Roger of Salerno’s ‘Surgery’

Left, Damage to the Cerebral Membrane. Right, View of Dispensary. (f. 240r)
Fig. 1 – Left, Diagnosing damage to the Cerebral Membrane. Right, View of Dispensary. f. 240r

Trinity College Library’s Manuscript O.1.20 is one of the earliest and most important known collections of vernacular medical texts from the middle ages. It includes among its various treatises and receipts an illustrated Anglo-Norman translation of the Chirurgia Practica of Roger of Salerno.

Exploratory surgery. (f. 254r)
Fig. 2 – Exploratory surgery. f. 254r

Rogerius (before 1140 – c. 1195), also known as Roger of Salerno, brought academic respectability to the discipline of surgery through the hugely popular work on the subject that is attributed to him. Chirurgia Practica or The Practice of Surgery was actually compiled by his students from his lecture notes c.1180. Surgery brought about a renaissance in European medical writing and promoted innovations in antiseptic, anesthetic, diagnostic and surgical practices. It describes various activities of the medieval Dispensary, a place where remedies were prepared and applied, diagnoses made and surgeries performed by the doctor and his assistants.

Illustration of the Dispensary, accompanying a receipt for an ointment to treat fistula. f.272r.
Fig. 3 – Illustration of the Dispensary accompanying a receipt for an ointment to treat fistula. The doctor holds a bundle of herbs and instructs his assistants. f. 272r.

Trinity’s copy of Surgery was produced in the early 13th century. The French translation in this volume is likely based on a continental model, though was copied in England, as evidenced by the use of vernacular English names such as ‘henbane’ and ‘cockle’ throughout the text. With texts such as this that were transmitted through copying, scholars can make comparisons between editions and can learn quite a lot about their production, including peculiarities of individual scribes and artists working on a manuscript.

A surgeon pulls an arrow from a man's head. f. 248r
Fig. 4 – Extracting an arrowhead from a man’s shaven head by enlarging the exit wound with a trephine. (f. 248r)

Trinity’s copy of Surgery is illustrated throughout with scenes of medical preparations from a medieval dispensary as well as rather hair-raising scenes of surgical procedures. They are wonderfully executed not only in style and composition but in the details of facial expressions and body language that “imparts a sympathetic humanity to medical scenes which elsewhere can often seem brutal, callous or indifferent” (Hunt 1992). Another striking aspect of these illustrations is the relative accuracy with which the surgical instruments and procedures are portrayed.

Treatment of nasal polyps. f. 259v.
Fig. 5 – Treatment of nasal polyps. (f. 259v)

However, the unknown artist was limited by the text from which he was working. The original Latin text of Surgery clearly included a description of cauterising the wound after removing nasal polyps. “The Anglo-Norman translator, however, through eyeskip (i.e. inadvertently copying from a later occurrence of the same word or phrase) which is characteristic of him, has omitted the detail of the hot iron used for searing.” (Hunt 1992) The artist, who was basing his images on the Anglo-Norman text and not the Latin exemplar, did not show a bellows and hot iron in Fig. 5 although he included them with other procedures involving the tools for cauterisation. He seems not to have read the text too carefully when producing Fig. 1, however. One symptom of trauma to the dura mater is a blackened tongue, hence the doctor instructing the patient to stick out his tongue. The artist, however, inexplicably painted the patient’s protruding tongue red.

An assistant holds the patient while the doctor removes a facial tumor. f. 260r.
Fig. 6 – An assistant holds the patient still while the doctor removes a facial tumor. (f. 260r)

This blog has already dealt with some aspects of medieval medical scholarship, including the Zodiac Man figures featured in various medieval manuscripts and based on information like this, readers may have formulated a particular idea of medieval medicine that fits in with popular portrayals of the middle ages. It would be an injustice, however, to characterise medieval medicine as superstitious and backward. Medieval doctors worked with the knowledge they had and in many cases made ingenious advancements in treatment and diagnosis.

For example, it is believed that Roger of Salerno may have originated a technique for detecting a tear in the dura or cerebral membrane in skull fractures. Now known as the Valsalva maneuver, the doctor would have his patient hold their breath, introducing pressure into the skull, and the doctor would watch for air bubbles or cerebrospinal fluid leaking from the skull. Additionally, Roger was a pioneer in the treatment of nerve damage, advocating reanastomosis – the realignment of damaged tissue by surgical means – to repair severed nerves. By modern standards medieval medicine may seem unhygienic, agonizing, even barbaric. However, many of the surgeries and interventions performed were potentially life-saving procedures based on the knowledge available at the time as well as a fair amount of experimentation and innovation.

