L.O. To understand the importance of Ambroise Pare

In 1552 I was appointed surgeon to King Henri II of France. I now had official royal approval for my work and continued to write medical texts. In 1545 I published my first work upon the Method of Treating Wounds. In 1575 my Collected Works was published and in 1585 The Apology and Treatise of Ambroise Pare. This last text was based upon my own life experience and the methods of treatment I had adopted. I was born in France in My father was a Barber Surgeon and I followed in his footsteps by training as a Barber Surgeon myself in However, in 1534 I became surgeon to the Hotel- Dieu, the only public hospital in the whole of France. I left the Hotel-Dieu in 1537 to become a military surgeon. It was during this time that I learnt a lot about surgery as I had to deal with many terrible wounds – many caused by muskets.

In 1552 I was appointed surgeon to King Henri II of France. I now had official royal approval for my work and continued to write medical texts. In 1545 I published my first work upon the Method of Treating Wounds. In 1575 my Collected Works was published and in 1585 The Apology and Treatise of Ambroise Pare. This last text was based upon my own life experience and the methods of treatment I had adopted.

Gunshot wounds During The Renaissance muskets were being used more and more during battles. Gunshot wounds therefore became an increasing problem for surgeons. Can you think of any problems associated with gunshot wounds that surgeons during The Renaissance would have to deal with?

Gunshot wounds The scale of damage caused by musket balls entering and exiting the body (Shattered bone, ripped muscle and tissue, etc) During The Renaissance muskets were being used more and more during battles. Gunshot wounds therefore became an increasing problem for surgeons. Can you think of any problems associated with gunshot wounds that surgeons during The Renaissance would have to deal with?

Gunshot wounds Musket balls carrying infection deep inside the body. Musket balls dragged dirt, material and lead with them as they entered the body The scale of damage caused by musket balls entering and exiting the body (Shattered bone, ripped muscle and tissue, etc) During The Renaissance muskets were being used more and more during battles. Gunshot wounds therefore became an increasing problem for surgeons. Can you think of any problems associated with gunshot wounds that surgeons during The Renaissance would have to deal with?

Gunshot wounds Musket balls carrying infection deep inside the body. Musket balls dragged dirt, material and lead with them as they entered the body The scale of damage caused by musket balls entering and exiting the body (Shattered bone, ripped muscle and tissue, etc) New methods of surgery had to be learnt to deal with the new types of wounds being encountered During The Renaissance muskets were being used more and more during battles. Gunshot wounds therefore became an increasing problem for surgeons. Can you think of any problems associated with gunshot wounds that surgeons during The Renaissance would have to deal with? Patients often died from bleeding or shock caused by excessive pain

Questions: 1)What is the title of this text? 2) What does the top right hand picture show? 3) What does the top left hand picture show? 4) Why do you think that the human skeleton and figure have been placed at the centre of the title page ? 5) Describe some of the operating tools seen on this page Image courtesy of the U.S. National Library of Medicine

Using hot oil Pare used the accepted treatment for gunshot wounds used by surgeons at the time – cauterisation - until he stumbled across a new method for treating these injuries. Cauterisation involved burning the wound, either with a red hot cautery iron, or by pouring boiling hot oil (sometimes mixed with treacle) into the wound. Pare knew that this method of treating wounds caused the patient great pain, but did as the other surgeons did, applying the oil as hot as possible to burn away any possible infection that had set in. Then, one day he ran out of oil and was forced to use an alternative.

Egg YolkRose OilTurpentine Pare had published his idea for treating gunshot wounds in The account of how he made his discovery was not published however until 1585 in The Apology. I wonder what Pare may have been apologising for? Pare describes how he ran out of oil and was ‘forced to use an ointment made from yolks of eggs, oil of roses, and turpentine’. Pare feared that this mixture may cause the soldiers he was treating more pain as infection set into the wound. He also feared that he would return to his patients the next day to find many of them dead. The patients however told Pare the next morning that the swelling around their wounds had gone down and that they felt little pain. Those who had been treated before the oil ran out were much worse off. They were in pain and many were ‘feverish with….swelling about the edges of their wounds.’

