Medieval Surgery and Islamic Medicine

Surgery was a last resort

Surgery was a desperate measure, done only when nothing else was left, while the most advanced medicine of the period was happening far away in the Islamic world.

What medieval surgery involved

• Most surgery was carried out by barber-surgeons rather than trained physicians, using simple tools such as knives and saws.
• The common operations were cauterisation (sealing a wound with a hot iron), amputation of a damaged limb, and trepanning (drilling a hole in the skull to relieve pressure on the brain).
• Surgeons also set broken bones with wooden splints and stitched wounds closed with thread made from gut or silk.

The three killers

• Pain, infection and blood loss were the three dangers that made even minor surgery so often fatal.
• The only pain relief came from crude anaesthetics such as opium, mandrake and hemlock, and an overdose could kill the patient outright.
• To clean wounds surgeons used wine and honey, which can in fact kill some bacteria, though no one understood why they worked.
• There was no reliable way to stop heavy bleeding and no idea that dirt caused infection, so patients often died even after the operation itself went well.

The surgeons who pushed medicine forward

• Most surgeons believed in laudable pus, the mistaken idea that pus forming in a wound was a healthy sign, so they left wounds open to let it form.
• Hugh and Theodoric of Lucca, two Italian surgeons, argued the opposite: wounds healed better kept clean and dry, washed with wine and bandaged.
• John of Arderne (1307-1392) specialised in operations on anal fistulas and wrote manuals that stressed keeping wounds clean.
• John Bradmore removed a deeply lodged arrowhead from the face of the future Henry V in 1403, using a tool he designed himself and honey to help the wound heal.

Islamic medicine led the way

• While European ideas stood still, the Islamic world was the leading edge of medicine, translating Greek texts and building on them.
• Bimaristans were purpose-built hospitals that treated all patients free of charge, with separate wards, clean water and teaching for students.
• Some regions licensed doctors only after they passed an examination, a level of regulation Europe did not yet have.
• Al-Razi was the first to tell measles and smallpox apart, Ibn Sina wrote the Canon of Medicine that Europe used as a textbook for centuries, and Al-Zahrawi wrote illustrated guides to surgical instruments.
• This knowledge reached Europe mainly through Muslim Spain, where Arabic texts were translated into Latin for use in universities.