WILLIAM OF SALICET
The third of the great surgeons in northern Italy was William of Salicet. He was a pupil of Bruno's and the master of Lanfranc. The first part of his life was passed at Bologna and the latter part as the municipal and hospital physician of Verona. He probably died about 1280. He was a physician as well as a surgeon and was one of those who insisted that the two modes of practising medicine should not be separated, or if they were both medicine and surgery would suffer. He thought that the physician learned much by seeing the interior of the body during life, while the surgeon was more conservative if he were a physician. It is curiously interesting to find that the Regius Professors at both Oxford and Cambridge in our time have expressed themselves somewhat similarly. Professor Clifford Allbutt is quite emphatic in this matter and Professor Osler is on record to the same effect. Following Theodoric, William of Salicet did much to get away from the Arabic abuse of the cautery and brought the knife back to its proper place again as the ideal surgical instrument. Unlike those who had written before him, William quoted very little from preceding writers. Whenever he quotes his contemporaries it is in order to criticise them. He depended on his own experience and considered that it was only what he had actually learned from experience that he should publish for the benefit of others.
A very good idea of the sort of surgery that William of Salicet practised may be obtained even from the beginning of the first chapter of his first book. This is all with regard to surgery of the head. He begins with the treatment of hydrocephalus or, as he calls it, "water collected in the heads of children newly born." He rejects opening of the head by an incision because of the danger of it. In a number of cases, however, he had had success by puncturing the scalp and membranes with a cautery, though but a very small opening was made and the fluid was allowed to escape only drop by drop. He then takes up eye diseases, a department of surgery rather well developed at that time, as can be seen from our account of the work of Pope John XXI as an ophthalmologist during the thirteenth century. See Ophthalmology (January, 1909), reprinted in "Catholic Churchmen in Science," Philadelphia, The Dolphin Press, 1909.
William devotes six chapters to the diseases of the eyes and the eyelids. Then there are two chapters on affections of the ears. Foreign bodies and an accumulation of ear wax are removed by means of instruments. A polyp is either cut off or its pedicle bound with a ligature, and it is allowed to shrivel. The next chapter is on the nose. Nasal polyps were to be grasped with a sharp tenaculum, cum tenacillis acutis, and either wholly or partially extracted. Ranula was treated by being lifted well forward by means of a sharp iron hook and then split with a razor. It is evident that the tendency of these to fill up again was recognized, and accordingly it was recommended that vitriol powder, or alum with salt, be placed in the cavity for a time after evacuation in order to produce adhesive inflammation.
In the same chapter on the mouth one finds that William did not hesitate to perform what cannot but be considered rather extensive operations within the oral cavity. For instance, he tells of removing a large epulis and gives an account in detail of the case. To quote his own words: "I cured a certain woman from Piacenza who was suffering from fleshy tumor on the gums of the upper jaw, the tumor having grown to such a size above the teeth and the gums that it was as large or perhaps larger than a hen's egg. I removed it at four operations by means of heated iron instruments. At the last operation I removed the teeth that were loose with certain parts of the jawbone."
In the next chapter there is an account of the treatment of a remarkable case of abscess of the uvula. In the following chapter the swelling of cervical glands is taken up. In his experience expectant treatment of these was best. He advises internal medication with the building up of the general health, or suggests allowing the inflamed glands to empty themselves after pustulation. After much meddlesome surgery we are almost back to his methods again. He did not hesitate to treat goitre surgically, though he considered there were certain internal remedies that would benefit it. In obstinate cases he suggests the complete extirpation of cystic goitre, but if the sac is allowed to remain it should be thoroughly rubbed over on the inside with green ointment. He warns about the necessity for avoiding the veins and arteries in this operation, and says that "in this affection many large veins make their appearance and they find their way everywhere through the fleshy mass."
What I have given here is to be found in a little more than half a page of Gurlt's abstract of the first twenty chapters of Salicet's first book. Altogether Gurlt has more than ten pages of rather small print with regard to William; most of it is as interesting and as practical and as representative of anticipations of what is done in the modern time as what I have here quoted. William, as I have said, depended much more upon his own experience than upon what was to be found in text-books. He knew the old text-books very well however, but as a rule did not quote from them unless he had tried the recommendations for himself, or unless similar cases to these mentioned had come under his own observation. He was evidently a thoroughly observant physician, a skilled surgeon who was practical enough to see the simplest way to do things, and he proceeded to do them. It is no wonder that he influenced succeeding generations so much, nor that his great pupil, Lanfranc, continuing his tradition, founded a school of surgery in Paris, the influence of which was to endure almost down to our time, and give France a primacy in surgery until the nineteenth century.