When many people in the modern age think of medieval medicine, particularly inEngland, they imagine either the astrologer who bled people according to the placement of Leo or the blood-spattered barber who was content to pull a man’s tooth and stitch up an ox’s leg without wiping the blood off his tools.  Such preconceived notions make it difficult to imagine medieval practitioners as sympathetic, compassionate and concerned with their patients’ comfort. 

But medieval surgeons (“doctors” never dirtied their hands) were knowledgeable and committed to their patients, drawing from a wealth of Greek, Roman and Arabic masters.  They regularly engaged in complicated procedures with surprisingly good results.  They knew to keep wounds clean to prevent infection.  They knew to put pressure on bleeding wounds and sew inner and outer layers of skin separately.  They knew of sepsis and gangrene even if they could not always prevent them. 

Most of the well-known surgeons from the medieval period honed their craft on the battlefield.  The Church closely regulated the use of cadavers in the study of anatomy but did not forbid it outright.  Allowable corpses were those of criminals but medieval authorities liked those to hang for a while on public display.  So by the time surgeons got the corpses, they were often dried out, bird-pecked and not terribly useful.

On the battlefield, everything was in flux.  Surgeons could – and had to – experiment with tools and technique when performing under temporal and physical constraints.  They also had a large number of injured men to practice on, men who did not care how they were cured as long as they lived to tell the tale.

Most battlefield surgeons had tents to work beneath, often situated on high ground facing the wind if possible.  Southern facing tents were also valued for warmth and light.  What would have been in a thirteenth-century battlefield surgeon’s trunk?  He would have had a number of cutting tools including razors, knives, lancets and saws.  Even if he did not hold to the use of cautery, a number of cautery irons would have been in the trunk as well.

Grasping tools like forceps and scissors were also available to him as were a number of puncture tools such as trephines, spatumen and probes.  He would have had a number of flasks and jars containing salves such as apostolicon, verdigras, and poudre-rouge.  The herbal components of some of these medicines might have been stored in the trunk but it is more likely they were kept separately.

Wounds were always washed.  Heated wine was a common cleanser but boiling oil was not unknown.  Surgeons knew that a wound with foreign matter in it would fester and cause death.  They used egg white extensively as a disinfectant and made iodine from seaweed ash.  These were either soaked into bandages or applied with feathers.

A surgeon’s most-used tool would probably have been his forceps, used to pry arrows out of flesh.  First he would wiggle the arrow to loosen it.  If the arrow was barbed, he would use his forceps to bend the barbs inward toward the shaft.  If he could not bend the barbs, he worked goose quills onto the barbs to minimize the damage to surrounding flesh.  If the arrow had an exit wound, he would use a trephine to enlarge it, then break the fletching off the arrow and pull it through.

Slice wounds could be sutured.  A surgeon would use a steel needle and sinew before he would use a bone needle and woven thread.  He would make his stitches a finger’s width apart, then he would apply a pad soaked in egg white and wrap the wound.  If he had it, the surgeon might apply a waxy paste made from senecion (groundsell) and grease.

Surgeons left gaps in their sutures to allow for the wound to drain; for deep wounds they used cannulae, or hollow tubes inserted far into the wound.  Dressings and bandages were changed every three days and it was thought damaging to unwrap newly made stitches before three days were up.

Slice wounds could also be cauterized and kept open with corrosives.  A number of cautery irons of all shapes and sizes as well as a chafing dish to heat them would have been standard in a battlefield surgeon’s trunk.  The irons were heated in the chafing dish, then rubbed in the open wound to make it bleed.

Caustics and corrosives kept the wounds open after the initial cauterization to allow for drainage.  A well-known caustic was rupertory; lye and quicklime.  Once the surgeon thought the wound had been purged of toxins, he smeared it with apostolicon or poudre-rouge (both anticoagulants) and left it unwrapped.

Surgeons also set broken bones on the battlefield.  First, the surgeon would restore the bones to their original position by gentling them apart or together.  Once the bones were set, he would wrap the limb with thin cloth soaked in egg white followed by a sturdier cloth stiffened with wheat paste and egg-white plaster.

Wounds to the trunk on a battlefield very often meant death regardless of the skill of the surgeon.  They could do little to treat internal injuries but they sometimes tried.  A treatment is recorded to use on a patient with an abdominal wound but some historians doubt it was ever successful.  If the patient’s entrails hung out, they were warmed with a slain animal till they returned to body temperature.  The intestines were cleaned, then returned to the body cavity.  The surgeon inserted a tube for drainage, stitched the flesh very loosely and dusted it with poudre-rouge.  He left the wound open till it healed.  This operation is tricky and time-consuming and it is easy to see a surgeon thinking he could better serve ten men with arrows through their extremities than one with a probably-fatal chest wound.

Anesthetic was not unknown to the battlefield surgeon but he probably ran out of it quickly even through he must have hoarded it for the noblest patients.  Soporific sponges soaked in poppy were meant to be inhaled while aqua vitae and dwale were consumed.

Five good resources:

Gottfried, Robert S.  Medicine in Medieval England , 1340-1530.  Princeton, NJ: Princeton University Press, 1986.

Hunt, Tony.  The Medieval Surgery.  Woodbridge, UK: Boydell Press, 1992.

Leonardo, Richard A.  The History of Surgery.  New York: Froben Press, 1943.

MacKinney, Loren.  Medical Illustrations in Early Medieval Manuscripts.  Berkeley, CA: University of California Press, 1965.

Siraisi, Nancy G.  Medieval and Early Renaissance Medicine.  Chicago and London: University of Chicago Press, 1990.