Ambroise Paré was born, about the year 1517, at Laval, a small town in the Department of Mayenne, France. His father was probably the valet and barber of the Count of Laval. He went to Paris in early manhood and spent three years, at this period, in fitting himself for the career of a surgeon. He attended lectures on anatomy and surgery, did a certain amount of dissecting, served for over two years as a surgeon’s assistant in the great hospital of Hôtel-Dieu, made notes of some of the cases which he saw, and was occasionally permitted to prescribe for patients and even to perform some minor operations. From 1536 onward, nearly up to the time of his death, he was almost continuously engaged, in the capacity of a surgeon, in accompanying different French armies on their military expeditions. His professional title at first was that of “barber,” but he doubtless very soon discovered that, if he wished to advance, it would be absolutely necessary for him to secure a higher title. Accordingly, in 1541, he and his friend Thierry de Héry presented themselves for, and passed successfully, the required examination and were accepted as “master-barbers.” It is an interesting fact that, during his long professional career, Paré was Chief Surgeon to four Kings of France in succession—first to Henry the Second (1547–1559), next to Francis the Second (1559–1560), then to Charles the Ninth (1560–1574), and finally to Henry the Third (1574–1589). The last-named King bestowed upon him the additional honor of “Councilor to his Majesty.” He also served, during a certain period of his career, as an attending surgeon at Hôtel-Dieu. The three large volumes of Paré’s writings (Malgaigne’s edition) are filled with the rich experience which this great surgeon gained in the course of a large private practice and in the field expeditions and sieges conducted during the reigns of these Kings. Interspersed among the reports of cases and descriptions of operations are to be found not a few comments of a more general character and some biographic details which add greatly to the charm of the work as a whole, and which at the same time make it possible to form a general idea of Paré’s traits of character. On almost every page one finds statements which reveal the fact that he weighed almost all the duties of his daily life in a profoundly religious manner. He showed himself warmly sympathetic for all those whose ailments he was called upon to treat, and he was always as ready to bestow his best services upon the Roman Catholics as upon the Huguenots—to which latter denomination (if we may so call it) he himself is commonly reported to have belonged. It seems to me more probable, however, that he was a liberal-minded Roman Catholic rather than a Protestant, for there is trustworthy evidence showing that all his ten children were baptized in that faith and that he himself, nineteen years before the night of Saint Bartholomew (August 24, 1572), held the office of “Pathe” in the church of the parish in which he lived. Another prominent trait of Paré’s character was the modest estimate which he placed upon his own professional achievements. One of his sayings, which occurs a number of times in his writings and which has since become famous, is this:—

Some of the other sayings attributed to his pen and printed under the heading “Surgical Canons and Rules,” at the end of Book XXVI., are characterized by a homely type of wisdom which seems to have secured for them a permanent place in French literature. I give here in the form of English translations six or seven of the more striking specimens:—

In another place Paré expresses the same sentiment in a somewhat different form, as follows:—

All through his professional career, but more especially during the later years, Paré was repeatedly annoyed by the efforts which the Medical Faculty made to bring him into disrepute. These men were bitterly jealous of him on account of the great favor which he enjoyed at Court, and so they adopted every possible means to injure his reputation. When the complete collection of his writings was published in 1575, they petitioned the authorities not to allow these “works of a very impudent and ignorant man” to be sold until they should have received the official sanction of the Faculty. One of Paré’s chief offenses, as it appears, was that of not writing his treatises in Latin, and among the twenty-nine specifications of his shortcomings was that of plagiarism. (See remarks on this subject further on.)

