Ambroise Paré

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Ambrose Paré

to remove what is superfluous, to restore what has been dislocated, to separate what has grown together, to reunite what has been divided, and to redress the defects of nature’

M0000117 Portrait of Ambroise Pare [1510 - 1590], French surgeon

Contents

Surgery before Paré

The earliest surgical operations were probably circumcision (removal of the foreskin of the penis) and trepanation (making a hole in the skull, for release of pressure and/or spirits). (10) Primitive surgical instruments consisted of flint or obsidian knives and saws. (10) Stone Age skulls from around the world have been found with holes from trepanning. (10) Primitive people used knives to remove fingers, and the ancient Mesopotamian cultures practised surgery to some degree. (10) Small copper Sumerian knives of about 3000 B.C. are believed to be surgical instruments. (10) The Babylonian Code of Hammurabi of about 1700 B.C. mentions bronze lancets—sharp-pointed two-edged instruments used to make small incisions (10) The Code of Hammurabi, however, provided harsh penalties for poor treatment outcomes, so surgery was practised only sparingly. (10) Surgical amputations date back to Hippocrates and were for many years one of the main functions of the surgeon. (13) Ancient Chinese and Japanese cultures were opposed to cutting into the human body, so surgical instruments were used very little. (10) The Galenic system — a method of medicine that, before the 16th century, meant a dedication to theory over empirical knowledge — had dominated medicine since the second century. (12) Galen, a Greek physician in the Roman Empire, produced voluminous works on the treatment of diseases and the anatomy of the human body. (12) While Galen averred that personal observation was a necessary part of medical education, his advice was not often followed by later physicians. (12) His fierce character and the strength of his writings meant that his teachings were taken as dogma by physicians in the Roman, Muslim, and, later, European empires. (12) Instead of observing the actual forms of the body, Galen’s theories and frequently fantastical anatomies were accepted as truth, unchallenged by what one might personally observe. (12) The dogmatic quality of Galenism meant that physicians until the Renaissance — and in many ways until the 19th century — did not practice a medicine based on practical observation, experience, and empirical analysis. (12) [OR] Surgeons of the late Middle Ages were not as ineffective as some modern medical historians would lead us to believe. (10) The constant warfare of the age demanded skilled men who could dress wounds of soldiers, and almost all surgeons of the fourteenth and fifteenth centuries had seen military action. (10) On these expeditions the surgeons gained knowledge and experience in treating all forms of wounds and injuries. (10) They served as physicians and apothecaries as well as surgeons. (10) They experimented with various kinds of powders, plasters and fomentations for closing wounds. (10) They invented tools for extracting arrows and bolts; they learned techniques for healing fractured limbs and amputating diseased ones. (10) Some successes were had by these surgeons, often brought about by quite ingenious means. (10) On the battlefield, crossbows were used to extract crossbow bolts, and new tools were fashioned to perform difficult surgical operations. (10) Indeed, at the Battle of Shrewsbury, fought in 1403, the English military surgeon John Bradmore made a new surgical apparatus to extract an arrow from the cheek of Prince Henry, later to be crowned Henry V (10) On the battlefield, crossbows were used to extract crossbow bolts. (10) At the Battle of Shrewsbury, fought in 1403, the English military surgeon John Bradmore made a new surgical apparatus to extract an arrow from the cheek of Prince Henry, later to be crowned Henry V Gunpowder weaponry added a new destructive dimension to the late Middle Ages. (10) Already available in limited quantities throughout Europe in the early fourteenth century, guns began taking on a larger role in warfare as the century progressed. (10) They appeared on the battlefield of Crecy in 1346 used by Edward III ostensibly to create noise and panic. (10) Later that year they also appeared at the English Siege of Calais. (10) By 1377 guns had successfully been used to bring down the walls of a fortification when Philip the Bold, Duke of Burgundy, conquered the fortress of Odruik; and in 1382 they played a significant role in a battlefield victory when the Ghentenaar forces defeated the Brugeois troops at the Battle of Bevershoutsveld fought outside the town of Bruges. (10) By 1400 gunpowder weaponry appeared in nearly every engagement of the war. (10) Large guns were used in sieges and smaller weapons were used in battle and on ships. (10) Eventually handheld gunpowder weapons were made, and these began to be used by the infantry as a more powerful, although less accurate, replacement for archery. (10)

