6 September 2013

Medieval Battlefield Medicine

It is generally believed that the Medieval Era was almost entirely ignorant of medical and surgical procedures.

This is simply not true.

By about 1400, medical knowledge included knowledge of the importance of cleanliness; suturing of wounds, blood vessels, and nerves; treatment of simple and compound (open) fractures, dislocations, amputation, cauterization to prevent excessive blood loss; anaesthesia; trepanning to treat skull fractures; gangrene and debridment of dead tissuel; etc. etc. Much of this knowledge dates to the Classical era, but some of it was developed during the late Middle Ages.

Medieval surgeons knew pretty much everything you need for battlefield medicine with the notable exception of antibiotics, transfusion, intravenous drips, and organ transplantation.

What does this mean? Well, if you can get to a surgeon and haven't lost too much blood, you're in OK shape. You might get an infection, and there's really nothing they could do about that, but if you don't (or if you survive it), you're likely to live.

Battle commanders of the Middle Ages were well aware of this fact. For instance, during the campaign that included Agincourt, the English army of 10,000 brought at least 24 surgeons - about one for every 400 men (incidentally, the current standard is about 1 surgeon for every 500-800 men).

By the 1200 or so, there were established medical schools you could go too, and the requirements for training were actually not that far from today's - you would take a 3-year college degree, a 4-year medical degree, then a year of practical study, and possibly another year of anatomy for surgeons.

The idea of getting your wounded Fighter to the Surgeon is definitely a lot less snappy than getting hands laid on by a Paladin or a Cure Light Wounds from a Cleric, but for a high-grit low/no-magic campaign set in a Middle Ages-like setting, consider having Surgeons available for hire in major centres to patch up serious injuries.

Regarding pricing, there's some evidence that medieval physicians and surgeons charged on a charge-what-you-can plan - i.e. make the wealthy pay through the nose, and give care away for free to the needy. So excellent medical care need not only be available to the wealthy.

Surgery will feature in my upcoming draft of a Descriptive Damage System, a gritty replacement for a hit point system that focuses more on roleplayable injuries and treatments.


  1. Why do you need to keep making it so hard for me to stick with my high magic fantasy ideas? Stop pointing out reasonable ways to be low magic.

  2. I'm really looking forward to your damage system - your weapons/combat/criticals system have already forced me to reconsider a lot of what I use in my own game. At some point I'll have to stop reading and just live on in blissful ignorance!

  3. I like this idea a lot. I've been dissatisfied with the existence of healing magic for awhile.

    Looking forward to the descriptive damage system.

  4. Yes, I remember this post from reading it when you posted it. It is still a load of bollocks. I'm well familiar with the university system's talent for re-interpreting letters, random references, suggestions and images to produce a "truth" about what something was like 700, or 2700 years ago.

    Strange that the accounts you give now suggest a comprehensive manner of doing things that were hailed as great discoveries in the 18th century, or even the 19th. I wonder, then, why accounts of hospitals, such as the one given by Somerset Maugham, who worked as a doctor's apprentice in the late 19th century, seem to describe a world where the medicine you describe was performed with horrific indifference, incompetence, even cruelty. I wonder why medicants in the 19th century had to fight so hard for the implementation of cleanliness and decent treatment in hospitals, or why patients were casually left to die in alleys if their maladies proved too troublesome.

    Ah, of course, the medieval hospital was MUCH better than the 19th century hospital, and medieval medicine was FAR advanced of 19th century medicine. Silly me. But then, I've only read a bunch of books. I haven't cleverly reinterpreted them. So I'm obviously an ignorant moron.

  5. > So I'm obviously an ignorant moron.

    You're obviously not an ignorant moron, but I've read books, too, including books written in the medieval period which reference classical sources which include a truly astonishing amount of medical knowledge - far, far more than I possess, and far, far, FAR more than is typically attributed to Medieval scholarship. That can't be denied. They had a more or less complete knowledge of anatomy and basic battlefield medicine, among many other things. These are verifiable facts, not reinterpretations of letters. Paul of Aegina would be a starting point for your researches.

    I would wager that a 19th century hospital was probably more similar to a 15th century, or a 5th century, or even a 5th century BCE hospital than it was to a modern hospital. Not much changed in medicine until the wide dissemination of germ theory and antibiotics. The human body has been the same for millenia.

    >Strange that the accounts you give now suggest a comprehensive manner of doing things that were hailed as great discoveries in the 18th century, or even the 19th.

