Medieval surgery was a painful and unhygienic affair. Whilst practitioners had some basic accurate medical knowledge, much still went wrong in the form of infections and blood loss. Even with new inventions and theories that helped make it safer, it was still a very dangerous process. Let's examine medieval surgery!
Medieval Surgery History
There were many reasons why someone might need a surgical procedure. On a more day-to-day basis, people would employ surgeons for things like tooth-pulling, removing cysts, or bleeding.
Surgeons would also be called on to perform more major surgeries, like amputations. These would be done as quickly as possible to stop blood loss and minimise pain.
Fig. 1 - An illustration of a medieval woman undergoing bloodletting
No matter how big or small, all of these surgeries were performed without anaesthetic or clean, sterilised equipment! Surgery was often extremely painful and dangerous for the person involved.
The Barber-Surgeon
There were three types of medical practitioners in Medieval Britain; physicians, apothecaries, and barber-surgeons. Barber-surgeons were the ones who performed most surgeries.
Barber-Surgeons
Medieval surgeons were called barber-surgeons as they were actually hairdressers or barbers doubling as surgeons! The reason for this was because as barbers, they had skill with sharp blades and scissors and had to be very careful in their work. This meant they were well suited to the tricky work of operating on the human body.
Although they were looked down upon by other medical professionals, barber-surgeons were uniquely skilled, and some even became highly skilled in surgery. Some ended up having a better knowledge of anatomy and the workings of the human body than physicians.
Medieval Surgery Procedure
Medieval surgeons were experts in external surgery, like dressing ulcers and removing cysts and cataracts, but did not often do surgery deep inside the body.
The methods used during surgery in the Medieval era were based on those detailed in Greek, Roman, and Arabic texts. Patients would try to combat the pain of the surgery by drinking mixtures of alcohol and herbs. Cauterisation was used to try and stop infection by burning the skin, but it was very painful.
Developments
Here is an overview of some developments in the processes of surgery in the Medieval era.
- Opium began to be used as a form of pain relief. Arabic physicians had first written about the benefits of opium in stopping pain, so it became incorporated into English medicine when the knowledge reached Britain.
- Surgeons began to use wine as an antiseptic to wash wounds. This had been written about by the Greeks.
- As a result of battlefield injuries, new minor procedures to cure wounds from objects like arrowheads were invented.
- Surgeons began to use ligatures to tie up arteries to stop bleeding during surgery, trying to eliminate blood loss and increase the chances of survival.
OpiumA drug made from poppy seeds that was used as a pain reliever.AntisepticSomething used to disinfect and clean surface wounds.
Overall, surgeons recognised that the issues of pain and infection needed to be addressed and so tried to come up with new ways to make surgery safer and less painful. However, they had very limited success. Surgery continued to be a brutal and dangerous experience for a patient.
Fig. 2 - A 13th-century illustration of a nurse bandaging a patient's abdomen
Tools used by Medieval Surgery
Medieval surgical tools were largely similar to those used by the ancient Greeks and Romans. Alongside the usual smaller blades and saws, there were also some more specialised instruments.
John Bradmore
John Bradmore was an English surgeon who became famous for his role in saving the life of the future king of England.
In 1403, Prince Henry of England, who would later become Henry V, fought at the Battle of Shrewsbury. During this battle, he was hit in the face by an arrow. The arrow entered below his left eye and embedded about 5-6 inches in his face.
John Bradmore was called to help him. Bradmore ordered the wound to be filled with honey, a known antiseptic, and then used a tool that he invented to remove the arrow from the Prince's face. He then ordered the wound to be filled with wine, another antiseptic. The prince survived the operation and lived!
Bradmore's tools and other similar devices became popular as surgeons sought new ways to deal with battlefield injuries.
Al-Zahrawi, the Father of Surgery
Al-Zahrawi, also known as Abulcasis, was an Arabic scholar who lived during the 10th and 11th centuries. He is credited as the father of surgery as he was responsible for the creation of many new surgical tools and techniques.
Fig. 3 - A page from the Al-Tasrif, detailing surgical instruments
He wrote a book called the Al-Tasrif. Essentially, it was a surgical encyclopaedia, and it detailed around 200 different surgical tools, some of which Al-Zahrawi had invented himself.
Problems with the Medieval Surgery
There were three main issues that Medieval surgeons had to try and combat. These risks are what made Medieval surgery so dangerous.
Anaesthesia
In the Middle Ages, anaesthetics (pain relief) did not exist. This meant that surgery would be very painful for the individual involved. Therefore, surgeons tried to perform operations as quickly as possible to minimise the pain felt.
