Giovanni Filippo Ingrassia

Giovanni Filippo Ingrassia was called the Sicilian Hippocrates. Nothing appears to be known with certainty about Ingrassia’s family, and of his early education we know only that he first studied medicine in Palermo with Giovanni Battista di Pietra. Attracted by the fame of the medical faculty of the University of Padua, he went there to continue his studies, attending classes of Hierunymus Fabrizio ab Acquapendente (1537-1619), Bartolomeu Eustachi (1510-1574) and Andreas Vesalius (1514-1564), with whom he was particularly close. He received the M.D. degree in 1537.

From Naples to Palermo
Thereafter his activities are obscure until 1544, when he was invited to the chair of practical and theoretical medicine, as well as of anatomy, at the University of Naples. To Ingrassia this was a successful time, he was a celebrated teacher of anatomy and medicine, attracting large audiences of students, many of them from abroad.

In 1556, on the recommendation of the Spanish viceroy of Sicily and by decree of Philip II of Spain, he was called to Palermo as archiater – Protomedico generale – protomedicus. In 1563 Philip II made him chief physician to Sicily and neighbouring islands.

A celebrated case
Little is known likewise of Ingrassia’s medical practice in Palermo except for his celebrated case involving Giovanni d’Arragona, marquis of Terranova. During the spring of 1562, the duke suffered a penetrating wound of the left chest during a tournament. Under the care of Ingrassia, he failed to respond to treatment and developed a fistula with epyema. Ingressia circularized the leading physicians of Europa for suggestions and ultimately elicited, in 1562, Vesalius’ remarkable description of his surgical procedure for treatment of empyema. Vesalius’ long letter of advice – Consilium pro fistula – dated from Madrid, Christmas 1562, gives in detail steps in the procedure, using surgical drainage instead of the usual cauterization. Ingrassia acknowledged the advice in the following year but declared that he found it unnecessary to employ since the marquis had finally recovered. Nevertheless he published Vesalius’s description of his procedure in Quaestio de purgatione per medicamentum (1568, pp. 92-98), as he declared, for the sake of posterity.

A pioneer in legal medicine and hygiene
As protomedicus, Ingrassia was concerned for the most part with problems of hygiene, epidemiology, and the general administration of Sicilian medicine. His activities included efforts to suppress quackery, to control the pharmaceutical trade, and to improve the condition in hospitals. He was able with some success to control the endemic malaria of Palermo through drainage of marshes, and his greater use of isolation hospitals (lazzaretti) was instrumental in decreasing the severity of the epidemics of plague of 1575 and 1577. He is called the founder of legal medicine, which in his case included issues such as the validity of testimony taken under torture. He also contributed to veterinary medicine.

It was Ingrassia’s belief that there ought to be three kinds of hospitals: for those suspected to be infected, for the infected, and for the convalescent. The whole subject of plague and infection was discussed, with other matters of public health, in his Informazione del pestifero morbo (1576). Ingrassia was responsible for the establishment of one of the first sanitary codes and a council of public health. He was also a founder of the study of legal medicine, for which he composed his Methodus dandi relationes in 1578; owing to his death two years later, the book was not published until 1914.

The scientist
Ingrassia is best known for his anatomical studies, admittedly based upon the methods and procedures of Vesalius, for whom he expressed his greatest admiration. These studies were for the most part the result of his period of teaching anatomy at Naples, but were only published posthumously under the title of In Galenum librum de ossibus doctissima commentaria (Palermo, 1603; Venice, 1604).

Because of the long delay in publication of the book, whatever claims he may have had to certain discoveries were pre-empted by other scientists whose findings were printed during the second half of the sixteenth century.

Ingrassia must nevertheless be recognized as having investigated and described the sutures of the skull in minute detail. He provided a precise description of the sphenoid bone and its sinuses, as well as of the ethmoid. He displayed an excellent knowledge of the bony structure of the auditory ossicle or stapes, actually calling it stapha because of its resemblance in shape to the stirrup commonly used in Sicily.

Since his account of the ossicle did not appear in print until 1603, priority of published description must be awarded to the Spanish anatomists Pedro Jimeno (1515-1577) and Luis Collado, in 1549 and 1555, respectively.

Ingrassia is generally considered a founder of osteology. He discovered the stapes in 1546, and the lesser wings of the sphenoid are still called the processes of Ingrassia. He was the first to separate between chicken pox and scarlet fever, making the first description of both. His description of scarlet fever was based on an epidemic in Palermo in 1564.

