The growth of medicine from the earliest times to about 1800

by Albert H. Buck

FIGS. 23 and 24.

FORCEPS DEVISED IN 1552 BY AMBROISE PARÉ FOR DRAWING OUT THE CUT ENDS OF ARTERIES AFTER THE AMPUTATION OF A LIMB, AND HOLDING THEM WHILE THE LIGATURE IS BEING APPLIED.

(From von Gurlt’s Geschichte der Chirurgie, Berlin, 1898.)

Fig. 23 represents the earlier; Fig. 24 the later pattern (see text.)

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:—

The discovery of improved methods of caring for the wounded on the battle-field and of transporting them to a hospital or other refuge; the introduction of better methods of treating wounds inflicted in warfare—especially gunshot wounds; the correction of the idea, universally accepted at the beginning of the sixteenth century, that bullets are sufficiently hot, upon penetration of the skin, to affect injuriously the wounds which they inflict;[93] the substitution of ligation of bleeding vessels (of an amputation stump) for the prevailing practice of applying to them the red-hot cautery iron; the abandonment of the practice of applying the heated cautery iron to the surface of section of a sawed bone; the performance, for the first time, of exarticulation of the elbow-joint; the demonstration of the usefulness of more frequently employing orthopaedic apparatus and prosthetic contrivances; and the introduction of improvements in the operation of trephining the skull.

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.

FIG. 25. AMBROISE PARÉ, THE FAMOUS FRENCH SURGEON OF THE SIXTEENTH CENTURY.