1 Introduction: Interventions âWithout Ironâ
A plaster that breaks and opens wounds and scrofulous swellings without iron: Sal ammoniac, 1 pound; galena, 1 pound; oil, 1 pound; ashes of twigs, 1 pound; dove droppings, 3 ounces. Prepare [it] and use [it].1
The above recipe, a topical application made of various mineral, vegetable, and animal substances, claims to offer a non-surgical alternative to opening a wound or swelling: it presents a treatment that reputedly breaks them open sine ferro, âwithout ironâ. In a period before antibiotics and hygienic operating facilities, it is understandable that a substitute to surgical intervention would have been sought. Whether such a plaster would rupture a swelling or break open a wound is, of course, another matter and an investigation into the recipeâs efficacy is beyond the scope of this book.
In pre-modern medicine, dietary and pharmaceutical treatments were generally preferred to surgical intervention. In most cases, surgery would have been the last resort, turned to when non-invasive treatments had failed or if surgery was the only possible course of action, as might have been the case with traumatic injuries that occurred in battle.2 The general absence of early medieval surgical texts supports the idea that surgery was a rarity in this period, though exceptions, such as writings on the relatively minor surgical procedures of bloodletting, cautery, and scarification, are recorded. In contrast
An investigation into whether evidence of surgical procedures can be observed in the osteological record is inherently linked to signs of weapon injuries, falls, and other trauma. Skeletal remains may provide indicators of the types of treatments that occurred during this period other than, or in addition to, surgery based on signs of healing (or lack thereof) recorded in the bones. It is necessary, therefore, to consider the evidence of more general traumata in both the written sources and osteological record. Accordingly, this chapterâs recipe analysis explores the extent to which these texts attempted to heal and/or provide care for serious injuries, such as broken bones, rather than focusing on the examples of minor surgeries, including bloodletting and cautery, that occasionally appear alongside recipes or as part of treatments. The latter, given their superficial nature, are not recorded in the osteological record, whereas more significant injuries can be considered from both textual and skeletal perspectives.
In contrast to the conditions addressed in Chapters 7 and 8, trauma is usually the immediate result of a sudden event, such as a fall or blow. This direct cause and effect relationship has given rise to a fairly consistent understanding of the aetiology of traumatic injuries from Antiquity to the present day.4 Despite this unusually high degree of consistency between the modern and medieval identification of the underlying mechanisms responsible for these types of pathologies, trauma remains a notoriously difficult concept to define. The Oxford Concise Medical Dictionary, providing a modern clinical perspective, defines trauma as âa physical wound or injury, such as a fracture or blowâ,
Although evidence for invasive surgical procedures is lacking in the recipe literature, my analysis of this material indicates that non-invasive treatments for traumatic injuries are frequently recorded. The subsequent review of osteological evidence does, however, highlight a number of notable examples of major surgical procedures, such as trepanations. More generally, the high degree of healing observed in fairly standard traumata, such as broken bones, without signs of surgical intervention confirms the existence of non-invasive medical care. Re-evaluating the texts on the basis of the skeletal evidence, I argue that the non-invasive therapies presented in recipes would have been highly applicable to individuals in this period, and that they accord with the evidence preserved in the osteological record. At the same time, the limited evidence for more invasive surgeries seen in the skeletal remains provides a window onto medical knowledge that was transmitted through non-textual means during this period.
2
2.1 Surgery
Given the ancient precedent of describing surgical procedures separately from pharmaceutical and dietary prescriptions, it might seem strange to look for evidence of surgery alongside recipes.9 Yet, as explained in Chapter 2, the varied nature of early medieval medical compendia blurs such neat distinctions, and short, non-recipe excerpts and writings can be found in recipe collections. In a small recipe collection in cod. sang. 44, for example, entries such as De uulneribus putridis and De cautere, focus on superficial surgical procedures rather than recipes.10 Moreover, as noted above, recipes occasionally mention fairly minor, superficial procedures, such as phlebotomy, cautery, and scarification, as a component of treatmentâor even record treatments for the aftermath of these procedures. A poultice in cod. sang. 899 titled Cataplasma ad tumorem brachii que ex fleubotomo contingit, for example, is intended to combat swellings in the arm after bloodletting.11 Old English recipe collections, too, record a handful of fairly superficial surgeries, such as the lancing and draining of an abscess and the removal of gangrenous flesh.12 It therefore seems possible that if surgical techniques beyond the aforementioned minor procedures were recorded in the Carolingian world, they could have been located within this textual environment, either mentioned in recipes as part of a treatment or found as a discrete section of supplementary information within a larger collection. This, however, is not the case, and more complex surgical procedures are absent in the surviving texts.13 These findings suggest that knowledge of more invasive surgeries, if in circulation, was transferred through non-textual means, such as apprenticeships and oral traditions. However, many treatments for open wounds and/or broken bones involved bandaging and suggest that the injury was protected and possibly immobilised, splinted, and/or manipulated; depending on the complexity of the injury, these processes could have involved some minor surgical procedures, though explicit details are absent.
2.2 Trauma
Despite the lack of references to invasive surgeries, serious traumatic injuries do appear with some frequency in the textual record. I have identified 193 recipes that claim to treat fractures, dislocations, cut tendons, and/or injuries caused by a specific type of trauma, such as a blow, puncture wound, fall, or named weapon. Recipes that only include general terms for wounds, ulcers, and sores, such as uulnus and ulcus, without further contextualisation are excluded from this chapterâs analysis because they could not be linked to a traumatic injury. Likewise, recipes that use the non-specific tumor, which can range in meaning from swelling to tumour, without further clarification are not included. It should be noted, however, that three recipes for poultices in cod. sang. 899 combine this term with more details and suggest that they are treatments for swellings with bruising, and thus possibly linked to traumatic injuries. Two of these occur within a cluster of recipes under the heading Cataplasma ad tumorem; while the group of recipes cannot be taken as referring to bruising overall, these two recipes also include the words liuor (bruise) and contusio (contusion, bruise), pinpointing their target.14 Finally, treatments for animal bites and stings as well as the trauma of childbirth are also excluded because signs of these injuries are often more difficult to see in the osteological evidence.
Recipes that mention fractures and traumatic injuries
| Specificity | Total | NSp | SSp | HSp |
|---|---|---|---|---|
| # of Recipes % of Total |
184 100% |
26 14.1% |
17 9.2% |
141 76.6% |
As seen in Table 19, the majority of these recipes (76.6%) are highly specific, while non- and semi-specific recipes only account for twenty-six (14.1%) and seventeen (9.2%) recipes, respectively. The non- and semi-specific categories follow the same criteria outlined in previous chapters, although I have
The twenty-six non-specific recipes represent wide-ranging panaceas, eight of which correspond to just two antidotes that reoccur in multiple manuscripts. The Oxira crocira is found in codd. sang. 44, 761, bav pal. lat. 1088, and reg. lat. 1143, and in each case the treatment claims to heal luxum et fracturas, âdislocations and fracturesâ (the example in cod. sang. 761 also adds that it draws out thorns, extrahit spinas), alongside a host of other maladies.15 Similarly, the Apostolicon plaster is seen in four manuscripts (codd. sang. 44, 751, 761, and bav reg. lat. 1143) and consistently includes a phrase noting that it was intended to treat wounds caused by iron, glass, and other materials as well as embedded arrows.16 The lengthy list of medical problems this plaster claims to treat then continues with the bites and stings of venomous animals before moving on to a range of other ailments. The non-specific recipes, as these two cases illustrate (and as has been noted in previous chapters), tend to treat a mixture of extreme and general medical issues; in this hybrid context, it is not surprising to see life-threatening wounds caused by traumatic injuries, such as arrows or sword blows, alongside serious and urgent (if also unusual) health problems, such as poisoning and snake bites.
