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Views & Reviews Medical Classics

The Apologie and Treatise of Ambroise Paré

BMJ 2009; 338 doi: https://doi.org/10.1136/bmj.b203 (Published 28 January 2009) Cite this as: BMJ 2009;338:b203
  1. Harold Ellis, emeritus professor of surgery, University of London

    I first read this brilliant translation in its year of publication, 1951. I had just passed my FRCS examination and was completing my two years of national service. I was enthralled. I have dipped into its pages many times over the years, and I have learnt much from my surgical hero.

    Ambroise Paré (1510-90) trained as a barber surgeon and spent three or four years as a resident surgeon in that great repository of pathology, the Hôtel-Dieu, in Paris. At the age of 26 he began his career in military surgery as a surgeon to the mareschal de Montejan, commander of the French infantry in the campaign in Turin.

    This slim book, translated by the Barts surgeon Geoffrey Keynes from Paré’s medieval French, is in two parts. The first, the Apologie, which was written in 1585, defends Paré’s innovation of ligation of the major vessels in limb amputation. It also describes, in vivid detail, Paré’s management of war wounds in his many military campaigns. The book’s second half comprises a vivid selection of Paré’s other writings, including those on aneurysms, hernias, fractures, cataracts, and lithotomy for bladder stone; there is also an account of his clinical trial of the use of a very valuable bezoar, which had been presented to the Emperor Charles as a specific cure for poisoning. Paré proved, by an experiment on a poor unfortunate condemned prisoner, that, although expensive, it was quite useless.

    Paré’s books (written in French) reveal him as a brilliant innovator and a man who relied on his own observations in the face of the established textbooks (written in Latin). The military surgeons of the 16th century were appalled by the dreadful havoc produced by gunshot wounds, in comparison with the lacerated wounds produced by swords, arrows, and spears. The wounds produced by gun powder became horribly gangrenous and were usually rapidly fatal. We now know, of course, that this was due to clostridial infection of the necrotic tissues—gas gangrene. In those days, long before the science of bacteriology, the phenomenon was ascribed to poisoning by the gunpowder; the remedy: to destroy the poison by cauterising the wound or pouring in boiling oil.

    Ambroise vividly recalls how, in his first battle, he exhausted his supply of boiling oil and resorted to a placebo of egg yolk and rose oil. He describes what was, in fact, perhaps the first controlled clinical trial. Unable to sleep, he visited his patients at first light of day, expecting to see his “control group” dead or dying of poison. To his surprise they were all well and rested, while the conventionally treated patients were all “feverish with great pain and swelling.” Paré, this young inexperienced surgeon, “then resolved never again so cruelly to burn the poor wounded by gunshot.” He went on to show that ligation of major blood vessels could be used in major amputations rather than the advised—and terrible—technique of haemostasis through red hot cautery.

    Paré was essentially a kind and humble man. In his first campaign he ends his description of the treatment of a bullet wound of the ankle with perhaps his most famous phrase: “I dressed the wound, and God healed him.”

    Notes

    Cite this as: BMJ 2009;338:b203

    Footnotes

    • The Apologie and Treatise of Ambroise Paré with many of his writings upon Surgery

    • Edited with an introduction by Geoffrey Keynes, London, 1951

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