Late Middle Ages-Europe.

Area of Science:

• Medical History
• Surgical Techniques
• Late Middle Ages Medicine

Background:

• Surgical indications shifted towards the end of the Middle Ages.
• Prophylactic trepanation became less common.
• Standardization of wound management and cranial opening techniques emerged.

Purpose of the Study:

• To analyze the changes in surgical indications and techniques during the late Middle Ages.
• To investigate the preferred methods for cranial opening and wound management.
• To understand the rationale behind trepanation procedures, particularly concerning the dura mater.

Main Methods:

• Historical analysis of surgical texts and practices from the late Middle Ages.
• Examination of preferred surgical instruments, such as narrow non-plunging trepans and chisels.
• Review of decision-making criteria for performing trepanation.

Main Results:

• Draining pus was the principal indication for trepanation.
• Narrow non-plunging trepans were favored drills for cranial openings.
• The lenticular chisel was preferred for widening cranial openings created by multiple drill holes.
• Theodoric advocated delaying trepanation until clinical signs suggested separation of the dura from the cranium, to prevent damage.

Conclusions:

• Trepanation in the late Middle Ages was primarily indicated for draining pus.
• Surgical techniques for cranial access became more refined, focusing on minimizing damage to the dura mater.
• Patient's level of consciousness was not a consideration in determining the need for trepanation.