Stephen Paget.

Ambroise Paré and his times, 1510-1590 online

. (page 14 of 18)
Online LibraryStephen PagetAmbroise Paré and his times, 1510-1590 → online text (page 14 of 18)
Font size
QR-code for this ebook

232 Ambroise Pare

fine sieve, and flavour with sugar and canella, adding a
little citron-juice, or verjuice, or vinegar, to suit the
patient's taste."

Again, we do not greatly trouble over matters of
diet ; we value, perhaps too highly, the simplicities
of beef-tea and barley-water, fish and custard pudding.
Pare has a thousand devices against this monotone
of nourishment. Here is his dietary for a case of
fractured skull :

" Hippocrates wholly forbids wine : but instead of it
he shall drink barley-water, or boiled water with a little
bread in it, or hippocras made with water, or boiled
water with syrup of roses or violets, or acid, or boiled
water sugared, with lemon or citron juice. . . , He
may eat panada, soaked barley, cooked Damas plums,
Damas raisins preserved with a little sugar and canella
(particularly good for comforting the stomach and re-
freshing the spirits) : and sometimes a small fowl, a
pigeon, veal, kid, leverets, little field-birds, pheasants,
larks, turtledoves, partridges, thrushes, and other good
meats boiled Avith lettuce, sorrel, purslain, borage,
bugloss, chicory, endive, and the like. Or sometimes
these meats ma)'- be roasted : and then he may have with
them verjuice, oranges, citrons, lemons, sharp pomegran-
ates, sorrel-juice, changing them according to the pa-
tient's taste and the length of his purse. If he desire
fish, then trout, loach, and pike from clear waters, not
muddy, with raisins, Damas plums, sharp cherries : but
he must avoid cabbages and all leguminous vegetables,
because they trouble the head. And after dinner, com-
mon sweetmeats, or annis, fennel, coriander comfits,
conserve of roses, or quince marmalade." . . .

Opera Omnia 233

Again, there were no skilled nurses in Ambroise
Park's time : when Charles IX. lay dying of phthisis,
haunted by terrors, the old Huguenot nurse, the
" family nurse," settled herself to sleep on the big
carved chest in the King's bedroom. Pare was sin-
gle-handed : as he says in the Journey to Germany,
" I did my patient the office of physician, surgeon,
apothecary, and cook." The indefatigable neatness
and minute finish of his work never failed him.
Take his rules for bandaging ; the bandages must be
made of old linen already used, that they may be
soft and phable ; they must be of the right length,
not hemmed or stitched, without lace or seam, clean,
cut longways and not across, of the right strength :
the knot must come where it will not be felt, the
ends must be turned in : " the surgeon must consider
to what end the bandaging was done, and whether
he has done it well and properly, as also with neat-
ness and elegance, to the satisfaction of himself and
the beholders."

Or take the following rules for the comfort of his
patients. If the room be too hot, and the windows
may not be opened, sprinkle the floor with water and
oxycrate, and strew it with twigs of willow and vine.
If a plain bath, as opposed to a medicinal bath, be
prescribed, then plain warm water, wherein the
flowers of violets and of water-lilies, willow-leaves

234 Ambroise Pare

and barley, have been boiled, will be sufficient. In
time of plague, open your windows to the North and
East, shut them to the West : kindle a clear fire in
every living-room in the house, and perfume the
whole house with frankincense, myrrh, benzoin,
labdanum, styrax, roses, myrtle, lavender, rosemary,
sage, savory, wild thyme, marjoram, broom, fir-cones,
pine-wood, juniper, cloves, perfumes; and let your
clothes be dried in the same. It is indeed the plague
that shows most clearly his skill in practice. Or, if
we wish to see how he could concentrate on a single
case the whole of his strength, there is the story of
the Journey to Flanders, how he saved the life of the
Marquis d' Auret : a magnificent example of good

The work itself that he did in this fine spirit must
be studied by surgeons in his collected writings ; and
no technical account of it here would be of value or
in place. Many of his operations have in these lat-
ter days come again into practice, and have been put
to the credit of modern surgery. And every bit of
his work bore the naked impress of his character —
the same insight, diligence, and single-handed mas-
tery of the case : all through his life, he gave the lie
to that old saying that the Frenchman cures the dis-
ease, but the Englishman cures the patient. Next,
comes the question, what were the limitations and

