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William of saliceto—The School of Bologna
WILLIAM
OF SALICETO-THE INCUNABULA
SCHOOL OF BOLOGNA MEDICA
V
FELIX CUNHA, M.D. SAN FRANCISCO, CALIFORNIA
T
HE medical schoo1 and faculty at BoIogna were to pass through the same successive stages of growth and dechne as that of Salerno, Alexandria and other centers preceding it. The formula in this progress was the same: First a period of initial gathering together of students usuaIIy under the inffuence of some individua1 who stood head and shouIders above his feIIows in technica abiIity or inteIIectua1 knowIedge. GraduaIIy from al1 over the worId, the facuIty wouId be enIarged, progress and contribution wouId be exceptional and worthy and a middIe period of the flowering of medical knowIedge wouId foIIow; finaIIy, a third and Iast stage of waning influence and a shifting of the scientific and inteIIectua1 IocaIe to some other part of Europe. Such had been the history of each medica center and Bologna was to be no exception. The inteIIectua1 torch was destined to shift shortIy from BoIogna to Paris and the University there. During the period of its greatest activity Bologna contributed many iIIustrious names other than that of Hugo of Lucca to the history of medicine. These names are prominent because they represent men who did outstanding work in their day. Among these names we find that of William of Saliceto, a briIIiant surgeon, considered the greatest of his time. A pupi of his, Lanfranco, was to figure prominentIy in the actuaI transition of the center of surgical knowledge and activity from Italy into France.
GugIieImo de Placentinus SaIiceto, or WiIIiam of SaIiceto, so named because he was born (in I 2 IO) in SaIiceto, a smaI1 town near Piacenza and aIso near BoIogna, studied medicine at the medica schoo1 of BoIogna and received his degree there. FoIIowing the compIetion of his studies he obtained the post of town physician in Verona but remained there onIy a short time as he was calIed to the facuIty of his aIma mater. WhiIe engaged in this task of teaching he contributed much to medica Iiterature. His major work was a “Cyrurgia” consisting of five separate books or parts. Present day terminoIogy wouId caI1 these chapters. The first book is a rather misceIIaneous affair commenting on a variety of ihnesses and their treatment, with here and there an origina observation or comment of his own. In this book he described quite accurateIy and compIetely the symptoms and objective findings we associate today with Bright’s disease, and caIIed it “Ma1 de Renis” or disease of the kidneys. In the thirty-eighth chapter of this book he starts with, “Signa Iapidis in Renibus sunt,” “the signs of the stone in the kidney are,” and proceeds to give as accurate and detaiIed a description as couId be found anywhere today. The second book deals mainly with contusions in various parts of the body, particuIarIy contusions of the head, and an attempt is made to differentiate between the symptoms encountered in simple concussion and those in cases of fracture. 144
NEW SF.HIES
Vol. 1.11, No.
Cunha-WiIIiam
I
The third book is devoted to fractures and dislocations with a description of various ingenious devices used in their reducT
RAC.
of SaIiceto
American
Journal
of Surgery
‘45
make as a busy operating surgeon. Many the patient whose operation was proIonged in those times that the surgeon might take DOC.
VIl.
1
tt mammm:noncnim cxtrdtontnifi humartmi~ttr E curaon~m:~~tv~dcrur~dfcnf~lm. Prop,~rRct~nd< quomado IiiitcaotcriaeR~~ii.~ inRrumcntispr~~poe q taut< ria ztAuah2 Contcum ,I o,fr~&c;~ I’o;catlalinvcrocrlm mcdiciniscaoRlc~sInCtt,mcnr~ WC~ qt~ibusfiuntcao~cri~ &odia apudanrlqoos rr~nrJiuerf~:Modcr~iveroe~r~tr~~ x~runr~drcrtom’r;nm~rom:vrGuil.deSa~i~eto ad fcs,,,c~x,! oAo:Lrnfr~ncusaddcccn~:Heo~cus~d~ ptr,~.~Covrroe~muni~cauteriafacicbam eomf:x formlc:~cci~Ibucro cwtcria baebam cum pr0PrqS i~Rr~~n~tnrirfOrmatiSiuxtaiote~dOnemquam eom lrrr~;.?l.rb.7m:fialltautem de uaUbetformatrUw ~r~~mr~~t?par~urn magnum,98(mediom. ~~,~~~form~~R~~~ltellrrirrdform~cultellifatL: & ~Rd~~~~l~x,Dorlalisfcind~sab~vnrpte,Enf~ir~in d~nsv~c,~Esadu~bus.EtcumiiRo~ncidunturcul\es P fuorrf?u( h ~prriuntura~at~&re~tific~t.turVlccr~. C&uslormzeRtalis. A B SccunduminRrumentSrROliuarcn6ad(orm~m folijn!io~:vrputaurruflt Gulidmus&L~francus& HZricusTedolioarum oRibuslimile:vcdicir Halydb. in no~of~rmoncprrrisfecurd~decoqucndi~capiribus. Q$cir!sopcrxio ctiioRcndit:fiunt enimcsOli uxi:in tnmlratccrpitis:vtdocrrt pr$fatimagiRri:Et iuxrril,nCturlrproptereJrum dolorem& fupcroer ,,o,:\,rn6prolundcrurineorR C~bRantiadiicauterl panr~~r~prrrpu~ehbioni:Etfupcro[Fapropr~ma @rdc!irraredum caurerizanturpropterCorrOliOnC CuwsiormlcRtalis. C Trr~~un:~nRrumhumeRDattylarc~dlimililudi~ n~m~~li~~~,d ;Aylort%~ frCtum:rtualctndomninad q~~~ol.uarr:Rdip~~m~~cliorcmformarelinquirpoR C fr:ou~a chlor~am.&rRgrcR;usqusmoliu~rc. Et idrbcR prsripuuminvlcer~bus X o&m &COrrupriqmbur. Cuwformacff alis. D ~~arrominRrud~~~umcRPunAalchabenscufpi~ drmh,rac:lcm & rotundamcum r#uocautcrizaturfo 1ac~rir.EtrRduplcx,cumreRa8(plara:vtnonrran~ fc:r\~ltr~curirn cumquofiuntcaptcriaqu.xcBlnuni rcr x ocwwr adnoduluminfont~ndlisbrachiorum c:r&wum. AliudcRpl~numlon~um~dn~odum rrd~cu,nc~nn~~laveno~oofii,;d.~~i~rcra,c~quocau WI. anil:,- mca~brr.,vtfiR~l~lachrymalis,polypusin li2 n~liIm “% dtoirs. (: :?‘-‘fforma irimaeftform~ptimi. E ti F~rrnaGcu~~ c!rcRr;~h~. G Canwh* R&is. H H ~~~~~~~~mioRrr~m~turneRauteri~rrn fubtilccum quo F~~~~~mCUr fCiollCSCum~e~~~~li~l~;iS8( pcrfora-‘v.~llC.l~~C*iiillJ cl”teriumvtp”nCt~liaadnodl’!Cim.: 4 l%r:~~~or~& dmabRiora:eo q& nod”, l~~r$!hd~~!~:c\. c~ditIIpc~&indiSLtliSaturatcdiob: r.-ro.wrr:r: 1,011. cullls i,. macRr2lis. K IrXKulc li,nrtllrs.inforn~avtl~i~, 1
Moduraodfi~endic~oteriaaChrilia,tRcplnq~~ ratw bcnclocus ybi dcbentponi, & cxiccaur, h Ii~nctur,&~pplicatlpl~taaurcannulafrigidr,~ debzc poni:aut(incipiis vbinoncPnccclWirmiterpadem tcm tcn?do:&ignita cauteriabcncduovcl quotaiie ncccll%ia vfqucqua~beanequiatunccruntmclio~ rxrradantor ma~iiRrocautequodpati~s0oovidc~~ -%imprim~ntur~8[ tenwnturcum quadamteuol~* tionc,vtnonadl~src~ntc~oi:forriusamcnino~: lcuillrinncruo,vfquequo ndarwubedfnem.EttO titsreitcrcntur,quoufque I!ab~enrmrcntum:&pP~ ‘. ft.3 reg3ntur. fi\cdicinoverocum quiborfiuntcaute~pOteo’ .‘c.\lu;lli;rlinmcntum ofr~,~~ohre’cumq”inquc tialia,~~ntrup~oria:quorumaliquapoRTpdimi~oe 3ddU.TmCntli ld f.Kicn&:m quinquc caulrria ad“0. eTch~r.i,vtcalxiriua,et~pOmoliis,~quaIit~rdequoc dumcum ;~mqu~lt): fomminibus perforari filpcr librr,dr~chma.i.vclqoantumf~~dctadoper~~oo~ rcl.lntIrl~f0~rrc~~~lius.~ruyrlf,umcrumrrrupr~gib miRartccnrciintcqu~linr.iof~sjd~t~:vtdicitAlb~~ bolirxcm Iwmrr-o!nm S dolorof~m. dfisaddcndo ~oid&li~ini~:ot~icirHenriciIs:lut~~ Cur& ~ormacitt3lisvrllic. L Pt lir Jlkdi:vtprEcipitHJiy~bils.EtdcfJiuapait~ul~ gur: FIG.
