The North Italian Surgeons

After Roger and Rolando and the Four Masters, who owe the inspiration

for their work to Salerno and the south of Italy, comes a group of north

Italian surgeons: Bruno da Longoburgo, usually called simply Bruno;

Theodoric and his father, Hugo of Lucca, and William of Salicet.

Immediately following them come two names that belong, one almost feels,

to a more modern period: Mondino, the author of the first text-book on

di section, and Lanfranc (the disciple of William of Salicet), who

taught at Paris and gave that primacy to French surgery which it

maintained all the centuries down to the nineteenth (Pagel). It might

very well be thought that this group of Italian surgeons had very little

in their writings that would be of any more than antiquarian interest

for the modern time. It needs but a little knowledge of their writings

as they have come down to us to show how utterly false any such opinion

is. To Hugo da Lucca and his son Theodoric we owe the introduction and

the gradual bringing into practical use of various methods of

anaesthesia. They used opium and mandragora for this purpose and later

employed an inhalant mixture, the composition of which is not absolutely

known. They seem, however, to have been very successful in producing

insensibility to pain for even rather serious and complicated and

somewhat lengthy operations. Indeed it is to this that must be

attributed most of their surprising success as surgeons at this early

date.



We are so accustomed to think that anaesthesia was discovered about the

middle of the nineteenth century in America that we forget that

literature is full of references in Tom Middleton's (seventeenth

century) phrase to the mercies of old surgeons who put their patients

to sleep before they cut them. Anaesthetics were experimented with

almost as zealously, during the latter half of the thirteenth century at

least, as during the latter half of the nineteenth century. They were

probably not as successful as we are, but they did succeed in producing

insensibility to pain, otherwise they could never have operated to the

extent they did. Moreover the traditions show that the Da Luccas

particularly had invented a method that left very little to be desired

in this matter of anaesthesia. A reference to the sketch of Guy de

Chauliac in this volume will show how practical the method was in his

time.



Nearly the same story as with regard to anaesthetics has to be repeated

for what are deemed so surely modern developments,--asepsis and

antisepsis. I have already suggested that Roger seems to have known how

extremely important it was to approach operations upon the skull with

the most absolute cleanliness. There are many hints of the same kind in

other writers which show that this was no mere accidental remark, but

was a definite conclusion derived from experience and careful

observation of results. We find much more with regard to this same

subject in the writings of the group of northern Italian surgeons and

especially in the group of those associated with William of Salicet.

Professor Clifford Allbutt, Regius Professor of Medicine at the

University of Cambridge, England, in his address before the St. Louis

World's Fair Congress of Arts and Science in 1904, did not hesitate to

declare that William discussed the causes for union by first intention

and the modes by which it might be obtained. He, too, insisted on

cleanliness as the most important factor in having good surgical

results, and all of this group of men, in operating upon septic cases,

used stronger wine as a dressing. This exerted, as will be readily

understood, a very definite antiseptic quality.



Evidently some details of the teaching of this group of great surgeons

in northern Italy in the second half of the thirteenth century will make

clearer to us how much the rising universities of the time were

accomplishing in medicine and surgery as well as in their other

departments. The dates of the origin of some of these universities

should perhaps be recalled so as to remind readers how closely related

they are to this great group of surgical teachers. Salerno was founded

very early, probably in the tenth century, Bologna, Reggio, and Modena

came into existence toward the end of the twelfth century; Vicenza,

Padua, Naples, Vercelli, and Piacenza, as well as Arezzo, during the

first half of the thirteenth century; Rome, Perugia, Trevizo, Pisa,

Florence, Sienna, Lucca, Pavia, and Ferrara during the next century. The

thirteenth century was the special flourishing period of the

universities, and the medical departments, far from being behind, were

leaders in accomplishment. (See my The Thirteenth Greatest of

Centuries, N.Y., 1908.)