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Rev. Med. Chir. Soc. Med. Nat., Ia şi – 2013 – vol. 117, no. 3

SURGERY ORIGINAL PAPERS

699

PLASTIC SURGERY IN 17TH

CENTURY EUROPE.

CASE STUDY: NICOLAE MILESCU, THE SNUB-NOSED1

Daniela Dumbravă, Ştefan Luchian

Romanian Academy

Institute for the History of Religions-Bucharest

CASE STUDY: NICOLAE MILESCU, THE SNUB-NOSED (Abstract). The rising and the

existence of plastic and aesthetic surgery in early modern Europe did not have a specific pat-

tern, but was completely different from one nation to another. Colleges of Physicians could

only be found in some places in Europe; different Parliaments of Europe’s nations did notalways elevate being a surgeon to the dignity of a profession, and being a surgeon did not

always come with corporate and municipal privileges, or with attractive stipends. Converse-

ly, corporal punishments for treacherous surgeons were ubiquitous. Rhinoplasty falls into the

category of what Ambroise Paré named “facial plastic surgery”. The technique is a medicalsource from which many histories derive, one more fascinating than the other: the history of

those whose nose was cut off (because of state betrayal, adultery, abjuration, or duelling

with swords), the history of those who invented the surgery of nose reconstruction ( e.g.

Suśruta-saṃhit or Tagliacozzi?), the history of surgeries kept secret in early modern Europe(e.g. Tropea, Calabria, Leiden, Padua, Paris, Berlin), and so on. Where does the history of

Nicolae Milescu the Snub-nosed fall in all of this? How much of this history do the Molda-vian Chronicles record? Is there any “scholarly gossip” in the aristocratic and diplomatic e n-

vironments at Constantinople? What exactly do the British ambassadors learn concerning

Rhinoplasty when they meet Milescu? How do we “walk” with in these histories, and why

should we be interested at all? What is their stake for modernity? Such are the interr ogations

that this article seeks to provoke; its purpose is to question (and eventually, synchronise) his-

tories, and not exclusively history, both in academic terms but also by reassessing the practi-

cal knowledge of the 17th century. Keywords: HISTORY OF PLASTIC SUGERY, NICO-

LAE MILESCU, RHINOPLASTY, NASAL SURGERY, PRACTICAL KNOWLEDGE.

1 Paper presented during the Meeting of the Society of Physicians and Naturalists (Lecture Hall of the

Pulmonology Unit) of February 25, 2011, Iasi. Research funded within the project Social and Human

Sciences in the Context of Global Development – as implementation of the program of studies andpostdoctoral research – Contract code: POSDRU/89/S/1.5/49944, project co-financed by the European

Social Fund, Sectoral Operational Project Human Resources Development 2007-2013, which takes place at ”Alexandru Ioan Cuza” University, Iasi, Romania.




700

1. Nose fractures and nasal recon-

struction. Why are we interested in the

Antiquity in such cases?

We are interested in the Antiquity be-

cause history provides historians with ref-

erence documents enabling them to make

distinctions and construct a narrative.

There is historiographic consensus on the

fact that the oldest and most consistent

written source for the history of surgery is

the Edwin Smith Surgical Papyrus, dating

back to the Djoser period (c.3000-2500

BC) (1). This source provides us, among

others, with a first aetiology of the cases ofnose swelling or fracture. Consequently,

the novelty of the source resides in the fact

that it describes pathologies and provides

prescriptions. The papyrus, discovered in

Thebes and written in Hieratic, left Luxor

in 1862 with Edward Smith (1822-1906),

its discoverer, who had purchased it from

an anonymous Egyptian merchant (1, 2,

29). Smith donated the papyrus to the NewYork Historical Society before his death.

For a short period it was held by the Brook-

lin Museum, before being sent to the New

York Academy of Medicine, where it re-

mained permanently. The text of this pre-

cious papyrus was first translated in 1930

by the Orientalist James Henry Breasted,

Egyptologist and founder of the Institute of

Oriental Studies in Chicago (which is, tothis date, a sort of Mecca for Orientalists,

devoted mainly to the study of Near East-

ern civilisations). Breasted was aided by

Dr. Arno B. Lukhardt in the translation of

the papyrus, especially with regard to the

medical details (29). The Egyptologist

James P. Allen, Professor at Brown Uni-

versity, Head of the International Associa-

tion of Egyptologists and curator of the

Egyptian Art Section of the New York Met-

ropolitan Museum, provided a second criti-

cal edition in 2005, an initiative unequalled

so far (1). This source reveals the intense

medical activity of Imhòtep, a physicianand architect at the court of Pharaoh Net-

jerykhet or Djoser, the first king and

founder of the third Egyptian dynasty

(c.2760 BC). Imhòtep would be, at least intheory, the first physician to have indicated

the fact that a nasal fracture can be exam-

ined, diagnosed and cured. To exemplify,

we will quote two of the cases of nasal

fracture mentioned in the Edwin Smith

Surgical Papyrus:

Case 1. A fracture of the nasal cartilage

(5,10-15). Title. Practices for a fracture in

the pillar of his nose. Examination and

Prognosis. If you treat a man for a fracture

in the pillar of his nose, and his nose is

flattened and his face is flattened out, while

the swelling that is on it is high, and he has

bled from his nostrils, then you say about

him: “One who has a fracture in the pillarof his nose: an ailment I will handle”.Treatment. You have to wipe it for him

with two plugs of cloth. You have to push

tow plugs of cloth wet with oil inside his

nostrils. You have to put him on his bed in

order to reduce his swelling. You have to

set for him stiff rolls of cloth so that his

nose is restricted from moving, and treat

him afterward with oil and honey dressingevery day until he gets well. Explanations.