Early Life

Ambrose1 Paré was a French (1,3) barber (3) battlefield (1,2) surgeon (1,3) of the European Renaissance (6) and anatomist, (1,3) and an important Frenchman of the 16th Century. (2) He was a pioneer, and one of the (3) fathers of modern surgery (1,2) and forensic pathology. (3)

Childhood

He was born at Laval (7) [OR] at Bourg-Hersent, (4,6) a village (7,15) near Laval, (1,7) in Mayenne (7,15) in northwestern France, (11) in 1510 (11) [OR] in about 1510 (1,2) [OR] on 7th December (15) 1509 (4,7) His background was modest: his father was a farmer (7) [OR] a carpenter (8) [OR] a boxmaker. (15) He was the fourth son. (15)

Education

A chaplain was supposed teach him: but he treated him like a servant. (7) He left home knowing little, and drifted from job to job. (7) [OR] As a child he watched, and was first apprenticed to, his older brother, a barber-surgeon in Paris (11) [OR] to Jean Vialot, a barber surgeon at Vitré. (15) In the end Duke René de Montjean noticed his ability and (7) made him a barber-surgeon. (7,12) [OR] In about 1533, Paré went to Paris, where he (6) interrupted his studies to work as (7) a barber-surgeon apprentice (5,6) [OR] He was a pupil (11,12) at the Hôtel-Dieu, (6,11) France’s oldest hospital. (11)

The Hotel Dieu

By the 16th century, the Hôtel Dieu — the Parisian hospital where Paré trained — had become a renowned place of medical learning. (12) Its association with the Faculté de Médecine of the University of Paris made the Hôtel Dieu an extension of the traditional (Galenic) school of medicine. (12) This extended to the types of surgical procedures performed by those associated with the venerable institution. (12) While the physicians were those most educated in diagnostic and academic medical practice, the practical tasks were left to barber-surgeons. (12) Barber-surgeons were trained in extended apprenticeships and, sometimes, continued studies at public hospitals. (12) Unlike modern hospitals, these were often repositories for the destitute and indigent that offered primarily palliative treatments. (12) By the time Paré entered the Hôtel Dieu, barber-surgeons were incorporated into the education system of the University of Paris. (12) They could attend lectures on anatomy and surgery delivered by the faculté and could take the master-barber’s examination to receive professional recognition from the faculté . (12) His interest in anatomy was such that he went to the Paris Faculty of Medicine (7) where he was taught anatomy and surgery (6) by the greatest surgeons of the time. (7) He devoured medical books, practiced dissection and mixed with the sick, eager to become a surgeon. (7) In general, however, the physicians would diagnose and order the administration of certain procedures, which were carried out by the barber-surgeons who also cut hair and pulled teeth to maintain their livelihood. (12) The crude physicality of their professions aside, the barber-surgeons were thus much more intimately aware of the means of performing surgical procedures in Renaissance France than their more highly esteemed physician counterparts. (12)

AmbrosePareLab

Army Career

Ambrose Paré’s experience at the Hôtel Dieu permitted him to serve as a surgeon to the French army. (12) He joined the army (5,7) in 1536 [OR] 1537. (6) He was too poor at the time of his departure for Italy to pay for this examination, but passed it following his return. (12) Many surgeons gained experience as a result of war, and Paré was no exception. (5,7) He was an autodidact, who learned his trade on the battlefield. (7) He was a keen observer and did not allow the beliefs of the day to supersede the evidence at hand. (11) He gave an example of what he had done:

A German of the guard … was very drunk and his flask caught fire and caused great damage to his hands and face, and I was called to dress him. I applied onions to one half of his face and the usual remedies to the other. (14) At the second dressing I found the side where I had applied the onions to have no blisters nor scarring and the other side to be all blistered; and so I planned to write about the effects of these onions. (14)

