De curtorum chirurgia per insitionem, libri duo.

Venice: Gaspare Bindoni, 1597.

First edition, first issue, of the first book devoted entirely to plastic surgery. “Tagliacozzi studied under Girolamo Cardano at Bologna and later became professor of surgery and anatomy at that institution. This work, ‘Concerning the surgery of the mutilated by grafting,’ is a classic in the history of plastic surgery and is especially noteworthy for its description of rhinoplasty. Rhinoplasty had been practiced in ancient India and, in the thirteenth century, by a family of itinerant Sicilian surgeons who kept the operation a family secret. The volume is divided into two parts: the first, ‘Theory of the art of plastic surgery,’ is about the structure, function, and physiology of the nose; and the second part, ‘Practice of the art,’ describes and illustrates the instruments and operative procedures for restoration of the nose, lip, and ear. Tagliacozzi also fully discussed the complications, such as hemorrhage and gangrene, that often occurred during these operations. The numerous full-page woodcuts are well-executed and illustrate many of the techniques described in the text. The immediate popularity of the work caused it to be pirated by another Venetian printer, and that is the edition mentioned by Osler” (Heirs of Hippocrates). He also discusses medical complications, skin grafts, gangrene and scarring, and illustrates surgical instruments and progressive steps of the various reconstructive operations through the post-operative stage. Although Celsus and other early writers had discussed aspects of plastic operations, “Tagliaccozzi was the first to work toward establishing their scientific validity by publishing surgical procedures that had for generations been closely guarded secrets, and by improving these procedures in the light of the best medical knowledge of his day” (Norman). Rhinoplasty was much in demand in the sixteenth century and later, both as a remedy for the grotesque deformity of ‘saddle nose’ caused by syphilis, and for injuries resulting from duels (the great astronomer Tycho Brahe had his nose sliced off in a duel, and was forced to wear a replacement reportedly made of silver and gold).

“Although many earlier writers such as Celsus had discussed aspects of plastic operations, Tagliacozzi was the first to work toward establishing their scientific validity by publishing surgical procedures that had for generations been closely guarded secrets, and by improving these procedures in the light of the best medical knowledge of his day. Tagliacozzi described and fully illustrated the method of rhinoplasty that uses a graft from the patient’s arm, as well as various cosmetic operations on the ears, yet his contemporaries refused to adopt his methods, possibly for fear of complications, or possibly because the Catholic Church regarded plastic operations as meddling with the work of God (after Tagliacozzi’s death, the Church had his body exhumed and reburied in unconsecrated ground). Tagliacozzi’s work remained virtually forgotten until the revival of plastic surgery by Joseph Contantine Carpue and Carl Ferdinand von Graefe in the early nineteenth century.

“The series of twenty-two full-page woodcuts in Book III of De curtorum chirurgia depict Tagliacozzi’s instruments and the individual steps of the various reconstructive operations through the post-operative stage. Tagliacozzi went to great expense to have these illustrations prepared, as he indicated in his letter of I6 July 1596 to the Senators of Bologna (reprinted in Gnudi & Webster, p. 175). The artist who created them remains anonymous, although he may have been one of the many artists patronized by Duke Vincenzo Gonzaga, a powerful supporter of the arts in Bologna and the man to whom Tagliacozzi dedicated De curtorum chirurgia” (Norman).

Tagliacozzi was born in Bologna on 2 March 1545 and died there in 1599. He enrolled as a medical student at the university of Bologna in 1565, and was so gifted that while a student he was assigned the post of lecturer under the supervision of the professor of anatomy and surgery Giulio Cesare Aranzio (1530-99). He began teaching anatomy at the Ospedale della Vita Morte even before he completed his studies in 1570. “After Tagliacozzi graduated, Aranzio got him the position of lecturer in surgery at the university. In the meantime, this exceptional young man enrolled in the faculty of philosophy and after completing his studies in 1576, became a full member of the Collegio di Arti e Medicina, better known as the Collegio dei Dottori.

“Aranzio played an important role in Tagliacozzi’s professional career. He not only secured the post of lecturer in both anatomy and surgery for him but then designated him as the successor to his chair. As well as these well-deserved favours he apparently gave him operating experience, as Gnudi and Webster report: “Tagliacozzi was directly indebted to Giulio Cesare Aranzio for his first practical lessons on the Art.” Does this mean that Aranzio also taught his student the technique of rhinoplasty? This would be plausible because he himself had mastered the procedure, as we learn from a work discovered by Gnudi and Webster. It appears that the Polish physician, Wojciech Oczko visited Italy from 1565 to 1569, remaining for a considerable time in Bologna. In his book Przymiot he wrote admiringly “what Aranzio, professor of surgery, used regularly to do [facere solebat] during my days in Bologna, employing the skin of the arm and without touching the muscle … and there resulted a beautiful nose.” However little is known about Tagliacozzi’s activities as a surgeon before 1568, the year he wrote his famous letter to Mercurialis.

