilising Astley Cooper’s casebooks to explore the ‘emotion work’ of womanhood in the elaboration and understanding of breast cancer.

This chapter considers Romantic surgery from the patient’s perspective. It uses Astley Cooper’s rich archive of personal correspondence to explore the complex emotions associated with the experience of surgical illness and its treatment, as well as the ways in which emotional expression functioned as a form of agency within the private surgical relationship. In addition to considering private patients, this chapter also examines how emotions expressed and mediated agency within what, following Michel Foucault, we might consider the ‘disciplinary’ space of the hospital. The pre-anaesthetic surgical patient was a deeply unstable and ‘messy’ ontological entity whose pre-operative health and post-operative recovery were determined by a complex melding of constitutional, nervous, and emotional factors. Thus, as this chapter demonstrates, the patient’s own body could exert an unconscious material agency, often frustrating both surgical intervention and the patient’s own will, something that was most evident in the associations between irritability and obstreperousness that characterised contemporary discourses on amputation and its discontents.

This Epilogue considers the ways in which historical accounts of the Listerian antiseptic ‘revolution’ have shaped our perception not only of surgical modernity, but also of the pre-antiseptic and pre-anaesthetic past. By examining a number of historical and reflective works written by surgeons in the years following Lister’s death in 1912, it shows that such accounts of surgical modernity served to flatten the emotional landscape of the pre-anaesthetic, Romantic era, consigning it to a surgical ‘dark age’ of suffering, misery, cruelty, and death. In turn, it contends that these myths have determined popular perceptions of the history of surgery. Indeed, they have shaped the very practice of surgery itself. As such, it concludes by considering how a more nuanced and informed history might inform surgical practice in the present.

This chapter explores some of the new roles that have been introduced into perioperative care over the last couple of decades. These are the surgical first assistant, surgical care practitioner, and anaesthetic associate. It highlights the history, educational pathways, role boundaries, scope of practice, and the professional and legal implications of each of the extended or advanced roles.

This chapter discusses the management of obstetric patients undergoing anaesthesia and surgery. First, it outlines the distinct challenges of emergency obstetric anaesthesia and surgery. Second, it discusses pregnancy related changes to anatomy and physiology, common obstetric procedures, and drugs specific to the obstetric speciality. Finally, it highlights the advancements in care and medical technology and draws upon some of the moral and legal dilemmas faced by multidisciplinary teams in the obstetric setting.

This chapter explains the fundamentals of basic patient monitoring for patients undergoing general anaesthesia. Monitoring provides information and feedback of a patient’s physiological state in response to any therapeutic interventions or stimuli during anaesthesia and surgery. It is vital that perioperative practitioners understand the underlying principles of basic patient monitoring. This includes understanding how and what is being measured, how the monitoring is assembled, and how to problem solve to ensure optimal functionality and accuracy.

Healthcare-associated infections and more specifically surgical site infections, represent one of the biggest challenges facing practitioners in the perioperative environment. This chapter addresses the key points related to the causes of infection, and how they can be prevented. Infections are caused by pathogenic organisms, consequently, it is important to understand how they enter the body. The chain of infection model describes a series of links that outlines how infections can spread and provides a foundation to understand how they can be prevented. It is essential that perioperative practitioners understand how to break the chain of infection as well as the consequences of not doing so.

Patients with various ailments present to hospital with pain. This chapter defines pain and explores the assessment and the fundamental pathophysiology behind this common symptom. Pain can be managed using various pharmacological and non-pharmacological methods including interventional techniques. This chapter also explains the principles of management of acute pain in chronic pain patients on long term opioids and the problem of chronic post-surgical pain.