Ambroise Paré on gunshot wounds (Item of the Month)

By Lisa O’Sullivan, Director, Center for the History of Medicine and Public Health

The August item of the month is Ambroise Paré’s (1510 –1590) Les Oeuvres, or Works. Published in 1575 in 26 sections or books, the folio volume has 295 illustrations and includes Paré’s writings on anatomy, surgery, obstetrics, instrumentation, and monsters. This post focuses on Paré’s military surgery and is the first in a series of occasional posts looking at the relationship between medicine and war.

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Frontispiece of the first (1575) edition of Les Oeuvres, dedicated to King Henri III. Click to enlarge.

Dedicated to Henri III, Paré presents Les Oeuvres as an accumulation of his life’s studies and experience, and it incorporates many of his earlier publications. The French barber surgeon spent much of his life at war, serving in over 40 campaigns, and published numerous highly influential books, many of them directly based on his practice of military surgery.i Paré’s career was a prestigious one, progressing from working as an apprentice barber surgeon to great prominence as surgeon to Henry II, and subsequently his successors Francois II, King Charles IX, and Henry III.

Like his contemporary Andreas Vesalius, Paré is now celebrated as an emblematic figure of Renaissance thinking, willing to look beyond the established authorities and instead rely on the evidence of his own experience. In the Oeuvres, for instance, he mocks the use of “mummy” or “mummia,” a popular remedy ostensibly created from Egyptian mummies and used extensively by physicians.ii Such a position was particularly provocative given Paré’s identity as a surgeon, rather than a university trained physician with a formal education and knowledge of Greek and Latin.

Despite Paré’s close connections with many of its members, the Parisian Faculty of Medicine attempted to block the publication of the Oeuvres, arguing that the Faculty needed to approve all publications relating to medicine and surgery. In addition, they objected to Paré’s use of French, as he was among a small but increasing number of practitioners writing in the vernacular rather than the more scholarly Latin, making such works vastly more accessible to students of surgery operating outside the universities and the lay public.iii

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Reminiscent of a “wound man,” this illustration demonstrates techniques for extracting broken arrows from the body. Click to enlarge.

Much of Paré’s renown was based on his early work in the military context. Throughout the Oeuvres, he returns to examples of treating soldiers wounded during conflict. Perhaps the most famous vignette describes how, during his first campaign in 1536, Paré found that he had insufficient boiling oil to use in cauterizing gunshot wounds, and instead used a liniment made of egg yolk, rose oil, and turpentine. The following day, he discovered that those soldiers treated with the liniment were in a better condition than those whose wounds had been treated according to the prescribed manner. He subsequently argued for the treatment of gunshot wounds with liniments and bandaging, as well as removing affected tissue from the wound.iv

Gunpowder, whether projected from cannons or shot from firearms, had become a significant factor on European battlefields in the late 14th century. The use of gunpowder dramatically changed the practice of warfare. Increasingly numerous and accurate firearms contributed to the number of soldiers killed and wounded. These weapons produced new types of wounds that penetrated into the body, carrying foreign materials with them and leading to gangrene, while also deafening and blinding those near blasts.v

Descriptions of surgical tools, including a variety of tools for extracting bullets from wounds. On the top left, "crane bill" forceps for fragmented bullets; on right a shorter "duck bill" instrument designed for extracting whole bullets. At bottom, "lizard noses" for drawing out flattened bullets.

A variety of tools for extracting bullets from wounds. On the top left, “crane bill” forceps for fragmented bullets; on right a shorter “duck bill” instrument designed for extracting whole bullets. At bottom, “lizard noses” for drawing out flattened bullets. Click to enlarge.

