Archives of Disease in Childhood 1994; 71: F231-F232 F23 1

Arch Dis Child Fetal Neonatal Ed: first published as 10.1136/fn.71.3.F231 on 1 November 1994. Downloaded from http://fn.bmj.com/ on September 11, 2020 by guest. Protected by copyright.
PERINATAL LESSONS FROM THE PAST

Ambroise Pare (1510-1590): surgeon and

obstetrician of the Renaissance
Peter M Dunn

Ambroise Pare's life spanned most of the

sixteenth century. He was born in a village near
Laval in Maine, to a chest maker. After an
apprenticeship to a barber-surgeon in Angers
from the age of 15, he spent four years
(1532-36) as surgical dresser at the Hotel Dieu
in Paris. Sylvius was one of his teachers. He
qualified as a master barber-surgeon in 1541
and was admitted to the Royal College of
Surgeons in 1554, an institution which he was
eventually invited to head in 1567.
Pare's very active life was divided from 1536
onwards between campaigning as an army
surgeon in France's many wars and practising
in his beloved Paris. Distinction came early.
Even before qualification he had discovered
during the Italian campaign of 1537 that boil-
ing oil was not good for gun shot wounds. As
he used to say: 'I dressed him and God healed
him'. At that time he also rediscovered the
value of the ligature to control haemorrhage
during amputation.'
Pare was a man of the Renaissance and his
medical interests were encyclopaedic. Having
had no formal university education and know-
ing little Latin or Greek (for which he was
derided by the jealous physicians), he based
his knowledge on experience rather than on Ambroise Pare, aged 75 in 1585.
classical dogma. He was a man of indepen-
dence and originality, coupled with great These aphorisms of Pare help to illustrate
power of observation, curiosity, meticulous his practical attitude to his craft:
attention to detail, and an ability to draw broad
conclusions from the evidence before him. 'Hee that would performe any great and
Fortunately, he also had admirable powers notable worke, must diligently apply
of narration and his many writings were himselfe to the knowledge of his subject.'
eventually published as a complete works in 'The Chirurgion must be active, industri-
French in 1575.2 Twenty five books deal with ous, and well handed, and not trust too
subjects as diverse as anatomy, physiology, much to bookes, be they French, or Latin,
medicine, surgery, pathology, pharmacy, or Greek or Hebrew.'
natural history, infectious disease, obstetrics, 'The operations of Chirurgery are lean't by
and demonology. His original descriptions, the eye, and by the touch.'
discoveries, new techniques, and manage- 'Diseases are not to bee cured by eloquence,
ments are endless. As a biographer wrote: 'The but by remedies well and duely applyed.'
breadth, insight, force and humanity of his
writings, their shrewd humour, his infinite care Book 24 of the 'Complete Works' has the
of trifles, the gentleness and clear-headed sense title Of the Generation of Man. It provides a
Department of of his method - they are amazing'. This remarkable insight into sixteenth century
Child Health, volume, which went through several editions obstetrics through Pare's eyes as the following
University of Bristol, and was translated into many languages, had a extracts illustrate.
Southmead Hospital,
Bristol BS1O SNB profound influence on European medicine
P M Dunn during the following 250 years. The English On podalic version and breech
Correspondence to: version from which the extracts that follow are extraction:
Professor Peter Dunn. taken was translated by a London apothecary, 'Then must the chirurgion, having his nailes
Accepted 26 April 1994 Thomas Johnson, and published in 1634. closely pared, and his rings (if hee weare any)
F232 Dunn

