Found in the Eyes of Rams: The Bezoar and its Powers

By Emily Miranker, Project Coordinator

This post title is not strictly true. Or remotely true, actually. Bezoars are not found in rams’ eyes (to the relief of sheep everywhere, I’m sure). Maimonides, the 12th century Sephardic Jewish philosopher, reported an Eastern belief that bezoars could be found “in the eyes of rams,” though he then went on to note that “it is found in their [rams] gallbladder and this is true.”[i] Bezoars are in fact found in goats’ stomachs and gastrointestinal tracts, as well as that of other animals such as sheep, cows and us humans.

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Our library’s trichobezoar, ca.1862. Basically the coolest hairball you’ll ever see.

A bezoar is a mass of undigested or inedible material found in the GI tract. Today, they are typically grouped into four categories: phytobezoars (made of vegetable or fruit fibers), lactobezoars (made of milk proteins), trichobezoars (made of hair and food particles) and pharmacobezoars (aggregates of various medications).[ii] Nowadays, if a bezoar doesn’t pass through the digestive system on its own they can be treated through medication to dissolve the mass, lavage therapy, and even surgery.

Once upon a time you may have wanted one in your system. I referenced this in Poisons, Pirates, and Professors in September for National Talk Like a Pirate Day. If you had been poisoned by an attacking pirate, you’d want to swallow a bezoar to cure yourself. Pierre Pomet, 17th century French druggist, wrote of bezoars curing all manner of things from smallpox to epilepsy, ending with its ability to work as an antidote to poison.[iii]

pomet_hist-of-drugs_1725_bezoar-uses-watermarked

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The word bezoar comes from the Arabic bazahr or badzehr, meaning counterpoison[iv] and it is also mentioned in ancient Hebrew texts as bel zaard, “master” or “master of poison.”[v] Its power to counteract poison may come from a near eastern goat, the markhor. In Persian, mar is snake and khor means to eat. Snake-eater. So presumably immune to venom. Except that the markhor is an herbivore dining upon grasses and leaves. Misnomer alert! The name may have to do with their corkscrew-like horns (reminiscent of a winding snake) or that they are known to kill snakes on occasion.[vi]

Berlin_Tierpark_Friedrichsfelde_12-2015_img02_Markhor.jpg

This handsome markhor is clearly eating carrots or yam, not a snake.  Source: A. Savin, A Markhor in Berlin Tierpark, Wikimedia Commons.

Whatever the origins of the belief in curing poison, bezoars were popular in the Middle Ages and into the 17th century as antidotes. They were carried as charms, included as decor or attached to drinking and eating vessels to protect the diner, and tests were even designed to detect fakes –the selling of which was a punishable offense.[vii]

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basin-with-bezoar_med-journal-of-australia-1986_watermarked

Another Frenchman represented in our collections’ holdings, barber surgeon Ambroise Paré, conducted an experiment to test the healing properties of a bezoar stone in the 1500s.[viii] A royal cook caught stealing silver had been sentenced to death. The cook was offered the alternative of being poisoned and then being given a bezoar under Paré’s supervision. If the cook survived the poisoning, he’d be spared. The cook lived only seven hours after the poison was administered, and Paré concluded the bezoar could not cure all poisons.

Still, the bezoar as antidote and mythical token lives on in the popular imagination. In J.K. Rowling’s Harry Potter stories, Professor Snape quizzes Harry on where he’d find a bezoar in his first potions class and later when his friend Ron Weasley is poisoned with mead –intended for Professor Dumbledore- Harry quickly shoves a bezoar down Ron’s throat.

harry-potter-bezoars

Box of bezoars and Half Blood Prince movie still.  Source.

Join us for a free First Mondays lunchtime tour in our Drs. Barry and Bobbi Rare Book Reading Room for a chance to see our bezoar in person. It’s well worth a visit even if poison and goat guts aren’t high on your to-do list; the Rare Book Room is pretty much the real life Hogwarts.

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References:
[i] Rosner, F. (trans.) 1988. Maimonides’ Medical Writings, Treatises on Poisons, Hemorrhoids, Cohabitation. The Maimonides Research Institute, Haifa, 1988, 49-50.
[ii] Eng, Katharine and Marsha Kay. “Gastrointestinal Bezoars: History and Current Treatment Paradigms,” Gastroenterology & Hepatology. Vol. 8, Issue 11, November 2012. 776.
[iii] Pomet, Pierre. A compleat History of drugs. Bonwick, London. 1725.
[iv] Williams, Randolph S. “The fascinating history of bezoars,” The Medical Journal of Australia. Vol. 145. December 1986. 613.
[v] Barroso, Maria Do Sameiro. “The bezoar stone: a princely antidote,” Acta Med Hist Adriat. 2014;12(1):78.
[vi] “Capra falconeri – Markhor.”Brent Huffman. An Ultimate Ungulate Fact Sheet. Accessed November 11, 2016.
[vii] Williams. 613.
[viii] Thompson, C. J. S. (1924) Poison Mysteries in History, Romance and Crime J.B. Lippincott, New York, 61-62.