    These were ages that erroneously decried the Medieval Era as Dark Ages. Take the 18th and 19th centuries' view of the past with a grain of salt, they had rather too high an opinion of themselves, and rather too low an opinion of prior ages.

    For instance, historians of the 19th century lauded the round-earth hypothesis as a great achievement of the Age of Exploration, despite the fact that it had been disproved in the Classical era and never again held sway in Europe. I don't put much stock in what people of that time thought of earlier times, and neither should you.

    I'm also catching wind of fallacy of "progress" in your response - things were so in this era, so they *must* have been worse in prior eras. This is clearly nonsense.

    If you're basing your knowledge of medieval medical practices on a novel by Maugham, all I can say is - I expected better of you.

  6. I can deny plenty. I've read the same contemporary sources you have. Yes, there were surgeons at Agincourt, but we don't know what they did, exactly, or to how many. We have no statistics, no detailed notes, no numbers on how many the techniques worked on and how many died. We have many, many images and notes from Arabic texts, but again, no statistics. We have to guess, or imagine that they were effective. It would be nice if they were. But we don't KNOW anything about what was actually practiced, because there were no records kept. Just references and things that were supposedly taught. We don't even know for sure what WAS taught, because - again - no records, no classroom notes, no measurable sources whatsoever. We have loads and loads of conjecture. It is the stuff that Theses are made of.

    Let's not wager, hm? Evidence would be necessary to settle the bet.

    The 'erroneous decrying of the Middle Ages' is a scholar's fad that was initiated in the 1930s by Lewis Mumford and his invention of 'metrics.' I like Mumford, he's a marvelous early era technocrat, exactly as Talysman described on my last post, but he's quite plainly in his work just making shit up. But it's encouraging shit, very much the sort of thing the university system has now widely embraced. Hard to prove, however. But then, proof is not necessary for tenure.

    "Clearly nonsense" doesn't, to my mind, represent anything more than your opinion. I would like some evidence of my nonsensical position. Proof, please. Argument is all well and good, but in the absence of proof, I return again to the simplest solution is the best. Though, of course, that's inconvenient for the thesis mill.

    1. Basically, your theory is that in the absence of evidence, presume that people are idiots. Because that's what you're saying - people handed down and improved on this knowledge for *two thousand years*, at least, even though it didn't work.

      Well, we know these techniques work because they're the same ones we use today. The outcomes are better today because of germ theory and sanitization and antiobiotics, but a lot of these techniques haven't changed much even today.

      So, we know that people had the required knowledge of anatomy and technique to successfully perform these procedures, we know that people paid to go to university for 10 years to learn these techniques, we know that people employed these people for their special knowledge, and we know that this all went on for hundreds of years.

      You have to assume that basically everyone from the Greeks through the Enlightenment was a complete moron to think that this stuff wasn't widely disseminated and fairly effective.

      Evidence? There's tons. You just have to remember that people in 1400 were every bit as smart as people are today.

      And the theory of progress IS clearly nonsense. Someone with as much knowledge of history as you do surely knows that. Living conditions come and go. They were better in 1400 than in 1850, for a lot of people in England, for instance.

      The simplest solution is that these techniques existed and worked. Any other solution necessitates postulating some essential change in humanity for which there is no evidence.

  7. Reserved, for its own comment.

    Maugham was a well-respected orator and opinion-maker in his day, and has as much right as any person to speak about his personal experiences as a young doctor in Paris, on a stipend from his family enabling him to pay for it when he was a young man and broke, as any other doctor anywhere in the world. The fact that he was a novelist and playwright changes none of that. I am a writer. I also used to be a chef. Does the fact that I write preclude my knowledge of food? Of course not. The last comment of yours, therefore, indicates that you pick and choose your source material on some other criteria than its merit. I expected better of YOU.

    1. Sorry, I wasn't clear. My point wasn't that there was something suspect about Maugham's experiences, merely that someone's personal experiences of medicine circa 1900 have nothing whatsoever to do with medical practices in 1400.

  8. A minor observation or two.
    The brief information that Charles supplies in his post is fairly plausible. Is this post something I would cite in a scholarly work, not really, but as this is information for a psuedo-historical game that has MAGIC in it I don't really see how truly important the historical accuracy of his interpretation of primary or secondary sources is. Or are saying that he needs to [citation needed] every bloody statement he makes?
    Are you going to go through his posts on historical weapons and critique those as well?