As for “the pillar of his nose”, it is thebridge and his side of his nose, inside his

nose in the middle of his nostrils. As for

“his nostrils”, they are two sides of hisnose penetrating to his cheek, starting at

the end of his nose and exciting the top of

his nose” (1).

Case 2. A fracture of the nasal bone

(5,16-6,3). Title. Practices for a fracture in



Plastic surgery in 17th century Europe. Case study: Nicolae Milescu, the snub-nosed

701

the chamber of his nose. Examination and

Prognosis. If you treat a man for a fracture

in the chamber of his nose and you find his

nose crooked and his face flattened, while

the swelling that is on it is high, then yousay about him: “One who has a fracture inthe chamber of his nose: an ailment I will

handle”. Treatment. Set it back in its proper

place. Wipe for him the inside of his nos-

trils with two strip of cloth until every eel

of blood that is knotted inside his nostrils

comes out. Afterward, you have to push

two plugs of cloth wet with oil into his

nostrils. You have to set for him two stiffrolls of cloth bandaged on it and treat

<him> with an oil and honey dressing eve-

ry day until he gets well. Explanations. As

for “a fracture in the chamber of his nose”,it is the middle part of his nose down to

where it ends between his eyebrows. As for

“his nose crooked and his face flattened”, itmeans that his nose is awry and very swol-

len all over, and his cheeks likewise, so hisface is flattened out from it and is not in its

right form, because every sinus is distorted

with swelling, so his face looks flattened

from it. As for “every eel of blood that isknotted inside his nostrils”, it is the coagu-

lated blood inside his nostril, similar to the

eel that exists in the water” (1). The structure of Imhòtep’s “medical

chart” is remarkable in terms of its accur a-

cy, synthesis and solutions: it specifies the

name of the disease, defines the pathology,

establishes the diagnosis, prescribes the

treatment and, finally, offers practical ex-

planations (17, 29, 32). Also remarkable is

the distinction between the upper fracture

of the nose and the conditions associated

with the nasal cavities, more precisely, the

deformations at cartilage level, as well as

the different treatment approaches. As a

common denominator, the concern for the

patient constitutes a priority, as evidenced

in the medical indications themselves, as

well as in the very fact of their systematic

recording. For a physician, as well as for

the patient, medical prescriptions were ofoutmost importance.

As far as historians and philologists are

concerned, the typology of the text, the

author and the event itself are major land-

marks. The source also provides an area of

interference between two completely dif-

ferent worlds, namely physicians and histo-

rians, retracing the ancient approaches to

pathology: types of treatment, medicalsupplies, position towards the patient, and

typology of medical chart. For instance,

among the instructions referring to the

upper nose fracture, the document mentions

the use of linen cloths, useful in performing

the haemostasis but also during the first

steps in stopping the bleeding. Moreover,

linen cloths, dressed in a good lubricant

such as oil, once introduced in the twonostrils and positioned as high as possible,

stop the haemorrhage. In the case of frac-

ture, the deformed nosed can be bandaged

with oil and honey. The two relatively stiff

rolls inside the nose will be supported with

the patient’s hand, while the physicianhandles nasal bleeding or removes the

blood coagulated inside the nostrils, re-

spectively in the ears, when necessary. This

operation is extremely painful and can

impede the patient from speaking(1). His-

torical exegesis appreciates positively this

type of details, since they are clearly dis-

tinct from the idea of medicine as assimi-

lated to magical incantations or religious

rites. Edwin Smith Surgical Papyrus brings

to the fore a “rational” medical treatise, aslong as the pathology has an etiology, a

diagnosis and a treatment. From this per-

spective, as mentioned above, this papyrus




702

is the most important document of surgical

medicine in the ancient Near Est.

2. Suśruta-samhitā and effective nose

reconstruction as surgical procedure. As far as the tout court nasal recon-

struction techniques are concerned, the first

written source on nose reconstruction as a

surgical procedure is included in the Suśr u-

ta- samhitā source in chapter 16.27-31

Sūtrasthāna. According to this source,

Louis H. Gray explained that the divine

physician Dhanvantari (i.e.“well-famous”),

received the yur -Veda from Brahmtrough the successive meditation of

Prajpati and Indra, then taught it to Suśr u-

ta and other six colleagues (30). This is a

much earlier source than the Edwin Smith

Surgical Papyrus source, MS. Bower da-

ting back to the Gupta dynasty period (c.

