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 government funded public hospitals in the early medieval period. Italy’s cities began following Constantinople’s model long before the snowier parts of Europe did. Still, at first only the Greek (eastern) societies kept improving on the ancient traditions of elective and reparative surgery.
They still spoke and wrote Greek in Constantinople, but the use of Greek in Italy had mostly died out. The Romans had still studied it, but when Northern Europe took up Rome’s legacy, only Latin persisted. During the medieval period, it was rare to find a Greek-fluent scholar outside Constantinople’s zone of influence. The language barrier was overcome mostly by way of Baghdad, where Greek books were translated into Arabic. The Arabic books entered Europe through Muslim Spain, and then they were translated into Latin. It wasn’t until Greek scholars were fleeing Turkish conquest that European universities began to teach it. Still, through this twisting pathway, some Greek medicine began to enter Europe.