Gaspare Tagliacozzi and Early Modern Surgery

Faces, Men, and Pain

Paolo Savoia

• Publisher: Routledge
• Year: 2019
• ISBN:
  9780429535581
• Edition: 1
• Topic: Medicina
• Subtopic: Biografías médicas

This book uses the work of Bolognese physician and anatomist Gaspare Tagliacozzi to explore the social and cultural history of early modern surgery. It discusses how Italian and European surgeons' attitudes to health and beauty – and how patients' gender – shaped views on the public appearance of the human body.

In 1597, Gaspare Tagliacozzi published a two-volume book on reconstructive surgery of the mutilated parts of the face. Studying Tagliacozzi's surgery in context corrects widespread views about the birth of plastic surgery. Through a combination of cultural history, microhistory, historical epistemology, and gender history, this book describes the practice and practitioners considered to be at the periphery of the "Scientific Revolution." Historical themes covered include the writing of individual cases, hegemonic and subaltern forms of masculinity, concepts of the natural and the artificial, emotional communities and moral economies of pain, and the historical anthropology of the culture of beauty and the face and its disfigurements.

The book is essential reading for upper-level students, postgraduates, and scholars working on the history of medicine and surgery, the history of the body, and gender and cultural history. It will also appeal to those interested in the history of beauty, urban studies and the Renaissance period more generally.

1
PATIENTS AND CASES

Gaspare Tagliacozzi is elegantly dressed with a long robe and sports all the symbols of the College of Medicine of Bologna. He holds a book in his hand, while another one stands on a pile of volumes. The two open books show the key phases of an operation he is known for, the reconstruction of mutilated parts of the nose. The book has been written by the sitter, who is so proud of it that he chose to have it in the portrait (Figure 1.1).

This portrait has not been dated with precision, and its author has not been identified with certainty. The Federico Zeri Foundation attributes it to Bartolomeo Passerotti (1529–1592) and/or his school, while other scholars attribute it to Tiburzio Passerotti (1575–1612), the eldest son of Bartolomeo.¹ Bartolomeo and Tagliacozzi knew each other well. They were part of a circle of physicians, anatomists, artists, and naturalists that gathered at the museum of Ulisse Aldrovandi (1522–1605), one of the most famous naturalists and collectors of naturalia of his times.² Bartolomeo must have observed dissections practiced by Tagliacozzi several times.

Now, by the second half of the sixteenth century portraits of scholars were not uncommon, and the subjects were most often represented with books or instruments.³ However, this portrait of Tagliacozzi strikes the viewer because the physician is the author of the book shown in the painting. This was not so common. For example, Bartolomeo Paserotti’s portrait of mathematician Ignazio Danti (1536–1586) shows the sitter as appropriately reading Ptolemy’s Almagest (Figure 1.2). Lavinia Fontana (1552–1614) portrayed in Bologna the eminent physician Girolamo Mercuriale (1530–1606), professor of theoretical medicine there from 1587 to 1592, reading De humani corporis fabrica by Andreas Vesalius (1514–1564) (Figure 1.3). Mercuriale also has a pile of books by classical authorities such as Hippocrates, Galen, and Avicenna, as someone equally fluent in the new and the classic medical literature. But Tagliacozzi wanted to be identified so closely with his book on facial reconstructive surgery that he pushed the author of his portrait to break these stylistic rules.

FIGURE 1.1 Tiburzio (?) Passerotti, Portrait of Gaspare Tagliacozzi (date uncertain). Bologna, Putti’s Donation, Rizzoli Orthopaedic Institute (public domain).