Arch Dis Child Fetal Neonatal Ed: first published as 10.1136/fn.71.3.F231 on 1 November 1994. Downloaded from http://fn.bmj.com/ on September 11, 2020 by guest. Protected by copyright.
drawne off his fingers, and his armes naked, string, but it must rather be laid close to the
bare, and well anointed with oyle, gently region of the belly thereof, that thereby the
draw the flappes of the necke of the wombe heat (if there be any jot remaining) may bee
asunder and then let him put his hand gently stirred up againe ...'
into the mouth of the wombe, having first
made it gentle and slippery with much oile; Pare's writings also contain much interest
and when his hand is in, let him finde out the for the paediatrician:
forme and situation of the childe, whether it
be one or two, or whether it be a mole or not. On congenital dislocation of the hip
And when he findeth that he commeth 'There are three general causes of luxations,
naturally, with his head toward the mouth or internal, external and hereditarie ... infants
orifice of the wombe, he must lift him up in the very womb may have their joints dis-
gently and so turne him that his feet may located by a fall, blow, and compression and
come forwards, and when he hath brought by the too much humidity and loosness of
his feet fowards, he must draw one of them the joints: whence also we see many crook
gently out at the necke of the wombe, and legg'd and footed from their nativity ... It
then hee must binde it with some broad and also happens to many from their first con-
soft or silken band a little above the heele formation, that the cavities of their joints are
with an indifferent slack knot and when he less deprest than they should be and that
hath so bound it, he must put it up againe their verges are more dilated than they
into the wombe, then he must put his hand should be; whereby it happens that the
in againe, and find out the other foote, and heads of the bones can the less enter into
draw it also out of the wombe, and when it is them. It falls out, that other forms have the
out of the wombe, let him draw out the other ligaments, appointed by nature for fastening
againe whereunto he had before tyed the one together the bones of the joint, whether
end of the band, and when hee hath them inserted or placed about, so weak, that from
both out, let him join them both close their first original they are not sufficient
together, and so by them by little and little let strength or else abound with much phlem
him draw all the whole body from the ... so that by their too much slipperiness
wombe. Also other women or midwives may they less faithfully contain the knittings or
help the endeavour of the chirurgion, by articulations of the bones. In all these as the
pressing the patients belly with their hands bones are easily dislocated, so they may
downewards as the infant goeth out: and presently be easily restored without the
the woman herselfe by holding her breath assistance of a surgeon, as I have sometimes
and closing her mouth and nostrills, and observed in some.'
by driving her breath downewards with
great violence, may very much helpe the Pare married twice, first to Jehanne Mazelin,
expulsion. I wish him to put backe the foot aged 20, in 1541 by whom he had three
into the wombe againe after he hath tyed it, children and, after her death in 1573, to
because if that he should permit it to remain Jacqueline Rousselot with whom he had six
in the necke of the wombe, it would hinder children. Sadly, none of his sons survived
the entrance of his hand when he putteth it in infancy. Those who knew Ambroise described
to draw out the other ...' him as quiet, gentle, honest and loyal, and one
who kept aloof from the intrigues of the day.
On caessarean section after maternal His religion was the Bible. He loved the
death countryside and animals and was also fond of
'... If all the signes of death appeare in the good wine. He was a man of compassion who
woman that lieth in travell, and cannot be cared for the poor and always strove for peace.
delivered, there must then be a chirurgian Above all, he loved medicine and his country,
ready and at hand, which may open her body France.
so soone as shee is dead, whereby the infant In 1552 Pare was appointed surgeon to
may be preserved in safety... You shall often King Henry II and subsequently served all
times finde the childe unmoveable, as though his three royal sons, Francois II, Charles IX,
hee were dead; but not because he is dead and Henry III. As a Huguenot, he only
indeed, but by reason that he, being destitute survived the St Bartholomew's Massacre in
of the accesse of the spirits by the death of 1572 thanks to the personal protection of
the mother, hath contracted a great weake- Charles IX. In 1574 Henry III made him his
nesse: yet you may know whether hee be chief surgeon, valet de chambre and a member
dead indeed or not, by handling the artery of of the King's Council, a post he still held
the navell, for it will beat and pant if he be in 1587. In 1590, when aged 80, he died
alive, otherwise not; but if there be any life peacefully at his home in Paris, famous, well-
yet remaining in him, shortly after he hath to-do, loved and much respected, the greatest
taken in the aire, and is recreated with the surgeon and doctor of his time.
accesse thereof, he will move all his mem-
bers, and also all his whole body. In so great 1 Paget S. Ambroise Pari and his times, 1510-1590. New York:
a weakenesse or debility ofthe strength of the GP Putnam's Sons, 1897.
childe, the secundine must not bee separated 2 Pare A. The Workes of that famous chirurgion Ambroise Parey.
Translated by T Johnson. London: T Cotes & R Young,
as yet from the childe, by cutting the navell 1634.