The legacy of Renaissance surgeon Giovanni Andrea Dalla Croce on the history of military surgery and neurosurgery

Antonio Di Ieva MD, PhD, FRACS1 and Jeffrey V. Rosenfeld MD, MS, FRACS2,3
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  • 1 Faculty of Medicine, Health and Human Sciences, Macquarie Medical School, Macquarie University, Sydney, New South Wales;
  • | 2 Department of Neurosurgery, Alfred Hospital, Melbourne; and
  • | 3 Department of Surgery, Monash University, Melbourne, Victoria, Australia
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Giovanni Andrea Dalla Croce was a Venetian physician who lived in the 16th century and was famous for his treatment of wounds, which was surprisingly modern. He was the military surgeon of the Venetian Republic’s naval fleet. In 1537, he published the Chirurgiae universalis opus absolutum (The absolute work on universal surgery) in Latin, then expanded and translated into vernacular Italian and published in 1574 with the title Cirugia universale e perfetta di tutte le parti pertinenti all’ottimo chirurgo (Universal and perfect surgery of all the parts necessary for the optimal surgeon). This monumental work was a comprehensive handbook of surgery, medicine, and the treatment of many kinds of wounds with techniques to be used on the battlefield. It is also notable for the inclusion of illustrations of various weapons and projectiles, for the most comprehensive description and illustrations of surgical instruments at that time, and for the first illustrations of a surgeon performing trephination of the skull in an operating room. Dalla Croce also considered the writings of his surgical forebears in formulating his own ideas. Dalla Croce was a leader of traumatology, a universal surgeon who exemplified the erudite Renaissance man, and left a tremendous legacy to military surgery of the 16th century and beyond.

Giovanni Andrea Dalla Croce was a Venetian physician who lived in the 16th century and was famous for his treatment of wounds, which was surprisingly modern. He was the military surgeon of the Venetian Republic’s naval fleet. In 1537, he published the Chirurgiae universalis opus absolutum (The absolute work on universal surgery) in Latin, then expanded and translated into vernacular Italian and published in 1574 with the title Cirugia universale e perfetta di tutte le parti pertinenti all’ottimo chirurgo (Universal and perfect surgery of all the parts necessary for the optimal surgeon). This monumental work was a comprehensive handbook of surgery, medicine, and the treatment of many kinds of wounds with techniques to be used on the battlefield. It is also notable for the inclusion of illustrations of various weapons and projectiles, for the most comprehensive description and illustrations of surgical instruments at that time, and for the first illustrations of a surgeon performing trephination of the skull in an operating room. Dalla Croce also considered the writings of his surgical forebears in formulating his own ideas. Dalla Croce was a leader of traumatology, a universal surgeon who exemplified the erudite Renaissance man, and left a tremendous legacy to military surgery of the 16th century and beyond.

Technological innovation has always brought dramatic changes to daily life, but also to the methods of waging war. War, medicine, science, and technology are connected. Moreover, warfare has driven innovation in surgery. Treating injured soldiers has given the military surgeon a role of paramount importance on the battlefield.1 Since the middle of the 14th century, battlefields and military strategies were reshaped by the availability and use of gunpowder, causing new kinds of wounds in patients and triggering the necessity to develop new surgical techniques and knowledge among surgeons.2 In those times, no surgeon could avoid the management of soldiers and civilians injured in war, with several pioneers and known representatives of military surgery assuming a leadership role in performing surgery, developing new tools, and advancing and spreading knowledge in the field. Among these pioneers, Ambroise Paré (ca. 1510–1590) is probably the most celebrated representative of military surgery, along with other physicians who contributed to its development, such as Hans von Gersdorff (ca. 1455–1529), author of one of the first traumatology manuals, the Feldtbüch der Wundartzney (Field Book of Surgery, first published in 1517),3,4 and Berengario da Carpi (ca. 1460–1530), author of Tractatus de fractura calvae sive cranei (Treatise on fracture of the calvaria or cranium), published in 1518.5 Hans von Gersdorff was named the "surgeon of the dust" for being in the dirt with the soldiers.1 Among these "surgeons of the dust," the major contribution of the medico venetiano (Venetian physician, as he identified himself) Giovanni Andrea Dalla Croce should also be emphasized. His life and contributions are illustrated in this paper.