Seventeen semi-specific recipes list traumatic injuries with or secondarily to other potentially related conditions. Several recipes, for instance, mention fractures while also noting wounds, pains, and/or infections. These other ailments could stem from a traumatic event and thus be directly connected with the fractures but, equally, they could represent unrelated conditions. As an example, cod. sang. 751 records a recipe that claims to heal putrid shins and all blows, Qui facit ad tibias putridas et ad omnes plagas sanandas.17 While the putrid shins could reflect an open, infected sore that developed as a result of trauma, the limited description given in the recipe does not address whether
As shown in Table 20, the highly specific recipes can be divided into two main categories: forty-eight recipes (34.0%) name a general type of traumatic injury, such as fractures and dislocations, as the target of their treatment, while eighty-six (61.0%) note the source or cause of a traumatic injury, such as a blow or puncture. There are also seven recipes (5.0%) that mention both injury type(s) and cause(s) of trauma. I have further divided the two primary categories into more specific subunits, as seen in Tables 20â22, based on the recipesâ titles and any additional information contained within them.
Categories and subcategories of highly specific recipes that name traumatic injuries as the target of their treatment
| Category | Subcategory | Number | % of HSp recipes (141) |
|---|---|---|---|
| Recipes that name a general type of traumatic injury | Fractures | 26 | 18.4% |
| Dislocations | 15 | 10.6% | |
| Fractures & dislocations | 1 | 0.7% | |
| Cut tendons | 6 | 4.3% | |
| Total | 48 | 34.0% | |
| Recipes that name a source/cause of traumatic injury | Blows | 61 | 43.3% |
| Punctures | 22 | 15.6% | |
| Blows & punctures | 1 | 0.7% | |
| Falls | 2 | 1.4% | |
| Total | 86 | 60.1% | |
| Recipes that name both types and sources of trauma | 7 | 5.0% | |
Breakdown of highly specific recipes that name a general type of traumatic injury
| Category | Total | Fracture | Dislocation | Fracture & dislocation | Cut tendons |
|---|---|---|---|---|---|
| # of recipes % of total (48) |
48 100% |
26 61.4% |
15 15.9% |
1 2.3% |
6 13.6% |
Six recipes intended for fractures, like the treatment for fractures of the skull seen in cod. sang. 751, name specific areas of the body. One treatment in BnF lat. 11218 titled Ad costas fractas, âFor broken ribsâ, recommends a preparation made of glass, pitch, and vinegar.21 The other five recipes are all intended exclusively for cranial fractures, two of which, De simplices uulneribus ad capitis
As shown in Table 21, fifteen recipes target dislocations, such as the recipes titled Ad luxum, âFor a dislocationâ, in cod. sang. 751 or Ad luxatura, also meaning âFor a dislocationâ, in cod. sang. 44.24 The ankle, talus, is specifically mentioned in several treatments, such as a recipe under the heading Ad talorem dolorem quis luxauerit ut dolor pausit in cod. sang. 759, suggestive of a sprained ankle.25 Moreover, one recipe in cod. sang. 1396 and six in bav pal. lat. 1088 pair dislocation with bruising; this coupling is very fitting since discolouration and swelling often complement injuries such as sprains and dislocations. The six treatments in bav pal. lat. 1088 are found under the heading Ad contussionem
Finally, âcut tendonsâ are the focus of six recipes, four of which are found together in bav pal. lat. 1088 under the heading Ad neruos incisos.28 All four of these present simple topical applications: the first two recommend a preparation made with earthworms, the third sage, and the fourth a mixture of snails (with their shells) and frankincense. Intriguingly, although this general type of injury appears much less frequently in the recipe sample under analysis than either fractures or dislocations, cut tendons receive comparatively more coverage in classical and late antique sources. The Medicina Plinii, for example, devotes a fairly substantial chapter to Recentibus vulneribus et nervis incisis (âFor recent wounds and cut tendonsâ) that features over twice as many prescriptions as its later chapter on broken bones, Ossibus fractis.29 Indeed, the first and last of the four recipes for cut tendons in bav pal. lat. 1088 share much in common with two of the opening treatments found in the Medicina Plinii.30
Unlike the previous examples of recipes that name a general type of traumatic injury, eighty-six recipes name a source or cause of trauma that resulted in the injury. As seen in Tables 20 and 22, I have grouped these treatments into four subcategories: a) recipes for wounds sustained by blows or strikes,
Breakdown of highly specific recipes that name a source/cause of traumatic injury
| Category | Total | Blows | Punctures | Blows & punctures | Falls |
|---|---|---|---|---|---|
| # of recipes % of total (86) |
86 100% |
61 70.9% |
22 25.6% |
1 1.2% |
2 2.3% |
Sixty-one recipes mention blows and strikes of various kinds, totalling over two-thirds (70.9%) of the treatments that name a source of trauma. Most of these recipes provide only general descriptions of the cause of the injury they intend to heal, using terms such as plaga or percussus, as noted above. Cod. sang. 751, for example, contains ten general treatments for blows in which forms of the word plaga are given and three with percussus and related terms, bav pal. lat. 1088 includes thirteen and eight, respectively, and so on.32 Several of the recipes in cod. sang. 751, such as the three entitled Potio ad plaga, provide
Puncture wounds alone are mentioned on twenty-two occasions, as seen in Table 22. While most of the recipes offer general treatments for puncture wounds (punctas), one recipe in bav pal. lat. 1088 is intended to treat wounds caused by poisoned arrows, Ad eos qui cum toxicata sagittasi sunt, and a recipe in cod. sang. 751 offers a cure for a foot (or any other body part) pierced by a thorn, Si spina in pede uel in alico membro fuerit.37 Clusters of five and three recipes to treat puncture wounds of the side can be found in bav pal. lat. 1088 and cod. sang. 44, respectively, while another recipe for side punctures, Ad puncta que in lateribus superuenit, is located in BnF lat. 11218.38 The three recipes of cod. sang. 44 parallel the first three recipes of those listed in bav pal. lat. 1088, and the recipe in BnF lat. 11218 also appears to be loosely
The single example of a highly specific recipe that refers to both blows and punctures, Medicamen mirabile ad placas ad sagita percusso, is found in cod. sang. 759.42 Unlike most other subcategories, the majority of recipes that mention multiple forms of named trauma are non-specific recipes. The only other grouping in which non-specific recipes predominate is the âfractures and dislocationsâ subcategory, suggesting that antidotes and other panaceas, in their tendency to list particularly extreme medical problems, feature multiple weapon-based injuriesâif such injuries are listed at allârather than an arrow wound or a sword blow individually. Recipes that mention falls are only recorded twice (see Table 22); along with treatments for thorns, these recipes are unusual in naming traumatic injuries that do not necessarily stem from a violent act (whether intentional or accidental). These two recipes are found under the title Si homo de arbore uel de equo ceciderit, âIf a person has fallen
The final category, recipes that mention both general injuries as well as a named source of trauma, includes seven highly specific treatments. Although two recipes from cod. sang. 751 have titles that would suggest a single target, Ad luxum, âFor a dislocationâ, and Potio ad plaga, âA potion for blowsâ, additional information appears within the recipe itself. In the first, Ad luxum is written in red capitals and then followed by ad luxum uel quolibet casum si percussum fuerit ut liuorem faciat, a phrase that reveals that the recipe is intended to treat not only dislocations but also cases in which a strike has caused bruising.44 While this is similar to the dislocation recipes that mentioned bruising noted above, it differs in specifying that a blow, percussum, was involved. In contrast, a recipe from cod. sang. 878, Walahfrid Straboâs vademecum, titled Ad fracturam uel uulnera ferri, âFor a fracture or wounds of ironâ, more clearly indicates the multipurpose nature of the treatment in its title and recommends a mixture of âbarley flour, boar fat, and stinging nettleâ with no further instructions regarding the preparation or administration fo the treatment.45 Unusually, each of the ingredients in this recipe has been glossed in Old High German.46 These additions, however, date to the eleventh century and therefore cannot be taken as evidence for how this recipe was read in the Carolingian period.