IV-V AD). It describes a surgical technique

incorporated into one of the first treaties of

yurvedic medicine (3, 4, 8, 15, 19, 24).The British captain Hamilton Bower dis-

covered this manuscript in 1890 during one

of his travels to the Eastern Turkistan,

which accounts for the name MS. Bower.

The source is considered to date back to the

4th century, approximately a millennium

away from a possible original version.

Bower offered the voluminous manuscript

to the Asiatic Society of Bengal. During

one of the reunions of the above mentioned

Society in Calcutta, the manuscript was

exhibited to the public, drawing the atten-

tion of Orientalists, especially connoisseurs

of the Sanskrit language. A year later, the

manuscript was studied by Dr. Augustus

Rudolf F. Hoernle (1841-1918), a physician

and Indologist of Indo-British nationality

and one of the most educated persons in

Calcutta Madrasah (31). Calcutta Madrasah

is an institution founded primarily for the

study of Arab and Persian languages, aim-

ing to a comprehensive understanding of

the Koran texts, and which will later intro-

duce the study of exact sciences. Addition-

ally, Calcutta Madrasah is a place wheremedicine was studied and where medical

books and manuscripts were collected (16,

31).

The first studies and translations of the

Suśruta-saṃ hitā treaty were published in

the Journal of the Asiatic Society of Bengal

and, subsequently, in the Journal of the

Royal Asiatic Society of Great Britain and

Ireland. At the same time, Dr. Hoernlestarted to work on the first translations

there. At the beginning of the 20th century,

a complete edition translated from Sanskrit

into English was prepared by Kunda Lal

Bhishagratna. One of the most obvious

problems of the translated version, as the

reviewers rigorously warn, was related to

the fact that the English medical terminol-

ogy did not always coincide with the ho-mologous Sanskrit vocabulary (29). Thus,

it can be noticed that Orientalist studies in

Calcutta develop in tune with medical stud-

ies at the end of the 19th century and the

beginning of the 20th century.

Suśruta and his medical techniqueswere also adopted in Ancient China and in

the Middle Ages his treatise was translated

from Sanskrit into Arab (13, 17, 18, 19).

During the Renaissance and the Pre-

Modern periods, it finally entered Europe

(5, 6, 11, 12, 13, 19, 20, 27, 32). The oral

tradition was the first channel for the

transmission of medical practice, followed

by the tradition of widespread manuscripts

and the critical editions of Suśruta-

saṃ hitā, which are no less important. As

regards the variety of plastic surgery prac-

tice, Suśruta provides remedies for condi-

tions associated with the ear lobes and the




703

lips, in case of excessive swelling. Rhino-

plasty remains the most remarkable proce-

dure, considering its secular diffusion and

practice. Arion Roşu (1924-2007) an Indo-

logist of Romanian-French nationalityexplains the connexion between the name

of the technique and the technique itself:

„Connue sous le nom de ‘greffe indienneʼ,pour refaire un nez retranché, cettetehnique comporte une greffe pédiculée à

lambeau de joue (gaṇḍ a), alors que dans la

variante moderne de cette opération, révé-lée à l’Europe à la fin du XVIIIe siècle, le

lambeau est frontal” (19). In brief, the Indian nose reconstruction

technique consists primarily in measuring

the nose section to be reconstructed; then, a

live-tissue section of skin is treated so as to

cover the nose, keeping a small pedicle

connecting it to the cheek region. The nose

section, on which the skin is to be applied, is

previously excised (by removing the scar

tissue) with a knife. Subsequently, the sur-

geon carefully sutures the two parts, uplift-ing the skin and introducing two cylindrical

bandages coated in castor oil, directed on

the nostrils position, in order to support and

shape them. Once the skin is adapted, it has

to be powdered with sweet wood or liquo-

rice powder (Glycyrrhiza glabra), red san-

dalwood and barberry powder (Berberis

vulgaris). Finally, the nose has to be cov-

ered in linen and gently, although continu-ously, padded with sesame oil. When the

skin starts to turn uniform, in case the nose

is too long or too short, the supporting de-

vice (the flat) will be cut in half or modified,

as needed (5, 6, 13, 19, 21, 23, 32) (fig. 1).

Fig. 1: “Indian flap” for nasal reconstruction apud Sanjay S. (37)

At this point we can be sure that at least

the Antiquity provides the distinctions we

need in order to differentiate between thevirtues of nose treatment in Egypt and

those of nasal reconstruction in India. The

following conceptual link will refer to the

punishments or the various reasons leading

to nose mutilation, a link finally leading tothe episode featuring Nicolae Milescu, the

Snub-Nosed.




704

3. Punishments and offences.

Why the care for nose integrity?

