'Naturalists say that the inventor of phlebotomy was the hippo, an animal that lives on the Nile river, as big as a Frisian horse, of both earthly and aquatic nature; when it feels heavy for the excessive quantity of blood in its body, it goes into a reed bed or a similar place and under the push of a natural instinct he cuts its veins and lets blood out until it feels better. Then the hippo finds out some mud and patches up its wounds'. Taken from the Italian surgeon Tarduccio Salvi da Macerata’s bloodletting manual, which was first published in 1613, the 1650 edition of the book is accompanied by this eloquent illustration (Il ministro del medico, Rome, 1650, p. 4).

Bloodletting was the most common form of both preventative and therapeutic medical intervention in Renaissance Europe. It consisted of cutting one of the patient's vein to encourage noxious humours to move towards the open vein so that they could be expelled through the blood. It was performed with lancets, cupping glasses, or leeches and was meant to cover a range of treatments, including: healing fevers and pains; releasing bad humours from the whole body, particularly from the stomach; and even calming down the nerves.

But bloodletting had both a learned and a practical/technical pedigree. All classical Greek and Arabic authorities, including Hippocrates, Galen, and Ibn-Sina (Avicenna) had written about it, and it remained the subject of learned treatises throughout the early modern period. However, by the late middle ages its practice was entrusted to barbers and empirically-trained surgeons. The learned physician reserved for himself the role of supervisor.

As a side effect of this, by the second half of the 16th century barber-surgeons began to write books about their trade. Along with an abundance of technical details about how to skilfully use their hands and tools, they also began to take pride in their profession, underlining its important history and its reliance upon the fundamental self-healing power of nature. Salvi’s story on the hippopotamus in fact originally comes from Pliny’s Natural History (VIII.96): ‘The hippopotamus stands out as an actual master in one department of medicine; for when its unceasing voracity has caused it to overeat itself it comes ashore to reconnoitre places where rushes have recently been cut, and where it sees an extremely sharp stalk it squeezes its body down on to it and makes a wound in a certain vein in its leg, and by thus letting blood unburdens its body, which would otherwise be liable to disease, and plasters up the wound again with mud’.

Barber-surgeons’ manuals are often marked by a strong naturalism. In this spirit, they often described the origins of phlebotomy through the observation of animal behaviour. The hippopotamus was chosen to be the exemplum. This emphasis on the fundamental continuity of humans, plants, and animals was also typical of Renaissance naturalism.

PS

Further Reading:

• Pedro Gil-Sotres, 'Derivation and Revulsion: The Theory and Practice of Medieval Phlebotomy' in Luis García Ballester (ed.), Practical Medicine from Salerno to the Black Death (Cambridge, 1994), pp.110-55
• Sachiko Kusukawa, Picturing the Book of Nature: Image, Text, and Argument in Sixteenth-Century Human Anatomy and Medical Botany (Chicago, 2012)
  

In the second half of the sixteenth century, a group of professors of anatomy and surgery in Padua and Bologna began practising, and writing about, a complex procedure of surgical reconstruction involving mutilated parts of the face: lips, ears, and, in particular, noses. The most famous of these men was Gaspare Tagliacozzi (1545-1599), who published a detailed version of the procedure in his monumental two-volume De curtorum chirurgia per insitionem (1597).

The technique was a procedure of grafting. It consisted of cutting and preparing a skin flap on the upper region of the arm – and it was necessary to form the graft from the skin only and not using the flesh of the arm, as many believed in those days. To allow it to adhere to the defective nose, it was necessary to keep the two parts bound together for about three weeks, severing the flap from the arm, shaping the new parts of the nose, and finally making sure that the final result would last by using special moulds.

Tagliacozzi claimed that his elaborate procedure of skin grafting was based on the ancient art of grafting plants, especially trees, and he made special reference to the sixteenth-century humanist editions of the classical Latin writers of res rusticae, or agriculture, husbandry, and country lifestyle: 'I have derived the principles of this surgical procedure from agriculture, specifically from the process of grafting', Tagliacozzi wrote. In particular, he referred to the most accomplished and systematic of such writers, the first-century AD Columella. In describing his technique of skin grafting, Tagliacozzi followed closely the technique of Columella, making precise reference to the analogical correspondence between human skin and bark, which placed humans within a continuum that including plants and animals: '[...] if the bark of one tree can coalesce with the bark of another, as in the case of inoculation, there is no reason to believe that skin, which is analogous to bark, cannot be firmly and safely joined to other parts of the same body'.

