One problem exacerbated during the Middle Ages was the separation between surgery and medicine. Although the leech of the early medieval period was both physician and surgeon, his surgery was generally limited to simple emergency measures, such as phlebotomy (therapeutic bloodletting), cupping (applying evacuated glass cups to intact or scarified skin in order to draw blood towards the surface), cauterization, and simple emergency measures for coping with the usual run of burns, bruises, wounds, ulcers, sprains, dislocations, toothaches, and broken bones. A few more daring practitioners had the special skills needed for couching cataracts, tooth extraction, and lithotomy (the surgical removal of stones in the urinary bladder).
Modern specialists might be surprised to find their medieval counterparts among the lowly oculists, bone setters, tooth extractors, cutters of the stone, and other empirics, rather than in the company of learned physicians. Nevertheless, during the Middle Ages, ambitious surgeons were trying to win a more respectable professional status for surgery as a branch of knowledge with its own body of technical writings, as well as an eminently useful occupation. The specialized literature of surgery was growing by the thirteenth century, but glimpses of earlier surgical traditions have survived in epic poetry and mythology.
Because the need for surgeons is a common byproduct of warfare, semilegendary stories of great heroes and battles may reflect the conditions of battlefield surgical practice with more immediacy than learned texts. According to Scandinavian epic poets, if professional doctors were not available, the men with the softest hands were assigned to care for the wounded. Many famous physicians were said to have descended from warriors with gentle hands. Truly heroic warriors bound up their own wounds and returned to the battle. Sometimes women cared for the wounded in a special tent or house near the battlefield. One saga described a woman who cleaned wounds with warm water and extracted arrows with tongs. When the woman could not find the tip of the arrow, she made the patient eat boiled leeks. Then, the hidden wound could be located because it smelled of leeks.
Although epic heroes apparently emerged from crude battlefield surgery completely healed and eager to fight, the subjects of more mundane operations often succumbed to bleeding, shock, and infection. Despite their familiarity with the soporific effects of poppy, henbane, and mandrake, surgeons did not routinely use these drugs before an operation. Potions made of wine, eggs, honey, and beer were used to wash and dress wounds. A dressing for burns might be as gentle as a mixture of egg whites, fats, and herbs, or it might be strengthened by the addition of goat droppings.
Despite the low status of most medieval surgeons, some distinguished practitioners deplored the separation between medicine and surgery. The learned doctors of Salerno, the most famous Western medical school of the Middle Ages, maintained high standards of surgery and taught anatomy and surgical technique by dissections of animals. Medieval authors created simplified Latin texts by fusing the work of doctors at Salerno with excerpts from the Arabic literature. A treatise on surgery, based on the lectures of Roger Frugard, who taught and practiced surgery at Parma in northern Italy, was prepared about 1180 by his colleague Guido Arezzo, the Younger. Roger's influential and often copied Surgery described methods of wound closure, trephination, and lithotomy and recommended mercury for skin diseases and seaweed for goiter.
In the mid-thirteenth century, Roland of Parma produced an important new edition of Roger's surgical treatise that became known as the Rolandina. Roland, who taught at the new medical center in Bologna, based his teaching and practice on Roger's methods. Even as late as the sixteenth century, after newer Latin texts and translations of Galenic and Arabic texts became available, Roger's treatise was still respectfully studied. By the beginning of the fourteenth century, texts for surgeons who were literate but had not mastered Latin were appearing in vernacular languages. These simplified texts provided practical information on medicine and surgery and collections of remedies.
Hugh of Lucca (ca. 1160-1257), town surgeon of Bologna, and his son Theodoric, Bishop of Cervia (1210-1298), may have been the most ingenious of medieval surgeons. Theodoric is said to have attacked the two great enemies of surgery—infection and pain—and rejected the idea that the formation of pus was a natural and necessary stage in the healing of wounds. Indeed, Theodoric realized that the generation of pus, sometimes deliberately provoked by surgeons, actually obstructed wound healing. He also objected to the use of complex and noxious wound dressings.
To overcome the pain caused by surgery, Theodoric attempted to induce narcosis by the use of a ''soporific sponge'' containing drugs known to produce a sleep-like state. Just how effective his methods were in practice is unclear. Sponges were prepared by soaking them in a mixture of extracts from mandrake, poppy, henbane, and other herbs. Before surgery began, dried sponges were soaked in hot water and the patient was allowed to chew on the sponge and inhale the vapors. If the process was successful, the patient would fall asleep and remember nothing of the operation—if he woke up again.
Sometime in the early fourteenth century, Henri de Mondeville, surgeon to Philip the Fair of France, began writing a major treatise on surgery. The text was still unfinished when Henri died. Moreover, Henri's text was polemical in style, highly argumentative, and hostile to the medical authorities. Proud of his skills and accomplishments as a surgeon, Henri protested the disastrous results of separating surgery from medicine. By the end of the century, the physicians comprising the Faculty of Medicine in Paris were demanding that graduates take an oath that they would not perform any surgical procedures. Henri's work was gradually forgotten and his text was not printed until 1892. Eventually, the title ''father of French surgery'' was bestowed on Henri's student Guy de Chauliac (ca. 1298-1368), eminent physician and surgeon and author of a treatise on surgery that was still in use in the eighteenth century. Guy's treatise, composed about 1363, is generally considered the most valuable surgical text of its time. For at least two centuries, most of the Latin and vernacular texts on surgery produced in Europe were based on the work of Roger Frugard and Guy de Chauliac.
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