292 Journal of the Royal Society of Medicine Volume 85 May 1992
Premier Chirurgien du Rol: the life of Ambroise Pare (1510-1590)
M Shah MB ChB Department of Neurology, Dudley Road Hospital, Birmingham B18 7QH
Keywords: medical history; Ambroise Par6; Renaissance surgery
'In 1624 the Parliament of Paris issued a decree banishing
all who publicly maintained theses against Aristotle'
G H Lewes, History of Philosophy
It is 400 years since the death of one of the founding
fathers of modern surgery, the Frenchman, Ambroise
Pare. He possessed exceptional qualities that kept
not only himself, but his innovative work alive,
in an age of superstition and savagery. By a pro-
cess of scientific study, careful reasoning- and
observation, he was able to explode many ofthe myths
and traditions that were holding medicine back in the
16th century. Moreover, he was instrumental in the
elevation of surgery from a disordered, undisciplined
state to the respected profession it is today.
Surgery of the Renaissance
Although the renewal of classical learning in the 14th
to the 16th centuries furthered the development of art,
it had no immediate impact on the progress of science
and medicine. Scientific investigation was confined
to the study of the writings ofthe classical Greek and
Roman authors, principally Aristotle, Hippocrates
and Galen. Indeed, as the opening quotation suggests,
it was almost an impiety to question these works.
With the great anatomical awakening of the 16th
century came the birth of modern surgery. Those who
were to put the marvel of anatomy into practice were
hitherto of a contemptuous, despised profession; the
barber-surgeons.
Pare: the early years
The young Pare started his professional career as an
apprentice barber-surgeon. Around 1533 he was
appointed resident surgeon at the famous Hotel-Dieu,
the only public hospital in Paris at that time. After
3 years of invaluable experience khe left Paris to
become a military surgeon. His first campaign in 1537
was to Piedmont and Turin, serving under the army
commander Anne de Montmorency. It was during this
initial campaign that Par6 made his first major
contribution to surgery.
During the 16th and preceding centuries, gunshot
wounds were believed to be poisonous. The standard
treatment of such injuries was the application of
boiling oil to the raw flesh. During one particularly
bloody battle in the taking of the castle of Villiers,
the casualties were so numerous that Par6 ran out
of oil. Instead he was forced to apply a 'digestive of
egg yolk, rose oil and turpentine'". After a restless
night Par6 rose early, fully expecting to find his
patients dead from poisoning. However, he was
amazed to find those treated with his 'digestive
Correspondence to: Dr M Shah, 15 St Denis Road, Selly Oak,
Birmingham B29 4LN
Figure 1. The use ofpodalic version
medication' were relatively well, whilst those treated
with oil were feverish and in great pain. Afterwards
he wrote 'Then I resolved never again to so cruelly
burn the poor wounded by gunshot'". This discovery
led to the publication of his first book in 15452,
recommending the use of bland, soothing ointments
for gunshot wounds and amputations.
Pare's early career was not confined to treating the
casualties of war. He studied anatomy at every,
opportunity and, in 1549, he published a small
anatomy treatise containing a section on obstetrics3.
It was remarlable in that it included the first printed
description of the use of podalic version (Figure 1).
The King's surgeon
By 1552 Pare's reputation was such that he was taken
into the service of the King, Henri II. In the same
year the King sent Pare to the city of Metz, then
surrounded by the Imperial forces of Emperor
Charles I. He was smuggled through the besieger's
lines to tend to the city'"sick and wounded. Pare's
reputation in surgery and his humane attitude
towards the poor made him especially popular. He had
previously gained fame as 'the charitable surgeon'
during a campaign in Germany, when he saved the
lives of many common soldiers. On Christmas day
1552 the siege was abandoned.
The following year, at the siege of Hesdin, Pare
was not so lucky. The Spanish, incensed by their
defeat at Metz, attacked the great fort of Hesdin
in considerable numbers. Pare was sent to aid the
ill-prepared defenders. When the garrison surrendered
the Spanish marched into the fort, putting to death
most ofthe remaining soldiers, sparing only a handful
of noblemen for ransom. Par6, fearing discovery as
the King's surgeon, disguised himself as one of the
aids of the wounded commander, Lord Martigues, 0141 0768/92/
thereby narrowly escaping death. Unfortunately, 050292A03/$02.00/0
©
Martigues had been mortally wounded, and on his 1992
death several days later, Par6 was instructed to The Royal
perform an autopsy. He did this with such skill and Society of
authority that he was immediately asked to enter the Medicine
 Journal of the Royal Society of Medicine Volume 85 May 1992 293

"TgAN ofSWftigt.o*w"k-dwSW,7. 1567 saw the onset of the Second War-of Religion.
-r.`.I=M_
ifl _ Whilst continuing to treat the casualties of war, Par6
tried unsuccessfully, to unite the French, surgeons
under the King's Premier Surgeon. This move was
swiftly blocked by the Faculty of Physicians.