Gardeners, natural historians, natural magicians, professors of secrets, and agronomists were all extremely interested in the intersections between art and nature brought about by grafting practices. Gardens, orchards, botanical gardens, and aptly cultivated fields came to symbolise the hybridisation of nature and art. Cultural imagery in the sixteenth century was full of references to such hybrids, including alchemy, and the practice of grafting became one of the preferred examples of fundamental alteration. Human skin was as transformable as the bark of a tree and surgeons could learn from the ways in which farmers and gardeners competed with Nature’s creative ability.

PS

Further Reading:

• Paolo Savoia, 'Nature or Artifice? Grafting in Early Modern Surgery and Agronomy', Journal of the History of Medicine & Allied Sciences, 79.1 (2016): 67–86
• Martha Teach-Gnudi and Jerome Pierce Webster, The Life and Times of Gaspare Tagliacozzi, Surgeon of Bologna 1545-1599 (New York, 1950)
  

Image taken from Gaspare Tagliacozzi, De curtorum chirurgia per insitionem (Venice, 1597)

Cupping glasses were adopted in procedures for bloodletting and purging the body in early modern Europe. As such, their use sparked considerable interest among physicians and barber-surgeons in this period.

The idea of irritating the skin on certain parts of the body, in order to attract evil humours from those more 'noble' parts (i.e. the brain, heart, lungs, or liver), has a classical pedigree. Descriptions of cupping can be found in the Hippocratic corpus, as well as in Aristotle, Galen, and Pliny. By the time of Plutarch, cupping glasses were so common that they were even used as analogies in moral philosophy. European authors of the Renaissance were also aware that Arabic authorities, such as Avicenna and Albucasis, had brought their use to perfection.

This blend of western and eastern practical knowledge associated with cupping is also evident in Prosperus Alpinus’ description of this method as belonging to the ancient wisdom of the Egyptians. In his De medicina Aegyptiorum (1591), Alpinus writes how in Egypt physicians would let their patients’ feet soak in warm water. The physicians would then either rub vigorously or beat their patients' calves with a stick, until the calves became reddish. The next stage would be to scarify the skin.

The same 'irritating' function was also performed by cupping glasses. Formed whole or with a hole at the top, these cupping glasses were made of either glass, horn, wood, or copper. They could even be made from silver or gold. A physician would create a vacuum inside the cupping glass, either through suction or through the burning of the highly flammable, raw fibre tow (a byproduct in the manufacture of hemp or linseed). The body part had to be rubbed gently before the cupping device was applied. Once removed, the skilful practitioner would make small cuts on the irritated part of the skin.

It is also worthwhile to note that the production (and even the existence) of vacuum was a hotly debated topic in early modern science. So the use of this technique alongside cupping glasses provides further evidence of how practitioners dealing with skin surfaces were engaging with the most up-to-date scientific knowledge of their time.

PS

Further Reading:

• Alberico Benedicenti, Malati-medici e farmacisti: storia dei rimedi traverso i secoli e delle teorie che ne spiegano l’azione sull’organismo (Milan, 1924)
  

Image: Coloured cupping glasses, late 17th-early 18th century. Museum of the History of Medicine, University of ‘La Sapienza’, Rome

One of the most iconographic depictions of skin remains the flaying of St Bartholomew, one of the twelve apostles and martyred in Armenia in the first century. This statue from the Science Museum's collections aligns itself with traditional representations of the saint, who is usually depicted with his skin hung across his back or over his arm. Thought to be Italian and made somewhere between 1501 and 1700, it is most likely to date from the first half of this period when a number of social, artistic, and political contexts came together to promote a particular aesthetic to represent the perennially popular saint.