Historical Background

Beyond a long series of conflicts occurring between 1494 and 1559 in the Italian peninsula, referred to as the Italian Wars, the 16th century was also characterized by the Ottoman-Venetian wars, starting at the end of the 14th century and culminating with the major victory of the Republic of Venice at the Battle of Lepanto in 1571 (in the period of the fourth Ottoman-Venetian war, with the last one, the seventh, fought during the period of 1714–1718). The naval victory by the Holy League—a coalition of Catholic states arranged by Pope Pius V—over the Ottoman Empire’s fleet at the Battle of Lepanto strengthened the power of the Republic of Venice and further distinguished its fleet in the collective imagination.

Being a physician of the fleet of the Serenessima (i.e., the Republic of Venice) was one of the highest accomplishments for a doctor of the time. In the 16th century, the main university for medical training in the Venetian State, and one of the most important in Europe, was the University of Padua. To obtain the degree in surgery in such a prestigious university, it was necessary to complete a 3-year-long course based on the books by Galen and Mondino de’Liuzzi, with special emphasis on the study of anatomy.6 Moreover, a year of practice with a surgeon was required.7 After a student completed an examination in Latin or the vernacular, the Venetian College of Surgeons could award licenses to practice as medici condotti (public doctors).7 It was a very pragmatic way to train and license physicians (although there were also other pathways). The College eventually also licensed barbers, allowing them to treat minor non–life-threatening cases and to open a shop after a 4-year apprenticeship with a master barber.

Dalla Croce’s Life

Giovanni Andrea Dalla Croce (or Della Croce), was born in Venice, most likely in 1514. Dalla Croce was not his family name, but rather the site of his family’s house under the parish della Croce (of the cross).8 In that time, it was the habit to name a person according to the place they came from rather than by their family name. His father, Giuseppe Dalla Croce, was a barber-surgeon, himself being the son of a renowned surgeon in the service of the Duke of Milan.1 Giuseppe educated his son Giovanni Andrea in classic literature and the rudiments of the surgical art.

Giovanni Andrea Dalla Croce became a member (doctor chirurgiae) of the Venetian College in 1532, of which he became the Prior (i.e., the leader) in 1548, 1550, 1551, and 1558.8 In 1537, he was called to review the statutes of the Venetian College in a city for which he had a great admiration. As declared by Francesco Bernardi in his lecture on Dalla Croce, delivered at the University of Treviso in 1826:8

Una delle prime citta’ d’Italia che accogliesse, e facesse rivivere le buone arti dopo la universale loro decadenza si fu senza dubbio Venezia. Egli e’ quindi chiaro, che l’arte chirurgica cosi’ necessaria al genere umano dovette fra quelle prime trovarsi ed essere anch’essa accolta, e favoreggiata dal governo (One of the first cities in Italy that gave a revival to the good arts after their universal decadence was undoubtedly Venice. Therefore, it is clear that the surgical art, so necessary to mankind, had to be one of the first to be welcome and supported by the government).

Dalla Croce also became the Chair of Anatomy, the same one occupied a century later by Herman Boerhaave (1668–1738) and Albrecht von Haller (1708–1777). "Quanti genii usciti dalla scuola di tanto maestro?" ("How many geniuses came out from the school of such a maestro?"), Bernardi asked in his lecture referring to Dalla Croce.8

In 1537, Dalla Croce was employed in Feltre, an ancient town in the northwest part of Venice, founded by the Alpine tribe of the Rhaetians and known to the Romans as Feltria, and under control of the Venetian State since the beginning of the 15th century. Governed by an aristocratic council along with a Rettore, who was the Venetian representative, the town had a team of public doctors, generally two physicians and one surgeon. For 9 years, Dalla Croce was one of the medici condotti (public doctors) of the town, leaving in 1546 after one of his sisters was raped by a local nobleman who got away unpunished.3 He returned to Venice, where he was appointed chief practitioner to the naval fleet of the Venetian Republic. In Venice, he developed the city’s defense against the plague outbreak, ironically dying during a further plague outbreak in 1575. A bridge in Venice was dedicated to him.