3 Osteological Evidence for Trauma and Surgery
3.1 Identifying and Understanding Trauma in the Osteological Record
When assessing evidence for palaeotrauma, the nature of the wound and extent of bone remodelling can provide important information about the trauma that caused the injury, whether medical intervention occurred, and whether the patient survived the incident. Fractures are the primary source of evidence for trauma in the skeletal record, though dislocations, especially of the shoulder, may also be observable in some cases. The type of break and its location on the body provide a framework for understanding the injury
Although the latter example, a transverse fracture, can be caused by many different types of traumata and should not be automatically interpreted as the result of interpersonal violence, the location of the injury can be instructive. Fractures that occur on the shaft of the radius and/or ulna, for example, are often referred to as âparry fracturesâ since it is plausible âthat the individual was using his or her arm to ward off a blow aimed at the headâ.49 Yet, despite the information provided by the injuryâs location and form, it must be remembered that the interpretation of the traumatic incident always remains a case of speculation.50 While a âparry fractureâ is suggestive of an individual parrying a blow to the head, it is possible that this was not the case. Furthermore, as noted above with the example of âhorseplayâ from the Annals of St. Bertin, it is important to keep in mind that some weapon-based injuries in the past may have been accidental.51
Regardless of the question of intent, it may still be possible to deduce the means by which certain fractures occurred: cranial injuries located in the left frontoparietal region, for instance, suggest a âface-to-face encounterâ where âthe weapon inflicting these wounds [was] held in the right handâ.52 When considering trauma due to weapons, the appearance of the fracture may also
The presence or absence (and, if present, extent) of remodelled bone at the site of injury can shed light on the timing of the traumatic event and healing process. If there is no sign of remodelling, then the injury occurred at or very near to the individualâs death.55 In some cases, it can be difficult to distinguish between peri- and post-mortem trauma, though the fragmentation of bones due to soil weight or any damage incurred during the excavation process are often recognisable based on the appearance of the fracture edge.56 If the individual survived the initial trauma, bone repair begins almost immediately (evidence of remodelling can be seen within roughly two days of the incident) and may continue for several years.57 The gradation of remodelling seen at the site of injury can therefore provide a timeframe for understanding the healing process: did the individual make a full recovery or die within a few days or weeks after sustaining the trauma? If there are only early signs of bone repair, it suggests that the individual survived the initial traumatic incident but died relatively soon after, perhaps due to complications associated with the injury.58
When an individual survives a traumatic incident, it may also be possible to see evidence of treatment. The successful healing of a broken bone requires immobilisation and, depending on the location and type of fracture, returning the bone to its normal anatomical position.59 A number of complications may result if this does not occur, if it is done poorly, or if the individual begins to use the injured bone before it is fully healed, such as non-union, shortening, and/or angulation.60 Broken bones, and especially open fractures where the skin has also been broken, are susceptible to infection, and the development of osteomyelitis may be visible in the skeletal remains.61 The complete remodelling
Finally, the limits of osteological evidence must be remembered. Skeletal remains will only record evidence of traumatic injuries that have affected the skeleton, meaning that many forms of trauma will not be preserved in the archaeological record: while a sword blow might produce an obvious cutmark in a bone, a dagger might only pierce the soft tissue and leave no trace of the injury. The resulting underrepresentation of traumatic injuries in the skeletal record is therefore essential to keep in mind in the following review of skeletal evidence and will be revisited in the discussion that follows. Similarly, the lack of evidence for soft tissue trauma is also important to note in relation to the limited textual evidence for surgical intervention. Although, as mentioned above, surgery is rarely seen in the early medieval written record, a number of superficial procedures, most frequently bloodletting, do appear in medical texts as well as other documentary evidence. The Plan of St Gall, for example, includes a room in the medical area specifically designated as the monasteryâs site for phlebotomy.63 Information regarding certain times to avoid bloodletting, such as lists of Egyptian Days (days thought to be unlucky, especially with respect to phlebotomy), also appears in and alongside calendrical texts.64 While the practice is occasionally mentioned in medical recipes as a component of a treatment, there are also writings that focus specifically on bloodletting, including epistles and other treatises that provide guidance on the best (or worst) days and times to phlebotomise, describe the different veins involved, and so on.65 Within the manuscript sample involved in this book, examples of calendars that include information on bloodletting can be seen in codd. sang. 751 and 878, while BnF lat. 11218, bav reg. lat. 1143, codd. sang. 44,
3.2 Evidence for Trauma in Early Medieval Skeletal Remains
Although fractures, wounds, and other injuries appear less frequently in the skeletal record than the oral pathologies and joint diseases addressed in previous chapters, there is still extensive evidence of trauma. Based on the criteria for assessing fractures outlined above, such as the type and location of the wound or degree of bone remodelling, it is also possible to consider the types of traumatic incidents that caused these injuries and whether the individuals survived. In some cases, these variables can shed light on the wider context in which the trauma occurred. At the northern Italian site of San Martino di Ovaro, a cemetery containing thirty-one individuals, skeletons exhibited evidence of a variety of types of injuries, including fractures suggestive of both accidental traumata and intentional violence. Radial fractures typical of a fall can be seen on two individuals, for example, whereas signs of a significant attack were observed on another skeleton.67 The skull of this individual showed evidence of two major peri-mortem blows with a heavy cutting weapon (probably a sword), one across the jawbone and one from above.68 Roughly a fifth of this population also exhibited signs of osteomyelitis. While the development of an infection of the bone could stem from an open wound, it is also possible that these cases resulted from an existing infection that spread haematogenously.69 At the Corso Roma cemetery in Acqui Terme, a site in use from the seventh to ninth centuries that contained thirty-three individuals, fractures were observed in three skeletons: one male and one female had ulnar fractures, while another individual had broken their fifth metatarsal.70 Periostitis, inflammation of the periosteum, was also recorded in the humerus
A mixture of traumatic injuries was also reported at the cemetery excavated at La Perosa in Rivoli. This cemetery includes thirty-seven individuals and dates from the sixth to eighth centuries.72 A radial fracture was seen on one male, while another male exhibited cranial injuries.73 Although the fracture of the radius is not described in detail, the authors note that the fractured cranium showed no signs of remodelling and that this blow was almost certainly the direct cause of the individualâs death.74 Traumatic injuries were observed on a number of the individuals uncovered during restoration work at the Carolingian church of SantâAgostino in Caravate.75 For example, a âsmall quadrangular perforationâ was observed on the skull of one individual, a female aged approximately forty to fifty years old at death, and interpreted as the result of a blow from âa pointed weapon with a pyramidal trunk headâ, such as an arrow.76 Bone remodelling was present at the site of the injury, indicating that this individual survived the incident.77 A second individual, a male of roughly the same age, exhibited a fractured fibula, depressed cranial fracture, and deviated septum. While the direct cause of the fibular fracture is unclear, the depressed fracture was the result of blunt force trauma. According to the authors, the deviated septum âis probably the result of a traumatic eventâ, though a congenital origin is also possible.78 In the case of both fractures, complete bone
At the rural monastic site of Santa Maria Assunta di Cairate, which includes three distinct burial areas, relatively little trauma was recorded in the more privileged burial groups found within the church (Groups A and B), though it must be noted that the majority of these individuals were female and thus perhaps less likely to participate in the types of activities that tend to result in traumatic injuries, such as hunting or fighting.80 One exception, however, stands out: a particularly tall female found in Group B (which, as noted in Chapter 7, has been interpreted as an elite family unit) suffered a compound fracture of her left tibia.81 Evidence of extensive bone remodelling is visible, suggesting that this individual lived for at least several years after the traumatic incident occurred. In contrast, many more injuries are observed in Group C, a collection of sixty-eight individuals thought to represent the general population who lived in the surrounding area during this period. Fractures of the clavicle, ribs, ulna, and tibia were recorded.82 While the presence of remodelled bone in these cases indicates that the injured individuals survived the traumatic incidents that caused these injuries, evidence of periostitis, especially in the bones of the lower limbs (the femur, tibia, and fibula), was also frequently noted.83 Although it often remains unclear if this inflammation was due to an infected wound or the spread of an existing infection, in some of these cases, such as the female with the compound tibial fracture, the periosteal reaction can be convincingly linked to a traumatic injury.
