William Of Salicet

The third of the great surgeons in northern Italy was William of

Salicet. He was a pupil of Bruno's and the master of Lanfranc. The first

part of his life was passed at Bologna and the latter part as the

municipal and hospital physician of Verona. He probably died about 1280.

He was a physician as well as a surgeon and was one of those who

insisted that the two modes of practising medicine should not be

separated, or i they were both medicine and surgery would suffer. He

thought that the physician learned much by seeing the interior of the

body during life, while the surgeon was more conservative if he were a

physician. It is curiously interesting to find that the Regius

Professors at both Oxford and Cambridge in our time have expressed

themselves somewhat similarly. Professor Clifford Allbutt is quite

emphatic in this matter and Professor Osler is on record to the same

effect. Following Theodoric, William of Salicet did much to get away

from the Arabic abuse of the cautery and brought the knife back to its

proper place again as the ideal surgical instrument. Unlike those who

had written before him, William quoted very little from preceding

writers. Whenever he quotes his contemporaries it is in order to

criticise them. He depended on his own experience and considered that it

was only what he had actually learned from experience that he should

publish for the benefit of others.



A very good idea of the sort of surgery that William of Salicet

practised may be obtained even from the beginning of the first chapter

of his first book. This is all with regard to surgery of the head. 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 an incision because of the danger of it. In a number of

cases, however, he had had success by puncturing the scalp and membranes

with a cautery, though but a very small opening was made and the fluid

was allowed to escape only drop by drop. He then takes up eye diseases,

a department of surgery rather well developed at that time, as can be

seen from our account of the work of Pope John XXI as an

ophthalmologist during the thirteenth century. See Ophthalmology

(January, 1909), reprinted in Catholic Churchmen in Science,

Philadelphia, The Dolphin Press, 1909.



William devotes six chapters to the diseases of the eyes and the

eyelids. Then there are two chapters on affections of the ears. Foreign

bodies and an accumulation of ear wax are removed by means of

instruments. A polyp is either cut off or its pedicle bound with a

ligature, and it is allowed to shrivel. The next chapter is on the nose.

Nasal polyps were to be grasped with a sharp tenaculum, cum tenacillis

acutis, and either wholly or partially extracted. Ranula was treated by

being lifted well forward by means of a sharp iron hook and then split

with a razor. It is evident that the tendency of these to fill up again

was recognized, and accordingly it was recommended that vitriol powder,

or alum with salt, be placed in the cavity for a time after evacuation

in order to produce adhesive inflammation.



In the same chapter on the mouth one finds that William did not hesitate

to perform what cannot but be considered rather extensive operations

within the oral cavity. For instance, he tells of removing a large

epulis and gives an account in detail of the case. To quote his own

words: I cured a certain woman from Piacenza who was suffering from

fleshy tumor on the gums of the upper jaw, the tumor having grown to

such a size above the teeth and the gums that it was as large or perhaps

larger than a hen's egg. I removed it at four operations by means of

heated iron instruments. At the last operation I removed the teeth that

were loose with certain parts of the jawbone.



In the next chapter there is an account of the treatment of a remarkable

case of abscess of the uvula. In the following chapter the swelling of

cervical glands is taken up. In his experience expectant treatment of

these was best. He advises internal medication with the building up of

the general health, or suggests allowing the inflamed glands to empty

themselves after pustulation. After much meddlesome surgery we are

almost back to his methods again. He did not hesitate to treat goitre

surgically, though he considered there were certain internal remedies

that would benefit it. In obstinate cases he suggests the complete

extirpation of cystic goitre, but if the sac is allowed to remain it

should be thoroughly rubbed over on the inside with green ointment. He

warns about the necessity for avoiding the veins and arteries in this

operation, and says that in this affection many large veins make their

appearance and they find their way everywhere through the fleshy mass.



What I have given here is to be found in a little more than half a page

of Gurlt's abstract of the first twenty chapters of Salicet's first

book. Altogether Gurlt has more than ten pages of rather small print

with regard to William; most of it is as interesting and as practical

and as representative of anticipations of what is done in the modern

time as what I have here quoted. William, as I have said, depended much

more upon his own experience than upon what was to be found in

text-books. He knew the old text-books very well however, but as a rule

did not quote from them unless he had tried the recommendations for

himself, or unless similar cases to these mentioned had come under his

own observation. He was evidently a thoroughly observant physician, a

skilled surgeon who was practical enough to see the simplest way to do

things, and he proceeded to do them. It is no wonder that he influenced

succeeding generations so much, nor that his great pupil, Lanfranc,

continuing his tradition, founded a school of surgery in Paris, the

influence of which was to endure almost down to our time, and give

France a primacy in surgery until the nineteenth century.