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Cinq livres de chirurgie (1572), by Ambroise Pare

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Cinq livres de chirurgie
Paris, 1572
Ambroise Pare, 1510-1590

Life in Europe during the 16th century was fraught with one war after another -- either civil or religious. The use of guns and gunpowder produced particularly gruesome wounds for those unlucky enough to get in the way. If that wasn’t bad enough, physicians and surgeons of the time viewed gunpowder as a poison and recommended "treating" the wound with boiling oil to drive out the poison. Ouch! But thanks to an army surgeon named Ambroise Pare, cauterization of wounds by hot oil fell into disrepute.

Ambroise Pare

Born in Laval (France), Pare began his career as a dresser (or assistant-surgeon) at the Hotel Dieu, a hospital in Paris. Beginning in 1536, Pare served as an army surgeon for nine years and saw active service in several wars of the period. Upon leaving the military, Pare rose to become the foremost surgeon in France and served as surgeon-in-chief to Henry II, Francis, II, Charles IX, and Henry III. While Pare contributed much to medical learning, it was during his first campaign that he made an astounding discovery.

After the battle of Villaine, Pare treated gunshot wounds in the usual manner, but soon ran out of oil. He dressed the wounds of the remaining soldiers with a mixture of egg yolk, oil of roses, and turpentine. After a restless night worried about his patients, Pare rose the next morning and found that those patients treated with the egg mixture were healing well and resting comfortably. In contrast, those subjected to the boiling oil treatment were in considerable pain with swollen wounds. In his 1545 publication on the treatment of gunshot wounds, Pare described his new treatment and vowed "never so cruelly to burn poor wounded men."

While this may be the most dramatic finding by Pare, he is also known for several other important contributions to surgery and medicine. Pare perceived the importance of anatomy in relation to surgery and adopted this knowledge in his practices. By doing so, he elevated the surgeon to a position equal to that of the physician. In addition, Pare advocated the use of ligatures to halt bleeding after amputations rather than cautery, introduced the practice of turning the child in the womb before delivery, and invented several ingenious devices for use by amputees.

Pare authored several other works after the 1545 treatise, but his Cinq livres de chirurgerie, published in 1571 is considered his most important. No copies of the 1571 publication are known to exist today, but the volume was reprinted in 1572. Small enough for field work (470 pages and 18 cm.), it covered bandaging, fractures, dislocations, animal bites, and gout as well as containing illustrations of instruments, appliances, and ligatures. In a significant change for his time, Pare did not write in Latin (he never learned it) but in French, the "common" language. This incurred the wrath of the physicians (who feared competition from the surgeons) and actually led to legal action against Pare. But Pare’s use of French instead of Latin, and the translations of his works into other languages, including English, meant that his publications were widely read.

While none of Pare’s "discoveries" were without precedent, it was his skill as a surgeon, his lifelong efforts to increase his knowledge, and his compassion for his patients that elevated Pare above others. As Pare himself said many times in his writings "Je le panasis, Dieu le guerit" (I dressed him and God healed him).





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