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.

On Paré and Prosthetics

By Johanna Goldberg, Information Services Librarian

Saturday marks the 424th anniversary of the death of Ambroise Paré (1510–1590).

The French army barber-surgeon—and later master surgeon to four French kings and Catherine de Medici—has many accomplishments to his name.1 In 1537, he discovered that dressing gunshot wounds was more effective than the accepted practice of cauterizing them with boiling oil.2 He championed the use of ligatures to control bleeding post-amputation, which became more successful with the gradual adoption of tourniquets. He also developed an early “flap amputation,” saving skin and muscle during surgery.2,3 He authored 25 books with topics ranging from medicine and obstetrics to natural history and demonology (we hold many editions of his works).2

Paré also invented prosthetic devices, including Le Petit Lorrain, “a mechanical hand operated by catches and springs worn by a French Army captain in battle.” His above-the-knee prosthetic had properties still used today—“a locking knee and suspension harness.”1

Le Petit Lorrain. From  our 1633 edition of Les oeuvres d'Ambroise Paré.

Le Petit Lorrain. From our 1633 edition of Les oeuvres d’Ambroise Paré.

Artificial arm in use. From  our 1633 edition of Les oeuvres d'Ambroise Paré.

Artificial arm in use. From our 1633 edition of Les oeuvres d’Ambroise Paré.

Paré's  above-the-knee prosthetic. From  our 1633 edition of Les oeuvres d'Ambroise Paré.

Paré’s above-the-knee prosthetic. From our 1633 edition of Les oeuvres d’Ambroise Paré.

Perhaps more surprisingly, he also developed artificial noses:

Artificial noses. From  our 1633 edition of Les oeuvres d'Ambroise Paré.

Artificial noses. From our 1633 edition of Les oeuvres d’Ambroise Paré.

To celebrate Paré and his contribution to the field, we are featuring images of prosthetic devices throughout the centuries from items in our collection.

1696

Dutch surgeon Pieter Adriaanszoon Verduyn (ca. 1625–1700) developed the first below-knee prosthetic that allowed for knee movement and developed one of the first “true flap amputations,”3 as described in his Dissertatio epistolaris de nova artuum decurtandorum ratione of 1696.

Verduyn's below-knee prosthetic. In Dissertatio epistolaris de nova artuum decurtandorum ratione, 1696.

Verduyn’s below-knee prosthetic. Table VII in Dissertatio epistolaris de nova artuum decurtandorum ratione, 1696.

1718

In 1718, French surgeon Jean-Louis Petit (1674–1750) developed an effective tourniquet, allowing for more successful control of bleeding during and after amputation.3 He wrote about his achievement in Traité des maladies chirurgicales, et des opérations qui leur conviennent.

1862

Douglas Bly’s new and important invention, advertised in pamphlets from 1859 and 1862, offered a “ball and socket ankle, which were made of an ivory ball resting within a rubber socket,” and allowed for increased mobility.4 Bly publicized his leg throughout the Civil War, but the U.S. government found it too expensive to provide to wounded soldiers. Instead, the government offered to pay the difference between a government-issued limb and Bly’s higher-end model.4

Pages one and two of Douglas Bly's "A new and important invention," 1862.

Pages one and two of Douglas Bly’s “A New and Important Invention,” 1862. Click to enlarge.

Amputated, in stockings, and pants rolled up to show the artificials. On page 24 of Douglas Bly's ""A new and important invention," 1862.

Amputated, in stockings, and pants rolled up to show the artificials. In Douglas Bly,  “A New and Important Invention,” 1862, p. 24. Click to enlarge.

1885/1889

Henry Heather Bigg published Artificial Limbs and Amputations in London in 1885, almost exactly thirty years after the Crimean War (1853–1856). Our library holds the 1889 edition. Bigg illustrates advances he witnessed at the Royal Hospital at Netley.

Regulation box leg and regulation boot. In Henry Heather Bigg, Artificial Limbs and Amputations, 1889, p. 110 and 111.