The book on reconstructive surgery came out in 1597. One of the best candidates as the author of the painting, Bartolomeo, died in 1592. This circumstance could of course mean that Tiburzio, who died in 1614, is in fact the author of the painting. But one detail can make us doubt about it. Besides the fact that the two illustrations reproduce quite faithfully those we can find in print, Tagliacozzi’s

FIGURE 1.2 Bartolomeo Passerotti, Portrait of Ignazio Danti (between 1576 and 1586). Brest, Musée des beaux-arts (public domain).

books are here clearly in a manuscript form.⁴ We know that a letter sent by Tagliacozzi to Mercuriale, in which the former described in detail the surgical procedure, was printed in the latter’s De decoratione in 1587.⁵ So by that date at least Tagliacozzi was known as an expert on reconstructive surgery. We could speculate that a manuscript of the book – or of some parts of it – circulated well before 1597, even before 1592, accompanied by illustrations. The hypothesis that Bartolomeo is the author is not absurd. If this is the case, the image of a learned physician, anatomist, and surgeon wanting to be immortalized as the author of a book on facial surgery that was not even in print yet appears all the more clear. Also, with this portrait, Tagliacozzi stressed the fact that he was the first one to write the procedure down.

FIGURE 1.3 Lavinia Fontana, Portrait of Girolamo Mercuriale (1590). Baltimore, The Walters Art Museum (creative commons).

What is missing from the portrait are the surgeon’s patients; conversely, the illustrations in the book only represent patients and never the surgeon at work. Tagliacozzi described very few case histories of patients whose faces he reconstructed. In this chapter I try to understand why.

I describe the patents’ identities and culture as they appear from the few cases circulating in early modern Europe from the fifteenth to the seventeenth centuries. Patient stories and culture – which I reconstruct mostly indirectly, because almost no direct, first-person patient account of the procedure survives – provide a first point of entry into Tagliacozzi’s book and its context. First, I describe the history of facial reconstructive surgery through these case histories. I then put into question a widespread historical narrative associating the success of plastic surgery with the ravages of the French disease and prove that the known cases concern male patients wounded in duels or war. Finally, I analyze two previously unknown cases that I have found in the criminal court of Bologna in which Tagliacozzi served as medical expert on disfigured women. It appears that the world of reconstructive surgery was a men’s world, from which women were deliberately removed. The popularity of facial reconstructive surgery in early modern Bologna is specifically linked to an encounter between learned surgeons and upper-class men.

Cases

In the literature on facial reconstructing surgery, either in the pre- or the post-Tagliacozzi versions, I have been able to find no more than 13 case histories. However, I use here the term “case history” in a rather liberal way. In fact, these cases include episodes in which the physician advised patients not to undertake the procedure and episodes in which we do not even know whether the procedure was performed or not. Moreover, in many instances, we even lack the names of the patients, for reasons that will be discussed later in the chapter.⁶ Almost all of these historiae are either short anecdotal narratives embedded in longer texts or fragments of a bigger whole. I say “anecdotal” and not anecdotes because however fragmentary, brief, and isolated from their context these narratives might be, in most cases they still retain the function of connecting one single instance to a set of rules or norms.⁷ Moreover, all these cases were historiae in the early modern sense of the word, in all their broad range of meanings, which went from compilation from learned sources to direct observation, or a combination of the two, from the valorization of firsthand experience to a new sense of the specificity of time and place.⁸

Early witnesses

Procedures of surgical reconstruction of mutilated parts of the face – noses in the first place – are the subject of a long and global history.⁹ The earliest mentions of a procedure of surgical reconstruction of facial disfigurements belong to the classic ancient Indian text of the Sushruta Samhita, written around the fifth century BCE. This text described a method for covering up nasal mutilations through skin flaps taken from the forefront.¹⁰ A very similar method was described by Celsus (c. 25 BCE–50 CE) in the first century CE in his De medicina, which circulated in fragments in the Middle Ages and was published in its entirety only in 1478. While Lanfranc of Milan (c. 1250–1306), Henri de Mondeville (c. 1260–1320), and Guy de Chauliac (1300–1368), three of the “rational surgeons” of the Middle Ages, all addressed issues of nose loss and repair, none of them described a technical procedure for reconstructing missing portions of the nostrils and the soft parts of the nose.¹¹ Treating facial wounds was also part of the empiric and vernacular tradition of surgery. For example, in a fifteenth-century anonymous Italian manual there appeared a long chapter on the “wounds of the nose caused by swords and arrows” that detailed a complex typology of wounds and the relative ways of treating them with unguents and manual manipulation of skin, flesh, cartilage, and bones.¹²

