The History of Rhinoplasty ④ — Tagliacozzi, the surgeon who defied the will of God

Sixteenth-century Europe was an age with an unusual number of people who had lost a nose. It is a curious thought — say mediaeval Europe and the first impression that comes to mind is something ornate and pretty.

Two reasons overlapped. Duelling with the rapier was in fashion, and syphilis, which spread through Europe from the end of the fifteenth century, destroyed noses.

The man who systematised nasal reconstruction in this period was Gaspare Tagliacozzi (1545–1599), professor of surgery at the University of Bologna.

He set out a method of making a nose from the skin of the inner upper arm.

The arm was held fixed against the face, and once the blood supply had taken, the arm was released. It later came to be called the Italian method.

In 1597 he published De Curtorum Chirurgia per Insitionem — the surgical restoration of defects by grafting.

It is counted as the first book devoted to plastic and reconstructive surgery.

There is a sentence he left in that book. Its sense is that we restore what has been lost not to delight the eye, but to lift the spirit of the one who suffers.

Four hundred years on it is still quoted often as the sentence that stands for plastic surgery.

There is a point here I want to make carefully.

The story is widely told that he was excommunicated after his death, and that his remains were dug up and reburied in unconsecrated ground — on the grounds that a man had laid hands on what God had made.

Blasphemy, in other words.

In fact, when I went to the sources to write this, I found the accounts diverge.

There is a record that he was buried as he had asked, in the church of San Giovanni Battista, and that a memorial mass was held with fellow physicians present.

Against that, there are accounts saying the remains were later moved on the instruction of the church.

What is clear, though, is that after his death the Italian nasal reconstruction vanished from European medicine for a long time and did not reappear until the nineteenth century.

It is very likely the hostile gaze of the age had a hand in the technique disappearing.

“This is what I was born with — is it all right to change it?” The question is that old.

In my consulting room there are people who put that into words every day. Thinking that the same question was being asked in Europe four hundred years ago makes that hesitation look a little different.

What is certain is that other people’s opinions should not weigh heavily on that decision.

It is also why I never press surgery on a patient. There is no pushing in my consulting room, and no urging.

The one who decides has to be the patient.