Regulation box leg and regulation boot. In Henry Heather Bigg, Artificial Limbs and Amputations, 1889, p. 110 and 111. Click to enlarge.

Regulation common stump arms. In Henry Heather Bigg, Artificial Limbs and Amputations, 1889, p. 122 and 123.

Regulation common stump arms. In Henry Heather Bigg, Artificial Limbs and Amputations, 1889, p. 122 and 123. Click to enlarge.

1906-1926

The A. A. Marks Company of New York regularly released A Manual of Artificial Limbsour library holds seven editions, published from 1906 to 1926. There are only slight variations in the volumes, most notably the mention of services for Great War veterans in the later editions. The manuals aim to convince customers of the value of the devices throughout a person’s daily tasks and career (even when performing a magic show).

"It never occurs to anyone that his lower extremities are not real." A. A. Marks Co., Manual of artificial limbs, 1906, p. 108-109.

“It never occurs to anyone that his lower extremities are not real.” A. A. Marks Co., Manual of Artificial Limbs, 1906, p. 108-109. Click to enlarge.

"I am a professional prestidigitateur." A. A. Marks Co., Manual of artificial limbs, 1906, p. 265.

“I am a professional prestidigitateur.” A. A. Marks Co., Manual of Artificial Limbs, 1906, p. 265. Click to enlarge.

1945

Atha Thomas, associate professor of orthopedic surgery at the University of Chicago School of Medicine, and Chester C. Haddan, president of the Association of Limb Manufacturers of America, co-wrote Amputation Prosthesis, published in 1945 and heavily influenced by both world wars. They conclude their first chapter: “Where amputations were once considered only as a life-saving measure they are now performed yearly by the hundreds in a deliberate attempt to substitute a useful prosthesis for a useless, unsightly, or hopelessly deformed extremity” (12).

"Below-knee prosthesis equipped with rubber foot." In Thomas & Haddan, Amputation Prosthesis, 1945, p. 97.

“Below-knee prosthesis equipped with rubber foot.” In Thomas & Haddan, Amputation Prosthesis, 1945, p. 97.

"Great dexterity is possible also with this type of mechanical hand."  In Thomas & Haddan, Amputation Prosthesis, 1945, p. 212-213.

“Great dexterity is possible also with this type of mechanical hand.” In Thomas & Haddan, Amputation Prosthesis, 1945, p. 212-213. Click to enlarge.

1954

In 1945 the U.S. National Research Council established the Committee on Prosthetic Devices, later called the Advisory Committee on Artificial Limbs. The Committee published Human Limbs and their Substitutes in 1954, describing such progress as the electric arm, new methods of knee stabilization, and advances in suction sockets.

An electric arm. In National Research Council, Human Limbs and their Substitutes, 1954, p. 398.

A suction socket leg. In National Research Council, Human Limbs and their Substitutes, 1954, p. 665.

1962

In Upper and Lower Limb Prostheses (1962), author William A. Tosberg includes a brief history of the materials used in prostheses: after WWII, plastics predominated. The post-WWII era also lead to professional certifications and education programs for prosthetists (no longer called “limbmakers,” as they are by Thomas and Haddan) and orthotists.

Cosmetic hand for partial amputation. In William A. Tosberg,  Upper and Lower Limb Prostheses, 1962, p. 17.

Cosmetic hand for partial amputation. In William A. Tosberg, Upper and Lower Limb Prostheses, 1962, p. 17.

Adjustable above-knee leg. In William A. Tosberg,  Upper and Lower Limb Prostheses, 1962, p. 67-68.

Adjustable above-knee leg. In William A. Tosberg, Upper and Lower Limb Prostheses, 1962, p. 67-68.

References

1. Thurston AJ. Paré and prosthetics: the early history of artificial limbs. ANZ J Surg. 2007;77(12):1114–9. doi:10.1111/j.1445-2197.2007.04330.x.

2. Dunn PM. Ambroise Paré (1510-1590): surgeon and obstetrician of the Renaissance. Arch Dis Child Fetal Neonatal Ed. 1994;71(3):F231–2. Available at: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1061134&tool=pmcentrez&rendertype=abstract. Accessed December 4, 2014.

3. Sellegren KR. An Early History of Lower Limb Amputations and Prostheses. Iowa Orthop J. 1982;2:13. Available at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2328816/. Accessed December 4, 2014.

4. Dr. Bly’s Artificial Leg. The Shelf: Preserving Harvard’s Library Collections. 2014. Available at: http://blogs.law.harvard.edu/preserving/2014/01/13/dr-blys-artificial-leg/. Accessed December 9, 2014.