The growth of medicine from the earliest times to about 1800

by Albert H. Buck

Case III.—A man was struck by a heavy stone on the upper part of the forehead close to where the hair grows, and was thrown to the ground by the force of the blow. Here he lay as if dead. When Leone was called, a short time afterward, to see the patient he found the skin unbroken except at one small spot, and from this point he made an incision of such length that he was thereby enabled to explore the surface of the skull. In this way he discovered that there was a fracture which appeared to extend through the entire thickness of the skull. He then, without further delay, trephined the cranium over the line of the fracture. This was followed by such a copious flow of blood that Leone was obliged to adopt measures for arresting any further hemorrhage. During the following fourteen days (the summer season then being at its height) large quantities of decomposed and evil-smelling blood escaped from the wound; but the dura mater gradually assumed a more natural appearance, many splinters of bone were ejected, and finally—at the end of forty days—the wound healed. (As no further details are given in the text, it is fair to assume that there were no sequelae of an unfavorable nature.)

The whole subject of injuries to the skull is treated in a most thorough manner by Leone, and the book is pronounced by Scarpa (1752–1832), the famous anatomist, the best that, up to his time, had been written on the subject. The three histories of cases which I have here reproduced and which furnish such striking proof of what surgery may accomplish when practiced by a man of good courage as well as of good judgment, certainly justify the favorable opinion expressed by Scarpa upon Leone’s work.

Fabricius ab Acquapendente, of whom I have already given some account on a previous page, was distinguished not only as an anatomist and as a physiologist, but also—which was true of his instructor, Fallopius—as a surgeon. From his published writings, however, it appears very clearly that, like Fallopius, he had a decided aversion to the use of the knife; his activities as a surgeon being restricted largely to the improvement of certain of the more bloodless operations (for example, tracheotomy and thoracentesis and operations for the relief of stricture of the urethra). He also invented several new surgical instruments and devised a number of machines for use in orthopaedic practice. He attached great value to the teachings of Celsus and Paulus Aegineta, his writings containing frequent and copious references to these authorities and relatively few data based upon his own experience. In the section which he devotes to the subject of wounds of the abdomen, Fabricius confirms the opinion very generally held by the ancients, viz., that a wound of the small intestine is invariably fatal.

Gaspare Tagliacozzi was born at Bologna in 1546. He studied medicine under Girolamo Cardano, Professor of Medicine, first at Pavia and afterward at Bologna, and received his degree (“Doctor of Philosophy and Medicine”) in 1570. Very soon afterward he began teaching surgery, and a little later he also taught anatomy and the theoretical part of medicine. In this work he was so successful that in 1576 he was made a member of the Faculty. He died on November 7, 1599, at the age of fifty-three.

The Italian method of performing plastic operations, says von Gurlt, had already flourished for about one hundred and fifty years before Tagliacozzi took up the subject in serious earnest and attained results of decided scientific value. There are some doubts, however, as to the precise degree of credit that should be awarded Tagliacozzi for his share in the development of the operation which bears his name. The facts which throw some light upon this question may be stated in the following paragraphs:—

(1.) Tagliacozzi’s Latin is not easy to understand, and he certainly does not furnish satisfactory information as to the manner in which he learned the details of the operation which we are here considering. Vesalius, Paré and other surgical authors of that period throw no light upon that question and furnish erroneous descriptions of the steps of the operation. Apparently they had never witnessed one of that character. (Von Gurlt.)

(2.) The records seem to warrant the statement that, about the middle of the fifteenth century a surgeon by the name of Branca, who lived in the city of Catania on the southeast coast of Sicily, devoted himself largely to the reconstruction of damaged or defective noses. At first he transplanted a flap from the forehead or cheek; but afterward his son sought to improve the method by utilizing a flap of skin taken from the arm. By this plan the disfiguring of the patient’s face was avoided. The son employed the same method in repairing the lips and the ears. Pupils of the latter carried a knowledge of the method to the Bojano (Vianea or Vieneo) family in Tropea, Calabria, and from them it was transmitted, about the middle of the sixteenth century, to Tagliacozzi and eventually to the medical profession in every part of the world.

(3.) In 1581 there was published at Cracow, Galicia (formerly Poland), a book which bore the title “Przymiot” and which gave a most complete account of the disease syphilis in all its manifestations and complications. This book, in its original form, is to-day one of the greatest bibliographical rarities; but a reprint of the work was published in 1881 by the Warsaw Surgical Society. In this volume Wojciech Oczko, the personal physician and secretary of the Polish kings Stephan Bathory and Sigismund the Third, discusses other surgical topics beside syphilis. He states, for example, that Aranzio (or Arantius), who was Professor of Surgery at Bologna at the time (1569) when he frequented that medical school, was successful in making a new nose by transplanting a flap of skin from the patient’s arm; and that he performed this operation without injuring the muscles of the arm, and also with perfect success as regards the creation of a straight and shapely nose. “This statement,” says von Gurlt, “coming as it does from an eye-witness who was at Bologna several years before Tagliacozzi’s time, furnishes satisfactory proof that rhinoplasty was successfully performed in that city several years before the date of publication (1586) of Tagliacozzi’s earliest comments on the subject, and that the credit for first bringing the operation to the knowledge of European surgeons is due to Aranzio rather than to Tagliacozzi.” The latter’s famous treatise on rhinoplasty (“De chirurgia curtorum per insitionem”) was published at Venice in 1597.

FIG. 21. THE MANNER IN WHICH THE SO-CALLED TAGLIACOTIAN OPERATION FOR REPAIRING A DEFECTIVE NOSE SHOULD BE CARRIED OUT.