I.
IIlustration
of instruments
used and
tion. Many of these were of his own invention. Book Four is more interesting than any of the others as it represents the first attempt to write a topographica anatomy. Its weakness lies in the fact that it was not based upon human dissection, but only upon those observations he was abIe to
devised
by
\I’illiam
of $&&to.
advantage of the opportunity to orient himseIf better anatomicaIIy with the area in view! The fifth book was more or Iess a materia medica, Iisting drugs, pIants and their uses medicinally. The probIem of migraine was apparently as perplexing in his day as in ours if one can judge by the number of
146
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prescriptions he lists for it-seventeen a11 toId. From his diaIogue here he made the differentia1 diagnosis of tertian and quartan
of SaIiceto overuse of the cautery, which was a prominent custom then and fostered mainIy by Arabian authorities. Here credit must be
DB VLCERIBVS MEMB. ORCA. SJ hsmor~i,oid~.Erpro~tcrhocbcnedi~eI~~tL~nfr~, A hzmorrhoidumclt’duplcx:vniucrral= Cu% rphslnOrrl~o~~r~arnorncn CWUI~U~IC membri Re$?imen h particularc Vniuerfalc rcgim? ha argritud,n,s. Inanoaucc,~ tcrminanrur qtiinquc bettresintcntionavnaeiit, vita,ip ncm generctur venX, q~~bxm~rrhoidcs twnrupanrur, vtin ano. C~n~~sgro~usmehncholicos,iccund~c~in mareromiafuitdirfom.Er~~lTio & mcmbrum ii~dtrirur riaantecedenti. cpligcncr~t~c~,domrrtic~cxpclla~bh~t~~rrl,~,~gr~te,quodcPflu~us~n~,t~isl~~ tur.rcrria eitin potionibus, jr anddoris proprie taliti+,quaab ,llish,,gu,s air: & cupurg&.Glttm ,tscasdclicqnr,h ikwx. busabintra&tis viqucad capita vcnirum, d Ldu~ur q,rantutn ad ~rmwm camp ‘7 etwcum dcb,ta ;Idminiitrarionc furdas:aliquando nxuralitcr, aliquando prrrcr ttaixr~rumnonmturaltum,e( rriumciidcmmncxatur~m:loqucndodcn~tu:aliiccundiiqu~d, mxtvr rum. QtasprrtraAarc cxquilirf clTcrlongum,altc~ in fluxu mcnliruorum,qui limplicircradilutcm to riuset,im ipcculationis c~+.Ercuml,~cma~i~erAr~ tiusipecik, ordinarus cit,kd pnrtis win CorPoribur noldus&Kabbi Moyismulrab diffuix drxeriitdc mclancholinm habc,,t,bus.Nrillaprsieruatabs~i iplis:iuRic,rquantomef?depr&wi, icirc~icun~ rudintbus mukis,nonobfiantc q, in i&o dum Rabbi.,q.imtcibi a uib,,sdcbcnt caucripadeaccidenti B morbo,~oomnisAuxus~lnguiniseR rienresharmorrhoidc~:vidc 9,,cetacctum,fab~,lct,tcs, pr;rternat,,ram. men~ruorumcommcnfurarorum grylT~,caulesrubei,da&yli,piicsgrofi,carnesbo~ ~~~p~,eexCcp~o.~ntc~lcxiteniml,ocintcrriociuCde~n B uins,&cnpriny, &J iall,t$, carnesnui,,maquadcar~, libriaperte diipolidonisnonnacur~rcg~lar,ter ape capitaan,malium, c&usantiquus, panisa(ymus & rantis, a% ia,,guincm malumcxpcllentis. Hrmormalcco!tus$al,& 0mniayutailimcnta:homnia rhoid,tm mult~i,,ttipccic~& d,ffhre,,dr:qusdao, u~d,Aafueruntiupcriusin.~poitcmat,burmclan1.. _ aim iumunrur expartematcrir, qusdamrx parE ol,as.Ercu hocCumccnurlrlcBrripationevitris_ re loci,quxda cx partcincxorum. Secundumcompletur pcrxccptioncm interporcrixiumuntur.difircnti$:quiaab omn E2parre us humo. ‘ll=lacam diaratolicon auc diacafia ,.a~ pilularum de rib& excepuchokra poi~mr furi. monks liunta bdcllio,qus~cundumRali,n,Rc.,nyrabolanorum ianguine groffo.verrucaksa melancholia.vcficalcs bulliricorum,,chebutorum,indorl?,zmadrac.ii~.Cc~ P phlcgmxc.vualescx mcdiocribus humor,bus. EC rapini,+c.i,j.nakurcij,drac.ij.liquirici~ r&z, drx. nomin~nturitaalitnilitudincrcrumaquibusiu~n~c i.bdcllr),drac.xv.cumii,cco porri,fi~ntpilull,dolip nuncupationcm, vthabeturexdi&sAuicen.it, wfirdrac.ij.viqwad.iij.vcr,tm Aukdrcitcpnonco,~ rio canoii.Cui. feruntinno,,t,abcnt,busoeriodos. Exp~telociqu~dlfuntmanifc$,qqd~occult~. Terdum complctur, cdn talietcAuarioprobaro. Ex parteannexorum uiaq,lsdan,fu,,rCurdr n6 Rc.myrabolanorumindorom,bclliricorum,cmbliflucntes,qu+damaurcm ? ,mtaperts,bBucntes. corumlauatorumcuma uabuglolTzviqucquodimiicrinteoram amaritu 9.mem, drac.v.radic,stalG Caufahazmorrhoidum ~~$$j$‘f~~~ c barbani,drac.ij.Fin$ib.dnnamomi,gal9 ( nuciimu f>. iangttinis growl? mclancholici vtplurimum: vt rare Cchat~,olibani,anadra~i.amcos,ip~cs, qu,namJ,r. ramet~atiorumiccundumcpdi~,,tr,cit: innaturam anadrac.~,icorixfcrripr~ppantx& co& cumaccr tamen mclancholi~~pproximntorum.Ingro~nrur to,vnc.i.prnidiarum lib.5.pnnis ~uccari lib. ij. WE mim,S(adurunturhumorcsckmmJlorcp,mine:dein plus,li frxrirdcl,cxus,fiatcle&,,x,um. deiu~pondcroiirate ad,nfcrioradcicndunt: &relnrcgimineparticulxi b;cmorrhoidum iccyndii plcntucnasillas, qushmtin marginc ani, calcfamagilirumAr,toIdum duoi,,~Edunrur.pr,mumcR ciunt & dolorant,cx qu,bus,,,flantur,h crepnnrur, lin,~ntsfluant,cpto~rcrtring~ntur,lccundum eR9 SC faciunt flux~.Etc~smctr~ntlnalc matcrisacuta-, d$o~prototopollcidct,,r. currc,,tcsadlocr?:aut~cutsnr~dici~;.~, vclutaloc& r,mumcomplcturc,tmrribw.primo tp vit&ur fcamonra,h ci5fimilcsif,s,vtHcb~Mciuedicitctc. acria& ac,,t~,hinA~m,~~antil,vrlra,coirup, &cxrr cirium fortc:&rp vtaturdc&b,lib~s,Rydrids,n~ Signahacmorrhoidtim ~~&“~:~~~f”~~ ~~,~rcc~b,,,,,:idp&,proptrrvcnrris conlripation?, vtlir,,tpir? co&a, N lim,l,a,amylii,h rizum+hor rumiumtinrtru~ncntum dilataroriubipcculu~ndi dc3tuncii,,itclc,41,R pcdcs,crauriculpporcorFt,et Aum:m2ximein occuMs,quhcumipCoapcritur,h D vin,,m groHilm,S: fiyptic,,m,& aquafcrran. diJaraturanus. Etli fucritsrfas,wtcfI,,ti ma.ncrt~roivruwroT. Hrmorrhoidts coniucuerunr icqui dolores, &