Similarly, at the Saint Servatius complex in Maastricht, one instance of osteomyelitis observed on a skeleton dated to the siteâs final phase of use âwas most likely secondary to a fracture of the femurâ.84 Among the individuals dated to this period, nearly twenty percent exhibit evidence of fractures, all of which show signs of healing.85 This is not the case, however, for trauma caused by sharp-bladed or pointed objects. In a study of a larger sample of
Both the urban cemetery excavated at Piazza Marconi in Cremona (in use from the seventh to tenth centuries) and the rural necropolis excavated at Bolgare (in use during the seventh and eighth centuries) contain large skeletal assemblages exhibiting evidence of traumatic injuries. Some of these skeletal markers, such as radial fractures, suggest episodes of interpersonal violence or injuries derived from occupational activities, not unlike many of the other sites reviewed above.89 Yet, in contrast with other excavations, trauma was most frequently noted in the lower limbs of individuals buried in these cemeteries; this prevalence, however, appears to be linked to the use of a broad definition of trauma at these sites.90 For example, fractures are recorded primarily on leg bones at Cremona, a result heightened by the inclusion of osteochondritis dissecans, a type of fracture âcaused by direct trauma or repetitive microtraumaâ, while small fractures in the phalanges due to repeated microtraumata were often reported at Bolgare.91 Overall, this evidence for lower limb and foot injuries inclusive of microtraumata, relates more to long-term processes of wear and tear (see Chapter 8) than to a sudden traumatic incident.
A somewhat similar combination of fractures and signs of stress was observed among adult males at San Cassiano.92 The eight tombs found inside the church contained seven adult males and one child; although these burials, dated to the late sixth or seventh centuries, predate the Carolingian period,
Moving to southwest Germany, Jochen Weber and Alfred Czarnetzki conducted a study of head injuries based on the skeletal remains found in four early medieval cemeteries (Kirchheim am Ries, Neresheim, Nusplingen, and Schretzheim) that were in use from the sixth to the eighth centuries.95 Thirty-three of the 304 skulls analysed (11%) exhibited cranial fractures, twenty-nine of which were judged to be male and four female.96 Twenty-one skulls had linear fractures caused by a strike from a sharp-edged weapon, such as a sword, whereas depressed fractures due to blunt force were observed on nine skulls; three skulls show evidence of both types of fractures.97 Of the twenty-one skulls with evidence of sword blows, six recorded multiple fractures, and in all six of these cases, no sign of bone remodelling was present, suggesting that these individuals probably died as a result of their injuries.98 Two of the skulls exhibiting sharp fractures also showed no signs of healing, but some degree of bone remodelling was observed on the remaining twenty-five skulls.99 In other words, over three-quarters of the individuals with cranial fractures survived the initial traumatic incident. Furthermore, three skulls exhibited signs of trepanation, âthe deliberate removal of pieces of bone from the skullâ, evidenced by scratching or cutmarks around a circular opening, and, incredibly, all of these wounds showed signs of healing.100 While the evidence of healed
Comparative evidence from earlier sites in continental Europe as well as contemporary sites in the British Isles provide additional examples of surgery. Charlotte Roberts and Jacqueline McKinley, for example, highlighted nineteen cases of trepanation in Insular contexts from the fifth to ninth centuries, while more recent studies have identified further examples.101 An excavation from Hemmaberg, Austria, has produced one of the most remarkable cases of early medieval surgery and medical intervention. Twenty-nine individuals dated to the sixth century were found in a small cemetery associated with the early medieval church of St Hemma and Dorothea; though pre-dating the Carolingian period, stratigraphic evidence combined with grave goods and burial customs âplace [these individuals] firmly within the Frankish cultural sphereâ.102 One of the skeletons, a male aged 35 to 50 years old at death, was missing the left foot and distal joints of the left tibia and fibula. While it might be assumed that this was due to poor preservation, the skeleton was otherwise well-preserved and the point where the tibia and fibula ended was marked by extensive bone remodelling.103 Furthermore, âa sub-circular iron band with a diameter of 6.8â7.3 cmâ was found in place of the lower leg and foot, highly suggestive of a prosthetic attachment.104 Ultimately, the osteological analysis of the tibia and fibula indicated that the foot and distal portion of the tibia and fibula had been amputated and that, despite suffering from osteomyelitis, this individual eventually recovered. Full remodelling of the bones indicates that the wound completely healed and the individual survived for at least some years after the surgery.105 Although there is not enough evidence to deduce the cause of the amputation, the existence of this case of surgical intervention followed by long-term medical careâas illustrated by the individualâs survival of
Overall, the above examples indicate that standard traumatic injuries, such as broken bones, were not infrequent; while some may have been caused by interpersonal violence, others could have been due to accidents, such as a fall. There are, however, a number of spectacular cases that bear witness to surgical inventions, such as multiple trepanations and the Hemmaberg amputation. Most significantly, the evidence of healing in many examples reflects effective (and often long-term) medical care.
4 Reading Recipes in the Light of Osteological Evidence for Trauma and Surgery
The skeletal evidence presented above preserves signs of trauma from a variety of sources, including violent incidents involving weapons, injuries caused by falls or occupational hazards, and, rarely, examples of surgical intervention. Bone remodelling indicates that large numbers of early medieval individuals survived not only an initial traumatic incident but also made full recoveries (at least in terms of the skeletal healing process). Evidence of healed fractures is highly suggestive of medical care, even if this care remains otherwise invisible in the skeletal record. Although many of the examples of surgery listed above, such as the trepanations from early medieval England, are from sites beyond the Frankish Empire or, as in the case of the amputation, pre-date the Carolingian period, there are occasional signs of surgery in potentially Carolingian contexts, including the handful of trepanations in southwest Germany which may date to the eighth century.
While the textual evidence lists treatments for a similar range of traumatic injuries, there are no clear signs of trepanation, amputation, or other surgical procedures beyond superficial surgeries, such as bloodletting and cautery, in the recipes under analysis. The reference to the removal of bone fragments comes closest to providing a possible hint of more complex and potentially invasive surgical practices (and is especially intriguing given that it occurred in the context of cranial fractures), yet it offers no direct comments on surgery. Reassessing the recipe literature in view of the skeletal evidence thus indicates that the surviving written sources do not provide a complete picture of contemporary medical approaches since surgical procedures, as documented by the skeletal remains, were clearly performedâif only rarely.
With these two bodies of evidence in mind, several areas of analysis can be pressed further in relation to the question of applicability.