Dalla Croce’s Books

Giovanni Andrea Dalla Croce wrote four books: two Italian tracts on wounds published in Giovanni da Vigo’s compendium, the Treatise on military medicine and treatment of wounds (1560); the Chirurgiae universalis opus absolutum (The absolute work on universal surgery), in Latin (1573); and an Italian translation and expansion of such a work, the Cirugia universale e perfetta di tutte le parti pertinenti all’ottimo chirurgo (Universal and perfect surgery of all the parts necessary for the optimal surgeon), in 1574 (Fig. 1).9,10

FIG. 1.
FIG. 1.

The title page of Dalla Croce’s Cirugia universale e perfetta di tutte le parti pertinenti all’ottimo chirurgo (Universal and perfect surgery of all the parts necessary for the optimal surgeon), the 1573 edition in Latin (left) and the 1583 edition in Italian (right). Public domain.

Dalla Croce translated Vigo’s Practical Surgery (1560) with Francesco Sansovino.11 In the cultural effort to translate classic books and write new ones in vernacular rather than Latin, Dalla Croce wrote his books in both Latin and vernacular, giving great accessibility to barber surgeons, medical practitioners, and readers with no Latin knowledge.

The Cirugia universale e perfetta di tutte le parti pertinenti all’ottimo chirurgo was translated into French and German soon after its publication, where the author offered "the theory and the practical aspects necessary in surgery," aimed to forge the ottimo chirurgo (best surgeon).10 This comprehensive work is surely his main legacy to medicine. In the same way that Guido da Vigevano (1280–1349) is considered to be the pioneer of illustrated anatomical books,6 Dalla Croce’s books could be regarded as the forerunners of the illustrated surgical textbooks of today.

In the book’s preface, Dalla Croce clarified the definition of surgery; its allocation in medicine; the topic, principles, and aims of the surgical art, summarizing the intenti (intents) in the knowledge about anatomical parts (as single parts and as a whole, in relation to the entire human body); techniques; instruments to perform surgery; and postoperative instructions, including bandages, sleep, and diet. Moreover, he also emphasized the importance of medications, and he suggested that a surgeon should also learn from expert and good apothecaries.7

Being an educated humanist surgeon, Dalla Croce emphasized his debt to Hippocrates, Galen, Celsus, Avicenna, Oribasius, Aetio, Paulo Aeginata, and Albucasis. Following Aristotle’s meaning of practical intellect, which encompasses ars (i.e., an artificial operation concerned with changeable things in nature, things which can be manipulated by manual, mechanical operations) and prudentia (i.e., faculty responsible for making moral decisions), Dalla Croce defined surgery as work of the hands guided by the practical intellect.12 In the book’s preface, he reiterated the meaning of surgery: chiros (hand) and logos (thought), emphasizing that surgery is part of medicine, as it is practical medicine. Dalla Croce argued that surgical knowledge should be acquired through apprenticeship and by reading texts.7 Dalla Croce’s book contained many addittione (addendums), dubitatione (doubts), and digressione (digressions) to summarize a comprehensive view of the topic, from its historical and philosophical background to the most advanced surgical techniques. He also shared many similar ideas with his predecessor, Berengario da Carpi (1460–1530),5 whose first book on head injury was published in 1518:10,12

Surgery is the oldest and most certain part of medicine, and it is a habit of the practical intellect, acquired with many rules and by experience [isperimenti], that is, with artful operations of the hands and proper instruments, joining, separating, and tying together the many wounds that run through the parts of the body; I say that one does this quickly, with certainty and with little pain, the artificial operation is done by the hands of the Medico, which is different from the other operations done by him with the intellect, such as seeing, composing, resolving, defining, demonstrating or other various actions completed with the parts of the soul…. [Surgery] is the artificial operation, done with order, with art, with prudence, and not without a light touch, and it is structured by anatomical learning and extended practice.

Regarding the importance of anatomy in the surgical practice, Dalla Croce wrote:10

The anatomical art is different from surgery, by reason of its subject, as surgery works on the living human body and anatomy on the dead body; and by reason of the goal, since surgery works to unite the parts that are separate or divided in the human body, while anatomy seeks to separate and divide the parts that are continuous and united.