In Suśruta's India (18), as well as lateron, the nose was associated with respect

and dignity; this was probably due to theassimilation of body integrity per se with

the moral norms. Nose mutilation involves

dishonour, the stigma of an undesirable

sign at the very centre of the face, and

automatically means marginalisation and

seclusion from the others. Any deviation

from the norms of a sexuality controlled by

the Brahmin caste and the Vedic/Hindu

principles involves a punishment equiva-lent to the dishonour caused. Similarly, the

historian is likely to be familiarised with

the punitive measures derived from the

Justinian law code, fully functional from

late Antiquity to the definitive fall of Con-

stantinople. Crimes related to treason, con-

spiracy, adultery were not always punished

by death, but, just like in India, they could

be identified with the image of disgrace.Nose cutting or seclusion in a monastic

environment particularly signified political

treason or adultery. Mutatis mutandis, from

pseudo-Aristotle‘s Physiognomonikà or

that by Giovanni Battista Della Porta, from

Salvadore De Renzi’s Collectio Salernitana

to the screening of the play Cyrano de

Bergerac by Edmond Rostand or the come-

dy Roxanne (1987) and the famous line:

“with that nose you can satisfy two women

at the same time”, one cannot help distin-

guishing between nobilissimus nasorum

and nasus correspondet praeputio or virile

noses. This is a “detail” that the imagina-

tion (scholarly or otherwise) has not ceased

to make use of, consolidating the correla-

tion between anatomic characteristics and

character or moral features (20). In the 16th

century, much more solemnly, the French

scientist Laurent Joubert – cited by the

historian Luigi Monga (20) – argued that

there was not necessarily a correspondence

between the proportions of certain anatom-

ical parts: “la portion des membres n’est

observée en tous, plusieurs ont une belletrompe de nez qui sont camus du reste et

plusieurs camus du nez sont bien ap pointésdu membre principal” (20). We need to

remember that, ultimately, most cases of

nose mutilation derive from the behaviour

of cheated husbands, hence the duel or the

nose mutilation punishment. Therefore, a

severely punished masculine virility is

preferred over a dishonoured femininitykilled with stones. But the case of Nicolae

Milescu is completely different, though no

less exciting.

We will next follow the narrative thread

of the chronicler relating the adventure of

Nicolae, the Snub-Nosed, stories of Molda-

vian rulers, then Ottoman chronicles, ru-

mours on unusual subjects from the corre-

spondence of British diplomats at Constan-tinople, all building, little by little, the

story of nose recovery and the luxury of the

aesthetic surgery Milescu benefited from in

the 17th century at the Prussian court of the

Great Elector Frederick William of Bran-

denburg, most probably under the close

supervision of the physician Christian

Mentzel.

Power struggle, exile, treason, conspir-

acy make up, then just like now, the histo-

ries of opportunism and of the reigns medi-

ated by the Ottoman Empire, materialising

scenarios of political interests. Since histo-

riography does not specify the exact date

when Milescu’s nose was cut, ever ything

tends to be uncertain. However, after hav-

ing read exhaustively the polemics between

historians, we started looking for the germs

of the story in completely different sources

than those previously mentioned. For many




705

scholars in our field, Ion Neculce’s chron i-

cle was not a reliable source, which in-

trigued us even more. Finally, the story of

Milescu’s nose mutilation could not be

sought only in the Romanian Chronicles,which led us to a Turkish chronicle dating

back to the 18th century (9, 10). Thus,

Naima Targhi briefly gives the following

account of: first, the efforts made by Prince

Vasile Lupu to redeem his daughter taken

hostage by the Ottoman Empire – which

revealed his anti-Ottoman views – by

promising the damsel’s hand to Timush,

son of a famous Ukrainian Cossack, Bog-dan Zynovii Mykhailovych Khmel’nyts’ki;then, the intention of Eflak bey, the Otto-

man nickname of Vasile Lupu, to strength-

en his army, strong enough reasons to de-

termine the Ottoman Empire to ask for a

fabulous sum in return. Finally, Naima

Targhi bitterly speaks of a Turkish leader,

Bektash aga, who facilitated the exchange.

In this context, Naima Targhi mentions theinitiative of a devil logothete, none other

than Gheorghe Ştefan (?-1668), one of

Vasile Lupu’s logothetes, the same who, inthe second half of 1653, became involved

in the rivalry between the Moldavian

Prince and Matei Basarab (1623-1654),

which would later undermine his authority.

Why does Naima Targhi consider the

logothete (i.e. Gheorghe Ştefan) an un-

grateful character? Precisely because it was

aga Matei Basarab who mediated his as-

cension to the Moldavian throne. George

Ştefan is known to be the ruler who em-

ployed the copyist Milescu, but the moment

of the plot causing the Moldavian scholar

to lose his nose was yet to arrive. The 1653

plot against the Moldavian ruler Vasile

Lupu fully succeeded, despite the intercep-

tion of some messages between Matei

Basarab and Gheorghe Ştefan or the

logothete Costin Ciogolea. Vasile Lupu

was aware of conjure, but had to leave the

throne. Oddly enough, in 1653, Milescu

was in Moldova, supporting Gheorghe

Ştefan, despite his links with the Lupuroyal family. The whim for power never

left Gheorghe Ştefan, not even after he lost,a few years later, the royal seat again; thus,

