Medieval Surgery

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.

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.

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 13^th-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.

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 10^th and 11^th 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.

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.

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.

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.