In his efforts to extend his knowledge of the science of medicine, and in particular to learn what the ancients had written on the subject, Paré soon discovered that many obstacles stood in his way. He did not allow himself, however, to be discouraged by this fact, but set to work, without delay and in his usual resolute fashion, to remove them. He found, in the first place, that all the available treatises of the ancient medical authors were written in Latin, a language of which he possessed scarcely any knowledge. So he was obliged to hire men to translate for his own use large portions of these books. Then, at a later date, after he had begun to accumulate notes for the treatises in which he proposed to publish his own experiences and his own views about the surgical topics in which he was interested, he saw clearly that suitable pictorial illustrations would add materially to the value of the written text, and he therefore did not hesitate to spend a considerable sum of money—Malgaigne says three thousand livres—in having the needed drawings made. Paré was also in no small degree a public benefactor, for he purchased the formulae of some of the more valuable of the remedies employed by the leading charlatans, in order that he might print them and so place them within the reach of everybody.

Paré gives the following picturesque account of his first experiences as an army surgeon in actual warfare:—

In 1545, when he was about twenty-eight years of age, Paré was sent as a military surgeon to Boulogne-sur-Mer, which at that moment was being besieged by the French. In 1544 the city had been captured by the army of Henry the Eighth of England, and fighting of a desultory character was in progress between the besiegers and the besieged at the time of Paré’s arrival. He had not been there a long time when he was asked to see professionally Francis of Lorraine, Duke of Guise, who had been seriously wounded by a lance in a recent encounter with the enemy. The metal head of the weapon, under the impulse of a glancing blow, had penetrated the skin just above the right eye, had then traveled toward the left side and in a slightly downward direction, along the surface of the skull, and had finally come to rest at a point behind and below the left ear, near the nape of the neck. When the lance had penetrated thus far the wooden shaft broke in two, leaving the metal head in its entirety and a part of the shaft so firmly lodged in the wound that great force had to be employed before it was found possible, with the aid of strong pincers, to extract it from its bed. An examination of the injured parts then showed that there had been some fracturing of the bony structures and extensive laceration of the arteries, veins, nerves, etc., but that the left eye had apparently not been seriously damaged. The onlookers were naturally impressed with the belief that the Duke could not possibly recover from such a slashing of the face and head; and Paré himself was careful at first not to commit himself to a prognosis of too favorable a nature. However, he treated the wound with the greatest care and in the course of a few weeks had the satisfaction of seeing his patient restored to perfect health, but with a deeply scarred face.

As can readily be imagined, this experience proved a splendid triumph for Paré, and speedily brought him into great favor at Court and among the nobility throughout France.

For several years subsequent to these events, Paré continued to serve actively as a surgeon in the frequent wars which took place between the royal troops of France and the armies of other European monarchs. In 1552, when he was thirty-five years of age, his rank in the army was raised to that of “Surgeon to the King,” the entire medical staff of that period consisting of twelve surgeons of this rank. In 1554 he was admitted to the Collège de Saint Côme in Paris, the highest professional honor to which a barber-surgeon might aspire; and in 1563, after the siege of Rouen, he received the appointment of “First Surgeon to Charles the Ninth.” After the latter’s death, Henry the Third also appointed Paré to the same position in his Court. Thus, from almost the very beginning of his professional career to the time of his death, Paré was honored in every possible way by four successive Kings of France. It was Charles the Ninth, however, who appears to have taken a greater interest in Paré’s prosperity than did either of the other three Kings. It was at Charles the Ninth’s request, for example, that the brother-in-law of the Duke of Ascot, the Marquis of Auret, sent for Paré to undertake the treatment of a wound which he had received from a harquebus ball seven months previously. Paré gives the following account of this interesting case which foreshadows—for example, in the changing of the patient’s bed and linen and keeping him entertained during convalescence—the best modern hospital nursing:—

After a course of treatment lasting several weeks, Paré says:—

Among the varied experiences which fell to the lot of Paré during his association with Charles the Ninth, there is one which throws a little additional light upon the man’s manner of promptly dealing with an event which, without such promptness of action, might have led to serious consequences.