4.1 Type of Injury: Conflicting Evidence?
Puncture wounds appear with some frequency in the recipe sample, with arrows (sagittae), thorns (spinae), and other non-specified punctures (punctae) mentioned on over twenty occasions. The skeletal remains, however, provide relatively little evidence of such injuries: the vast majority of weapon injuries appear to be linked to either sharp-edged weapons or blunt force trauma. The female skull with a probable arrow wound as well as a male excavated at Saint Servatius with evidence of a similar injury represent some of the few exceptions.106 Does this disjuncture suggest that the textual record, at least with respect to this type of injury, had little relevance to early medieval populations? While this could be the case, like the example of gout in the preceding
Injuries that could be classified as ânon-violentâ, such as falls, seem to present the opposite situation with respect to the two bodies of evidence. Among the recipes that named specific causes of traumatic injuries, over ninety-five percent listed a violent action or weapon as responsible for the wound in question.107 The two recipes for falling off a horse or out of a tree and two treatments for punctures from thorns represent the only exceptions. Surely falls and injuries from occupational hazards occurred more frequently than this record suggests; indeed, some of the reports consulted in this study argued that the osteological evidence exhibited not only markers of horseback-riding but also injuries related to falls. While this could represent a disconnect between the textual and skeletal evidence, again, I argue that a deeper analysis of the texts reveals a different story. Unlike an arrow wound or a sword blow, which may need fairly specialised treatments, a fall could result in a broken bone, a dislocation, a sprain, major bruising, and so on. Many of the recipes for general injuries, such as fractures, dislocations, and bruising, could apply to these types of general accidents. Given the varied nature of the resulting injuries, it would be more appropriate to treat the specific issue with which the patient presents rather than âa fallâ. With this in mind, the lack of recipes explicitly intended for falls and other accidents makes more sense and supports the applicability of the general injury treatments to individuals in the Carolingian world.
4.2 The Question of Surgery
As noted in the textual analysis, several parts of the body, including the head, were mentioned repeatedly. The recipesâ emphasis on this area fits with the archaeological evidence: cranial fractures were among the most frequently observed traumatic injuries in the skeletal record. While the trepanations observed in the osteological record reveal that some surgical methods were used to treat head conditions (though it is often unclear if the underlying
Yet, some invasive, complex surgeries did occur, if only rarely. Given the relative pausity of surgical information in the texts, especially with respect to complex, invasive surgeries, such as amputation and trepanation, where did the individuals who performed these surgeries acquire their knowledge? Debby Banham and Christine Voth have argued that oral traditions and practical training may have played a significant role in the transmission of surgical knowledge in the Insular world, and it appears that continental Europe experienced a similar phenomenon.108 This is not to say that much surgery was occurring during this period, but to acknowledge that texts were certainly not the exclusive source of medical knowledge at this time. Here, it is important to remember that the Hemmaberg amputation as well as several trepanations occurred within a Frankish context. Though largely pre-dating the Carolingian period, these cases of surgical intervention offer a glimpse into earlier Frankish medical practices, suggesting that knowledge of surgery, perhaps drawing on Frankish traditions or medical practices picked up through contact with the Roman military, was passed on outside of the written record. The potential links between military medicine and surgical practice in relation to the particularly violent traumata of warfare will be considered in the following section.
4.3 Evidence for Trauma Beyond Medical Texts
Finally, a comment must be made on the wider context and the evidence for trauma as documented by textual sources beyond the medical manuscripts, such as capitularies, law codes, annals, histories, and poetry. Records of warfare and violence represent perhaps the most obvious source of information regarding traumatic injuries recorded by non-medical texts. Einhardâs Life of Charlemagne, for example, emphasised the brutality of the Saxon Wars,
- 242.Concerning the illegal minting of coins: He who mints gold or strikes money without the kingâs command shall have his hand cut off.
- 243.On forged charters: He who forges a charter or other kind of document shall have his hand cut off.121
An understanding of the wider Carolingian context in which violence occurred helps to situate the evidence of trauma preserved in the archaeological record as well as approaches to traumatic injuries seen in the recipe literature. The archaeological sites reviewed above do not appear to represent battlegrounds given that, although trauma was evident, it was not recorded in the majority of individuals, as might be the case with a mass grave of war dead. Similarly, there is no evidence to suggest that the collections of recipes under consideration were written with either warfare or judicial punishments in mind. Instead,
Overall, the types of recipes recorded in the medical texts appear to have been highly applicable to many individuals in the Carolingian world, offering basic treatments for standard injuries. Indeed, the recipe literature seems particularly suited to those individuals who would have had access to the texts, such as the members of ecclesiastical communities and elite households. Warfare, however, represents violence on a different scale given the severity, urgency, and sheer number of injuries that would have occurred in battle.122 When entire limbs could be removed in a single blow, a topical plaster could only do so much.123 I suggest, therefore, that medical practitioners involved in military campaigns relied on an additional body of knowledge unrecorded by the written sources, and one that quite possibly included surgery. This information must have been primarily transmitted through non-textual knowledge exchange, such as oral traditions and practical experience.
5 Conclusion
Traumatic injuries, despite their seemingly straightforward cause-and-effect relationship, remain a challenging subject to investigate in past populations. This chapter has revealed that there is a fairly high degree of overlap between the textual evidence and skeletal record, especially with respect to fractures and wounds sustained from various types of blows. This suggests that much
Despite the general parallels between the two bodies of evidence, there are particular areas that might, at first glance, seem to present conflicting results. Yet, an in-depth analysis of the evidence has revealed that these more challenging topics are not necessarily incompatible with the bigger picture: with respect to puncture wounds or non-violent traumatic injuries, by contextualising the evidence, the seemingly contradictory results were reconciled. Surgery and warfare, however, are special cases, offering an important reminder that, although there is much evidence to support the use of the recipes recorded in Carolingian manuscripts in the practice of medicine, alternative sources of medical knowledge, such as oral traditions, remained vitally important during this period.
Cod. sang. 44, p. 243: Emplastrum qui sine ferro rumpit uulnera et scrofas et aperit. Salis ammoniaci lib I, mollibdine lib I, oleo lib I, cineris sarmentorum lib I, femus columbino ~ III, conficis et uteris. See Appendix 2, entry 5.5.
Mitchell, Medicine in the Crusades, 184. The topic of wounds received in battle will be considered in more detail below; for more on wounds generally in the medieval period, see Larissa Tracy and Kelly DeVries, eds., Wounds and Wound Repair in Medieval Culture (Leiden: Brill, 2015). âPeriodic bloodlettingâ, i.e., regular, and highly regulated, bloodletting, represents an important exception whereby a (minor) surgical procedure was actively sought; see Mary K. K. Yearl, âBloodletting as Recreation in the Monasteries of Medieval Europeâ, in Between Text and Patient: The Medical Enterprise in Medieval and Early Modern Europe, ed. Florence Eliza Glaze and Brian K. Nance (Florence: sismel Edizioni del Galluzzo, 2011), 217â43.
Debby Banham and Christine Voth, âThe Diagnosis and Treatment of Wounds in the Old English Medical Collections: Anglo-Saxon Surgery?â, in Wounds and Wound Repair in Medieval Culture, ed. Larissa Tracy and Kelly DeVries (Leiden: Brill, 2015), 153â74.
Margaret A. Judd and Rebecca Redfern, âTraumaâ, in A Companion to Paleopathology, ed. Anne L. Grauer (Chichester: Wiley-Blackwell, 2012), 359â79, at p. 359.
See âtrauma, n.â in Elizabeth A. Martin, ed., Oxford Concise Medical Dictionary, 9th ed. (Oxford: Oxford University Press, 2015),
Judd and Redfern, âTraumaâ, 360.
Ibid, 359â62.
