Cosmetic Surgery in the Renaissance; What was Possible and Why it was Done

This is a paper I have had in the works for some time.  It was submitted this winter as a research entry for Arts & Sciences Faire here in the Middle Kingdom and it took a First place.  Unfortunately, some of my pictorial data has been stolen and I have not been able to replace it.  I have gone through and made a note of the places where the manuscript page I photographed was missing or the museum artifact image is gone.  Despite those setbacks, the paper is here for any who wish to read it.



Cosmetic Surgery in the Middle Ages and Renaissance: What Was Possible and Why it was Done

 Modern medicine has blessed us with many cures and advancements including the area of cosmetic medicine. These can be loosely defined as medical procedures which are elective and focused on the appearance of the patient. Procedures can include, but are in no way limited to, breast augmentation, rhinoplasty, cheekbone implants, skin grafts, and hair implants. Today both genders undergo cosmetic procedures and the reasons for doing so are as varied as the procedures themselves. But is our modern culture unique in its desire to transfigure the body? Did our ancestors have any means to alter their bodies? In the time before a formalized scientific method and germ theory, why would an individual choose to undergo a procedure which is best described as dangerous?

Documentation for some cosmetic procedures actually predates the SCA period. The Sushruta Samhita is a Sanskrit text on surgery dating from the 3rd or 4th century. It is one of the foundations of traditional Indian medicine. By the 8th century, the text was translated into Arabic under the name, Kitab-i-Susrud. This Arabic version was known by the end of the Middle Ages and Italian surgeons such as Gasparo Tagliacozzi were using this text to perform cosmetic procedures in Renaissance Bologna. The procedures which were described and practiced in these texts were nose, lip, and earlobe reconstruction. Ambroise Pare’s work as an army surgeon in sixteenth century France sees the development of modern prosthetics.
The reasons a person would choose to undergo such procedures varied from individual to individual but basically centered on social inclusion. War and accidents could lead to disfigurement and loss of limb. Birth defects existed just as they do in the modern world. Illnesses such as leprosy and syphilis often lead to serious facial deformities. The social exclusion, financial, and legal repercussions of these conditions might be severe enough to lead some people to risk death and infection.
To begin, let’s look at the procedures and techniques which were available to the surgeon in the Renaissance. As previously stated, we can find a description of nose, lip, and earlobe reconstruction in the Sushruta Samhita. The earliest preserved version of this text is the Bower Manuscript, currently housed in the Bodleian Library in Oxford. Here is an English translation based on this manuscript which describes how a patient was prepared for reconstructive surgeries;

Then the hair of the patient, whether male or female, should be gathered and tied up in a knot, and the patient should be given a light food (so as to keep up his strength without hampering his digestion); after which his friends and relations should be asked to hold him firm….Of course the adhesion should be effected with the blood being still left in the parts that have been scraped. Then having anointed them with honey and clarified butter, they should be covered with cotton and linen, and tied with strings of thread, neither too loose nor too tight, and dusted over with powders of baked clay. Then directions should be given as regards the diet and nursing of the patient.—Vol 1, Chapter XVI, p 148, (Bhishagratna, 1907).

This same chapter goes on to describe the methods in which the earlobe can

be reconstructed;


…the process, known as the Nemisandhanska, should be used in cases where each of the bifurcated lobes of the ears would be found to be thick, extended, and equal in size. The process, known as the Utpala-Bhedyaka, should be used in cases where the severed lobes of the ears would be found to be round, extended, and equal in dimensions. The process, Valluraka should be resorted to in cases where the severed lobes of the ears would be found to be short, circular, and equal in size. The process, known as the Asangima, should be adopted in cases where the anterior surface of one of these severed appendages would have a more elongated shape than the other. The process, known as the Ganda-Karna, consists in slicing off a patch of healthy flesh from one of the regions of the cheeks and in adhering it to one of the severed lobes of the ears which is more elongated on its anterior side than the other. (Plastic operations). In the case of extremely short lobes, the flesh should be cut off from both the cheeks and adhered to them, the process being known as the Aharyaya. The lobes of the ears which have been completely severed from their roots are called Pithopamas. The process known as the Nirvedhima should be resorted to in such cases by piercing the two Putrikas (Tragus and anti-tragus) of the ears—Vol. 1 Chapter XVI, p 144 (Bhishagratna, 1907).