Gal.dixit
i?d_
grauitatrs akharum. & dorlL&hcici colonrio ma la.Ervtpluri,n~ven~untprribdicede,ncnirin m?fim:vcldcquartaant,ivcldcanno. Iudicaturq, Ii currr,mrmoderxe,confcr,,nt,& bmcfcrunt:& tfic ~,~ni,~nrrc~ring~d~,quiapr~~ru~rc~rpur~.lcpr~, mania,rtr+ria,& abspr,tudinihusmcl~ncholios. S,~utZli,pcrfluant:ct,~6 cbnfcranr, rcitringirur: q,,,~,nnlctolrrx patwns:&cadduc,,nt hydropllim, ~tplwlim. Ir’tiu hoc kquitur documFtu,n H,ppo. 6.xpl,or,imorum. H~morrt,o,d~s~nt,quasl,~bcnti CXWI, mG v,n rrlifnfucrir,pcr,culnnt crntl,ydropi lud,cx,,rct,an,n~~i c,co OCf,m,.,urpl,tiIim h‘cri. c,,rrx,,r donor, htmorrl,o,d,,m, act> apoficnritur, 6: ~!:u~p”lic,,,~.sdfiiti;la,ninume,t,t,:r.
FIG. 2. The causes, symptoms
and treatment “Chirurgia.”
maIaria and states that in rare cases it was possibIe for the patient to have both types simuItaneousIy and that when this occurred there was no definite timing of the occurrence of chiIIs-not bad diagnostic acumen for the earIy part of the thirteenth century. This book cIoses with a tirade against
of hemorrhoids
from Saliceto’s
given to the independent mind and spirit of the man. The influence of Constantin and the SchooI of SaIerno was feIt, even after many years, in the teachings and practice of the SchooI of BoIogna. The SchooI of SaIerno had been IargeIy Arabian in its own teaching and practice, and had foIlowed
New SERIES VW.. Lll, No.
I
Cunha-WiIIiam
of SaIiceto
very cIosely the written words of Rhazes, Avicenna and Avenzoar. Although WilIiam was quite familiar with Arabian medicine, he was not entirely
American
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117
pIea for those who considered themseIves surgeons to adopt his recommendation, and bIasts those who dared not change because of their Iimited abiIities. MAIORIS
LANFRANCl
=*3
*fiafiquid innolrsndii.Trddcimirrrico,di~‘roJ~txpc A
c?anda. Srd dolorc pcrfcurranrcc,i tun;:~ r”,,, & nirimulrirudwcrcii virr”rrf*,ri:rrw4itnc ficumo, aliquirin pw~rpofirrinri Ixcris~ppa,& rxt,~jnter quartam Sr quinri roRam diminutam,fa;inc;lionZ nO”~p~nc~a~crmdont~adIo~~~rn~anC~~~~n~~~:& P~,Jn~“mil~“m bnicmrrr,ahc:&dl”d vulnusno. “~~~n~rsap~,r”m:vcrurvc,ofolidp,~p~~i~~c,~~S n~~~Lfi~,ritp~,~ll”dn~~~ii~~~~n”r~~~~r~~n~~~n~ ~:a rxrr,i~lsmundifir~riuum.,rppon~vf~~d pc,fc *~mhniri m”ndificrrioncmcu,~m illamcondnua. JGII m”lro~icsaccidicp,ou~~ln~,~pcnrr,~r~inp~,. ~~~“p~~o,iq”~S6ngui5&ranirsinf~,i”J fuprartflc xioni diapl~,agmariradun~ri.q”~quid~ rcflcxjo& 3nlocOquicfiinrr, uinri& q”artacofi~m,qucmdi ximusincidcndii. a CCporrfi6nguis & fanicsad vul ~“~f”p~r~“~h~bt,cdrr”rfum:cr~in~~t”,~nf~~”s, B finks dckatur : & a-gcrqui rlio mode mofmmr. firempyicus.vulntriitho,~ci~
&F.c~oti~fino~f~m
pcncr,itir curaah diorii curis vulncrii n6 m”taI”,. D~uuJncrilurfpinr~crr~~ndylilmr:o~~um~nrromi~. trdffrturfirundi. cup.
v I.
c
P6dyl_rrco!lidikimus +fcfcprEij~~~yl~ quw or cofrar~dinmur &.&,enGai%fpod. . $-Ics fuhr. v.fp6dyl~~rub.r;nibllsf”n~fpondyl~~~. upalocti gdicirurabora~ur alahumc. Oscaudrc5poGtum CR~~r,ih~~~fp8d~lih”~.fii~i~r”,oirfpSdyles.rxr. EFr.n.fpfdylisosin media pcrforacP:pcr@fo,~mi ~~l~~n~~l~~.Eth~b~vn~q”~qifp6dylir,qmo,~d~ cam~ta,ct qu~dihabcnrplu,a:qufqqidladdi~m~~a +dfMunlcm opcrdoni clli,urgicambn~cRnt~c~~ numnumwa,c. Sedhifpondylcscum hoc habent C foram~nmr~nii,pcrquod~rnGtnuchr,ha ‘g cntalit fo,rminnlnrrralia,pcrq”~onpi cxe”n& w@b intrmr. Vmqur ipP,“m $ondyliii.xx~+~“~ rua.rOti+ rigamcntis XXdb”salligatur:quibus fpady I~somnc~6,mir~r,~nqu~c~tvnum~,=~n”i~~= aIligancu,.Erillrro~cllunCUo.fpondyli”m~~~~”~ fp6dylib”s,inhriusvoutu,,dOrr”rnfc”fpin~~~ cotiusco,po,infundamcnrum. dewlncribus. Vulncraq”( 65C Prognoflkatio in h~~JO&aiinrproptcr aliud ~mo,of+li uh rare condn ‘cquin aut nuchaina z- ccranfii&lisindGo, ,jdrrurcxtmn f ucrro:quzqur mO,t~m inducirp’roprcrdrbilinti nuchfacc,?brO, anqurm flu”iurafonicd~uanrc:aurp~p~~, d”~ Jf~on~:q”~~~~ccrn6inc~dn~,~x~O~O:td~~~np~ ~n~,~~ipinrJxliontm morus rrfcnfis mcmbmrum fnf~,iO,“mimpdilur:quipc,Oauo* VCnilnCnl?”
