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Hugh of Lucca
Hugh of Lucca or Hugh Borgognoni (also Ugo) was a medieval surgeon. He and Theodoric of Lucca, his son or student, are noted for their use of wine as an antiseptic in the early 13th century.

Life Story
Hugh of Lucca – also known as Hugo of Lucca, or Ugo de Borgognoni, of which the family Borgognoni thought to belong to a small nobility, centered in Monsummano, Valdinievole - was born in 1160, around the time the teaching of corpus juris was said to be common where the University of Bologna had included the `healing art` of medicine into its subjects of grammar, dialectic, rhetoric, and the free subjects of music and astronomy.

Hugh of Lucca was a physician at the end of the period where the art of healing was deemed as a profession transmitted from father to son via various techniques that were observed and practiced, in the first half of the thirteenth century.

It is assumed that he had arrived in Bologna by following a relative of his, Count Rodolfo Borgognoni – who is assumed to become the mayor of the city, from his residency in Lucca, and continued his profession as a surgeon until his death there. Some regard him as the founder of the surgical school of Bologna, as he was the pioneer of a new wound management concept, and the starter of a new era. Although it is also declared in some sources that in the early thirteenth century the Salernitan surgical traditions of the Medical School of Salerno had been bought to Bologna by Roland of Parma, who was a disciple of Roger, at the time Hugh of Lucca was employed by the city as the military surgeon. The following of students he attracted through his practice involving empiricist ideologies and the aseptic theory is said to be in a significant amount.

He is also said to be a man of action and quite dutiful, since he accompanied the Bolognese Army on the Fifth Crusade, visiting both Syria and Egypt and being present at the Siege of Dammietta in 1219. He is thought to gain a rich experience in not only the wounds of the soldiers but also on the Black Death, which was ravaging the opposing armies, during the lengthy period of time of conflict he was a witness to.

Acts in the Crusades
Hugh of Lucca was initially an empiricist, challenging the doctrine of Galen by approaches as well as techniques and methods rooted in experiments and experiences. He advocated the aseptic theory against the conventional treatment methods that were generally used where suppuration and pus formation were thought necessary for healing. He condemned the laudable pus theory, which he regarded as `hindering the nature and prolonging the healing`.

While on the crusades, he travelled with the Bolognese soldiers between 1218 and 1221, even though he was over sixty years old of age. Over the time period he was treating the war wounds, he came into the understanding that the best way to heal the wounds of the skull involved the prevention of suppuration.

It is known that the knowledge he gained from war was passed down to Theodoric, a Dominican cleric trained in medicine, who is regarded as his son in some sources. Theodoric, whose actual identity is in dispute, recorded the information, and built his own method upon those of Hugh of Lucca. Theodoric is believed by many historians, including the Italian specialists Sarti and Verdrani, to be Teodoricus, one of the three doctor sons of Hugh of Lucca. However, the French historian Louis Karl points out evidence that Theodoric was a Catalonian apprentice of Ugo Borgognoni’s for approximately six or seven years.

In 1221, after his return to Bologna from his duties in battle, he was appointed as a legal physician in the city; a position recorded for the first time and thought to be concerned with medical juris-prudence. Although he lived into his 90s, and assumedly passed away in 1259, it is continuously stated in numerous sources that he left no written record to humanity’s knowledge, and all his achievements were noted down by Theodoric.

The Method of Hugh of Lucca: innovations in wound treatment

For those wounded on the medieval battlefield, the odds of survival were not great. Despite being treated, many would die shortly afterwards from infections. In the thirteenth and fourteenth centuries, a small group of surgeons believed they had a better way of treating these injuries. But they would have to challenge hundreds of years of medical knowledge. Hugh of Lucca (1160-1257), his pupil and son, Theodoric, Bishop of Cervia (1205-96), and French anatomist and surgeon Henri of Mondeville (1260-1320), who learned this method from studying Theodoric’s Surgery in medical courses taught by Jean Pitard (1235-1330) and Lanfranc of Milan (1250-1306) challenged the conventional treatment of wounds sustained in battle, which involved suppuration, or the encouragement of pus formation, held to be necessary in the healing process. They advocated and practiced a treatment known as the aseptic theory or dry method of wound treatment in which foreign objects were removed, haemorrhaging was stopped, and wounds were closed immediately. Upon closure, wounds were dressed in a dry cloth without encouraging pus formation or suppuration.The dry method of healing was controversial for two reasons. Firstly, it rejected conventional medical wisdom based on Galen and other ancient writers who believed that the healing was not possible without the removal of “bad humours”. Several experts have argued that the doctrine of the humours was so entrenched in the medieval medical community that to challenge it was an act of heresy. Any medic who opposed the thousand-year method of healing was maligned. Secondly, the dry method of healing repudiated a religious belief system that taught that the evacuation of bad humours was a cleansing of evil from the body. Suppuration was a form of exorcism. Medieval people often viewed disease and infection as punishment for bad behaviour. The individual needed to be cleansed both physically and spiritually.