“During the sixteenth century Gerolamo Mercurialis (1530 - ca. 1604) was one of the most influential figures in Italian medicine. He studied at Bologna and taught at the University of Pisa before becoming professor of medicine at Padua. He was the author of a systematic treatise on skin diseases in 1572 and well-known illustrated compendium on medical gymnastics in 1573. As a cultivated intellectual with a broad range of interests, he was appointed Superintendent of the Vatican Monuments by the Pope.

“In 1585 Mercurialis published the first edition of De Decoratione Liber in which he mentions the nasal reconstructions that were being carried out in Italy: “In our time applause has been accorded for the discoveries of those who restored noses, certainly in Calabria,” and adds, “There is also the excellent Tagliacotus in Bologna, who recently showed me, when I was there visiting, two patients whose noses had been reconstructed.”

“Tagliacozzi was fully aware of Mercurialis’ influence in academic circles and “in Bologna on the 22nd day of February in the year of our Lord 1586” wrote him a letter to inform him that since his visit he had successfully completed another two nasal reconstructions … until Tagliacozzi published his book, this four-page letter constituted the only source of information available on the rhinoplasty technique as it was practiced in Bologna. In his letter Tagliacozzi provided a concise and lucid description of the operation, although he expressed concern that its brevity might induce the inexpert surgeon: “… like a sailor who has learned [to navigate] from books, to attempt the operation without success, to the detriment both of the patient and the very reputation of the Art.”

“Tagliacozzi had good reason to be worried because he had already seen how his method could be misinterpreted or completely misunderstood. As he wrote: “Vesalius, Paré, Gourmelin and others have written that a small hole or cavity of prepared on the arm, in which the mutilated nose is buried until the flesh grows into it, and that this flesh is moulded into the shape of a nose.” This of course was a wholly incorrect interpretation of the technique, which was to raise a flap on the arm and stitch it to the nose before separating it at a later operation. The nose was not “buried:” beneath the skin of the arm.

“Tagliacozzi furnished instructions on the preparation of the patient for the operation. For example: “Briefly, any cacochymia [he probably meant any general illness] must be removed … [Patients suffering from] a venereal disease must be rued out absolutely … The bowels should be moved daily or be stimulated appropriately.” However most of his letter covered the technical details of the operation itself. “An incision is made in the skin of one of the arms, right or left, down to the flesh, right down to the surface of the muscle; in other words, simple and solid skin is taken from the anterior brachial region.”

“One of his next points was destined to be either misinterpreted or completely ignored and remained a controversial issue for 150 years. Tagliacozzi wrote: “The removal of the bandage should be decided on the basis of the union and on a satisfactory nourishment of the skin and this will vary considerably according to the varying temperament of the patient. But when one observes a good union of the wound and a good nourishment of the skin, then one may cut the arm from the face.” Tagliacozzi did not specify exactly how much time should elapse before dividing the flap, leaving it instead to the judgement of the surgeon. But he did conclude that “a period of about fourteen days is in general necessary for the process of thickening and solidification to become complete.” These straightforward recommendations were often ignored by Tagliacozzi’s detractors, who claimed that the patient must remain for no less than forty days in a very uncomfortable position with his arm attached to his face. This they believed made the operation unendurable. Tagliacozzi, no doubt having already had to persuade worried patients, took care to explain that “on the contrary the procedure is so well tolerated that, even leaving aside the outcome, [this procedure] has won universal admiration.”

“Tagliacozzi’s instructions concluded with an explanation of how to splint and bandage the flap, a complex but necessary manoeuvre to ensure the proper shape of the new nose. Finally, he listed with pride the aristocratic patients, three Italians and a Belgian, whom he had successfully treated and announced to his illustrious colleague in Padua that he was writing a treatise in which every aspect of the operation would be thoroughly discussed.

“[In 1597] Tagliacozzi published De curtorum chirurgia per insitionem under the auspices of the University of Bologna and with the financial support of Vincenzo Gonzaga, Duke of Mantua. The result was a unique work – the first text of plastic surgery in the history of medicine. [In it] the author analyses the principles of the operation, discusses the indications and contraindications, explains the healing process (cohalascere) as the flap becomes attached to the recipient site, and describes the surgical instruments (often of his own design) that were required. The problems of post-operative care and the prevention of complications are not neglected. All of the difficulties that a surgeon might encounter in the creation of a new nose are raised and discussed in detail. Finally, he explains how the flap could be used to repair other parts of the face” (Santoni-Rugiu & Sykes, pp. 185-9).

Two issues of this book appeared in the same year: the second has the license printed on the verso of the title page, the first does not.

Cushing T16; Durling 4310; GM 5734; Gnudi & Webster, The life and times of Gaspare Tagliacozzi, pp. 183-216; Heirs of Hippocrates 379; Mortimer (Italian) 488; Norman 2048; Santoni-Rugiu & Sykes, A History of Plastic Surgery, 2007; Wellcome 6210; Zeis 175.

Folio (313 x 203 mm), pp. [xxviii], 94, [2], 95, [1], 47, [33], with engraved frontispiece attributed to Oliviero Gatti, woodcut text illustrations, including 22 full-page with keys on opposite pages. Contemporary vellum.

Item #5862

Price: $65,000.00

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