He saw appalling things on the battlefield and made successful efforts to find more humane methods (2) especially in the treatment of wounds. (2,3) He went on several campaigns, (2,3) and spent much of the next 30 years as a military surgeon. (5,7) He took part in the Piedmont campaign of 1537–1538 (3) On June 30th, 1542, he married Jehanne Masselin at the church of Saint-André-des-Arts at Paris2. (15) The couple had three children: Francis (1545), Isaac (1559) and Catherine (1560). (15) In 1542 he was present at the siege of Perpignan, occupied by the Spanish. (2) He had to deal with the relatively new domination of the battlefield by firearms. (1) He invented a number of surgical instruments and techniques. (1,3) and shed light on a number of questions of anatomy, physiology and the healing process. (3)

Gunshot wounds

By the 1470s infantry units equipped with handheld guns often faced enemy infantry units also equipped with handheld guns. (10) This interest in gunpowder weaponry increased as warfare3 progressed. (10) As guns became more numerous and more accurate and powerful, more soldiers were killed and wounded. (10) Guns changed the nature of battlefield injuries from penetrating stab wounds and blunt injuries of earlier centuries to extensive soft tissue damage and comminuted4 fractures, coupled with contamination from embedded missiles and clothing. (13) These frequently resulted in gangrene and death and so amputation was the only effective treatment. (13) Small guns fired metal balls, usually made of lead or iron, and larger guns fired stone balls, especially fashioned for that purpose. (10) Gunshot wounds from both these weapons could be and were often fatal; metal balls could pierce the skin, while larger stone balls could kill on impact with the body or by splintering into fragments which would then enter the torso or limbs. (10) It was common practice at the time for surgeons (5,6) to seal gunshot (6,11) wounds by (5,6) cauterising them with (2,3) a boiling oil (2,6) solution conventionally used to ‘detoxify’ wounds (11) which were believed to be poisonous. (6) [OR] a red hot iron. (3,11) This cauterisation often failed to arrest the bleeding and caused patients to die of shock. (11)

The tincture 1536

In his autobiographical book, ‘Journeys in Diverse Places’, Paré describes an incident (11) during the siege of (12) Turin, (7,12) his first deployment as a war surgeon in 1536, (5) [OR] 1537. (12) [OR] The French troops, after a bloody fight, had captured the castle of Villaine. (13) He had run out of the boiling oil which was used to seal the soldier’s wounds. (5,9) Instead, he made a tincture (5) [OR] mixture (6) of egg yolk, turpentine and oil of roses. (5,6) [OR] Book 7 says he refused to cauterize, rather than that he was forced away from it by the shortage of oil5. (7) The following morning, and to his amazement, (5) the soldiers who had been treated with the tincture were in a much better condition than those who had been treated with boiling oil, (5,6) because turpentine has antiseptic properties. (11) The ones who had been cauterised were in agony, (9,11) ‘feverish’ and afflicted with ‘great pain and swelling about the edges of their wounds’. (12) This discovery, that boiling oil was not only of no use, but actually hurtful in gunshot wounds, (13) proved his method effective. (9,11)From then I resolved never again so cruelly to burn poor men wounded with arquebus shot.’ (14) Nevertheless his methods were not widely copied until many years later. (9)

Bullet extraction

In 1542, during the siege of Perpignan, Paré, accompanying the French army, employed a novel technique to aid in bullet extraction. (11) During a battle, Maréchal de Brissac was wounded, having been shot in the shoulder. (11) When finding the bullet seemed impossible, (11) Paré had the idea to ask the victim to put himself in the exact position he was in when shot. (3,11) The bullet was then found and removed by Henry’s personal surgeon, Nicole Lavernault. (11)