D
lxin; &i
FIG. 3. Description
ERcnimlqurntulJabvnrp~~e~bOf”~8( Ib alirmagir~lanus.Quiq”idZtxduobur &ompOli
mpanniruli% lnrclior “crovillotis & nmlorus:a rerinr p~anuaBLanOruc. ininteri~rip~nni~u~~
runt
villil6gk”dinrln: pcrquorfitmraAiO:gl aducniiit dvili~~n~~lle~:pr,q”afi~rmnrio.lnextc,iorl ~un~cafuncuillila~~“~n~l~s:~c, ‘t“0s ficexpullio.In __.. rerlormrEcunicrfuirnrm0lovt u~lkWrecuwun0 ni.~ruriurf”itca,nati:cllidrg~ch”mida,wpc,cC fiirct dig&o: quiaponfidi crentis n&opcrurnkc rd,cm:q”rdigcrlcu, linen fr usoccur&. Attdker awon finlibilc nonhwir rem tqibilcm:
nilicunr
lkula crciblfucu&~so~~,f”. In~~rior~ut~ co~cacr nucrft”rrcccpdii~it?oir &o. Exrtrioraurcm cxfanguincab hc~adrlcguop~q~ndrmucn~m “= ~,ipGw Ron~hi difprrgir”, fubltaiwiam. BPml IO, autcmcreoc”,zirb”s, quf komachi, Yin* In inrcriori partc
plurimo & inuolurionibur muldplicibus. Jnuoludo primawforct necc(luisanirmlic~“m fumrre:ctin condntnri ad Cdlacur,actkundG conf”rnrdinZbeft*IE.ErdigCftloinRom;lcbodiminu~Jt~p~
of stomach disorders written by his pupi1, Lan France, tiaIIy the work of Saliceto.
converted to some of its practices, specificaIIy in its use of the cautery. AI1 around him he saw men cauterizing everything because it was the easy thing to do. He urged that the skiIIfu1 use of the scaIpe1 was a much better procedure and in this fifth book of his, “Surgery,” he cIoses with a
hut essen-
This “ Cyrurgia ” proved to be very popular. There are many incunabula editions of it. The first was printed in the town of Piacenza, in 1476, aImost two hundred years after his death; those copies existing prior to that time were onIy in written manuscript form. A few complete manu-
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of Surgery
Cunha-WiIIiam
scripts were available to students in Italy and in France. TransIations from the Latin into ItaIian of parts of the book were avaiIabIe in the medica centers of BoIogna, Padua, Milan and SaIerno. Another incunabuIa edition was printed in Venice in 1490 by the famous AIdus Press, and another edition which just misses the incunabuIa period was printed by the same press in 1502. In the interim many transIations had been made of the origina1, one in French, one in EngIish and two partia1 translations into Hebrew. One of the French transIations was printed in Lyons in 1492 and is incIuded in the incunabuIa group. He compIeted another manuscript entitled “ Summa Conservationis et Curationis.” Like the “ Cyrurgia,” it aIso consisted of five parts. Part One was devoted to specia1 pathoIogy, “A Capite Ad CaIcem,” from “head to hee1.” Part Two consists of thirty eight chapters devoted to fevers, their diagnosis and treatment. Part Three deals with diseases of the skin and contains severa chapters on the use of cosmetics, or the “decorative arts” as it was cahed. Part Four is a toxicoIogy, describing the toxic symptoms of many drugs and the antidote indicated for each. As one searches in the oId Iiterature of this period, he cannot but be struck with the overemphasis pIaced upon toxicoIogy and the myriad of “Antidotarium” manuscripts which were written then. One hesitates to assume that so many peopIe used medica means to commit suicide, and one is Ieft to wonder if the art of poisoning enemies was not deveIoped to such a high and efficient degree that extensive knowIedge aIong these Iines was caIIed for on the part of the physician. Necessity made famiIiarity with these many Iists of antidotes essential. AImost every physician who had much experience in this sort of practice found incumbent upon himseIf to pubIish a list of his own antidotes, otherwise consider himself “decIasse.” Part Five of the “Summa” is an “Art of Practicing Medicine” or couId be titled.
of Sahceto
APRIL., 19~
I
“The Proper Bedside Manner.” It consists of a description of the manner in which a history shouId be taken and the proper diagnostic enquiries which shouId be made in various types of cases in order to cIarify the diagnosis. Interns disgruntled with the prosaic task of taking an extensive history can take either heart or head in the fact that this same procedure has been going on for hundreds of years, as witness a man in the middIe of the thirteenth century insisting on a compIete detaiIed history of each of his cases. In his “ Cyrurgia ” many authorities cIaim to find reference to human dissections, and that some of his anatomical descriptions are based upon knowIedge and experience greater than that which could be obtained by means of exercising the surgica1 art per se. It is we11 recognized that in addition to being a flourishing medica center during this century, BoIogna was at the same time the greatest center of IegaI teaching in the worId. It wouId not be surprising in view of this if some of the Iaw facuIty recognizing the vaIue of postmortem evidence, wouId not take some means of furthering the possibiIities of obtaining such evidence. The church did not formahy prohibit human dissection but did specificaIIy forbid the cutting up of corpses and boiIing them in order to separate the bones from the flesh. This strange practice had come about during the Crusades. Many who died during these piIgrimages wished that their bones be repatriated in their own parish at home. As the probIem of transportation was an a11important factor, and interpretation was made, a11 too IiteraIIy, that it was the bones which were to be reburied and not the whoIe body, resulting in the above practice. Some one some day shouId write the story of the Crusades from an iconoclastic viewpoint and tear away the beautifu1 coating of varnish with which they have been ecclesiasticaIIy endowed. It is known that WiIIiam had as a patient a Franciscan monk from Parma who died suddenIv in the street at BoIogna. The
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I
Cunha-WiIIiam
law facuIty before certifying to the death, insisted that some type of medica postmortem examination be made to determine more accurateIy the cause of death. WiIham, as the Ieading medical authority of the city was chosen to make this examination. It is recorded that as in his own mind the cause of death must be in the heart, he opened onIy the chest cavity and removed the heart for further study. If it is accepted that his anatomical drawings and descriptions are based upon human dissection, then his anatomy is the first such work. A gIance at some of his anatomical pIates would indicate that they are far inferior to those of da Vinci and hardIy to be compared with those of the great anatomists who were to come later. In the Iater years of his Iife WilIiam took first as a pupi then as an associate, one Lanfranco of MiIan, who was to prove worthy of his choice, as through him, WiIIiam’s work and teachings Iived on and were to inffuence another schoo1 or center of Iearning in another part of the world. This Lanfranco was to take to France
of Saliceto
American
Journal
of Surgerv
‘49
that of medicine and surgery which was ItaIian, and to serve as the torch bearer in the transition of the seat of medica Iearning from BoIogna to Paris. The influence of this great center was to wane graduaIIy and that of Paris to ascend rapidIy. The scene once again moves westward, France to have its day, Paris the Iocale. WiIIiam died in 1280 and was buried at Piacenza. In recent years some of the authorities in the freId of medica history have raised the controversy that the books in surgery and medicine that have been attributed to him could not possibIy have been of his authorship. EntireIy too much stress is laid on the fact that printed works of his are exceedingIy rare and possessed 6) only one or two of the great collections in the world. Lists of the works printed during the incunabuIa period by the AIdine and Giunte presses in Venice fai1 to mention any manuscript of WiIIiam’s as being used for publication. AI1 of this seems beside the point when one finds hidden away in the haphazard bindings of several works b\ different authors much materia1 that it is SaIiceto’s and Lanfranco’s.