Further reading

Greenblatt, S. H., Dagi, T. F., & Epstein, M. H. (1997). A history of neurosurgery: in its scientific and professional contexts. Park Ridge, Ill., American Association of Neurological Surgeons.

Hunt (1992) The Medieval Surgery. Woodbridge: The Boydell Press.

Treating cranial fissures. (f. 243v)
Fig. 7 – Treating cranial fissures. (f. 243v)

The Voyages Extraordinaires of Jules Verne

Kessler.b.22 cover
Kessler.b.22 cover

The Voyages Extraordinaires (literally Extraordinary Voyages or Extraordinary Journeys) are a sequence of fifty-four novels by the French writer Jules Verne (1828-1905), originally published between 1863 and 1905. According to Verne’s editor Pierre-Jules Hetzel, the goal of the Voyages was “to outline all the geographical, geological, physical, and astronomical knowledge amassed by modern science and to recount, in an entertaining and picturesque format … the history of the universe.” Verne’s meticulous attention to detail and scientific trivia, coupled with his sense of wonder and exploration, form the backbone of the Voyages.  Part of the reason for the broad appeal of his work was the sense that the reader could really learn knowledge of geology, biology, astronomy, palaeontology, oceanography and the exotic locations and cultures of the world through the adventures of Verne’s protagonists.  This great wealth of information distinguished his works as “encyclopaedic novels”. The works in this series included both fiction and non-fiction, some with overt science fiction elements (e.g., Journey to the Centre of the Earth) or elements of scientific romance (e.g., Twenty Thousand Leagues Under the Sea).

In the system developed by Hetzel for the Voyages Extraordinaires, each of Verne’s novels was published successively in several different formats.  This resulted in as many as four distinct editions of each.  The books on display here (and currently in the Wren Library) are taken from the Kessler collection and are examples of Cartonnages dorés et colorés (gilded and coloured bindings): complete editions of the text, published in grand in-8º  (“large octavo”) book form with a lavishly decorated cover.  These deluxe editions, designed for Christmas and New Year’s markets, include most or all of the illustrations from the serializations.

Kessler.b.19 cover ‘Around the world in eighty days’
Kessler.b.19 spine
Kessler.b.22 p. 124
Kessler.b.22 p. 124 ‘Twenty thousand leagues under the sea’
Kessler.b.22 frontispiece
Kessler.b.22 frontispiece
Kessler.b.21 cover
Kessler.b.21 cover ‘Star of the South’

Thanks to Wikipedia

St Urith of Chittlehampton

The Glastonbury Commonplace Book (O.9.38), described by M. R. James as “the note-book of a Glastonbury monk”, contains a remarkable collection of miscellaneous material. Today, however, we are focusing on the legend of St Urith (or Hieritha) whose feast day is celebrated on 8th July. The manuscript contains the fullest known account of this saint in the form of a rhyming poem. The poem appears towards the end of the volume (f. 87r) and, although the leaf has been damaged on the outer edges resulting in the loss of the ends of some of the lines, James worked on the text and published a transcription in 1902.

O.9.38, f86v-f87r
O.9.38, f86v-f87r

Based on this text, he summarised the legend as follows: Urith, a maiden dedicated to a religious life, had a jealous (pagan) step-mother who bribed some haymakers to attack and kill her. A fountain sprung up from the ground where she fell. This legend is very similar to those of two other west-country saints – St Sidwell of Exeter and St Juthwara – both beheaded at the instigation of their stepmothers. However the poem locates this particular legend in Chittlehampton, north Devon:

Nunc gaudet tota patria/innocens virgo [vicerit]/Quod sue nouerce odia/O villa chitelhamptonia/quod tal[amum sponsi subiit]/Letare cum deuonia

The church at Chittlehampton is dedicated to St Urith who was probably buried in a small chapel on the north side where a medieval slab may now cover her burial place. Urith’s well is found at the east end of the village. There were regular pilgrimages to her shrine until the mid-16th century and the considerable offerings there seemingly funded the building of the impressive Church tower. The carved stone pulpit (c. 1500) includes a figure of Urith holding a martyr’s palm as well as the church’s foundation stone.

The Tower of Chittlehampton Church
The Tower of Chittlehampton Church. Photograph by Rex Harris.


The Pulpit at Chittlehampton
The Pulpit at Chittlehampton. Photograph by Rex Harris.

As a local saint, the name Urith was popularly used for girls during the sixteenth and seventeenth century in the west country. Urith Chichester from Raleigh in Devon, for example, married John Trevelyan of Nettlecombe Court in Somerset in 1591. It has been suggested that the stained glass window in the church at Nettlecombe may, at the time of the marriage, have been inscribed St Urith when it originally depicted St Sidwell.