Surgeons based their treatment of gunshot wounds on the belief that the gunpowder carried into the body by the bullets brought poison with it. This idea came from Giovanni da Vigo (1450–1525), an Italian surgeon whose 1514 Practica in arte chirurgica copiosa and 1517 Pratica in professione chirurgica were highly influential surgical texts. Rapidly translated into multiple European languages, these books include da Vigo’s suggestion to cauterize (burn) the wound with boiling oil in order to counteract the poisonous traces of gunpowder and to seal any severed arteries. This procedure became considered standard practice.viParé, after his experience with liniment rather than oil, experimented further, and recounts seeking advice from other surgeons and testing a folk remedy for onion poultices for burns suggested by an older local woman. Concluding that they were effective against blistering offered Paré another rhetorical opportunity to emphasize his commitment to observation and experimentation.vii

The evidence found in earlier surgical manuals suggests that medieval surgeons had made similar experiments, and that it was the popularity of the more recent ideas promulgated by da Vigo that led to treatments with cauterization and oil.viii While he was not the only surgeon to be working towards more humane and effective treatment of gunshot wounds, Paré became the most well-known and is often celebrated today as the “father” of modern military surgery.ix This reputation rests on not only his work around gunshot wounds but his broad interests, influence, and innovation. A future post will explore other aspects of Paré’s Oeuvres and its long-term impact on military surgery.

References

i.  A full bibliography of his works was produced by Academy librarian Janet Doe in 1937. See Janet Doe, A Bibliography of the Works of Ambroise Pare; Premier Chirurgien et Conseiller du Roy (Chicago: University of Chicago Press, 1937).

ii. Ambroise Paré, Les Oeuvres de m. Ambroise Paré … Avec les figures & portraicts tant de l’anatomie que des instruments de chirurgie, & de plusieurs monstres. Le tout diuisé en vingt six livres … (Paris : Chez G. Buon, 1575), p399.

iii. Paré defended his publication with a written defense and in the Parisian courts. While the verdict was not recorded, the book went on sale and sold out almost immediately. See Wallace B Hamby, Ambroise Paré, Surgeon of the Renaissance (St. Louis: W.H. Green, 1967), pp153-156.

iv. Ambroise Paré, Les Oeuvres de m. Ambroise Paré, pp357-359.

v. John Pearn, “Gunpowder, the Prince of Wales’s Feathers and the Origins of Modern Military Surgery,” ANZ Journal of Surgery 82 (2012): 240–244, 241; Kelly R DeVries, “Military Surgical Practice and the Advent of Gunpowder Weaponry,” The Canadian Bulletin of Medical History / Bulletin canadien d’histoire de la médecine 7(2) (1990):131-46, p135.

vi. DeVries, “Military Surgical Practice and the Advent of Gunpowder Weaponry,” pp141-142.

vii. Ambroise Paré, Les Oeuvres de m. Ambroise Paré, p359.

viii. DeVries, “Military Surgical Practice and the Advent of Gunpowder Weaponry,” p142.

ix. Frank Tallett, War in Context: War and Society in Early Modern Europe : 1495-1715 (London, US: Routledge, 2010), pp108-110.

The Origins of Automated Ice

By Danielle Aloia. Special Projects Librarian

This August, for most of us, ice is a second thought:  easily obtained for cooling drinks and chilling food, and usually only a few steps away.   An 1844 title in our collections offers an intriguing snapshot of a time when this was not always the case.

In 1844, a Londoner with a shop on Regent Street and an inventive mind published The Ice Book: Being a Compendious and Concise History of Everything Connected with Ice.  His name was Thomas Masters.   In this publication, Masters enumerates the practical uses–both culinary and medical– of his own patented ice machine.  In his introduction, Masters describes his obsession with the process of freezing:

The transformations narrated in the “Arabian Nights,” those gorgeous repositories of Eastern legendary lore, are not more marvelous or more speedy than the change of a liquid body to a block of solid ice.1

During the course of The Ice Book, Masters introduces his invention and its applications and takes readers on a whirlwind tour of ice through space and time.  Along the way, he also supplies some delectable frozen recipes–sign us up for the maraschino ice cream, the nectar ice and the punch a la Victoria, stat.

Masters reports that the Greeks and Romans were known to use snow from the surrounding mountains to cool their wine.2 Nero’s cooks flavored snow with “honey, juices, and pulp of fruits,” creating a precursor to the flavored ice of today, and eventually ice cream.3

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Depiction of a runner delivering snow from the mountains to Nero. Published in the National Dairy Council’s Ice Cream Through the Years, 1946.