around the years 1659-1660, in similar

conditions but with different actors, he

tried again to reconfigure the same type of

plot, by the same means and for the same

purpose: regaining the royal seat of Moldo-

va. This is when Milescu became a part ofGheorghe Ştefan’s plan. Neculce wroteabout the interception of infamous corre-

spondence, which uncovered the plot, this

time with Milescu as a victim, i.e. one of

the participants in the plot. As chronicler

Neculce mentions, Prince Ştefanită Lupu, agood friend of Milescu’s, did not sentencehim to death, but handed the executioner

his own knife to cut Milescu’s nose:There was a certain boyar, Neculai

Milescul, the spatharios (Nicolae the Snub-

Nosed Spatharios, by the name of Milescul

from Vaslui) from his estate of Vaslui, a

learned man and a scholar, who knew many

languages: Old Greek, Slavonic, Greek and

Turkish. And he was proud and rich, and he

would ride in front of the prince, with mac-

es and swords, with harness on the horses.

And Prince Ştefăniă treasured and hon-

oured him, placing him at his table and

playing cards with him, asking for his ad-

vice, for he was a copyist. And then once,

for too much good and being too much

honoured by Prince Ştefăniă, he set out towrite false letters, and sent them in a

drilled stick to Prince Constantin “the Old”Băsărabă in ara Leşească (Poland), urging

him to come with the army and remove

Prince Ştefăniă from his throne. But Prince




706

Constantin refused to listen to what was

written, and sent the drilled stick and the

letters back to Prince Ştefăniă. And PrinceŞtefăniă, as soon as he saw the stick and

the letters, got angry and asked for NicolaiMilescu to be brought to him, in the small

house and had an executioner cut his nose.

And Prince Ştefăniă, hastily taking theknife of his belt, he gave it to the execu-

tioner to cut his nose. And they did not

want to cut his nose with the executioner’sknife; they cut it instead with the knife of

Prince Ştefăniă himself. Later, Nicolai the

Snub- Nosed fled to ara Nemească (Ger-many) and found a doctor, for blood flowed

from his cheek and his nose wrinkled, and

day after day his blood thickened, and his

nose grew back, heeling. And when he

returned in the country, under the reign of

Prince Iliaş, it could barely be noticed hisnose had been cut (11).

Milescu’s mutilation presumably took

place sometime between 1659 and 1600.This can be deduced from the fact that, in

1659, the chair of Moldavia belonged to

Prince Ştefăniă Lupul, and, given the un-

timely death of the prince, more precisely

on the 17th

of January 1661, this appears to

be the only plausible timeline.

Historical dates, throne succession, in-

trigues and plots all abound in the history

of the Romanian Principalities, but, as

regards Gheorghe Ştefan alone, he had thefate of a perpetual wandering prince, ask-

ing for support and subsidies from most

European countries – a story we will not

dwell on here. Milescu left Moldavia in

1660, oscillating between the two Romani-

an principalities; he was later appointed

kapukahya at Constantinople (1661-1664),

in the service of Prince Grigorie Ghica, the

latter being very familiar to the Constanti-

nople environment and a good friend of the

princely family Cantacuzino, which also

explains the connection between Constan-

tinople and the translation of the Septuagint

by the Moldavian humanist.

In 1665, Milescu was appointed secre-tary of the same prince, Grigorie Ghica,

and headed in 1666 to Berlin, where he

resorted to rhinoplasty. Historical sources

do not provide further details on this as-

pect, but due to the correspondence be-

tween two British ambassadors, one in

Constantinople, and the other in Tuscany – correspondence published by the British

historian Eric D. Tappe and taken over bylocal historians (34) – it can be inferred

that Milescu’s snub nose was not over-

looked. Why would that be so? The British

ambassador, Lord Heneage Winchelsea

(1621-1682) wrote a letter dated January 13

- 23, 1667, to his brother in law Sir John

Finch, ambassador at the court of the Grand

Duke of Tuscany. In this letter, he de-

scribed in detail Prince Gheorghe Ghica’scomplaints about an impostor who had

betrayed his own master – Grigorie Ghica,

none other than his son – and who was

using the royal seal in his various esca-

pades in the European courts, taking ad-

vantage of the benefits arising from such a

recommendation. Finally, as historiography

clarifies, Lord Winchelsea mistook the

impostor for Constantin Nacul, sent to

London in 1666 by Gheorghe Ştefan, acharacter sharing the same destiny with

Milescu: nose mutilation. Despite this con-

fusion, Lord Winchelsea also mentions the

mutilation of Milescu’s nose and the lat-

ter’s vast knowledge, recording the episodeof the surgery he was subject to in Germa-

ny: “He hath a little mark upon the tip ofhis nose which was cut off by justice for

his former knaveries, but in Germany they

have so well recovered that deformity that




707

it is little visible. The name of that person

is Nicolai. This you will do well to ac-

quaint the Secretary of State, and cause

secret enquiry whether such a person be not

at Venice or in Italy”(27).Sir John Finch (1626-1682) was no

common addressee, considering the fact

that his main profession was that of physi-

cian, Doctor of Medicine, a degree ob-

tained at the University of Padua in 1656.

