This paper examines how, over the course of the nineteenth and early twentieth centuries, the appreciation of skill in surgery shifted in characteristic ways. Skill is a problematic category in surgery. Its evaluation is embedded into wider cultural expectations and evaluations, which changed over time. The paper examines the discussions about surgical skill in a variety of contexts: the highly competitive environment of celebrity practitioners in the amphitheatres of early nineteenth-century Britain; the science-oriented, technocratic German-language university hospitals later in the century; and the elitist surgeons of late nineteenth and early twentieth-century United States with their concerns about distancing themselves from commercialism and cheap showmanship. For analysing the interaction of surgical practices with their various contexts the paper makes use of the concept of 'performance' and examines how the rules of surgical performance varied according to the prevailing technical, social, and moral conditions. Over the course of the century, surgical performance looked more and more recognisably modern, increasingly following the ideals of replicability, universality and standardisation. The changing ideals of surgical skill are a crucial element of the complex history of the emergence of modern surgery, but also an illuminating example of the history of skill in modern medicine. The paper examines the discussions about surgical skill in a variety of contexts: the highly competitive environment of celebrity practitioners in the amphitheatres of early nineteenth-century Britain; the science-oriented, technocratic German-language university hospitals later in the century; and the elitist surgeons of late nineteenth and early twentieth-century United States with their concerns about distancing themselves from commercialism and cheap showmanship. ‘Unspoken normative codes’ are typical for craft training, which has ‘as much to do with how to behave as it has to do with mastering specific tasks’. 24 Particular ways of performing practices come 41 In Liston’s case, nonchalance went along with his famous bluntness and with what was described as his ‘harsh and discordant’ voice. 42 It is no wonder that Liston anecdotes abound in the popular historiography of surgery. Performances such as Liston’s were part of a culture of surgeon celebrities, who, especially in the British capital, competed for fame and glory as well as for high-status patients. 43 In that context, elegance was another quality that was admired in surgical work. Surgeons praised colleagues by comparing them to artists, poets and writers. An admirer described Charles Aston Key’s style as the ‘poetry of surgery’. In the late nineteenth-century German-speaking world (as today), a pedant was a formal character who clung to insignificant details – a stickler for detail, someone who regards trivialities as important, who is fussy and overly formal. 76 This was what antiseptic surgeons looked like to those of their colleagues who did not adopt their specific style. ‘The Days of Brilliancy are Past’: Discipline and Science In the 1880s and 90s, many surgeons, starting in the German-speaking world, supplemented or replaced Lister’s antisepsis by what they called ‘asepsis’. 77 In asepsis, instead of killing the germs, they were to be avoided in the first place. To his chagrin, the American had missed the critical moment. Schleich characterised Langenbeck as a ‘genius’, whose ‘sure and elegant hand of an aristocrat demonstrated almost exclusively operating methods that he had invented himself, in the same way a virtuoso demonstrates his skills that were only given to him and were unachievable by others …’. 81 The term ‘genius’ tapped into a specific cultural repertoire that was available for characterising this particular – and now obsolete – aspect of surgical style at his time. The idea of genius in the modern sense had originated in the Romantic period earlier in the century. Along these lines, at the end of the century one of the most influential surgeons of his generation, the Breslau head surgeon Mikulicz, made a similar move and identified surgery as one of a number of modern technologies that were associated with a particular risk potential. He demanded a regime of risk management that was in keeping with the ones used in transport and industry and stated that ‘in the same way as in other areas of technology – in the operation of railways, in mining and in the metal industry – it can be demanded of us that we improve as much as possible the arrangements for the safety of the people who are entrusted to us’. 168 In the twentieth century the ‘theatricality of surgery’ was changing, as Brieger has phrased it; the place of surgery was now more often prosaically referred to as ‘operating room’ instead of ‘theatre’, with the focus shifting ‘from the operation itself to the results that were achieved’. 169 Figure 1: An example of the new form of the surgeon’s actor-role: Cushing operating before the Harvey Cushing Society; photograph, taken at some point 1929–32. Source: Harvey Cushing Photograph Collection, Harvey Cushing/John Hay Whitney Medical Library, Historical Library, Boston. However, the surgeon’s actor-role did not disappear. It merely took on a new form (see Figure 1 ). 171 Skill and Modern Surgery We have looked at the discussions about surgical skill in a variety of contexts: the highly competitive environment of celebrity practitioners in the amphitheatres of early nineteenth-century Britain; the science-oriented, technocratic German-language university hospitals later in the century; and the elitist surgeons of the late nineteenth and early twentieth-century United States with their concerns about distancing themselves from commercialism and cheap showmanship. 172 We have seen that context was not the whole story: within the changing contexts, individuals and their characteristics played a significant role.