Masters also describes Indian methods of making artificial ice, reporting that during the winter months, ice was created by filling rows of small earthen pans with boiled water, which was then cooled and left overnight.  The thin ice was gathered up, thrown in a pit that was lined with straw and layered with blankets, and pressed into a solid mass.  The pit was closed up with straw, blankets and a thatched roof.

Masters devotes a significant portion of his narrative to the promotion of his portable “patent freezing machine.”  In his introduction he writes:

The preparation of one of the most delectable refections known to this advanced era of modern culinary civilization, has been hitherto left to the experienced confectioner, on whose skill, not always within reach, depended the supply.  By attending to the instructions contained in the following pages, ices may now be procured from the machine within five minutes.4

A review of the book in The Patent Journal and Inventors’ Magazine offers this glowing endorsement of The Ice Book:

The specification of Mr. Masters’ patent appeared in #53 of our journal…it will be seen that he invented a number of very ingenious apparatus, by means of which, the luxury of cold liquors, &c. may be the most readily supplied; his Ice safes and well are excellent, and his ready mode of freezing, astonishing.  It is really a disgrace to buttermen and other shopkeepers to vend their edibles in the nasty state they frequently do, and the public should demand the use by tradesmen of these safes…5

The benefits of Masters’ machine were not limited to food and drink preparation.  Ice was used in medicine to relieve headaches, fever, hemorrhaging, and, believe it or not, symptoms of rabies.6 Masters includes testimonials from MDs.  One Dr. John Ryan writes that Masters’ machine will “enable [doctors] at all seasons, whether in the crowded fever wards of the hospital, or in private practice, to obtain for the patient a necessary adjunct to medical treatment.”7

An elevation of a double-motion machine with pails (B), a2 (machinery), and P (flapdoor).  Some were made with a drawer underneath, which serves as a wine-cooler.  Plate 1 published in Thomas Masters' The Ice Book, published in 1844.

An elevation of a double-motion machine with pails (B), a2 (machinery), and P (flapdoor).  Some were made with a drawer underneath, which serves as a wine-cooler.  Plate 1 published in Thomas Masters’ The Ice Book, published in 1844.

A single-motion machine with a freezer that is rotated by turning the crank handle at the top.  Plate 3, published in Thomas Masters' The Ice Book, 1844.

A single-motion machine with a freezer that is rotated by turning the crank handle at the top.  Plate 3, published in Thomas Masters’ The Ice Book, 1844.

The machine had various interchangeable parts and could be setup for private use to make blocks of ice, flavored ice and ice cream, and to cool wine and drinks. In plate 6 below, Figures 1-3 depict the special churns needed to get the fineness and smoothness necessary to keep the flavored ice or ice cream from separating; “a proper beating-up, a process which never can be accomplished by the hand.”8 Figures 4-5, depict separate ice preserving containers for game, fish, butter, etc. Figures 6-8, depict the cold storage for beverages, such as wine and beer.

Plate 6 published in Thomas Masters' The Ice Book, 1844.

Plate 6 published in Thomas Masters’ The Ice Book, 1844.

Below, we’ve included a few tantalizing recipes from the book.  Masters supplies instructions for making plain and flavored ice creams:

Recipes for plain, pistachio, biscuit, maraschino, "nouveau" and cinnamon ice creams, from Thomas Masters' The Ice Book, 1844.

Recipes for plain, pistachio, biscuit, maraschino, “nouveau” and cinnamon ice creams, from Thomas Masters’ The Ice Book, 1844.

Recipes for pine-apple, ginger, and apricot ice cream, from Thomas Masters' The Ice Book, 1844.

Recipes for pine-apple, ginger, and apricot ice cream, from Thomas Masters’ The Ice Book, 1844.

Other recipes instruct on making flavored ices.

Wine ices, from Thomas Masters' The Ice Book, 1844.

Wine ices, from Thomas Masters’ The Ice Book, 1844.

Raspberry water ice et al., published in Thomas Masters' The Ice Book, 1844.

Raspberry water ice et al., published in Thomas Masters’ The Ice Book, 1844.