Moreover, he stated that surgeons should be culturally sophisticated, not be reduced to the manual skill of a "mere" dissector, arguing that anatomy was instrumental to surgery, not the other way around.13 Surgeons’ activities should be focused on uniting and consolidating or mending the broken parts of the human body:9,10 "I say, in the human body to demonstrate the difference between the art of Surgeons and that of horse masters who work upon inhuman or animal bodies; and I say living to make it understood that surgery is very different from anatomical actions, which work solely upon dead bodies." Quoting Galen, he wrote:10

Chi vuol sapere in che modo sia fabbricato un palazzo, li fa bisogno vedere e intendere tutte le parti di quello, fino alli ultimi fondamenti…l’artefice per anatomia conosce il corpo humano, si nella parti di dentro, come di fuoici (Who wants to know how a building is made, has to see and comprehend all its parts, until its foundations…so the surgeon/anatomist knows the human body, both in all the parts inside as well as outside).

And quoting Celsus:10 "É necessario anatomizzare li corpi morti, e diligentemente conoscere la fabbrica loro instrinseca ed intrinseca. É adunque la cognition anatomica la prima intentione del chirurgo" ("It’s the aim of the surgeon to cut, separate, and unite anatomical parts, therefore it’s part of the surgical art to know each element of the anatomical art").

The universal and perfect surgery of all the parts necessary for the optimal surgeon contains 7 books. In the first book, there are 6 essays on causes, localization, and treatment of Apostomes (tumors). In this book, there is also the description of the skull (with its two laminae), brain and cerebellum, meninges (dura and pia mater, as well as the sagittal commissure, i.e., the falx cerebri), skin, hair, and sutures (sagittal, lambda, and coronal, the latter "dove si coronano i re e Imperatori,"10 "where Kings and Emperors are crowned"). Figure 2 shows some of the skull’s anatomical variations from the book’s preface.

FIG. 2.
FIG. 2.

Skull drawings from the preface of book 1, including anatomical variations of the sutures, meninges with vascularization, and brain. From Dalla Croce GA. Cirugia universale perfetta di tutte le parti pertinenti all’ottimo chirurgo. Giordano Ziletti; 1583. Public domain.

In the second book, composed of 7 essays, he treated head and face wounds, skull fractures, nerve damage, tendon and ligament injuries, chest and abdominal wounds, ways to extract bullets and arrows from the chest and abdomen, and any kind of wound. The third book (composed of 5 essays) is about ulcers. The fourth book (made up of 2 essays) is about long-bone fractures and dislocations. The fifth book is composed of 12 essays about many different topics, including phlebotomies, use of leeches, child delivery, rectal prolapse, cataracts, teeth affections, bladder stones, and "the French disease" (syphilis). The sixth book consists of 2 essays on antidotes. In the seventh book, Dalla Croce described all the instruments of the Officina della cirugia (surgical laboratory; Fig. 3), ancient and modern, "che nell’arte della Chirurgia possono essere necessary" ("which can be necessary in the surgical art"). The book contains almost 500 illustrations of surgical instruments.

FIG. 3.
FIG. 3.

Illustrations of the officina della cirugia (surgical laboratory), from the seventh book, depicting a skull trephination. These three woodcuts were the first depictions of cranial surgery in an operating room of the time. Depictions of scalp incision and raising the periosteum (upper), use of the hand trephination tool (middle), and use of the brace for burr holes or trephination (lower). From Dalla Croce GA. Cirugia universale e perfetta di tutte le parti pertinenti all’ottimo chirurgo. Giordano Ziletti; 1583. Public domain.

Although copies of diagrams and ideas appeared in various medical authors’ books during the Renaissance, this was the most extensive and original compilation published at that time. Aware of the limitations related to the existing instruments, Dalla Croce designed or improved previous tools, such as the vertibulo commune (common brace; Fig. 4):5,9 "an instrument made of iron, square and hollow at the bottom to allow the insertion of the drill bits [Fig. 5], bent in the middle and with a rotating ball on top. Place the bits on the head, and with one hand holding the ball, with the other you turn the middle section." He also described hand-turning trephines (Fig. 6). He also introduced a new instrument, a kind of syrinx, to remove liquid from the chest.

FIG. 4.
FIG. 4.

Illustration of the vertibulo commune (common brace). From Dalla Croce GA. Cirugia universale e perfetta di tutte le parti pertinenti all’ottimo chirurgo. Giordano Ziletti; 1583. Public domain.

FIG. 5.
FIG. 5.

Examples of terebri (drill bits), to be inserted in the common drill (depicted in Fig. 4) for different types of trephination. From Dalla Croce GA. Cirugia universale e perfetta di tutte le parti pertinenti all’ottimo chirurgo. Giordano Ziletti; 1583. Public domain.