The process is basically the same despite the many descriptions of earlobe shapes. In each process the lobe is slightly scarified and the new piece of flesh (or part to which the scarified lobe will be attached) would be adhered to this scarified part and bandaged. The newly formed earlobe would be bandaged, monitored and re-bandaged to ensure proper attachment
The surgery for an artificial nose, or rhinoplasty, would be conducted thusly;

First the leaf of a creeper, long and broad enough to fully cover the whole of the severed or clipped off part should be gathered; and a patch of living flesh, equal in dimension to the preceding leaf, should be sliced off (from down upward) from the region of the cheek and, after scarifying it with a knife, swiftly adhered to the severed nose. Then the cool-headed physician should steadily tie it up with a bandage decent to look at and perfectly suited to the end for which it has been employed…The physician should make sure that the adhesion of the severed parts has been fully effected and then insert two small pipes into the nostrils to facilitate respiration, and to prevent adhesioned flesh from hanging down…Adhesion should be deemed complete after the incident ulcer had been perfectly healed up,…–Vol. 1, chapter XVI, p 153-154 (Bhishagratna, 1907).

The Sushruta Samhita also describes the surgery for repairing cleft lips in this chapter. It is nearly identical to the nose surgery, with the exception of the insertion pipes.
The Sushruta Samhita was translated into Arabic and spread across Europe beginning in the 8th century. An entry from the Leechbook of Bald, an Anglo-Saxon medical text dating from the 9th century, details a method for repairing a cleft lip which has some similarities to the Sanskrit text;

For harelip, pound mastic very small, add the white of an egg, and mingle as thou dost vermillion. Cut with a knife, sew with silk, then smear without and in with the salve, fast ere the silk rot. If it draw together, arrange it with the hand, anoint again soon—(Early English Manuscripts in Facsimile, vol. 5, Bald’s Leechbook)

The idea that the area to be attached should be scarified can be seen here as well as a few new elements. The instruction for making a salve is really an early type of skin glue. Mastic is a tree sap with both analgesic and anesthetic properties. The egg white would be used as a binder, similar to the way painters mix tempera paint, as we can see from the reference to vermillion in the text. The silk thread mentioned in the entry would bind the edges of the wound together until the skin could grow.
Another medical text from earlier in the sixteenth century outlines additional procedures to repair the nose, lips, and earlobes;


Jff ther be wound apone the nose or on the lypp or in any other place or noble member of the bodye that shall be sewd ffirst pat obe pt shall be joynyd to p op rightly and than pat on pties of the skynne as delicatly and easely as it may be shall sowed so as it may dure with a subtile quarell and sylk threde euly stich by hym selve ech A littell fro op.

If there be a wound upon the nose or on the lip or in any other place or noble member of the body that shall be sewed, first the one part shall be joined to the other rightly; and then that other part of the skin shall be sewed, as it may dure with a fine needle and silk thread, every stitch by itself a little from the other.—(A Leechbook or Collection of Medical Recipes of the Fifteenth Century, 1934, # 963).

In his medical treatise Oeuvres Compleat d ‘Ambroise Pare, published in 1585, you can find drawings describing this procedure and the needle (figure 1 missing, due to theft). In the second half of the sixteenth century, Gasparo Tagliacozzi published De Curtorum Chirurgia per Instittonem. Tapliacozzi had been a barber-surgeon in Bologna for some time, and published his method of repairing ears, lips, and noses. They are nearly identical to the previously described methods in the Sushruta Samhita. However, he made two improvements. For his nose surgeries, Taglicozzi made a small flap with the skin of the inner arm. He attached one end of the now open flap to the nose. Instead of removing the flap from the inner arm completely, he left it in place for a period of time (usually 10-14 days). This allowed the skin to be nourished with fresh blood and also allowed the skin to firmly attach itself to the nose. In order to make the patient more comfortable during healing, Tagliacozzi invented a special harness which allowed the arm to rest in place. Figure 2 & 3(missing) show pages from a 1598 copy of Tagliacozzi’s book which illustrate the harness and how it should be attached to the patient. Figure 3a is a modern reconstruction of this device based on Tagliacozzi’s book.

