Rev. Med. Chir. Soc. Med. Nat., Iai 2013 vol. 117, no.

SURGERY

ORIGINAL PAPERS

PLASTIC SURGERY IN 17 TH CENTURY EUROPE.

CASE STUDY: NICOLAE MILESCU, THE SNUB-NOSED1
Daniela Dumbrav, tefan 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 pa ttern, but was completely different from one nation to another. Colleges of Physicians could
only be found in some places in Europe; different Parliaments of Europes nations did not
always 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. Convers ely, corporal punishments for treacherous surgeons were ubiquitous. Rhinoplasty falls into the
category of what Ambroise Par named facial plastic surgery. The technique is a medical
source 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.
Suruta-sahit 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 Moldavian Chronicles record? Is there any scholarly gossip in the aristocratic and diplomatic e nvironments at Constantinople? What exactly do the British ambassadors learn concerning
Rhinoplasty when they meet Milescu? How do we walk within 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) histories, and not exclusively history, both in academic terms but also by reassessing the practical knowledge of the 17th century. Keywords: HISTORY OF PLASTIC SUGERY, NICOLAE MILESCU, RHINOPLASTY, NASAL SURGERY, PRACTICAL KNOWLEDGE.

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 and
postdoctoral 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.

699

Daniela Dumbrav, tefan Luchian

1. Nose fractures and nasal reconstruction. Why are we interested in the

Antiquity in such cases?
We are interested in the Antiquity because history provides historians with reference 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 of
nose 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 New
York Historical Society before his death.
For a short period it was held by the Brooklin Museum, before being sent to the New
York Academy of Medicine, where it remained permanently. The text of this precious 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, to
this date, a sort of Mecca for Orientalists,
devoted mainly to the study of Near Eastern 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 University, Head of the International Association of Egyptologists and curator of the
Egyptian Art Section of the New York Metropolitan Museum, provided a second criti-

700

cal edition in 2005, an initiative unequalled

so far (1). This source reveals the intense
medical activity of Imhtep, a physician
and architect at the court of Pharaoh Netjerykhet or Djoser, the first king and
founder of the third Egyptian dynasty
(c.2760 BC). Imhtep would be, at least in
theory, the first physician to have indicated
the fact that a nasal fracture can be examined, 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 pillar
of 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 dressing
every day until he gets well. Explanations.
As for the pillar of his nose, it is the
bridge and his side of his nose, inside his
nose in the middle of his nostrils. As for
his nostrils, they are two sides of his
nose 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

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 you
say about him: One who has a fracture in
the chamber of his nose: an ailment I will
handle. Treatment. Set it back in its proper
place. Wipe for him the inside of his nostrils 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 stiff
rolls of cloth bandaged on it and treat
<him> with an oil and honey dressing every 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, it
means that his nose is awry and very swollen all over, and his cheeks likewise, so his
face 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 is
knotted inside his nostrils, it is the coagulated blood inside his nostril, similar to the
eel that exists in the water (1).
The structure of Imhteps medical
chart is remarkable in terms of its accuracy, synthesis and solutions: it specifies the
name of the disease, defines the pathology,
establishes the diagnosis, prescribes the
treatment and, finally, offers practical explanations (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 of
outmost importance.
As far as historians and philologists are
concerned, the typology of the text, the
author and the event itself are major landmarks. The source also provides an area of
interference between two completely different worlds, namely physicians and historians, retracing the ancient approaches to
pathology: types of treatment, medical
supplies, 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 two
nostrils and positioned as high as possible,
stop the haemorrhage. In the case of fracture, the deformed nosed can be bandaged
with oil and honey. The two relatively stiff
rolls inside the nose will be supported with
the patients hand, while the physician
handles nasal bleeding or removes the
blood coagulated inside the nostrils, respectively in the ears, when necessary. This
operation is extremely painful and can
impede the patient from speaking(1). Historical exegesis appreciates positively this
type of details, since they are clearly distinct from the idea of medicine as assimilated to magical incantations or religious
rites. Edwin Smith Surgical Papyrus brings
to the fore a rational medical treatise, as
long as the pathology has an etiology, a
diagnosis and a treatment. From this perspective, as mentioned above, this papyrus