Amputations and ligatures

During the 16th century the decision to amputate was influenced more by religious belief than by the nature of the injury, as death from a limb wound was often more readily accepted than elective mutilation of the human body. (13) When amputation did occur it was reserved for gangrenous extremities and was performed through dead tissues to avoid blood loss. (13) Infection following gunshot would rarely resolve until all sequestra and debris were removed; in such cases secondary amputation was the only potentially curative option. (13) It was also common to use fire after amputations of the limbs, in order to consume and check the putrefaction which is common to gangrene and mortification. (13) Although cauterisation was also used to stem haemorrhage it also destroyed flaps of skin needed to cover the amputation site, increasing the risk of infection. (13) Amputation was therefore often complicated by infection and haemorrhage and many patients died. (13) French military surgeon Ambrose Paré, although not the first to advocate the ligature (11,13) as they first been used by Galen (11) was responsible for introducing it in favour of cauterisation. (13) Paré’s account of his experiences at the siege of Metz in 1552 is one of the most graphic of his revelations. (13) The Emperor Charles V laid siege to Metz in the late autumn of 1552. (13) The Duc de Guise, d’Enghien, Conde, and many other nobles were in the city and determined to hold out to all extremities. (13) There was great mortality among the wounded in the town and Guise sent word to the King requesting him to send Ambrose Paré with a fresh supply of drugs for him as he feared those they had were poisoned. (13) Paré states that he does not believe the drugs were poisoned but that the wounded died because of the severity of their wounds and the extreme cold of the weather. (13) The King arranged to have Paré smuggled through the enemies’ lines by an Italian captain who received 1,500 écus for convoying him. (13) Paré arrived within the walls of Metz at midnight. (13) He was taken to the bedside of the Due de Guise who greeted him warmly. (13) The very next morning Paré set to work. (13) After he had brought the greetings of the King to the various nobles and gentlemen who were so bravely defending the city and had distributed his load of drugs to the surgeons and apothecaries, he fell to dressing the wounded who kept sending for him from all quarters. (13) He set one seigneur’s leg, which had been broken by a cannon shot. (13) Paré amputated an officer’s leg by his new method, using the ligature instead of hot irons to check the haemorrhage. (13) ‘I dressed him and God healed him. (13) ‘He returned home gaily with a wooden leg, saying that he had got off cheaply without being miserably burned to staunch the bleeding. (13) In 1552, in Damvillers, in the Meuse, war between France and Spain was raging. (8) The fortress was occupied by the Spanish troops. (8) At the foot of the ramparts, the French soldiers tried to open a breach to allow the passage of their army. (8) In the midst of them, Ambrose Paré, a 42-year-old surgeon, faced a new weapon: the arquebus. (8) It was wreaking havoc, with wounds that were complex and dangerous in terms of infection. (8) The risk was gangrene. (8) Following normal procedure Ambrose Paré amputated many limbs without anaesthetic. (8) The priority was to stop the bleeding. (8) For this, the standard procedure was cauterization. (8) The big risk was infection. (8) Paré was faced with a soldier’s leg damaged from an arquebus shot and needing amputation; (8) he rejected cauterisation to seal wounds after amputation. (3,5) Instead, he used ligatures to tie off the blood vessels, (3,5) before the amputation. (7,8) taking from the ambulance and tying two ligatures at the level of the femoral artery so as to prevent bleeding. (8) Paré used a thread-like or wire material (13) in this instance horsehair (8) to constrict a patient’s blood vessels. (13) This surgical technique, which stops the flow of blood from a severed artery and vein, greatly reduced the patient’s chances of losing too much blood. (13) Paré was one of the first military surgeons to encourage primary amputation for the treatment for gunshot wounds; he was also one of the first to choose an amputation site well above the gangrenous area. (13) While this was less painful for the patient, the ligatures could cause infection, complications and death, so were not adopted as readily by other surgeons, (5,6) but their use was still an important breakthrough in surgical practice. (9)