FIG. 6.
FIG. 6.

Illustration of trivella (borer), a hand-turning trephine. Dalla Croce wrote, "É pericolo che non violi le membrane del cervello" ("It is a danger that it does not violate the membranes of the brain" [i.e., the meninges]). From Dalla Croce GA. Cirugia universale e perfetta di tutte le parti pertinenti all’ottimo chirurgo. Giordano Ziletti; 1583. Public domain.

Traumatology and Military Surgery

Traumatology occupies an important position in Dalla Croce’s book about "universal surgery." Understanding and addressing military-related injuries could save soldiers’ (and civilians’) lives and raise the profile and income of a surgeon. Dalla Croce was appointed Surgeon-in-Chief of the Venetian fleet for his well-recognized expertise in treating wounds and head injuries. Dalla Croce devotes 52 pages of dense text in the second book of the Cirugia universale to the management of cranial fractures, dural and cerebral injury, and their complications, including "apoplexy," epilepsy, spasms, and fever, and their prognoses. He then discusses injuries to the face and eyes. This text includes many historical references. These extensive descriptions are indicative of the seriousness and frequency of head injury in military and civilian practice and the need to instruct other surgeons.

Dalla Croce’s text generally follows Hippocratic teaching; Vidus Vidius (Guido Guidi, 1509–1569) had translated Hippocrates into Latin in 1542. Dalla Croce also describes various methods and instruments for opening the skull in book 7 (Fig. 7). The type of skull fracture determined the need for surgical intervention rather than intracranial pathology14 and the indications for trephination in closed head injury remained controversial among Renaissance surgeons.15 An appreciation of the effect of trauma on brain function rather than the skull itself would not occur until the 18th century. This appreciation included an understanding of the difference between concussion with immediate coma and an expanding hematoma with delayed drowsiness. Nevertheless, compound depressed fractures, cranial gunshot wounds and arrow injuries, and suppurating cranial wounds all required the attention of the renaissance military surgeon. Leonardo Botallo (1530–1587) showed a method for creating a bone flap by interconnecting closely placed burr holes.16 Dalla Croce also described placing multiple adjacent burr holes in different patterns to enlarge a skull opening.

FIG. 7.
FIG. 7.

Illustration of different methods and instruments for opening the skull, from book 7. From Dalla Croce GA. Cirugia universale e perfetta di tutte le parti pertinenti all’ottimo chirurgo. Giordano Ziletti; 1583. Public domain.

The illustrations in Dalla Croce’s Cirugia included three beautifully rendered woodcuts that are the first to depict the drama of a surgeon trephining the skull in an operating room of the time (Fig. 3). In these depictions, it appears that the rooms were heated with braziers, also with respect to the classic literature stating that cold was "very dangerous to the brain."17 The number of persons attending the surgical room, different figures such as a girl praying, a cat catching a mouse, a dog, and many of the room’s details make the effect of these operating room tableaux even more dramatic (Fig. 3). There are also dramatic illustrations of Italian and Ottoman military surgeons removing arrows from soldiers on the battlefield.

By 1560, some sections of his book Cirugia circulated as separated monographs, such as the one on extracting arrows and bullets, making his work not only a comprehensive handbook for the practitioner surgeon, but also introducing the format of short brochures on specific topics. This would have been very useful for military surgeons.

Arrows, spears, and projectiles are displayed in the second book, wherein he described three types of weapons "when thrust with violence can easily enter the flesh": the first, acute and short like an arrow; the second, wide and long like a spear ("which, when stuck in the body, it is not convenient to take it out from the other side so as not to cause more damage than the spear itself did when entering"); and the third, spherical or angular like a ball of lead, iron, or any other metals, or stone.1 The cure of all wounds (including the ones incurred on the battlefield) is the main theme of Dalla Croce’s book:1

Therefore, about these wounds, we shall make a brief digression because often, being in battles and skirmishes, at sea as well as on land, diverse sorts of balls, chains, scales of marble and similar things are shot against men by those evil tools such as muskets, rifles, guns, mortars, falconets [a kind of light cannon developed in the 15th century], cannons, etc. etc..

