The Rational Surgery of the Middle Ages (review)

As Michael McVaugh admits in his preface, this is not a general history of medieval surgery. Rather, it is the reconstruction of an intellectual tradition as it appears in twelve interrelated surgical texts that survive from the thirteenth and fourteenth centuries. It is an account of how, between 1240 and 1320, the authors of these works—Teodorico Borgognoni, Bruno Longobucco, Guglielmo Saliceto, Lanfranc of Milan, and Henri de Mondeville—collectively fashioned a new and distinctive professional identity for learned surgeons.

McVaugh's intention is to liberate us from naïve questions concerning the objective experience of surgery in the Middle Ages and focus our attention instead upon how texts may help to explain their authors' understanding of the nature of surgery. McVaugh interprets his texts as instantiations of a collaborative project in which their authors are self-consciously creating a new tradition of "rational surgery." Their works, he argues, were written to convince readers that surgery should be regarded as an intellectual activity in which learning was as important as observing and where good practice depended on prior knowledge of the subject matter. These claims were designed to engender academic respect for learned surgery and secure an advantageous position for learned surgeons in an increasingly competitive marketplace for medical care.

In seeking to establish this new identity for surgery, surgeon writers deployed a range of intellectual concepts such as scientia and ars, which medical authors had already used to great effect to secure a place for medicine in the early universities. They also mined Arabic and Greek medical works (in their new Latin translations) for authoritative statements on surgery as well as a much more extensive treatment of the subject. Most importantly, they assimilated anatomy as the theoretical basis of their new rational surgery.

One effect of this was to greatly extend the range of surgical intervention. Now that the learned surgeon was expected to know the underlying causes of ailments, he was required to offer his judgment upon conditions emanating from inside the body that had hitherto been the responsibility of physicians. Moreover, the learned surgeon's new literary sources provided him with more differentiated accounts of ailments together with many more alternatives for treatment. But the task of surgeon writers was not merely to enumerate instances of these new interventions; rather, their job was to generalize from them the rule or theory upon which the learned surgeon could speculate. This is what made the new surgery "rational."

This strategy had its risks, however. With their claims to superior knowledge of the human body, their new procedures, and their powerful new drugs (many of which were prepared using alchemical techniques), learned surgeons were called upon to perform ever riskier operations, such as couching for cataracts, removing bladder stones, and repairing inguinal hernias. Their knowledge of the potential risks involved made them understandably cautious, but with empirical practitioners always willing to perform these operations when others would not, the pressure was on learned surgeons to intervene.

With Gui de Chauliac as a self-conscious last addition to this group, the tradition of Latin surgeon writers dies out. On the one hand, surgery was assimilated within university medicine, especially with the incorporation of anatomical teaching and human dissection in the medical curriculum. On the other hand, it was popularized through vernacular translation and abridgement, a process that inevitably undermined the integrity of rational surgery in terms of its concepts, language, and authoritative sources. These were forms of dissemination that a coherent literary tradition could not survive.

This engagingly written book is testimony to the years of extensive reading and serious reflection that McVaugh has devoted to his topic. It lays out the occupational terrain in which learned surgeons competed with physicians and empirical practitioners; it explains many of the procedures and techniques used by medieval surgeons; and it clarifies the relationship between the Latin and vernacular literary traditions of late medieval surgery. It is a work that, in...