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:—
Both God and Nature constantly remind the surgeon that, no matter how poor, in a given case, the prospect of a cure may seem, he should not for one moment cease doing his full duty; for Nature often accomplishes what the surgeon believes to be impossible. Cornelius Celsus [about the time of Jesus Christ] says: “Contingunt in morbis monstra, sicut et in natura.” [Marvels are observed in diseases, very much in the same manner as they are frequently encountered in nature.]
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:—
As soon as I fully realized the true nature of the injury and had examined the mass of tissue (about the size of a small nut) which had been expelled from the wound, I predicted that the patient would probably not recover. A young surgeon who happened to come into the room at this moment, examined the mass of tissue which had escaped from the wound and at once pronounced it to be fat. I assured him that, if he would wait until I had finished dressing the patient’s wound, I would prove to him that the mass was in reality cerebral tissue and not fat.... If this substance, I said, is fat, it will float on the water; but, if it is brain tissue, it will sink at once to the bottom of the dish. And, again, if it is fat it will promptly melt on exposure to heat, whereas brain substance will simply become desiccated. These tests were applied and it was shown that the tissue consisted, as I had declared, of brain substance.
Notwithstanding the apparently serious damage which had been inflicted upon his brain the page made a good recovery, but remained permanently deaf in the right ear.
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.
