Battlefield Medicine & Surgery Medieval Ages


#1

I have wondered about surgery and medical assistance in/after battles in Medieval Ages. If we look at modern warfare we all know the “medics”. We all see them in movies, coming to aid wounded soldiers even during a still ongoing battle risking their own lifes for another person’s life. But how was this done in Medieval times? Did something like a “medic” excist? If so should the game have these “medics”?

The information I did gather can be viewed below. Personally I would defenitely like to see surgery in the game. Like amputations after a battle in a tent full with wounded soldiers, soldiers caring away fallen comrades, maybe even a surgeon doing tests in a village or city. This would not only show the harsh and cruel way of the aftermath of a battle it would add tremendously to the realism of the game. It’s something you rarely see in games, maybe because they want to avoid a higher rating of the game since this is “gory” to say the least, but it is truly fascinating to see in my opinion.

What do you think and what can you find about this subject from that period in history?

The Barber Surgeon

Barber surgeons could be found in most medieval towns and, as well as trimming and cutting beards and hair, were also known for surgical procedures. The most common of these was bloodletting, a commonplace procedure which was believed to be essential for good health.

Many of the procedures carried out by the barber surgeon related to violence, such as tending wounds caused by swords, knives or arrows. Because the use of anaesthetics was restricted to those who could pay for it, many people had to suffer the pain of an operation with only a plank of wood to bite on to deflect their attention from the pain, or drinking large quantities of wine to dumb the senses.

The Medieval Surgeon

A good surgeon tended to be known by reputation as much as qualification, and, if successful, would be called upon to attend the families of royalty and nobility. Many of the operations which are carried out in the twenty first century, were also attempted in the Middle Ages.

These included caesarean births, bone setting, dentistry, the removal of bladder stones and even cateract procedures. However, many of these procedures resulted in the death of the patient, either on the operating table, or as a result of a later infection or complication from the operation.

Surgeons would sometimes attend the aftermath of a battle, to ascertain who was still alive and to aid those who had survived the fighting. Signs of life were checked by placing a bowl of water on the patient’s chest to see if it rose and fell with his breathing.

Some surgeons specialised in removing arrow heads from their patient’s bodies. Each time they were successful, a new type of arrow would be invented and the surgeon would need to alter his procedure slightly.

Operations in the Middle Ages

Surgeons had to make use of natural or herbal medicines such as mandrake root, hemlock and opium, which were used as anaesthetics and wine which was used as an antiseptic. It’s even known that urine was also used as an antiseptic in those times.

Bloodletting was one of the most common medical procedures of the Middle Ages. It was performed by making a small cut on the inside of the arm, from which the blood was allowed to run into a bowl. Many barber surgeons had street signs showing a blood bowl to advertise their profession and attract new customers.

Bloodletting was sometimes performed by using leeches to suck out blood from the patient, instead of draining the blood from his or her body.

Trepanning was an operation on the skull, which some historians believe was carried out in an attempt to cure mental illness. The procedure involved cutting a hole into the skull. Examinations of skeletons from this era have showed that the skull bones did grow back, proving that some patients survived the operation.

Cauterisation was another risky procedure which involved treating the affected part of a patient’s body with red hot pokers. In some cases, this did actually work by sanitising the injury. Wounds caused by an amputation were sometimes sealed by burning.

Although medieval surgery carried risks, many operations were successful, and this was despite a lack of knowledge about germs and sanitation, something which would not be fully understood for a few more centuries.

Example of a surgery during that time

*"They brought to me a knight with a sore on his leg; and a woman who was feeble-minded. To the knight I applied a small poultice; and the woman I put on diet to turn her humour wet.

Then a French doctor came and said, “This man knows nothing about treating them.” He then said, “Bring me a sharp axe.” Then the doctor laid the leg of the knight on a block of wood and told a man to cut off the leg with the axe, upon which the marrow flowed out and the patient died on the spot.

