{"id":251,"date":"2010-09-05T18:29:35","date_gmt":"2010-09-05T18:29:35","guid":{"rendered":"http:\/\/www.williameamon.com\/?p=251"},"modified":"2016-12-21T20:53:44","modified_gmt":"2016-12-21T20:53:44","slug":"the-mysterious-malady-of-marulla-greco","status":"publish","type":"post","link":"https:\/\/williameamon.com\/the-mysterious-malady-of-marulla-greco\/","title":{"rendered":"The Mysterious Malady of Marulla Greco"},"content":{"rendered":"

Surgery is no art for the squeamish. A simple slice through the skin \u2013 the practiced surgeon\u2019s daily experience \u2013 may be enough to give an ordinary person nausea. \u00a0<\/p>\n

The history of surgery is replete with instances of daring surgical interventions, harrowing battles against blood-gushing wounds, amputations accomplished at lightning speed and without anesthesia, amazing successes as well as spectacular failures. If it takes a certain amount of daring to be a surgeon, with or without anesthesia, it also takes practice, and the learning curve can be a steep one.<\/p>\n

My book, The Professor of Secrets: Mystery, Medicine and Alchemy in Renaissance Italy<\/em>, tells the story of one novice surgeon\u2019s learning curve on the way to becoming an expert surgeon. Leonardo Fioravanti, the book\u2019s protagonist, practiced his art at a time when surgeons did not go to medical school, but instead learned their art as did other craftsmen: by watching and imitating a master.<\/p>\n

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Leonardo Fioravanti<\/p><\/div>\n

Leonardo, an eager and observant apprentice, was dissatisfied with what he had learned in his native Bologna. So he journeyed to Sicily, where it was said that surgeons accomplished remarkable things. There, he learned the art of alchemy, which he used to perfect unguents to heal wounds. An old pharmacist showed him diapalma<\/em>, a rare salve for treating the sores caused by syphilis made from the plant zaffaioni<\/em>, which grows only on Mount Pellegrino near Palermo. Another old empiric taught Leonardo ways to treat wounds that were completely new to him.\u00a0 The man was able not only to heal patients, \u201cbut to almost raise them from the dead.\u201d\u00a0 As he gathered knowledge, his reputation as a surgeon grew.\u00a0 Before long, people were calling him \u201cthe New Asclepius.\u201d<\/p>\n

Emboldened, he would take on any case brought to him, no matter how risky\u2014even those that the physicians had \u201cgiven up as dead.\u201d\u00a0 In April 1549, a captain in the Spanish navy by the name of Matteo Greco came to visit Leonardo. His 24-year-old wife, Marulla\u2014said to be the most beautiful woman in the city\u2014was desperately ill.\u00a0 Some months back, Captain Greco recounted, Marulla had come down with a \u201cmalignant fever\u201d that had swollen her spleen and \u201ccaused both of her legs to become horribly ulcerated,\u201d leaving her utterly debilitated. Several physicians had examined Marulla and told her the spleen would have to be removed.\u00a0 The operation was not dangerous, they assured her\u2014though as Fioravanti matter-of-factly notes, \u201cnone of them would do it.\u201d\u00a0<\/p>\n

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Boy with splenomegaly<\/p><\/div>\n

In modern medical terms, Marulla had splenomegaly (also megalosplenia), or \u201cbig spleen disease.\u201d\u00a0 It is characterized by massive swelling of the spleen and sharp pain in the abdomen.\u00a0 The spleen can grow to enormous proportions\u2014as much as 80 times its normal size\u2014grotesquely distending the abdominal region.\u00a0 The most common cause of splenomegaly is malaria, endemic to southern Italy and Sicily in Fioravanti\u2019s day.\u00a0 Splenomegaly is easily treated with antimalarial drugs. Left untreated, however, it can be a dangerous disease. Rapid enlargement of the spleen may result in splenic rupture, and massive splenomegaly can place a heavy burden on the heart and circulatory system.\u00a0 Whereas a normal spleen absorbs only 5 percent of the heart\u2019s blood output, an enlarged spleen may absorb more than half. \u00a0In addition, splenomegaly often causes an increase in the volume of blood plasma, which may result in anemia. \u00a0It can also cause sharp pain in the abdomen and back, especially if the spleen has become so large that it puts pressure on other organs.\u00a0 That was evidently the case with poor Marulla.\u00a0 She was in such pain, Leonardo writes, that \u201cshe finally decided that she would either be cured or would die.\u201d\u00a0 Marulla begged her husband to find a surgeon who could perform the recommended operation.\u00a0<\/p>\n

Aware of Fioravanti\u2019s reputation, Captain Matteo asked the surgeon if he had the courage to take out her spleen.\u00a0 Leonardo picks up the story:<\/p>\n