Apple water ice et al., published in Thomas Masters' The Ice Book, 1844.

Apple water ice et al., published in Thomas Masters’ The Ice Book, 1844.

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How to clarify sugar, from Thomas Masters’ The Ice Book 1844.

We found this errata slip laid in amusing:

Errata slip, Thomas Masters' The Ice Book, 1844.

Errata slip, Thomas Masters’ The Ice Book, 1844.

Another peculiar aspect of this work is the Appendix. Masters delights in supplying real-life anecdotes about ice.  Among the highlights are an ice storm in 1672 that destroyed numerous trees; an ice market in 19th-century St. Petersburg containing the bodies of thousands of frozen animals, captured inside ice; and in that same city, the Ice Palace of St. Petersburg built near the banks of the River Neva in 1739, which began to give way under its own weight before the last ice blocks were placed.9  We’ll be returning to this book again for these fascinating stories, and for the recipes within…particularly on hot summer days.

References

1.   Masters, Thomas. The Ice Book. London: Simpkin, Marshall, & Co., 1844.

2.  Masters, 6.

3.  National Dairy Council. Ice Cream through the Years.  Chicago: National Dairy Council, 1946.

4.  Masters, x.

5.  “Thomas Masters’ Ice Book:  The Ice Book: Being a Compendious and Concise History of Everything Connected with Ice.”  Patent Journal and Inventors’ Magazine, June 5, 1847, accessed online.

6.  Masters, pp. 180-187.

7.  Masters, pp. 185-187.

8.  Masters, pp. 194-196.

9. Masters, pp. 134-146.

 

Is Air-Conditioning Heating Up Our Environment?

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The former Sackett & Wilhelm printers’ building in Brooklyn, the place where Willis Carrier first put air-conditioning into practice in 1902. Image Credit: Stan Cox.

This summer, we’re teaming up with our friends at The Museum of the City of New York to offer “Fast, Cool & Convenient: Meeting New Yorkers’ High Demands,” our free three-part talk series supported by a grant from The New York Council for the Humanities.

Tomorrow night (Thursday the 11th) the Academy will host the second of these three events, entitled COOL: Uncomfortable Truths About Our Air-Conditioned City.  The speaker will be Stan Cox, Ph.D., research coordinator and climate change expert at The Land Institute in Salina, Kansas.  The event will begin at 6:30pm; please register in advance here.

This week, Dr. Cox has guest-authored “Is Air-Conditioning Heating Up Our Environment?” for the Academy’s Urban Health Matters blog.  You’ll find a link to the post here.  Enjoy, and we hope to see you tomorrow evening!

Historical Advice on Breastfeeding in Honor of World Breastfeeding Week

By Becky Filner, Head of Cataloging

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“Mother nursing twins simultaneously.”  From Reginald Charles Jewesbury’s Mothercraft, antenatal and postnatal.

World Breastfeeding Week – August 1-7, 2016 – seeks to promote, protect, and support breastfeeding. How was breastfeeding regarded in the past? To answer this question, I consulted books on child rearing from the early 19th century to the mid-20th century.

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Title page, William Buchan’s 1804 Advice to Mothers.

The earliest book I looked at, Dr. William Buchan’s 1804 Advice to Mothers, on the Subject of Their Own Health; and on the Means of Promoting the Health, Strength, and Beauty, of Their Offspring, is extremely critical of women who do not breastfeed:

Unless the milk….finds the proper vent, it will not only distend and inflame the breasts, but excite a great degree of fever in the whole system… It may be said, that there are instances without number, of mothers who enjoy perfect health, though they never suckled their children. I positively deny the assertion; and maintain, on the contrary, that a mother, who is not prevented by any particular weakness or disease from discharging that duty, cannot neglect it without material injury to her constitution.1

At the end of the 19th century, Dr. Genevieve Tucker’s Mother, Baby, and Nursery: A Manual for Mothers (1896) also strongly advocates breastfeeding:

Every mother who has health sufficient to mature a living child ought, if possible, to nurse it from her own breast. Her own health requires it, as the efforts of the child to draw the milk causes the uterus to contract, and nothing else will take its place to her infant.2