701

Daniela Dumbrav, tefan Luchian

is the most important document of surgical

medicine in the ancient Near Est.
2. Suruta-samhit and effective nose
reconstruction as surgical procedure.
As far as the tout court nasal reconstruction techniques are concerned, the first
written source on nose reconstruction as a
surgical procedure is included in the Suruta-samhit source in chapter 16.27-31
Strasthna. According to this source,
Louis H. Gray explained that the divine
physician Dhanvantari (i.e.well-famous),
received the
yur-Veda from Brahm
trough the successive meditation of
Praj pati and Indra, then taught it to Suruta and other six colleagues (30). This is a
much earlier source than the Edwin Smith
Surgical Papyrus source, MS. Bower dating 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 discovered 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 attention 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

702

study of Arab and Persian languages, aiming to a comprehensive understanding of

the Koran texts, and which will later introduce the study of exact sciences. Additionally, Calcutta Madrasah is a place where
medicine was studied and where medical
books and manuscripts were collected (16,
31).
The first studies and translations of the
Suruta-sa hit 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. Hoernle
started 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 terminology did not always coincide with the homologous Sanskrit vocabulary (29). Thus,
it can be noticed that Orientalist studies in
Calcutta develop in tune with medical studies at the end of the 19th century and the
beginning of the 20th century.
Suruta and his medical techniques
were 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 PreModern 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 Surutasa hit, which are no less important. As
regards the variety of plastic surgery practice, Suruta provides remedies for conditions associated with the ear lobes and the

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

lips, in case of excessive swelling. Rhinoplasty remains the most remarkable procedure, considering its secular diffusion and
practice. Arion Rou (1924-2007) an Indologist of Romanian-French nationality
explains the connexion between the name
of the technique and the technique itself:
Connue sous le nom de greffe indienne,
pour refaire un nez retranch, cette
tehnique comporte une greffe pdicule
lambeau de joue (ga a), alors que dans la
variante moderne de cette opration, rvle lEurope la fin du XVIIIe sicle, 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 surgeon carefully sutures the two parts, uplifting 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 liquorice powder (Glycyrrhiza glabra), red sandalwood and barberry powder (Berberis
vulgaris). Finally, the nose has to be covered in linen and gently, although continuously, padded with sesame oil. When the
skin starts to turn uniform, in case the nose
is too long or too short, the supporting device (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 the
virtues 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 to
the episode featuring Nicolae Milescu, the
Snub-Nosed.

703

Daniela Dumbrav, tefan Luchian

3. Punishments and offences.

Why the care for nose integrity?
In Suruta's India (18), as well as later
on, the nose was associated with respect
and dignity; this was probably due to the
assimilation 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 equivalent 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 Constantinople. Crimes related to treason, conspiracy, 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-Aristotles Physiognomonik or
that by Giovanni Battista Della Porta, from
Salvadore De Renzis Collectio Salernitana
to the screening of the play Cyrano de
Bergerac by Edmond Rostand or the comedy Roxanne (1987) and the famous line:
with that nose you can satisfy two women
at the same time, one cannot help distinguishing between nobilissimus nasorum
and nasus correspondet praeputio or virile
noses. This is a detail that the imagination (scholarly or otherwise) has not ceased
to make use of, consolidating the correlation between anatomic characteristics and
character or moral features (20). In the 16th
century, much more solemnly, the French
scientist Laurent Joubert cited by the

704

historian Luigi Monga (20) argued that

there was not necessarily a correspondence
between the proportions of certain anatomical parts: la portion des membres nest
observe en tous, plusieurs ont une belle
trompe de nez qui sont camus du reste et
plusieurs camus du nez sont bien appoints
du 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 femininity
killed 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 Moldavian rulers, then Ottoman chronicles, rumours on unusual subjects from the correspondence of British diplomats at Constantinople, 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 Brandenburg, most probably under the close
supervision of the physician Christian
Mentzel.
Power struggle, exile, treason, conspiracy make up, then just like now, the histories of opportunism and of the reigns mediated by the Ottoman Empire, materialising
scenarios of political interests. Since historiography does not specify the exact date
when Milescus nose was cut, everything
tends to be uncertain. However, after having 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

