Paré, Ambroise
PARé, AMBROISE
(b. Laval, Mayenne, France, 1510 [?]; d. Paris, France, 22 December 1590)
surgery.
Pare was the son of an artisan. He served an apprenticeship to a barber-surgeon in the provinces (probably at Angers or Vitre), then went to Paris, where he became house surgical student at the Hotel-Dieu, a post that provided him a valuable opportunity to study anatomy by dissection. About 1536 Pare became a master barber-surgeon and entered military service under Marechal Montejan; he accompanied the army on an expedition to Italy, where he spent two years. He returned to Paris in 1539, but intermittently participated in military campaigns throughout most of the next three decades. In 1552 Henry II appointed him one of his chirurgiens ordinaries; he became premier chirurgien to Charles IX in 1562 and served Henry III in the same capacity. He had a flourishing practice at court and in Paris, and, as a military surgeon, treated the wounded of both sides during the Wars of Religion. (Although often reported to have been a Huguenot, Pare remained a Roman Catholic throughout his life.)
Military practice afforded Pare experience in treating a wide variety of injuries. In particular, he revolutionized the treatment of gunshot wounds, which had been considered to be poisonous and were routinely cauterized with boiling oil. At the siege of Turin in 1536, Pare (according to his own account, published almost half a century later) ran out of hot oil and instead used a“digestive”dressing composed of egg yolk, oil of roses, and turpentine. The following day, he noted that the soldiers who had had their wounds dressed in this improvised manner were recovering better than the soldiers treated by the conventional method; they were free from pain, and their wounds were neither inflamed nor swollen. Pare then experimented with a number of different dressings (including some containing aqua vitae, which would, together with turpentine, have acted as a topical antiseptic) and concluded that gunshot wounds were not in themselves poisonous, and did not require cautery. He reported his discovery in his first treatise, La methode de traicter les playes faites par les arquebuses et aultres bastons a feu, published in 1545. This treatise, written in the vernacular because Pare knew no Latin, brought him immediate fame.
Pare also rejected cautery as a method of achieving hemostasis and advocated the ligature of blood vessels to control hemorrhage during amputations. He devised a new instrument for this purpose–the“crow’s beak,” a sort of hemostat that he used to grasp was also innovative, and he revived the ancient technique of podalic version for difficult deliveries. (Pare’s method was widely used after his own time; one of his chief disciples, Jacques Guillemeau, was primarily an obstetricians extended throughout the seventeenth century.)
Pare’s motto was“Je le pensai, Dieu le guarist”–“I dressed him, God cured him.” Many of the details of his surgery are no longer of scientific interest; despite his innovations, he labored under the humoral theories and superstitions common to sixteenthcentury surgery and was ignorantf of such considerations as circulation of the blood and asepsis. Nonetheless, he saved many patients who would be the despair of a modern surgeon, and he came to represent the ideal practitioner, both for his technical competence and for his humanitarian concern for his patients. He had a vague, reasoned anticipation of some form of transmissible infection and a crude appreciation of public health measures. Although his knowledge of pathology was at best rudimentary, he advocated and practiced (and left records of) autopsy investigations of fatal illnesses.
Pare’s theories and writings were often in opposition to those of the university authorities. He desired to spread anatomical knowledge among his fellow barber-surgeons, and to this end performed dissections and wrote a number of works on anatomy. His use of the vernacular and the advent of the printing press assured his books a wide distribution, although they were published, for the most part, only after legal conflicts with the members of the Paris Faculty of Medicine, who wished to suppress them. Pare was, however, widely supported by his noble clientele, and their support brought him the acceptance of professional associations that were usually closed to all except university graduates. (He was, for example, invited to join the guild of academic surgeons of Paris in the College de Saint-Come, despite his lack of Latin –although the physicians and the Faculty of Medicine always scorned and snubbed him.)
Pare’s personal life was marked by honesty, piety, and concern for the poor and defenseless. His last recorded act is his having, at the age of eighty, stopped a religious procession in the streets of Paris so that he might plead with its leader, the archbishop of Lyons, to come to terms with Henry of Navarre (later Henry IV), who was then besieging the city. Pare hoped thus to alleviate the lot of the starving Parisians, and whether or not his unprecedented act exerted any influence, the siege was lifted about a week later. He died shortly thereafter, in the house in which he had lived throughout most of his active career. He was buried in his parish church, St. Andre-des-Artes (destroyed in 1807, in which year Pare’s bones were transferred to the catacombs). Twice married, Pare had nine children, of whom three daughters survived him.
Pare left a powerfully reactivated surgical tradition at his death. His many publications, which were translated into both Latin and modern languages, circulated throughout Europe, and had considerable influence during his life and well into the following century. But in France itself surgeons were again under the Hippocratic yoke within two generations, and the art of surgery had reverted to about the level at which Pare had found it. Part of the blame for this must be attached to the reactionary character of French academic medicine, and to the prevailing moral and religious antipathy toward the scientific principle; the reforms for which Pare struggled did not come until both the College de Saint-Come and the once powerful and privileged Faculty of Medicine were abolished in the French Revolution.