Much of her other advice seems outdated now, including her claim that “nursing babies suffer from too frequent nursing” and her suggestion to nurse “as seldom as possible at night.” Perhaps strangest to modern ears is her analysis of a woman’s ability to nurse based on her physical and emotional state:

Different temperaments and constitutions in women have great influence in the quantity and quality of milk. The richest milk is secreted by brunettes with well developed muscles, fresh complexions, and moderate plumpness. Nervous, lymphatic, and fair-complexioned women, with light or auburn hair, flabby muscles, and sluggish movements, as a rule, secrete poor milk. Rheumatic women secrete acid milk, which causes colic, diarrhea, and marasmus in the child.3

Tucker also suggests that a nursing mother should be producing a whopping forty-four ounces of breast milk every twenty-four hours.

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Breastfeeding baby, from Stella B. Applebaum’s Baby, A Mother’s Manual, published ca. 1946.

Dr. Charles Gilmore Kerley in his Short Talks with Young Mothers: On the Management of Infants and Young Children  wrote in the early 19th century that contemporary pressures on women hinder their breastfeeding abilities:

A mother, to nurse her child successfully, must be a happy, contented woman… The American women of our large cities assume the cares and responsibilities of life equally with men. Among the so-called higher classes, — those who have all that wealth and position can give, — there is a constant struggle for social pre-eminence. Among the majority of the so-called middle classes the contest for wealth and place never ceases from the moment the school days begin until death or infirmity closes the scene. Among the poor there are the ceaseless toil, the struggle for food and shelter, the care of the sick, and the frequent deaths of little ones in the family whom they are unable properly to care for. In all classes, therefore, the conditions of life are such as seriously to interfere with the normal function of nursing, no matter how excellent may be the mother’s physical condition.4

This emphasis on a woman’s mind being at rest is repeated in much of the early 20th- century literature on breastfeeding.

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“Hungry!” from Myrtle M. Eldred and Helen Cowles Le Cron’s For the Young Mother, 1921. p. 31.

Most of the books from the first few decades of the 20th century contain a passage about keeping the breasts and nipples clean. Kerley and others recommend washing the nipples (and even the child’s mouth!) with a solution of boracic (boric) acid. Myrtle M. Eldred and Helen Cowles Le Cron write in For the Young Mother (1921) that “the breasts are tender and easily infected at first, so that the boric acid acts as a cleanser to protect the baby from possible germs and as a preventive of abscessed breasts.5”Boric acid, though it is sometimes used as an antiseptic, is toxic to humans if taken internally or inhaled in large quantities. Other books recommend rinsing the breasts with hot water prior to nursing.6

Many books also contain lists of foods the nursing mother should and should not eat. Dr. Anne Newton, in her Mother and Baby: Helpful Suggestions Concerning Motherhood and the Care of Children (1912), advises mothers to practice “sacrifice and self-denial” in eating meals, and to avoid rich and seasoned foods altogether.7 Newton specifies that mothers should eat “nothing about which there is any question of fermentation. Such vegetables as cabbage, turnips, cauliflower, and tomatoes should not be given until the baby is four months old at least, and even then certain things may cause discomfort and cannot be indulged until the child is weaned.8” Dr. Thomas Gray, in Common Sense and the Baby: A Book for Mothers, notes that the breastfeeding mother should “eat an abundance of wholesome, nutritious food; avoid indigestible pastries and salads. Take sparingly of tea and coffee. Drink freely cocoa and milk. Eat fruits – not acid.9”  Some more recent books are much less rigid about the mother’s diet. Dr. Dorothy Whipple, writing in 1944, is less cautious, and argues that there’s very little a mother can eat that harms a nursing baby, mentioning only certain foods like onions that may, in breast milk, deter babies with its “unusual taste.10

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A mother breastfeeding and a selection of foods recommended for the breastfeeding mother, taken from Stella B. Applebaum’s Baby:  A Mother’s Manual (1946).

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Front cover of the New York City Health Department’s The Care of Baby, 1932.