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

scholars in our field, Ion Neculces chronicle was not a reliable source, which intrigued us even more. Finally, the story of
Milescus 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 damsels hand to Timush,
son of a famous Ukrainian Cossack, Bogdan Zynovii Mykhailovych Khmelnytski;
then, the intention of Eflak bey, the Ottoman nickname of Vasile Lupu, to strengthen his army, strong enough reasons to determine 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 the
initiative of a devil logothete, none other
than Gheorghe tefan (?-1668), one of
Vasile Lupus logothetes, the same who, in
the 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 tefan) an ungrateful character? Precisely because it was
aga Matei Basarab who mediated his ascension to the Moldavian throne. George
tefan is known to be the ruler who employed 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 interception of some messages between Matei
Basarab and Gheorghe tefan 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
tefan, despite his links with the Lupu
royal family. The whim for power never
left Gheorghe tefan, 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 Moldova. This is when Milescu became a part of
Gheorghe tefans plan. Neculce wrote
about the interception of infamous correspondence, 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 tefanit Lupu, a
good friend of Milescus, did not sentence
him to death, but handed the executioner
his own knife to cut Milescus nose:
There was a certain boyar, Neculai
Milescul, the spatharios (Nicolae the SnubNosed 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 maces and swords, with harness on the horses.
And Prince tefni treasured and honoured him, placing him at his table and
playing cards with him, asking for his advice, for he was a copyist. And then once,
for too much good and being too much
honoured by Prince tefni , he set out to
write false letters, and sent them in a
drilled stick to Prince Constantin the Old
Bsrab in ara Leeasc (Poland), urging
him to come with the army and remove
Prince tefni from his throne. But Prince

705

Daniela Dumbrav, tefan Luchian

Constantin refused to listen to what was

written, and sent the drilled stick and the
letters back to Prince tefni . And Prince
tefni , as soon as he saw the stick and
the letters, got angry and asked for Nicolai
Milescu to be brought to him, in the small
house and had an executioner cut his nose.
And Prince tefni , hastily taking the
knife of his belt, he gave it to the executioner to cut his nose. And they did not
want to cut his nose with the executioners
knife; they cut it instead with the knife of
Prince tefni himself. Later, Nicolai the
Snub-Nosed fled to ara Nem easc (Germany) 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 Ilia, it could barely be noticed his
nose had been cut (11).
Milescus 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 tefni Lupul, and, given the untimely death of the prince, more precisely
on the 17 th of January 1661, this appears to
be the only plausible timeline.
Historical dates, throne succession, intrigues and plots all abound in the history
of the Romanian Principalities, but, as
regards Gheorghe tefan alone, he had the
fate of a perpetual wandering prince, asking 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 Romanian principalities; he was later appointed
kapukahya at Constantinople (1661-1664),
in the service of Prince Grigorie Ghica, the
latter being very familiar to the Constantinople environment and a good friend of the

706

princely family Cantacuzino, which also

explains the connection between Constantinople and the translation of the Septuagint
by the Moldavian humanist.
In 1665, Milescu was appointed secretary 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 aspect, but due to the correspondence between two British ambassadors, one in
Constantinople, and the other in Tuscany
correspondence published by the British
historian Eric D. Tappe and taken over by
local historians (34) it can be inferred
that Milescus snub nose was not overlooked. 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 described in detail Prince Gheorghe Ghicas
complaints 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 escapades in the European courts, taking advantage 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 tefan, a
character sharing the same destiny with
Milescu: nose mutilation. Despite this confusion, Lord Winchelsea also mentions the
mutilation of Milescus nose and the latters vast knowledge, recording the episode
of the surgery he was subject to in Germany: He hath a little mark upon the tip of
his nose which was cut off by justice for
his former knaveries, but in Germany they
have so well recovered that deformity that

