Great teachers of Gaspare Tagliacozzi (1546–1599)

Introduction

Gaspare Tagliacozzi, born at Bologna, became a professor of anatomy and surgery at Bologna (Figure 1). He devoted himself to that part of surgery whereby wholeness, insofar as possible, might be restored to defective parts of the face, particularly the nose, by the use of tissues from another part of the body. Although not the inventor of the principles he was the first to describe in his treatise, he was far more than a codifier. Tagliacozzi successfully practised the art of plastic surgery, as many contemporary eyewitnesses testify, and conducted a long series of precise observations on the basis of which he formulated exact and detailed precepts for performance of rhinoplastic. He wrote the first complete description of nasal reconstruction using skin from the arm. Gaspare Tagliacozzi's great work was the folio volume De curtorum chirurgia per insitionem (On the Surgery of Mutilations by Grafting). The first, or Bindoni, edition of Tagliacozzi's work published by Roberto Meietti appeared in Venice in 1597. ¹ Tagliacozzi's treatise is divided into two books. Book I consists of 25 chapters that review the nomenclature, anatomy and importance of the parts of the indications for use of surgery in remedying defects in the human body, the part from which the skin flap for restoration of the nose to be lifted, and how much skin to take. Book II contains 20 chapters that discuss surgical restoration of ear, nose and lip defects. These include preparation of the cutaneous flap, application of the flap to the defective part, keeping the parts bound together until union is affected, severing the flap from its original site and shaping the new parts. ² OPEN IN VIEWER

Tagliacozzi's teachers at the University of Bologna during his student days remain largely unknown. Gnudi and Webster review the life of Tagliacozzi, with special emphasis on Girolamo Cardano, Giulio Cesare Aranzio and Ulisse Aldrovandi. ³

The medical curriculum and scholar days of Gaspare Tagliacozzi

The University of Bologna with which Tagliacozzi's life was to be intimately connected was the centre of learning in the sixteenth century. The teaching of medicine at Bologna was divided into theoretical and practical medicine, the first embracing the general principles of pathology, the second concerned with the particular cures for the various disease. Both Greek and Arabic authors were included in the required texts for study. ⁴ There was the Canon of Avicenna,⁵ The Colliget of Averroes,^6,7 a book De simplicibus medicinis, perhaps of Serapion or of Mesue, ⁸ the Regimen of Maimonides, ⁹ the Aphorisms of Hippocrates ¹⁰ and the Ars medica, the De crisibus and the De febrium differentiis of Galen.^11,12 In surgery, the teaching was still based chiefly on the text and tradition of Galen's writings.

Tagliacozzi began his studies early, undoubtedly following the customary curriculum in the humanities, grammar, rhetoric and dialectics. He took up the study of dialectics in his fifteenth year, philosophy in his seventeenth and medicine in his nineteenth. In 1565 Tagliacozzi entered upon his five year's training in medicine at Bologna. The various schools of the Studium of Bologna, in which Tagliacozzi studied as a medical student, had been brought together in 1562–1563 and housed in one building, the Archiginnasio, now the Communal Library of Bologna. ¹³

Based on the medical curriculum of that time, Tagliacozzi received both theoretical and practical courses in medicine. Natural philosophy, moral philosophy and philosophy were theoretical courses of importance which Tagliacozzi was required to study in medicine. These subjects were all presented in ‘ordinary lectures’ and the professors who taught them were called ‘ordinary professors’. They were the most important courses for their subject matter, for the calibre of the teachers presenting them and for the days on which they were scheduled. There were also ‘extraordinary lectures’ in the theory of medicine and in philosophy.

Astronomy and a course in medicinal simples, as well as supplementary courses in medicine and surgery, were given on feast days. Also included in Tagliacozzi's training were courses in theology, logic and the humanities.

Tagliacozzi's practical training included the dissections and anatomical demonstrations that taught him the structure and nature of the body. In addition, the direct and practical contact which he had with patients in the Ospedale della Morte (The Hospital of Death) gave him experience in the nature of disease in the human body and skill in its care and cure. The proximity of Ospedale della Morte to the Archiginnasio, as well as the relations between the Confraternity of Death and the professors of anatomy in the matter of procuring cadavers for dissection, account for its use as a training hospital for the students. ¹³ We can imagine Tagliacozzi, on his way to a lecture, to an anatomical dissection, or to a solemn inaugural ceremony, moving through the long corridors of the recently constructed Archiginnasio. We can see him making his way from bed to bed in the Ospedale della Morte, observing the patients and listening attentively to the comments of the doctors and teachers he encountered there.

