It seems that very little of medical knowledge was lost during the fall of Western Roman Empire, as the medical traditions survived in the Eastern Empire and both the contemporary ideas and methods, as well as classical works they were based on (e.g. those of Hippocrates, Aristotle, Galen or Soranus) were preserved and copied quite efficiently. This had a side effect of perpetuating artificial ideas that stalled actual medicine, such as the concept of humours that, even though if possibly based on factual observations (it somehow corresponds to modern influence of four main neurotransmitters on human behaviour) it gave almost completely false explanations concerning human physiology, causing Western medicine (save surgery) to be dogmatic rather than practical until 19th century.

Regardless, lack of antiseptics in procedures conducted by surgeons during the Civil War suggests either simple shortages of equipment or rejection of 'old methods' rather than loss of ancient knowledge. It should be noted that wine, honey and resins, typical for Middle Ages, ceased to be used somewhere around 18th century, as the preferred post-operative antiseptic during Civil War appears to be bromide solution. It is interesting that Joseph Lister's proposal of using carbolic acid as an disinfectant was basically return to the ancient and medieval methods rather than something completely innovative (natural resins and tars were efficient due to antibacterial properties of phenols and terpenes).

There is a detailed record concerning the operation conducted by John Bradmore who tended to the wound suffered by Henry of Monmouth (later king Henry V) in the battle of Shrewsbury in 1403 and later included the description of the operation in his medical treatise 'Philomena'. To extract an arrowhead stuck in the deep wound, Bradmore says that he first created a channel with wooden probes 'stitched in purified linen and infused with 'rose honey', extracted the arrowhead with forceps then 'cleansed the wound with squirtillo (lit. wash bottle, possibly some kind of syringe) filled with white wine' and finally 'inserted probes [...] dipped in mundificative (cleansing) ointment made of [...] barley, mead and terebinthine'. The probes were changed regularly, and replaced with progressively smaller ones. Bradmore says that the wound was perfectly cleansed and healed within 20 days. During recuperation, Bradmore also says that he 'regenerated flesh with unguentum fuscum'. This possibly means dressing of the entry wound with 'dark ointment' that 'Dictionary of Medical Vocabulary in English, 1375–1550' describes as a mixture of olive oil, beeswax, colophony, turpentine, rosin, mastic or terebinthine, in general - a mixture of plant resins in oil or wax carrier, what makes pretty reasonable antibacterial topical remedy. Similar measures were taken by Bradmore while healing one of the king's courtiers who suffered piercing wound to the abdomen: a probe soaked in resin ointment was inserted in the wound, a poultice of rosins and wine was put over the entry wound, the whole area was washed with wine and firmly bandaged. Wound was washed and bandages changed daily until recovery.

These examples, typical for the period of High/Late Middle Ages, shows that idea of disinfection was very well known and very sound from practical standpoint, mainly due to awareness of the natural processes that will be explained by germ theory several centuries later. It also proves that when in comes to disinfection and surgical procedures, not only Graeco-Roman knowledge was not lost, but it has been expanded first by Christian physicians, predominantly from Salernian Medical School that rose to prominence in 10th century and later through cultural and scientific exchange with the Muslim World in 11th-13th century.

Main problem with assessment of the knowledge level in the early medieval Europe is scarcity of written materials, especially operation records, that makes hard to establish what methods and treatments were used in surgery or medicine in general. There is vast archaeological evidence of advanced surgical procedures from 6th-8th century Germany and 10th century Bohemia and Slovakia, with roughly 10% of skulls with severe slashing wounds (suggesting combat damage) showing trepanation marks. Remains of copper implants surrounded with bone tissue show that complex operations were performed and ended with patient's survival. Surviving documents show also existence of advanced analgesia, including inhalational anaesthesia that was abandoned and returned only in 19th century after the introduction of nitrous oxide and diethyl ether.

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L. Garcia Ballester, R. French, J. Arrizabalaga, A. Cunningham, 'Practical Medicine from Salerno to the Black Death', Cambridge 1994.

P.D. Mitchell, 'Medicine in the Crusades: Warfare, Wounds and the Medieval Surgeon', Cambridge 2004.

M. McVaugh. 'The Rational Surgery of the Middle Ages', Florence 2006.

P. Juvin, J.-M. Desmonts, 'The Ancestors of Inhalational Anaesthesia: the Soporific Sponges (XIth-XVIIth Centuries). How a Universally Recommended Technique was Abruptly Discarded', in: Anesthesiology 93, 2000, pp. 265-9.

T. Hunt, 'The Medieval Surgery', Woodbridge 1999.