Moreover, Finch was an extraordinary

fellow of the College of Physicians of Lon-

don and of the Royal Society. Undoubtedly,

Finch was highly interested in the varioustypes of special surgery, such as, for in-

stance, rhinoplasty. Several sources of

medical history indicate the 18th century as

the period when the practice of rhinoplasty

in Europe becomes known to the British.

This may seems rather unrealistic, since the

very fact that a British doctor completed

his medical studies at a university such as

the one in Padua automatically sugests thatrhinoplasty was already known in the 17th

century and that, in fact, information on

nasal reconstruction arrived sometime ear-

lier in England.

In fact, the historian might be tempted

to return to the history of the secret medical

practices and the European Academies

where the study and the practice of surgery

was common. In Cambridge, Paris, Leiden,

Padua there were the so-called anatomy

lecture halls, places designed for carrying

out dissections, where the first steps in the

study of surgery were made. Together with

Italy and England, Germany was part of the

barber-surgeon avant-garde; the best-

known German surgeon of the time was

Wilhelm Fabry von Hilden (1560-1634).

However, given the chronological gap, he

could not have operated Milescu, nor could

have Johannes Schultheiss (1595-1645), the

author of a popular treatise on surgery,

Armamentarium Chirurgicum (1653). An-

other famous surgeon of Polish origins with

comprehensive experience acquired in

Germany was Matthaeus Gottfried Pur-mann (1649-1711), professor of the Ger-

man doctor Michael Ettmuller (1644-1683).

Identifying the surgery practice where

Milescu was subject to the nasal recon-

struction operation will definitely not be an

easy task; we only know that the Medical

Academy at the Prussian court in Berlin

was represented by Friedrich Hoffmann

(1660-1742) and Georg Ernst Stahl (1660-1734). Only Stahl was permanently at the

Prussian court in Berlin, elected President

of the College of Physicians (Collegium

medicum), but at the time Milescu resorted

to this intervention, Stahl was only 7 years

old. Two clues could lead us to believe that

the Indian technique of rhinoplasty was

known at the court of the Great Elector

Frederick William: (i) the fact that he hadalready been favourable to the idea of or-

ganizing trade missions to India, (ii) the

presence at the court of the great elector of

Andreas Müller (1630?-1694) and his per-

sonal doctor Christian Mentzel (1622-

1701), both residing in Brandenburg, both

familiar with the Asian world and the Chi-

nese language, and both in contact with

Jesuit missionaries in the Far East such as,

for example, Father Philippe Couplet

(1623-1693) (35). Clues of such contacts

with the Far East are even traceable in the

library of the Great Elector Frederick Wil-

liam, namely in the manuscripts and books

briefly described by the Orientalist Julius

Klaproth in his Verzeichniss der

Chinesischen und Mandschuischen Bücher

und Handschriften der Königlichen Biblio-

thek zu Berlin, published in Paris in 1822.

The volumes dedicated to Chinese medi-




708

cine include: Clavis Medica ad Chinarum

doctrinam de pulsibus and Medicamenta

Simplicia quae à Chinensibus ad usum

medicum adhibentur, both edited with

modified titles by Andreas Cleyer andChristian Mentze, but signed by “R. P.Michaelis Boymi Poloni, è Societate Jesu, èRegno Siam, Anno 1658”, more precisely,by the Polish Jesuit Michael Boym (1612-

1659). (36) The issue of the knowledge of

rhinoplasty in mid-seventeenth century

Berlin could be summarised as follows:

either the Prussian doctor Heinrich von

Pfolsprundt spread the method of nasalreconstruction specific to the Branca fami-

ly, or this information was brought by the

Jesuit missioners in China, who provided

the Sinologists at the Prussian court with

medical information. We tend to believe

that the first hypothesis is more accurate,

and that the doctor who performed surgery

on Milescu in Berlin knew the secrets of

nose reconstruction techniques from anautochthonous source. This point of view

could give rise to future research, which is

likely to map even more precisely the tem-

poral coordinates of the practice of this

technique in 17th century Berlin and its

influence in other European countries.

4. We do know that Milescu had tochoose between the nasal reconstruction

of Indian origin and the Tropaean one ,

practised by the Vianeo brothers in the

early 15th century (32). This brings back

into discussion the secret surgery practices,

more precisely those where nasal recon-

struction was assiduously performed. Such

practices could be found in central Italy,

near Naples and even in some regions of anethnically composite Sicily, considering the

Arab domination and the flow of Sephardic

Jews, genius loci. We will begin by men-

tioning the Branca family, since this in-

volves the Prussian doctor Heinrich von

Pfolfprundt, the closest to both the secrets

of the surgical profession and to Antonio

Branca. Pfolfprundt wrote a book in 1460,

Buch der Bündth-Ertznei, published nosooner than 1868 (5, 32), a volume detail-

ing the technique of nasal reconstruction

(fig. 2).