Remote heritage and great teachers of Tagliacozzi

Some of the most memorable names who taught or studied at Bologna in the early annals of medicine should be recalled: Taddeo di Alderotto of Florence (1223–1295), ¹⁴ followed by Ugo Borgognoni of Lucca (1180–1258) and his son Theodoric of Cervia (1205–1298), founded the school;^4,15 Guy de Chauliac (1300–1368)^16,17 and Henri de Mondeville (1270–1320)^18,19 studied there; Mondino dei Luzzi (1270–1326), ²⁰ Alessandro Achillini (1463–1512) ²¹ and Berengario da Carpi (1470–1550) ²² carried forward its great teaching tradition. From all these stemmed the remote heritage of Tagliacozzi when he entered upon his medical studies in about 1565; the nearer heritage he was to receive from other great men, from Girolamo Cardano, Giulio Cesare Aranzio and Ulisse Aldrovandi. ³

Girolamo Cardano (Gerome Cardan, 1501–1576)

Girolamo Cardano (Hieronymus Cardanus) was born in Pavia in the Duchy of Milan, the illegitimate son of a local jurist, Fazio Cardano, whom Leonardo da Vinci consulted on mathematical questions. Despite poverty and miserable childhood full of sickness, he managed to study medicine at the University of Pavia and at the University of Padua, receiving his degree in 1524. In 1532 he was appointed to the chair of mathematics in Milan but continued to practise medicine. ²³

In 1539 he was admitted to the College of Physicians and later in 1541 was appointed Rector of the College. In 1543 he was Professor of Medicine at the University of Pavia. Following his professorship at Pavia, which he had to resign after his son's conviction for murder in 1562, he was appointed Professor of Medicine at the University of Bologna, three years before Tagliacozzi began studying medicine at the University ²⁴ (Figure 2). He taught a course in the theory of medicine at the University of Bologna between 1562 and 1570, a period overlapping with Tagliacozzi's five-year medical training between 1565 and 1570. OPEN IN VIEWER

It was in mathematics that Cardano's real talents lay. In 1539 he published his first mathematical text, Practica arithmetica et mensurandi singularis (Practice of Mathematics and Simple Mensuration). ²⁵ In 1545, the year of Tagliacozzi's birth and two years after the appearance of the monumental and revolutionary works of Copernicus and Vesalius, he published the first great Latin treatise the Ars magna (Great Art) devoted solely to algebra. ²⁶ It contained the theories of algebraic equations as they were known at that time. Among these is the rule, now called ‘Cardan's Rule’, for solving depressed cubic equations. He also showed how to find approximation of roots of equations that could be calculated as close to the true ones as one cared to make them. He described numbers as ‘fictions’ and their square roots as ‘sophistic’.

In his later Liber de ludo aleae (Book on Games of Chance) Cardano did some pioneering work in the mathematical theory of probability. ²⁷ Cardano's another popular book was De subtilitate rerum (1550) (The Subtlety of Things), corresponding to what would now be called Transcendental Philosophy, an encyclopedia of physical inventions and experiments. ²⁸ This was followed by a companion piece, De varietate rerum, published in 1557. In his writings on magnetism he advanced the idea that magnets can grow old and lose their potency. He distinguished between electrical and magnetic attraction, defining the former as the flow and return of a fatty substance to which dry things adhere.

Cardano made a significant contribution to optics. He described the use of a bi-convex lens in conjunction with a camera obscura, the earliest known mention of such a design. He also included detailed descriptions of the improved images he was able to achieve with the configuration, which increased both sharpness and intensity. In the book Opus novum de proportionibus (on mechanics), Cardano tried to apply quantitative methods to the study of physics. ²⁹