Once the skin had had time to attach itself to the nose, a second surgery was performed which removed the skin from the inner arm completely.  Now the skin could be fully attached to the nose and a full healing could begin. Figure 4 is another illustration from the 1598 edition diagramming how the nose should be bandaged. Like the Sushruta Samhita, the surgeon would tie the newly bandaged nose with string according to Tagliacozzi’s diagram (Figure 5).
Tagliacozzi’s surgery to repair earlobes was performed just as it was outlined in the Sushruta Samhita. Figures 6 & 7 illustrate the surgery which has been previously described in this paper. Figure 7 even gives the surgeon alternate places to cut a flap of skin for the newly constructed earlobe.
Although he does not provide a specific recipe for preparing the patient for such surgeries, it is possible that he might make use of something similar to this one found in a 15th medical text;

To put a man to sleep, that he may be treated or cut (operated upon). Take the gall of a swine three spoonfuls, and take the juice of hemlock-root three spoonfuls, of vinegar three spoonfuls, and mingle all together; and them put them in a vessel of glass to hold to the sick man that thou wilt treat or cut; and take thereof a spoonful and put (it) to a gallon of wine or ale. And if thou would make it strong, put two spoonfuls thereof, and give him to drink, and he shall sleep soon. Then mayst thou treat or cut him as thou wilt.—(A Leechbook or Collection of Medical Recipes of the Fifteenth Century, 1934, # 852)

This recipe along with the mastic and eeg white mixture from Bald’s Leechbook which was mentioned earlier indicate that the patient did not have to undergo surgery fully conscious. Some illustrations of surgery from the period still show men holding the patient down while the doctor does some procedures.

The beginning of modern prosthesis can be seen in sixteenth century France. Ambroise Pare, whose treatise was referenced earlier, was a barber surgeon with experience as an army surgeon and eventually became Royal Surgeon to Kings Henry II, Francis II, Charles IX, and Henry III of France. He is often credited with the now common practice of sewing blood vessels (ligatures) shut in order to control bleeding. He is also noted for his development of artificial limbs with articulated joints. In fact, a statue of Pare can be found in the Hall of Fame at the International Museum of Surgical Science in Chicago, IL. Figure 8 (missing) is a sketch of his design for an artificial hand taken from his work, Oeuvres Compleat d’Ambroise Pare. The International Museum of Surgical Science has a prosthetic hand on display which is nearly identical (figure 9, missing due to theft). Figure 10 (missing) shows an artificial leg on display at the International Museum of Surgical Science which is of the more common “peg leg” type we often think of.. Figure 11 (missing) is a diagram of an artificial leg taken from Oeuvres Compleat d’Ambroise Pare. Other notable developments shown in Oeuvres Compleat d’Ambroise Pare include artificial eyes made of gold or silver, and false teeth (figures 12 & 13,missing).. Devices such as these are the forerunners of modern prosthetics and cosmetic dentistry.

Did any real person ever actually use the devices or surgeries which were available? There are signs of wear on the leg in the International Museum of Surgical Science, so we can conclude that it was worn by someone. Perhaps the most famous wearer of a prosthetic was Danish astronomer Tycho Brahe. During a drunken duel in 1566, a twenty year old Brahe, had the bridge of his nose severed off. From that point until his death in 1601, Brahe wore a prosthetic nose made of metal. During his lifetime it was rumored that the nose was made of a blend of gold and silver, which he glued in place everyday. The glue was possibly something similar to the mastic and egg white mixture which was referenced earlier, but there is not concrete evidence of this. A 2010 exhumation of Brahe’s body showed evidence that the prosthetic nose was made of copper, which would have been more comfortable. In most portraits of him, you can see a slight blur at the bridge of the nose, which is where the nose would be glued in place. It is possible that his distinct mustache was an effort to further disguise the wound.

Now that we know what was possible we must ask ourselves why would an individual choose to undergo such procedures? Both Pare and Tagliacozzi make reference to the fact that these surgeries were performed on actual patients in the treatises. Pare even notes in his text that an early form of scientific method was used by him in some of his procedures. However, these surgeries seem to be conducted largely without the use of pain relievers and with the patient being fully conscious. Although texts make mention of using clean tools, there is no recommendation that the tool be treated with anything to make it sterile. Germ theory was not a proven and accepted idea until well into the 19th century. The idea that epidemic diseases were caused by microorganisms was proposed as early as 1548 by Girolamo Frscastoro, but his idea did not extend to infections which might occur as a result of open wounds or childbirth. This means that even with the variety of cosmetic procedures available to the Renaissance person, they would be facing death and intense pain. Why take such a risk unless you absolutely had to? Is a cosmetic issue worth the risk? Let’s look at a few reasons that might drive a person to take such a risk in the Renaissance.