None of the books I consulted recommended breastfeeding to two years or beyond, the WHO’s current recommendation on breastfeeding. Most books recommend weaning the baby between eight and fourteen months of age.  The New York City Department of Health warns against weaning in summer because of the risk of spoiled cow’s milk:

If possible, do not wean your baby during the hot summer months…. If you are well, it will not harm you to nurse your child until the dangerous, hot weather is over. This precaution may mean saving your child’s life.”11

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“One of life’s richest experiences,” from Dorothy Whipple’s Our American Babies, published in 1944.

Another common thread in the literature about breastfeeding is an emphasis on the pleasure and health benefits experienced by the nursing mother.  According to Tucker, “under the right conditions of lactation, … the mother should thrive and even grow stout.12” Others emphasize that breastfeeding will help the mother “get her ‘good figure’ back much more quickly than the mother who doesn’t nurse” because “nursing causes the uterus or womb to contract.13” Stella Applebaum provides this summary of the mother-baby nursing relationship:

Mother’s milk is the perfect baby food. From a healthy mother’s clean nipples, this pure, fresh, warm, nourishing, digestible food is delivered, germ-free, directly into the baby’s mouth. At the same time mother’s milk protects him against certain diseases. Suckling at the breast makes the baby feel close to his mother, happy, and secure.

Nursing benefits you, too. It stimulates the uterus to contract to normal size and contributes to your personal enjoyment and contentment. Propped in a comfortable chair or bed, you share a uniquely satisfying experience with your baby.14

Other writers underscore the vital role nursing plays in strengthening the emotional bonds between mother and child.   Buchan writes in 1804 that “the act itself is attended with sweet, thrilling, and delightful sensations of which those only who have felt them can form any idea.15” Dorothy Whipple has the last word:

…to sit in a comfortable chair and hold a little snuggling baby in your arms, to watch him grab that nipple with all the fury of his tiny might and suck and work away until he reaches that complete satisfaction that comes to a baby with a full stomach is one of the pleasantest sensations in life.16

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A mother and her baby breastfeeding while lying down, from Louise Zabriskie’s Mother and Baby Care in Pictures, published in 1941.

References

1.  Buchan, William. Advice to Mothers, on the Subject of Their Own Health; and on the Means of Promoting the Health, Strength, and Beauty, of Their Offspring. Philadelphia: John Bioren, 1804, p. 75-76.

2-3. Tucker, Genevieve. Mother, Baby, and Nursery: A Manual for Mothers. Boston: Roberts Brothers, 1896, p. 85-87.

4. Kerley, Chalres Gilmore. Short Talks with Young Mothers: On the Management of Infants and Young Children. New York: G.P. Putnam’s Sons, 1904, p. 13-15.

5.  Eldred, Myrtle M. For the Young Mother. Chicago: The Reilly & Lee Co., 1921, p. 37.

6.  Kenyon, Josephine Hemenway. Healthy Babies Are Happy Babies: A Complete Handbook for Modern Mothers. Boston: Little, Brown, and Company, 1934, p. 55-56; Zabriskie, Louise. Mother and Baby Care In Pictures. Philadelphia: J.B. Lippincott Company, 1941, p. 131.

7.  Newton, Anne B. Mother and Baby: Helpful Suggestions Concerning Motherhood and the Care of Children. Boston: Lothrop, Lee & Shepard Co., 1912, p. 74.

8.  Ibid., p. 78.

9.  Gray, Thomas N. Common Sense and the Baby: A Book for Mothers. New York: the Bewick Press, 1907, p. 39.

10. Whipple, Dorothy V. Our American Babies: The Art of Baby Care. New York: M. Barrows and Company, Inc., 1944, p. 139.

11.  New York City Department of Health. The Care of Baby. New York: Department of Health, 1932, p. 10.

12. Tucker, p. 86.

13. NYC Dept. of Health. The Care of Baby, p. 5.

14. Applebaum, Stella B. Baby: A Mother’s Manual. Chicago and New York: Ziff-Davis Publishing Company, 1946.

15. Buchan, p. 79.

16. Whipple, p. 122.