¹ Scholars traditionally interpret the history of the operating room as part of the history of the modern hospital, e.g., Charles E Rosenberg, The care of strangers: the rise of America's hospital system, New York, Basic Books, 1987, or as part of the history of surgery in general, e.g., Owen H Wangensteen and Sarah D Wangensteen, The rise of surgery: from empiric craft to scientific discipline, Folkestone, William Dawson and Sons, 1978, pp. 453–73. For a separate history of the operating room, see Christoph Mörgeli, The surgeon's stage: a history of the operating room, Basel, Editiones Roche, 1999.

² On the pitfalls of interpreting the material culture of surgery in terms of function, see Ghislaine Lawrence, ‘The ambiguous artifact: surgical instruments and the surgical past’, in Christopher Lawrence (ed.), Medical theory, surgical practice: studies in the history of surgery, London and New York, Routledge, 1992, pp. 295–314, on pp. 298–300.

³ Exceptions, that is scholarly work that does use material culture, would include: Dianne Dodd, ‘Nurses’ residences: using the built environment as evidence’, Nursing History Review, 2001 9: 185–206; Annmarie Adams, ‘Rooms of their own: the nurses’ residences at Montreal's Royal Victoria Hospital', Material History Review, 1994, 40: 29–41; idem, ‘Borrowed buildings: Canada's temporary hospitals during World War I', Can. Bull. Med. Hist., 1999, 16 (1): 25–48; Rosemary Gillespie, ‘Architecture and power: a family planning clinic as a case study’, Health & Place, 2002, 8: 211–20; Charles R R Hayter, ‘The clinic as laboratory: the case of radiation therapy, 1896–1920’, Bull. Hist. Med., 1998, 72: 663–88; and Peter Galison, Image and logic: a material culture of microphysics, University of Chicago Press, 1997.

⁴ See Peter Galison, ‘Buildings and the subject of science’, in Peter Galison and Emily Thompson (eds), The architecture of science, Cambridge, MA, and London, MIT Press, 1999, pp. 1–25, on pp. 11–12.

⁵ Other authors who have attempted similar analyses are Lindsay Prior, ‘The architecture of the hospital: a study of spatial organization and medical knowledge’, Br. J. Sociol., 1988, 39: 86–113. Prior interprets the spatial organizations in hospitals in relation to the discursive practices of which they form a part. J T H Connor, ‘Bigger than a bread box: medical buildings as museum artifacts’, Caduceus, 1993; 9: 119–30, and Thomas A Markus, Buildings and power: freedom and control in the origin of modern building types, London and New York, Routledge, 1993, also use hospital architecture as evidence of medical and social change.

⁶ J T H Connor, ‘The Victorian revolution in surgery’, Science, 2 Apr. 2004, 304: 54–5; Michael Essex-Lopresti, ‘Operating theatre design’, Lancet, 20 Mar. 1999, 353: 1007–10, p. 1007; Guenter B Risse, Mending bodies, saving souls: a history of hospitals, Oxford University Press, 1999, p. 387.

⁷ Allan M Brandt and David C Sloane, ‘Of beds and benches: building the modern American hospital’, in Galison and Thompson (eds), op. cit., note 4 above, pp. 281–305, on p. 288.

⁸ Ibid., p. 288.

⁹ ‘Le cœur de l'hôpital’, Pierre-Yves Donzé, ‘L'ombre de César : les chirurgiens et la construction du système hospitalier vaudois (1840–1960)’, PhD thesis, University of Neuchatel, 2004, p. 111.

¹⁰ On the significance of spaces for the production of scientific knowledge, see, for example, Galison, op. cit., note 4 above; Adi Ophir and Steven Shapin, ‘The place of knowledge: a methodological survey’, Science in Context, 1991, 4: 3–21.

¹¹ When discussing the influence of surgeons on the architecture of operating rooms, architect William A Pite characterizes his profession's role in this context as one of coordinating surgeons' and nurses' demands and “translating them into a consistent and logical arrangement”. Pite reports that deep and prolonged discussions among surgeons about the requirements of surgical spaces often took place, “before the architect appears upon the scene’. William A Pite, ‘Hospital operating theatres”, The Architects’ Journal, 24 June 1925, 61: 968–72, p. 968.