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

it is little visible. The name of that person

is Nicolai. This you will do well to acquaint 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 physician, Doctor of Medicine, a degree obtained at the University of Padua in 1656.
Moreover, Finch was an extraordinary
fellow of the College of Physicians of London and of the Royal Society. Undoubtedly,
Finch was highly interested in the various
types of special surgery, such as, for instance, 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 that
rhinoplasty was already known in the 17th
century and that, in fact, information on
nasal reconstruction arrived sometime earlier 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 bestknown 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). Another famous surgeon of Polish origins with
comprehensive experience acquired in
Germany was Matthaeus Gottfried Purmann (1649-1711), professor of the German doctor Michael Ettmuller (1644-1683).
Identifying the surgery practice where
Milescu was subject to the nasal reconstruction 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 (16601734). 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 had
already been favourable to the idea of organizing trade missions to India, (ii) the
presence at the court of the great elector of
Andreas Mller (1630?-1694) and his personal doctor Christian Mentzel (16221701), both residing in Brandenburg, both
familiar with the Asian world and the Chinese 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 William, namely in the manuscripts and books
briefly described by the Orientalist Julius
Klaproth in his
Verzeichniss der
Chinesischen und Mandschuischen Bcher
und Handschriften der Kniglichen Bibliothek zu Berlin, published in Paris in 1822.
The volumes dedicated to Chinese medi-

707

Daniela Dumbrav, tefan Luchian

cine include: Clavis Medica ad Chinarum

doctrinam de pulsibus and Medicamenta
Simplicia quae Chinensibus ad usum
medicum adhibentur, both edited with
modified titles by Andreas Cleyer and
Christian Mentze, but signed by R. P.
Michaelis Boymi Poloni, Societate Jesu,
Regno Siam, Anno 1658, more precisely,
by the Polish Jesuit Michael Boym (16121659). (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 nasal
reconstruction specific to the Branca family, 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 an
autochthonous 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 to
choose 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 reconstruction was assiduously performed. Such
practices could be found in central Italy,
near Naples and even in some regions of an
ethnically composite Sicily, considering the
Arab domination and the flow of Sephardic
Jews, genius loci. We will begin by mentioning the Branca family, since this involves 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 Bndth-Ertznei, published no
sooner than 1868 (5, 32), a volume detailing the technique of nasal reconstruction
(fig. 2).

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

708

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

The Vianeo family also contributed to

the creation of a most abundant literature in
the history of the practice of nasal reconstruction, not only due to their outstanding
skills, but also especially due to a revolution in the technique per se (clearly different 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 Universit 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 history, considering the posterity of their discovery. 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 dating back to 1654 (7). We also need to
point out that the interest in rhinoplasty
manifested in this period was due particularly to syphilis, an incurable disease, inevitably 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 his
notoriety 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 Par, similar to the one made by Tagliacozzi in De
curtorum chirurgia per insitionem: Il sest
trouv en Italie un chirurgien qui par son
artifice refaisoit des nez de chair en ceste
maniere. Cest quil coupoit entierement
les bords calleux ou cicatrisez du nez perdu
comme lon fait aux becs de lievre : puis
faisoit une incision tant grande et profonde
quil estoit necessaire au milieu de muscle
dit biceps, qui est lun de ceux qui flechist
le bras; puis subit faisoit poser le nez en
ladite incision et bandoit si bien la teste
avec le bras quil ne pouvoit vaciller ne
l; et certains jours aprs, qui est ordinairement sur le quarantiesme jour, cognoissant lagglutination du nez avec la chair
duduit muscle, en coupoit tant quil en
falloit pour la portion du nez qui manquoit:
en aprs la faonnoit de sorte quil rendoit
le nez en figure, grandeur et grosseur quil
estoit requis, et traittoit ce pendant la playe
du bras comme les autres, lors quil a
d[]perdition de substance. Et durant les
dits quarante jours faisoit user son malade
des panades, pressis et autres viandes faciles transgloutir, et quant aux rem[]des
desquels 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 his
nose grew back, heeling we can infer that