OF SALICETO-THE INCUNABULA
SCHOOL OF BOLOGNA MEDICA
V
FELIX CUNHA, M.D. SAN FRANCISCO, CALIFORNIA
T
HE medical schoo1 and faculty at BoIogna were to pass through the same successive stages of growth and dechne as that of Salerno, Alexandria and other centers preceding it. The formula in this progress was the same: First a period of initial gathering together of students usuaIIy under the inffuence of some individua1 who stood head and shouIders above his feIIows in technica abiIity or inteIIectua1 knowIedge. GraduaIIy from al1 over the worId, the facuIty wouId be enIarged, progress and contribution wouId be exceptional and worthy and a middIe period of the flowering of medical knowIedge wouId foIIow; finaIIy, a third and Iast stage of waning influence and a shifting of the scientific and inteIIectua1 IocaIe to some other part of Europe. Such had been the history of each medica center and Bologna was to be no exception. The inteIIectua1 torch was destined to shift shortIy from BoIogna to Paris and the University there. During the period of its greatest activity Bologna contributed many iIIustrious names other than that of Hugo of Lucca to the history of medicine. These names are prominent because they represent men who did outstanding work in their day. Among these names we find that of William of Saliceto, a briIIiant surgeon, considered the greatest of his time. A pupi of his, Lanfranco, was to figure prominentIy in the actuaI transition of the center of surgical knowledge and activity from Italy into France.
GugIieImo de Placentinus SaIiceto, or WiIIiam of SaIiceto, so named because he was born (in I 2 IO) in SaIiceto, a smaI1 town near Piacenza and aIso near BoIogna, studied medicine at the medica schoo1 of BoIogna and received his degree there. FoIIowing the compIetion of his studies he obtained the post of town physician in Verona but remained there onIy a short time as he was calIed to the facuIty of his aIma mater. WhiIe engaged in this task of teaching he contributed much to medica Iiterature. His major work was a “Cyrurgia” consisting of five separate books or parts. Present day terminoIogy wouId caI1 these chapters. The first book is a rather misceIIaneous affair commenting on a variety of ihnesses and their treatment, with here and there an origina observation or comment of his own. In this book he described quite accurateIy and compIetely the symptoms and objective findings we associate today with Bright’s disease, and caIIed it “Ma1 de Renis” or disease of the kidneys. In the thirty-eighth chapter of this book he starts with, “Signa Iapidis in Renibus sunt,” “the signs of the stone in the kidney are,” and proceeds to give as accurate and detaiIed a description as couId be found anywhere today. The second book deals mainly with contusions in various parts of the body, particuIarIy contusions of the head, and an attempt is made to differentiate between the symptoms encountered in simple concussion and those in cases of fracture. 144
NEW SF.HIES
Vol. 1.11, No.
Cunha-WiIIiam
I
The third book is devoted to fractures and dislocations with a description of various ingenious devices used in their reducT
RAC.
of SaIiceto
American
Journal
of Surgery
‘45
make as a busy operating surgeon. Many the patient whose operation was proIonged in those times that the surgeon might take DOC.
VIl.
1
tt mammm:noncnim cxtrdtontnifi humartmi~ttr E curaon~m:~~tv~dcrur~dfcnf~lm. Prop,~rRct~nd< quomado IiiitcaotcriaeR~~ii.~ inRrumcntispr~~poe q taut< ria ztAuah2 Contcum ,I o,fr~&c;~ I’o;catlalinvcrocrlm mcdiciniscaoRlc~sInCtt,mcnr~ WC~ qt~ibusfiuntcao~cri~ &odia apudanrlqoos rr~nrJiuerf~:Modcr~iveroe~r~tr~~ x~runr~drcrtom’r;nm~rom:vrGuil.deSa~i~eto ad fcs,,,c~x,! oAo:Lrnfr~ncusaddcccn~:Heo~cus~d~ ptr,~.~Covrroe~muni~cauteriafacicbam eomf:x formlc:~cci~Ibucro cwtcria baebam cum pr0PrqS i~Rr~~n~tnrirfOrmatiSiuxtaiote~dOnemquam eom lrrr~;.?l.rb.7m:fialltautem de uaUbetformatrUw ~r~~mr~~t?par~urn magnum,98(mediom. ~~,~~~form~~R~~~ltellrrirrdform~cultellifatL: & ~Rd~~~~l~x,Dorlalisfcind~sab~vnrpte,Enf~ir~in d~nsv~c,~Esadu~bus.EtcumiiRo~ncidunturcul\es P fuorrf?u( h ~prriuntura~at~&re~tific~t.turVlccr~. C&uslormzeRtalis. A B SccunduminRrumentSrROliuarcn6ad(orm~m folijn!io~:vrputaurruflt Gulidmus&L~francus& HZricusTedolioarum oRibuslimile:vcdicir Halydb. in no~of~rmoncprrrisfecurd~decoqucndi~capiribus. Q$cir!sopcrxio ctiioRcndit:fiunt enimcsOli uxi:in tnmlratccrpitis:vtdocrrt pr$fatimagiRri:Et iuxrril,nCturlrproptereJrum dolorem& fupcroer ,,o,:\,rn6prolundcrurineorR C~bRantiadiicauterl panr~~r~prrrpu~ehbioni:Etfupcro[Fapropr~ma @rdc!irraredum caurerizanturpropterCorrOliOnC CuwsiormlcRtalis. C Trr~~un:~nRrumhumeRDattylarc~dlimililudi~ n~m~~li~~~,d ;Aylort%~ frCtum:rtualctndomninad q~~~ol.uarr:Rdip~~m~~cliorcmformarelinquirpoR C fr:ou~a chlor~am.&rRgrcR;usqusmoliu~rc. Et idrbcR prsripuuminvlcer~bus X o&m &COrrupriqmbur. Cuwformacff alis. D ~~arrominRrud~~~umcRPunAalchabenscufpi~ drmh,rac:lcm & rotundamcum r#uocautcrizaturfo 1ac~rir.EtrRduplcx,cumreRa8(plara:vtnonrran~ fc:r\~ltr~curirn cumquofiuntcaptcriaqu.xcBlnuni rcr x ocwwr adnoduluminfont~ndlisbrachiorum c:r&wum. AliudcRpl~numlon~um~dn~odum rrd~cu,nc~nn~~laveno~oofii,;d.~~i~rcra,c~quocau WI. anil:,- mca~brr.,vtfiR~l~lachrymalis,polypusin li2 n~liIm “% dtoirs. (: :?‘-‘fforma irimaeftform~ptimi. E ti F~rrnaGcu~~ c!rcRr;~h~. G Canwh* R&is. H H ~~~~~~~~mioRrr~m~turneRauteri~rrn fubtilccum quo F~~~~~mCUr fCiollCSCum~e~~~~li~l~;iS8( pcrfora-‘v.~llC.l~~C*iiillJ cl”teriumvtp”nCt~liaadnodl’!Cim.: 4 l%r:~~~or~& dmabRiora:eo q& nod”, l~~r$!hd~~!~:c\. c~ditIIpc~&indiSLtliSaturatcdiob: r.-ro.wrr:r: 1,011. cullls i,. macRr2lis. K IrXKulc li,nrtllrs.inforn~avtl~i~, 1
Moduraodfi~endic~oteriaaChrilia,tRcplnq~~ ratw bcnclocus ybi dcbentponi, & cxiccaur, h Ii~nctur,&~pplicatlpl~taaurcannulafrigidr,~ debzc poni:aut(incipiis vbinoncPnccclWirmiterpadem tcm tcn?do:&ignita cauteriabcncduovcl quotaiie ncccll%ia vfqucqua~beanequiatunccruntmclio~ rxrradantor ma~iiRrocautequodpati~s0oovidc~~ -%imprim~ntur~8[ tenwnturcum quadamteuol~* tionc,vtnonadl~src~ntc~oi:forriusamcnino~: lcuillrinncruo,vfquequo ndarwubedfnem.EttO titsreitcrcntur,quoufque I!ab~enrmrcntum:&pP~ ‘. ft.3 reg3ntur. fi\cdicinoverocum quiborfiuntcaute~pOteo’ .‘c.\lu;lli;rlinmcntum ofr~,~~ohre’cumq”inquc tialia,~~ntrup~oria:quorumaliquapoRTpdimi~oe 3ddU.TmCntli ld f.Kicn&:m quinquc caulrria ad“0. eTch~r.i,vtcalxiriua,et~pOmoliis,~quaIit~rdequoc dumcum ;~mqu~lt): fomminibus perforari filpcr librr,dr~chma.i.vclqoantumf~~dctadoper~~oo~ rcl.lntIrl~f0~rrc~~~lius.~ruyrlf,umcrumrrrupr~gib miRartccnrciintcqu~linr.iof~sjd~t~:vtdicitAlb~~ bolirxcm Iwmrr-o!nm S dolorof~m. dfisaddcndo ~oid&li~ini~:ot~icirHenriciIs:lut~~ Cur& ~ormacitt3lisvrllic. L Pt lir Jlkdi:vtprEcipitHJiy~bils.EtdcfJiuapait~ul~ gur: FIG.
