From “Do Not Touch Me” to a Hungry Wolf: A Medieval Surgeon's Cancer Challenge

In the eleventh century, Constantine the Africanhad tried to explain “the cause of disease” by bringing the East's treasure of theoretical medicine (Liber Pantegni) to the West. Yet theoretical knowledge alone was not enough for a physician confronting a bleeding wound at a patient's bedside. By the twelfth century, the balance in European medicine began to shift from theory to practice, toward surgery .

At the heart of this transformation was southern Italy's famous Salerno Medical School. One of the brightest minds it produced was Roger Frugardi , also known as “Roger of Parma.” Frugardi was not merely an academic who read old books; he was a surgeon who wielded his knife, observed wounds, and systematically recorded what he saw.

Practica Chirurgiae: The First Systematic Book of Surgery

Written around 1180, his Practica Chirurgiae (The Practice of Surgery) was the first systematic surgical manual written in Latin Europe. Later known as “Rogerina,” this work was written in a clear, observational style, free of scholastic quotations.

Covering a broad range from head injuries to goiter operations, the work introduced an innovation that was revolutionary particularly for oncology history: Classifying diseases by their anatomical location and estimating prognosis (the course of disease).

The Birth of a Metaphor: “Lupus” (Wolf)

Roger Frugardi introduced a term into medical literature that we still use today, although it had a much broader meaning at the time: Lupus (Wolf).

Note: The “Lupus” Roger described does not correspond exactly to today's autoimmune disease, Systemic Lupus Erythematosus (SLE). He was probably describing cutaneous tuberculosis, severe venous ulcers, or necrotizing infections. Yet this distinction was evidence that physicians had begun to differentiate diseases that “look similar but behave differently.”

The Vital Distinction: Noli Me Tangere vs. Lupus

The pinnacle of Frugardi's oncological vision was his sharp distinction between tumors of the face and wounds elsewhere on the body. This distinction tells the history of a surgeon knowing when to stop.

Roger also used the term “Cingulus” (Belt) for rash-like lesions on the trunk, probably referring to shingles (Herpes Zoster).

Medieval Treatment: Egg-White Dressings

Roger Frugardi's treatments combined the pharmacology of his time with practical solutions. The protocol he developed for neck injuries and certain superficial lesions was particularly interesting:

• Egg White (Egg-Albumen): Dressings coated with egg white were applied to wounds. When the egg white dried, it formed a natural protective, airtight, tissue-contracting layer over the wound.
• Mercury Ointments: The use of mercury for skin diseases began to become widespread in this period, and Roger also recommended topical (superficial) applications in certain situations.