What war is good for

What war is good for

Cite this as:BMJ2011;342:d2416

Wendy Moore, freelance writer and author, London

“War—what is it good for?” asks the old protest song. Advances in surgery, if nothing else, might be the answer. The patients of the French surgeon Ambroise Paré (1510–90) certainly benefited from his long experience treating the casualties of muskets and cannons in the conflicts that ravaged Renaissance Europe.

From humble origins, Paré was apprenticed to a barber before he enrolled as a trainee surgeon at the Hôtel-Dieu, Paris. After joining his first military campaign at the age of 27, he spent almost 30 years amputating limbs and excising musket balls on European battlefields, and applied the lessons he learnt to improving surgery for all. Despite his rise to the rank of royal surgeon to three French kings, Paré wrote his many books on surgery in French rather than the customary Latin and remained humble and open minded about his craft.

Decades of wading through blood did not inure Paré to the horrors of warfare. Musing on the inventor of the gun, he concluded, “I think the deviser of this deadly Engine hath this for recompense that his name should be hidden by the darkness of perpetual ignorance.”

Paré made his most famous discovery on his first outing as a rookie army surgeon during an expedition to Italy in 1536. Following standard practice, he was cauterising gunshot wounds with scalding oil, based on the common belief that this neutralised the supposed poison in gunpowder. When he ran out of oil, in desperation Paré applied a salve of egg yolk, rose oil, and turpentine to the wounds. Unable to sleep that night from guilt, he rose early the next day to discover those soldiers treated with the salve were healing while their fellows scalded with oil still writhed in feverish pain.

Importantly, Paré resolved to apply the results of his unintentional randomised controlled trial to future practice, deciding that “neither I nor any other should ever cauterise any wounded with gun-shot.”

Paré popularised his finding in the first of many medical texts, his Treatise on Gunshot Wounds, published in 1545. He applied the same scientific method to test a folk remedy of raw onions on a boy who fell into a cauldron of scalding oil. Paré coated some injured areas with onion salve and others with orthodox remedies, and found that the folk remedy reduced blistering. Always mindful to reduce pain and diminish suffering, Paré also pioneered ligatures in amputations, designed prosthetic limbs, and championed podalic version in obstetrics.

With a wit as sharp as his amputation knife, his works were dedicated to promoting rational medicine and dispelling superstition. His “rules of chirurgy” were simple and logical, beginning with the sage observation, “Health is not received by words, but by remedies fitly used.” Poignantly, Paré countered criticism from snobbish physicians in his Apologia, published when he was 75 years old, detailing his vast battlefield experience with clinical precision. Addressed to Étienne Gourmelen, dean of the faculty of physicians, Paré wrote, “My little master, I wish you had been there.”

 

Notes

 

Cite this as: BMJ 2011;342:d2416

 

Footnotes

• Source: Paré, Ambroise. The Collected Works of Ambroise Paré, translated out of the Latin by Thomas Johnson. London, 1634 (first published 1575).

http://www.bmj.com/content/342/bmj.d2416