Marianus Sanctus of Barletta near Naples (born in 1489, died at some unknown date after 1550) is credited with having been the first to publish a description of the so-called “apparatus magnus”—the name given in those early days to the method of extracting a calculus from the urinary bladder through an incision in the perineum after a grooved sound or director had first been passed into this organ by way of the urethra. The title of the book in which this description is given is the following: “De lapide renum liber et de lapide ex vesica per incisionem extrahendo,” Venice, 1535. Marianus, however, does not claim to have been the inventor of this method. Some writers give the credit for this to Jean da Vigo’s father, Bernardo di Rapallo, who communicated a knowledge of the method to Giovanni de Romanis, who in turn instructed Marianus Sanctus. It is believed, furthermore, by some writers that Giovanni de Romanis was the inventor of lithontripsy[86]—the operation of crushing a stone in the bladder or urethra. Laurent Colot, the famous French lithotomist of the eighteenth century, obtained his knowledge from a certain Octavianus de Villa, a friend of Marianus Sanctus, and then kept the matter secret for many years.
Fallopius, the famous anatomist of the early part of the sixteenth century, does not appear to have attained equal distinction in the field of surgery. So far as one may judge from the portions of the text selected from his writings by von Gurlt, Fallopius was a very conservative if not a very timid surgeon, in this respect being not unlike Fabricius ab Acquapendente. In the text to which reference has just been made, I find a brief mention of a case which passed under Fallopius’ observation and which, perhaps, is of sufficient interest to be recorded here. The patient’s—a German student’s—finger had been nearly severed by some cutting instrument, and the greater part of the member remained attached to the hand only by a narrow strip of flesh. “I stitched together the separated edges, and at the end of three or four days I was astonished to find that firm union between the separated parts had already taken place. This result seemed to me like something miraculous.”
Carcano Leone was born at Milan in 1536, his parents being people of good social standing. After receiving a thorough classical education, he began his medical studies in his native city, under the guidance of Pietro Martire, a pupil of Vesalius. He next continued his studies at the University of Pavia, but eventually went to Padua, where he enrolled himself among the pupils of Fallopius. After a residence of two years in that city, he returned to Milan and opened a medical school of his own. Upon the occasion of the death of the Cardinal and Archbishop Carlo Borromeo, whose remains now rest in the cathedral of Milan, it was Carcano Leone who was invited to make the postmortem examination. He carried on the practice of his profession during a period of about twenty-eight years, his death occurring—so far as may now be learned—in 1606.
Carcano Leone’s reputation as a surgeon rests mainly on the treatise which he wrote on the wounds of the head, and which was published at Milan in 1583. From among the numerous cases of this character which came under his observation, and of which a certain number are reported by von Gurlt, I have selected the very brief histories of three that seem to me well adapted to serve as examples of Leone’s knowledge of surgery and also of his ability to cope with problems of so serious a character. They reveal the fact that he was a surgeon of excellent judgment, most persevering, and very resourceful. Briefly told, the accounts of the three cases to which I have referred read as follows:—
Case I.—A small boy was hit on the right temple by a stone that had been thrown by one of his companions. Unconsciousness resulted and lasted for six days. On the seventh day signs of returning consciousness manifested themselves, but inability to speak persisted. By the end of another week the boy had already made some efforts to speak, but his speech was incomprehensible. After the twentieth day it was possible to understand a little of what the boy was trying to say; and from this time onward steady improvement in this respect was recognizable from day to day; but the boy’s speech did not become quite normal until after the lapse of about a year.
When Carcano Leone was called to see the patient he found that the entire temporal muscle had been crushed and that almost the entire right side of the head was occupied by a fluctuating swelling. By making a free incision in the swelling Leone gave exit to a large quantity of black coagulated blood. On the following day, when he made an examination with the probe, he found that the entire squamous portion of the temporal bone was in a fractured state, one part of it overriding the rest. By the aid of elevators he succeeded in lifting up the depressed part of the bone, but the accomplishment of this result left a large gap between the opposite edges of the fragments, and through this opening one could see the movements of the dura mater. Complete healing took place only after the lapse of twelve months.
When Leone reported the case to his former teacher, Fallopius, the latter replied that he would not have had the courage to adopt the course which his former pupil had pursued.
Case II.—In another case the patient, a full-grown man, was struck on the right temple by a highwayman with a heavy cane which broke in two in the middle under the great force which the assailant had employed. He was left lying on the roadside in a state of unconsciousness until some passers-by discovered him and carried him to his home. He remained unconscious for several days. Before the physician was summoned all sorts of measures had been resorted to for the purpose of dissipating the swelling in the temporal region, but without success. Leone, on arriving upon the scene, made a free incision which afforded escape to a large quantity of decomposing blood that appeared to be collected, not between the muscle and the skin, but between the muscle and the bone. The latter was found to be fractured transversely and depressed; and, in order to lift it back to its proper level, it became necessary first to incise the muscle transversely. At the end of three months the wound had completely healed and the patient had regained his health.
Speaking of the cases just narrated and of others of a similar nature, Leone remarks that he has never had any experience that would justify the fear expressed by Hippocrates that convulsions are likely to result from dividing the temporal muscle.
With reference to the value of trephining the skull in cases of injury to the head, Leone narrates the following experience:—