Larghi, Bernardino

(b. Vercelli, Italy, 27 February 1812; d. Vercelli, 2 January 1877),

surgery.

Larghi was the son of Francesco Larghi and Maria de Giudice. He graduated in surgery from the University of Turin in 1833 and in medicine from the University of Genoa in 1836. Returning to Vercelli, he established a dispensary and a small infirmary in his house and began to practice surgery privately. He was so successful that in 1838 he was asked to operate at the St. Andrea Hospital in Vercelli, first in an honorary capacity and from 1844 as head surgeon.

Larghi is known chiefly for his performance of subperiosteal resection before the introduction of antisepsis. The reasons for Larghi’s specific interest in this operation require further research; but it appears that earlier biological experiments on the power of the periosteum to regenerate bone were less influential than the brilliant practical results that he obtained. His surgical technique was marked by the extreme care that he took to respect soft paraosteal parts when separating the periosteum from the bone.

In 1845 Larghi performed a resection of the ribs—or actually, an extraction of their bony part—on a twelve-year-old boy suffering from abscess and central caries of the eighth and ninth ribs on the total removal of the bone with its periosteal covering; it required that intercostal muscles, nerves, and vessels be cut and thereby introduced the danger of hemorrhage and pneumothorax from pleural perforation. Larghi considered such resection to be more a “demolition” than a surgical procedure. He maintained that the surgeon should not destroy the ribs but, rather, restore and rebuild them, since he believed that nature “strongly thickens the periosteum and for this purpose exudes a gelatinous humor which, working its way between the periosteum and the deteriorated bony part, separates them; this humor awaits only the expulsion of the deteriorated bony part, so that it can occupy the site more properly and be converted to new bone inside the case that generated it.” The surgeon’s task must therefore be to complete removal of the necrotic bone and to extract it from the thickened periosteal sheath.

Larghi’s subsequent works, published in the Giornale della R. Accademie medico-chirurgica di Torino, reveal the progress of his techniques for subperiosteal resection and the improvement of his surgical instruments. In May 1852 he extracted the necrotic right hemimandible of a patient, removing the condyle but leaving the articular capsula—as well as the periosteum—in position. The neoarthrosis that formed between the neocondyle of the regenerated mandible and the glenoid cavity suggested to Larghi that other soft parts might be preserved, as shown in his most noted work, Operazioni sottoperiostee e sottocassulari … (Turin, 1855). After the introduction of antisepsis, subperiosteal resection developed substantially, especially through the work of L. Oilier.

BIBLIOGRAPHY

I. Original Works. Larghi’s main works are related to bone surgery and include “Estirpazione o rescissione delle ossa convertita nell’estrazione della loro parte ossea rigeaerata dal periostio conservato,” in Giornale delle scienze mediche pubblicato della R. Accademia Medico-Chirurgica di Torino, 28 (1847), 512-520; “Rescissione della costole convertita nell’estraction della loro parte ossea,” ibid., 521-529; “De l’extraction sous-périostée et de la réproduction des os; extraction sous-périostée des côtes en par-ticulier,” in Gazette médical de Paris, 12 (1847), 434-437; “Taglio perpendicolare-longitudinale per le amputazioni delle membre umane,” in Giornale dell Accademia di medicina di Torino, 5 (1849), 385-398; and “Estrazione e disarticolazione sottsperiostea della porzione destra della mascella inferiore affetta da necrosi,” ibid., 17 (1853), 49-62; and “Operazioni sottocassulo-periostee e sottocassulari e guarigione delle malattie delle ossa ed articolazioni per il nitrato d’argento,” ibid., 24 (1855), 19-81, 131-169, 302-345, 410-461; 26 (1856), 350-378, 500-506; 27 (1856), 98-130, 410-461; 31 (1858), 422-428, 467-482; 32 (1858), 225-248; “Estrazione sotto-cassulo-periostea radio-carpea,” ibid., 31 (1858), 299-302; and “Supplemento alle operazioni sotto-periostee e sottocassulari,” ibid., 7 (1869), 242-356, 373-390, 463-475, 515-523; 8 (1869), 37-62.

II. Secondary Literature. On Larghi’s life, see Luigi Belloni, “Dalla osteogenesi periostale alla resezione sottoperiostale, Michele Troja (1775) e Bernardino Larghi (1847),” in Simposi clinici, 8 (1971), XXV–XXXii; Enrico Bottini, “Bernardino Larghi. Cenno necrologico,” in Giornale della R. Accademia di medicina di Torino, 21 d.s. III (1877), 174-185; Carlo Dionisotti, Notizie biografiche dei Vercellesi illustri (Biella, 1862), 188-190; and Gabriele Stringa, “Bernardino Larghi,” in Archivio ‘Putti’ de chirurgla degli organi movimento, 5 (1954), 592-599.

Luigi Belloni