Increasing age did nothing to stem the multitude
of significant works produced by the great man. He
continued to treat the injured of war and published
another aurgical book in 1572, 'Cinq livres de
chirurgie
' , which, contains the first description of
firacture of the head of femur. Later that year on 24
August, the infamous St Bartholomew's day massacre
Figure 2. An example of 16th century saws* of French Huguenots occurred in Paris6. It- is almost
certain Pare would himself have been murdered had-
service of his captor, the Duke of SavQy. When Pare', it iotbeen for the interention the King. Although
refused he was put under the charge of Monsieur de, atl
_Par6,was,outwardly Catholic, his -allegiance. was
Vaudeville, Governor of Graveline. This may have probably to the Protestant,faith. -As far back as
been the end of an illustrious career had this October 1562 he had been deliberately poisoned by
ingenious surgeon not bargained his own liberty by the Catholics in Rouen'. Even so, Par6 held himself
curing his captor's chronically ulcerated leg. above religious arguments and continued to care for
When Henri II died in 1559, Pare performed the. all patients whatever their faith or status. This
autopsy and embalmment of the body. He had the i g h f i b C a
unfortunate honour of repeating this process some 18 Protestant camps, and probably saved his life on more
months later for Francois II, Henri U's successor. than one occasion.
1562 saw the promotion of Par6 to the post of Premier
Surgeon to King Charles IX. It also heralded the onset The twilight years
of the bloody First War of Religion. Once more Pare In the final years of his life, Pare devoted much of his
gained enormous experience of battlefield surgery, time to defending his own works, whilst condemning
enabling him to write his 'Dix livres de la-chirurgie, talton and superstitions common in medicine at
published in 15644. This hitoric book describes the that time. He incurred the wrath of the-p.owerul
first use of ligatures in amputations. Prior-
* to this
limbs were simply sawn off quickly and the raw flesh ~~~~Facuilty
of Physicians for his denunciation of the use
of 'mummy and unicorn's horn', long established
was cauterized with red-hot irons (Figure 2). Par6Es ics of the pra
apothecaries and physicianS7.
humane~~~~ ~ ~reasonefof
~ reomehegligationle thatcn
humane reason for recommendig ligation was that =Henri wasIII elevated Pare to the position of Premier
crushing ofthe nerves nunibe the hiimb,-significantlyLxx
crushing of the
nreSurgeon,
Corseiller and Valet-de-Chambre in 1574.
reducingpain and sufferingtoatoe patient. Performing Despite his high rank, as a surgeon he was not
so many amputations enabled him to ue and develop O immune to,repeated
attack by the physicians. He was
a great number of artificial limbs and aids (Figure 3). denounced as a charlatan in 1575 on the publication
of his greatest work, 'Ls Oeuvres de Monsieur
'lbe de Ltgs xm* mfciatfcriptiea
LeironsAmbroise
of Par6'1, a collection mainly of earlier works,
forming a complete surgical treatise. The Faculty of
Physicians was incensed that it liad been published
. r -inn Fr~±ich
; rather than Latin. Publication was allowed
.nly after:intense
Paris Parliament.
debate, a.nd intervention by the
On the 20 December 1590 Ambroise Par6 died in
* 4 Paris. Dogma, tradition and conqervatism were still
torule medicine and surgery for many years to come,
but the.seed.of scientific investigation had. been well
-and tru own. That bright flame of knowledge and
-truth, extinguished since classical time had been-
\, { z- .tt_ ~~~~~~rekled

eConclusion
* 1 g ' Ft> _ | - AAmbroise Par6 is credited with making four major
coJBributions to medicine. Firstly the discovery that
gunshot wounds were not 'poisonous' and the use of
bland ointments was superior to, hot oil for their
treatment. Secondly he described the treatment of
-3 s rl....
/ .amputations
i1 with ligature, rather ilian cauttery. He
Alal prdiuced the first prntedAescrpo of lic
D1 version, and helped make popular -the-extensive use
*13 ] - |2 | ^ of artificiil limbs. -
- a IThere_ awere other discoveries Xto. Par6 was the first
_ ... ~o-Xcument liver abscess following head injury,
the-,firstJto describe salivary fistulae, the first to
m--putate through a-n infeeted joint in an extremity
and- 'fi'rt to remove a foreign bod fiom the
Figure 3. Artificial iron leg ,: knees. Whilst serving on the Plague Commission in
294 Journal of the Royal Society of Medicine Volume 85 May 1992
Paris, he wrote a book containing the first description
of liver and lung abscess in plague8.
His discoveries which were of tremendous import-
ance, his dynamic character and his charisma helped
elevate this little-known barber-surgeon to the rank
of surgeon to four kings. Par6 e xtraordinary
qualities for a man of his time.- He wasrespected by
rich and poor alike for his skills, humaity and
courage. He was a man who stood steadfastly by -his
beliefs, at a time when many were being persecuted
for views contrary to the established religious and.
scientific bodies.
At a time when surgery was struggling for
recognition, Pare's influence helped- carry the
profession from the Dark Ages- through to the
enlightened times of the Renaine. His struggle
against prejudice and established dogma is as
relevant today as it was 400 years ago.
Acknowledgments: The figures are taken from: Johnson T.
The Works of that Famous Chirurgion Ambroise Parey.
Forthcoming events
continued from p276
EUROCHIRURGIE/EUROSURGERY 192
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References
1 Par4 A. Les Ouvres de M. Ambro'se Pir. Pai , 1575..
2 Par6 A. La Methode de trakcer lee plzyes. Paris, 1545
3 Par6 A. Briefve collection de l'administration anatomique.
Paris, 1549 A.
4 Par6 A. Dix livres de la.ch4iq 'Paris, 1564
5 Par6 A. Vinq livres de- ri. Paris, 1572
6 Malgaigne JF. Oevres compktes d'Ambroise Pare. Paris:
JB Bailliere, 3 vols, 1840-1
7 Keynes G. The Apologie and Treatise ofAmbroise Pare.
Chicago: University of Chicago Press, 1952
8 Par6A. Traicte de la peste ... .eroll... rougeolk ...
lepre. Paris, 1568
(Accepted 22 May 1991)
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