744901

research-article2017
SRIXXX10.1177/1553350617744901Surgical InnovationMarkatos et al

History of Innovation
Surgical Innovation

Ambroise Paré (1510-1590) and His

2018, Vol. 25(2) 183­–186
© The Author(s) 2017
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DOI: 10.1177/1553350617744901
https://doi.org/10.1177/1553350617744901

War Injuries journals.sagepub.com/home/sri

Konstantinos Markatos, MD, PhD1  , Anna Tzivra, MD, PhD2,

Spyridon Tsoutsos, MD, PhD2, Gerasimos Tsourouflis, MD, PhD3,
Marianna Karamanou, MD, PhD1, and Georgios Androutsos, MD, PhD1

Abstract
The purpose of this study is to summarize the innovations of Ambroise Paré (1510-1590) on the treatment of war
wounds and improving amputation technique through ligature in arteries and veins. Ambroise Paré debunked the
widely accepted idea that gun powder was poisonous for wounds. He also minimized the use of cautery of wounds by
his dressing methods and the application of ligature during amputations. All these innovative rationales revolutionized
the practice of war surgery during the Renaissance and paved the way for the introduction of modern surgery.
Nevertheless, although his wound dressing innovations became widely accepted, the same did not happen with ligature
and amputation; those techniques could become widely applicable if one could somehow control bleeding until the
blood vessels had been tied. This became possible much later in the 18th century when Jean Louis Petit invented the
first useful and efficient tourniquet.

Keywords
history of medicine, orthopedic surgery, surgical education

Introduction Barber-surgeons had earned the right to be taught anatomy

Ambroise Paré (1510-1590) (Figure 1) was one of the
most prominent surgeons of his time. For many, he is
considered as the “Father of Modern Surgery.” The son of
a barber-surgeon and a trained barber-surgeon himself, he
managed to overcome the obstacles of not having signifi-
cant academic education that he was not provided with.
He was one of the most significant innovators of the
Renaissance in the fields of military operation, bandages,
wound healing, bloodletting, close blood vessels tech-
niques, and cesarean section.1
The purpose of this study is to summarize his innova-
tions on treating war wounds and improving amputation
technique through ligature in arteries and veins.
and surgery in the medical school of Paris and shortly after
they could take the official master-barber’s examination; in
this way they became accepted and recognized in the aca-
demic circles as a distinct professional class.1-3
Ambroise Paré became an apprentice barber-surgeon
at an early age; later on he became barber-surgeon at the
Hotel Dieu, Paris, and surgeon in the army of Francis I
(1536-1538). He reenlisted on the French army multiple
times, and in 1545 he began the study of anatomy at Paris,
under François-Jacques Dubois (Sylvius). He was
appointed as a field surgeon by Marshal Rohan, and in
1552, he was named surgeon to King Henry II.2,3
For the next decade, he followed the French Army where
he acquired a significant experience in traumatology. He