Prosthetics

Using ligatures, he saved many soldiers, but the amputees eventually ended up on the streets of Paris. (8) The plight of these mutilated men upset Ambrose Paré. (8) Paré reflected on the plight of the amputees, and how he might help them. (8) He made artificial limbs, (5,6) such as an articulated prosthesis of the hand. (8) He made beautifully crafted prosthetics. (8) He helped the soldier wounded at Damvillers in 1552 to get up again. (8) After a hesitant first step, the soldier succeeded in walking. (8) He went on to make artificial noses and ears made of leather or horn, (8) false teeth, artificial eyes made of gold and silver, and trusses. (6)

Royal Surgeon

His gentle methods won over the soldiers, (7) and in 1551 he successfully healed the Duke of Guise, Francis of Lorraine, (7) who had suffered a terrible spear thrust over the right eye, which came out on the other side of his head between neck and ear, as a result of which the Duke was always referred to as ‘Scarface’. (15) The generous treatment of wounded prisoners at Metz, in which Paré was the prime mover, was a feather in the cap of the French army. (15) By 1552 (6,9) he had gained such popularity that he came to the attention of the crown, (6,7) and was promoted to be the royal surgeon. (2,3) In July 1553 Paré was taken prisoner, but released when the King paid his ransom. (15) On 8th December 1554, at the request of King Henry II he became a Doctor of Surgery of the Paris Faculty. (7) [OR] it was not until more recent centuries that it became usual for a surgeon to be a holder of a M.D. degree. (11) This was two years after his first ligature. (8) Between 1559 and 1575 (7) he was successively surgeon to Henry II, Francis II, Charles IX and Henry III. (2,3) While he was treating the kings he never forgot his soldiers, or ‘his beggars’ as he called them. (8) He is remembered as having ‘treated them like kings’ (8)

Fails to save Henri II

On July 10th, 1559 (7) Henry II was wounded (7,9) in the eye (7) during a tournament. (7,9) Ambrose Paré treated him but in vain: (7,9) Henri expired after a long agony, at the age of 40. (7)

Survives St Bartholomew’s Massacre

According to Henri IV’s Prime Minister, Sully, (9) Paré was a fervent (2) Huguenot (2,9) [OR] While there is evidence that Paré may have been sympathetic to the Huguenot cause, he was twice married, was buried, and had his children baptized into the Catholic faith. (9) He survived the Massacre of St Bartholomew’s (2,9) on 24th August (9) 1572 (2,9) thanks to the protection of the Catholic Guises. (2) [OR] because King Charles IX locked him in a clothes closet. (9)

Other areas of expertise

Unlike many surgeons of his time, Paré resorted to surgery only when he found it absolutely necessary. (6) He was also interested in the application of new anatomical ideas – such as those of Andreas Vesalius – (5) developed a number of instruments. (5,7)

Pain Relief

The barber-surgeons before Paré expected that any sort of surgical technique would require that the patient experience pain, sometimes pain so extreme that the subject would lose consciousness during the procedure. (12) His realization that one might act gently in the capacity of a surgeon and that such gentleness actually might improve the lot of his patients was transformative. (12) Pain relief was extremely limited in the 16th century — opium, henbane, mandrake, and strong spirits being the only offerings — and a quick, painful procedure often meant survival in a pre-antibiotic era. (12) Tremendous pain was an accepted part of surgery. (12) For Paré, the benefits of a gentle hand during surgery would soon become a clear means of reducing the suffering of his patients. (12)

Phantom pain

During his work with injured soldiers, Paré documented the pain experienced by amputees which they perceive as sensation in the ‘phantom’ amputated limb. (11) Paré believed that phantom pains occur in the brain (the consensus of the medical community today) and not in remnants of the limb. (11)

Forceps

He used two instruments for the first time: one forceps to open the wound and the other to remove the bullet. (10)