I.
IIlustration
of instruments
used and
tion. Many of these were of his own invention. Book Four is more interesting than any of the others as it represents the first attempt to write a topographica anatomy. Its weakness lies in the fact that it was not based upon human dissection, but only upon those observations he was abIe to
devised
by
\I’illiam
of $&&to.
advantage of the opportunity to orient himseIf better anatomicaIIy with the area in view! The fifth book was more or Iess a materia medica, Iisting drugs, pIants and their uses medicinally. The probIem of migraine was apparently as perplexing in his day as in ours if one can judge by the number of
146
American
Journal
of Surgery
Cunha-WiIIiam
prescriptions he lists for it-seventeen a11 toId. From his diaIogue here he made the differentia1 diagnosis of tertian and quartan
of SaIiceto overuse of the cautery, which was a prominent custom then and fostered mainIy by Arabian authorities. Here credit must be
DB VLCERIBVS MEMB. ORCA. SJ hsmor~i,oid~.Erpro~tcrhocbcnedi~eI~~tL~nfr~, A hzmorrhoidumclt’duplcx:vniucrral= Cu% rphslnOrrl~o~~r~arnorncn CWUI~U~IC membri Re$?imen h particularc Vniuerfalc rcgim? ha argritud,n,s. Inanoaucc,~ tcrminanrur qtiinquc bettresintcntionavnaeiit, vita,ip ncm generctur venX, q~~bxm~rrhoidcs twnrupanrur, vtin ano. C~n~~sgro~usmehncholicos,iccund~c~in mareromiafuitdirfom.Er~~lTio & mcmbrum ii~dtrirur riaantecedenti. cpligcncr~t~c~,domrrtic~cxpclla~bh~t~~rrl,~,~gr~te,quodcPflu~us~n~,t~isl~~ tur.rcrria eitin potionibus, jr anddoris proprie taliti+,quaab ,llish,,gu,s air: & cupurg&.Glttm ,tscasdclicqnr,h ikwx. busabintra&tis viqucad capita vcnirum, d Ldu~ur q,rantutn ad ~rmwm camp ‘7 etwcum dcb,ta ;Idminiitrarionc furdas:aliquando nxuralitcr, aliquando prrrcr ttaixr~rumnonmturaltum,e( rriumciidcmmncxatur~m:loqucndodcn~tu:aliiccundiiqu~d, mxtvr rum. QtasprrtraAarc cxquilirf clTcrlongum,altc~ in fluxu mcnliruorum,qui limplicircradilutcm to riuset,im ipcculationis c~+.Ercuml,~cma~i~erAr~ tiusipecik, ordinarus cit,kd pnrtis win CorPoribur noldus&Kabbi Moyismulrab diffuix drxeriitdc mclancholinm habc,,t,bus.Nrillaprsieruatabs~i iplis:iuRic,rquantomef?depr&wi, icirc~icun~ rudintbus mukis,nonobfiantc q, in i&o dum Rabbi.,q.imtcibi a uib,,sdcbcnt caucripadeaccidenti B morbo,~oomnisAuxus~lnguiniseR rienresharmorrhoidc~:vidc 9,,cetacctum,fab~,lct,tcs, pr;rternat,,ram. men~ruorumcommcnfurarorum grylT~,caulesrubei,da&yli,piicsgrofi,carnesbo~ ~~~p~,eexCcp~o.~ntc~lcxiteniml,ocintcrriociuCde~n B uins,&cnpriny, &J iall,t$, carnesnui,,maquadcar~, libriaperte diipolidonisnonnacur~rcg~lar,ter ape capitaan,malium, c&usantiquus, panisa(ymus & rantis, a% ia,,guincm malumcxpcllentis. Hrmormalcco!tus$al,& 0mniayutailimcnta:homnia rhoid,tm mult~i,,ttipccic~& d,ffhre,,dr:qusdao, u~d,Aafueruntiupcriusin.~poitcmat,burmclan1.. _ aim iumunrur expartematcrir, qusdamrx parE ol,as.Ercu hocCumccnurlrlcBrripationevitris_ re loci,quxda cx partcincxorum. Secundumcompletur pcrxccptioncm interporcrixiumuntur.difircnti$:quiaab omn E2parre us humo. ‘ll=lacam diaratolicon auc diacafia ,.a~ pilularum de rib& excepuchokra poi~mr furi. monks liunta bdcllio,qus~cundumRali,n,Rc.,nyrabolanorum ianguine groffo.verrucaksa melancholia.vcficalcs bulliricorum,,chebutorum,indorl?,zmadrac.ii~.Cc~ P phlcgmxc.vualescx mcdiocribus humor,bus. EC rapini,+c.i,j.nakurcij,drac.ij.liquirici~ r&z, drx. nomin~nturitaalitnilitudincrcrumaquibusiu~n~c i.bdcllr),drac.xv.cumii,cco porri,fi~ntpilull,dolip nuncupationcm, vthabeturexdi&sAuicen.it, wfirdrac.ij.viqwad.iij.vcr,tm Aukdrcitcpnonco,~ rio canoii.Cui. feruntinno,,t,abcnt,busoeriodos. Exp~telociqu~dlfuntmanifc$,qqd~occult~. Terdum complctur, cdn talietcAuarioprobaro. Ex parteannexorum uiaq,lsdan,fu,,rCurdr n6 Rc.myrabolanorumindorom,bclliricorum,cmbliflucntes,qu+damaurcm ? ,mtaperts,bBucntes. corumlauatorumcuma uabuglolTzviqucquodimiicrinteoram amaritu 9.mem, drac.v.radic,stalG Caufahazmorrhoidum ~~$$j$‘f~~~ c barbani,drac.ij.Fin$ib.dnnamomi,gal9 ( nuciimu f>. iangttinis growl? mclancholici vtplurimum: vt rare Cchat~,olibani,anadra~i.amcos,ip~cs, qu,namJ,r. ramet~atiorumiccundumcpdi~,,tr,cit: innaturam anadrac.~,icorixfcrripr~ppantx& co& cumaccr tamen mclancholi~~pproximntorum.Ingro~nrur to,vnc.i.prnidiarum lib.5.pnnis ~uccari lib. ij. WE mim,S(adurunturhumorcsckmmJlorcp,mine:dein plus,li frxrirdcl,cxus,fiatcle&,,x,um. deiu~pondcroiirate ad,nfcrioradcicndunt: &relnrcgimineparticulxi b;cmorrhoidum iccyndii plcntucnasillas, qushmtin marginc ani, calcfamagilirumAr,toIdum duoi,,~Edunrur.pr,mumcR ciunt & dolorant,cx qu,bus,,,flantur,h crepnnrur, lin,~ntsfluant,cpto~rcrtring~ntur,lccundum eR9 SC faciunt flux~.Etc~smctr~ntlnalc matcrisacuta-, d$o~prototopollcidct,,r. currc,,tcsadlocr?:aut~cutsnr~dici~;.