Nevertheless, doctors did recognise that they needed to do something to relieve the pain during surgery. There were a couple of methods for this:
- The patient would drink a mixture of alcohol and herbs that were supposed to relieve pain.
- The patient would take opiates to combat pain which became more popular in the Middle Ages.
Despite this, doctors believed that it was necessary to keep the patient awake and alert during an operation, so these were used sparingly.
Even after some of the developments in the Middle Ages, surgery was still an excruciatingly painful experience.
Infection
Due to the lack of knowledge about germs, surgeries were always done without clean, sterilised equipment. Equally, it was rare that surgeons or doctors would wash their hands before and after examining a patient. Therefore, wounds and surgical cuts became infected very easily, which could quickly lead to a patient's death.
Signs of infection
Some doctors believed that it was good to cause pus in people's wounds. Today, we know that if a wound is leaking pus, then it is infected and needs to be treated quickly. However, in the Medieval era, some doctors thought that the appearance of pus meant that toxins were being removed from the blood.
This did not mean that surgeons didn't try to stop infections. Many surgeons used honey and wine as antiseptics as well as cauterisation to seal wounds, which did work to some degree.
Without the knowledge of germs, proper hygiene routines, and the sterilisation of equipment, Medieval surgeons had little hope of stopping infection.
Surgery in later centuries
Surgery would remain a risky procedure until the 19th century when germs were finally discovered.
It wasn't until 1846 that a Hungarian doctor, Ignaz Semmelweis, noticed that women who were being treated by doctors who washed their hands had a better chance of surviving childbirth than those who didn't!
Some of the most important figures in the discovery of germs were:
- Ignaz Semmelweis (1818-1865) - A Hungarian doctor who discovered the benefits of handwashing.
- Louis Pasteur (1822-1895) - A French scientist who became one of the first proponents of germ theory - he discovered pasteurisation and contributed to the development of vaccination.
- Robert Koch (1843-1910) - A German physician who discovered the germs and microbes that caused tuberculosis and cholera.
Blood Loss
With limited knowledge of anatomy, blood loss was another major risk in Medieval surgery.
The invention of the ligature was an important step forward in preventing blood loss during surgery, especially on the battlefield.
Ligature
A piece of thread that is tied around a structure in the body, usually a blood vessel to shut it off. This meant that surgeons could tie up blood vessels to stop the bleeding and prevent the patient from losing too much blood during surgery.
Did you know? The idea of ligation was first attributed to the Arabic physician Al-Zahrawi, but the process did not become popular in Europe until the 1500s when it was reintroduced by the French surgeon Ambroise Paré.
Of course, we can't forget that another popular way of treating illness in the Middle Ages was through bleeding, a task that might be performed by a barber-surgeon. In some cases, patients would lose too much blood, and it would weaken them, rather than heal them.
Ligation was a great help in reducing the risk of blood loss during surgery in the Middle Ages. However, surgery still remained very risky.
Medieval Surgery Summary
Overall, Medieval surgery remained a highly hazardous business despite the attempts to render it otherwise during this period. Death from blood loss and infection was still a constant issue for surgeons, as well as the excruciating amount of pain that surgery would put their patients through.
Yet, in Medieval Surgery, we can see the foundations of more accurate, modern medical theory. Washing wounds with wine and cauterisation were early attempts of disinfecting wounds, and drugs like opium were experimented with to help relieve pain.
As the Early Modern period approached, many of the characteristics of Medieval surgery carried over into the 1700s and were built upon by the medical scholars of the Enlightenment. Victorian Britain saw an intensive interest in the human body, and finally, Louis Pasteur's discovery of germ theory in the 1800s provided answers to the questions posed by Medieval surgeons hundreds of years before.
Medieval Surgery - Key takeaways
- Surgery in Medieval times was a painful and dangerous procedure.
- Barber surgeons performed most surgeries. Surgeries were usually external, not internal.
- Surgical tools were still mainly based on those from Ancient Greece and Rome, as well as the work of Al-Zahrawi. However, some specialised instruments were invented, e.g. Bradmore's arrow-removing tool.
- There were some developments in surgery - namely the introduction of opiates and alcohol as pain relief and the process of ligation helped stop blood loss.
- However, it did not balance out the major risks of infection due to a lack of proper hygiene and sanitation.
- Overall, surgery remained a risky, painful, and dangerous procedure in Medieval Britain.
References
- Fig. 2 - Nurse bandaging a patient's abdomen, 13th century. (https://commons.wikimedia.org/wiki/File:Nurse_bandaging_a_patient%27s_abdomen,_13th_century._Wellcome_M0010148.jpg) by Wellcome Images (http://wellcomeimages.org/) licensed by CC BY SA 4.0 (https://creativecommons.org/licenses/by-sa/4.0/)
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