He was passing through Montpellier one day in company with the King, when he stopped for a few minutes at the shop of an apothecary for the purpose of ascertaining how he preserved alive the vipers which he used in compounding the remedy which is called “theriaca,” and which has been used from time immemorial as an antidote to the poison of venomous serpents. The apothecary placed before him a glass jar in which were kept a number of these reptiles; and, when Paré took one of them up in his fingers in order to obtain a better view of his fangs, the reptile bit him near the tip of his index finger, between the nail and the flesh. The pain which immediately followed was severe, partly, as Paré explains, because the tip of the finger is a very sensitive part, and probably also on account of the irritating effect of the venom. Then, to quote Paré’s own words, “after making firm pressure upon the soft parts above the wound, to prevent the poison from traveling upward, I crowded the skin downward in the hope of forcing as much of the venom as possible out of the finger. While doing these things I instructed the apothecary’s assistant to mix some old theriaca with brandy, and then to apply a pledget of cotton, saturated with the mixture, over the wound. In the course of a few days, and with no other treatment, all effects of the bite disappeared.”

In 1536, two years after his first experience with actual warfare in the vicinity of Susa, Italy, and while he was still very young to assume so great a responsibility, Paré—as we learn from the text of Chapter 28, Book X., of Malgaigne’s edition—performed the operation of exarticulation of the elbow-joint (the first recorded instance of this operation, says von Gurlt). The case was that of a common soldier who had been shot through the forearm, a little above the wrist, who had been treated unsuccessfully by other surgeons, and who, at the time when he came under Paré’s care, was suffering from a variety of complications—viz., gangrene extending as high up as the shoulders, extensive inflammation of the integuments on the adjacent side of the thorax, and other symptoms that pointed toward a fatal issue. To complicate matters, it was winter and the only approximately warm shelter available was a cow-stable. At this early date, in the history of surgery, the practice of ligating the blood-vessels which had been divided in the course of an amputation had not yet been adopted, and consequently the red-hot cautery had to be employed for arresting the bleeding which followed the operation. (See also page 512.) In addition to the amputation it was found necessary to make a number of long and deep incisions into the inflamed tissues and to apply the actual cautery freely “for the purpose of drying up and destroying the virulent matters that had penetrated these parts.” Then, fourteen days later, the patient, who had been lying all this time, exposed to draughts of air, upon a receptacle intended for the storage of grain, and who was protected from the cold by only the scantiest coverings, developed trismus (lockjaw). When this new complication appeared Paré, already at his wits’ end to find means with which to overcome the difficulties which surrounded the case, decided first to have the man removed to an adjacent stall in which there were several cows, the presence of which in such a confined space might be counted upon to increase appreciably the warmth of the surrounding air. Next, he gave orders to rub briskly the back of the patient’s neck, as well as the shoulders, the uninjured arm and the legs, with heated cloths which were immediately afterward to be wrapped around him; and then, for an outside covering, he utilized the straw and cows’ dung which were plentifully within reach. In addition, two braziers which had been procured from a neighboring dwelling, were charged with coals and kept burning close to him. During three successive days and nights these measures were kept up faithfully, and from time to time a mixture of milk and soft egg was introduced into the patient’s mouth through a suitable tube, after the jaws had first been pried open by a bit of willow wood. The effect of these measures was to make the patient perspire copiously and to induce a gentle action of the bowels; and, as a further effect, the trismus was also overcome. For some time afterward, in addition to the ordinary dressing of the healing wounds, it was thought best to apply the red-hot cautery regularly at certain intervals to the end of the bone of the upper arm. (This practice was abandoned by Paré at a later date.) Final and perfect healing took place after several large splinters of bone had been exfoliated.

At the end of his account of what one is tempted to call the wonderful victory of a surgeon over the death that threatened to carry off this gravely wounded soldier, Paré adds one of his characteristic appeals to the oncoming younger generation of physicians:—

In the two preceding histories of actual cases treated,—one of these patients being a wealthy officer of high rank and birth, and the other a common soldier of the peasant class,—we obtain the best of evidence that Paré was not influenced by the wealth, rank or social position of his patients. Upon both classes he bestowed freely the fruits of his knowledge, experience and skill.