Fig. 2: Heinrich von Pfolfprundt, Buch der Bündth-Ertznei (1460; 1868)




709

The Vianeo family also contributed to

the creation of a most abundant literature in

the history of the practice of nasal recon-

struction, not only due to their outstanding

skills, but also especially due to a revolu-

tion in the technique per se (clearly differ-

ent from the Indian technique), a technique

they did not describe themselves, but which

was stolen and disseminated by Gaspare

Tagliacozzi (1545-1599) from Bologna by

means of his popular treatise: De curtorum

chirurgia per insitionem (7, 32).

In the summer of 1947, in Tropaea, a

large number of surgery professors from

the Università del Mezzogiorno celebrated

the activity and memory of the Vianeo

brothers, within the very precincts of the

public hospital Ignazio Toraldo, putting

Calabria on the map of the history of the

nasal reconstruction technique. Ironically

or not, this is a somehow misleading histo-

ry, considering the posterity of their dis-

covery. The secret of the reconstructive

technique in the Vianeo manner was dis

closed, as mentioned above, in a luxurious

Italian Seicento, in medical publications

and in illustrations that reveal, step by step,

both the technique and the necessary

equipment. We mention to this purpose the

study De curtorum chirurgia per insitionem

by Tagliacozzi, a treatise that is fully and

freely available in a Frankfurt edition da-

ting back to 1654 (7). We also need to

point out that the interest in rhinoplasty

manifested in this period was due particu-

larly to syphilis, an incurable disease, inev-

itably related to the destruction of nose

integrity. Tagliacozzi was a surgeon who

dealt with the reconstruction of the nose,

the ears and the lips, which ensured hisnotoriety despite the revolution in the rhi-

noplasty technique made by the Vianeo

brothers, Vincenzo, Paolo and Pietro, as a

result of a much slower accumulation. A

detailed description of the rhinoplasty

technique of Tropaean origin was provided

by the French doctor Ambroise Paré, simi-

lar to the one made by Tagliacozzi in De

curtorum chirurgia per insitionem: “Il s’est

trouvé en Italie un chirurgien qui par son

artifice refaisoit des nez de chair en ceste

maniere. C’est qu’il coupoit entierement

les bords calleux ou cicatrisez du nez perdu

comme l’on fait aux becs de lievre : puisfaisoit une incision tant grande et profonde

qu’il estoit necessaire au milieu de muscle

dit biceps, qui est l’un de ceux qui flechist

le bras; puis subit faisoit poser le nez en

ladite incision et bandoit si bien la teste

avec le bras qu’il ne pouvoit vaciller çà ne

là; et certains jours après, qui est ordina i-

rement sur le quarantiesme jour, cognois-

sant l’agglutination du nez avec la chair

duduit muscle, en coupoit tant qu’il enfalloit pour la portion du nez qui manquoit:

en après la façonnoit de sorte qu’il rendoit

le nez en figure, grandeur et grosseur qu’il

estoit requis, et traittoit ce pendant la playe

du bras comme les autres, lors qu’il a

d[é]perdition de substance. Et durant les

dits quarante jours faisoit user à son maladedes panades, pressis et autres viandes fa-

ciles à transgloutir, et quant aux rem[è]desdesquels il usoit, estoyet de quelques

baumes aglutinatifs” (6).

Then, which technique was applied to

Milescu during the nasal reconstruction

performed in Berlin? Calling back into

discussion the description made by Neculce

- and found a doctor, for blood flowed

from his cheek and his nose wrinkled, and

day after day his blood thickened, and hisnose grew back, heeling – we can infer that




710

the Suśruta technique was the techniquepreferred by the anonymous doctor treating

Milescu. From the account made in the

chronicle, we can infer that the source of

the tissue used in the reconstruction of the

nose was the cheek (the genian region),

that the transfer of live-tissue indicates a

surgical strategy, and that the transfer from

the genian region to the nasal region was

produced successively. In this case, the

resemblance between the source provided

by chronicler Neculce and the Indian tech-

nique, the one according to the Suśruta-

saṃ hitā, seems more plausible: there is apreliminary period, that of manufacturing

the pattern of the defect by means of a leaf,

followed by drawing and incising the pedi-

cled flap, which is then transferred into the

nasal defect to be reconstructed at various

successive stages. This delay technique

could be what Neculce describes as: and

found a doctor, for blood flowed from his

cheek and his nose wrinkled, and day afterday his blood thickened, and his nose grew

back, heeling (6).

However, we should further comment

that, based on this description, we cannot

distinguish whether the genian flap used

involved a random movement – thus ex-

plaining the delay – or was an axial (na-

sogenian) flap. In reconstructing the nasal

defect, the hypothesis of a nasogenian flap isdifficult to support, since two such flaps

would be actually needed, bilaterally rotat-

ed. A single ampler genian flap would have

produced a noticeable deformation of the

cheek and, consequently, a visible deformity

of the patient’s face. The Indian method

consists, grosso modo, in harvesting the flap

from the genian region, as well as alterna-

tively, designing a pedicled frontal flap. TheSicilian method (Branca, Tagliacozzi) pre-

pares the brachial pedicled flap in the medial

part of the arm. The technique of the brachi-

al pedicled flap, as it results from European

Medieval and Pre-Modern sources, was

diffuse and the ways of accessing the infor-

mation cannot always be known when pub-

lications on the topic are missing.

