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,

b sides 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

superfluous.



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.