BIBLIOGRAPHY
Pare’s writings have been collated and described in Janet Doe, A Bibliography of the Works of Ambroise Pare; Premier Chirurgien et Conseiller du Roy (Chicago, 1937). His best books are in J. F. Malgaigne, Oeuvres completes d’Ambroise Pare, 3 vols. (Paris, 1840). Accounts of Pare’s life and works are available in W. B. Hamby, The Case Reports and Autopsy Records of Ambroise Pare (Springfield, Ill., 1960), Surgery and Ambroise Pare (Norman, Okla., 1965), trans. and ed. from J.F. Malgaigne, op cit., and Ambroise Pare; Surgeon of the Renaissance (St. Louis, Mo., 1967). See also G. Keynes, ed., The Apologie and Treatise of Ambroise Pare, Containing the Voyages Made Into Divers Places With Many of His Writings Upon Surgery 9Chicago, 1952); F. P. Packard, ed., The Life and Times of Ambroise Pare (New York, 1926); and Stephen Paget, Ambroise Pare and His Times: 1510–1590 (New York-London, 1897).
Wallace B. Hamby
Ambroise Paré
Ambroise Paré
1510-1590
French Surgeon
Ambroise Paré inaugurated modern military surgery and was the greatest military surgeon before Dominique Jean Larrey (1766-1842). He invented or introduced many surgical instruments and popularized the use of trusses, ligatures, artificial limbs, and dental implantations. His Oeuvres were first published in 1575 and had gone into five editions by 1598.
The son of an artisan in Laval, France, Paré served as apprentice to a barber-surgeon then studied surgery at the Hôtel Dieu hospital in Paris. He became a master barber-surgeon in 1536 and joined the army the same year.
In 1536 King François I made war on the Duke of Savoy and besieged Turin, Italy. Paré was a surgeon with the French army. Until this time, the standard surgical procedure for arrow, bullet, and similar puncture wounds was to cauterize them with hot oil. European doctors had used this ancient Arabic technique for over 500 years and no one questioned it. Paré used it too, until the Savoyard defenders of Turin shot so many French soldiers that he ran out of oil. Desperate because he could not cauterize, he wrapped the newer wounds in bandages soaked with egg yolk, rose oil, and turpentine. The next day he was surprised to discover that the bandaged wounds were healing better than the cauterized ones. He never cauterized again.
Paré experimented with various substances to soak the bandages and presented his results in his major work, La méthode de traicter les playes faictes par hacquebutes et aultres bastons à feu, et de celles qui sont faictes par flèches, dardz, et semblables (The method of treating wounds made by harquebuses and other firearms, and those made by arrows, darts, and the like), published in 1545. He was at first disbelieved because he did not know Latin. He wrote in the vernacular at a time when all learned treatises were supposed to be written in Latin. After 1552, when King Henri II appointed him as one of the royal surgeons, such criticism diminished.
While competing in a tournament in 1559, Henri II received a lance wound to the eye. He was attended by Paré, but died eleven days later. Because of this incident, Paré turned his research toward head wounds and published La méthode curative des playes et fractures de la teste humaine (The method of curing wounds and fractures of the human head) in 1561.
In his 1549 Briefve collection de l'administration anatomique (A short collection on governing the body), Paré improved upon podalic version, an obstetrical technique introduced in the second century by the Greek gynecologist Soranus. Podalic version is a means of extraction used in cases of difficult birth. The physician, with the right hand on the abdomen and the left hand inside the uterus, turns the fetus and extracts it by the feet. No further improvements of this technique were made until John Braxton Hicks (1823-1897) did so in the 1860s.
Paré's 1564 Dix livres de la chirurgie (Ten books on surgery) discuss dental and oral surgery, amputations, and several other topics. His 1573 Deux livres de chirurgie (Two books on surgery) contains both scientific and fanciful accounts of birth defects.
Among Paré's innovations were tying (ligating) blood vessels to control bleeding during operations, performing autopsies to determine the cause of death, and using bandages rather than stitches to close wounds so as to minimize scarring. His autopsies led him to think that syphilis might be the cause of some aneurysms. His colleague Jean François Fernel (1497-1558) held the same belief, but the relationship between syphilis and aneurysm was not proved until 1899 by Arnold Heller (1840-1913).
A lifelong devout Catholic, Paré's motto was "I treated him; God cured him."
ERIC V.D. LUFT
Ambroise Paré
Ambroise Paré
The French military surgeon Ambroise Paré (1510-1590) restored and reformed the surgical art through his practice, writings, and personal leadership to earn the sobriquet "father of modern surgery."
Ambroise Paré was born in Bourg-Hersent (now absorbed into Laval). His father seems to have been barber-surgeon to the Comte de Laval. His elder brother and his brother-in-law were also barber-surgeons, under whom he may have served his apprenticeship. From 1532 to 1537 Paré served under the surgeons of the Hôtel-Dieu in Paris as a clinical assistant studying anatomy and surgery. This experience, unusual for the times, Paré acknowledged was of the greatest importance to his future career.