Opera Omnia 235

the faults of his work? How wide is the gulf be-
tween him and modern surgeons? He had no know-
ledge of the circulation of the blood, or of the
absorbent system : no anaesthetics, no antiseptics,
no bacteriology : his understanding of the nervous
system was not in advance of his times, and he had
neither microscope nor stethoscope nor thermometer.
Other things also stood between him and accurate

(i) He believed, though without much care for the
matter, that the stars influence the course of disease.
He says of the operation for cataract, " You must
choose a proper time for it, when the moon is on the
wane, and not any time of lightning or thunder,
and not when the sim is in A vies, which has dominion
over the Jiead'' ; but he only added these last words
in the second edition of his works, 1579. There is
no evidence that he followed astrology, though the
rage for it was so strong in Paris in his old age. Fie
believed the moon affected human life ; but only as
do the sun and the east wind. And where he speaks
of the change of type, or involution, of a disease, he
throws over the astrologers altogether. " Astrolo-
gers think the cause of it to be that the celestial in-
fluences, by the contrary revolutions of the stars,
lose their power and become weak. But physicians
had rather take to themselves the glory, that this

236 Ambroise Pare

disease is become less furious, and refev it to the
many v/holesome means which have be'er, invented,
used, and opposed to it by the happy labours of
noble minds."

(2) He believed that the plague came of itself, by
the Divine will, apart from nature, He doe? not
wholly ignore the philosophical d/^ctrines of first
causes and second causes, but they have no interest
for him. His only concern is to believe and prove,
from Scripture and from Hippocrates, that the
plague is sent to punish men for their sins. In a
recent account of the plague, its variations in inten-
sity of virulence are said to be " phenomena which
have to be regarded as indicative of a secular evolu-
tion of morbid changes."

(3) He lived when all men believed in spontane-
ous generation ; a belief which died hard, not many
years ago. It was a common thing in his time for
maggots to breed in a wound. He notes it not only
in the army, but even in his private practice :

" What wonder was it, if in these late civil wars the
wounds have caused so many grievous accidents, and
lastly death itself ? Especially since the air encompass-
ing us, tainted with putrefaction, corrupts and defiles
the wounds, and the body and the humours are already
disposed or inclined to putrefaction. There came such
a stench from these wounds, when they were dressed,
that the bystanders could scarce endure it. Nor could

Opera Omnia 237

this be attributed to the want of dressing, or the fault of
the surgeon, for the wounds of the princes and the no-
bility stank as ill as those of the common soldiers. And
the corruption was such that if any chanced to be left
without dressing for one day — which sometimes hap-
pened with such a multitude of wounded — next day the
wound would be full of worms. Many also had abscesses
in parts opposite to their wounds ; which I remember
befel the King of Navarre, the Due de Nevers, and
sundry others."

With this terror of the powers of the air, it is no
wonder that he sometimes despaired of getting good
results in military surgery. " If things went wrong,
owing to this great malignancy of the wounds in the
civil wars, the surgeon was not to be blamed, for it
were a sin to fight against God, and the air, wherein
are the hidden scourges of Divine justice." There
was the same frightful mortality, the same fear of
the air, two hundred years after Fare's time, in his old
hospital. And with the air, he included the time
of year, the condition of the soil, the locality, the
weather ; to all these things he paid heed : he had
no great dread of pure air, save lest it should give
the patient cold. For this reason he advises that
when a wound of the head is dressed a chafing-dish
or a hot iron should be held near it, that the air and
the wound may be gently warmed.

(4) He believed in the devil, evil spirits, sorcery,

238 Ambrolse Pare

and witchcraft ; that the devil and his angels were
permitted to plague men with diseases, to put for-
eign bodies inside them, to possess and enslave them.
Magicians and sorcerers sold themselves to devils,
and got power from them. There were devils in the
air, and underground in mines. All this, and more
like it, he firmly believed, on the authority of Scrip-
ture, history, and his own eyes. He is not clear how
far the works of the devil and of devils are material,
how far they are illusions inflicted on man's senses ;
and in his old age he was still uncertain on this
point :

" Not long ago, in the presence of King Charles IX.,
and MM. de Montmorency, de Retz, de Lussac, and M.
de Mazille, first physician to the King, and M. de Saint
Pris, valet-de-chambre in ordinary to the King, I saw a
certain impostor and enchanter do many things which
are impossible for men to do without the subtlety of the
Devil, who deceives our vision, and makes us see some-
thing false and fantastic ; which this impostor freely con-
fessed to the King, that what he did was by the subtlety
of a spirit, and he had to be enslaved to him for yet
three years longer, and was sore tormented by him. And
he promised the King, when this time was come and over,
he would be an honest man. God forgive him, for it is
written, Thou shalt not suffer a witch to live. King Saul
was cruelly punished, because he sought counsel of the
witch of Endor ; likewise Moses commanded the Jews to
exterminate all sorcerers."

opera Omnia 239

He attended one or two cases of possession : he
did not use exorcism, but followed what we may
call an expectant line of treatment.

