Surgery in the early middle ages: Evidence of cauterisation from Pisa

Abstract

ARCHEOLOGIC EXCAVATIONS carried out in the famous Cathedral Square of Pisa brought to light a multiple ground grave dating to the early Middle Ages (8th–10th Centuries AD). The well preserved skull of an adult female aged about 30 years revealed some form of ‘‘surgical’’ intervention. In the central part of the frontal bone, 4 cm from the bregma, a 20 3 17 mm elliptical lesion limited by a shallow 1-mm thick groove is easily visible (Fig, A); the surface of the lesion appears to be finely cribrose with minute bone crests radially disposed around a more marked central crest (Fig, B). The endocranial surface is intact. The lesion appears to be the result of an inflammatory process of the soft tissues and the periostium that involved the underlying skull vault. The central position on the sagittal axis and the size and regular shape of the lesion excludes some disease as the cause, suggesting that this lesion is an artifact, in particular the result of cauterization, a surgical practice attested since the time of Hippocrates. The last sentence of his Aphorisms, which had a large circulation in the Antiquity and in the Middle Ages, reads: ‘‘What drugs will not cure, the knife will; what the knife will not cure, the cautery will; what the cautery will not cure must be considered incurable.’’ The Roman iron cautery, ferrum candens, was heated and used extensively in Roman medicine