The Biography of Ambroise Paré 1

Biomedical Research Foundation of the Academy of Athens, Athens,
Ambroise Paré was born in 1510 in Bourg-Hersent in Greece
2
Kapandriti Medical Center, Oropos, Attiki, Athens, Greece
northwestern France. At the age of 19, he was admitted at 3
National and Kapodistrian University of Athens, Athens, Greece
the Hotel-Dieu Hospital of Paris where the most famous
barber-surgeon school of the time was active. There, he Corresponding Author:
Konstantinos Markatos, Biomedical Research Foundation of the
studied and worked for 4 years. By the time Paré entered
Academy of Athens, 4 Soranou Ephessiou Street, Athens 11527,
the Hotel Dieu, the University of Paris had started to use Greece.
barber-surgeons and their expertise in its education system. Email: gerkremer@yahoo.gr
184 Surgical Innovation 25(2)
Figure 1.  Portrait of Ambroise Paré (1510-1590).
was a great reformer of surgery at a time when most sur-
geons supported the advantages of blood loss for trauma
patients. His contribution was acknowledged in 1554 when
he became a fellow of the College of Surgeons of Saint-
Come.1,2 In 1563, after the siege of Rouen, he was appointed
first surgeon and named chamberlain to King Charles IX,
later also serving Henry III and Catherine de Medici.3
He was accepted as the king’s barber-surgeon in 1552
under Henry II of France, and although he failed to cure
him from a head injury that occurred during a tournament
in 1559, he remained in the service of the kings of France
with the assistance and supervision of Andreas Vesalius
(1514-1564) until his death in 1590. He served under
Henry II, Francis II, Charles IX, and Henry III.3
According to Henry IV’s Prime Minister, Sully, Paré
was a Huguenot, and on August 24, 1572, the day of the
St. Bartholomew’s Day Massacre, the King, in order to
save him from the Massacre, had him confined in a
clothes closet. Henry IV was so fond of him and appraised
his services constantly and in every chance given. Paré
died in Paris in 1590 from natural causes in his 80th year.
While there is evidence that Paré may have been inclined
to the Huguenot movement and their religious beliefs, he
seems to have kept his distances by accepting the Catholic
dogma in order to avoid prosecutions. He was married
twice, he had a Catholic funeral, and he had his children
baptized into the Catholic faith.2,3
Nevertheless, although he is considered the father of
modern surgery, just like his contemporaries and col-
leagues, he did not enjoy the same esteem and respect
that surgeons do today. Surgeons at the time had a lesser
education and they were working mainly with their
hands; therefore, they were considered somehow inferior
to physicians, who practiced pure and intellectually supe-
rior medicine. Paré’s publications were constantly criti-
cized by physicians and he personally was damned for
entering their fields and daring to write about topics
beyond his education and area of specialization.2,3
Paré and His Groundbreaking
Treatment of Gunshot Wounds
Perhaps the most important innovation of Paré was his
technique and contribution to the treatment of gunshot
wounds. Up to this point in the history of medicine, such
wounds were treated by means of cautery by applying
burning iron or potential cautery through the use of scald-
ing oil. This was done in order to destroy the so-called
poison and to forestall putrefaction according to the most
accepted views of the era.1
Paré described an incident when he was a novice sur-
geon in Italy in 1537 on a military campaign of the French
Army. When he ran out of oil he had to improvise in order
to treat the wounded soldiers. He made a healing salve
consisting of egg-white, rose-oil, and turpentine. The fol-
lowing night he could not sleep feeling guilty for the
patients whose wounds he had not cauterized because of
lack of oil, so he got up early to pay them a visit in dis-
tress. He was surprised to see that those treated with the
salve suffered little pain, had no inflammation or swell-
ing, and they had a quiet, relatively painless night.
Moreover, those treated with burning oil suffered from
high fever with aches and inflammation around the
wound. Therefore, he resolved never again to burn
patients suffering from shot wounds.2-4
Thus, Paré managed to dissolve the widely accepted
myth that gunpowder and gunshots were poisonous. He
thereafter started treating gunshot wounds through the
application of the salve he had invented that day made of
egg, oil of roses, and turpentine.3
Paré and the Use of Ligatures in
Amputations
One of the most groundbreaking innovation that Paré had
to offer in the history of surgery was the use of ligatures
in the procedures of limb amputations. This technique is
described in detail in his Ten Books of Surgery. Paré had
to rediscover the use of ligatures, and he used a thread-
like or wire material used with a needle to constrict blood
vessels (arteries and veins as well) in patients and stop
Markatos et al 185
Figure 2.  Ambroise Paré performing a leg amputation of a
wounded soldier in the field of battle.
bleeding during amputations (Figure 2). Other writers
before him had proposed ligature for blood loss manage-
ment during amputation, but Paré was the one who solved
the practical problems and established this technique as
