Human history can be followed by the history of the scalpel.

Human history can be followed by the history of the scalpel. Many fantasy gamers pride themselves on their knowledge of historical weapons, but while it’s all well and good (and occasionally even useful) to be able to differentiate a gladius from a kopis, a knowledge of weapons without a knowledge of other tools will always be woefully incomplete. Many have said that weapons are the truest indicator of scientific and cultural advancement over the course of history, but the evidence suggests that blades have been used for healing for at least as long as they’ve been used for warfare, if not longer. Ironically, it’s only as modern science inches ever closer to the realm of science fiction that our own cutting tools have begun to mimic those of medieval fantasy, and we’re learning ever more about how surgical tools might work in the average campaign setting.

Cuttings tools may have been among the earliest tools devised by humanoid life. The human body, after all, is very ill-suited to be a bludgeoning weapon, whereas several parts of the human body are sharp. Early humans undoubtedly learned that they could perform any number of vital tasks with their own teeth and nails, including cutting umbilical cords and killing other animals. The earliest knives, not counting those people were born with, were probably naturally sharp rocks. There’s actually evidence that as far back as ten thousand years ago, such crude knives were already being used for a rather surprising medical procedure: neurosurgery. Ancient skulls have been found with signs of relatively careful drilling which, much like later trepanation, is speculated to have been a way to treat seizures, headaches or mental disorder. Sharp stones gave way to sharpened stones and early metals, and by 2500 BCE Egyptians had specialized tools with which to work on the body. The most famous of their tools, of course, were primarily used on dead bodies, but the few records of Imhotep and other surgeons of his era confirm that they had more than just convenient rocks.

Two thousand years later, Hippocrates, who is somewhat unfairly credited with almost every other “first” in medicine, produced the earliest surviving descriptions of a knife specifically crafted for surgery. He described a broad, thin blade with a single edge, sharpened to the keenest edge possible, and a sharp point. He further described having used the knife to drain fluid from a patient’s lungs through a very, very small incision in the chest wall.

Surgery became more or less unknown in Europe during the dark ages, when it was declared illegal to cut the body even to save a life. In this, the evolution of the scalpel still parallels that human civilization, because it stopped. In the Arabic world, however, techniques continued to advance. Precursors of many of our modern surgical instruments are believed to have been invented before the 13^th century and probably spread to Europe over one or two centuries, meaning that it’s not far-fetched to suppose that they would be available in any medieval fantasy setting with a tradition of scholars and intellectuals.

The “modern” scalpel, being a small and exquisitely sharp steel blade, probably evolved over the late Renaissance and was a common tool by the eighteenth century. The biggest developments in our era have been two fold. First, steel scalpels were initially cast as single pieces, making it much more prohibitive to dispose of them as they dulled or wore out. Replaceable blades made it much easier and more cost effective to have sharp blades available. Second, the ongoing discovery of superior alloys has made it possible to produce sharper, longer-lasting blades which also cause less irritation and infection to the patient.

The advancement which brings us back to the level of medieval fantasy is electrosurgery. Surgeons have been using heat as a way to control bleeding and kill diseased tissue since at least the sixth century BCE, but the discovery that electricity can be used to heat metal is what’s given us the capacity to create, in a sense, “magic weapons.” Electricity can be used to kill tissue without causing unwanted surrounding damage, while tools kept at a precise and steady heat can reliably cut and instantly cauterize. By the same logic, the field has been slowly moving towards other sci-fi-like advancements in cutting, including the use of lasers, which are already common in ophthalmological surgery. While we’re still a long way from performing routine surgeries with blades composed of shaped coherent plasma, it’s the direction that we’re slowly moving in.

Unburdened as they are by our stubborn laws of physics, it may be that the surgeons in your setting are actually much more advanced than we are in terms of their tools. Consider: one of the biggest advances in modern surgery  was essentially the invention of a +1 flaming scalpel. Costly as it may be, there’s theoretically nothing to stop a healer from creating a magic scalpel that not only heats itself to cauterizing temperatures, but also adds a dexterity bonus to the surgeon’s hands and magically closes an incision when the surgery is finished. Another person might forgo a blade entirely and have a scalpel whose cutting edge is pure force, able to cut with monomolecular precision. The advantage that we have here is that our scalpels can be mass-produced in their millions, whereas a magical scalpel would be so costly that the average healer would never be able to afford such a thing. They could beat us another way, though, since

materials that are prohibitive for us are often relatively commonplace in fantasy. In our world, we use steel because it’s easy to shape into a blade with our production techniques, but obsidian remains the sharpest substance known to modern science. In the Pathfinder SRD, obsidian is, if anything, even cheaper than steel; it wouldn’t be at all surprising if in such a fantasy setting, using steel blades in surgery is considered second-rate and foolish.

I always tend to assume that characters in a fantasy campaign are at least as creative as real thinkers. Any number of magical weapon enhancements have the potential to be creatively applied to medical equipment. If real engineers are labouring to do exactly this in our world, there’s no reason why you shouldn’t come up with some clever applications in yours. 

More than four years ago, Dr. Eris Lis, M.D., began writing a series of brilliant and informative posts on RPGs through the eyes of a medical professional, and this is the one that appeared here on March 22, 2015. Lis is a physician, gamer, and author of the Skirmisher Publishing LLC OGL sourcebook Insults & Injuries, which is also available for the Pathfinder RPG system.