~, vclutaloc& r,mumcomplcturc,tmrribw.primo tp vit&ur fcamonra,h ci5fimilcsif,s,vtHcb~Mciuedicitctc. acria& ac,,t~,hinA~m,~~antil,vrlra,coirup, &cxrr cirium fortc:&rp vtaturdc&b,lib~s,Rydrids,n~ Signahacmorrhoidtim ~~&“~:~~~f”~~ ~~,~rcc~b,,,,,:idp&,proptrrvcnrris conlripation?, vtlir,,tpir? co&a, N lim,l,a,amylii,h rizum+hor rumiumtinrtru~ncntum dilataroriubipcculu~ndi dc3tuncii,,itclc,41,R pcdcs,crauriculpporcorFt,et Aum:m2ximein occuMs,quhcumipCoapcritur,h D vin,,m groHilm,S: fiyptic,,m,& aquafcrran. diJaraturanus. Etli fucritsrfas,wtcfI,,ti ma.ncrt~roivruwroT. Hrmorrhoidts coniucuerunr icqui dolores, &
Gal.dixit
i?d_
grauitatrs akharum. & dorlL&hcici colonrio ma la.Ervtpluri,n~ven~untprribdicede,ncnirin m?fim:vcldcquartaant,ivcldcanno. Iudicaturq, Ii currr,mrmoderxe,confcr,,nt,& bmcfcrunt:& tfic ~,~ni,~nrrc~ring~d~,quiapr~~ru~rc~rpur~.lcpr~, mania,rtr+ria,& abspr,tudinihusmcl~ncholios. S,~utZli,pcrfluant:ct,~6 cbnfcranr, rcitringirur: q,,,~,nnlctolrrx patwns:&cadduc,,nt hydropllim, ~tplwlim. Ir’tiu hoc kquitur documFtu,n H,ppo. 6.xpl,or,imorum. H~morrt,o,d~s~nt,quasl,~bcnti CXWI, mG v,n rrlifnfucrir,pcr,culnnt crntl,ydropi lud,cx,,rct,an,n~~i c,co OCf,m,.,urpl,tiIim h‘cri. c,,rrx,,r donor, htmorrl,o,d,,m, act> apoficnritur, 6: ~!:u~p”lic,,,~.sdfiiti;la,ninume,t,t,:r.
FIG. 2. The causes, symptoms
and treatment “Chirurgia.”
maIaria and states that in rare cases it was possibIe for the patient to have both types simuItaneousIy and that when this occurred there was no definite timing of the occurrence of chiIIs-not bad diagnostic acumen for the earIy part of the thirteenth century. This book cIoses with a tirade against
of hemorrhoids
from Saliceto’s
given to the independent mind and spirit of the man. The influence of Constantin and the SchooI of SaIerno was feIt, even after many years, in the teachings and practice of the SchooI of BoIogna. The SchooI of SaIerno had been IargeIy Arabian in its own teaching and practice, and had foIlowed
New SERIES VW.. Lll, No.
I
Cunha-WiIIiam
of SaIiceto
very cIosely the written words of Rhazes, Avicenna and Avenzoar. Although WilIiam was quite familiar with Arabian medicine, he was not entirely
American
Journal
of Surgery
117
pIea for those who considered themseIves surgeons to adopt his recommendation, and bIasts those who dared not change because of their Iimited abiIities. MAIORIS
LANFRANCl
=*3
*fiafiquid innolrsndii.Trddcimirrrico,di~‘roJ~txpc A
c?anda. Srd dolorc pcrfcurranrcc,i tun;:~ r”,,, & nirimulrirudwcrcii virr”rrf*,ri:rrw4itnc ficumo, aliquirin pw~rpofirrinri Ixcris~ppa,& rxt,~jnter quartam Sr quinri roRam diminutam,fa;inc;lionZ nO”~p~nc~a~crmdont~adIo~~~rn~anC~~~~n~~~:& P~,Jn~“mil~“m bnicmrrr,ahc:&dl”d vulnusno. “~~~n~rsap~,r”m:vcrurvc,ofolidp,~p~~i~~c,~~S n~~~Lfi~,ritp~,~ll”dn~~~ii~~~~n”r~~~~r~~n~~~n~ ~:a rxrr,i~lsmundifir~riuum.,rppon~vf~~d pc,fc *~mhniri m”ndificrrioncmcu,~m illamcondnua. JGII m”lro~icsaccidicp,ou~~ln~,~pcnrr,~r~inp~,. ~~~“p~~o,iq”~S6ngui5&ranirsinf~,i”J fuprartflc xioni diapl~,agmariradun~ri.q”~quid~ rcflcxjo& 3nlocOquicfiinrr, uinri& q”artacofi~m,qucmdi ximusincidcndii. a CCporrfi6nguis & fanicsad vul ~“~f”p~r~“~h~bt,cdrr”rfum:cr~in~~t”,~nf~~”s, B finks dckatur : & a-gcrqui rlio mode mofmmr. firempyicus.vulntriitho,~ci~
&F.c~oti~fino~f~m
pcncr,itir curaah diorii curis vulncrii n6 m”taI”,. D~uuJncrilurfpinr~crr~~ndylilmr:o~~um~nrromi~. trdffrturfirundi. cup.
v I.
c
P6dyl_rrco!lidikimus +fcfcprEij~~~yl~ quw or cofrar~dinmur &.&,enGai%fpod. . $-Ics fuhr. v.fp6dyl~~rub.r;nibllsf”n~fpondyl~~~. upalocti gdicirurabora~ur alahumc. Oscaudrc5poGtum CR~~r,ih~~~fp8d~lih”~.fii~i~r”,oirfpSdyles.rxr. EFr.n.fpfdylisosin media pcrforacP:pcr@fo,~mi ~~l~~n~~l~~.Eth~b~vn~q”~qifp6dylir,qmo,~d~ cam~ta,ct qu~dihabcnrplu,a:qufqqidladdi~m~~a +dfMunlcm opcrdoni clli,urgicambn~cRnt~c~~ numnumwa,c. Sedhifpondylcscum hoc habent C foram~nmr~nii,pcrquod~rnGtnuchr,ha ‘g cntalit fo,rminnlnrrralia,pcrq”~onpi cxe”n& w@b intrmr. Vmqur ipP,“m $ondyliii.xx~+~“~ rua.rOti+ rigamcntis XXdb”salligatur:quibus fpady I~somnc~6,mir~r,~nqu~c~tvnum~,=~n”i~~= aIligancu,.Erillrro~cllunCUo.fpondyli”m~~~~”~ fp6dylib”s,inhriusvoutu,,dOrr”rnfc”fpin~~~ cotiusco,po,infundamcnrum. dewlncribus. Vulncraq”( 65C Prognoflkatio in h~~JO&aiinrproptcr aliud ~mo,of+li uh rare condn ‘cquin aut nuchaina z- ccranfii&lisindGo, ,jdrrurcxtmn f ucrro:quzqur mO,t~m inducirp’roprcrdrbilinti nuchfacc,?brO, anqurm flu”iurafonicd~uanrc:aurp~p~~, d”~ Jf~on~:q”~~~~ccrn6inc~dn~,~x~O~O:td~~~np~ ~n~,~~ipinrJxliontm morus rrfcnfis mcmbmrum fnf~,iO,“mimpdilur:quipc,Oauo* VCnilnCnl?”