Cardano made noteworthy contributions to the early study of clinical psychiatry, reporting his observations of types of abnormal mentality in a book written – characteristically – on the occasion of the decapitation of his son Giovanni Battista for having poisoned his wife. He published a book On the Bad Practice of Medicine in Common Use that proved very popular with the public, who had their doubts and suspicions about medical practitioners. The medical writings of Cardano covered a wide range of subjects and are again a mark for his intense interest in all aspects of science. He refused to rely on the authorities of the past, including Galen and Hippocrates, and developed his own ideas in medical practice. He wrote about the instruction of deaf-mutes and blind persons, the treatment of syphilis and the causes of disease. One of his notable achievements was to give the first clinical description of typhus fever.^30,31

Cardano was also interested in philosophy and wrote two books on the subject. In spite of his accomplishments and devotion to science, he remained a strong believer in astrology and claimed to be able to draw horoscopes and determine character from facial appearances. ³²

He believed firmly in dreams and signs, and his enthusiasm for astrology led him to plot the horoscope of Jesus Christ in his book De astrorum iudiciis. ³³ It may have been for this brave act, as well as for other writings attacking the Church, that he was thrown into prison for several months by the Holy Inquisition in 1570. In the same year, the year of Tagliacozzi's graduation, following his incarceration, Cardano was dropped from his post at the University of Bologna which he held since 1562. He left for Rome where he was allowed to stay in the College of Physicians and was given a pension by Pope Gregory XIII. ³⁴ After Cardano left his university chair, Aranzio continued to teach there until his death in 1589; and Ulisse Aldrovandi (1522–1605), with his long teaching career of almost fifty years, outlived Tagliacozzi by a little over five years. ³

Cardano spent the last year of his life in Rome and there he finalized his autobiography, De propria vita (The book of my life).^24,35 This book can be described as one of the three great archetypes of the autobiographical form. He died in Rome.

Giulio Cesare Arantius (Julius Caesar Arantius, Aranzio or Aranzi, 1530–1589)

With The Renaissance, the scholastic tradition was replaced by a wave of intense experimentation and observation throughout Europe, particularly in Northern Italy. Arantius was a notable representative of the School of Bologna in the 16th century and contributed significantly to the development of surgery and anatomy ³⁶ (Figure 3). OPEN IN VIEWER

He was born in Bologna, the son of Ottaviano di Jacopo and Maria Maggi, and he graduated there in 1556. In the same year, he became Professor of Surgery and Anatomy at the University of Bologna. Arantius wrote books entitled De Humano Foeto Opusculum (Rome: 1564, Venice: 1571, 1587, and Basel: 1579), Observationes Anatomicae (Basel: 1579, Venice: 1587, 1595), and De Tumoribus Secundum Locos Affectos (Bonon: 1571). These works were published together in Venice in 1587 and 1595. ³⁷ In 1580 he published the commentary Hippocratis Librum de Vulneribus Capitis Commentarius Brevis (Hippocrates's Wounds of the Head). ³⁸

One of Aranzi's major accomplishments was his revolutionary role in the official acknowledgment of the teaching of anatomy as a discrete subject separate from the surgery that took place in 1570. Analysis of his anatomical books demonstrates that Aranzi was definitely a representative of anatomists who relied on observation and experiment for discoveries similar to Vesalius and at variance with Galenic anatomy. ³⁶

Aranzi wrote the first adequate account of the gravid uterus and his description of the fetus was by far the best at that time. He was the first to describe the deformed pelvis and he discovered that the blood of the mother and the fetus circulated separately during pregnancy. ³⁶

Aranzio described the cerebellar cistern and Ammon's Horn. He was credited with the discovery of the hippocampal formation although investigation of the original 1587 text of his De Humano Foetu suggests it was not the hippocampus but a part of it, the dentate gyrus, to which he referred. Aranzio provided the first description of the superior levator palpebral muscle of the upper eyelid and he described accurately the foreman ovale, the ductus venosus and the ductus arteriosus. Arantius's study of the valves of the heart led to his discovery of the ‘nodules of Arantius’ for which he is best known to modern physicians. Aranzio gave the first description of the coracobrachialis.