¹² John Harley Warner, ‘The history of science and the sciences of medicine’, Osiris, 1995, 10: 164–93.

¹³ Andrew Cunningham and Perry Williams (eds), The laboratory revolution in medicine, Cambridge University Press, 1992.

¹⁴ Warner, op. cit., note 12 above, p. 182.

¹⁵ Joel D Howell, Technology in the hospital: transforming patient care in the early twentieth century, Baltimore and London, Johns Hopkins University Press, 1995.

¹⁶ Ibid., p. 61.

¹⁷ Warner, op. cit., note 12 above, p. 178.

¹⁸ Steve Sturdy and Roger Cooter, ‘Science, scientific management, and the transformation of Britain c. 1870–1950’, Hist. Sci., 1998, 36: 421–66, on p. 449. Cf. Howell, op. cit., note 15 above, p. 2: “Rather than simply attributing change to the march of science, it is far more interesting for the historian and valuable for the policymaker to examine when and how the appeal to science derived its current power”.

¹⁹ Warner, op. cit., note 12 above, p. 186.

²⁰ Thomas Schlich, Die Erfindung der Organtransplantation: Erfolg und Scheitern des chirurgischen Organersatzes (1880–1930), Frankfurt am Main, Campus, 1998, p. 225; John E Lesch, Science and medicine in France: the emergence of experimental physiology, 1790–1855, Cambridge, MA, Harvard University Press, 1984, pp. 5–8, 12–14, 50–124, 199–218.

²¹ Claude Bernard, An introduction to the study of experimental medicine, transl. Henry Copley Greene, New York, Dover, 1957 (original French edition, 1865), e.g., pp. 101, 102.

²² Emil Theodor Kocher, ‘Concerning pathological manifestations in low-grade thyroid diseases’, Nobel Lecture, December 11, 1909, in Nobel lectures: Physiology or Medicine, volume 1 1901–1921, published for the Nobel Foundation by Elsevier, Amsterdam, 1964, pp. 330–83, on p. 331.

²³ This is the programme of physiology and experimental medicine as outlined by Claude Bernard, in his influential Introduction to the study of experimental medicine, op. cit., note 21 above, pp. 55–6; see also John V Pickstone, ‘Ways of knowing: towards a historical sociology of science, technology and medicine’, Br. J. Hist. Sci., 1993, 26: 433–58, see p. 437; and Bruno Latour, ‘Give me a laboratory and I will raise the world’, in K D Knorr-Cetina and M Mulkay (eds), Science observed, Beverly Hills, Sage 1983, pp. 141–70.

²⁴ See, for example, Thomas Schlich, Surgery, science and industry: a revolution in fracture care, 1950s–1990s, Basingstoke, Palgrave Macmillan 2002, p. 240; control is a dominant theme in surgical literature, such as control of infection, control of haemorrhage, etc., see, for example, Martin Kirschner, Operative surgery: general and special considerations, transl. I S Ravdin, Philadelphia and London, J B Lippincott, 1931, pp. 229–349.

²⁵ Latour, op. cit., note 23 above, p. 163.

²⁶ On pavilion plan hospitals, see Jeremy Taylor, The architect and the pavilion hospital: dialogue and design creativity in England 1850–1914, London, Leicester University Press, 1997.

²⁷ On the elevation drawing No. 13, labelled HJK, this washroom section is X-ed out in pencil, and someone has written “out”, perhaps indicating that these facilities were not included in the hospital as built.

²⁸ See ‘The Royal Victoria Hospital’, Montreal Med. J., Jan. 1894, 22 (7): 534–53, on p. 539, the hospital secretary John J Robson describes accommodation for 300 students.

²⁹ Changes in hospital lighting took place against a whole host of associated changes, not the least being the advent and widespread use of electricity. Although the original Royal Victoria Hospital was wired for electricity, its use was interrupted daily at 11:00 pm. Improvements were made in 1899 with the construction of a new laundry and boiler building. See D Sclater Lewis, Royal Victoria Hospital 1887–1947, Montreal, McGill University Press, 1969, pp. 129–30.

