Medieval Surgical Procedures

Yesterday's post took a turn toward a particular surgical procedure, so I thought we'd talk a little more about that topic. What procedures were known and practiced with evidence of patient survival, back when doctors believed in the Four Humors of Hippocrates? I have talked about medicine numerous times, so here I want to focus on actual invasive practices with instruments.

Purging was one of the most common forms of surgery, piercing a vein to let out blood because a person's fever or angry nature indicated an excess of blood.

Amputation was another fairly common practice when a limb was so damaged by accident or warfare that there was no chance of it healing. Unfortunately, surviving an amputation was not always assured. An interesting article by the National Library of Medicine points out early art of people with crutches that supports their educated medical opinion that a leg amputation was only likely to survive if it were below the knee. Above the knee amputation led to too much bleeding. [link] Presumably amputations of smaller parts—toes, fingers, arms up to elbows—were less of a problem.

Related to amputation was cautery/cauterization, sealing off blood vessels by heating iron and pressing it to the wound. In an ideal situation, the wound was sealed, bleeding was stopped, infection did not occur, and the patient would survive. Even in this situation, however, the process caused intense pain, especially if you accepted the treatment for hemorrhoids that involved inserting a hot poker. This did not work, nor did the non-surgical suggestion of going to sit on the rock where St. Fiacre was cured of hemorrhoids. [link] (Maimonides finally wrote a seven-chapter treatise on the subject ultimately suggesting a good soak in a bath.)

Dental surgery was not unknown. Toothache was a major problem in the Middle Ages, and extractions were common. Situations arose, however, whose descriptions suggested the client had oral cancer. Roger Frugard (pre-1140 - c.1195), a surgeon in Salerno, wrote a Practica Chirurgia ("Practice of Surgery") in which he describes cancer in the jaw:

"if the flesh is hard, perforated and blackened' ('Si la char est dure, perse e anercie') cancer ('cancre') of the mouth was difficult to cure."

He describes cutting into the healthy flesh around the hard cancer, cauterizing the wound, and sealing it with muel de oef ("egg yolk"!).

Trepanning—boring a hole in the head to relieve pressure—is the oldest surgical procedure for which we find evidence: Skulls—many hundreds of them—that were trepanned have been found dating back 7000 years ago and more, with evidence of healed bone around the edges showing that the patient lived. The circumstances under which it was decided to drill a hole in the cranium are unknown.

Cataracts were originally dealt with by using a thick needle to push the cornea back. Islamic medicine came up with a better solution: a thin hypodermic needle inserted through the white part of the eye to extract the obstructing cataract material.

The illustration above is from a later manuscript copy in the Trinity College Library of Roger Frugard's Practica Chirugia that has many illustrations that help explain his techniques. Let's learn a little more about him and them tomorrow.