White magic, the popular use of spells, charms,
amulets, and the like, he mostly derided and de-
spised ; he admits it can cure diseases, but it is a
false and palliative sort of cure at the best :

" I have seen the jaundice, all over the body, disappear
in a night, because they hung a little sentence round the
patient's neck ; I have seen fevers cured by words and
ceremonies ; but they came back again worse than ever.
. . . They say it cures a quartan fever, if the patient
drinks wine stirred with a sword that has cut off a man's
head ; if this were true, the Paris headsman would be
better off than he is. . . . A rope that has hanged a
man, tied round your forehead, cures the headache : it
is pleasant to know this way of practising medicine."

He quotes a multitude of quaint charms and spells,
but says they are foolish nonsense ; being especially
sore against them, because they were opposed alike
to religion and to the honest practice of medicine.

(5) He was a firm believer in the power of the
saints to cure diseases ; and this belief he justifies,
oddly enough, by appealing to Hippocrates. " They
do not send diseases upon us, but these diseases,
sent on us by the just judgment of God, are cured
by their means. And herein I have written as a
surgeon, following the doctrine of divine Hippo-

240 Ambroise Pare

crates, in his book De Morbis Sacris, who says those
who beHeve the saints send diseases on us are miser-
able men, deceivers, wicked ; not that he denies these
diseases are cured by their power and means." (1575).
(6) He beheved in the royal touch for the king's
evil :

" It is known and affirmed by all men, that the Kings
of France have this power of healing. I have seen it, an
infinite number of times, and I said nothing of it in my
book, because it is a thing familiar to everybody. I
could prove, by the evidence of many in this city, men
of good repute, what authority I attribute to this gift of
grace granted to the Kings of France by the loving kind-
ness of God, having sent them to the King, and used all
my influence to get them admitted to him, seeing there
was no help for them from remedies of man's making."

But in practice, some of his operations and meth-
ods were curiously modern. He understood and
practised what we now call massage ; he had a good
way of producing local ansesthesia ; he was opposed
to immoderate bleeding; he knew the value of rest
and of silence for his patients. He says, for instance,
of wounds of the head, " The patient must be in a
place of rest, as far from loud noise as possible, far
from church bells, not near a farrier's, cooper's, car-
penter's, or armourer's shop, or the traffic of carts or
the like, because noise increases pain, fever, and

Opera Omnia 241

other complications." Yet still in London we see
hospitals built straight on to the main road.

Of the two discoveries which all men know that
he made, the story of the first is told in the Journey
to Turin. The second, the use of the ligature in
amputation-wounds, was probably made at or about
the time of the Journey to DanviUiers. He recom-
mends good threads, two together — l?on fil qui soit
en double — and a catch-forceps such as is now used
by surgeons. Then comes the famous passage :

" Here I confess freely and with deep regret that for-
merly I practised not this method but another. Remem-
ber, I had seen it done by those to whom these
operations were entrusted. So soon as the limb was
removed, they would use many cauteries, both actual
and potential, to stop the flow of blood, a thing very
horrible and cruel in the mere telling. . . . And
truly of six thus cruelly treated scarce two ever escaped,
and even these were long ill, and the wounds thus
burned were slow to heal, because the burning caused
such vehement pains that they fell into fever, convul-
sions, and other mortal accidents ; in most of them,
moreover, when the scar fell off, there came fresh bleed-
ing, which must again be staunched with the cauteries,
which, thus repeated, consumed a great quantity of flesh
and other nervous parts. By which loss the bones re-
mained long afterward bare and exposed, so that, for
many, healing was impossible ; and they had an ulcer
there to the end of their lives, which prevented them from

having an artificial limb. Therefore I counsel the young

242 Ambrolse Pare

surgeon to leave such cruelty and inhumanity, and fol-
low my method of practice, which it pleased God to
teach me, without I had ever seen it done in any case,
no, nor read of it."