The main reason a person might choose to undergo cosmetic procedures is social inclusion. The idea that a person is disfigured because of some inner moral defect is mentioned in both the Bible and popular literature at the time. The story of Job is perhaps the best known Bible story of one who is disfigured by God. In Job 2, the now afflicted Job is visited by his good friends. In Job 4:7 Eliphaz asks Job “Remember, I pray thee, who ever perished being innocent? Or when were the just destroyed?”   In other words, has an innocent person ever truly been punished by God? Popular literature carries on the idea that personal sin can be reflected by outer appearance like in Dante’s Inferno, where alchemists are punished by disfigurement.  The epic poem, Der Arme Heinrich, written sometime in the 1190’s by Hartmann Von Aue provides us with the tale of a knight who was punished for his excessive pride & conceit with horrible disfigurement. The poem opens with an introduction of the main character Heinrich;

{29}He read this same tale—how there was a lord situated in Swabia
in whom no quality had been forgotten that a knight in his prime should have to win full esteem.
In all the lands no one spoke of no one so highly.

Later in the poem, Heinrich goes from having everything he desires in the

world to this;

{120} When people noticed on his body God’s severe punishment,
he became repulsive to man and woman.
Just look how appealing he had been to the world before.
And now he was of so little consequence that no one cared to look at him.


By line 133 Heinrich “…realized that he was repulsive to the world—as all those like him are.” The plot of the poem sounds very similar to that of Job, but Heinrich reacts to his situation in a more angry and sullen manner. In my opinion the author, Hartmann Von Aue, reports how the average person in the 12th century reacted to a person with facial deformities—they were repulsed.
In the case of birth defects such as cleft lip, social inclusion is perhaps least worrisome. In the Middle Ages and Renaissance children born with cleft lip often did not even survive infancy due to their difficulty in breastfeeding. According to the World Health Organization, cleft lip and palette occur at a rate of 1 per 500-700 births worldwide.  The group cites environmental factors, such as poor diet, tobacco smoking, and alcohol use, as the cause of these deformities in 80% of cases. We have no concrete data about the rate of this birth defect in the Middle Ages or Renaissance, but we do know that prenatal care was quite different from what we enjoy in the modern world. I think it is reasonable to assume that the rate of this birth defect is similar to what we can currently report in light of information about prenatal care from the Renaissance. We have an idea of the recommended diet for pregnant women from Savonarola’s book , Practica Major, a guide which was specifically addressed to the women of Ferrara but enjoyed wider distribution thanks to Giovanni Marinello’s Delle Medicine Partenenti All’ Infermita dell Donna. Book 3 of this work is a nearly identical copy of Savonarola’s handwritten manual. Both books advise expectant mothers to avoid fish, fruit, milk products, seeds, and many grains due to the humoric properties of these foods. Consumption of alcohol is mentioned, but merely to caution pregnant women against drinking white wine. There is no message of avoiding alcohol entirely. In fact both Savonarola and Marinello expressly forbid the drinking of cold water under any circumstances. In contrast, the modern recommendation for pregnant women is 6-8 8 oz. glasses of water daily or 48-64 oz. total. We can compare this to a modern nutrition guide for pregnant women seen below.  From this information we can assume that most pregnant women of the time did their best to follow what was seen as sound medical advice. You do not need to have an advanced degree in nutrition to know a diet such as this is going to be unbalanced to say the least. The 16th century guidelines lack many nutrients which could possibly lead to vitamin deficiency in both the mother and child or even birth defects like cleft lip.

Of course, once an infant with cleft lip is born, it faces the difficulty of gaining nourishment. The medical definition of cleft lip is as follows;


A fissure in the upper lip that is due to failure of the left and right sides of the fetal lip tissue to fuse, an event that should take place by 35 days of fetal age. Cleft lip can be on one side only or on both sides. Because failure of lip fusion can impair the subsequent closure of the palatal shelves, cleft lip often occurs in association with cleft palate. It is one of the most common physical birth defects and it can be corrected with surgery.—(