While the inclusion of surgery as a type of trauma has, as noted above, been debated, it is usually categorised as such.
Skinner, âVisible Prowessâ, 92.
Cod. sang. 44, pp. 332â3: lxii. De uulneribus putridis; lxiii. De cautere.
Cod. sang. 899, p. 141: Cataplasma ad tumorem brachii que ex fleubotomo contingit. See Appendix 2, entry 14.4.
Banham and Voth, âThe Diagnosis and Treatment of Woundsâ, 154â6.
A small number of texts related to surgery, such as a list of surgical instruments, have survived. See Bliquez, âTwo Lists of Greek Surgical Instrumentsâ and Fischer, âUniversorum ferramentorum nominaâ.
Cod. sang. 899, p. 141: Item ad tumores, liuores, contusiones; Item ad liuorem tollendum. See Appendix 2, entries 14.5.2â3.
Cod. sang. 44, pp. 243â4: Oxira crucira emplastrum; cod. sang. 761, pp. 59â60: Oxyra crocira; bav pal. lat. 1088, f. 60r: Oxira crocira; and bav reg. lat. 1143, ff. 172râ172v: Oxyra grocira. See Appendix 2, entries 5.6, 12.2, 16.23, and 18.8, respectively.
Cod. sang. 44, pp. 238â9: Emplastrum apostolicon; cod. sang. 751, pp. 423â4: Inplastrum apostolicon; cod. sang. 761, pp. 65â6: Emplastrum apostolicum; and bav reg. lat. 1143, ff. 133râ134r: Apostolicon. The shared phrase, with some variation between recipes, is: ad ⦠omnes plaga quae a ferro inciditur siue [sudibus] siue uitro siue canna, sagittas educendas infixas corpori. See Appendix 2, entries 5.4, 9.24, 12.4, and 18.4, respectively.
Cod. sang. 751, pp. 367â8: Qui facit ad tibias putridas et ad omnes plagas sanandas. See Appendix 2, entry 9.5.
Cod. sang. 759, p. 63: Malagma aduersus dolores uel fracturas et podagra ad luxum. See Appendix 2, entry 11.11.
Cod. sang. 751, p. 378: Ad osso fracto. Solfor bibat per die VIIII terciam partem dinarium pinsantem ieiunus cum uino et aqua; p. 432: Ad ossa si fuerint fracta in testa. De pipinella puluis facis super teola exsiccas et super puluere ponis, si reticolus fuerit ruptus lana de papiro super reticulo ponis, et inde aceto et mel lauabis. See Appendix 2, entries 9.6 and 9.25, respectively.
Cod. sang. 759, p. 52: Ad fracturas ossorum. See Appendix 2, entry 11.6.
BnF lat. 11218, f. 97r: Ad costas fractas. Uitro, pice, acito resoluis in patena, bene adiuuat. See Appendix 2, entry 3.7.
bav pal. lat. 1088, f. 44v: De simplices uulneribus ad capitis fracturam. Uittonica contussa et super uulnus inposita mira celeritate gluttinat eo quide sanabis si tertio quoque die recentiorem frequentius inposueris donec sanescat etiam et ossa fractura extrahit; cod. sang. 751, p. 408: Ad capitis fractura. Uerba uittonica contusa in capitÄ in plaga inpositam rase celeritate gluttinatur. For full transcriptions, see Appendix 2, entries 16.9 and 9.14, respectively. Cf. Pseudo-Antonius Musa, De herba vettonica liber, ed. Howald and Sigerist, no. 1: Ad capitis fracturam. Herba uettonica contusa et super capitis ictum inposita uulnus mira celeritate glutinatum sanabit; eo quidem efficacius, si tertio quoque die refectam, id est recentiorem, frequentius inposueris, donec sanat. Eius potestas tantam habere fertur utilitatem, ut ossa quoque fracta ui sua extrahat.
Cod. sang. 751, pp. 405â6: Ad capitis fractura; p. 437: Ossa in capite si fracta fuerint. See Appendix 2, entries 9.13 and 9.28.
Cod. sang. 751, p. 405: Ad luxum; p. 440: Ad luxum; cod. sang. 44, p. 348: Ad luxatura. See Appendix 2, entries 9.12, 9.29, and 5.20, respectively.
Cod. sang. 759, p. 72: Ad talorem dolorem quis luxauerit ut dolor pausit. See Appendix 2, entry 11.15.
bav pal. lat. 1088, f. 45v: Ad contussione uel luxatura de praesenti; cod. sang. 1396, p. 20: Ad luxum uel contussim. See Appendix 2, entries 16.12 and 15.2, respectively.
Cod. sang. 759, p. 75: Unguentum ad fractura uel luxatura. See Appendix 2, entry 11.17.
bav pal. lat. 1088, f. 45r: Ad neruos incisos. See Appendix 2, entry 16.11.
Plinii Secundi Iunioris qui feruntur De medicina libri tres, ed. Ãnnerfors, 3.3 and 3.25. For the English translation, see The Medicina Plinii, trans. Hunt, 72â5, 94â5.
Plinii Secundi Iunioris qui feruntur De medicina libri tres, ed. Ãnnerfors, 3.3.1â2: Vermes terreni triti conglutinant, adeo ut etiam neruos incisos solident die septimo ⦠cochleae cum suis testis tusae cum myrrha et ture pari pondere etiam praecisos neruos sanant.
Annales Bertiniani, ed. Waitz, entry for 864 (at p. 67): Karolus iuvenis ⦠noctu rediens de venatione in silva Cotia, iocari cum aliis iuvenibus et coaevis suis putans, operante diabolo ab Albuio iuvene in capite spatha percutitur pene usque ad cerebrum; translation from The Annals of St Bertin, trans. Nelson, 111â12.
Cod. sang. 751, recipes with plaga: pp. 39 (two cases), 392, 399, 405, 407, 410, 435, 451 (two cases); recipes with percussus: pp. 404, 439, 471; bav pal. lat. 1088, recipes with plaga: ff. 39r, 44râ45r (one cluster of five recipes, one cluster of six recipes), 50v.
Cod. sang. 751, p. 392: De mandragora ⦠Ipsa radice teris et dequoquis cum oleo et super plaga pone mirum sanat. See Appendix 2, entry 9.7.1.
bav pal. lat. 1088, f. 50v: Puluera ad plagam assucandam et stringendam et celerius sanandam et carnem mortuam manducat. See Appendix 2, entry 16.18.
bav pal. lat. 1088, f. 44v: Ad alia uulnera uel plagas ubicumque a ferro aut quolibet. See Appendix 2, entry 16.10.
Cod. sang. 759, p. 61: Puluis qui facit ad implire placas etiam et si ossa minuta habuerit excutit; BnF lat. 11219, f. 225ra: Puluis ad implere plagas et si ossa habet minuata discutit. See Appendix 2, entries 11.10 and 4.3, respectively.
bav pal. lat. 1088, ff. 46vâ47r: Ad eos qui cum toxicata sagittasi sunt; cod. sang. 751, p. 396: Si spina in pede uel in alico membro fuerit. See Appendix 2, entries 16.13 and 9.9, respectively.
Cod. sang. 44, pp. 364â5: Ad punctas qui in latere superueniunt; bav pal. lat. 1088, ff. 39vâ40r: Ad punctas que lateribus superueniunt; BnF lat. 11218, f. 97r: Ad puncta que in lateribus superuenit. See Appendix 2, entries 5.29, 16.6, and 3.8, respectively.
