The fourth of these great surgeons at the North of Italy was William of Salicet. He was a pupil of Bruno of Longoburgo. Some idea of his practice as a surgeon may be obtained from even the first chapter of his first book. 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 incision because of the danger of it. He had successfully treated some of these difficult cases, however, by puncturing the scalp and membrane by a cautery, a very small opening being made and fluid being allowed to escape only drop by drop. William did not quote his predecessors much, but depended to a great extent on his own experience. He has many interesting details of technique with regard to the special subject of surgery of the nose, the ear, the mouth; and he did not even hesitate to treat goitre when it grows large, and says that if the sac is allowed to remain it should be thoroughly rubbed over on the inside with “green ointment.” He warned “that in this affection many large bloodvessels make their appearance, and they find their way everywhere through the fleshy mass.”

A very interesting development of surgery along a line where it would probably be least expected was in plastic surgery. In the first half of the fifteenth century the two Brancas, father and son, performed a series of successful operations for the restoration of the nose particularly, and the son invented a series of similar procedures for the restoration of mutilated lips and ears. The father seems to have built up the nose from other portions of the face, possibly using, as Gurlt suggests, the skin of the forehead, as the Indian surgeons had done, though without any known hint of their work. Fazio, the historian of King Alphonso I. of Naples, who died in 1457, describes the favourite operation of Antonio Branca, the son, who in order not to disfigure any further the face in these cases, made the new nose from the skin of the upper arm; and in anticipation of Tagliacozzi, who attracted much attention by a similar operation in the latter half of the sixteenth century, separated the new nose from the arm sometime during the third week. There is abundance of other evidence as to the Brancas’ work from contemporary writers—for instance, Bishop Peter Ranzano the annalist, the poet Calenzio, and Alexander Benedetti, the physician and anatomist—so that there can be no doubt of the fact that this wonderful invention in surgical technique was actually made before the close of the Middle Ages.

It is interesting to realize that, while we hear much about the work of the Brancas, and from ecclesiastical authorities, there is no word of condemnation of the practice of restoring the nose or other facial features until much later in history. Tagliacozzi, who revived the operation of rhinoplasty just about the beginning of the seventeenth century, did not share so kind a fate. The latter Italian surgeon was roundly abused by some of his colleagues, even, it is said, by Fallopius and Paré, and bitterly satirized in Butler’s “Hudibras.” As late as 1788 (!) the Paris faculty interdicted face-repairing altogether. It is this sort of intolerance, on some superstitious ground or other, that is usually attributed to the Middle Ages. For such events the adjective medieval seems particularly adapted. As a matter of fact, we find comparatively little trace of such intolerance in medieval times; but it is comparatively easy to find the bitterest treatment of fellow-mortals for all sorts of foolish reasons in the seventeenth and eighteenth centuries.

CHAPTER VII

SURGEONS OUTSIDE OF ITALY: SURGEONS OF THE WEST OF EUROPE

“Sciences are made by addition, and it is not possible that the same man should begin and finish them....” “We are like infants at the neck of a giant, for we can see all that the giant sees and something more.”—(Guy De Chauliac, Papal Physician to the Popes at Avignon.)

The very interesting and in many ways astonishing development of surgery which occurred in Italy in the twelfth and thirteenth centuries, was followed up by similar developments in the western countries of Europe. France was the first to fall into the line of progress with important advances in surgery, and owes her teaching directly to the Italians; but in Flanders, in England, in Spain, and in Germany, we have records of some significant advances in surgery, and distinguished surgeons wrote books that fortunately for the history of surgery were preserved. The most important of the surgical writings of the time, put in type during the great nascent period of printing at the Renaissance, have come down to us. Many of these have been republished in recent years, and as the texts are now readily available they enable anyone to see for himself just what were the interests of the surgeons of the later medieval period, their technique, and their successful applications of great practical principles to the solution of important surgical problems.

The beginning of French scientific surgery came with the exile from Italy of Lanfranc, as he is known, though his Italian name was Lanfranchi or Lanfranco, and he is sometimes spoken of as Alanfrancus. He had practised as physician and surgeon in Milan until banished from there by Matteo Visconti, about 1290. He made his way then to Lyons, where he attracted so much attention by his success as a surgeon that he was offered the chair of professor of surgery at the University of Paris. “He attracted an almost incredible number of scholars to his lessons in Paris, and by hundreds literally they accompanied him to the bedside of his patient and attended his operations” (Gurlt). Paris was at this time at the very height of its glory as a University. It had had a series of distinguished professors whose writings are still known and honoured, Albert the Great, Thomas Aquinas, Roger Bacon, and Duns Scotus; and during the latter half of the thirteenth century Louis IX. had encouraged the University in every way, and had helped in the foundation of the Sorbonne. There were probably more students in attendance at the University of Paris about the time that Lanfranc was there than there has ever been in attendance at any University before or since. The prestige of Lanfranc’s position, then, and his opportunity to impress the world of his time, can be readily appreciated.