As previously outlined, we do have a written treatment for cleft lip in Sushruta and The Leechbook of Bald. There is no information of the age of a patient who might undergo this surgery and it is safe to say that this treatment would prove too expensive to be readily available to everyone. It is most likely that infants born with this condition were most likely left to die unless the parents, especially the mother, were willing to invest the extra effort required to care for the child. It is very difficult for infants with this condition to latch on to the breast and form a good seal, so great time and patience is required by the mother (or wet nurse). However, despite the extra work, there is some evidence that not all infants with this condition died. The Sturlunga Saga, which dates from approximately the thirteenth century, features an appearance of a character with a cleft lip. He is called Porgils skaroi Boovarsson. He first appears in Islendinga Saga, Chapter 132:


Porgils was a handsome man in appearance, big-shouldered and accomplished, fair of hair and complexion, very fine eyed, slim- waisted and broad-shouldered, with fine hair that fell attractively. He was strong and hardy, a good swimmer, and very vigorous in whatever he entered upon. He was close-mouthed but kept his word. Whatever he promised, for good or ill, he was energetic in carrying out. In his upper lip was a cleft he was born with—on that account he was called Porgils skaroi (harelip)—Porgils saga skaroa


The saga explains that he is the eldest son which might explain why he was given the special care and attention he needed during infancy. At the time, he was the only hope of carrying on the family name; although we see later on that his parents went on to have two more sons. Later in the saga, Porgils makes quite an impression on King Hakon, who rewards Porgils with facial surgery. We know that there are two procedures outlined beginning in the 3rd century, so it is highly possible that those who could afford to leave Iceland to have the surgery might have done so, though they would most likely go to England and have a procedure similar to the one outlined in The Leechbook of Bald, because it is closer and more up-to-date.

Medical texts such as those from Hippocrates, Quintillian, and Mercurio from the sixteenth century caution prospective parents that the sights a woman fixates upon while having intercourse can affect the appearance and even the gender of the baby. Hippocrates sets down his theory beginning in the 4th century B.C.E.15 Marcus Fabius Quintillanus, better known as Quintillian, was a first century Roman orator whose book Institution Oratoria, was a favorite of Renaissance people. Volumes I & II, which deal with the early life and education of the would-be orator, cite this as the reason for white couples giving birth to black children, or of the baby looking more like the lover of an adulterous wife than her husband. Girolamo Mercurio’s La Commare Oriccoglitrice, a mid-16th century Italian midwifery manual, uses both of the prior texts as support for this idea as well as citing book 10, chapter 30 of St Augustine’s The City of God. Mercurio also addresses the idea that a pregnant woman should not lay her hands on her belly in any one place for very long, lest she give the baby an unsightly birthmark in this manual.

In addition to social exclusion, a person with a severe disfigurement might be barred from earning a living or inheriting property because of it. Although this is most often cited as the reason to exclude those with leprosy, one might be barred from entering the Church based on their physical appearance. Leviticus 21:17-20 from the Latin Vulgate Bible says;


Loquere ad Aaron homo de semine tuo per familias qui habuerit maculam non offered panes Deo suo. Nec accedet ad ministerium eius si caecus fuerit si claudus si vel parvo vel grandi et torto naso. Si fracto pede si manu. Si gibbus si lippus si albuginem habens in oculo si iugem scabiem si inpetiginem in corpore vel hirniosus.



Say to Aaron; Whosoever of thy seed throughout their families, hath a blemish, he shall not offer bread to his God. Neither shall he approach to minister to him; if he be blind; if he be lame; if he have a little, or a great, or a crooked nose; If his foot, or if his hand be broken; If he be crookbacked; or blear-eyed; or have a pearl in his eye, or a continual scab, or a dry scurf in his body, or a rupture.

This passage refers to Jehovah giving Moses directions for Holy Communion. According to the passage, anyone who is deemed to have a defect as outlined above, shall not approach the altar or handle the bread or wine during worship. There is no stipulation in the passage about those “defectives” taking Communion but it appears to bar them from participating in the ceremony in any other way. This stipulation might be a reason for those desiring a career in the Church to undergo a cosmetic surgery in the Renaissance.
Those who have suffered the loss of a limb might choose to use prosthesis in order to earn money to feed themselves and their families. As already noted in figures 8 & 11, the limbs designed and crafted by Ambroise Pare have movable joints. In the case of the artificial hand in figure 8, being able to move the fingers in a curved position would mean that the patient could use his prosthetic to hold or grasp objects like buckets or tools. This ability might give him the means to support himself instead of turning to vagrancy. Prosthetic legs with joints at the ankles or knee (figure 11) would give an amputee a more natural gait, which could dramatically improve his prognosis on life. With this device, he could go back out into the workplace instead of resorting to begging or relying on his family for support.