Unable to pay for licensure, Paré joined his patron, René de Montejan, a colonel general of infantry, as military surgeon in the French expedition of 1537 to Turin. In his first campaign he realized that, on the basis of the poisonous nature of gunpowder, the accepted method of cauterizing gunshot wounds with boiling oil was destructive, and he therefore substituted more humane treatment.
On the death of Montejan in 1539, Paré returned to Paris now able to pay his fees to be accepted into the Company of Barber-Surgeons. A few months later he married Jeanne Mazelin, daughter of a wine merchant, by whom he had three children.
In Paris, Paré visited the celebrated physician Jacques du Bois (Sylvius), who encouraged him to write on his experiences with gunshot wounds. However, the outbreak of war with Spain saw Paré accompanying the Vicomte de Rohan on campaigns before Perpignan, in the Hainaut, and before Landrecies. This delayed the completion of his first book, The Method of Curing Wounds Made by Arquebus and Other Firearms (1545). Written in the vernacular instead of Latin, the book had a practicality and sound common sense that made it instantly popular and its author famous. Thereafter books on his experiences appeared in almost every decade of his long life. His Anatomy, based on Vesalius, contained his important contribution to midwifery, reintroducing podalic version. His texts on surgery reintroduced the ligature in amputation. These many writings were gathered together in his Works (1575), which disseminated his teachings throughout the world.
Paré served in many campaigns, and beginning with Henry II, was surgeon to no less than four successive kings of France. With Vesalius, Daza Chaçon, and Jean Chapelain, he attended at the tragic death of Henry II, killed in a joust with the Comte Montgomery which eventually split France in civil war. Paré cited the case to establish the fact that the brain can be injured without fracture of the skull. His last piece of writing, The Apology and Voyages, is a supreme literary achievement and unique historical document in which he defends his methods. Paré was the emancipator of surgery, whose modesty and humanitarianism is remembered by his aphorism, "Je le pensay, et Dieu le guarit" (I dressed it, and God healed it).
Further Reading
The Apologie and Treatise of Ambroise Paré, edited by Geoffrey Keynes (1952), contains the Voyages and other important excerpts. Two excellent but rare biographies of Paré are Stephen Paget and Francis Packard, Ambroise Paré and His Times, 1510-1590 (1897), and Life and Times of Ambroise Paré, 1510-1590, edited and translated by Francis Packard (1921). A recent study is Wallace Hamby, Ambroise Paré: Surgeon of the Renaissance (1967). A superb bibliography containing several important essays is Janet Doe, A Bibliography of the Works of Ambroise Paré (1937). □
Paré, Ambroise
Paré, Ambroise
Ambroise Paré (1510-1590) is widely considered the greatest surgeon of the sixteenth century. Renowned as much for his compassion as his surgical skill, Paré guided his life with a humble credo of patient care: "I dressed him, God cured him."
Paré was born in an era in which physicians considered surgery well beneath their dignity. Doctors left all cutting to the lowly barber-surgeons. Pare initially served as an apprentice to a barber in the French provinces, and at age 19 went to Paris where he became a surgical student at the famous Hotel Dieu hospital. After his graduation in 1536, Pare joined the army as a regimental surgeon. He served intermittently in the army for the next 30 years, during which time he also developed a flourishing private practice and gained fame through his writings and his considerate, democratic treatment of soldiers of all ranks. Before his career ended, he had acted as surgeon to four French kings as well.
It was during the siege of Turin (1536-1537) that Paré made his first great medical discovery. Gunshot wounds, a new medical condition, were considered poisonous and routinely treated by cauterization (sealing off) with boiling oil. When Paré ran out of oil during the siege, he turned instead to simple dressings and soothing ointment, and immediately noted the improved condition of his patients. Pare popularized this revolutionary treatment in his Method of Treating Wounds in 1545.
Paré's next contribution to medicine was his promotion of ligature (tying off) of blood vessels to prevent hemorrhage (uncontrolled bleeding) during amputations. In a book on these new techniques, Pare also included large parts of Andreas Vesalius's authoritative work on anatomy, translated from the original Latin into French. This information dramatically increased the barber-surgeon's knowledge of anatomy, since the typical barber-surgeon was never taught Latin as part of his training.
Paré was an innovator, always willing to try new practices. He favored massage and designed a number of artificial limbs as well as an artificial eye. He advanced obstetrics (the study of childbirth) by reintroducing podalic version (turning a fetus in utero into a position possible for birth) and inducing premature labor in cases of uterine hemorrhage. As always, he spread knowledge of these discoveries through his writings.
Paré's greatest accomplishment, aside from actually coming up with new surgical techniques, was to spread this information throughout the barber-surgeon community, elevating surgery's status to a professional level and paving the way for vast improvements in surgical care.
[See also Bandages and dressings ]