The first recipes of the clusters and the single recipe in BnF lat. 11218 are as follows: bav pal. lat. 1088, f. 39v: Ad punctas que lateribus superueniunt. Aprotano trito in aqua colatum medium calicem tepidum bibat, admiscis modicum sal; cod. sang. 44, p. 364: Ad punctas qui in latere superueniunt. Abrotano trito in aqua colato medio calice tepidum bibat, admiscis modicum sal; BnF lat. 11218, f. 97r: Ad puncta que in lateribus superuenit, hoc est defecciones se in febre acute superuenit. Abrotanum in aqua tritum et euaporacione ne adhibeatur propere omnia et agriamen uetandum est. For full transcriptions, see Appendix 2, entries 16.6.1, 5.29.1, and 3.8, respectively.
Ferraces RodrÃguez, âUn recetario médico altomedievalâ; Ferraces RodrÃguez, âReutilización de fuentes en recetarios medicos de la antigüedad tardÃaâ.
Cod. sang. 759, p. 68: Remedium ad punctas lias de ceruisa recentis colas n<â¦> das et alio tando buter simul miscis et bibe dabis statim sanabitur. See Appendix 2, entry 11.14 for the full transcription.
Cod. sang. 759, p. 67: Medicamen mirabile ad placas ad sagita percusso. See Appendix 2, entry 11.13.
Cod. sang. 751, p. 395: Si homo de arbore uel de equo ceciderit. See Appendix 2, entry 9.8.
Cod. sang. 751, p. 400: Ad luxum. See Appendix 2, entry 9.10.
Cod. sang. 878, p. 333: Ad fracturam uel uulnera ferri. Farina ordeacia, adeps aprinus uel uerrinus, urtica minor. See Appendix 2, entry 13.1.
For the glosses, see von Steinmeyer and Sievers, Die althochdeutschen Glossen, vol. 4, 455.
Tosi, Badino, and Pezzoni, âMedical Conditions Observed in Osteoarchaeological Remainsâ, 29â34.
Waldron, Palaeopathology, 139â41.
Ibid, 151.
For a discussion of the need for caution when interpreting signs of violence in the past (and examples of overzealous readings of the skeletal evidence), see M. R. Geldof, ââAnd to describe the shapes of the deadâ: Making Sense of the Archaeology of Armed Violenceâ, in Wounds and Wound Repair in Medieval Culture, ed. Larissa Tracy and Kelly DeVries (Leiden: Brill, 2015), 57â80.
Annales Bertiniani, ed. Waitz, entry for 864 (at p. 67); translation from The Annals of St Bertin, trans. Nelson, 111â12.
Jochen Weber and Alfred Czarnetzki, âBrief Communication: Neurotraumatological Aspects of Head Injuries Resulting from Sharp and Blunt Force in the Early Medieval Period of Southwestern Germanyâ, American Journal of Biological Anthropology 114, no. 4 (2001): 352â6,
Tosi, Badino, and Pezzoni, âMedical Conditions Observed in Osteoarchaeological Remainsâ, 30; Weber and Czarnetzki, âNeurotraumatological Aspects of Head Injuriesâ, 352.
Tosi, Badino, and Pezzoni, âMedical Conditions Observed in Osteoarchaeological Remainsâ, 30; Weber and Czarnetzki, âNeurotraumatological Aspects of Head Injuriesâ, 352.
Tosi, Badino, and Pezzoni, âMedical Conditions Observed in Osteoarchaeological Remainsâ, 30.
Waldron, Palaeopathology, 138; Tosi, Badino, and Pezzoni, âMedical Conditions Observed in Osteoarchaeological Remainsâ, 30.
Waldron, Palaeopathology, 148.
Ibid.
Ibid, 142.
Ibid, 143.
Ibid, 143â4.
Ibid, 144.
Cod. sang. 1092. The label reads: fleotomatis hic gustandum uel potionariis; see Horn and Born, The Plan of St. Gall, 184â8.
On the relationship between calendars and medicine, see Wallis, âMedicine in Medieval Calendar Manuscriptsâ; on Egyptian Days, see Don C. Skemer, âArmis Gunfe: Remembering Egyptian Daysâ, Traditio 65 (2010): 75â106.
For a list of texts on bloodletting, see Beccaria, I codici; see also Sabbah, Corsetti, and Fischer, btml, nos. 185â8, 234â41; Fischer, btml 1, no. A-100.
Cod. sang. 751, p. 428: untitled lunar calendar; cod. sang. 878, pp. 366â7: Conservatio fleotomiae et dies caniculares. BnF lat. 11218, ff. 34vâ37r: Epistola fleobotomie; bav reg. lat. 1143, ff. 94vâ96v: Epistola fleopotomiae; cod. sang. 44, pp. 191â4: Epistula de phlebotomia; cod. sang. 217, pp. 252aâ252b, 255aâ255b; cod. sang. 751, pp. 359â61: Epistula de fleotomia Gallieni, pp. 455â6: Epistula de phlebotomia, and pp. 456â8: Epistula de phlebotomia.
Amoretti, âAnalisi paleobiologiche dei resti scheletriciâ, 513â15.
Ibid.
Aufderheide and RodrÃguez-MartÃn, The Cambridge Encyclopedia of Human Paleopathology, 172.
Mallegni, Bedini, Vitiello, Paglialunga, and Bartoli, âSu alcuni gruppi umaniâ, 233â61.
Mallegni, Bedini, Vitiello, Paglialunga, and Bartoli, âSu alcuni gruppi umaniâ, 233â61; Aufderheide and RodrÃguez-MartÃn, The Cambridge Encyclopedia of Human Paleopathology, 179.
Mallegni, Bedini, Vitiello, Paglialunga, and Bartoli, âSu alcuni gruppi umaniâ, 233â61.
Ibid.
Ibid.
Marta Licata, Mario Ronga, Paolo Cherubino, and Giuseppe Armocida, âDifferent Types of Traumatic Lesions on Mediaeval Skeletons from Archaeological Sites in Varese (North Italy): Diagnosis on ante mortal Fractures Using Macroscopic, Radiological and ct Analysisâ, Injury 45, no. 2 (2014): 457â9,
Licata, Ronga, Cherubino, and Armocida, âDifferent Types of Traumatic Lesionsâ, quotation from p. 458; further discussion in Licata, Borgo, Armocida, Nicosia, and Ferioli, âNew Paleoradiological Investigationsâ, 327.
Licata, Ronga, Cherubino, and Armocida, âDifferent Types of Traumatic Lesionsâ, 458.
Ibid, 458â9.
Licata, Ronga, Cherubino, and Armocida, âDifferent Types of Traumatic Lesionsâ, 458â9; Licata, Borgo, Armocida, Nicosia, and Ferioli, New Paleoradiological Investigationsâ, 327.
Monica Motto, âSepolture nel monastero di Cairate: tipologia e organizzazione delle aree cimiteriali, uno sguardo di sintesiâ, in Un monastero nei secoli. Santa Maria Assunta di Cairate: scavi e ricerche, ed. Valeria Mariotti (Mantua: sap, 2014), 501â17; Mattucci, Ravedoni, and Rettore, âAnalisi antropologica e paleopatologicaâ, 519â32.
Ibid, 523.
Ibid, 521â4.
Ibid, 523.
Panhuysen, âDemography and Health in Early Medieval Maastrichtâ, 197.
Ibid, 181.
Raphaël G. A. M. Panhuysen, âHet scherp van de snede: Sporen van geweld in vroegmiddeleeuws Maastrichtâ, Archeologie in Limburg 92 (2002): 2â7; Robert C. Woosnam-Savage and Kelly DeVries, âBattle Trauma in Medieval Warfare: Wounds, Weapons and Armorâ, on Wounds and Wound Repair in Medieval Culture, ed. Larissa Tracy and Kelly DeVries (Leiden: Brill, 2015), 27â56, at p. 35.
