A professor of surgery in Edinburgh in the 1850s confided that patients entering hospital for surgery were 'exposed to more chances of death than was the English soldier on the field of Waterloo'. By the end of the 19th century, however, Joseph Lister had introduced an effective antisepsis routine, and this, combined with anaesthesia, had transformed surgery (though mortality rates were still high). Surgeons were becoming heroes: in the United States, William and Charles Mayo, the founders of the Mayo Clinic in Rochester, had become household names and millionaires. The cultural resonance of surgery was the more powerful in a period haunted by biological metaphors, in which nations were seen as bodies, vulnerable to various forms of contamination. One of the greatest challenges to the health of the national body was posed by the mentally ill: the cost of caring for this group exceeded that for all other patients put together. There was a need to reduce the amount of money spent on the mentally ill and to modernise the discipline of psychiatry, just as surgery had been brought up to date.

LRB 18 August 2005 | PDF Download