St Bartholomew, Marco d'Agrate, 1562. Milan Cathedral, Italy

Although popular throughout the Middle Ages, towards the end of the fifteenth century the veneration of St Bartholomew was particularly keen in the Holy Roman Empire and Italy. The reason for this was quite literally embodied in the saint's skin; since the twelfth century there had been brisk trade in relics connected to the saint and, specifically, his flayed skin. Elector Frederick the Wise, who chose St Bartholomew as his patron saint, owned many of these, including a monstrance said to contain his facial skin, two of his ribs, and a part of his skull. At least in part because of this relation to skin, popular devotion to St Bartholomew emphasised the saint's role in protecting people from plague. It is not a coincidence that the oldest hospital in England, St Bartholomew's (or more affectionately Bart's), was named after the twelfth apostle. St Bartholomew was also the patron saint of tanners - a group of artisans with skills of particular interest to skin and its surface.

Valverde de Hamusco 'Anatomie': flayed skin. Credit: Wellcome Collection. CC BY

As art and anatomy converged in sixteenth-century visual culture, St Bartholomew was a key study for prominent artists. Michelangelo famously included a flayed Bartholomew in his Last Judgment fresco for the Sistine Chapel, unveiled in 1541. A statue of St Bartholomew by the artist Marco d'Agrate and dating to 1562 can still be seen in Milan Cathedral (see image). Like the anonymous Science Museum carving shown here, the Milanese piece demonstrates considerable attention to the anatomically correct display of the saint's musculature. More generally, the parallels between this and anatomical illustrations from the sixteenth century are hard to miss. Landmark anatomical publications by Vesalius, Valverde (see image), and others used flayed skin to dramatise and frame the wonders of the human body, as well as to demonstrate the artistic ingenuity which made possible the production of new bodily knowledge. 

Many of the issues represented by this sixteenth-century statue of St Bartholomew resurface regularly. Damien Hirst's large-scale, bronze statue of the saint standing at 2.5m high is currently on display at Chatsworth House and reminds us that preoccupation with the relationship between the body, piety, death and beauty remains, and is still at the surface of society.

HM

Main image: 'Statue of St Bartholomew, Europe, 1501-1700' by Science Museum, London. Credit: Science Museum, London. CC BY

Concepts of maintaining the balance of the four humours (black bile, yellow bile, blood, and phlegm) to keep the body in good health were applied to both human and equine care. Bloodletting, purging, sweating, and similar treatments were employed to cure a horse of its ailments. Bleeding is the principal remedy advised by Sir Nicholas Malby (1530?-1584) in his short treatise A plaine and easie way to remedie a horse that is foundered in his feete (1576):

Rays of the sun descend to the horse's body, which is superimposed with the signs of the Zodiac to indicate which part is influenced by that sign. Laurentius Rusius, Livro de la Menscalcia de li cavalli, Italy, 15th century. Pierpont Morgan Library, MS M.735, f.62r (view original)

‘When you find your horse to bee foundred in his feete, which you shalt perceive by drawing in all his foure legs togeather, and by his standing croaching as though hee stoode upon needles, and will be loth to goe: you must cause him to be let blood on his two brest vaines of his too forelegs, somewhat about the knees. Let him also blood on his spurre vaines on both his sides, and on the vaines of his too hinder feete a little aboue the hoofe, betweene the hoofe and the pastorne [...] Let the vaines bleede well to the quantitie of a quart, or three pintes, which blood you must save in some vessell, and stirre it with a sticke to keepe it from cluttering: and when he hath bled as above said, put it all into one vessell, then stop the wounds with some horse dunge or some earth'.

Malby then instructs the reader to mix up the reserved blood with wheatmeal, eggs (including the shells), vinegar, and Armenian bole clay. This paste was then to be applied to the horse’s back, buttocks, and shoulders.

Medical astrology was just as prevalent in veterinary care. This field of study required a practitioner to know and understand the movements of influential stars and planets in order to assess their patient correctly, and subsequently prescribe the correct treatment. The famous ‘zodiac man’ iconographic scheme had its equine counterpart; the latter was used by veterinary practitioners to determine the appropriate time to bleed a horse. The sky was divided into twelve sections, each ruled by one of the twelve signs of the zodiac. When the moon was in a particular sign of the zodiac, the horse could not be bled in the part of the body ruled by that sign. For example, if the moon was in Capricorn, the horse’s knees were not to be bled. If in Taurus, no blood was to be extracted from the neck. Many veterinary texts from the late Middle Ages to the 18th century, in both manuscript and print form, included rather helpfully a diagram of the ‘zodiac horse' to serve as a visual guide to the practitioner when bloodletting.