He then examined the woman and said, “There is a devil in her head.” He therefore took a razor, made a deep cross-shaped cut on her head, peeled away the skin until the bone of the skull was exposed, and rubbed it with salt. The woman also died instantly".*


Combat Scars: an "involuntary customization"
This discussion is about an idea I have for a new feature
#2

Definitely not in Act 1 but its a very very cool idea.


#3

Basically surgery at middle ages was more like stitch/burning wound shut and amputations. Alcohol was only anaesthetic at the time or somebody would knock you out before cutting starts. There were also no medic as we know today, first of all medical skill was invaluable and rare so you don’t want your doctor getting cut down or filled with arrows.


#4

@MrSoKoLoV Thanks for making a topic for this! I brought this up awhile back Here, but didn’t cover the subject in detail.

Here are some cool links I found Useful, Medieval Medicine, Surgery History, History of Sutures.

@MINTEEER so what there will be no combat in Act I? I agree that “we” as the player may not be able to do or get involved with these practices but we surely would see evidence of it.

@Juhnimus Medieval surgery extends a bit father then just suturing, cauterization, and amputations. there was also trephining and bloodletting as well all the other things mentioned in the Original post.

Alcohol was the most common, Dwale as well as many other herbal potions were used. Local herbs with anesthetic qualities were commonly harvested and made into tinctures to increase potency.

There is no evidence of any kind of Combat Medic from these times however accounts/statements like these:

During the Battle of Shrewsbury in 1403, Prince Henry had an arrow removed from his face using a specially designed surgical instrument.

and

During the Crusades, surgeons would go around to determine whether the soldiers were dead or alive. Some surgeons became specialized in removing arrow heads from their patients bodies

Suggest that medics were close to if not on the battlefield.

It should be a general note that most of all the forms of surgeries performed during this time were only used in life or death situations, also many of these procedures/“medicines” are the cause of death for many in these times.


#5

Yes surgeons would be at army’s camp waiting battle to stop and yes some guys would carried to him by friends/bodyguards during fighting too. But most of healing stuff would be after a battle as said above they would go around battlefield looking wounded among dead and that is quite hard when battle rages around you.


#6

Yes there will be combat, but Henry is not a Medic, he wont go from tent to tent looking at what the ‘‘doctor’’ is doing :open_mouth: most likely after the battle is done he will ride out somewhere.


#7

This is an open world game however and the player will get to decide what they do and do not go look at. so when the battle is over you may get too chose what you wanna do.

As stated above I don’t see us being able to participate, but this doesn’t mean it won’t have a presence in Act I. In any case you would see a few surgical practitioners in various parts of the game world in Large villages or cities.

Edit: Also we already know that alchemy will be in the game and it is something Henry will be able to do; so it would even be plausible to have a scenario where a surgeon calls upon Henry’s assistance in making him a new Dwale solution, or aid him in any other herbalism aspect.


#8

I like your post but I feel I should point out a few things.

Formation melee fighting is still something of a mystery to historians because we can’t really turn on the television and see how it worked out. People in the middle ages didn’t bother to write such common experiences such as the experience of battle down.

The current theory is that formation fighting was mostly fought at some distance with pole weapons and spears until a ‘breach’ in the line was opened and exploited by the opposing side(or if the formation routed/was flanked etc etc.). What we also know or can assume is that two opposite formations might retire back distance enough (could be a meter or hundred) to replace the front rank of fighters. Some battles lasted over five hours and in some cases days, a single person who isn’t named superman can’t simple stand and fight for five hours in armor without having to catch his breath and drink some water. This simple fact leads me to believe that the front rank of soldiers might only fight in the front rank for an hour or so before he either died and was replaced by the soldier behind him or moved back alive to catch his breath and have a sip of water (water carriers are mentioned in medieval accounts a few times).