Upon his death in 1580 Ingrassia left a treatise in which considered the possibility of sound wave conduction through the teeth. He is remembered for distinguishing between chicken pox and scarlet fever.

Ingrassia was entombed in the chapel of Santa Barbara in Palermo.

• Iatroplologia etc. Venice, 1544, 1558.
• Scholia in iatropologiam. Naples, 1549.
• De tumoribus prater naturam, tomus primus. Naples, 1553.
• Raggionamento fatto sopra l’infermità epidemica dell’ anno 1558. Palermo, 1560.
• Trattato assai bello et utile dei doi mostri nati in Palermo in diversi tempi.
  Palermo, Giovanni Matteo Mayda, 1560.
  The value of this work consists in the reproduction of two Siamese twins, one of the few ancient representations of this type of twin births.
• Constitutiones et capitula necnon jurisdictiones regii protomedicatus officii cum pandectis eiusdem reformatis. Palermo, 1564; 1567.
• Quaestio de purgatione per medicamentum. . . . Illustrissimi ducis Terraenovae casus enarratio . . . . Quaestio utrum victus.
  4 parts in 1 volume. Venice: Sumptibus Angeli Patessii, 1568.
  In this collection of lesser works of Ingrassia appears the transcript of a letter from Vesalius to Ingrassia, a rare and little-known piece of Vesaliana which indicates that Vesalius was ahead of his time in surgical as well as in anatomical knowledge. During the spring of 1562, John, Duke of Terranova, suffered a penetrating wound of the left chest during a tournament. Under the care of Ingrassia, he failed to respond to treatment and developed a fistula with empyema. Ingrassia sought help and about eight months later Vesalius wrote a long letter of advice ("Consilium pro fistula"), in itself a treatise on his manner of therapy in empyema. In this letter, dated from Madrid, Christmas, 1562, he gives in detail the steps in the procedure, using surgical drainage instead of the usual cauterization. The patient recovered.
• Quaestio de purgatione per medicamentum atque obiter etiam de sanguinis missione, an sexta die possit fieri. Venice, 1573.
• Galeni ars medica. Venice, 1573.
• De frigidae potu post medicamentum purgans epistola.
  Venice, 1575; Milano 1586.
• Informazione del pestifero e contaggioso morbo il quale afligge et have afflicto la citta di Palermo . . . . nell’ anno 1575 e 1576. Palermo, 1576.
  
  
• Methodus dandi relationes pro mutilatis torquendis aut a tortura excusandi, pro deformibus, venenalisque judicandis; pro elephantliacis, extra urbem propulsandis, sive intus urbem sequestrandis, vel fortassis publice conservari dimittendis.
  Venice 1578 and 1637. No copy has survived, but the manuscript itself is preserved in Palermo.
  According to one source, this book was not printed until 1914.
  
  Posthumous:
• In Galeni librum de ossibus doctissima et expectatissima commentaria . . . Quibus appositus est Græcus Galeni contextus, una cum ... ejusdem Ingrassiæ in Latinum versione.
  Palermo, Giovanni Battista Maringo, 1603; Venice, 1604.
  Edited by the scholar Matteo Donia and Published by his grandson Biographical etc:
• Hermann Josef Hohnerlein:
  Geschichte der Entdeckung der Gehörknöchelchen, insbesondere des Steigbügels.
  Tübinger dissertation, 1922, pp. 16-18, 22, 27 (machine typed).
• August Hirsch (1817-1894), publisher:
  Biographisches Lexikon der hervorragenden Ärzte aller Zeiten und Völker.
  2nd edition. Berlin, Urban & Schwarzenberg, 1929.
  First published in 6 volumes 1884-1888. 3rd edition, München 1962.
• Harry Wain (1907-1970):
  The Story Behind the Word. Some Interesting Origins of Medical Terms.
  Springfield, Illinois, Charles C. Thomas, 1958.
• Charles Donald O'Malley (1907–1970):
  Ingrassia, Giovanni Filippo.
  In: Charles Coulston Gillispie, editor in chief: Dictionary of Scientific Biography. Charles Scribner’s Sons. New York, 1970. Volume 7: 16-17.
• Heirs of Hippocrates.
  Friends of the University of Iowa Libraries. Iowa City, 1980
• Richard Toellner:
  Illustrierte Geschichte der Medizin. Andreas & Andreas Verlag, Salzburg, 1990.
  Original title: Histoire de la Médicine, de la Pharmacie, de l'Art Dentaire et de l'Art Vétérinaire. Paris 1978.