KWM

Further Reading:

• Sir Nicholas Malby, A plaine and easie way to remedie a horse that is foundered in his feete (London, 1576)
  
• Laurentius Rusius, Hippiatria (Paris, 1532)
  

Main image taken from Sir Nicholas Malby, A plaine and easie way to remedie a horse that is foundered in his feete (London, 1576)

Other images:

• Zodiac horse. Martín Arredondo, Obras de albeyteria (Zaragossa, 1704). US National Library of Medicine
• Horse, standing, bleeding from wounds covering its body. Laurentius Rusius, Livro de la Menscalcia de li cavalli, Italy, 15th century. Pierpont Morgan Library, MS M.735, f.2v
• Sweating - bridled horse, covered by a blanket stands under in the sun. Laurentius Rusius, Livro de la Menscalcia de li cavalli, Italy, 15th century. Pierpont Morgan Library, MS M.735, f.75r

The subjects of skin grafting and the general transplantation of body parts were highly popular among 17^th-century natural philosophers across Europe. At the same time, this coincided with the structure of human and animal skin being studied under the new light of the microscope. New understandings about the mechanics of the veins and arteries, alongside the emerging concept of the human body as a montage of machines and corpuscles, seemed to offer new insights into the existing stories of grafting and transplants.

In 1663, the newly formed Royal Society took upon itself the task to verify the rumours about skin grafting that were coming from Italy and France. In his History of the Royal Society (London, 1756), Thomas Birch wrote how many members of the Society reported strange observations: Hoare talked about the possibility of a cock's spur being attached to its head; Boyle mentioned how someone had made a horn grow on the forefront of a horse; and Clayton and Whistler recalled the case of a lady who had lost a tooth and got a new one from the mouth of one of her servants, the tooth then grew strong and firm. The members of the Society conducted an experiment using dogs, but this completely failed. Jon Wilkins ‘proposed the experiment of making a piece of the skin of a dog to grow upon another. Some things were objected against the probability of success thereof, viz., how veins, arteries, and fibres could disseminate themselves and grow into this strange piece of flesh patched on: it being necessary even to the restoring of a separated part to the same animal that there may be left some vessels, and that they join another, and it being hardly conceivable, how the healing can be effected, where the orifices of said vessels do not meet. Others alleged experience and several examples of separated parts healed together again.’

The experiment consisted of cutting a piece of skin from a dog and then reattaching it. Robert Hooke was appointed to undertake this. It was mutually agreed that it would be best to perform the experiment during a warmer season, and so they waited until the spring of 1664. During the first attempt, the dog removed the patch and the graft; while on the second attempt, the dog ran away before it was possible to control the outcome. One of the first things that the members of the Society did notice was that the piece of skin, once cut, shrunk to about half of its original size. However, interest in the project was short-lived. On 10 November 1664, Hooke wrote to Robert Boyle that the pain was unbearable in the skin grafting experiment: ‘I shall hardly be induced to make any further trials of this kind, because of the torture of the creature: but certainly the enquiry would be very noble, if we could find a way so as to stupefy the creature, as that it might not be sensible, which I fear there is hardly any opiate will perform.’

Subsequently, the Royal Society became more interested in another kind of experiment: blood transfusion. The first documented attempt was by Robert Lower, a physician who in 1665 demonstrated a blood transfusion between two dogs at the Royal Society. The dogs survived. In 1667, Edmund King reported to the Royal Society that Lower had performed a second successful experiment when he administered the blood of a sheep to a human being, a certain Arthur Coga, who survived. The news generated considerable expectation, even if the method and mechanics of the transfusion remained opaque and uncertain. Famously, Jean Baptiste Denis performed a therapeutic transfusion in France. Encouraged by Lower’s attempts, the French doctor transfused the blood of a lamb into a boy named Antoine Mauroy in 1667 and repeated the procedure one year later. Parallel experiments of blood transfusion between lambs were performed in Bologna and published in 1668. In 1668, however, the young French patient Mauroy died and, as a result of this, experiments on humans were put on hold.

The science of skin grafting had to wait until the 19^th century.