³⁰ Wangensteen and Wangensteen, op. cit., note 1 above, p. 462.

³¹ Ibid., p. 464.

³² Bernard, op. cit., note 21 above; Schlich, Erfindung, op. cit., note 20 above, pp. 222–40. It is important to note that “experimental” does not refer here to the open-endedness of the outcome, as when it is said that a treatment has not yet become routine but is still “experimental”. On the contrary, “experimental medicine” in Bernard's sense denotes complete control and predictability of treatment results.

³³ Schlich, Surgery, op. cit., note 24 above, pp. 106–7; Bernard, op. cit., note 21 above.

³⁴ The variation in individual skill is an ongoing issue in surgery. Even if a procedure can be shown to be viable in the hands of an individual master surgeon, the challenge remains to institute it on a larger scale; see Schlich, Surgery, op. cit., note 24 above, pp. 65–85.

³⁵ The importance of transplant surgery was by no means just symbolic. In this period, hundreds of organ transplants were performed on patients. Mainstream surgeons remained convinced of the immediate viability of organ transplantation up until about the First World War; see Schlich, Erfindung, op. cit., note 20 above.

³⁶ Ibid., pp. 226–30. Ulrich Tröhler, ‘Surgery (modern)’, in W F Bynum and Roy Porter (eds), Companion encyclopedia of the history of medicine, 2 vols, London and New York, Routledge, 1993, vol. 2, pp. 984–1028; Thomas Schlich, ‘The emergence of modern surgery’, in Deborah Brunton (ed.), Medicine transformed: health, disease and society in Europe, 1800–1939, Manchester University Press, 2004, pp. 61–91.

³⁷ Victor Horsley, ‘Remarks on the function of the thyroid gland: a critical and historical review’, Br. med. J., 1892, i: 215–19, 265–8, see p. 216. Horsley did thyroid ablation experiments on apes to explore the role of the organ in a “scientific way”. In 1885 Horsley was the first investigator who could offer a really convincing animal model of a lack thyroid function, Schlich, Erfindung, op. cit., note 20 above, pp. 58, 61–2.

³⁸ Annmarie Adams, ‘Modernism and medicine: the hospitals of Stevens and Lee, 1916–1932’, J. Soc. Archit. Hist., 1999, 58: 42–61, on p. 42.

³⁹ Edward F Stevens, The American hospital of the twentieth century, 2nd rev. ed., New York, F W Dodge Corporation, 1928, p. 102.

⁴⁰ Mörgeli, op. cit., note 1 above, p. 234.

⁴¹ Kirschner, op. cit., note 24 above, p. 250.

⁴² Pite, op. cit., note 11 above, p. 970.

⁴³ Kirschner, op. cit., note 24 above, p. 250.

⁴⁴ Miss R K Felter, Nurse in Charge, Royal Hospital, Montreal, ‘Operating room technic in the Royal Victoria Hospital’, Mod. Hosp., 1914, 3 (1): 28–32, on p. 28.

⁴⁵ Kirschner, op. cit., note 24 above, p. 245.

⁴⁶ Howell, op. cit., note 15 above, p. 32.

⁴⁷ Donzé, op. cit., note 9 above, p. 113.

⁴⁸ Ibid., p. 111. New techniques of organization may well have made it theoretically possible for a single dominant surgeon to control more than one operating room. But this would have been a different kind of control from the direct supervision that had been the norm in Type I, the earlier, undivided operating theatres. On the growth of managerial capitalism in the twentieth century, see Alfred D Chandler, The visible hand: the managerial revolution in American business, Cambridge, MA, Belknap Press, 1977.

⁴⁹ Kirschner, op. cit., note 24 above, pp. 243–4. On the isolation of the OR from its environment, see Stefan Hirschauer, ‘The manufacture of bodies in surgery’, Soc. Stud. Sci., 1991, 21: 279–319, on pp. 283–4.

⁵⁰ Kirschner, op. cit., note 24 above, p. 1.

⁵¹ Kocher, op. cit., note 22 above, p. 335.

⁵² Schlich, Erfindung, op. cit., note 20 above, pp. 75–80.

