Abstract
Most of us, if called upon to make any immediate association between the practice of surgery and the activities of medieval Scandinavians,1 might think first, if only involuntarily, of amputation. Matthew Arnold’s conventional description of the Nordic perception of heaven is typical of the orthodox association of Norsemen with gore:
And all day long they there are hacked and hewn,
mid dust, and groans, and limbs lopped off, and blood.2
Although medieval Scandinavians are more often associated with a bloodthirsty swinging of swords than with any humane manipulation of the blade, post-Christian Scandinavia was, in fact, heir to European surgical knowledge as it was to other branches of European learning. Although few technical handbooks on medical practice have been preserved from medieval Scandinavia, and although the treatises on medicine that do exist are, on the whole, incomplete or preserved only in late and fragmentary copies, nevertheless the prose narrative literature of medieval Iceland preserves an abundance of incidental accounts of medical treatments — describing regulation of the diet, the ministration of physic, and particularly the practice of surgery, that branch of the doctor’s craft which Guy de Chauliac designated the “third instrument of medicine”.3
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Notes
Much of the material in this paper is drawn from standard studies of medicine in medieval Scandinavia: F. Grön, Altnordische Heilkunde, extract of Janus 13 (Harlem 1908);
Finnur Jónsson, Lœgekunsten i den oldnordiske oldtid (Copenhagen 1912);
V. Møller-Christensen, Middelalderens lœgekunst i Danmark (Copenhagen 1944), Bogen ont Æbelholt kloster (Copenhagen 1958), “Kirurgi” in Kulturhistorisk leksikon for nordisk middelalder (publ. in 22 vols, Copenhagen 1956–78; henceforth cited as KLNM), vol. 8, cols 420–23, and “Lægekunst”, KLNM 11, cols 79–82;
and the introduction to Guðrún P. Helgadóttir, ed., Hrafns saga Sveinbjarnarsonar (Oxford 1987), pp. xci–cviii, which provides the best survey in English of materials pertaining to the history of surgery in medieval Iceland. I am grateful to Peter Foote and Svanhildur Óskarsdóttir for advice about various points in the paper.
Matthew Arnold, “Balder Dead” II.15, ed. K. and M. Allott, The Poems of Matthew Arnold (London and New York 1979), p. 392.
See Guy de Chauliac, Chirurgia magna (Lyon 1585; repr. with intro. by G. Keil, 1976), p. 2: “chirurgia… est tertium instrumentum medicinæ… (sine exclusione aliorum duorum instrumentorum medicinæ pharmaciæ, videlicet & diæte)”.
See Knýtlinga saga ch. 16, ed. Bjarni Guðnason, Danakonunga sǫgur, Íslenzk Fornrit (henceforth ÍF) 35 (Reykjavik 1982), p. 120.
Cf. Theodoricus monachus, Historia de antiquitate regum Norwagiensium ch. 14, ed. G. Storm, Monumenta historica Norvegiae (Kristiana 1880), p. 25; Ágrip ch. 21 and Fagrskinna-Nóregs konunga tal ch. 26, ed. Bjarni Einarsson, Ágrip af Nóregskonunga sǫgum, Fagrskinna Nóregs konunga tal, ÍF 29 (Reykjavik 1985), pp. 24 and 167 respectively.
Íslenzk Fornrit (henceforth ÍF) 35 (Reykjavik 1982), p. 120. Cf. Theodoricus monachus, Historia de antiquitate regum Norwagiensium ch. 14, ed. G. Storm, Monumenta historica Norvegiae (Kristiana 1880), p. 25; Ágrip ch. 21 and Fagrskinna-Nóregs konunga tal ch. 26,
ed. Bjarni Einarsson, Ágrip af Nóregskonunga sǫgum, Fagrskinna Nóregs konunga tal, ÍF 29 (Reykjavik 1985), pp. 24 and 167 respectively.