PS

Further Reading:

• David Hamilton, A History of Organ Transplantation: Ancient Legends to Modern Practice (Pittsburgh, 2012)
• Domenico Bertoloni Meli, 'Early Modern Experimentation on Live Animals', Journal of the History of Biology, 46, 2 (2013): 199–226
• François Delaporte, Figures of Medicine: Blood, Face Transplants, Parasites (New York, 2013)
  

Image taken from Matthias Gottfried Purmann, Grosser und gantz neugewundener Lorbeer-Krantz, oder Wund Artzney… (Frankfurt: Leignitz, 1705). Robert Lower experiments with ovine and human blood.

What did anatomists and butchers have in common in the Renaissance? Despite what we might be inclined to think, it is certainly not true that comparisons between early modern surgeons and butchers were necessarily always satirical nor attacks on physicians. In fact, surgeons and anatomists knew that they could learn something about cutting and treating the human body from butchers, as well as from leatherworkers, furriers, and even executioners (these will be discussed in future entries).

In the section of his work De humanis corporis fabrica (1543) that describes how to dissect skin and flesh and how to separate skin from the membrane which lies beneath it, the famed sixteenth-century Flemish anatomist and physician Andreas Vesalius declared:

A butcher flaying a lamb from Giuseppe Maria Mitelli, Scorticatore d’agnelli (late 17^th century)

No doubt, empirical surgeons compared anatomists and butchers mocking their intentions. But if we read passages from the 'professor of secrets', Leonardo Fioravanti, we realise that the comparison touched on a deeper layer of contiguity between the two professions, related to how manual skills could provide access to knowledge. Fioravanti wrote in 1578 that 'No art in the whole world is more similar to the anatomist’s than the art of butchers; both arts in fact are based on cutting, flaying, and dismembering bodies'. And he goes on to explain that in both medicine and butchery a certain 'science' is associated with those 'manual operations' and, therefore, they are both to be termed as arts rather than pure sciences. Interestingly, in addition to having the skills necessary to recognise and evaluate animals at first sight, the practical knowledge required of a butcher also included being able to flay animals in the correct manner 'in order not to waste their skin' and being able to bleed animals out 'so that the meat will not bee too reddish' [Dello specchio di scientia universale, (Venice, 1583), pp. 52-53]. Less than one century later in 1639, one of the heroes of the scientific revolution, Renée Descartes, wrote to Marin Mersenne that he had his practical training in anatomy at a 'butcher’s yard' in Amsterdam.

Different artisans and artisanal practices shared a set of skills about how to observe and manipulate human and non-human surfaces, from skin to bark, from rinds to animal flesh, from the surface of a landscape to dyes, from cloth to hair. How did practical knowledge about the surface of things and bodies interact with 'higher' knowledge and lead to conceptions of nature and matter as composed of layers, corpuscles, or artificially reproducible solid parts? Can we speak of a science of surfaces in early modern Europe?

PS

Further Reading:

• Piero Camporesi, The Incorruptible Flesh: Bodily Mutation and Mortification in Religion and Folklore (Cambridge, 1988)
• Christopher Lawrence, 'Medical Minds, Surgical Bodies: Corporeality and the Doctors' in Christopher Lawrence and Steven Shapin (eds.), Science Incarnate: Historical Embodiments of Natural Knowledge (Chicago, 1998)
• Lynda Payne, With Words and Knives: Learning Medical Dispassion in Early Modern England (Aldershot, Hamphire, 2007)
  

Main image shows dissecting tools from Vesalius, De humani corporis fabrica (Basel, 1543)

The city of Norcia located in central Italy, in what is now Umbria, became noted in the Renaissance and the early modern period for the skill of its inhabitants in cutting the skin and flesh of both animals and humans, and in manipulating the interior and exterior of dead and living bodies. Indeed, the very word norcino enjoyed a very interesting polysemy in the Renaissance, able to signify simultaneously butcher, castrator, and surgeon.

Norcini were famous as butchers from Ancient Roman times. In the 1960s, the historian Ignazio Pappalardo argued that norcini 'acquired a special skill in cutting, eviscerating, dissecting animals [pigs above all] and their knowledge of human anatomy was perfect. Moreover, in order to make pork’s meat better, tastier and softer, it was common to castrate animals while they were still young'. By the 16^th century, norcini were engaged regularly in the castration of young boys whose lives were to be dedicated to singing. In the same period, these very men also became employed as 'empirical' surgeons in Italian hospitals and towns, specialising in hernias, stones, and cataracts.

