Renaissance Nose Jobs

By Holly Tucker

For your viewing pleasure: a classic illustration from Gaspare Tagliacozzi's De curtorum chirurgia per insitionem (1597, book 2).

Tagliacozzi shows autografting--grafts using the patient's own skin. In addition to the ravages of syphilis, nose jobs were needed to repair injuries in battle, but also after duels.

The question that I always get is: Did they work? The problem is that we do not have a lot a data on survival rates after such surgeries. We have a good number of case histories, but often there is more information about the specifics of the surgery--rather than the post-op outcomes.

I can say that it's important to remember that antisepsis and anesthesia were 19th-century discoveries. This means that surgery had an even more complex set of potential complications than it does today. Like most of the early-modern folks, I would certainly not line up to get a nose job or breast enhancement surgery just for the heck of it. Come to think of it...I wouldn't do that now anyway!

For more on all of this, I recommend Sander Gilman's excellent Making the Body Beautiful: A Cultural History of Aesthetic Surgery. Gilman is on the faculty at Emory and a top cultural historian.

Image courtesy of: Lilly Library, Medical Collections.

The Knife Man

By Holly Tucker

Coming up next week is a guest post from Wendy Hunter, who will be talking about 18th century domestic violence, in conjunction with her new book Wedlock. I came across Wendy's fabulous work about a year ago, when I read her The Knife Man: Blood, Body Snatching, and the Birth of Modern Surgery.

THE KNIFE MAN is a biography of the 18th century John Hunter, who is often referred to as the "Father of Surgery." The book has been praised far and wide for its spot-on presentations of what early dissection classrooms and surgical theaters would have been like several hundred years ago. I, for one, will never be able to visit Covent Garden in London again without scanning the buildings in search of the exact space where the Hunter brothers performed their countless dissections. Wendy's chilling chapter on the negotiations that happened in prisons with family members of the soon to be hanged is well worth the read.

As regular Wonders and Marvels readers know, the website's pages are frequently home to inquiries about early surgery. If your nerves are steadied and you're not prone to queasiness, head over to the surgery articles grouped HERE.

And for those who can't get enough of this gory stuff, may I also recommend:

Dream Anatomy, an online exhibit at the National Library of Medicine

Morbid Anatomy, a magnificent and smart website on historical anatomies

Early Surgery & Cautery: Or How to Boil a Puppy

By Holly Tucker

How did early surgeons control bleeding? Many of you can guess the answer. For as horrific as it sounds, cautery with hot metal instruments and boiling oil were the methods of choice in the 16th and 17th centuries.

What is less well-known, however, is that the practice was thoroughly critiqued by Ambroise Pare, one of the most prominent French surgeons of the early-modern period.

In his First Discourse Upon Wounds Made by Gunshot (published in English in 1617), Pare experimented with salves as a way to avoid causing his patients the intense pain that comes--understandably--with pouring boiling oil on open wounds.

"I observed the method of the other Chirgurians in the first dressing of [gunshot] wounds, which was by the application and infusion of the Olye as hot as they could suffer it...:wherefore I became embolded to do as they did. But in the end, my oyle fayled me, so that I was constrained to use in steede thereof, a digestive made of the yolke of an Egge, Oyle of Roses and Terebinth. The night following, I could hardly sleepe at mine ease, fearing lest that for want of cauterizing, I should find my Patients on whom I had not used the aforesayed Oyle, dead and impoysoned; which made mee to rise earely in the morning to visit them: where beyond my expectation, I found those on whom I had used the disgestive medicine, to feele but little paine, and their wounds without inflammation or tumor, having resting well all that night.

The rest, on whom the aforesaide Oyle was applyed, I found them inclining to Feavers, with great pain, tumor, and inflammation about their Woundes: then I resolved with myselfe never to burn so cruelly the wounded Patients by Gunshot anymore."

Pare continued to pursue his studies on post-surgical balms. Not long after, he went to Paris and met with the King's surgeon. This high ranking surgeon gave Pare the "receipt" for his own balm. And, I should add here my history of medicine students cry out in protest when I remind them that "whelps" mean puppies...

RECIPE

"He sent me to fetch him two young whelpes, one pound of earth-wormes, two pounds of the oyle of Lillies, six ounces of the Terebinth of Venice, and one ounce of Aqua-vitae: and in my presence he boiled the whelpes alive in the saide Oyle, until the flesh departed from the bones. Afterward, he tooke the wormes (having before killed and purified them in white wine, to purge themselves of the earth which they have always in their bodies) being so prepared, he boyled them also in the said Oyle till they became dry, this he strained through a Napkin, without any great expressions, that done, he added thereto the Terebinth, and lastly, the Aqua-vitae, and called God to witnesse, that this was his Balme which is used in all wounds made by Gunshot."

