Learning from mistakes: early twentieth-century surgical practice

Archibald Watson was an Australian anatomist and surgeon who kept operating theater diaries. He made detailed notes on the work of surgeons that he observed in Britain and North America, as well as in Australia. Watson's diaries provide significant evidence that early twentieth-century surgeons did not just apply scientific knowledge produced somewhere else. They generated new surgical knowledge themselves and worked within a culture that valued innovation. Some of the surgeons observed by Watson practiced in academic centers and regularly engaged in laboratory research, but most did not. Nevertheless, it is clear that whether in Australia, Britain, or North America, the active search for improved techniques was a routine feature of the practice of full-time surgeons. In the process, they often made mistakes--or rather, they often did things with which at least some of their colleagues did not agree. Much of surgical practice was contestable. Doing things the "right" way and finding better ways to do things were overlapping categories; but it is often difficult or impossible to draw any distinction at all between doing things the "wrong" way and failed attempts at finding a better way to perform an operation. This article examines some aspects of the relationship between scientific ideas, clinical experience, contestable errors, and the generation of new knowledge through surgical practice.