5. Homage to the Society of Physi-

cians and Naturalists in Iaşi.

We may all be familiar with the novella

Secretul doctorului Honigberger (The Se-

cret of Doctor Honigberger), by Mircea

Eliade, published in 1940, in RevistaFundaț iilor Regale. In the magazine Cu-

vîntul of 30 July 1928, Eliade praised the

scientific activity and the contributions

made to the history of medicine by Dr.

Vasile Gomoiu and Valeriu Bologa, having

kept a close correspondence with the latter

during his stay in Calcutta (1929-1931)

(33). In fact, Eliade uses this eulogy on the

occasion of the establishment of the firstAcademic Society in the Romanian Princi-

palities in order to establish a link between

the impressive editorial and scientific ac-

tivity of George Sarton – founder of the

journal Isis, the first journal devoted to the

history of sciences in the United States –

and the assiduous activity of the two physi-

cians, Gomoiu and Bologa, members of the

International Society for the History ofMedicine and founders of the studies in the

history of medicine in Cluj during the first

decades of the 20th century (33). Returning

to Eliade’s period in Calcutta, the Indolo-

gist and historian of religions Eugen Ci-

urtin argues that Eliade first found out

about Johann Martin Honigberger (1795-

1869), the Transylvanian Saxon physician

from Braşov, by reading the English ed i-tion of his autobiography, published in




711

1852, Thirty-Five Years in the East, which

was translated and edited in Romanian in

2004 by Polirom publishing house, with an

impressive critical apparatus and an intro-

ductory study (9).

Eliade-Honigberger or Honigberger-

Eliade? In this case, reality precedes fic-

tion; based on clear and convincing histori-

ographical findings, it has become common

knowledge that Johann Martin Honigberger

existed indeed, that he had an absolutely

impressive biography, of which we will

briefly mention no more than two details:

first, Thirty-Five Years in the East, a vol-ume offering a generous description of

rhinoplasty in India (8); second, Ho-

nigberger, the anonymous contributor to

the politico-literary publication Albina

Românea scă, a newspaper founded in 1829

in Iaşi by Gheorghe Asachi, shortly before

the establishment of the distinguished So-

ciety of Physicians and Naturalists.

This is how Honigberger describes therhinoplasty procedure in the volume Thirty-

Five Years in the East: “I introduced to ourdistinguished guests, Col. Wade and Dr.

Murray an Akalee or Nahung, whose nose,

ears and hands had been cut off by order of

Runjeet Sing (he had even deserved the

gallows), and whose nose had been so well

restored in the mountains that we were all

surprised, and confessed it could not havebeen better done in Europe. As we know,

from history, this operation was even in the

remotest antiquity, practised by Hindoos;

and they formed the nose out of the cuticle

of the forehead, which proceeding is now,

and always will be the same. In Europe,

where cutting off of noses is only in use, in

exceptional cases – as when ulceration or

other circumstances make it requisite – thisoperation is usually performed with the

cuticle of the arm, and judiciously too, as,

according to our custom, the head mostly is

uncovered, and a scar on one’s forehead,

with a new nose on the face, makes rather an

ugly appearance; whilst, in the East, the scar

remains hidden beneath the turban” (8). The contribution of the Transylvanian

Saxon physician to the knowledge about

Asian medicine, flora, fauna and antiquity

studies, together with his political and mili-

tary contributions were often presented in

the pages of the Albina Românească news-

paper, which determined, most probably,

the visit of Honigberger in Iaşi, during one

of the reunions of the Society of Phhysi-cians and Naturalists, an event also sig-

nalled by the Albina Românească, no. IX,

15 May 1838. Returning from Constantino-

ple – he had no knowledge of Nicolae the

Snub-Nosed – Honigberger was received

with some ceremony, considering the title

(prince of Aracan Aureg-Seib of India) as

the Calendarul pentru poporul românesc, a

magazine from Iaşi, chose to announcehim, recalling him (with a slight delay)

between 1838 and 1861.

As regards Johann Martin Ho-

nigberger’s visit at the Society of Physi-

cians and Naturalists, besides other highly

interesting details, the historian would have

more to say.

This is where the circle somehow closes:

we argue that the history of Asian studiesand the study of Oriental languages contrib-

ute to strengthening the epistemological

space of the history of medicine, offering

adventure and erudition as the ingredients of

a huge intellectual horizon, encapsulating

the memory of alterities and of the history of

practical knowledge.

If the mutilation and reconstruction of

Milescu’s nose stir such a historiographicalinterest in the analysis of an extremely

unusual excerpt from Neculce’s chronicle,




712

which then leads to a partial explanation of

an unclear episode in the adventurous life

of the Moldavian scholar, then the effort

was worthwhile.

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