I'll stick with neosporin, bactine, and my favorite hand lotion...Thanks.

Image: Ambroise Pare, De la methode curative des playes, et fractures de la teste humaine (1651). Wellcome Library, London

Realism in Dissection

by Mary Coleman (Vanderbilt University)

During the scientific revolution and particularly the 17th century, anatomical dissections and representations took on a new element of "realism." Dutch anatomist Govard Bidloo's 1689 anatomical manual, Anatomia Humani Corporis, and the controversy surrounding its illustrations highlight the manner in which such realism was a product of the times.

The manual's hauntingly precise illustrations, drawn by Dutch artist Gerard de Lairesse, were central to the success of the work and proved so in later allegations of plagiarism. When William Cowper published an anatomical manual in 1698 using the same plates drawn by de Lairesse, he gave no credit to the artist or the anatomist. Although Cowper wrote an entirely original English text to accompany the plates, his status as a plagiarist remains. Author and historian William Cobb considers the importance of illustrations in 17th century medical publishing: "Precise anatomical descriptions were a key part of the scientific revolution's attempt to provide a material account of the universe" (163).

Why were such illustrations so imperative to the livelihood of 17th century anatomists? The invention and development of the microscope in the Netherlands during the early 17th century brought medical and public attention to the uncharted realm of minute structures. With the enhanced observational power of the microscope, realism and even hyperrealism became vital to the success of anatomical illustration. During the Dutch Golden Age of the 17th century, the Netherlands really was the center of scientific and artistic innovation, producing such celebrated artists as realist painter Jan Vermeer and Rembrandt, certainly a master draftsman. During this "golden" era, distinguished artists and scientists mingled in the universities and public spheres.

Medical education during the century increasingly included observation of dissection in "anatomical theatres." Professors performed dissections while dictating anatomical lessons to students, and public dissections were put on display for a fee. As interested parties became well versed in the drama of dissection and anatomical macro-structure, anatomists were pressed to deliver cutting-edge observations with precision.

Govard Bidloo's text and the controversy surrounding its publication demonstrate the beginnings of an emphasis on exacting observation that continues today in medical experimentation.

Image: Gerard de Lairesse, "Structure of Head" (1685).

Bidloo, Govard. Anatomia Humani Corporis, 1685.

Book of the Week: Blessed Days of Anaesthesia

Anesthesia is a relative newcomer to medicine. Up until the 19th century, surgeries were done without effective pain management. The best bet for pain was loads of alcohol and a variety of herbal concoctions. One well-used herb: the mandrake. The little forked root made famous by Harry Potter's time at Hogwarts.

Stephanie Snow's book tells the charged story of chloroform, ether, politics, and murder in the 19th century. A smart book, a fascinating read. Dr. Snow is a Research Associate at the Center for the History of Science, Technology, and Medicine at the University of Manchester.

Of Bloodletting and Birthdays

While Monday's are normally reserved for the Book of the Week, I'll break tradition in order to call the Wonders and Marvels group to order for a birthday party. Mine!

I won't divulge my age, but I will mention that a birthday on November 3 makes me a Scorpio.

And because this blog is about the history of medicine and not me, I'll use this opportunity to transition into a discussion of bloodletting. How's that for a fluid transition?

Astrology and astronomy were not two separate fields in the early-modern era. In fact, astrology and medicine were also inextricably linked. While most bleeding was done from the arm, it was sometimes thought advantageous to bleed from other parts of the body depending on the ailment.

The bleeding chart above shows the places of the body that are governed by specific star signs. The heart is connected to Leo. The feet, Pisces. Libra, the gut. And Scorpio, well, ouch!

A barber-surgeon would do well to consult this or any of the many, many charts like it before bleeding. Any bleeding from the body part that matched the current star sign was ill-advised.

I'm sure men everywhere are relieved that the stars are in Scorpio right now.

Early Surgical Tools

C-sections were, again, the surgery of very last resort and rarely performed until the mid-to-late eighteenth century. While they were not common, this does not mean that the procedure did not take up good-sized sections of obstetrics texts. In fact, the more difficult and horrific the procedure...the more often you'll get to read about it in early manuals.

You have here an inventory of the tools required for a caesarean section in the very early eighteenth century. This is taken from Pierre Dionis's Course on Surgical Operations [Cours d'Operation de Chirurgie], published in 1708.

Dionis (pronounced Dee-oh-nees) was an innovator in surgical instruction and ushered in a new emphasis on formal training of surgeons. He began his professional life as a surgical and anatomical demonstrator at the Jardin du Roi--now the Paris Jardin des Plantes. Open-air dissections were performed at the gardens and usually drew a large crowd of spectators.

