Premodern (Pre-1800) Surgery

by

Cynthia Klestinec, Gideon Manning

• LAST MODIFIED: 17 April 2025
• DOI: 10.1093/obo/9780197768723-0008

Introduction

Generally underserved by historians of medicine, the history of surgery has received greater attention since the 1980s. The earliest indications of surgical interventions are trepanations, evident in fossils from the Neolithic period, while the earliest written accounts of surgery come from ancient Egypt, India, and Mesopotamia. Babylonian medical texts make little mention of surgery. By contrast, the Smith Papyrus (c. 1600 BCE) testifies to Egyptian surgical knowledge in the second millennium BCE. The formal stance toward surgery in the later Hippocratic tradition is ambiguous. The Hippocratic Oath (c. 435 BCE) singles out surgery for exclusion from the physician’s responsibilities using the example of lithotomy, which should be left to specialists. This division between physicians and surgeons would have lasting consequences in Euro-Western medicine. Nevertheless, surgery was a consistent part of medicine throughout the premodern era, with Hippocratic works such as On Head Wounds, or the multiauthored Sushruta Samhita from the Ayurvedic tradition, advocating surgical activity. Typically presented as a patient’s last resort after dietetics and therapeutics, the work of the surgeon by its very nature involved handiwork and instruments. Accordingly, the symbols of the surgeon came to be their hands and their instruments, both of which implied surgery was a manual operation and form of craft knowledge. But as the texts within the Hippocratic corpus indicate, surgery was also part of the long tradition of erudite or literate medicine. This tradition especially flourished in the Middle Ages, as medical schools developed curricular interest in anatomy and human dissection. These curricular efforts continued in the early modern period as anatomists brought attention to human dissection as important training for physicians and for learned surgeons. By the late eighteenth century, professional, intellectual, and institutional divisions between physicians and surgeons were disappearing, with surgeons gaining influence and social prestige while also joining with physicians in common cause against unregulated practitioners. In some quarters they were arguably seen as even more useful than physicians. By the end of the nineteenth century, medical progress and the growth of hospital care would be linked to surgery above all other medical specialties. Today, the history of surgery is a thriving subfield within the history of medicine, with detailed scholarship enriched by historians of science, historians of the book, philosophers, and medical doctors, all of whom have taken up the pen to better understand the history of the knife.

General Overviews

The long history of surgery cannot be adequately covered by any individual work. Still, valuable studies can be found that provide overviews of its general development and major figures (Lawrence 1993), procedures (de Moulin 1988), and instruments (Kirkup 2006), as well as its relationship to adjacent fields and nonsurgical inflection points in medical history (Temkin 1951). Some histories, like Wangensteen and Wangensteen 1978 and Rutkow 2022, lean toward a progressive account of surgery developing from an ancient craft to a scientific discipline, while others, like Lawrence 1992 and Wallis 2018, lean away from a progressive account, instead casting surgeons as actors in a complex social, intellectual, cultural, and institutional world. The specificity of surgery and surgical knowledge has also received recent attention in Schlich 2018. Several bibliographic surveys, such as Huard, et al. 1966 and Huard, et al. 1968, continue to frame and make accessible early surgical texts.

• de Moulin, Daniel. A History of Surgery: With Emphasis on the Netherlands. Dordrecht, The Netherlands: Martinus Nijhoff, 1988.

  DOI: 10.1007/978-94-009-3357-6

  Provides a general overview of the subject before 1800, detailing techniques, individuals, and institutions, especially, but not exclusively, in the Netherlands.

• Huard, Pierre, and Mirko D. Grmek. Mille ans de chirurgie en Occident: Ve-XVe siècles. Paris: Dacosta, 1966.

  Introduces the history of medieval surgical works translated from Arabic into Latin, specific manuscripts and prominent figures of the medieval tradition, and details the spread of surgery to northern Europe in the later medieval period. Includes nearly two hundred illustrations of difficult to find material in the history of surgery.

• Huard, Pierre, and Mirko D. Grmek. Le chirurgie moderne—ses débuts en Occident: XVIe–XVIIe–XVIIIe siècles. Paris: Dacosta, 1968.