Father and son

The first proponent of the controversial method of wound treatment, Hugh of Lucca, born circa 1160, was a medicus possibly educated at Salerno. An October 1214 contract with the city of Bologna as a municipal surgeon stipulated that he would reside in that city for six months of the year and during periods of civil war. Residents, including inhabitants of the nearby countryside, would be treated free of charge. The contract also required that Hugh provide medical services to the army in the field. In return, he was paid 600 Bolognese lire per year and received some property. This has been called “the earliest undisputedexample in medieval Italy where a doctor was hired long term by a city to treat its population”. Although he was over sixty years of age, Hugh accompanied Bolognese soldiers on the Fifth Crusade to Egypt between 1218 and 1221. Hugh’s wartime experience of treating injured Bolognese soldiers in the field convinced him that the most effective method of healing wounds of the skull was without the encouragement of suppuration. He recommended removing foreign objects from flesh wounds and cleansing the wound with wine-soaked cushions, then drying the wound immediately. Theodoric, who recorded his father and master’s techniques, described the procedure of treating wounds as “not only desirable but attainable,” and offered an explanation of the process: "Therefore in the case of a simple skin wound, if the lesion should not entail loss of tissue, or should be a lesion of the skull, you will treat it thus: in the first place, the lips of the wound, and all about the wound should be debrided; and then the wound should be completely cleansed of fuzz, hair, and anything else, and let the wound be wiped quite dry with fine lint soaked in warm wine and wrung out. Thus, the lips of the wound may be reunited as well as possible in accordance with their original healthy state and having made compresses from fine clean lint soaked in warm wine and placed upon the wound so as to fit, it be bound up with a light bandage in such a way that the reapproximation of the wound edges cannot be disturbed at all." "

Why did he use wine in his method?
Wine, throughout the known history of medicine and the art of health, was a very favored and commonly used ingredient. It was mainly used as a numbing or, preferred in more times, as an agent to ease and diminish the pain of the wounded patients. Wine was initially given orally during procedures involving the consumption of it. The main reason being that; once the patient who was to be treated drank the wine, they forgot about ever going through the painful operation, and they were unburdened of the trauma an operation of the likes would have caused.

Hugh of Lucca used wine as a means to disinfect the flesh wound. As the name of his technique “Antiseptic technique” also suggests, it was primarily used by him for its antiseptic properties. In many cases he saw it fit to use wine, he boiled it. And then soaked either lint or compresses or both inside the boiled wine. Thus, he had the basic idea of wine, and wanted to prevent it from, potentially getting contaminated through air.

His experiences sure to be gained during the 5th Crusade by treating the wounded Bolognese soldiers have also been thought to aid in developing his technique, and this journey enabled him to lay the main outline of his ideas behind his method.

How did he use wine?
Hugh of Lucca’s technique gained fame as he used wine directly on the wounds. His method of treating fresh wounds, followed by soaking lint in boiled wine, was used to clean the wound of any foreign materials as well as to disinfect the area. After this operation was successfully accomplished, he would cover the cleaned wound with a compress that had also been soaked in boiled wine.

When did he discover wine as a treatment?
Unfortunately, there is no record stating the exact date of when he discovered this technique. However, the vast usage of wine by others during operations through history of medicine suggests it was used mostly mixed together with various herbs or numerous oils. The main and primary purpose of wine being used during surgical operations at these times was to drive off any sense of the patient and induce forgetfulness of the pain the next day of the operation.

Hugh of Lucca, on the other hand, relied mostly on practical knowledge by trial and error, as the philosophy he followed regarded experience as the sole source of knowledge. He found oils to be too slippery and hard to add his sources as a material for clinical operations to bond the two edges of the wound in surgeries. He preferred using wine instead, as it vaporized after a period of time, unlike oils in general, and dried with the the wound while cleaning it with the alcohol inside. As mentioned here:

''” Hugh and Theodoric for the fresh wound rejected oil as too slippery for union and poultices as too moist; they washed the wound with wine, scrupulously removing every foreign particle; then they brought the edges together, forbidding wine or anything else to remain within. Upon the outer surface they laid only lint steeped in wine. Powders they regarded as too desiccating, for powder shuts in decomposing matters; wine, after washing, purifying, and drying the raw surfaces, evaporates''.”

Category:History of medicine