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Bruno Da Longoburgo

The first of this important group of north Italian surgeons who taught
at these universities was Bruno of Longoburgo. While he was born in
Calabria, and probably studied in Salerno, his work was done at Vicenza,
Padua, and Verona. His text-book, the Chirurgia Magna, dedicated to
his friend Andrew of Piacenza, was completed at Padua in January, 1252.
Gurlt notes that he is the first of the Italian surgeons who quotes,
besides the Greeks, the Arabian writers on surgery. Eclecticism had
definitely come into vogue to replace exclusive devotion to the Greek
authors, and men were taking what was good wherever they found it. Gurlt
tells us that Bruno owed much of what he wrote to his own experience and
observation. He begins his work by a definition of surgery, chirurgia,
tracing it to the Greek and emphasizing that it means handwork. He then
declares that it is the last instrument of medicine to be used only when
the other two instruments, diet and potions, have failed. He insists
that surgeons must learn by seeing surgical operations and watching them
long and diligently. They must be neither rash nor over bold and should
be extremely cautious about operating. While he says that he does not
object to a surgeon taking a glass of wine, the followers of this
specialty must not drink to such an extent as to disturb their command
over themselves, and they must not be habitual drinkers. While all that
is necessary for their art cannot be learned out of books, they must not
despise books however, for many things can be learned readily from
books, even about the most difficult parts of surgery. Three things the
surgeon has to do:--to bring together separated parts, to separate
those that have become abnormally united, and to extirpate what is

In his second chapter on healing he talks about healing by first and
second intention. Wounds must be more carefully looked to in summer than
in winter, because putrefactio est major in aestate quam in hyeme,
putrefaction is greater in summer than in winter. For proper union care
must be exercised to bring the wound edges accurately together and not
allow hair, or oil, or dressings to come between them. In large wounds
he considers stitching indispensable, and recommends for this a fine,
square needle. The preferable suture material in his experience was silk
or linen.

The end of the wound was to remain open in order that lint might be
placed therein in order to draw off any objectionable material. He is
particularly insistent on the necessity for drainage. In deep wounds
special provision must be made, and in wounds of extremities the limb
must be so placed as to encourage drainage. If drainage does not take
place, then either the wound must be thoroughly opened, or if necessary
a counter opening must be made to provide drainage. All his treatment of
wounds is dry, however. Water, he considered, always did harm. We can
readily understand that the water generally available and especially as
surgeons saw it in camps and on the battlefield, was likely to do much
more harm than good. In penetrating wounds of the belly cavity, if there
was difficulty in bringing about the reposition of the intestines, they
were first to be pressed back with a sponge soaked in warm wine. Other
manipulations are suggested, and if necessary the wound must be
enlarged. If the omentum finds its way out of the wound, all of it that
is black or green must be cut off. In cases where the intestines are
wounded they are to be sewed with a small needle and a silk thread and
care is to be exercised in bringing about complete closure of the wound.
This much will give a good idea of Bruno's thoroughness. Altogether,
Gurlt, in his History of Surgery, gives about fifteen large octavo
pages of rather small type to a brief compendium of Bruno's teachings.

One or two other remarks of Bruno are rather interesting in the light of
modern developments in medicine. For instance, he suggests the
possibility of being able to feel a stone in the bladder by means of
bimanual palpation. He teaches that mothers may often be able to cure
hernias, both umbilical and inguinal, in children by promptly taking up
the treatment of them as soon as noticed, bringing the edges of the
hernial opening together by bandages and then preventing the reopening
of the hernia by prohibiting wrestling and loud crying and violent
motion. He has seen overgrowth of the mamma in men, and declares that it
is due to nothing else but fat, as a rule. He suggests if it should hang
down and be in the way on account of its size it should be extirpated.
He seems to have known considerable about the lipomas and advises that
they need only be removed in case they become bothersomely large. The
removal is easy, and any bleeding that takes place may be stopped by
means of the cautery. He divides rectal fistulae into penetrating and
non-penetrating, and suggests salves for the non-penetrating and the
actual cautery for those that penetrate. He warns against the
possibility of producing incontinence by the incision of deep fistulae,
for this would leave the patient in a worse state than before.

Next: Hugh Of Lucca

Previous: The North Italian Surgeons

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