Arantius was also a competent surgeon and his works threw light on many subjects. He relied on ancient Greek medical literature and frequently quoted Galen and Paulus, at the same time incorporating his personal experience. ³⁶

Arantius was full Professor of Surgery and Anatomy in the years 1570–1571 when Tagliacozzi was assigned to Arantius for anatomic and surgical training. Tagliacozzi's association with Arantius started with the selection of Tagliacozzi as an Assistant in Anatomy early in 1570. It seems probable that he often assisted Arantius in his anatomic dissections. Tagliacozzi was appointed Professor of Surgery immediately after taking his degree in medicine in 1570. Tagliacozzi thus became the colleague and close associate of his former teacher, Arantius. There is strong evidence that Arantius performed nasal reconstruction using brachial skin in Tagliacozzi's student days at Bologna. Analysis of the English translation of Tagliacozzi's De Curtorum Chirurgia per Insitionem, written by Alexander Read in the 17th century, ² shows Tagliacozzi's emphasis on the use of arm skin for nose repair, which is in line with the technique of his teacher, Arantius, who had performed nasal reconstructions long before Tagliacozzi. It is likely that Aranzi gave practical instructions to Tagliacozzi in the principles of nasal reconstruction.^37,38 The Polish text of Wojciech Ocko (1537–1599) demonstrates clearly the similarity of technique used by Arantius and Tagliacozzi in nasal reconstruction: ³⁸

‘In my days in Bologna, what Arantius, Professor of Surgery, did from the skin on the arm was easier. He performed it in such a manner that when it healed, the skin integrated the patient's own nose, and thus covered it, without touching the muscle, the arm would not be much harmed and a good looking nose would be reconstructed’.

When Arantius died in 1589, Tagliacozzi was appointed one of the four professors to the Chair of Anatomy and in this position conducted anatomic dissections for the university.^36,39–43 Since the anatomical theatre of the Archiginnasio was built in 1637, Tagliacozzi must have performed his anatomical dissections in another room of the Archiginnasio.

Ullise Aldrovandi (1522–1605)

Aldrovandi, Italian naturalist, was born of noble parentage at Bologna.^44,45

He obtained a degree in medicine and philosophy in 1553 and started teaching logic and philosophy in 1554 at the University of Bologna. Aldrovandi succeeded his mentor Ghini as Professor of Natural History at the University of Bologna in 1556. In 1559 he became Professor of Philosophy and in 1561 he became the first Professor of Natural Sciences at Bologna (Figure 4). Aldrovandi taught Tagliacozzi the ‘ordinary’, that is the principal, course in natural philosophy as part of the University medical curriculum. Aldrovandi increased the significance and scope of natural history over the next few decades. He gave natural history some degree of autonomy from medicine by arguing that it was also an important part of natural philosophy. OPEN IN VIEWER

In 1568 Aldrovandi became Inspector of Drugs and in that capacity published in 1574 the work Antidotarii Bononiensis Epitome which formed the model for many subsequent pharmacopoeias. ⁴⁶ As Professor of Medicinal Herbs and as Protomedico of the College of Medicine, that is Inspector of the Medicaments and ingredients used and sold in the pharmacies of the city, he was greatly concerned with the quality and kinds of herbs grown in Bologna.

In 1557 Aldrovandi embarked on a botanizing expedition in the Sibylline Mountains of Italy, the first such expedition of its kind in Europe. One of the projects he desired was the establishment and cultivation of a botanical garden. There was already an herbal garden in the convent of San Salvatore, a church which had always been closely associated with the medical school and in which the examinations for the degree in surgery had been held in the fourteenth century, and Aldrovandi himself had also cultivated and collected plants and herbs privately for his own study. But in 1568 the Senate decided to establish an official herbal garden in the courtyard of the Public Palace and allowed Aldrovanni to take charge of it. It flourished there under his care until 1587 when the Legate decided to build a well in the courtyard and the garden was moved to lands near the Santo Stefano gate. These lands and the adjoining houses where Aldrovandi went to live were provided by the Studium. ⁴⁷

His museum of animals, minerals and fossils and his library were widely known in his days. His vast collections in botany and zoology were conserved in the Palazzo Pubblico, then in the Palazzo Poggi, Bologna, until 1742. Then they were distributed among various libraries and institutions in the course of nineteenth century. In 1907 a representative part was reunited at Palazzo Poggi, Bologna, where the 400th anniversary of his death was memorialised in 2005. ⁴⁸

