Roger of Salerno’s ‘Surgery’

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.

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.

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.

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.

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.

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.

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