Óláfs saga ch. 266, ed. Ólafur Halldórsson, Óláfs saga Tryggvasonar en mesta II, Editiones Arnamagnæanæ, ser. A, vol. 2 (Copenhagen 1961), p. 317: “Eirikr j(arl) var aa Englandi einn vetr… en aNat haustit eptir ætlaðiz hann til Romferþar. En aðr hann hæfi þa ferð vpp. feck hann ser lækni at skera ser vf. En i þvi er læknirinn miðaði til hvar hann skylldi af skera. Gekk ath þeim maðr. segia svmir menn at þar væri Knutr konungr. en hitt segia fleiri at þar væri einn af þeim monnum sem voro aa Orminum langa með Olafi konungi. Sa maðr mælti til læknissins. Þar mundi ek nv nockurv meiR. lækniriN svar(ar). hversv meiR. Sva sagði hann at eigi þyrfti optaR at skera af en vm siN. Geck þessi maðr þa brott. En læknirinn veik eptir orðum hans ok skar meira af vf iarlsins en hann hafði aðr ætlat. blæddi þa sva aakafliga at eigi varð stǫðvat. fekk Eirikr j(arl) af þvi bana”. Save where noted, the English translations provided for cited Icelandic texts are mine, and are meant to be as literal as the norms of decent English will allow. Some attempt has been made to retain the characteristic variation of tense in the originals. On treatment of diseases of the uvula in medieval Scandinavia, see Grön, Altnordische Heilkunde, pp. 56–58; Finnur Jónsson, Lœgekunsten, pp. 29–30; Møller-Christensen, Middelalderens lœgekunst, p. 118, and “Halssygdomme”, KLNM 6, cols 72–74 at 73–74.
See K. Sudhoff, Beiträge zur Geschichte der Chirurgie im Mittelalter, 2 vols, Studien zur Geschichte der Medizin, Heft 10, 11–12 (Leipzig 1914–18), I, 200.
Þorgils saga skarða ch.7, in Jón Jóhannesson et al., eds, Sturlunga saga, (Reykjavik 1946), p. 114. On this operation cf. Grön, Altnordische Heilkunde, pp. 58–59; Finnur Jónsson, Lœgekunsten, p. 26; Møller-Christensen, Middelalderens lœgekunst, p. 119, and “Hareskår”, KLNM 6, col. 230.
E.g. see the list of 104 MSS (dating from the 13th to the early part of the 16th c.) that contain such illustrations, in L. MacKinney, Medical Illustrations in Medieval Manuscripts, Publications of the Wellcome Historical Medical Library, n.s. 5 (London 1965), p. 265, and cf. pp. 56–57 and 252, figs 52–53.
See E.H. Lind, Norsk-Isländska personbinamn från medeltiden (Uppsala 1920–21), cols 386, 401; Finnur Jónsson, Lœgekunsten, p. 21.
Reproduced in Møller-Christensen, Middelalderens lœgekunst, p. 118, fig. 12; and in G. Franceschi and Ø. Hjort, Kalkmalerier fra Danske Landsbykirker (Copenhagen 1969), fig. 194. I am grateful to Niels Blædel of Rhodos International Publishers, Ltd, for giving me permission to reproduce here Franceschi’s photograph of the Ottestrup devil.
Noted in G.F. Still, The History of Paediatrics (Oxford 1931, repr. 1965), p. 54.
See R. Finucane, Miracles and Pilgrims (London 1977), p. 78.
“Xenophon, dignus medicus”, in Sudhoff, Beiträge, I, 88, quoted in Guðrún P. Helgadóttir, Hrafns saga, pp. xcvii–xcviii: “Elefantiacus incenditur in hunc modum: Tres cocturas recte facies in fronte cum rotundo et duas in occipitio capitis cum lato cauterio et duas in timporibus et unam sub labro et unam in fossula gutturis et duas sub cathenis et tres in pectore in fossula animae in modum crucis et duae in una coxa et duae in altera, aliae vero duae sub nodis pedum cum cauterio rotundo”. It is interesting that the parts of the body that the surgeon is directed to cauterize in this treatment, and particularly the procedure of burning marks in the shape of a cross, recall the points and method of anointment in the various traditions of the medieval rite for unction of the sick and dying. E.g. compare the elaborate account of the fifteen parts of the body in which the sick are to be anointed in the Capitulare of Theodulf of Orléans (ca. 750/60–821), PL 105, cols 220–22; and see F. W. Puller, The Anointing of the Sick in Scripture and Tradition (London 1904), pp. 193–94, 351–57, 397–405;
H.B. Porter, “The Origin of the Medieval Rite for Anointing the Sick or Dying”, Journal of Theological Studies (henceforth JTS) n.s. 7 (1956) 211–25 at 220–22, and “The Rites for the Dying in the Early Middle Ages, II: The Legendary Sacramentary of Rheims”, JTS n.s. 10 (1959) 299–307 at 304–07. I am grateful to Frederick Paxton for pointing out this parallel in medieval church ritual.