Trepanning

The trepanning technique was used for many indications before the fifteenth century, and the use of trepanning for military treatment of skull fractures clearly increased with the introduction of guns. (10) As guns became more numerous, more accurate and powerful, more soldiers were wounded in the head and treatment of head wounds and trepan use were more frequent. (10) Tools for head surgery and trepanning were improved by Ambrose Paré. (10) In his treatises on surgery, Paré also described ‘trepans or round saws for cutting out a circular piece of bone with a sharp-pointed nail in the centre projecting beyond the teeth’ and another trepan with a transverse handle. (10) Furthermore, Ambrose Paré with appropriate technology sought to ensure safe use, i.e. that the conceived instrument be the least harmful possible even in less skilful or unpracticed hands (10) An example is his trepan à Chaperon with a protective lid. (10) He also improved safety by moving from a two-point bearing (bipod trepan, Gersdorff, to a three-point bearing trepan. (10) This instrument was used much in the same way as a modern hand drill—held in one hand and cranked with the other. (10) But it was extremely heavy and cumbersome, and therefore did not become popular among the surgeons of the time. (10)

Haemostats

His ‘Bec de Corbin’ (‘crow’s beak’), was the forerunner of modern haemostats. (9)

Obstetrics

He introduced new ideas in obstetrics. (5) Paré was also an important figure in the progress of obstetrics in the middle of the 16th century. (9) He revived the practice of podalic6 version, and showed how even in cases of head presentation, surgeons with this operation could often deliver the infant safely, instead of having to dismember the infant and extract the infant piecemeal. (9) Paré was ably seconded by his pupil Jacques Guillemeau, who translated his work into Latin, and at a later period himself wrote a treatise on midwifery. (9) An English translation of it was published in 1612 with the title Child Birth; or, The Happy Deliverie of Women. (9) Giovanni Pico della Mirandola reported the case of an Italian woman, Dorothea, who allegedly gave birth to undecaplets after having given birth to nonuplets. (11) Paré also introduced the lancing of infants’ gums using a lancet during teething, in the belief that teeth were failing to emerge from the gums due to lack of a pathway, and that this failure was a cause of death. (11) This belief and practice persisted for centuries, with some exceptions, until towards the end of the nineteenth century lancing became increasingly controversial and was then abandoned. (11)

Castration for hernia

He was one of the first surgeons to discard the practice of castrating patients who required surgery for a hernia. (6)

Symptoms of syphilis

He was the first to suggest syphilis as a cause of aneurysm (swelling of blood vessels). (6)

Dislocations

He was also the first to perform a dislocation of the elbow to treat dislocation. (7) (?)

The Bezoar Stone

In 1565, Ambrose Paré described an experiment to test the properties of the Bezoar Stone. (9) At the time, the bezoar stone was commonly believed to be able to cure the effects of any poison, but Paré believed this to be impossible. (9) It happened that a cook at Paré’s court was caught stealing fine silver cutlery, and was condemned to be hanged. (9) The cook agreed to be poisoned, on the conditions that he would be given some bezoar straight after the poison and go free in case he survived. (9) The stone did not cure him, and he died in agony seven hours after being poisoned. (9) Thus Paré had proved that the bezoar stone could not cure all poisons. (9)

Chest wounds

He developed treatments for sucking chest wounds.

Skin Ulcers

He developed a cure for chronic ulcers of the skin (12)

Forensic Medicine

His writings and instructions about court proceedings represent the beginning of modern forensic pathology. (11)