safe and usable.1,4,5
At the time, the usual method of sealing wounds was by
cauterization with a red-hot iron, which often failed to
arrest the bleeding and caused patients to die of shock.
Paré, for the ligature technique, designed the “Bec de
Corbin,” which had a similar use to modern hemostats.
Although ligatures had often been criticized for spreading
infections, they were still an important innovation in surgi-
cal practice. Paré described in detail the technique of using
ligatures to prevent hemorrhaging during amputation in his
1564 book Treatise on Surgery. One of the most notable
clinical observation of Paré, during his work with injured
soldiers, was the pain experienced by amputees, which
they perceive as sensation in the “phantom” amputated
limb and it could last for weeks and months after the ampu-
tation. Paré believed that phantom pains occur in the brain
(the consensus of the medical community today) and not in
remnants of the limb, so he described it as a neurologically
based side-effect of the amputation.4,5
Paré, in a letter he wrote to Etienne Gourmelen, in
defense of his choice to use ligature instead of cautery,
refers to the instructions of Hippocrates and later Galen,
Celsus, and their Arab follower Aviccena, who recom-
mended the use of tying around a vessel or limb to stop
bleeding. In addition, he mentions the recommendations
of his contemporaries like Vezalius, Guy de Chauliac,
Hollier, Jean de Vigo, Tagault, Pierre de Argellata of
Boulogne, John Andreas a Cruce, D’Alechamp, and Bec
de Corbin Calmetheus, who all suggest tying vessels and
limbs with ligature to stop massive and lethal bleeding
during amputations and major traumatic conditions.4,5
Paré also constructed limbs for the amputee soldiers he
had treated. His main innovation was that he demanded
them to be functional, not just stopgap solutions. Paré was
an accomplished anatomist taught by Sylvius, and so when
he designed limbs, he attempted to make them work the
way biological limbs worked. The legs he designed carried
a mechanical knee that could be locked when standing and
bent at will. He designed an arm that could be bent with a
pulley that mimicked arm muscles. Paré had the idea to use
the progress in robotics that occurred in his period to create
prostheses that worked with the mechanical devices
invented for robotic toys or clocks. After all the mechani-
cal revolution was at hand and every major innovator tried
to implement its teachings in his work.6,7
His mechanical hand was operated by multiple catches
and springs, which simulated the joints and movements
of a biological hand. When he showed his design to his
colleagues, it was accepted by such enthusiasm that they
worked up a prototype, and in 1551, a movable prosthesis
designed by Paré was worn into battle by amputees.6,7
Nevertheless, in cases of extensive amputations the
great number of ligatures required made the presence of a
trained assistant mandatory (in the case of a thigh ampu-
tation at least 53 ligatures are necessary under this proce-
dure). Therefore, this method could become widely
applicable if one could somehow control bleeding until
the blood vessels had been tied. This became possible
much later in the 18th century when Jean Louis Petit
invented the first useful and efficient tourniquet.2,6
Ambroise Paré summarized his massive experience
and innovations in the treatment of war injuries in his
textbook titled The Method of Curing Wounds Made by
Gunshot.4,7
Conclusion
The achievement of Paré was literally groundbreaking for
his time; he debunked the widely accepted idea that gun
powder was poisonous for the wounds. He also minimized
the use of cautery of wounds by his dressing methods and
the application of ligature during amputations. All these
innovative rationales revolutionized the practice of war
surgery during the Renaissance and paved the way for the
introduction of modern surgery. Paré remained surpris-
ingly humble and timid with the revolution he provoked in
surgery. At the siege of Metz in 1552, having witnessed all
the deaths and surgical failures during military campaigns,
after his first successful amputation of the leg of an officer
with ligature, he expressed his moderate character through
his historic phrase: “I dressed him and God healed him.”1,2,5
Author Contributions
Study concept and design: Konstantinos Markatos, Anna
Tzivra, Spyridon Tsoutsos
186 Surgical Innovation 25(2)
Acquisition of data: Konstantinos Markatos, Anna Tzivra,
Spyridon Tsoutsos, Gerasimos Tsourouflis
Analysis and interpretation: Konstantinos Markatos, Marianna
Karamanou, Gerasimos Tsourouflis
Study supervision: Georgios Androutsos
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect
to the research, authorship, and/or publication of this article.
Funding
The author(s) received no financial support for the research,
authorship, and/or publication of this article.
ORCID iD
Konstantinos Markatos  https://orcid.org/0000-0001-5753-1927
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4. Paré A. Oeuvres d’Ambroise Paré. Paris, France: J-B
Baillière; 1840-1841.
5. Hernigou P. Ambroise Paré II: Paré’s contributions to
amputation and ligature. Int Orthop. 2013;37:769-772.
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