D
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FIG. 3. Description
ERcnimlqurntulJabvnrp~~e~bOf”~8( Ib alirmagir~lanus.Quiq”idZtxduobur &ompOli
mpanniruli% lnrclior “crovillotis & nmlorus:a rerinr p~anuaBLanOruc. ininteri~rip~nni~u~~
runt
villil6gk”dinrln: pcrquorfitmraAiO:gl aducniiit dvili~~n~~lle~:pr,q”afi~rmnrio.lnextc,iorl ~un~cafuncuillila~~“~n~l~s:~c, ‘t“0s ficexpullio.In __.. rerlormrEcunicrfuirnrm0lovt u~lkWrecuwun0 ni.~ruriurf”itca,nati:cllidrg~ch”mida,wpc,cC fiirct dig&o: quiaponfidi crentis n&opcrurnkc rd,cm:q”rdigcrlcu, linen fr usoccur&. Attdker awon finlibilc nonhwir rem tqibilcm:
nilicunr
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plurimo & inuolurionibur muldplicibus. Jnuoludo primawforct necc(luisanirmlic~“m fumrre:ctin condntnri ad Cdlacur,actkundG conf”rnrdinZbeft*IE.ErdigCftloinRom;lcbodiminu~Jt~p~
of stomach disorders written by his pupi1, Lan France, tiaIIy the work of Saliceto.
converted to some of its practices, specificaIIy in its use of the cautery. AI1 around him he saw men cauterizing everything because it was the easy thing to do. He urged that the skiIIfu1 use of the scaIpe1 was a much better procedure and in this fifth book of his, “Surgery,” he cIoses with a
hut essen-
This “ Cyrurgia ” proved to be very popular. There are many incunabula editions of it. The first was printed in the town of Piacenza, in 1476, aImost two hundred years after his death; those copies existing prior to that time were onIy in written manuscript form. A few complete manu-
148
American
Journal
of Surgery
Cunha-WiIIiam
scripts were available to students in Italy and in France. TransIations from the Latin into ItaIian of parts of the book were avaiIabIe in the medica centers of BoIogna, Padua, Milan and SaIerno. Another incunabuIa edition was printed in Venice in 1490 by the famous AIdus Press, and another edition which just misses the incunabuIa period was printed by the same press in 1502. In the interim many transIations had been made of the origina1, one in French, one in EngIish and two partia1 translations into Hebrew. One of the French transIations was printed in Lyons in 1492 and is incIuded in the incunabuIa group. He compIeted another manuscript entitled “ Summa Conservationis et Curationis.” Like the “ Cyrurgia,” it aIso consisted of five parts. Part One was devoted to specia1 pathoIogy, “A Capite Ad CaIcem,” from “head to hee1.” Part Two consists of thirty eight chapters devoted to fevers, their diagnosis and treatment. Part Three deals with diseases of the skin and contains severa chapters on the use of cosmetics, or the “decorative arts” as it was cahed. Part Four is a toxicoIogy, describing the toxic symptoms of many drugs and the antidote indicated for each. As one searches in the oId Iiterature of this period, he cannot but be struck with the overemphasis pIaced upon toxicoIogy and the myriad of “Antidotarium” manuscripts which were written then. One hesitates to assume that so many peopIe used medica means to commit suicide, and one is Ieft to wonder if the art of poisoning enemies was not deveIoped to such a high and efficient degree that extensive knowIedge aIong these Iines was caIIed for on the part of the physician. Necessity made famiIiarity with these many Iists of antidotes essential. AImost every physician who had much experience in this sort of practice found incumbent upon himseIf to pubIish a list of his own antidotes, otherwise consider himself “decIasse.” Part Five of the “Summa” is an “Art of Practicing Medicine” or couId be titled.
of Sahceto
APRIL., 19~
I
“The Proper Bedside Manner.” It consists of a description of the manner in which a history shouId be taken and the proper diagnostic enquiries which shouId be made in various types of cases in order to cIarify the diagnosis. Interns disgruntled with the prosaic task of taking an extensive history can take either heart or head in the fact that this same procedure has been going on for hundreds of years, as witness a man in the middIe of the thirteenth century insisting on a compIete detaiIed history of each of his cases. In his “ Cyrurgia ” many authorities cIaim to find reference to human dissections, and that some of his anatomical descriptions are based upon knowIedge and experience greater than that which could be obtained by means of exercising the surgica1 art per se. It is we11 recognized that in addition to being a flourishing medica center during this century, BoIogna was at the same time the greatest center of IegaI teaching in the worId. It wouId not be surprising in view of this if some of the Iaw facuIty recognizing the vaIue of postmortem evidence, wouId not take some means of furthering the possibiIities of obtaining such evidence. The church did not formahy prohibit human dissection but did specificaIIy forbid the cutting up of corpses and boiIing them in order to separate the bones from the flesh. This strange practice had come about during the Crusades. Many who died during these piIgrimages wished that their bones be repatriated in their own parish at home. As the probIem of transportation was an a11important factor, and interpretation was made, a11 too IiteraIIy, that it was the bones which were to be reburied and not the whoIe body, resulting in the above practice. Some one some day shouId write the story of the Crusades from an iconoclastic viewpoint and tear away the beautifu1 coating of varnish with which they have been ecclesiasticaIIy endowed. It is known that WiIIiam had as a patient a Franciscan monk from Parma who died suddenIv in the street at BoIogna. The
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law facuIty before certifying to the death, insisted that some type of medica postmortem examination be made to determine more accurateIy the cause of death. WiIham, as the Ieading medical authority of the city was chosen to make this examination. It is recorded that as in his own mind the cause of death must be in the heart, he opened onIy the chest cavity and removed the heart for further study. If it is accepted that his anatomical drawings and descriptions are based upon human dissection, then his anatomy is the first such work. A gIance at some of his anatomical pIates would indicate that they are far inferior to those of da Vinci and hardIy to be compared with those of the great anatomists who were to come later. In the Iater years of his Iife WilIiam took first as a pupi then as an associate, one Lanfranco of MiIan, who was to prove worthy of his choice, as through him, WiIIiam’s work and teachings Iived on and were to inffuence another schoo1 or center of Iearning in another part of the world. This Lanfranco was to take to France
of Saliceto
American
Journal
of Surgerv
‘49
that of medicine and surgery which was ItaIian, and to serve as the torch bearer in the transition of the seat of medica Iearning from BoIogna to Paris. The influence of this great center was to wane graduaIIy and that of Paris to ascend rapidIy. The scene once again moves westward, France to have its day, Paris the Iocale. WiIIiam died in 1280 and was buried at Piacenza. In recent years some of the authorities in the freId of medica history have raised the controversy that the books in surgery and medicine that have been attributed to him could not possibIy have been of his authorship. EntireIy too much stress is laid on the fact that printed works of his are exceedingIy rare and possessed 6) only one or two of the great collections in the world. Lists of the works printed during the incunabuIa period by the AIdine and Giunte presses in Venice fai1 to mention any manuscript of WiIIiam’s as being used for publication. AI1 of this seems beside the point when one finds hidden away in the haphazard bindings of several works b\ different authors much materia1 that it is SaIiceto’s and Lanfranco’s.