Author

Ambrose Paré’s career was distinguished by his reliance on personal experience. (12) Previous barber-surgeons did not record their experiences and did not have ready access to the Latin texts available to the faculté. (12) To spread the benefits of his innovations as far and as fast as possible, Paré published accounts of them (8) and was able to exert a powerful influence by abandoning academic tradition: (12) as the son of a carpenter (8) he wrote in French, and not in Latin, as was the custom. (6,8) This made it accessible to those of the literate general population who lacked Latin, and so broke the monopoly of knowledge which doctors sold to their patients. (14)His books were ridiculed because of it, (6) but by writing in his native language, Paré was able to produce a series of volumes renowned for their clarity of form and easily accessible to his fellow barber-surgeons. (12) His use of the vernacular encouraged later surgeons to do the same and his focus on novel surgical principles established a strong foundation upon which the modern institution of surgery is built. (12) He wrote several books, (4,11) such as his autobiographical book, ‘Journeys in Diverse Places’ in which he described his first steps. (11) He also wrote ‘Treating bullet wounds’ (1545) (4,11) ‘La Méthod de traicter les playes faites par les arquebuses et aultres bastons à feu’. (6) Later works were ‘Treating head wounds and skull fractures, with illustrations of instruments to be used’ (1561); (4) Treatise on Surgery, (1564) (11) in which he explained the technique of using ligatures to prevent haemorrhaging during amputation; (11) ‘Five Books on Surgery’ (1571) (4) and a collection of his works called (9) ‘Les Oeuvres’ in 1575. (5,9) He also created and wrote, ‘Reports in Court’, a procedure on the writing of legal reports in relation to medicine. (11) His reliance upon the experiences of a long and notable career (he was often away at wars, attending high officials and, later, kings) gave his arguments heft and allowed him to share his new techniques with a wide audience. (12) Ambrose Paré’s publications went beyond the descriptions of procedures and his books included illustrations of the instruments he employed, another groundbreaking innovation for surgical texts. (12) These features strengthened Paré’s arguments and gave his teachings great strength among barber-surgeons, physicians, and their clients. (12) [OR] This book provoked the fury of the medical establishment because Paré had dared to print it without their authorization: the Provost and the city fathers of Paris declared the work shameless and contrary to good morals, and demanded that it be burned. (15) As a young surgeon, well ingrained in the old Galenic tradition of medical practices and beliefs, Paré’s experience on the battlefields of Italy prepared him to take on the surgical establishment. (12) Paré’s clear writing and use of the vernacular, backed by decades of practical experience, ensured that his texts and techniques would become the foundation of a new surgery. (12) His books were frequently reprinted, several editions appeared in German and Dutch, and among the English translations was that of Thomas Johnson (1665). (9) These books, and his famed work as a war surgeon, and afterward as a surgeon in Paris, ensured that his techniques and ideas spread across Europe. (5)

Death

He died, (3,6) from natural causes, (11) still in the service of the Kings of France, (9) on 29th (1) [OR] 20th (3,6) December 1590 (1,3) at Paris. (1) He is buried at the church of Saint André-des-Arts. (11)

Estimate

He set the stage for the modern melding of scientific medicine and the invasive procedures that define surgery at the turn of the 21st century. (12) Paré brought to the field of surgery a revelation: that a surgeon might treat patients while simultaneously limiting the pain resulting from treatment. (12) He replaced an ancient system with one based primarily upon the ability of a surgeon to promote healing in the very tissues that his art tore apart. (12) The treatments proscribed by Galen and the earlier Hippocratic writings were first comprehensively challenged by Paré and the anatomical writings of Paré’s contemporary, Andreas Vesalius. (12) He had no knowledge of microbiology. (11) He was a humanist, and took great care with his patients regardless of their rank, treating them as if they were his family. (4) He was famous for his sayings: such as ‘Hard work overcomes everything’, (7) and ‘I won’t ask if you’re a Catholic or a Protestant, rich or poor, but simply ‘What’s the problem’?’ (4) In his personal notes about the care he delivered to Captain Rat, in the Piedmont campaign of 1537–1538, Paré wrote: (3) ‘Je le pansai, Dieu le guérit’ (‘I bandaged him: God healed him’). (3,9) These words, inscribed on his statue in Laval, are reminiscent of the Latin adage ‘medicus curat, natura sanat’. (3) This epitomises a philosophy that he used throughout his career. (3) ‘Guérir quelquefois, soulager souvent, consoler toujours’: ‘Cure occasionally, relieve often, console always’. (9) Although this experimentally driven medicine did not come to define the physician’s practice until the rise of the Paris Clinic in the 19th century, these first writings established an important foundation of empiricism in European medicine. (12) Ambrose Paré’s numerous technical innovations and literary contributions to the art of surgery were deeply felt in the continued development of surgery following the 16th century. (12) His emphasis on techniques that minimized the damage done to the tissues of the patient has guided the development of the gentle art of surgery in the many centuries since his writings first appeared. (12) Although his writings and techniques appeared during a time in which surgery was a separate realm from medicine proper, physicians and surgeons can now look to Paré as the founder of modern surgery, a restorative process that heals the body with minimal suffering. (12)

