The Big Story of Europe’s medieval period is something like, “How the rude northern tribes took over for Rome and then gradually learned to adapt to and surpass Rome’s standards of civilization.” You see this same shape in every topic: building bridges, writing poems, making laws. Medieval Italy didn’t step as far back in civilization as England and “Frankia” did. And on the other side, the Germanic tribes had some cultural ways that serve the modern world very well; the post-Roman civilization they created has strengths that the Roman world did not.
So when we first look at “medieval” surgery, by common American’s-eye-view convention we mean “the state of surgery in England, France and Germany around 1100.” However, in medicine too, there was cultural lag and catch-up going on.
Alexandria and Constantinople maintained and improved on the knowledge base from Greece and Rome. The most famous medieval surgery book was written in Alexandria by “Paul of Aegina,” about whom little is known. He was born on the island of Aegina, he lived in Alexandria with its great library, and he compiled a complete 7-volume medical encyclopedia. Some portion of what he wrote seems to have been original. More about Paul’s book in the next installment.
Constantinople’s “byzantine” bureaucratic government funded public hospitals in the early medieval period. I’ll write more about Europe’s hospitals later, but for now let’s stipulate that no surgery occurred in them. Italy’s cities began following Constantinople’s model long before the snowier parts of Europe did. Still, only the Greek-writing world kept improving on the ancient traditions of elective and reparative surgery.
So the primary issue in the early Middle Ages was just the language barrier. When a French king married Princess Anne of Kiev, the French court for a little while had Greek speakers. But basically, Greek was not an important language for study in the medieval period. It wasn’t until the late 1400s, after the fall of Constantinople, that Greek study became normal. After that, the sky was the limit, as we know.
One of the translation pathways for Greek books, in the meantime, was to be purchased by the Caliph of Baghdad (in the glory days of Harun al-Rashid, for fellow Arabian Nights fans) and translated into Arabic. Arabic copies then went to Cordoba, where scholars fluent in Latin and Arabic shifted them into Latin. That’s how the medieval world learned of most things, including these surgery books. It wasn’t until after the fall of Constantinople that they got them direct from Greek. Thomas Aquinas, as far as I know, would have gotten his Aristotle this way via Arabic.