In the mid-sixteenth century, Pope Paul IV (r. 1555-59) prohibited women from singing in churches. Soon after, Italy became the land of castratos – boys singing as girls – in both religious and secular contexts. The boys involved had their testicles removed when they were young, roughly between the ages of 7 and 12. It was undoubtedly a delicate operation, requiring precision in cutting and knowledge of human anatomy. Many early modern sources suggest that the norcini were specialists in castration techniques, particularly in the big cities and starting in Rome. The eminent physician Gabriele Falloppio praised the special practice of the norcini in his book on surgery, published in 1561: 'This procedure can be carried on in different ways, and it is actually made in several different ways, since some, like the norcini, make a cut: truly there is no better way to remove the testicles, and this is why I praise this method above all others [...] Others pass a ring or a golden thread around the testicles to remove them, but none of these procedures is a safe as the norcini’s.' To add another celebrity to the list of sources, in 1634 Galileo Galilei sent his nephew Carlino to the norcini to have him castrated.

It is easy to understand why the norcini also became famous for being specialists in inguinal hernias and the removal of bladder stones – incidentally, among the most painful and disabling afflictions for early modern patients – since all procedures involved particular skill in cutting parts around the genital area. But, as empirical surgeons, they acquired a quasi-official and sanctioned status as eye and teeth surgeons too. In fact, until the 18th century, they comprised the majority of surgical staff within Italian hospitals. In 1583, Girolamo Mercuriale - a specialist in skin diseases - wrote about extraction of bladder stones, stating that 'for this procedure you need to pick the best surgeons [...] this treatment is to be performed by the right surgeon, precise and experienced [...] In these times, such surgeons are the so-called norcini, the most excellent in this art'.

An ocular case to treat fistula lacrimalis, a sore or opening in the tear duct and/or the lacrimal sac. Scacchi says he invented this case to keep the eye from moving. The lateral holes allow the needle-shaped cautery (hot iron) to touch the lateral parts of the eyes. Durante Scacchi, Subsidium medicinae (1596).

The quasi-official status of norcini as surgeons is embodied by the figure of Durante Scacchi (1540-1620). Scacchi was born in Preci near Norcia and went to Rome to study under the guidance of the famous anatomist Realdo Colombo. He practised as a surgeon and physician in several cities in Umbria and the Marche, and was eventually nominated city surgeon in Fabriano in 1567. He held this position until 1609. In 1596 while in Urbino, he published Subsidium medicinae. This was translated into Italian in 1609 by his brother Cesare, he too a norcino. The structure of the book is noteworthy, since it is different from both learned surgical books and barbers’ manuals. It is divided into four parts: book I is on eye conditions (see image) and, in particular, discusses the removal of cataracts; book II deals with the extraction of bladder stones and other problems related to the bladder; book III is concerned with several surgical operations including anal fistula, hernias, hare-lips, polyps, and eye-fistula; book IV is a compendium of surgery covering tumours, ulcers, aposteme, wounds, fractures, cancers, and gunshot wounds, but to name a few. In other words, the whole work truly reflects the knowledge of the norcini and places it in the context of learned surgery, such as was typically written about in Latin.

Appearing right in the middle of the early modern period, norcini are a perfect example of what anthropologists and historians of science call 'trading zones'. These trading zones are bi-directional exchanges among different groups of professionals and experts. In the case of the norcini, the exchanges took place both between different experts and between men of practice and men of knowledge.

PS

Further Reading:

• Giuseppe Gerbino, 'The Quest for the Soprano Voice: Castrati in Renaissance Italy,' Studi musicali 33, no. 2 (2004)
  
• Katharine Park, 'Eyes, Bones, and Hernias: Surgical Specialists in Fourteenth- and Fifteenth-Century Italy' in Roger K. French (ed.) Medicine from the Black Death to the French Disease (Ashgate, 1998)
  
• Gianfranco Cruciani, Cerusici e fisici: preciani e nursini dal XIV al XVIII secolo: storia e antologia (Thyrus, 1999)
  

Main Image: 'Butchers' from Tacuinum sanitatis casanatensis (14th century).