I Dressed Your Wounds, God Healed You — A Wounded Person’s Psychology According to Ambroise Parè

    Ambroise Parè (1510–1590) achieved the reverence of the lower class and the friendship of four kings of France. The greatness of his life should be considered in the framework of a century remembered mostly for its ruthlessness.¹

    Parè was a surgeon, a job usually performed by barbers. “Doctors” were lecturers wearing long gowns, often teaching medicine like philosophy. They were not trained to face the challenges of gun-produced wounds. Humble and uneducated, Parè took part in a number of battles as a medical officer, which helped advance his surgical talents. The acute and complicated nature of war wounds demanded quick and appropriate medical treatment and affirmed his resolution to find better ways to provide care to hundreds of wounded soldiers. He wrote²:

    “… Now, at the times I was a novice; and I had not seen treating the sore produced by arquebus [a forerunner of the rifle] yet. It is well true that I had read in Giovanni Virgo… that the sore produced by batons of fire have an I don’t know what of poisonous because of the dust: and to take care of it he orders to cauterize them with oil of hot elder, mixing some tearica. Trying not to make errors using the hot oil, knowing that it would have provoked a pain to the sick, I wanted to know before applying it how the other surgeons behaved. They applied the said oil, the hottest possible, in the sore, with tente and setons: this emboldened me to do as they did. At the end, the said oil finished and I was forced to apply an ointment in its place composed of yellow of egg, rosy oil and turpentine. That night I could not sleep, fearing to find again the wounded, to which I had missed to put the said oil, dead or poisoned: this made me awake at dawn to visit them. Here, against every hope of mine, I found those to which I had applied the same ointment to suffer little pain and their sore without neither swelling nor inflammation. I found the others, to which the hot oil had been applied, feverish, with big pain and swelling around the sore. Then I finally decided not to so horribly burn the poor men wounded by arquebus anymore…”.

Documenting Care

    Written reports. Parè’s compassion, honesty, discretion, curiosity, and the deep belief that saving a man was a must were uncommon. Through his writings — translated from French (the informal language of the people, not the language of the medical works at the times, which was Latin) to English, German, and Dutch — he tried to share with his colleagues and with future generations the empirical knowledge developed in the battlefield as well as in the royal court.

    Illustrations and advanced treatment. Parè’s works also were considered a milestone in 16th century surgical art,³ documenting the care he provided. For example, Parè diligently cared for the ulcers of the Lord of Vaudeville. In exchange for this care and once the ulcer was healed, Pare would be returned to the freedom he had lost in war. Parè immediately sketched the profile of the ulcer on a sheet of paper before beginning the care. The subsequent treatment is still acceptable today: he exsected (an old medical term meaning to take away part of the skin with a sharp device) the callous edges of the sore, treated it for a few days with Egyptian ointment (which may have contained honey and astringent herbs) to cleanse it, put the patient on absolute bed rest (as was the protocol at the time), and applied a compressive bandaging on the vein. A lead foil imbued with quicksilver was placed on the cleansed sore. The ulcer healed and the surgeon was set free.⁴

Case Study: Caring for a Chronic Wound

    In his autobiographical work The Apologia and the Dissertation written 5 years before his death, Parè offered an accurate description of a case in which he successfully cured the pressure ulcers of an aristocratic Frenchman wounded 7 months before⁵:

    “… The king called me and commanded me to go to see the Lord of Havret. Immediately, as soon as I arrived, I visited him, and I told him that the king had commanded me to come to see him and to cure his wound. He told me to be well pleased of my arrival. I found him with a strong fever and hollow eyes, with a dying and yellowish face, the dry and arid tongue and the whole body emaciated and thin; the speaking was too soft as of a man next to death; a sore great as the palm of a hand on the coccyx (for he has been too much in the bed); besides he could not take rest neither in the daytime neither at night, he was not hungry but thirsty a lot. He was shaken, at times, in the bed from epileptic attacks and he had desire to vomit because of a continuous trembling; furthermore, he could not bring the hand to the mouth, if not with the help of someone. The bone of the thigh was fractured and moved for a long section on the wrong side, with fragments, some scattered and others no. He had in the groin a deep ulcer up to the mean of the thigh; besides, around the knee there were other fistulae. All the muscles, both those of the thigh and those of the leg, were swollen and imbibed of pituite-like humour, cold, damp and malodorous. Once I had detected all these complications and I was made sure that his abilities of recovery were in practice near to nothing I was sorry a lot for this gentleman that I believed could have died in my arms. However, kept account of his young age, I still had some hope: because at times God and the nature make things that seem impossible to the surgeon. Insofar I asked to that gentleman if he had courage and I told him that, if he had borne them, I would have made some incisions, more than necessary for his recovery and that in this way soon all of its pains and the other complications would be stopped. He accepted and I made two incisions to drain the matter that surrounded the bone and the muscles: a great quantity of it flowed away. I patiently cured him for days and prescribed him good meats, good wine and beer (… I went into the kitchen where I saw someone removing from a big pot half ram, a quarter of calf, three big pieces of ox, two chickens and a big quarter of lard: then I wondered that broth of pot had to be juicy a great deal and a great deal nourishing…). The peasants of the outskirts came to cheer the life of the gentleman with songs, dances and laughters in such a way that in little time he recovered even if he was not able to well bend the knee anymore...”

Additional Wound Care Concepts

    Nutrition. Diet was of particular importance to Parè. Possibly drawing inspiration from the theories of Hippocrates (4th century BC): “… let the food be your first medicine,” Parè tried to shape the diet according to the patient’s needs and tastes. The following excerpt² provides a description of his approach:

    “… Besides, you have to consider the lifestyle of the patient: if he had gotten used to eat and to drink a lot, every time, it won’t be worth to prescribe him such a rigorous diet as to whom has gotten used to eat and to drink few and to fixed times. For example, the soups of bread are not very pleasant to Frenchmen as are to Italians: it needs to grant something to the tradition that is a bit another nature. […] The consideration of the strengths of the patient is more than everything else to respect: if this is missed or scant, it needs to left all things aside to meet it, as when necessity forces us to amputate a limb or to make deep incisions. If the patient doesn’t have the strength to bear the pain, it needs to delay the operation until the nature is strengthened and the patient has recovered the vigour with good foods and rest.”

    Patient-centered concerns.
    Plan of care. Parè never forgot to involve the patient in the plan of care: the sensibility with which he dealt with patients, asking them to collaborate on ways to withstand the pain or to commit themselves to respect the prescriptions, was surprisingly effectual. Present-day care plans sometimes do not show similar concern for the patient. “Best outcomes” require the collaboration of the patient. An approach to care should be, Do not invest in useless resources — instead, strengthen positive attitudes where necessary.

    Mind-body connection. The psychological dimension of the injured person should always be considered as part of complementary therapy. Parè encouraged patients, prescribing visits of friends, minstrels, and parties. His oft-quoted “I dressed your wounds, God healed you,”⁶ embraces both the importance of providing the most up-to-date medical/nursing care available and the recognition of its limits — that the final outcome of every care process is determined by several factors, some of which are not fully understood or known. No medical practitioner, physician or nurse, should think otherwise.³

Conclusion

    Parè’s principled approach to wound care is evident in the dialogue he had with Charles IX⁷:

    “I hope well that you will take care of the king better that the poor men!
    No Sire, it is impossible!
    And why?
    Because I take care of them as of the kings…”

    Parè’s impartiality toward his patients, his recognition that treatment can be improved, his documentation of service, and his insights into nutrition and the mind-body connection distinguish him as a forerunner of modern day wound care.