Now if this is the method of combat in real life than a person who was wounded might just be able to move to the back of his formation and retire back to the camp/baggage train. I doubt we would see medics running around with stretchers and red crosses on their helmets. Perhaps one of your comrades would carry you back to the rear of the battlefield. Once there you might find someone who was a trained surgeon but if he would help you is an entirely different matter. That said survival rates for the most common wounds to the limbs are probably survivable if you can get them stitched up and bandaged provided you don’t get an infection.

This guy was a knight who survived a blow to the head which didn’t penetrate the skull (but just barely).

text says it all.

Further more I know at least two cases of members of nobility surviving an arrow to the face. One being Henry the fifth the other being a knight from the 12th century (Dutch one I believe). The arrowhead in Henry’s skull was removed by a pair of specialty pliers, the Dutch knight had the arrowhead lodged in his skull for 28 years.

Another case of the 16th century (so not strictly medieval) was Blaise de Monluc who got shot with a musket/araquebus between 5 and 7 times in his lower arm, shoulder and face.

Amputations are a treatment mostly reserved for treating lead bullets. Medieval wounds from arrows and edged surfaces are usually much “cleaner” as in that the bleeding can be stopped more easily. One method for this was cauterization with hot oil, if that didn’t seal the wound then amputation would be an option.

I sincerely doubt this. A medieval arms race to counter medical practices seems highly unlikely if not ridiculous.

Honey is another (possible better) alternative.

Your last quote is from a Muslim account and description of the crusades. I am not saying it didn’t happen but it could be exaggerated a little bit.

Here is another description.

[quote]Bradmore “devised a pair of hollow tongs the width of an arrowhead with a screw-like thread at the end of each arm and a separate screw mechanism running through the centre. The wound had to be enlarged and deepened before the tongs could be inserted and this was done by means of … large and long probes made from ‘pith of old elder… stitched with purified linen cloth… infused with rose honey. When Bradmore judged he had reached the bottom of the wound he introduced the tongs at the same angle as the arrow had entered, placed the screw in the centre and maneuvered the instrument into the socket of the arrowhead.’

In Bradmore’s on words “Then by moving it to and fro (with the help of God) I extracted the arrowhead”. Barker than goes on to recount how ‘he cleansed the wound by washing it out with white wine and placed into it new probes made of wads of flax soaked in cleansing ointment, which he had prepared from an unlikely combination of bread, sops, barley, honey and turpentine oil. These he replaced with new wads every two days with shorter wads until, on the twentieth day, he was able to announce with justifiable pride that ‘the wound was perfectly well cleansed’. A final application of ‘dark ointment’ to regenerate the flesh completed the process”[/quote]

http://www.scienceinschool.org/2013/issue27/monastic

http://news.bbc.co.uk/2/hi/health/3745498.stm


#9

I just remembered this peculiar case. Nobleman Márk Baksa of Baksaháza got hit by a cavalry lance in 1598 in the head (right eye), and it completely penetrated his skull. I found some contradiction in the sources, but most likely it seems that he got his injury in the siege of Győr against the ottomans.

Now comes the magic: Not only did he survive the day, but - according to the sources - he lived for a year after! Looks like this was possible due to mainly two factor:

  • The lance went between the cranium and the brain, and if the meninges remained intact, then - as it protects the brain from infections - all is (somewhat) well. On the picture, on the left is the painting of the gentleman from the time period and on the right a patient from the Innsbruck Medical University for comparsion. (Interesting to note the - i guess - cut mark on the painting on the head as well.)
  • The paint coating of the lance contained toxic materials, such as lead, this also sterilized the wound.
    Mr. Baksa ultimately died because of the wound’s infections, but - as it seems - this needed time to develop.
    Funny thing, a source even stated that the nobleman parttake more in the battles of the fifteen years war after his injury. I guess there are a few people who never learn from anything…

A model of the case:


#10

Im guessing back then people were ‘‘Stronger’’ as in they didnt have toxic painkillers like we do now, that our mothers took, and mothers before that took, and maybe even before that. Therefore our sense of pain is probably much higher than it was back.