Jartegnabók Þorláks byskups en forna ch.113, MS. C3 (= AM 380 4to, 17th c), variant MS. C4 (= AM 379 4to, written 1654), ed. Jón Helgason, Biskupa sögur: 2, Editiones Arnamagnæanæ, ser. A, vol. 13/2 (Copenhagen 1978), pp. 356–57: “Sa adburdur vard a Þorkautlu stodum j Grinda vyk ad sa madur sem Þorbiorn hiet, brendi þann mann… med þess hattar adferd, ad harm lagdi ä kuidinn þad jarn sem bora var ä, Enn af þui ad ecki vidur näm var a knapp jarnenu, þa hliop þad so diupt, ad þeim er brendur var þotti a hol hlaupa, vottadi þessa hans þyckiu mikill brestur sa sem þa vard er hinn minne himnan brast j sundur, sv sem la j ystrinu. Enn sa sem brendi kipti skiotliga j burt jarnenu, þa er hann kiendi ad ecki nam vid, þui hann villdi þa þrysta dylanum, og fiell feyti vt j moti, su sem þeir trvdu ad ystran væri, og er hann stod vpp kiendi hann a sier so mikinn sarleyk, ad honum þotti sig taka naliga aptur j hrygginn, gieck hann þa til hrosshvss [krosshvs var.], og þotti þeim monnum sem hann sau honum ollum brugdid. Hann hiet þa a hinn sæla Thorlak byskup, ad fæda v. fatæka menn, og syngia v. Dauids psalltara, og lesa Orationem. Deus qvi populo tuo*. honum til dyrdar, og fasta vj. dægur fyrer dag hans, og vatnfasta þar fyrer hina sydustu nätt, og giefa halfa mork j Skalaholt, og ganga þangad. Epter þad drack hann vatn þad er j var lagdur steinn sä er lagdur hafdi verid a kistu hins sæla Thorlaks byskups, Bættist honum so þa ad hann gat a hesti setid heim a Huals nes, var hann þa so hraustur, ad hann vatnfastadi næstu nott epter Mariu messu, og þo med þui moti ad hann var storliga krankur, og neytti nær ecki matar tueim nottum epter vatnfostuna, laust j dylann hinum sama verk so ad honum og þeim sem hann säu þotti honum lytil lyfs von. þa tok Hallur prestur beyna vatn Thorlaks byskups og steypti iij. sinnum j särid, og rann jafhann jnn til, þo ad onduerdu væri fullt. Säu aller þeir sem j hia voru jstruna jnn j quidinn, vidur þetta syndist þeim draga samann opid a särinu, þad sem jnn vissi til holsins, so ad þadan af vard honum ecki ‹mein ad var.›, og var sydann betur heill enn adur. Baru þeir vitni Hallur prestur, Þorsteinn klerkur, og sa sem lækningina skylldi veytt hafa j fyrstu, og marger adrer goder menn”. *See J. Deshusses, Le Sacramentaire grégorien, 3 vols (Fribourg 1971–82), I, pt 4, 296*, and “Les Messes d’Alcuin”, Archiv für Liturgiewissenschaft 14 (1972) 7–41, no. 26, Natale Sancti Martini confessoris. MS. AM 241b fol. IX contains an 18th-century transcript of a St. Þorlákr collect with incipit “Deus qui populo tuo æternæ salutis beatum torlacum confessorem tuum atque pontificem ministrum tribuisti: præsta quesumus”. This collect is used for St. Þorlákr’s December feast in the Nidaros Missal (1519), 394.
See L. Gjerløw, Liturgica Islandica, vol. I, Bibliotheca Arnamagnæana 35 (Copenhagen 1980), p. 70.
