Surgery: Crude, blunt and horribly painful

Surgery in the Middle Ages was crude and blunt and … PAINFUL! Surgeons had a very poor understanding of human anatomy, anesthetics and antiseptic techniques to keep wounds and incisions from infection. It was not a pleasant time to be a patient, but if you valued your life, there was no choice. To relieve the pain, you submitted to more pain, and with any luck, you might get better. Surgeons in the early part of the Middle Ages were often monks because they had access to the best medical literature – often written by Arab scholars. But in 1215, the Pope said monks had to stop practicing surgery, so they instructed peasants to perform various forms of surgery. Farmers, who had little experience other than castrating animals, came into demand to perform anything from removing painful tooth abscesses to performing eye cataract surgery.

But there were some great successes. Archeologists in England found the skull of a peasant man from about 1100 who had been struck in the head by a heavy, blunt object. Close examination shows the man had been given life-saving surgery called trepanning, where a hole was drilled and a section of the skull was lifted, allowing smashed bone segments to be removed. The surgery alleviated pressure on the brain and the man recovered. We can only guess how painful it must have been!

Dwale: A crude anesthetic that could cause death in itself
Surgery in the Middle Ages was really only used in life/death circumstances. One reason is that there was no reliable anesthetic to dull the excruciating pain caused by the rough cutting and procedures. Some potions used to relieve pain or induce sleep during surgery were potentially lethal. An example was a concoction of lettuce juice, gall from a castrated boar, briony, opium, henbane, hemlock juice and vinegar. This was mixed with wine before being given to the patient.

The Middle English word used to describe an anesthetic potion was "dwale" (pronounced dwaluh).

The hemlock juice alone could easily have caused death. While the anesthetic might induce a profound sleep, allowing a surgery to take place, it might be so strong that the patient would stop breathing.

Paracelsus, a medieval Swiss physician, was the first to use ether for its anesthetic qualities. Ether did not gain wide acceptance and its use declined. It was rediscovered in America some 300 years later. Paracelsus also used laudanum, a tincture of opium, to alleviate pain.

Spells: Pagan rituals and religious penance as a form of cure


Early medieval medicine was often a mix of the pagan, religious and scientific. As the church gained more control, pagan “rituals” were made punishable offences. One such punishable offence might have been the following:

"When [the healer] approaches the house where the sick person lies, if [the healer] finds a stone lying nearby, [he turns] the stone over and looks in the place where the stone was lying [to see] if there anything living under it, and if [the healer] finds there a worm or a fly or an ant or anything that moves, they [the healer] avers that the sick person will recover." (From The Corrector & Physician).

Patients who had contracted the bubonic plague were told to perform penance – the practice of confessing one’s sins, then performing a religious devotion prescribed by a priest – a common “treatment.” They were told they might be spared death if they correctly confessed their sins.

Eye Cataract Surgery: Painful procedure that rarely saved patients’ sight


An early operation for removal of a cataract included inserting a sharp instrument, such a knife or large needle, through the cornea and forcing the lens of the eye out of its capsule and down to the bottom of the eye.

Once Islamic medicine became more widely followed in medieval Europe, cataract surgery improved. The syringe was used for the extraction of cataracts by suction. A hollow metallic hypodermic syringe was inserted through the white part of the eye and successfully extracted the cataracts through suction.



Blocked Bladders: Metallic catheters inserted into the bladder


Blockage of urine in the bladder, due to syphilis and other venereal diseases, was fairly common at a time when antibiotics were not available. The urinary catheter – a metal tube inserted through the urethra into the bladder – was first used in the mid-1300s. When a tube could not easily be passed into the bladder to relieve the obstruction, other procedures to enter the bladder were devised, some quite novel, though all probably as painful and dangerous as the condition itself.

Here is a description of the treatment of kidney stones: "If there is a stone in the bladder make sure of it as follows: have a strong person sit on a bench, his feet on a stool; the patient sits on his lap, legs bound to his neck with a bandage, or steadied on the shoulders of the assistants. The physician stands before the patient and inserts two fingers of his right hand into the anus, pressing with his left fist over the patient's pubes. With his fingers engaging the bladder from above, let him work over all of it. If he finds a hard, firm pellet it is a stone in the bladder... If you want to extract the stone, precede it with light diet and fasting for two days beforehand. On the third day, ... locate the stone, bring it to the neck of the bladder; there, at the entrance, with two fingers above the anus incise lengthwise with an instrument and extract the stone."