Dionis later became a court surgeon. He documents the work he did at court and describes the demonstrations that he performed at the request of Queen Maria Theresa (Louis XIV's wife). One that sticks in my mind is the dissection that he did following the death of a pregnant woman. The Queen requested that he give her a lesson on the anatomy of the womb and specifically demanded that he bring in specimens from the newly dissected corpse.

Gross Anatomy

This one goes out to all of the first-year medical and nursing students I know. The Dittrick Medical History Center at Case Western has an online exhibit on the history of gross anatomy classes--Haunting Images: Photography, Dissection and Medical Students. Just know that you're not alone as you memorize ever single, solitary, teeny-tiny anatomical structure imaginable. You're part of a very long history.

For those who can't get enough of this gross stuff, you might head over to the Morbid Anatomy website. It's a smart, well-researched site by someone who knows her stuff. And I thought that I had some peculiar interests!

C-Sections before Anesthesia

By Holly Tucker

In 1581, Francois Rosset was one of the first surgeons to claim that the procedure could be done successfully. We know, however, that he never tried it himself. This did not, however, keep him from describing the case of a women who presumably survived the surgery not just once, but six times.

For as optimistic as Rosset may have been, he was something of a renegade thinker. More established surgeons like Ambroise Pare argued vehemently against the idea in 1585.

Almost 80 years later, doctors still considered the c-section to be a "great excess of inhumanity, of cruelty and of barbarity" (Mauriceau 1668). And others felt that performing a c-section would be the surest road to hell possible.

Now, keep in mind that anthesthia and antisepsis are nowhere near the medical radar in the 17th century. There were plenty of painful, unmedicated, surgeries performed at the time. But this one was particularly concerning because of high death rates. And, of course, not one--but two--lives were at stake.

By the 18th century, caesarian sections became increasingly common as surgeons refined the procedure. Early c-section incisions (despite the illustration above) were often done across the belly horizontally. Surgeons shifted from the paramedial incision to a central vertical incision, one that did not slice through quite as many muscles. By the end of the 18th century, surgeons such as Andre Levret were claiming that the procedure was "praticable on living women"--and argued that it was at times absolutely necessary.

Image: Wellcome Library

Nose Jobs

As promised, a classic illustration from Gaspare Tagiacozzi's De curtorum chirurgia per insitionem (1597, book 2). Tagliocozzi shows autografting--grafts using the patient's own skin. In addition to the ravages of syphilis, nose jobs were needed to repair injuries in battle, but also after duels.

The question that I always get is: Did they work? The problem is that we do not have a lot a data on survival rates after such surgeries. We have a good number of case histories, but often there is more information about the specifics of the surgery--rather than the post-op outcomes.

I can say that it's important to remember that antisepsis and anesthesia were 19th-century discoveries. This means that surgery had an even more complex set of potential complications than it does today. Like most of the early-modern folks, I would certainly not line up to get a nose job or breast enhancement surgery just for the heck of it. Come to think of it...I wouldn't do that now anyway!

For more on all of this, I recommend Sander Gilman's excellent Making the Body Beautiful: A Cultural History of Aesthetic Surgery. Gilman is on the faculty at Emory and a top cultural historian.

Image courtesy of: Lilly Library, Medical Collections.

Renaissance Plastic Surgery

I have a lot of former students who are either physicians or who are in medical school. In many ways, you guys provide the inspiration for these blogs!

Case in point. A former student just told me over Facebook (yes, Facebook--even I can't believe I use it) that she is doing a clinical preceptorship in plastic surgery. She'll be scrubbing in for the first time tomorrow morning. This one's for you, SD!

We can find illustrations of plastic surgery going back to the 16th century, particularly in the works of Gasparo Tagliacozzi (1546-1699). The most famous images from his surgical manuals have to be the nose jobs. Rhinoplasty remains front and center in the early-modern surgical imagination for one primary reason: syphillis. From what I understand, highly advanced cases of syphilis--as many were--can devastate the membranes around the nose. Tagliacozzi was among the first to attempt skin grafts. I'll post some pictures on that tomorrow.

One of my favorite medical figures, though, has to be the inimitable Ambroise Pare (1510-1590)--and I'm certain that he will show up on these pages frequently. Pare was a self-trained surgeon (as nearly of them were). A battlefield surgeon, Pare had an intense interest in helping restore lost limbs and mangled bodies more generally. His works are full of beautiful illustrations of mechanical limbs, prostheses, and techniques for what we'd now call plastic surgery.

Note to SD: here's an image to help you prep for your first surgery. Tell me if it looks anything like what you see tomorrow. Something makes me think it's a little more complicated than this!