As previously stated, those most often affected by restrictions concerning earning a living, inheriting property, or even being part of the community were those with leprosy. It was perhaps the most feared disease in the Middle Ages, mostly because of what happens to its victims in later stages of the disease. It often took many months or years, but some victims of leprosy experience loss of sensation in parts of their body, facial anomalies resulting in loss of the nose or earlobe, and open sores which never heal. Most leprosy restriction laws were based upon the teachings of the Bible, specifically, Leviticus 13:46, “All the time that he is a leper and unclean he shall dwell alone without the camp”.18 This is further supported by the Third Lateran Council of 1179. Canon 23 of this edict says;

23. Although the Apostles says that we should pay greater honor to our weaker members, certain, ecclesiastics, seeking what is their own and not the things of Jesus Christ, do not allow lepers, who cannot dwell with the healthy or come to church with others, to have their own churches and cemeteries or to be helped by the ministry of their own priests. Since it is recognized that this is far from Christian piety, we decree, in accordance with apostolic charity, that wherever so many were gathered together under a common way of life that they are able to establish a church for themselves with a cemetery and rejoice in their own priest, they should be allowed to have them without contradiction. Let them take care, however, not to harm in any way the parochial rights of established churches. For we do not wish that what is granted them on the score of piety should result in harm to others. We also declare that they should not be compelled to pay tithes for their gardens or the pasture of animals.

From this edict, we can see a number of separate leper communities being established. A detailed study of leper communities in Germany published in 2000 provides us with a map of these communities which existed in the Middles Ages (figure 14)19 The large numbers of these communities suggest that leprosy was indeed a very serious problem. However, once a leper community was set up, it needed money to maintain itself. After the Third Lateran Council, we can find further details from the records of the communities themselves. A syndic dated November, 1220 from Ypres, Flanders which was cited in the 2000 study requires the leper living within their community to turn over all property which he might inherit from his parents to the community (leprosariu) (Brenner, 2011).20 An upper-class man afflicted with leprosy in 1312 in Rouen, France, Pierre de Saint-Gille by name, gave ten livres of Tours, two houses, and surrounding lands, to the leprosarium of Mont-aux-Malades so that he might have “the goods of the house like the sick brothers” (Brenner, 2011).21

In light of all of the challenges people with deformities faced during the Middle Ages and Renaissance, it no longer seems surprising that some people would choose to risk a dangerous surgery. If all that kept you from a desired career in the Church was a malformed earlobe or cleft lip, you might be tempted to visit a surgeon and try your luck, provided you or your family could afford it. Replacement eyes of gold or silver, jointed artificial limbs, or premier surgeons such as Tagliacozzi were not things that the average person in the Middle Ages or Renaissance could afford, but when one considered the amount of inheritance or social status the upper classes stood to lose, some might consider it a small price to pay. In the case of a disease like leprosy, you might be tempted to undergo a procedure to replace your nose or earlobe in an effort to regain some social standing, especially if you have reached a stage in the disease where you have little to no sensation of pain.

Also in the case of a disfiguring disease like leprosy, even people of modest means tried to avoid the label. Once the Third Lateran Council made its ruling in 1179, many places in Europe organized iudicium leprosorum, or “judgement of lepers”. This was an organized, semi-public examination presided over by a mixture of physicians, priests, and prominent townspeople in which anyone suspected of leprosy was carefully looked over and deemed leprous or not. People brought before the iudicium leprosorum were then given a certificate which outlined the results of their examination. Luke Demaitre gives the details of several of these cases in his book Leprosy in Premodern Medicine: a Malady of the Whole Body. The book highlights the cases of many servants and working class people who endured the iudicium leprosorum. Some cases even appealed to larger councils in an effort to escape being labeled lepers and losing their social status or livelihoods.