The first mention of a technique similar to that described by Tagliacozzi comes from the first half of the fourteenth century, when members of the Branca family were practicing surgery in the city Catania, Sicily. They were licensed “empiric” surgeons, without university training, as the family-related nature of their trade attests. In particular Antonio, the son of Gustavo, who had received a license from the King of Aragon in 1412, is credited of having invented the technique of taking the skin flap not from the forefront but from a more discreet, virtually invisible site: the upper interior part of the arm.¹³ Many hypotheses have been made regarding where the Brancas might have learned the technique, whether from Arabic sources or from Persian ones via the Sushruta, but no plausible explanation has been advanced.¹⁴ As the court historian of the Aragonese king, Bartolomeo Fazio (1410–1457) wrote in the mid-fifteenth century:

[W]hereas his father had taken the flesh for the repair from the mutilated man’s face, Antonius took it from the muscles of the man’s arm, so that no distortion of the face should be caused. On the arm that was cut open and into the wound itself, he bound the [site of the] mutilated nose so tightly that the patient might not move his head at all. After fifteen days or sometimes twenty, little by little with a sharp knife he cut away the flap which had become attached to the nose; finally he severed it entirely from the arm and shaped it into a nose with so much ingenuity that it was scarcely possible with the eye to detect the flap that had been added, since the deformity of the face had been entirely removed.¹⁵

The detail concerning the “muscles” that had to be excised from the arm would be repeated several times in the sixteenth century and would then be corrected by Gaspare Tagliacozzi, who greatly emphasized this difference with respect to the empiric surgeons’ technique. By this time the Brancas were famous enough to be remembered in a dialogue of the humanist, diplomat, and courtier of the Aragonese, Giovanni Pontano (1492–1503). In his Antonius (1487) one of the characters, Compater, says that “the Catalans” have brought many vices to Naples and among them the “daggers,” namely the habit of fighting:

[N]nor is anything sold more cheaply than a man’s life, and if your Branca, a second Asclepius, had not arrived to heal them, you would see the majority of the citizens with their ears and lips cut off, or with their nose mutilated.¹⁶

Antonio Branca’s technique was known by a German nobleman and surgeon with the Prussian Army in the 1460s, Heinrich von Pfolsprundt (c. 1415–1465), who described it in a manuscript published only in the nineteenth century. In this work, the German surgeon made reference to an Italian family of surgeons from whom he had learned the technique.¹⁷

Traces leading to the actual practice of such an operation on one specific individual come from the fifteenth century. In the 1950s, Ladislao Münster found in the State Archives of Milan a letter sent by Federico I Gonzaga (1441–1484), marquis of Mantua, to the duke of Milan’s commissioner for Piacenza, dated January 31, 1470. With this letter, Fererico Gonzaga intended to defend one of his soldiers, Antonio Terzo, who had been arrested for a brawl with a Milanese soldier. Federico Gonzaga mentioned that Antonio was passing through Piacenza en route “to have his nose re-made (per farsi rifare lo naso).” In another letter, this time sent directly to the Sforza duke of Milan to ask for the release of Antonio, Federico Gonzaga said that his protégé was in Piacenza with the Bolognese surgeon Gaspare Speranza Manzoli (c. 1410–1475), who “was re-making his nose anew, which had been cut off in a brawl (gli stave facendo lo naso da novo, che per questione gli fu tagliato).” Unfortunately, the letters do not go into any further detail about the procedure. Besides appearing once as a medico-legal expert in a 1471 trial, nothing has been found about the surgeon Manzoli, but nonetheless this scant information reminds us that the art of making noses was practiced in Bologna in the late fifteenth century and that the Gonzaga and the Sforza families were well aware of that.¹⁸

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Table of contents

• Cover
• Half Title
• Series Page
• Title
• Copyright
• Dedication
• CONTENTS
• Acknowledgments
• List of abbreviations
• List of figures
• Introduction
• 1 Patients and cases
• 2 Patients and practitioners: swords, books, and knives
• 3 The culture of the face
• 4 Health and appearance
• 5 Grafting humans and plants
• 6 Surgery and the moral economy of pain
• Conclusion: the place of Tagliacozzi
• Bibliography
• Index