Surgeons on the Battlefield: Pulling of arrows was a nasty business


Use of the longbow – a large powerful bow that could shoot arrows great distances – flourished in the Middle Ages. This created a real problem for battlefield surgeons: how to remove arrows from the bodies of soldiers.

The heads of war arrows weren’t necessarily glued onto the shafts, but attached with warm beeswax. After the wax set, they could be handled normally, but once shot into something if the shaft was pulled, the head would come off inside the body.

One answer was the arrow spoon, based on a design by an Arab physician, named Albucasis. The spoon is inserted into the wound and attaches itself around the arrowhead to be drawn from a wound without causing further damage as the barbs rip out.

Wounds such as these were also treated with cautery, where red hot irons were applied to the wound so that the tissue and veins sealed over, preventing blood loss and infection. Cautery was especially used in amputations.

A famous illustration for surgeons was called, “The Wound Man,” which showed the various kinds of wounds a battlefield surgeon might expect to see.

Bloodletting: A cure-all for almost any ailment


Physicians in the Middle Ages believed that most human illnesses were the result of excess fluid in the body (called humour). The cure was removing excess fluid by taking large amounts of blood out of the body. Two of the main methods of bloodletting were leeching and venesection.

In leeching, the physician attached a leech, a blood-sucking worm, to the patient, probably on that part of the body most severely affected by the patient's condition. The worms would suck off a quantity of blood before falling off.

Venesection was the direct opening of a vein, generally on the inside of the arm, for the draining of a substantial quantity of blood. The tool used for venesection was the fleam, a narrow half-inch long blade, which penetrates the vein, and leaves a small wound. The blood ran into a bowl, which was used to measure the amount of blood taken.

Monks in various monasteries had regular bloodletting treatments – whether they were sick or not – as a means of keeping good health. They had to be excused from regular duties for several days while they recovered.

Childbirth: Women told to prepare for their death


Childbirth in the Middle Ages was considered so deadly that the Church told pregnant women to prepare their shrouds and confess their sins in case of death.

Midwives were important to the Church due to their role in emergency baptisms and were regulated by Roman Catholic law. A popular medieval saying was, "The better the witch; the better the midwife"; to guard against witchcraft, the Church required midwives to be licensed by a bishop and swear an oath not to use magic when assisting women through labour.

In situations where a baby's abnormal birth position slowed its delivery, the birth attendant turned the infant inutero or shook the bed to attempt to reposition the fetus externally. A dead baby who failed to be delivered would be dismembered in the womb with sharp instruments and removed with a "squeezer." A retained placenta was delivered by means of counterweights, which pulled it out by force.

Clysters: A medieval method of injecting medicines into the anus


The medieval version of the enema was known as the clyster, which is really an instrument for injecting fluids into the body through the anus. The clyster was a long metallic tube with a cupped end, into which the medicinal fluid was poured. The other end, a dull point, which was drilled with several small holes, was inserted into the anus. Fluids were poured in and a plunger was used to inject the fluids into the colon area, using a pumping action.

The most common fluid used was lukewarm water, though occasionally medical concoctions, such as thinned boar’s bile or vinegar, were used.

In the 16th and 17th centuries, the medieval clyster was replaced by the more common bulb syringe. In France, the treatment became quite fashionable. King Louis XIV had over 2,000 enemas during his reign, sometimes holding court while the ceremony progressed.

Hemorrhoids: Agony of the anus treated with hot irons


Treatment of many diseases in the Middle Ages included prayers to patron saints for possible divine intervention. A seventh century Irish monk, St. Fiacre, was the patron saint for hemorrhoid sufferers. He developed hemorrhoids from digging in his garden, one day, and sat on a stone which gave him a miraculous cure. The stone survives to this day with the imprint of his hemorrhoids and is visited by many hoping for a similar cure. The disease was often called “St. Fiacre’s curse” in the Middle Ages.

In more extreme cases of hemorrhoids, medieval physicians used their cautery irons to treat the problem. Others believed that simply pulling them out with their fingernails was a solution, a solution that the Greek physician, Hippocrates suggested.

The 12th century Jewish physician Moses Maimonides wrote a seven-chapter treatise on hemorrhoids and disagreed with the use of surgery, instead prescribing the most common treatment used to this day: the sitz bath