In the book, he not only gave advice on how to remove arrows and bullets from the body but also added considerations on how to treat the pain ("the pain cannot wait and hastens to the place that hurts as much material as possible in proportion to the bodily fluids that run through the wound, thus making it swell"),10 and how to prepare, clean, and drape the wound. Dalla Croce’s management of wounds was comprehensive and surprisingly modern. His techniques were similar to some of those used in the early part of the 20th century. Viale identified several other 16th century military surgeons who described more enlightened cranial wound care that was beyond the traditional and harmful use of cautery, hot elder oil, and theriac.17

In the seventh part of the second book,10 Dalla Croce describes the types of wounds caused by those diabolici istromenti (diabolic instruments) such as arquebus (archibuggi), shotguns (schioppi), muskets (moschetti), mortars (spingarda), cannons (cannoni), falconets (falconetti), etc., which cause wounds associated with lacerations, bone fractures, and acute pain (dolor crudele). He summarized 5 recommendations for wound treatment: 1) identify the cause, 2) reduce the pain, 3) prepare the wound and manage the lacerations, 4) clean and prepare the wound, and 5) avoid wound degeneration. For the identification of the cause, he suggested placing the finger in the wound, looking for the "palla di piombo, o quadretto di ferro, o squama di pietra, o pezzo di catena, o di armature, o osso rotto" ("lead ball, or iron square, or stone flake, or piece of a chain, or of an armor, or broken bone"), trying to remove it with the finger or with the help of a terebro di due ali (a two-wings drill). He emphasized that this had to be performed without injury to any veins or large arteries, trying not to make the situation worse ("cerca almeno di non augmentarlo," paraphrasing Hippocrates’ maxim, "first, do not harm"). In the second recommendation, he suggested rebalancing the wounds’ temperature, "refrigerando quella che é calda, scaldando quella che è fredda, seccando l’humida, & humettando la secca" ("cooling down the warm one, heating up the cold one, drying up the wet one, and making wet the dry one"). To accomplish this, he provided a list of unguents to be used for the purpose, including warm-like common oil, or roses’ oil, eventually adding egg yolk, wheat, and saffron. He also suggested that breadcrumbs boiled in cow’s milk with egg yolk and oil of rose could be used for the purpose, applying the potions around the wounds. According to the tradition of the time, during the convalescence, the patient had to have sound sleep, avoid drinking wine, and limit psychological stress and intercourse ("gli accidenti dell’animo, & il coito sono cattivi"). Quoting Galen, Celsus, Paulus, and Hippocrates’ references, Dalla Croce continued this section suggesting the medications, unguents, and potions "che aiutano à generar la marcia" ("that help to generate the march [toward the healing]"), and how to manage contusions of the flesh. Moreover, he suggested the medications to apply on the nerves, which was considered of paramount importance in general wound management:

le offese de’ nervi per la gagliardezza del loro sentimento, & perche queste parti sono continuate al cervello, sono pronte ad eccitar lo spasmo, il quale quando sopraviene alle ferite, minaccia morte: adunque bisogna avvertire con diligenza, che non venga tal’accidente (nerve wounds for the power of their sensation, and because these parts are in continuity with the brain, are ready to excite spasm, that when it appears with the wounds, it threatens death).

He suggested that a surgeon’s bag should contain at least 6 instruments, including a razor, scissors, tweezers, a stylet, some needles, and a lancet. He stated that a deep knowledge of instruments and materials is the way of learning the surgical art.

In Dalla Croce’s textbook, there are also many descriptions on the types and treatments of skull fractures. Some skull elevators, drills, and techniques are described to perforate and open the skull without damaging the meninges, "per non poter descender alle membrane del cervello" ("to avoid penetrating brain’s membranes") (Fig. 8).10 Moreover, he confirmed the previous Hippocratic doctrine to avoid drilling the skull directly on skull sutures. In the second book, he also summarized some prognostic factors in patients affected by skull fractures ("Del modo di pronosticare nelle fratture del craneo" ["On the way to prognosticate in fractures of the skull"]),10 with meningeal and brain injury with associated vomiting as the worst prognostic factors, while pericranium injuries alone were generally associated with a good prognosis.

FIG. 8.
FIG. 8.

Depiction of an instrument to elevate a depressed fracture of the skull, which was first shown in Hans von Gersdorff’s book Feldtbüch der Wundartzney (Fieldbook of Surgery), published in 1517. From Dalla Croce GA. Cirugia universale e perfetta di tutte le parti pertinenti all’ottimo chirurgo. Giordano Ziletti; 1583. Public domain.