PAIN INFECTIONBLEEDING In order for surgery to be successful the surgeon has to combat the problems of Pain, Infection and Bleeding. Pare knew this and through his work tried to tackle and combat the problems associated with each.

With a lack of anaesthetics before and during The Renaissance, doctors and surgeons knew that their patients could suffer a great deal from the pain that they felt when injured or wounded. They were also aware of the dangers involved in operating upon patients. Without adequate anaesthetics (patients were often given wine or were knocked out) there was the risk that the patient would feel a great deal of pain and would be conscious for much of the during the operation. Patients were also as likely to die of shock on the operating table as from the infection that set in the wound after the operation was over. Anaesthetics – Something, usually a drug, that causes a loss of sensation (such as feeling or pain).

With a lack of antiseptics before and during The Renaissance, doctors and surgeons knew that their patients could suffer a great deal from the infection that set into a wound before an operation. They were also aware of the dangers involved in operating upon patients. Without adequate antiseptics there was a risk that the surgeon would put germs into the wound himself, sealing the infection deep within the patient. Because there was no knowledge of germs, medical instruments were not always cleaned thoroughly and surgeons themselves often failed to ensure that their hands were clean of dirt and bacteria. It would be some time – long after The Renaissance - before doctors wore masks and gowns and sterilised their equipment. Antiseptics – Substances that help to prevent infection.

If patients lost a lot of blood, either during an operation or from a particularly bad wound, they were in great danger of not only losing their strength, but of their body not being able to function properly. In short, they were in all probability going to die. Surgeons during this time could not, as we do today, transfuse blood or put it back. Some doctors had experimented with blood transfusions, trying to replace a human’s lost blood (usually with an animal’s), but patients rarely lived for long afterwards. Doctors and surgeons did not know, as we do today, about such important factors that influence blood transfusions, such as how to store blood and knowledge of blood groups. Pare, like most surgeons, realised that veins and arteries had to be tied up speedily so that bleeding could be stopped. Pare therefore used a Crow’s Beak (an instrument that looks like a set of pliers) to pull out the arteries and silk thread to sew them up.

What type of surgical instruments can you see? What do you think each instrument was used for?

Tools of the Surgeons trade. * Knives to open and split flesh * Forceps to pull the flesh apart and to extract parts of the body * Saws for cutting through bone * Hammers for driving in instruments or breaking bone * A needle and thread for sewing up wounds Pare maintained that the patient should gather strength before an amputation by eating ‘meats, yolks of eggs, and bread toasted and dipped in wine’. A ligature should then be tied above the area where the operation (cutting) is to take place. The flesh should then be cut with a sharp, preferably crooked knife down to the bone. You then saw through the bone with a small saw (one foot and three inches long), then smooth the front of the bone with a file, or some same instrument.

Pare maintained that you should only cut away what is necessary – the diseased or infected area of the body. Pare also advised that the veins and arteries be allowed to bleed a little before being tied up as quickly as possible. Pare used a crows beak (which looks like a set of crooked pliers) to pull out the arteries and veins. He then used a double silk thread to tie them off. Pare had, before developing this method, used hot irons to seal the wound and stop the bleeding. But, as he states in Of Amputations, which appeared in his Collected Works, he was troubled by the ‘great and tormenting pain’ that this caused patients. He left ‘this old and too cruel way of healing and embraced the new ’.

What do you think Pare is doing here? What can you find around the room to support your theory?

People had mixed herbs and plants to create ointments and medicines for thousands of years before The Renaissance. Apothecaries opened shops and sold these mixtures that were often based upon remedies that had been handed down over generations. Plants that were made into a plaster and applied for joint pain. Tinctures (liquid made with alcohol), Poultices (solids mixed into a paste and applied to wounds and bruises) and Infusions (boiling water poured over leaves or flowers) were all used by apothecaries. Pare himself mixed together Rose Oil, Turpentine and Egg Yolk into an ointment which he applied to gunshot wounds, instead of using the traditional method of cauterising, or burning the wound with hot oil.