A member of the Colleges of Medicine and Philosophy, Professor of Logic and Philosophy (and later of Medicinal Herbs), Aldrovandi was also a prodigious writer in natural history. Aldrovandi wrote about animals because of his intrinsic interest in their anatomy and physiology. Similarly, his work on plants and minerals attempted to describe each specimen comprehensively, in keeping with his vision of natural history as an encyclopedic project. However, he published very little of his research in his lifetime. The first volume of his Natural History, The Ornithology (1599–1603), did not appear until shortly before his death. ⁴⁹ After his death a number of other volumes were compiled from his manuscript materials, under the editorship of several pupils to whom the task was entrusted by the senate of Bologna.^50–57

Aldrovandi gathered the largest collections of animals, plants, minerals and fossil remains of his time, containing more than 18,000 specimens according to his written description from 1595. ⁴⁷ Aldrovandi tried to bridge the gap between simple collection and modern scientific taxonomy by theorizing a new science base on observation, collection, description, and ordered classification of all natural objects.^58,59

Aldrovandi defined the modern meaning of the word ‘geology’ in 1603. ⁶⁰ He influenced a school in natural history that reached its climax with the Istituto della Scienze of Bologna in the seventeenth and eighteenth centuries with succeeding scientists.

Tagliacozzi's other teachers

Other teachers under whom Tagliacozzi studied included Lattanzio Benacci (1499–1572) in astronomy, ⁶¹ Giovanni Lodovico Cartari in philosophy, Fabrizio Garzoni and Felice Castelli in the practice of medicine and Nicolo Turchi in philosophy and physics. Both Garzoni and Benacci were nearly at the end of their long teaching careers at this time. Garzoni took his degrees in philosophy and medicine in 1544; he taught logic and later philosophy until 1550, when he became Professor of the Theory of Medicine. This post he held with honour until 1573; he died in Bologna in 1574. Benacci, son of the Bolognese count Vincenzo Benacci, took his degrees in philosophy and medicine in 1538. He became first Professor in Astronomy in 1554 and in this capacity he continued until his death in 1572. Cartari, also Bolognese, took his degrees in 1557 and taught at Bologna until 1571 when he was called to Perugia. After four years of teaching in that city, in 1575 he returned to Bologna where he taught with a considerable following until his death in 1593. Nicolo Turchi took his degrees in 1554 and taught logic, philosophy and physics until 1587; he died in 1588 (Mazzetti, Repertorio). ³

Conclusion

Tagliacozzi was privileged in the teachers whom he encountered in the school of his native city. Three belong, in different fields, to that group of intellectual searchers, scattered here and there throughout Europe, who made the first advances in a renaissance of science and who, with their experimental methods, replaced empiricism and brought about the positivistic studies of Newton and Bacon in the following century. Their mentality was similar to that of Leonardo and Vesalius.

Quietly they went about their daily tasks of teaching, searching and analysing, and quietly they recorded their findings. Within the established structure of university organization, their activity contributed to the slowly working ferment which was finally to take over the Galenic teachings in medicine and the static acceptance of tradition in all science.

The fresh notes of Cardano's originality, of Aranzio's questing searches and of Aldrovandi's eager curiosity and scientific method must have arrested the attention of Tagliacozzi with penetrating sureness. The example set by these teachers, as well as the daily impact of their minds and of their varied activities, must have had an inspiring effect on Tagliacozzi as a student and undoubtedly influenced the character of his interests.

The influence of these teachers on Tagliacozzi can be substantiated with the following sample extracts obtained from the abstract of Book I of his De Curtorum Chirurgia made by Israel Edward Drabkin (1905–1965). ⁶² Tagliacozzi discusses the nomenclature and importance of the parts of the face in Chapters 1 to 10 of his Book I. Particularly in Chapter 4, Tagliacozzi reviews the reasons for the primacy of the face quoting Cardano's views and direct evidence of his impact on Tagliacozzi on the subject.

Tagliacozzi believes that the principles of using arm skin for nasal reconstruction are derived from agriculture, namely from the process of grafting analogous to that employed in plant grafts. For instance, in Chapter 12 various kinds of grafting are discussed with quotations from the ancient writers and more recent writers on agriculture including Palladius ⁶³ and Aldrovandi. Tagliacozzi must have been considerably influenced on this matter by his teacher, Aldrovandi, who himself had successfully cultivated plants.

Having been influenced directly and indirectly by the great teachers of his time, something in Tagliacozzi's own nature developed and flourished, for his own life was to follow a somewhat similar pattern making a unique place for himself in the history of surgery for his work in the reconstruction of nose, lip and ear defects using brachial skin.