Panhuysen, âHet scherp van de snedeâ, 2â7; Woosnam-Savage and DeVries, âBattle Trauma in Medieval Warfareâ, 35.
Ibid.
Cattaneo and Mazzucchi, âPopolazioni tardo antiche e dellâalto medioevoâ, 87â98.
Ibid.
Cattaneo and Mazzucchi, âPopolazioni tardo antiche e dellâalto medioevoâ, 87â98; Waldron, Palaeopathology, 153â4.
ChavarrÃa and Marinato, âFrammentazione e complessità â, 61â8.
Ibid.
ChavarrÃa and Marinato, âFrammentazione e complessità â, 61â8; Cattaneo and Mazzucchi, âPopolazioni tardo antiche e dellâalto medioevoâ, 87â98.
Weber and Czarnetzki, âNeurotraumatological Aspects of Head Injuriesâ, 352â6.
Ibid, 353.
Ibid.
Ibid.
Ibid.
Waldron, Palaeopathology, 161; Weber and Czarnetzki, âNeurotraumatological Aspects of Head Injuriesâ, 353.
Charlotte A. Roberts and Jacqueline McKinley, âA Review of Trepanations in British Antiquity Focusing on Funerary Context to Explain Their Occurrenceâ, in Trepanation: History, Discovery, Theory, ed. Robert Arnott, Stanley Finger, and C. U. M. Smith (Lisse: Swets & Zeitlinger Publishers, 2003), 55â78; S. A. Mays, âA Possible Case of Surgical Treatment of Cranial Blunt Force Injury from Medieval Englandâ, International Journal of Osteoarchaeology 16, no. 2 (2006): 95â103,
M. Binder, J. Eitler, J. Deutschmann, S. Ladstätter, F. Glaser, and D. Fiedler, âProsthetics in AntiquityâAn Early Medieval Wearer of a Foot Prosthesis (6th Century ad) from Hemmaberg/Austriaâ, International Journal of Paleopathology 12 (2016): 29â40,
Binder, Eitler, Deutschmann, Ladstätter, Glaser, and Fiedler, âProsthetics in Antiquityâ, 31â2.
Ibid, 32.
Ibid, 33â9.
Panhuysen, âDemography and Health in Early Medieval Maastrichtâ, 183â4.
Although it must be remembered that some of these injuries may have been accidental, the method of inflicting damage (blows, strikes, cuts, etc.) can be described as violent.
Banham and Voth, âThe Diagnosis and Treatment of Woundsâ, 153â74.
Einhard, Vita Karoli Magni, ed. O. Holder-Egger, mgh ss Rer. Germ. 25 (Hanover: Hahn, 1911), Chapter 7 (at p. 10): Nam numquam eos huiuscemodi aliquid perpetrantes inpune ferre passus est, quin aut ipse per se ducto aut per comites suos misso exercitu perfidiam ulcisceretur et dignam ab eis poenam exigeret, usque dum, omnibus qui resistere solebant profligatis et in suam potestatem redactis. Translation from Einhard, Life of Charlemagne, in Two Lives of Charlemagne, trans. David Ganz (London: Penguin Books, 2008), Chapter 7 (at p. 23).
Angelbert, Versus de bella quae fuit acta Fontaneto, ed. Ernst Dümmler, mgh Poet. 2 (Berlin: Weidmann, 1884), 138: Caedes nulla peior fuit campo nec in Marcio; / fracta est lex christianorum; sanguinis proluvio, / unde manus; inferorum, gaudet gula Cerberi. Translation from Angelbert, The Battle of Fontenoy, in Poetry of the Carolingian Renaissance, trans. Peter Godman (London: Duckworth, 1985), 263.
Ekkehard I of St. Gall, Waltharius, ed. and trans. Abram Ring (Leuven: Peeters, 2016), 124â5: Huic galeam findens cerebrum diffudit et ipsam / Cervicem resecans pectus patefecit, at aegrum.
Ekkehard, Waltharius, ed. and trans. Ring, 128â9: Hinc indignatus iram convertit in ipsum / Waltharius humerumque eius de cardine vellit / Perque latus ducto suffudit viscera ferro.
Jan M. Ziolkowski, âFighting Words: Wordplay and Swordplay in the Walthariusâ, in Germanic Texts and Latin Models: Medieval Reconstructions, ed. Karin E. Olsen, Antonina Harbus, and Tette Hofstra (Leuven: Peeters, 2001), 29â51; Jan M. Ziolkowski, âBlood, Sweat and Tears in the Walthariusâ, in Insignis Sophiae Arcator: Medieval Latin Studies in Honour of Michael Herren on his 65th Birthday, ed. Gernot R. Wieland, Carin Ruff, and Ross G. Arthur (Turnhout: Brepols, 2006), 149â64.
Simon Coupland, âCarolingian Arms and Armor in the Ninth Centuryâ, Viator 21 (1990): 29â50.
Coupland, âCarolingian Arms and Armour in the Ninth Centuryâ, 44.
On Roman military medicine, see, for example, Ido Israelowich, âMedical Care in the Roman Army during the High Empireâ, in Popular Medicine in Graeco-Roman Antiquity: Explorations, ed. William V. Harris (Leiden: Brill, 2016), 215â30. For medicine in the Crusades, see Mitchell, Medicine in the Crusades.
Warren C. Brown, Violence in Medieval Europe (Harlow: Pearson Education Limited, 2011), 71â8; Capitulare Haristallense, ed. Alfred Boretius, mgh Capit. 1, no. 20 (Hanover: Hahn, 1883), c. 1; Admonitio generalis, ed. Alfred Boretius, mgh Capit. 1, no. 22 (Hanover: Hahn, 1883), c. 8.
Brown, Violence in Medieval Europe, 75; Capitula a sacerdotibus proposita, ed. Alfred Boretius, mgh Capit. 1, no. 36 (Hanover: Hahn, 1883), c. 18; Capitulare missorum item speciale, ed. Alfred Boretius, mgh Capit. 1, no. 35 (Hanover: Hahn, 1883), c. 37; Capitula de causis cum episcopis et abbatibus tractandis, ed. Alfred Boretius, mgh Capit. 1, no. 72 (Hanover: Hahn, 1883), c. 4.
Cod. sang. 878, p. 333: Ad fracturam uel uulnera ferri; see Appendix 2, entry 13.1.
Edictus Rothari, in Leges Langobardorum, ed. Friedrich Bluhme, mgh ll 4 (Hanover: Hahn, 1868), 1â90; Rothairâs Edict, in The Lombard Laws, trans. Katherine Fischer Drew (Philadelphia: University of Pennsylvania Press, 1973), 39â130; on early medieval law codes more generally, see Katherine Fischer Drew, Law and Society in Early Medieval Europe: Studies in Legal History (London: Variorum, 1988).
Edictus Rothari, ed. Bluhme, 242 (at p. 60): Si quis sine iussionem regis aurum figuraverit aut moneta confinxerit, manus ei incidatur; 243 (at p. 60): De cartola falsa. Si quis cartolam falsam scripserit aut quodlibet membranum, manus ei incidatur. Translation from Rothairâs Edict, trans. Fischer Drew, 100.
Banham and Voth, âThe Diagnosis and Treatment of Woundsâ, 169.
As illustrated by Walterâs attack on Gunther: Walter âpried Guntherâs shield away on the right, made a mighty and amazing blow, and tore off his leg up to the knee, all of it below the thighâ (Impetit et scuto dextra de parte revulso / Ictum praevalidum ac mirandum fecit eique / Crus cum poplite adusque femur decerpserat omne); Ekkehard, Waltharius, trans. Ring, 152â3.