Ambroise Paré and Battlefield Surgery (1545): Gunshot Wounds

Ambroise Paré, a French barber-surgeon, published in 1545 a short book on treating wounds caused by firearms. Based on his experience with the army in Italy, it argued against the standard practice of pouring boiling oil into gunshot wounds and recommended gentle dressings instead. Written in French rather than Latin, the book launched the career of the most celebrated surgeon of the sixteenth century.

Background: guns and surgery

Firearms became common on European battlefields in the late fifteenth and early sixteenth centuries, especially during the long Italian Wars between France and the Habsburgs. Surgeons faced wounds of a new kind. An influential Italian surgeon, Giovanni da Vigo, taught in 1514 that gunpowder poisoned a wound and that the poison should be destroyed by cautery with boiling oil of elder, or by a red-hot iron.

Surgery itself had low status. University-trained physicians wrote in Latin and rarely touched patients, while barber-surgeons, who learned by apprenticeship, carried out operations, set fractures and treated wounds.

Paré was born around 1510 at Bourg-Hersent near Laval, in north-western France. He trained as a barber-surgeon and spent about three years as a resident surgeon at the Hôtel-Dieu, the great hospital of Paris, in the 1530s. In 1537 he joined the army of Marshal René de Montejan in the campaign against Turin in Piedmont.

What happened at Turin

During the fighting around Turin in 1537, Paré treated many soldiers with gunshot wounds. As he later recounted, his supply of boiling oil ran out. He improvised a dressing of egg yolk, oil of roses and turpentine and spent a sleepless night expecting the untreated men to die of poisoning.

The next morning he found the opposite. Those given the dressing were resting with little pain or swelling, while those burned with oil were feverish and in agony. He resolved never again to cauterise gunshot wounds so cruelly. In 1545 he published La méthode de traicter les playes faictes par hacquebutes et aultres bastons à feu (“The Method of Treating Wounds Made by Arquebuses and Other Firearms”), setting out his approach.

Ligatures and later work

Paré’s second major reform concerned amputation. Surgeons usually stopped bleeding by searing the stump with hot irons. Paré instead tied off the major blood vessels with thread, using a forceps called the bec de corbin (“crow’s beak”) to grasp them. The idea was ancient, but he made it practical for battlefield amputations and described it in his Dix livres de la chirurgie of 1564.

Paré also designed artificial limbs, described the sensation of a phantom limb after amputation, and wrote on obstetrics, including turning a baby in the womb to deliver it feet first. In 1567, at court, he tested the supposed antidote called the bezoar stone on a condemned cook who had agreed to take poison; the man died, and Paré concluded that the remedy was worthless. His collected Œuvres appeared in 1575 and, because they were written in French and touched on medical topics, provoked opposition from the Paris Faculty of Medicine.

Key people

• Ambroise Paré (c. 1510–1590): barber-surgeon, military surgeon and royal surgeon.
• Henry II of France: fatally wounded in a joust in 1559; Paré and Andreas Vesalius were among those who attended him.
• Charles IX of France: king during the St Bartholomew’s Day massacre of 1572, who kept Paré close at court.
• Giovanni da Vigo: Italian surgeon whose teaching on poisoned gunshot wounds Paré rejected.

Legacy

Paré served on many campaigns, including the siege of Metz in 1552, and became surgeon to four kings: Henry II, Francis II, Charles IX and Henry III. He died in Paris on 20 December 1590. His works were translated into Latin, English, German and Dutch and remained in use well into the seventeenth century.

His reputation rests on a combination of practical experiment, humane care and clear writing for working surgeons. Like his contemporary Paracelsus, he valued experience over textbook authority, but he expressed it with famous modesty: “I dressed him, and God healed him.”

Myths and facts

• Myth: Paré was a Protestant saved from the 1572 massacre by the king. Fact: the story comes from the memoirist Brantôme; Paré’s religion is debated, and most historians think he was a Catholic.
• Myth: Paré invented the ligature. Fact: ligature was known in antiquity; Paré revived and popularised it for amputations.

Timeline

• c. 1510: Paré born at Bourg-Hersent, near Laval.
• 1530s: trains as house surgeon at the Hôtel-Dieu, Paris.
• 1537: serves in the Turin campaign and abandons boiling oil.
• 1545: publishes his treatise on gunshot wounds.
• 1552: serves at the siege of Metz.
• 1559, July: attends the fatally wounded Henry II.
• 1564: describes ligatures for amputation in Dix livres de la chirurgie.
• 1575: publishes his collected works.
• 1590, 20 December: dies in Paris.

Why it matters

Paré showed that careful observation could overturn a widespread and painful practice. His gentler wound care and use of ligatures saved lives, raised the status of surgery and laid foundations for modern surgical practice.