Barber Surgeons

He was part of the Parisian Barber Surgeon guild, (3) and his dedication to empirical observation and reasoning (12) and the success he thereby achieved (5) was also influential in beginning to raise the status of barber-surgeons. (5,12)

Bibliography

  1. https://www.babelio.com/auteur/Ambroise-Pare/39982
  2. http://www.histoire-france.net/biographie/ambroise_pare
  3. wiki small
  4. https://www.larousse.fr/encyclopedie/personnage/Ambroise_Par%C3%A9/137051
  5. http://broughttolife.sciencemuseum.org.uk/broughttolife/people/ambroisepare
  6. https://www.britannica.com/biography/Ambroise-Pare
  7. http://www.linternaute.com/biographie/ambroise-pare/
  8. https://www.allodocteurs.fr/se-soigner/chirurgie/chirurgie-reparatrice-chirurgie-esthetique/histoire-de-la-medecine-ambroise-pare-le-pere-de-la-chirurgie-moderne_22914.html
  9. http://www.apimsf.org/default.aspx?id=33
  10. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3631503/
  11. https://en.wikipedia.org/wiki/Ambroise_Par%C3%A9
  12. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2605308/
  13. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3609990/
  14. http://www.jameslindlibrary.org/articles/ambroise-pares-accounts-of-new-methods-for-treating-gunshot-wounds-and-burns/
  15. http://www.medarus.org/Medecins/MedecinsTextes/pare.html

FRESCI Analysis

F b. west France; Educated Paris; Campaigns in Italy, Languedoc. Military surgeon, dealing with novel problems of gunshot wounds. Prisoner of war. ‘Courtesy of Metz’

R Catholic or Huguenot? ‘I won’t ask if you’re a Catholic or a Protestant, rich or poor, but simply ‘What’s the problem’?’; empirical verification.

E poor background

S Treated all classes the same; Medical techniques – ligature; anti cauterisation; anti pain; Instruments; prosthetics; Used French not Latin.

C Rivalry between physicians and surgeons. Breaking medical monopoly; Book burned.

I Duc de Guise; Henry II paid ransom as POW.

Mnemonic PARECLOPS

P Paris physicians and their monopoly

His early life and lack of education; arrives in Paris where barber Surgeons allowed to listen to physicians

A Arquebus wounds

Firearms dramatically worsen injuries compared with spears; gangrene.

R Religion and class mattered not;

Told king he couldn’t treat him better than a poor man

E Experiment with Onions

P 5. Cook burned; treated half his face with onions & observed results. Example of empirical verification

C Cauterisation Rejected

Advised by Galen but caused extreme, sometimes fatal pain, and didn’t prevent infection

L Ligatures and Language

Prevent bleeding better than cauterisation but vulnerable to infection as well; wrote books in French which threatened the medical monopoly. Medics burned his 1575 Book.

O Other Obstetrics; Trepanning; Haemostats; Extraction of bullets; Rude bits

Methods of delivering babies; Haemostats are devices for cutting off blood supply prior to tying ligature. Symptoms of Syphilis; castration for hernias.

P Prosthetics and Poisoning Experiment with the cook & Bezoar Stone

Amputees were helped; then teeth, eyes, ears, noses, hands. B Stone did not cure

S Scarface with Spear wound Duke of Guise

By treating his wound he became known to the Ruling aristocracy, which helped him in his battles with the Medical Establishment (Like Vesalius with Charles V and Harvey with James I)

1 Ambroise

2 Where he would eventually be buried.

3 It actually said ‘the war’.

4 i.e. broken into pieces.

5 Pare himself wrote ‘at length my oil lacked…’ (13)

6 Feet-first

 

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