Stained glass window in Nettlecombe depicting St Urith or St Sidwell (second from right) (Photograph by Peter Tremain)


M. R. James, ‘St Urith of Chittlehampton’, Proceedings of the Cambridge Antiquarian Society (1901-2), pp. 230-234.

Revd J. F. Chanter,  ‘St Urith of Chittlehampton: A Study in an Obscure Devon Saint’, Report and Transactions of the Devonshire Association, Vol 46 (1914).

Labours of the Month: July

Wheat harvest. Trin MS B.11.4, ff.iv recto.
Harvesting wheat with a long-handled scythe and clippers. Trin MS B.11.4, ff.iv recto.

July has arrived and with it the warmer weather we have been waiting for. If you had quite enough of hard labour with harvesting hay last month then you may wish to avert your eyes for the remainder of this post as July’s Labour of the Month involves more mowing, with the wheat harvest coming into full swing this month.

Medieval farmers had to make the most of their land in order to produce a surplus should some crops fail or be spoiled. This meant that wheat was planted and harvested twice a year. However, intensive farming can drain the soil of its nutrients so sustainable farming methods were required. Medieval farmers used crop rotation, alternating crops that used different nutrients – such as hay and wheat in the same field – in subsequent growing seasons. Additionally, every third year a field would be left fallow. Fallow fields were often sown with legumes or strewn with burnt weeds, which were then plowed under in order to force nutrients back into the soil.

B.11.7, f.4r
Harvesting the wheat, Trin MS B.11.7, f.4r

The wheat was harvested into sheaves and then brought indoors for storage. Threshing and winnowing the wheat – removing the edible grains from the stocks and then separating the chaff or inedible husks from the grains was done indoors over the winter. Incidentally, this is where we get the phrase “separate the wheat from the chaff”, meaning to divide what is good or helpful from what is useless. Wheat fields also needed regular weeding, as dock, dead-nettle and other weeds proliferated among the crops. In what we would now understand as a “sustainable farming” model (the concept would, of course, be anachronistic to medieval farmers), these weeds would be plowed back into the fallow fields to return nutrients to the soil. The back-breaking labours of July were often performed on nearly empty stomachs as grain stores were at their lowest in this month, so the wheat harvest was one of the least pleasant tasks for medieval agricultural workers. What little food they had was supplemented by foraging or even poaching.

Leo the lion from Trin MS B.11.31, f.7r.
Leo from Trin MS B.11.31, f.7r.

The zodiac sign beginning in July is Leo, represented by the lion. Leo is one of the earliest perceived constellations, dating back to the Mesopotamian zodiac around 4000 BC. The lion may have originally represented a monster from the epic of Gilgamesh, and in Babylonian astronomy the star Regulus was known as “the star that stands at the Lion’s breast” and the “King Star”. In Greek astronomy, Leo was identified as the Nemean Lion, who was slain by Hercules in one of his Twelve Labours.

Lion imagery is so common in medieval European artwork, from heraldry to religious artifacts, that we seldom recall that most Europeans would never have seen a lion in real life. Lion iconography and symbolism came to northern Europe from Biblical and Ancient sources that flourished in the Mediterranean and the Middle East, where lions were relatively common in the wild. But it was probably an early Christian book on animal symbolism by Physiologus that had the greatest influence on medieval lion symbolism, for it was this book that popularised the idea of the lion as the “King of the Jungle”. The allegorical significance of the lion as Christ in medieval Christianity only reinforced these regal associations.

Arms of Trinity College, Cambridge

Thanks to their regal associations, lions are a recurring motif in royal symbols, especially heraldic devices. Here at Trinity College, Cambridge we are quite fond of heraldic lions. Our crest, shown right, is emblazoned with a lion passant guardant, also known as a “lion of England” as three lions appear in this same posture on the royal arms of England. This particular leonine posture is also confusingly referred to as léopard by French heralds.

The posture or pose of an animal, mythical beast or human figure in heraldry is referred to as its attitude, and certain attitudes are reserved for predatory beasts, and others for birds and winged creatures. Every graphical device, colour and shape has its own terminology, usually derived from Old French, so that one could faithfully reproduce a coat of arms from its description – known as its blazon – alone. For the purposes of such descriptions, animals who are passant (or trippant, the equivalent for stags and other beasts of the chase) always face dexter, the viewer’s left, as default. Guardant in the description passant guardant describes the positioning of the animal’s head as facing the viewer. A lion passant would be looking in the direction it was striding (dexter), and a lion passant regardant would be looking over its shoulder (sinister, or the viewer’s right).

Leo from Trin MS B.11.4, f iv recto.
Leo from Trin MS B.11.4, f iv recto.

So, even if you have a sinister attitude or the hunger of a lion from working in the fields on an empty stomach, we hope you have a lovely July!