The first mention, in medical literature, of a fracture through the neck of the femur close to the joint, is to be found in Chapter 21, Book XIII., of Paré’s treatise (page 753, Vol. II., of Malgaigne’s edition). Furthermore, the first published account of a case of diaphragmatic hernia is that given by Paré. (Von Gurlt.)

In 1538, during a visit to Turin in the capacity of surgeon to the Mareschal de Montjean, Paré was asked by the latter to take charge of one of his pages who had been wounded by a stone which struck him on the right side of the head, causing a fracture of the parietal bone, with escape of a portion of the brain substance from the external wound. The subsequent history of this case is given by Paré in the following words:—

Among Paré’s numerous reports of cases there is one which possesses, as I believe, sufficient interest—as well from the viewpoint of the pathologist as from that of the surgeon—to justify me in reproducing it, in a somewhat condensed form, in the present chapter.

Henry the Second, King of France, while tilting (June 30, 1559) with Gabriel, Count of Montgomery, an officer of that sovereign’s Scottish Lifeguard, received injuries which soon afterward proved fatal. Montgomery’s lance—so Paré’s account states—struck the King’s vizor and, breaking off at the spot where the metal tip or head is attached to the wooden shaft, carried away this part of the helmet. Then, impelled by the force which had originally been communicated to the lance, the splintered end of its shaft struck the King’s now unprotected head with great violence just above the right eyebrow, tore up the skin and underlying muscular tissue of the forehead as far as the outer angle of the left orbit, and finally destroyed the adjacent eye. Five or six of the most experienced surgeons of France were immediately summoned, and Philip the Second, King of Spain, sent Vesalius from Brussels to aid them in their efforts to save the injured King’s life. But all the measures adopted proved of no avail. Henry the Second died on the eleventh day following the injury. Although in the published account no statement is made to the effect that Paré was one of the surgeons who attended the King during his illness, Malgaigne expresses the opinion that he was probably present in the capacity of a consultant; and the interesting comments which he (Paré) makes on the nature and extent of the injury inflicted certainly justify this opinion. No evidence of fracture of the skull was discovered either before death or at the postmortem examination, and the most conspicuous symptoms appear to have been fever and a comatose condition. At the autopsy there was found, on the left side posteriorly, in the occipital region, a clot of blood lying between the pia and the dura mater. The brain substance in the immediate vicinity of the clot was of a yellowish tinge and showed evidences of having already begun to undergo decomposition. Paré’s diagnosis, in this case, was that of violent concussion of the brain with rupture of meningeal vessels by contre-coup at a point opposite to that at which the blow was originally inflicted by the lance. He did not believe that the immediate damage done to the frontal portion of the cranium and to the left eye had anything to do with the fatal issue.

One of the greatest discoveries made by Paré in the domain of surgery is his method of promptly, effectively and safely arresting the bleeding from the divided vessels of the stump after the amputation of a limb. This discovery was made between the years 1552 and 1564, before which period it had been customary to arrest the bleeding by applying the red-hot cautery iron to the exposed ends of the divided vessels. The new method consisted in tying a ligature (preferably doubled) around the free or cut end of the blood-vessel, and allowing it to remain undisturbed in situ until, as the result of a localized suppuration, it should be cast off. The accompanying cuts (Figs. 23 and 24) which have been copied from an earlier edition (1585) of Paré’s work, represent the kind of forceps which he employed in separating the free end of the artery or vein from the soft tissues in which it was imbedded—a preliminary procedure which enabled him to tie the ligature firmly around the vessel. The earlier pattern of forceps (Fig. 23) was not equipped with a spring, the purpose of which was to keep the opposing blades separated, but the later pattern (Fig. 24) has this useful addition. Another instrument which owes its origin to the inventive genius of Paré is the grooved director—an instrument that is of great value to the surgeon, particularly in operations for the relief of strangulated hernia.

