Medieval surgery (eleventh-thirteenth century): barber surgeons and warfare surgeons in France.

Abstract

From the eleventh to the thirteenth century, three major events marked surgery in France: the appearance of an epidemic linked to ergotism which led to numerous amputations, the emergence of barber surgeons for civilian practice, and the organization of war surgery for the First Crusade. If a certain separation between medicine and surgery had appeared at the beginning of the Middle Ages, it would have been from 1215 (at the time of the Lateran Council) that the real separation between medicine and surgery was made. Before this date, the surgery was done by the clergy (monks) who had some experience of surgical practice. After the Council de Lateran, the barbers will take charge of the surgery. In the Middle Ages, the first cause of amputation was linked to poisoning by ergot of rye, intoxication due to the ingestion of contaminated bread. Due to ergotamine-related vasoconstriction, many patients will die with a frequency ranging from 10 to 20% in times of starvation. For survivors, gangrenes will lead to amputations made at the beginning by monks, then by the barber surgeons after 1215. With the name of barber surgeon, barbers are initially responsible for small surgical procedures, then for amputations given the epidemics linked to ergotism which led to numerous amputations. By this practice, they will acquire the knowledge of anatomy and the knowledge of the surgery. Apart from this civilian practice of surgery carried out by barber surgeons, the military practice of surgery will appear with the conquests of England and the start of the crusades which will require a more professional organization of surgery. After 1371, as only barbers surgeons had some surgical practice, their knowledge surpassed knowledge of the university. This supremacy of the barber surgeon over the surgeons of the university will be demonstrated by Ambroise Paré.