709

Daniela Dumbrav, tefan Luchian

the Suruta technique was the technique

preferred 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 technique, the one according to the Surutasa hit, seems more plausible: there is a
preliminary period, that of manufacturing
the pattern of the defect by means of a leaf,
followed by drawing and incising the pedicled 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 after
day 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 explaining the delay or was an axial (nasogenian) flap. In reconstructing the nasal
defect, the hypothesis of a nasogenian flap is
difficult to support, since two such flaps
would be actually needed, bilaterally rotated. A single ampler genian flap would have
produced a noticeable deformation of the
cheek and, consequently, a visible deformity
of the patients face. The Indian method
consists, grosso modo, in harvesting the flap
from the genian region, as well as alternatively, designing a pedicled frontal flap. The
Sicilian method (Branca, Tagliacozzi) pre-

710

pares the brachial pedicled flap in the medial

part of the arm. The technique of the brachial pedicled flap, as it results from European
Medieval and Pre-Modern sources, was
diffuse and the ways of accessing the information cannot always be known when publications on the topic are missing.
5. Homage to the Society of Physicians and Naturalists in Iai.
We may all be familiar with the novella
Secretul doctorului Honigberger (The Secret of Doctor Honigberger), by Mircea
Eliade, published in 1940, in Revista
Funda iilor Regale. In the magazine Cuvntul 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 first
Academic Society in the Romanian Principalities in order to establish a link between
the impressive editorial and scientific activity 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 physicians, Gomoiu and Bologa, members of the
International Society for the History of
Medicine and founders of the studies in the
history of medicine in Cluj during the first
decades of the 20th century (33). Returning
to Eliades period in Calcutta, the Indologist and historian of religions Eugen Ciurtin argues that Eliade first found out
about Johann Martin Honigberger (17951869), the Transylvanian Saxon physician
from Braov, by reading the English edition of his autobiography, published in

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

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 introductory study (9).
Eliade-Honigberger or HonigbergerEliade? In this case, reality precedes fiction; based on clear and convincing historiographical 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 volume offering a generous description of
rhinoplasty in India (8); second, Honigberger, the anonymous contributor to
the politico-literary publication Albina
Romneasc, a newspaper founded in 1829
in Iai by Gheorghe Asachi, shortly before
the establishment of the distinguished Society of Physicians and Naturalists.
This is how Honigberger describes the
rhinoplasty procedure in the volume ThirtyFive Years in the East: I introduced to our
distinguished 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 have
been 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 this
operation 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 ones 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 military contributions were often presented in
the pages of the Albina Romneasc newspaper, which determined, most probably,
the visit of Honigberger in Iai, during one
of the reunions of the Society of Phhysicians and Naturalists, an event also signalled by the Albina Romneasc, no. IX,
15 May 1838. Returning from Constantinople 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 romnesc, a
magazine from Iai, chose to announce
him, recalling him (with a slight delay)
between 1838 and 1861.
As regards Johann Martin Honigbergers visit at the Society of Physicians 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 studies
and the study of Oriental languages contribute 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
Milescus nose stir such a historiographical
interest in the analysis of an extremely
unusual excerpt from Neculces chronicle,

711

Daniela Dumbrav, tefan Luchian

which then leads to a partial explanation of

an unclear episode in the adventurous life

of the Moldavian scholar, then the effort

was worthwhile.