Besides the two inventions to which a brief reference has just been made, Paré describes and pictures in his great treatise scores of instruments and apparatus of all sorts, many of them doubtless products of his own inventive genius. But to assign to these contrivances their true value calls for a degree of expert knowledge which I do not possess. Rather than to attempt any such appraisal, I prefer to furnish here a summary of the more important of Paré’s achievements in surgery; for such an enumeration—although it may prove to be in some measure a recapitulation of things that have already been mentioned in the preceding account—may be found useful for purposes of reference:—

It was a very common practice among the medical authors of the sixteenth century—and, indeed, among authors generally—to utilize the writings of their predecessors without giving them proper credit for their work; and Paré, it appears, was not entirely free from this fault. Von Gurlt mentions a few of the more glaring instances of such sinning, and among them the following: Paré’s two chapters on tumors are taken from the “De institutione chirurgica” of Jean Tagault (Paris, 1543), who in turn is charged with having borrowed the data from Guy de Chauliac’s treatise; in his chapter on wounds in general, Paré has also borrowed largely from the same work; and the chapter which he devotes to the subject of special wounds is taken from the writings of Hippocrates; and, finally, he has transferred almost bodily Philippe de Flesselle’s “Introduction pour parvenir à la vraie cognoissance de la chirurgie rationelle.” Before we condemn Paré for plagiarism, and although the facts as stated by von Gurlt are undeniable, we should take several things into careful consideration. It is fitting, for example, that we should make some sort of an estimate of the value of the text thus appropriated, in order that we may be able to measure the seriousness of Paré’s sinning; and, if we do this, we cannot fail to be struck with its insignificance in comparison with the admittedly valuable character of all the remaining text of these three huge volumes—text which bears every mark of being the product of Paré’s brain. Paré himself, in speaking of his borrowings from other authors, says that his acts of this nature are “as harmless as the lighting of one candle from the flame of another.” Then, again, there are several of these borrowings which are evidently the handiwork of a rather dull person, and this fact alone makes one bold to assert that Paré, who was certainly not lacking in brains or in a desire to follow the golden rule in his treatment of the property of such writers, could scarcely have been guilty of such clumsily contrived interpolations. Inasmuch, however, as many important facts bearing upon the question at issue are not within my reach, I am obliged, in my attempt to defend the memory of Paré, to fall back upon speculative reasoning. The medical profession at large has long since heard this charge of plagiarism and it refuses to attach any importance to it as affecting the personal character of Paré. It prefers to believe that he is guiltless and that somebody else—at a time, perhaps, when Paré, being well advanced in years, was too ill to revise the manuscript of the “Collection of his Writings” edited by Guillemeau—thoughtlessly yielded to the impulse to remedy, by borrowing from other sources, the trivial defects or omissions noted in the text. In any case, whatever the actual truth may be, I am, I believe, justified in maintaining that Paré is not rightly chargeable with the guilt of plagiarism.

Strange as it might appear, if history did not furnish many examples of the same character, Paré’s merits as a man and as a surgeon were not as fully appreciated as they deserved to be until after the lapse of nearly two centuries. In 1812 the Société de Médecine de Bordeaux offered a prize for the best eulogy of Ambroise Paré, and it was awarded to Vimont. Finally, in 1840, a fine bust of the distinguished surgeon was completed by the sculptor David of Angers, and set up in bronze in Laval, Paré’s birthplace. The portrait here reproduced from the engraving in von Gurlt’s work represents the bust in question (Fig. 25).

A complete collection of the writings of Paré has been prepared by J. F. Malgaigne, the distinguished French surgeon, and published in three very large volumes (Paris, 1840–1841). This collection is based on a careful comparison and collation of all the previously published editions. The contents of these volumes cover very nearly the entire range of surgery.