The growth of medicine from the earliest times to about 1800

by Albert H. Buck

On arriving at the Chateau of Auret, writes Paré, which is located not far from Mons in Belgium, I learned that the harquebus ball had entered the thigh near the knee, had done considerable damage to the soft parts, and had fractured the femur. When I was ushered into his bedchamber, I found the Marquis very much emaciated, his eyes deeply sunken in their sockets, his skin hot and of a yellowish hue, and his voice feeble like that of man very near to death.... The leg was drawn up against the wall of the abdomen, and two large bedsores were visible posteriorly—one near the root of the spine and the other somewhat higher up. Thus it was impossible for the patient to assume any posture in which he would be free from suffering.... All things considered, it did not seem to me that the Marquis could possibly recover from such a combination of bodily ills. Nevertheless, to give him some encouragement,—for he was very low in spirits,—I told him that, with the aid of God and the assistance of his regular medical attendants, I would soon have him on his feet again....

After dinner, in the presence of the Duke of Ascot, a few friends of the family, and the assembled physicians and surgeons, I expressed considerable surprise that free openings had not been made in the Marquis’s wounded thigh, in which bone caries and decomposition of the resulting discharge were already well established. The medical attendants replied that the patient was unwilling to submit to any such measures, and that he had even forbidden them to substitute clean linen bedclothes for those which were soiled and which had not been changed during the previous two months....

When the consultation had come to an end and the local medical attendants had given their full approval of the different measures which I recommended, ... I proceeded to carry them out without further delay.

Two or three hours after the completion of this operative work I instructed the house servants who were in immediate attendance upon the Marquis to place alongside his bed a second one equipped with a soft mattress, over which a fresh linen sheet, etc., had been spread. The transfer from one bed to the other was easily effected by a strong attendant, and when the change had been made the Marquis manifested great contentment. Two feather pillows were so placed under his back and loins that no pressure whatever would be made upon his bedsores. A refreshing sleep of four hours’ duration followed the adoption of these different measures, and there was much rejoicing in the entire household.

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

Under this treatment the fever steadily diminished, the pain grew less and less, and the patient’s strength increased. When the proper moment arrived, I advised the Marquis to engage the services of some musicians (players on stringed instruments) and one or two comedians, in order that his spirits might be cheered by occasional entertainments of this character. Already at the end of one month we found it practicable to carry him in a chair into the garden and as far as the entrance gate, where he could watch the passers-by. When it became known among the peasants that he was in the habit of sitting close to the highway, they came from far and near to sing and dance in groups for his entertainment. He was greatly loved by both the common people and the nobility.

At the end of six weeks the Marquis was able to get about on crutches, and two weeks later still I bade him good bye and returned to Paris. Before I left he presented me with a gift of great value, and the Duchess of Ascot insisted on my accepting a beautiful diamond ring as a mark of her appreciation of the services which I had rendered her brother.

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.