He had often used the ligature to vessels bleeding
in an ordinary wound ; this method was as old as Ga-
len. When it came to his thoughts that he might use
it in amputation-wounds, he conferred with Estienne
de La Riviere and other Paris surgeons, and they
agreed together to make trial of it, having the cau-
teries ready to hand, in case the ligature should fail.

To know Ambroise Par6 from his books, it is not
enough to quote passages from them ; their sequence
must be noted, his reasons for writing them, and the
circumstances under which they were published.
Malgaigne gives many facts about them, which can-
not all be put here. The list of them is as follows :

1. " The method of treatment of wounds made by
arquebuses and other firearms, and of those made
by arrows, darts, and the like ; also the burns made
by gunpowder. By Ambroise Par^, Master-barber,
surgeon at Paris. 1545." A small 8vo of 61 pages,
dedicated to M. le Vicomte de Rohan. Written by
the advice of Sylvius.

2. " A short compendium of the chief facts of
anatomy, with the articulations of the bones. By

opera Omnia 243

Ambroise Pare, Master-barber, surgeon at Paris.
1550." With a treatise on obstetrics. Small 8vo,
96 pages, dedicated to M. de Rohan. This book
was the outcome of the dissections and demonstra-
tions made by Pare and Theodoric de H6ry at the
School of Medicine, for the physicians' lectures there.
The Advice to the Reader shows the strain of Park's
life at this time :

" Dear Reader, I would have you know that when I
had sent this book to press I was compelled to go to the
camp at Boulogne, for the service of my Lord and Master ;
and in my absence many mistakes have been made, which
I have corrected with the pen, to save you trouble, desir-
ing your advancement, and hoping to give you some-
thing else after this, God helping me. Whom I pray to
enrich us with His grace."'

3. A second edition of the book on gunshot
wounds, with additions. 1551 and 1552. 8vo., 80
pages. Dedicated to the King. In the Advice to
the Reader, he says that the tumult of the wars has
prevented him from properly finishing and correct-
ing the book.

4. " The method of curing wounds and fractures
of the human head ; with illustrations of the instru-
ments necessary for their cure. By M. Ambroise
Par6, surgeon-in-ordinary to the King, sworn sur-
geon at Paris. 1561." With a portrait, and the

244 Ambrolse Pare

motto, " Labor improbus omnia vincit." 8vo, 226
pages: dedicated to Chapelain, Pages 1-113 give
the anatomy of the head ; the rest of the book is
surgical. The case of Henri II. is given at length;
his death was doubtless the occasion of the book.

5. " Universal anatomy of the human body. By
Ambroise Pare, surgeon-in-ordinary to the King,
and sworn surgeon at Paris. Revised and enlarged
by the author with I. Rostaing du Bignosc, Pro-
vencal, also sworn surgeon at Paris. 1561." 8vo.,
277 pages, with portrait and motto. Dedicated to
the King of Navarre. This book was the outcome
of dissections and demonstrations made with Ros-
taing du Bignosc at the School of Medicine. Many
of the illustrations were taken from Vesalius.

6. " Ten Books of Surgery ; with the set of in-
struments necessary for it. By Ambroise Pare,
premier surgeon to the King, and sworn surgeon
at Paris. 1568." With illustrations, portrait, and
motto. 8vo., 234 pages. Dedicated to the King.

7. " Treatise on the plague, small-pox, and
measles ; with a short account of leprosy. By
Ambroise Pare, premier surgeon to the King, and
sworn surgeon at Paris. 1568." 8vo., 235 pages.
Dedicated to Castellan. Written at the wish of
Catherine de Medici, after the Royal progress to

Opera Omnia 245

8. "Five Books ot Surgery, 1572." No copy of
this book is now to be found.

9. " Two Books of Surgery. By Ambroise Par6,
premier surgeon to the King, and sworn surgeon
at Paris. I573-" 8vo., 519 pages, with portrait and
motto. Dedicated to M. le Due d'Uz^s.

10. " Discourse of Ambroise Par6, councillor and
premier surgeon to the King, on mummy, poisons,
unicorn, and the plague. 1582." 8vo., 75 pages,
with portrait. Dedicated to M. des Ursins.

11. Reply of Ambroise Par6, premier surgeon to
the King, to the answer made against his discourse
on unicorn. 1584." Quarto, 7 pages.