\u201cWhy, yes,\u201d I answered cheerfully, even though up until that time I\u2019d never done anything like it.\u00a0 To tell the truth, even though I promised him I\u2019d do it, I really didn\u2019t want to because I was afraid I might botch it.\u00a0 But I knew an old surgeon from the town of Palo in the Kingdom of Naples.\u00a0 He was called Andreano Zacarello and he operated with the knife, removing cataracts and similar things, and was very expert in that profession.\u00a0 So I called for the old man and he hurried to my house.\u00a0 I asked him, \u201cDear Master Andriano, a strange wish has come to Captain Matteo\u2019s wife:\u00a0 by Hercules, she wants to have her spleen taken out!\u00a0 Tell me, can this be done safely?\u201d<\/p>\n

“Of course,\u201d the old man answered.\u00a0 \u201cI\u2019ve done it many times.\u201d<\/p>\n

“Do you have the courage to go ahead with it now?\u201d\u00a0 He said that he\u2019d do it with me, but otherwise not. So we agreed to do it together.\u00a0<\/p>\n

I\u00a0went back to arrange things with the woman and her husband, then went to the authorities to give her up as dead, according to the custom.\u00a0 With this license, we went back one morning to the woman\u2019s house.\u00a0 We laid her on a table and had two servants hold her fast.\u00a0 Then the good old surgeon took out a razor and cut the woman\u2019s body just above the spleen, which popped out of her body like a fishing float.\u00a0 We quickly separated the organ from the tissue until we had it completely out, then sewed up the wound, leaving a tiny air-hole.\u00a0 I treated the wound with hypericon oil, powder of incense, mastic, and myrrh with sarcocolla, and made her drink water boiled with a dried apple, betony, and cardo santo.\u00a0 I took care of her in this way until, in just twenty-four days, she was completely healed.\u00a0 She went to mass at the Madonna of the Miracles, according to her obligation, and was healed and saved.\u00a0<\/p><\/blockquote>\n

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Enlarged spleen caused by splenomegaly<\/p><\/div>\n

Having accomplished the unimaginable, Fioravanti created an amazing publicity stunt to advertize his surgical talents.\u00a0 He carried the deformed organ to the open-air merchants\u2019 arcade (loggia de\u2019 mercanti<\/em>), where it was displayed for three days. Marulla\u2019s spleen, weighing fully two pounds (the organ normally averages only about five ounces), was a marvelous sight to behold.\u00a0 As people passed by to view it, Leonardo must have told and retold the story of the extraordinary surgery, embroidering it with each iteration until it became a mythical tale of medical heroism.\u00a0 \u201cThe glory of this experiment was mine,\u201d he gloated, \u201cand because of this the people gathered about me, as to an oracle.\u201d<\/p>\n

Marulla Greco was lucky. She survived the operation and lived for several years. But the chances of failure were extremely high for such a procedure. The operation could have turned out very differently.<\/p>\n

Every surgeon is aware that every case is in some way unique, and that the art of surgery is perfected only through practice. As the surgeon an author Atul Gawande writes in his book, Complications<\/em>, \u201cThe moral burden of practicing on people is always with us, but for the most part unspoken.\u201d Just as in the art of playing the violin, the one thing that separates a good surgeon from the less accomplished one is the amount of practice put in. Patients, on the other hand, want perfection without a learning curve. What nobody wants to admit is that the two are contradictory desires.<\/p>\n

To readers wanting to learn more about the limitations of surgery, I recommend Atul Gawande, Complications: A Surgeon\u2019s Notes on an Imperfect Science<\/em> (New York: Metropolitan Books, 2002.)<\/p>\n","protected":false},"excerpt":{"rendered":"

Surgery is no art for the squeamish. A simple slice through the skin \u2013 the practiced surgeon\u2019s daily experience \u2013 may be enough to give an ordinary person nausea. \u00a0 The history of surgery is replete with instances of daring surgical interventions, harrowing battles against blood-gushing wounds, amputations accomplished at lightning speed and without anesthesia, […]<\/p>\n","protected":false},"author":5,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[26,34,37,47,55,56,57,59],"class_list":["post-251","post","type-post","status-publish","format-standard","hentry","category-uncategorized","tag-history-of-medicine","tag-leonardo-fioravanti","tag-malaria","tag-renaissance","tag-spleen","tag-splenectomy","tag-splenomegaly","tag-surgery"],"aioseo_notices":[],"_links":{"self":[{"href":"https:\/\/williameamon.com\/wp-json\/wp\/v2\/posts\/251","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/williameamon.com\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/williameamon.com\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/williameamon.com\/wp-json\/wp\/v2\/users\/5"}],"replies":[{"embeddable":true,"href":"https:\/\/williameamon.com\/wp-json\/wp\/v2\/comments?post=251"}],"version-history":[{"count":0,"href":"https:\/\/williameamon.com\/wp-json\/wp\/v2\/posts\/251\/revisions"}],"wp:attachment":[{"href":"https:\/\/williameamon.com\/wp-json\/wp\/v2\/media?parent=251"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/williameamon.com\/wp-json\/wp\/v2\/categories?post=251"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/williameamon.com\/wp-json\/wp\/v2\/tags?post=251"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}