A depiction of the two parts of this instrument (cautery and protective plate) is printed in E. Gurlt, Geschichte der Chirurgie und ihrer Ausübung, 2 vols (Berlin 1898), I, pl. V, no. 125a-b, discussed p. 788. See Grön, Altnordische Heilkunde, pp. 42–43; Finnur Jónsson, Lœgekunsten, pp. 26–27; Guðrún P. Helgadóttir, Hrafns saga, p. xcvi. A rather different drawing of the cauterium punctuate, which does not show the protective plate, is available in an illustrated English translation of William of Saliceto’s Cyrurgia, BL MS. Sloane 277 (15th c), fol. 49v. Next to this drawing is an illustration of another type of cautery, the cauterium rotundum, designed specifically to avoid excessive damage to bodily tissues. (It might be noted that this instrument is also prescribed by “Xenophon” for treatment of elephantiasis — see n. 36 above.) The author remarks that this device “is rownd” and “is a common instrument þat þe putting of þe causteries ben not maad deepe in þe membris & hurte þe senewes & arteries & veynes”. See Sudhoff, Beiträge, II, pl. XXIV, nos. 14–15, and cf. commentary p. 85.
Einar Ól. Sveinsson, ed., Brennu-Njáls saga, ÍF 12 (Reykjavik 1954), pp. 148, 159.
Fóstbrœðra saga ch. 23, ed. Björn K. Þórólfsson and Guðni Jónsson, Vestfirðinga sǫgur, ÍF 6 (Reykjavik 1943), p. 242: “hon var… læknir góðr ok nǫkkut fornfróð”.
See Ambrose, Exameron 4.7.29, in Corpus scriptorum ecclesiasticorum Latinorum 32/1, p. 135; Bede, De temporum ratione ch.28, ed. C.W. Jones, Bedae opera de temporibus (Cambridge, MA 1943), p. 231; Isidore, De natura rerum 19.2, in PL 83, cols 992D-993A. See also discussion in, e.g., Jones, Bedae opera, p. 362;
T.O. Wedel, The Mediaeval Attitude toward Astrology, particularly in England, Yale Studies in English 60 (New Haven 1920), pp. 24, 28;
H. Henel, Ælfric’s De temporibus anni, EETS o.s. 213 (London 1942, repr. 1970), p. 99.
Bartholomaeus Anglicus 5.3, 1601 ed., p. 125; cf. M.C. Seymour et al., eds, On the Properties of Things: John Trevisa’s Translation of Bartholomaeus Anglicus, De proprietatibus rerum. A Critical Text, 2 vols (Oxford 1975), I, 175: “However, the brain also has this characteristic, that it feels and follows the movement of the moon. For as the moon waxes, so the inner substance of the brain increases; and as it wanes, so the brain is diminished in substance and strength. For then the brain contracts and does not freely obey its vital spirit. And this is apparent in lunatics and those who suffer from liver disease [Trevisa: ‘epilectics’], who are greatly afflicted during the new and full moon”.
I wish to thank Ruth Harvey for providing me with a photograph of this drawing (fig. 4.5) from Magnus Hundt’s Anthropologium (Leipzig 1501),
fol. 1v, previously printed in E.R. Harvey, The Inward Wits (London 1975), fig. 2. For a useful survey of medieval descriptions and illustrations of the ventricles of the brain,
see W. Sudhoff, “Die Lehre von den Hirnventrikeln in textlicher und graphischer Tradition des Altertums und Mittelalters”, Archiv für Geschichte der Medizin 7 (1913) 149–205.
I am grateful to Joseph Shatzmiller for sending me a copy of the document, dated April-May 1307 (Archives des Bouches-du-Rhône, diploma no. B 1092, printed in Shatzmiller, Médecine et justice en Provence médiévale [Aix 1989], pp. 98–99), which contains (fols 62r–v) a record of cranial surgery performed on a man mortally wounded by an axe-blow to the head. The description of the removal of skull fragments in this account is in some respects reminiscent of the Icelandic operation described in Guðmundar saga D.
See Pseudo-Apulei Platonici Herbarius 20.1, 46.2, ed. E. Howald and H.E. Sigerist, Antonii Musae de herba vettonica liber. Pseudo-Apulei herbarius, etc., Corpus medicorum Latinorum 4 (Leipzig and Berlin 1927), pp. 4, 96.
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McDougall, I. (1992). The Third Instrument of Medicine. In: Campbell, S., Hall, B., Klausner, D. (eds) Health, Disease and Healing in Medieval Culture. Palgrave Macmillan, London. https://doi.org/10.1007/978-1-349-21882-0_4
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