  A concise, bibliographical survey of surgical writing from the sixteenth to the eighteenth centuries. Includes biographical sketches and, at the time of writing, up-to-date bibliographies that are still useful guides even if the account of progress in surgery is too linear. Contains 142 illustrations of instruments, procedures, and other relevant aspects of surgery as well as a concise introduction of the three hundred years covered.

• Kirkup, John. The Evolution of Surgical Instruments: An Illustrated History from Ancient Times to the Twentieth Century. Novato, CA: historyofscience.com, 2006.

  An encyclopedic history of surgical instruments that includes more than five hundred illustrations, this work provides a unique account of the materials and types of surgical instruments used in premodern surgery. Includes a contentious argument that surgical instruments specifically “evolved” to replace the non-artificial instruments of the hand, such as the fingers and nails.

• Lawrence, Christopher. “Democratic, Divine and Heroic: the History and Historiography of Surgery.” In Medical Theory, Surgical Practice: Studies in the History of Surgery. Edited by C. Lawrence, 1–47. London: Routledge, 1992.

  An excellent account not just of the history of surgery but also of the historiographical trends that have characterized the history of surgery both among surgeons themselves and among historians of medicine. Judicious in its use of primary and secondary sources, this chapter establishes a framework for much subsequent scholarship in the history of surgery.

• Lawrence, Ghislaine. “Surgery (Traditional).” In Companion Encyclopedia of the History of Medicine. Vol. 2. Edited by W. F. Bynum and Roy Porter, 961–983. London: Routledge, 1993.

  Provides a summary of the different aspects of medicine in the ancient, medieval, and early modern periods. Describes a range of healers including surgeons.

• Rutkow, Ira. Empire of the Scalpel: The History of Surgery. New York: Scribner, 2022.

  A recent survey written by an accomplished surgeon, this work contains ample discussion of the premodern period in the context of the surgery’s long history, beginning with ancient Egypt. Also offers high points in the early modern and modern periods of surgery, including developments in 16th-century anatomy with Andreas Vesalius.

• Schlich, Thomas. “Introduction: What Is Special about the History of Surgery?” In The Palgrave Handbook of the History of Surgery. Edited by Thomas Schlich, 1–24. London: Palgrave Macmillan, 2018.

  DOI: 10.1057/978-1-349-95260-1_1

  This introductory essay draws attention to the specificity of surgery and its presence as well as absence from histories of medicine. Some specificity is due to the knowledge surgery requires about the internal anatomy of the human body, while other features include the role of technology within the history of surgery.

• Temkin, Owsei. “The Role of Surgery in the Rise of Modern Medical Thought.” Bulletin of the History of Medicine 25 (1951): 248–259.

  Counters the view that the pre-antisepsis history of surgery is of little value. Draws attention to the development of technical skill, related especially to amputation and herniotomy, and diagnostic acumen, related to fractures and dislocations (and eventually ligatures—important to preserving limbs). The interest in limiting surgery helped to draw attention to the causes of disease and the uses of regimen and drugs.

• Wallis, Faith. “Pre-modern Surgery: Wounds, Words, and the Paradox of ‘Tradition.’” In The Palgrave Handbook of the History of Surgery. Edited by Thomas Schlich, 49–70. London: Palgrave Macmillan, 2018.

  DOI: 10.1057/978-1-349-95260-1_3

  Opens with the question of whether a premodern history of surgery is possible, given the developments around occupation, profession, and practice. Using a survey format, it provides a coherent approach to surgery in the ancient, medieval, and early modern periods, focusing on texts, textual organization, and the prominence of particular topics.

• Wangensteen, Owen Harding, and Sarah Wangensteen. The Rise of Surgery: From Empiric Craft to Scientific Discipline. Dawson, UK: Folkestone, 1978.

  An expansive study intended to demonstrate the value of the history of medicine to the teaching of medicine. Focused on the alleged transition of surgery from a craft to a well-grounded scientific medical specialty, it includes detailed accounts of cutting procedures ranging from amputation to lithotomy. Presented as a story of progress and technological innovation carried into the modern era, it includes a lengthy discussion of wound management from antiquity to the sixteenth century.