#11

Here is some more

Here’s a summary paragraph from Rogers, Soldiers’ Lives through History: The Middle Ages:

Basic knowledge of practical wound-treatment was widespread among medieval soldiers, and indeed among aristocratic women. Arrows and javelins that had not gone in too deep were usually pulled out as quickly as possible, often by the injured person. Wounds were washed with vinegar or wine—effective antiseptics-- to remove any possible source of infection (dirt, cloth, etc.), then covered with moistened lint, plasters, egg, or lard-based ointments, then bandaged, often with strips cut from a shirt. Sometimes herbal poultices would also be used. Later, the wounds would be washed and re-bandaged frequently, with any corrupted flesh being cut away. This was quite effective; in one sample of over 300 skulls dating from the sixth through the eighth century, only 12% of the wounds showed any evidence of infection.
Armies in the field were usually accompanied by physicians, surgeons, and barbers (who provided basic medical care). Great lords typically brought such men as part of their retinues, and infantry contingents often did the same. Medical personnel doubtless gave first priority to their own employers, but it was normally expected that wounded soldiers would eventually be tended by a physician if necessary: to say someone had been struck with such force that he would have no need of a doctor was to say that they had been killed outright. Despite the common belief to the contrary, Western European surgeons of the Middle Ages seem to have been roughly on a par with their Islamic, Byzantine and Jewish contemporaries. They could stop the bleeding of a cut artery with pressure and cauterization; they were skilled at treating broken skulls using trepanning; they could draw out barbed arrows using metal tubes or goose quills to cover the barbs; they knew how to splint smashed arms or legs. They could even suture intestines or severed jugular veins. They had analgesics and anesthetics made with opium, cannabis, and other less powerful substances.

Oh, and this is interesting:
After his leg was pierced through by an arrow, Pero Niño was warned by his doctors not to go back to sea until the wound was fully healed, as the wet air and the wearing of armor were likely to aggravate it. He ignored their advice, the wound became badly infected, and by the time he got back to Seville two months later the best surgeons of the city considered amputating his foot. When he refused to allow that, the doctors prepared a cauterizing iron, “big as a [crossbow] quarrel, white hot.” Pero Niño,

who was already used to such work, took the glowing iron in his hand and himself moved it all over his leg, from one end of the wound to the other. Without stopping, they gave him a second like it, and he applied it for the second time….Thenceforward his wound was well dressed, and it pleased God that each day it should mend.

Honey was a preferred wound-dressing, and both modern science and the US army survival manual agree it was very effective.


#12

What we also know is that the strongest men with the largest balls had double handed swords and used to go into full melee into the enemy formation in order to break it up and open for their own subsequent soldiers.

According to historical sources this was a very successful tactic of breaking up front of the enemy line, just that the swordsmen had survavibility rate quite below 30%.


#13

Those big great swords are from the 16th century are they not?


#14

A few years ago I actually made one just for sh*ts and giggles, although because I did not plan to fight with it and planned to buy a proper montante, I went for a more ceremonial-style, so I put tons of material and weirdness into it. The scale still stops at 4 kilograms.

But… this tactics is something we only know about for semi-sure in context with the late tercio warfare - and it wasn’t overly successful. It was a way, like any other. Out of a 500-man Fähnlein maybe 50 soldiers used two-handed weapons, and even they rather used halberds (maybe, say so, in a 40-10 rate in favour of the halberd). And yep, they got double money (Doppelsöldner), but this rather went for their expertise (the musketeers also got double money - honestly, almost everyone except the pikemen), and not their survival rate, the later which I read many numbers about but so far I skipped over any reliable sources of it if it was given at all.
Probably most importantly, at this time the drill slowly became dominant over personal prowess, we find strict formations on the battlefields with pike and musket squares; not spear-shield lines.
I do remember a good book about this warfare with the title “Pike and shot”, probably, and it is free for download in PDF, I’ll take a look at it if I won’t forget.


#15

From the sources (Art and Text) it seems the Swiss had a preference for the Halberd.

I can see why to be honest.