It is always wise to hold out hope to the patient, even if the symptoms point strongly to a fatal issue.
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 1536, he says, I accompanied the large army sent to Turin by Francis the First, King of France, to retake certain castles and fortifications which were held at that time by the troops of the Emperor Charles the Fifth. My official position was that of surgeon to the foot soldiers; and when our men took possession of Susa, after the enemy had been defeated, I was among the first to enter the city. Our horses rode rough-shod over the dead bodies lying on the roadway, and over the bodies of many who were simply wounded. It excited my compassion strongly to hear the cries of those who were thus subjected to great additional suffering, and I could not help wishing that I had never left Paris. Once actually in the city, I began to look around for a stable in which the horses of myself and my orderly might find shelter. The one I entered contained the corpses of four soldiers who had presumably died there, and three badly wounded men who were still alive, but whose faces were greatly disfigured by the wounds which they had received, and who—as we soon learned—were unable to see, hear or speak. An old soldier who entered the stable at that moment, and whose pity was excited by what he saw, asked me if it would be possible to save the lives of the men who were so badly injured. I replied “No.” He thereupon proceeded, without the least excitement and with due gentleness, to cut the throats of all three. At the sight of this act, of what seemed to me to be great cruelty, I exclaimed, “You are a wicked man!” His reply was: “I pray God that, if it should ever be my fate to be situated as these three men were when I entered the stable, there may be somebody at hand who will do to me what I have just done to these men, and will save me from a lingering and painful death.”
When the fighting was entirely over, we surgeons had much work to do. I had not yet had any personal experience with the treatment of gunshot wounds, but I had read in Giovanni da Vigo’s work that such injuries should be considered poisoned wounds, by reason of their contact with gunpowder, and that the correct way of treating such wounds was to cauterize them with oil of sambucus (elder flowers) that was actually boiling and to which a little theriaca had been added. At first I hesitated somewhat about carrying out this practice, but after watching the other surgeons, in order to learn exactly how they applied the boiling oil, I plucked up my courage and did exactly what they did. My supply of oil, however, soon gave out, and I then decided to use as a substitute a healing preparation composed of yolk of egg, oil of roses, and turpentine. I slept badly that night, as I greatly feared that, when I came to examine the wounded on the following morning, I should find that those whose wounds I had failed to treat with boiling oil had died from poisoning. I arose at a very early hour, and was much surprised to discover that the wounds to which I had applied the egg and turpentine mixture were doing well; they were quite free from swelling and from all evidence of inflammatory action; and the patients themselves, who showed no signs of feverishness, said that they had experienced little or no pain and had slept quite well.
On the other hand the men to whose wounds I had applied the boiling oil said that they had experienced during the night, and were still suffering from, much pain at the seat of the injury; and I found that they were feverish and that their wounds were inflamed and swollen. After thinking the matter over carefully, I made up my mind that thenceforward I should abstain wholly from the painful practice of treating gunshot wounds with boiling oil.
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:—