REFERENCES
1. Allen J. P. et all., The Art of Medicine in Ancient Egypt, New York: Metropolitan Museum of Art
Series, 2005, translation of Edwin Smith Surgical Papyrus, text retrieved by Turning the Pages (open
source): http://archive.nlm.nih.gov/proj/ttp/flash/smith/smith.html on the U. S. National Library of
Medicine website; retrieved on October 3, 2010; see also the most recent German version: Wolfgang
Kosack: Der medizinische Papyrus Edwin Smith. The New York Academy of Medicine, Inv. 217;
Neu in Hieroglyphen bertragen, bersetzt und bearbeitet Berlin 2011, Basel: Verlag Christoph
Brunner, 2012.
2. Breasted J. H., The Edwin Smith Surgical Papyrus. Published in Facsimile and Hieroglyphic
Transliteration with Translations and Commentary, vol. I-II; Illinois : Chicago University Press;
1930.
3. Bhishagratna Kaviraj K. L. (ed.), An English translation of the Surutasahit based on original
Sanskrit text. With a full and comprehensive introduction, translation of different readings, notes,
comperative
views,
index,
glossary
and
plates,
(open
source
available
to
http://archive.org/details/englishtranslati02susr, retrieved on October 3, 2010), Calcutta: Kashi
Ghoses Lane, 1907; the MS Bower also available to http://ia700809.us.archive.org/29/items/
TheBowerManuscript/TheBowerManuscript.pdf, retrieved on October 3, 2010.
4. Sharma P. V., Suruta-Sahit: With English Translation of Text and alha a's Commentary Along
with Critical Notes, viii+568p.; viii+695p.; viii+720p., Appendices; Index; 25cm., Varanasi:
Chaukhambha Visvabharti; 2005.
5. Pfolsprundt H. von (writen in 1460), Buch der Bndth-Ertznei, Berlin: Druck und Verlag von Georg
Reimer; 1868. (open source: http://archive.org/details/buchderbndther00pfol, retrieved on October 3,
2010)
6. Par A., uvres, Paris: G. Buon ; 1585. (open source : http://gallica.bnf.fr/ark:/12148/
bpt6k53757m/f4.image , retrieved on October 3, 2010)
7. Tagliacozzi G., De Curtorum Chirurgia Per Insitionem, Venice : Gaspare Bindoni the Younger;
1597. (open source: http://archive.org/details/decurtorumchirur02tagl, retrieved on October 3, 2010)
8. Honigberger J. M., Thirty-Five Years in the East. Adventures, Discoveries, Experiments, and
Historical Sketches, relating to the Punjab and Cashmere; in connection with Medicine, Botany,
Pharmacy &c. Together with an original Materia Medica; and a MEDICAL Vocabulary in Four
European and Five Eastern Languages by Johan Martin Honigberger, Late Physician to the Court of
Lahore, London: H. Baillire; 1852: 49-50.
9. Honigberger J. M., Treizeci i cinci de ani n Orient, ed. Ciurtin E., translated by Ciurtin E., Lupu C.,
Lupacu, introductory note by Rou A., Iai: Polirom; 2004: 153-154; n. 124: 320-321.
10. Mehmet M. A., Cronici Turceti privind rile Romne. Coll. Izvoare orientale privind istoria
Romniei, I (1455-1774), Bucarest: Insitutul de Studii Sud-Est Europene, Editura Academiei
Romne; 1976: 123-124.
11. Neculce I., Opere. Letopise ul rii Moldovei i o sam de cuvinte (Ed. trempel G.), Bucuresti:
Editura Minerva; 1982: f. 200v-201v, 189-191.
12. Vidal A., Trait de pathologie externe et de medicine opratoire, Paris: Librairie de LAcadmie
Royale de Mdicine; 18462.
13. Belifante L. S., History of Rhinoplasty, Oral Maxillof Surg Clin N Am 2012; 24(1): 1 9.
14. Thomas M., DSilva J., Ethnic Rhinoplasty, Oral Maxillof Surg Clin N Am 2012; 24: 131-148.
15. Raju V. K., Susruta of ancient India, Indian J Ophthalmol 2003; 51(2): 119-122.

