Saturday, April 18, 2015
P IS FOR AMBROISE PARE
At last, we come to my very favorite of all my A to Z subjects: Ambroise Pare, the greatest surgeon of the 16th century. But first, let me put him into context. In one of the many ways that the 1500's appear topsy-turvy to us, surgeons got no respect; in fact, performing surgery was often secondary to their main job, which was being barbers. Their status was nothing compared to that of physicians, who did important things like attach leeches to sick people so that they could benefit from bleeding, and taste the urine of their patients to diagnose their ailments. Yeah, it's pretty obvious now why physicians were such big deals, right?
Very little is known about Pare's early life except that he was the son of a cabinet-maker. He started working in his teens as an apprentice to a barber, and moved to Paris in about 1532. Later in life, he wrote that he had studied surgery for nine or ten years, three of them at the Hotel Dieu, the oldest hospital in Paris. In 1536, during a war with the Spanish Empire, Pare had his first experiences with battlefield surgery, serving as a surgeon to the commander of the French infantry. From then until 1544, Pare alternated between living in Paris and in military camps, where he continued to both learn and innovate new surgical practices.
In 1549 Pare published his first book, a study of anatomy (including a section on obstetrics). His reputation continued to grow, and in 1552 he was named surgeon-in-ordinary to King Henri II. In 1554, he took and passed the examination to become a master surgeon - even though it was given in Latin, which he admitted in his later writings he did not speak! I guess being the King's surgeon didn't hurt! Pare was also highly qualified, but I wouldn't want to take bets on which of those two factors counted for more. (Would you want to be the guy who failed the King's surgeon?)
As we know from my Nostradamus post, King Henri II died in 1559 from those awful facial injuries we read about two days ago. Pare remained the royal surgeon through the reigns of the next three kings, and Henri III, who came to the throne in 1574, also made Pare a royal counselor and valet. Pare published a second book of anatomy in 1561, and in 1564, his Dix Livres de Chirurgie (Ten Books of Surgery). For the record, the ten books dealt with: 1. gunshot wounds (or, as he phrased it, "the wounds made by arquebuses"); 2. arrow wounds; 3. fractures; 4. contusions; 5. burns; 6. caries of bones (which sounds to me like bone cancers); 7. gangrenes and "mortifications" (infections); 8. "hot pisses" (I'd say these were urinary tract infections); 9. stones; and 10. urinary blockages. He often suggested less invasive procedures than surgery to be tried first. I'm going to quote one of Pare's numerous recipes for "decoctions" here, to be attempted before turning to more drastic measures. This one is to soften bladder or kidney stones:
Root of asparagus, of graminis of polypody of oak, of cleaned
raisins, of each 3 ss, of betony, of herniosa, of agrimony, of
ominum capill, of Alexandrine laurel, of each m. ss, of the
four greater cold seeds, of seed of fennel, of each 3 i, of
leaves of senna 3 vi. Let decoction be made to lb. ss, in the
straining let be dissolved of syrup of althea and of herniosa,
of each 5 i ss; let very clear and very aromatic apozem be
made with a very little cinnamon for two doses; let him take
the first dose in the morning two hours before his meal, and
the other at four in the afternoon.
Of course, you can't make heads or tails of any of this, and neither can I. But look how precise and meticulous he was! And I would just add as a side note that many medieval herbal remedies were remarkably effective, and many modern medicines - like aspirin - are derived from natural sources that were first identified many hundreds of years ago.
After Ten Books was published, Pare spent two years traveling around the country with King Charles IX, during which time Pare not only cured himself of a viper bite, but also survived a bout of the plague with only a scar as a memento. Yep, we're getting into superhero territory here!
Pare had wide practical experience in performing surgeries. Sometimes the evidence he came across in this way conflicted with traditional views, many of which could be traced back to Galen (a renowned Greek physician and surgeon who had lived more than a thousand years earlier, during the time of the Roman Empire). When this happened, Pare did not hesitate to speak out against tradition. For example, he had this to say about the time-honored but torturous practice of treating hemorrhages by cauterizing blood vessels:
I counsel the young surgeon to abandon this miserable manner of burning and
butchering, admonishing him not to say any more, 'I have seen it in the book
of the ancient practitioners, I have seen it done by my old fathers and masters,
following in whose practice I can in no way fail.' This I grant you if you wish
to listen to your good master Galen in the book referred to above, and those
like him, but if you wish to stop at your father and masters in order to have
prescriptioners of time and license of ill-doing, wishing always to persevere
in it, such as one does in a certain degree ordinarily in all things, you will
render account of it before God and not before your father or your good
practitioner masters, who treat men in so cruel a fashion.
Pare's existence had been annoying the members of the Royal College of Physicians for some time by now, but by the early 1570s they began to make their hostility against him public. The physicians' main actual complaint against him was that he was invading their turf by discussing things like tumors in his writings, but they made up a lot of other claims against him to try to make their disapproval look legitimate. They attacked every one of his books from then on, but Pare's reputation only continued to spread and to improve, further enraging the physicians. Undeterred, Pare kept disseminating his vast store of knowledge through his writings until his death in 1590.
The cover of my copy of Pare's Ten Books contains this illustration of some of the tools he found necessary for performing surgeries:
It's a pretty scary selection, and there are a lot more pages of illustrations similar to it. Some of the illustrations that interested me the most, though, were those for prostheses, including noses and eyes. Here's one for a mechanical arm,
and one for a prosthetic hand that could open, close, and grasp:
Pare is rightly considered to be the preeminent surgeon of the 16th century. I'll end this post by quoting the concluding remarks of the unsigned preface to my (translated) edition of Pare's Ten Books of Surgery:
He saw the intellectual and moral deficit of many of the barber-surgeons of the
period, and since he was one of them, sought to elevate their position by education
and example.... Although a surgeon to kings, Pare was also a surgeon to the
common soldier and to the common man. This was unusual in the sixteenth
century because it was commonplace for many physicians to ignore the illnesses
of the common people. His rebuke to the physicians is stinging: "You [the patient]
will be able to have the counsel of the learned physician. Still considering that one
cannot always get a physician, I have indeed wished to describe for you here some
good and approved remedies...." While some of his therapy such as covering
the patient with warm manure is not acceptable today, his concluding state-
ment is: "Therefore, it is necessary that the surgeon have always before his
eyes that God and nature command him not to leave patients without doing
his duty although he may foresee the signs of death, for nature often does
what seems to the surgeon to be impossible."
Pare possessed many of the prejudices of the time and by no means was
able to break completely with the dogma of the past. However, in Dix Livres
he shows the ability to see, to reason, and to doubt. As such, he was a product
of the Renaissance as was no other surgeon.
All I can add to that summary of Pare's life and work is: amen.