The Benefit of the Doubt: The Logic Behind ‘Radical’ Gynaecological Operations (Belgium, 1890s–1900s)

For most of the nineteenth century, abdominal surgery had been regarded worldwide as inherently risky. At the end of the century, however, medical confidence in gynaecological surgery was growing. Increasing numbers of operation became possible with the introduction of aseptic and antiseptic techniques, and with anaesthesia and analgesia. As a result, diseases that used to be medically managed were increasingly treated by surgery in Europe and the United States. The more gynaecologists engaged in surgical experiments, the more they turned to radical operations that removed both diseased organs and increasing amounts of healthy tissue. Nonetheless, the number of deaths remained considerable in the 1890s, with mortality rates of about 30% for new operation techniques.

This chapter will focus on the first generation of Belgian physicians who identified as gynaecologists. Since the foundation of the Belgian Society of Gynaecology and Obstetrics in 1889, its members examined the question of whether abdominal surgery was worth the substantial risk to life. Some of them developed a special interest in radical surgery despite their doubts about accurate diagnoses and treatment outcomes. Focusing on the layers of medical uncertainty in the society’s bulletin, I argue that epistemic uncertainty, as much as medical confidence, was a fundamental contributing factor to the rise of gynaecological surgery. Gynaecologists with a taste for radical surgery often used doubts about the diagnosis and results of an operation as arguments to justify their experiments. Patient consent was another, yet less publicly discussed, area of uncertainty. Doctors appeared confident in clinical encounters, but they could never predict whether or not women would accept surgery.