Last Thursday we here in the States celebrated Thanksgiving. It is my absolute favorite holiday. All of my favorite foods are served in one glorious meal. Naps are fully expected. And it is the one day a year when people are (in theory) more inclined to be thankful than critical.
I have a lot to be thankful for this year, but number one on my list is modern medicine. My mom had spinal surgery last Tuesday–the exact same surgery I had a few years ago. She is doing great, but the recovery will take awhile. Fortunately, after the first few weeks, the worst part is that you have to wear a back brace that makes you look like a human/turtle hybrid.
So in honor of my mom’s newfound Ninja Turtle status, I decided to write this post on surgery in medieval Europe.
The Early Middle Ages
Meet your surgeon: Random Monk
You’ll notice he’s reading a book. This is a good thing. He has access to, and can understand, the Greek and Roman medical texts that have survived the fall of the Roman Empire. If your surgery is scheduled in the 10th century, he may have even studied medicine at the famous medical university in Salerno. If so, you’re in luck. Surgical instruction was a small part of the curriculum.
1215 and after
Meet your surgeons: The Barber-Surgeon, The Learned Surgeon, The Itinerant Surgeon
1215–Pope Innocent III decided the church really had no business slicing into people. Blood was contaminating, after all. So he ordered clergy members to hang up their surgical tools and leave the cutting to those who could afford a little blood on their hands.
Enter the Barber:
Sure they didn’t have a medical education or even experience, but they did have sharp tools. And that was a start. Barbers began performing minor surgeries–blood letting, wound care, burn treatment, skin lesions, teeth pulling, and draining abscesses. You could get all this done and have a shave and a hair cut. Pretty convenient.
Your barber will be easy to find. Just look for a shop with a red and white striped pole, a symbol of the blood and bandages that mark his trade.
These guys (or gals) might not have had a lot of book learning, but they had training. A master surgeon taught his knowledge to apprentices (often fathers and sons). Training began at 13 or 14 and lasted anywhere from 7-9 years.
Say you need a more complicated surgery. Perhaps you have cataracts or need some bladder stones removed. Learned surgeons might be reluctant to perform these risky surgeries. But if you’re lucky, a traveling surgeon might set up shop in your village for a few days and help you out. They’re willing to take on the risk. After all, should you experience any nasty complications, they’ll have skipped town before you have a chance to summon a lynch mob.
But I’m rich. Can’t I do better?
Of course you can! Money will buy you an actual physician. Remember that medical school in Salerno? People were so impressed that medical schools began popping up all over the place–Montpelier, Bologna, Paris, Oxford, and Cambridge all had medical schools by the late medieval period.
Or you might consider a literate surgeon. There were a group of educated men, pushing to elevate surgeons to the same status as physicians. They looked down on the “uneducated” men and women plying their trades as surgeons. A 13th century Italian surgeon by the name Bruno Da Longoburga describes his frustration with uneducated surgeons in the following passage:
l think scarcely anyone who is illiterate can understand this art, but at the present time . . . those who exerdse this art are for the most part ignorant and stupid peasants; and on account of their stupidity the worst possible diseases are generated in people, by which indeed the patients are killed since the surgeons operate neither Wisely nor according to certain reasoning, but haphazardly.
Bruno and other like-minded literate surgeons did their best to elevate the field of surgery. They wrote texts on the subject and even got some of the Universities to include special degree programs in surgery.
These degrees were wildly unpopular…
Between 1405 and 1434 not a single student completed the surgical degree at the University in Padua. Physicians looked down on surgeons they way literate surgeons looked down on lay surgeons. A university trained physician was considered qualified to perform any surgery, but an educated surgeon was not qualified to practice internal medicine. From a practical standpoint it made more sense to just go for the physician’s degree. And for those who really liked the idea of cutting into people, a degree wasn’t really necessary. Many got a few years of education under the belts and then dropped out to begin their careers as surgeons.
I’ve chosen my surgeon. What can I expect?
That depends on the type of surgery and your surgeon. But here are a few generalities:
1. You’re probably going to be strapped down.
Surgery isn’t going to feel good, and if you’re flailing around, it’ll be hard for the surgeon to do his job. If you’re lucky the surgeon will give you a soporific mixture. A sponge soaked in opium and mandrake placed in the mouth or under the nose will hopefully lull you to sleep…hopefully. If not, take heart. The surgeon will try to be quick.
2. The surgeon will have special tools
Guy de Chauliac, a 14th century surgeon and author of Chirurgia Magna, described the essential tools of a surgeon: knives, razors, and lancets for making incisions, cautery irons, grasping tools, probes, needles, cannulae, and a tool for trepanation.
3. The surgeon might clean your wound with wine or boiling oil
Wine has been used since antiquity to clean wounds, and your surgeon will likely follow his forefathers’ advice. The wine will work as an antiseptic, though your surgeon won’t know anything about the microorganisms he’s killing. If your surgery is schedule before 1500 and your surgeon suspects your wound is poisoned, he will likely pour boiling oil over it. It won’t feel great, but he’s doing what he thinks is best for you.
4. There will be pus.
In fact, your surgeon will be hoping for pus. Well, a certain kind of pus at least. Laudable pus, thick white pus, suggests that your infection will either heal or form a local abscess. This is considered a good sign, and some surgeons might even keep your wound open and use a special unguent to help encourage laudable pus. Your surgeon won’t want to see a watery, fetid pus. If he does, there’s a good chance you’re going to get gangrene and die. So keep your fingers crossed for the laudable type.
5. You might live
The following passage is taken from “Respectful Image”: Revenge of the Barbar Surgeon by by Charles E. Bagwell.
Records of Joseph Binns, a London surgeon who practiced from 1633 to 1663, describe 616 patient cases, 196 of venereal origin (apparently a special interest of his), 77 of swellings, 61 of medical symptoms (including aches, stomach illness, headaches, insomnia, diarrhea, and epilepsy), 15 with battle injuries, 14 from work-related injuries, 19 with injuries in falls from horses or coaches, and 41 injured in fights. Of the 402 outcomes listed, 265 were cured; 62 improved. There was no improvement in 22; 53 (8%) died.7
Not bad results considering he was working without anesthesia or knowledge of germ theory.
photo credit: <a href=”http://www.flickr.com/photos/11654579@N07/4265807885″>Main Street Barber Shop</a> via <a href=”http://photopin.com”>photopin</a> <a href=”https://creativecommons.org/licenses/by-nc-nd/2.0/”>(license)</a>