⁵³ Ibid., pp. 226–36. See, for example, Anton von Eiselsberg, ‘Zur Frage der dauernden Einheilung verpflanzter Schilddrüsen und Nebenschilddrüsen’, Verhandlungen der Deutschen Gesellschaft für Chirurgie, 1914, 43: 655–69, on p. 656, who said that surgeons had performed transplants on humans in analogy to the animal experiments. On the close relationships and overlapping research of surgeons and physiologists, see, in more detail, Schlich, Erfindung, op. cit., note 20 above, pp. 91–198, 233–4.

⁵⁴ Roger Cooter, Surgery and society in peace and war: orthopaedics and the organization of modern medicine, Basingstoke, Macmillan, 1993, pp. 234–7. See also Schlich, Surgery, op. cit., note 24 above, pp. 86–109.

⁵⁵ For the second half of the twentieth century, see, for example, Robert Danis, Technique de l'ostéosynthèse, Paris, Masson, 1949, pp. 5–6; Martin Allgöwer, ‘Wesen und Arbeitsgebiete des Laboratoriums im Forschungsinstitut Davos’, Helvetica Chirurgica Acta, 1962, 29: 176–9, on p. 178; Maurice Müller, ‘Treatment of nonunions by compression’, Clin. Orthop. Relat. Res., 1965, 43: 83–92, on p. 90; and Schlich, Surgery, op. cit., note 24 above, pp. 86–109.

⁵⁶ Stevens, op. cit., note 39 above, p. 102.

⁵⁷ Stevens used this window and skylight arrangement in the Bridgeport Hospital, Bridgeport, Connecticut, and the Barre City Hospital, Barre, Vermont, both illustrated in his book.

⁵⁸ This has also been pointed out by Howell, op. cit., note 15 above, pp. 58–9.

⁵⁹ ‘Natural daylight not suited to operating room requirements’, Canadian Hospital, Feb. 1930, 7 (2): 36–7, on p. 36. On electrical improvements to the Royal Victoria Hospital, see note 29 above. Direct current was used in many parts of the hospital until 1954.

⁶⁰ Ibid.

⁶¹ See note 6 above.

⁶² The translation is taken from Karel B Absolon, Mary J Absolon, and Ralph Zientek, ‘From antisepsis to asepsis: Louis Pasteur's publication on “The germ theory and its application to medicine and surgery”’, Rev. Surg., 1970, 27: pp. 245–58. The original quote can be found in L Pasteur, La théorie des germes et ses applications à la médecine et à la chirurgie. Lecture faite à l'Académie de Médecine, Paris, G Masson 1878, pp. 16–17.

⁶³ This relationship between the laboratory and operating room is spelled out in another example by Gerard J Fitzgerald, ‘Constructing the cradle: instrumental and architectural responses to airborn infection, 1935–45’, unpublished paper presented at ‘Form and Function: The Hospital’, 3rd international conference of the International Network for the History of Hospitals, Montreal, 21 June 2003.

⁶⁴ For example, Kirschner, op. cit., note 24 above, pp. 263–71. On the “aseptic disciplining of the surgeon-body”, see Hirschauer, op. cit., note 49 above, p. 286.

⁶⁵ Wangensteen and Wangensteen, op. cit., note 1 above, p. 465–70.

⁶⁶ Donzé, op. cit., note 9 above, p. 113.

⁶⁷ Hirschauer, op. cit., note 49 above, pp. 283–90.

⁶⁸ Mörgeli, op. cit., note 1 above, p. 254.

⁶⁹ We are grateful to one of the anonymous reviewers who suggests that hospital laboratories may also have changed during this time period, perhaps becoming more like industrial laboratories or other workplaces.

⁷⁰ Mary Douglas, Purity and danger: an analysis of the concepts of pollution and taboo, New York, Praeger, 1966.

⁷¹ In the popular imagination as testified by the postwar media, however, surgery remained daring, heroic and manly. We are grateful to one of the journal's reviewers for noting this point.

⁷² Christopher Lawrence, ‘Democratic, divine and heroic: the history and historiography of surgery’, in Lawrence (ed.), op. cit., note 2 above, pp. 1–47, on p. 32.