From this information, we can see that a variety of procedures were available beginning in about the 3rd century and further expanded throughout the SCA period. Most of these procedures centered on facial reconstruction, but this was not the only means of transforming the appearance available to people during the Middle Ages and Renaissance. By the 16th century we see the beginnings of our modern method of rhinoplasty in the work of Tagliacozzi. Despite the variety of procedures available, the scientific method and germ theory are still largely unknown, making these procedures risky. We can see from the example of Porgils and the very detailed instructions in the Sushruta Samhuta that a select few actually underwent cosmetic surgery despite the risks. Their reasons may vary, but most of those reasons center around the need for social inclusion, inheritance, and career prospects.


Alighieri, Dante. The Divine Comedy, Vol. 1: Inferno. Henry Wadsworth Longfellow, trans. 1879.

Arthurian Romances, Tales, and Lyric Poetry: The Complete Works of Hartmann Von Aue. Frank Torin, Kim Vivian, Richard H. Lawson, trans. The Pennsylvania University Press; University Park, Pennsylvania. 2001.

Brenner, Elma. Leprosy and Identity in Medieval Rouen. Presented at the King’s College of London Postgraduate Reading Group, 2011.

Cocchion, Antonio. Reconstruction of Taliacozzi’s Bandage from his 1597 Book. Musea di Storia Della Medicina, Rome.

Demaitre, Luke. Leprosy in Premodern Medicine: a Malady of the Whole Body. The Johns Hopkins University Press; Baltimore, Maryland. 2007.

Early English Manuscripts in Facsimile, vol. 5 Bald’s Leechbook. British Museum Royal Manuscript 12 D xvii. C. E. Wright, ed. London; 1954.

An English Translation of The Sushruta Samhita; Based on the Original Sanskrit Text, Vol 1—Sutrasthanam. Kaviraj Kunja Lal Bhishagratna, Trans. Calcutta; 1907.

Latin Vulgate Bible Online.

A Leechbook or collection of Medical Recipes of the Fifteenth Century, 1934. Warren R. Dawson, trans. London; 1934.

Marinello, Giovanni. Delle Medicine Partenenti All’ Infermita dell Donna. Venice; 1563.

Papal Encyclicals Online. Third Lateran Council, Canon 23.

Pare, Ambroise. Oeuvres Compleat d’Ambroise Pare. Published 1585.

Prosthetic leg, late 16th century. International Museum of Surgical Science, Chicago, IL.

Prosthetic hand with moveable fingers, late 16th century. International Museum of Surgical Science, Chicago, IL.

Savonarola, Joan Michael. Practica Major. Venice, 1560.

Sturlunga Saga including the Islendinga Saga, Vol. 1. Dr. Gudbrand Vigfusson, editor. Clarendon Press; Upsala, Sweden. 1897.

Tagliacozzi, Gasparo. De Curtorum Chirurgia per Insittonem. Mantua & Ferrara, 1598.

Uhrmacher, Martin. Leprosorien in Mittelatter und Fruher Neuzeit. Rheinland Verlag-Koln, 2000.








Aztec Armpit Remedy Update

In preparation for the upcoming Crown Tournament and Kingdom Arts & Science Competition here in the Middle Kingdom, I finally made the time to go search out the ingredient translation for a recipe which I originally shared with you on March 20, 2014.  Here is the recipe again:

Goaty Armpits of Sick People

This evil smell is removed by anointing the body with the liquor of the herbs ayauh-tonan-yxiuh, papalo-quilitl, (&) xiuhecapatli the leaves being macerated in water.  Also the leaves of the pine and the flowers oco-xochitl, tonaca-xochitl, totoloctzin, and sharp stones.–An Aztec Herbal, Martin de la Cruz, 1552 p604.


This entry is really two separate recipes.  As you can see from the entry, it has the names of the plants in the original Aztec language which were never translated into Latin with the rest of the book.  If I wanted to redact this recipe, I had two choices; learn the Aztec language or see if someone had decoded this for me.  I chose the second option.  In my March 20th entry I mentioned that I thought the answer might be in the manuscript known as the Florentine Codex.  This multi-volume work was written by a Spanish monk who went to great effort to learn about the Aztecs and record his findings in a way which is nearly free of bias.  As it turns out, I was right though I think I said it was in Book 13 of this work instead of where I actually found it.  The answers were actually found in Book 11; Earthly Things.  This volume describes the types of plants, trees, animals, fish, and insects which were known to the Aztecs.  In many cases it even has an illustration of them.  So my morning spent pouring over this book has indeed revealed what these ingredients might be.  The footnotes of this book gave me the botantical names which I then found the common name for.  At this point I have merely translated the ingredients; my next step will be to find them and make the recipe.  Here is the list of ingredients:

ayauh-tonan-yxiuh= Pinus ayacahute = Mexican White Pine

papaloquilitl= Porophyllum coloratum = Papalo (an aromatic edible which is tasty in tacos)

xiuhecapatli= Morinda Vinfolia= Indian mulberry, or cheese fruit

ocoxochitl= Polianthes tuberosa P. mexicana=tuberose (Mexican)

tonaca-xochitla= Pithecoctenium echinatum= Monkey’s comb

totoloctein= Dyospiros ebenaster= Black Sapote tree

I will of course update this further if and when I acquire the ingredients and make this recipe.  I will need testers!

Lavender Water, An All-purpose Perfume from 1555



ImagePerfumes are something I have been fascinated with for a long time but have been reluctant to try.  I finally decided to make a go of it thanks to Mistress Jadwiga Zajaczkowa’s work on Queen of Hungary recipes.  Like me, she has a tiny workspace and no alembic, so the challenge was to make a perfume which does not require this special equipment and the space it takes up. As it turns out this was a challenge in Renaissance Italy as well.  In many regions, you could not legally operate or own an alembic (distillation still) without a warrant.  These warrants were tightly controlled and very pricey to purchase.  In addition, few people had the extra space to set this up, especially in an urban setting.  The penalties for having an alembic without a warrant were severe.  One case in Rome in the 15th century resulted in a death sentence, so it is highly possible that my technique is similar to what many folks did in the Renaissance.  Household inventories abound with records of “scented waters” or perfumes, so we know they were in high demand.  My recipe comes from Gioventura Rosetti”s Notandissimi Secreti De L’Arte Profumatoria (Notable Secrets on the Art of Perfume), originally published in 1555.  This is one of ten scents I have started which will hopefully combine to make a pleasant, more complex perfume once the curing process is complete. 

Acqua de lavanda (Lavender Water)

Combine lavendar flowers with acqua vitae and let steep (sit) for three days.  On the third day, add rosewater, cinnamon, and cloves.  Heat in an alembic and distill gently to create a pleasant scent.–#302, Notandissimi Secreti De L’Arte Profumatoria


My Redaction/Method:

I put  1/4 cup of dried lavender flowers in a clean, dry, 4 oz canning jar (I arrived at 1/4 cup thanks to Mistress Jadwiga’s research, as there is no mention of amounts in the recipe).  For my acqua vitae, I used really cheap vodka, but you could also use brandy or even rubbing alcohol.  Whichever spirit you choose, you will need to add three ounces to your jar.  Seal and label your jar and let sit for three days.  You will notice a color change: don’t panic, that’s what you want to see.   After three days you can open your jar and add an ounce of rosewater, 1/4-1/2 a stick of cinnamon (your preference) and 2-3 whole cloves.  Reseal your jar.  Although the recipe mentions using an alembic, you can still get the same results using the things you have in your kitchen.  For my redaction, I made a water bath.  I took a large pot, added about 2 inches of water and brought it to a gentle boil.  I put my sealed jar in this water bath and covered it with a lid.  What you are basically trying to do is release the essential oils of the ingredients into the carrier liquid.  I let my jar simmer in its bath for about ten minutes.  Since i used a canning jar, I got my jar to seal during the cook time.  This is fine; you want a good seal on this in order to trap all of the plant essences you can.  Once you take your jar out of the bath, you will need to leave it sealed up for a minimum of two to four weeks.  Once you have completed this step, it’s time to open your jar and strain out your plant matter.  The picture above is the end result–a super concentrated perfume.  You could use it like this, but the more correct period method is to dilute it.  Why?  Because they use it everywhere.  What you have made here is a tincture.  Traditionally, tinctures are diluted 1 part tincture to 4 parts water (you should use distilled water to avoid a cloudy appearance).  What do you do with this stuff after you make it?  You have a wealth of options here.  Scented waters are used as facial cleansers, hair rinses, body sprays, colognes, and fresheners for linen and clothing.  In some cases, they were drank and touted as restoratives.  I would encourage you to try all of these options and find the methods you prefer.

*If you are going to Pennsic War this year, I will be teaching a class on this and other perfumes on July 30 and August 4.  I am also teaching a class on basic grooming recipes on July 30 and August 7.  Hopefully I will have the chance to see some of you there!