Conclusions

Giovanni Andrea Dalla Croce was a master of traumatology, personifying the erudite Renaissance man and universal surgeon.1 As a military surgeon during the Venice-Ottoman wars he would have acquired an extensive experience managing soldiers with penetrating trauma and head injury. He was defined as the "Ambroise Paré" of the Lagoons,18 and the Italian Hippocrates.8 Following the holistic view of the universal surgeon, he developed the concept of a richly illustrated monograph, designed to be of practical use to civilian and military surgeons. Cirugia universale was published in multiple languages and in multiple editions and was therefore widely distributed in Europe. Dalla Croce placed a special emphasis on the management of neurotrauma and on wounds occurring on the battlefield. He also focused attention on the instruments required for cranial surgery and improved on the design of previous neurosurgical instruments. Cirugia universale is a landmark publication in the history of surgery and neurosurgery, and its author Giovanni Andrea Dalla Croce was indeed a surgical thought leader and pioneer neurosurgeon of his time.

Disclosures

The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

Author Contributions

Conception and design: both authors. Acquisition of data: both authors. Analysis and interpretation of data: both authors. Drafting the article: both authors. Critically revising the article: both authors. Reviewed submitted version of manuscript: Di Ieva. Approved the final version of the manuscript on behalf of both authors: Di Ieva. Study supervision: Rosenfeld.

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  • 18

    Giordano G. Giovanni Andrea della Croce. Rass Clin Sci. 1939; 2:7383.

Captain Benny Brandvold stands "at the ready" outside of Dhahran, Saudi Arabia, during the early phase of Operation Desert Shield, fall of 1990. © Benny Brandvold, published with permission. See the article by Martin et al. (E16).

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    The title page of Dalla Croce’s Cirugia universale e perfetta di tutte le parti pertinenti all’ottimo chirurgo (Universal and perfect surgery of all the parts necessary for the optimal surgeon), the 1573 edition in Latin (left) and the 1583 edition in Italian (right). Public domain.

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    Skull drawings from the preface of book 1, including anatomical variations of the sutures, meninges with vascularization, and brain. From Dalla Croce GA. Cirugia universale perfetta di tutte le parti pertinenti all’ottimo chirurgo. Giordano Ziletti; 1583. Public domain.

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    Illustrations of the officina della cirugia (surgical laboratory), from the seventh book, depicting a skull trephination. These three woodcuts were the first depictions of cranial surgery in an operating room of the time. Depictions of scalp incision and raising the periosteum (upper), use of the hand trephination tool (middle), and use of the brace for burr holes or trephination (lower). From Dalla Croce GA. Cirugia universale e perfetta di tutte le parti pertinenti all’ottimo chirurgo. Giordano Ziletti; 1583. Public domain.

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    Illustration of the vertibulo commune (common brace). From Dalla Croce GA. Cirugia universale e perfetta di tutte le parti pertinenti all’ottimo chirurgo. Giordano Ziletti; 1583. Public domain.

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    Examples of terebri (drill bits), to be inserted in the common drill (depicted in Fig. 4) for different types of trephination. From Dalla Croce GA. Cirugia universale e perfetta di tutte le parti pertinenti all’ottimo chirurgo. Giordano Ziletti; 1583. Public domain.

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    Illustration of trivella (borer), a hand-turning trephine. Dalla Croce wrote, "É pericolo che non violi le membrane del cervello" ("It is a danger that it does not violate the membranes of the brain" [i.e., the meninges]). From Dalla Croce GA. Cirugia universale e perfetta di tutte le parti pertinenti all’ottimo chirurgo. Giordano Ziletti; 1583. Public domain.

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    Illustration of different methods and instruments for opening the skull, from book 7. From Dalla Croce GA. Cirugia universale e perfetta di tutte le parti pertinenti all’ottimo chirurgo. Giordano Ziletti; 1583. Public domain.

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    Depiction of an instrument to elevate a depressed fracture of the skull, which was first shown in Hans von Gersdorff’s book Feldtbüch der Wundartzney (Fieldbook of Surgery), published in 1517. From Dalla Croce GA. Cirugia universale e perfetta di tutte le parti pertinenti all’ottimo chirurgo. Giordano Ziletti; 1583. Public domain.

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