Some account of the complete editions of his Col-
lected Works has already been given. After his
death, the rights over them were granted to his
widow. Eight editions in all were published at
Paris; then five editions (1633-1685) were published
at Lyon ; inferior in every way to the Paris editions,
badly printed, corrupt. His works have been trans-
lated into Latin, English, Dutch, and German ; per-
haps Itahan also, but this is doubtful. In 1840,
Malgaigne published his classical edition of the
Works, restoring the text, and prefixing to it a long
historical and critical Introduction, 351 pages, a
masterpiece of learning and labour.

246 Ambroise Pare

The moral of Opera Omnia is not without encour-
agement for " the young surgeon," to whom Par6
ever addressed himself. He did not publish any-
thing till he was thirty-five ; his first two books were
very short, and there was an interval of five years
between them. The third book came eleven years
after the second ; the sum of his published works is
not so great that the young surgeon should despair.

Yet there is in his books a note of eagerness and
vehemence, telling that he did not take things leis-
urely. He cannot finish one book but he must
promise another. " If I hear you like this little
work, I will set myself to do something else." — " If
I learn you have found pleasure and profit herein, I
promise you a general treatise on the whole of sur-
gery." — " The author promises, God willing, you shall
soon see other of his works on surgery." These
sentences come in the prefaces of his first, fifth, and
seventh books. Certainly he worked very hard ; his
output for 1 561 was two books of 500 pages between
them ; a year busy with practice, and interrupted by
his breaking his leg — a bad compound fracture.*

* " This accident befell me on May 4, 1561 ; witness M. Nestor,
physician-regent in the Faculty of Medicine, and Richard Hubert
and Antoine Portail, master barber-surgeons of Paris, men of good
renown. They were called, and I with them, to see some patients
at the village of Bons-Hommes, near Paris. It happened thus :
Having to cross the water, and trying to get my mare into the ferry-

opera Omnia 247

Moreover, he lived a double life : with the army in
times of war, at Paris in the intervals of peace ; and
these two lives must be multiplied together, to find
the full strength of his character.

boat, I switched her behind, and the brute gave me such a kick that
she broke both bones of the left leg, four fingers' breadth above the
ankle. Having received the blow, and fearing she would have at me
again, I went back a step, but fell down at once, and the broken
bones stuck out through my flesh, my stocking, and my boot ; whereat
I felt such pain that in my judgment it is not possible for a man to
endure more without dying of it. My bones thus broken, and the
foot displaced, I greatly feared the leg must be cut off, to save my
life ; wherefore turning my eyes and my thoughts to Heaven, I in-
voked the name of God, and prayed Him of His goodness to be will-
ing to help me in my extreme necessity. Forthwith I was put in the
boat, to take me across the water to get my wound dressed ; but the
movement of it almost killed me. . . . Then I was taken to a
house in the village, with even worse pain than I had endured on the
boat : for one took my body, another the leg, and another the foot ;
and on the way one took me to the left, another to the right. . . .
They dressed me with such applications as we could get in the vil-
lage : applying to the wound white of egg, flour, soot from the chim-
ney, and fresh butter melted. I prayed Master Hubert to treat me
as one wholly unknown to him, and in reducing the fracture to forget
the friendship he owed me. . . ."



" Generosity he lias, such as is possible to those who practise an
art, never to those who drive a trade ; discretion, tested by a hundred
secrets ; tact, tried in a thousand embarrassments ; and what are more
important, Heraclean cheerfulness and courage. So it is that he
brings air and cheer into the sickroom, and often enough, though
not so often as he wishes, brings healing." — R. L. Stevenson.

THERE remain some aspects of Park's life which
have yet to be noted. From the beginning of
it to the end, he had good health. Till he was a
man, he lived in country air ; and his father and
mother were not too poor to give their children
decent food and comfort. A healthy simplicity kept
hold of him, body and mind, to the end of the four-
score years. His illnesses were but accidents in a busy
life : a broken leg, a bite from a viper, an attack of
haematuria after posting hard across France, a touch
of sciatica from sitting in a draught, working at night
in his study. Once he fainted, standing over a plague-
stricken patient ; he had the plague himself, late in



FROM Martial's " ancien paris."

Some Aspects of Park's Life 249

life, and pulled through it with a scar as big as the
palm of his hand. Except the toothache, of which
he writes with a grievance, this is the whole list of
his maladies : it would be hard to find a healthier set
of complaints. If there were more, we should know
it ; for he loved to teach the young surgeon by tell-

1 2 3 4 5 6 7 8 9 10 11 12 14 16 17 18

Online LibraryStephen PagetAmbroise Paré and his times, 1510-1590 → online text (page 14 of 18)