712

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

16. Bandyopadhyay D., Madrasa Education and the Condition of Indian Muslims, Economic and
Politically Weekly 2002; 37 (16): 1481-1484.
17. Westendorf W., Handbuch der gyptische Medizin, Handbuch der Orientalistik 36, 2 vol, LeidenBoston-Kln: E. J. Brill; 1999; See also the Book Review made by Ciurtin C., Une synthse de la
medicine gyptienne, Studia Asiatica 2001; 2(1-2): 145-168.
18. Meulenbeld J. G., A History of Indian Medical Literature, I A, Groningen: Egbert Forsten; 1999: 252;
333-346; Groningen: Egbert Forsten; I B, 1999; 311-314; 327-328.
19. Rou A., Aperu de lhistoire de la mdicine indienne, Annals of the Sergiu Al-George Institute 19951996; IV-V: 87-118.
20. Monga L., Odeporica e medicina: I viaggiatori del Cinquecento e la rinoplastica, Italica 1992; 69 (3):
378-393.
21. Zysk K. G., The Evolution of Anatomical Knowledge in Ancient India, with Special Reference to
Cross-Cultural Influences, J Am Orient Soc 1986; 106 (4): 687-705.
22. Lieber E., Asafs Book of Medicines: A Hebrew Encyclopedia of Greek and Jewish Medicine,
Possibly Compiled in Byzantium on an Indian Model, Dumbarton Oaks Papers 1984; 38: 233-249.
23. Suruta Sahit (A Scientific Synopsis) by Ray P., Gupta H., Roy M., Book Review Emmerick R. E.,
Bulletin of the School of Oriental and African Studies 1982; 45(2): 377-378.
24. Filliozat J., La doctrine classique de la mdicine indienne: ses origines et ses parallels grecs, 2me
ed., Publications hors serie de lEcole Franaise dExtreme-Orient, pp. Viii, 231, Paris 1975; BR by
Rou A., J Roy Asi Soc Great Brit Ireland 1977; II: 220-221.
25. Pilgrim M. C., Sands D., Reconstructive Nasal Surgery, Am J Nurs 1973; 73/3, 451-456.
26. Valluari M., Ancient Indian Medicine, East and West 1954; 5(2): 99-103.
27. Tappe E., An English contribution to the biography of Nicolae Milescu, Rev tud roum 1953, 1: 152160.
28. Mller F. G. R., On an Origin of the Caraka and Suruta Sahit s, J Roy As Soc Gr Brit Ireland
1933; 2: 323-327.
29. The Edward Smith Surgical Papyrus by James Henry Breasted, Book Review Sarton G., Isis 1931; 2:
355-367; idem, Isis 1923; 2: 447-449.
30. Gray H. L., The Indian God Dhanvantari, J Am Orient Soc 1922; 42: 323-337.
31. Bandyopadhyay D., Madrasa Education and the Condition of Indian Muslims, Economic and
Political Weekly 2002; 37/6: 1481-1484.
32. Santoni-Rugiu P., Sykes, A History of Plastic Surgery, Berlin-Heidelberg-New York: Springer, 2007:
167-198.
33. Eliade M., Istoria tiin elor n Romnia, Cuvntul, year IV, no. 1174, July 30, 1928, 1-2; Institutul de
Istorie a Medicinei, Cuvntul, year IV, no. 1267, October 31, 1928, 1-2; Sarton i Istoria tiin elor,
Cuvntul, year IV, no. 1276, November 11, 1928, 1-2 in Virilitate i ascez. Scrieri de tinere e 1928,
Bucureti: Humanitas, 2008: 207-211; 285-289; 297-300.
34. Cernovodeanu P., Cicanci O. tiri noi despre Sptarul Milescu i rela iile lui cu teologul anglican
Thomas Smith, Ortodoxia 1958; 10/3-4, 321-341.
35. Lach D., The Chinese Studies of Andreas Mller, J Am Orient Soc 1940; 60/4, 564-575.
36. Kajdaski E., Boyms M. Medicus Sinicus, Toung Pao 1987, 73/4-5, 161-189.
37. Sanjaj S, Sushruta: Rinoplasty in 600 B. C., The Inter J Plastic Surg 2007; 3/2,
http://archive.ispub.com/journal/the-internet-journal-of-plastic-surgery/volume-3-number-2/sushrutarhinoplasty-in-600-b-c.html#sthash.ZbiMP5T6.dpbs, retrieved on October 3, 2010.

713