Chapter 28, Book X., of Malgaigne’s Edition--Performed the Operation

of exarticulation of the elbow-joint (the first recorded instance of this operation, says von Gurlt). The case was that of a common soldier who had been shot through the forearm, a little above the wrist, who had been treated unsuccessfully by other surgeons, and who, at the time when he came under Paré’s care, was suffering from a variety of complications--viz., gangrene extending as high up as the shoulders, extensive inflammation of the integuments on the adjacent side of the thorax, and other symptoms that pointed toward a fatal issue. To complicate matters, it was winter and the only approximately warm shelter available was a cow-stable. At this early date, in the history of surgery, the practice of ligating the blood-vessels which had been divided in the course of an amputation had not yet been adopted, and consequently the red-hot cautery had to be employed for arresting the bleeding which followed the operation. (See also page 512.) In addition to the amputation it was found necessary to make a number of long and deep incisions into the inflamed tissues and to apply the actual cautery freely “for the purpose of drying up and destroying the virulent matters that had penetrated these parts.” Then, fourteen days later, the patient, who had been lying all this time, exposed to draughts of air, upon a receptacle intended for the storage of grain, and who was protected from the cold by only the scantiest coverings, developed trismus (lockjaw). When this new complication appeared Paré, already at his wits’ end to find means with which to overcome the difficulties which surrounded the case, decided first to have the man removed to an adjacent stall in which there were several cows, the presence of which in such a confined space might be counted upon to increase appreciably the warmth of the surrounding air. Next, he gave orders to rub briskly the back of the patient’s neck, as well as the shoulders, the uninjured arm and the legs, with heated cloths which were immediately afterward to be wrapped around him; and then, for an outside covering, he utilized the straw and cows’ dung which were plentifully within reach. In addition, two braziers which had been procured from a neighboring dwelling, were charged with coals and kept burning close to him. During three successive days and nights these measures were kept up faithfully, and from time to time a mixture of milk and soft egg was introduced into the patient’s mouth through a suitable tube, after the jaws had first been pried open by a bit of willow wood. The effect of these measures was to make the patient perspire copiously and to induce a gentle action of the bowels; and, as a further effect, the trismus was also overcome. For some time afterward, in addition to the ordinary dressing of the healing wounds, it was thought best to apply the red-hot cautery regularly at certain intervals to the end of the bone of the upper arm. (This practice was abandoned by Paré at a later date.) Final and perfect healing took place after several large splinters of bone had been exfoliated.

At the end of his account of what one is tempted to call the wonderful victory of a surgeon over the death that threatened to carry off this gravely wounded soldier, Paré adds one of his characteristic appeals to the oncoming younger generation of physicians:--

Both God and Nature constantly remind the surgeon that, no matter how poor, in a given case, the prospect of a cure may seem, he should not for one moment cease doing his full duty; for Nature often accomplishes what the surgeon believes to be impossible. Cornelius Celsus [about the time of Jesus Christ] says: “Contingunt in morbis monstra, sicut et in natura.” [Marvels are observed in diseases, very much in the same manner as they are frequently encountered in nature.]

In the two preceding histories of actual cases treated,--one of these patients being a wealthy officer of high rank and birth, and the other a common soldier of the peasant class,--we obtain the best of evidence that Paré was not influenced by the wealth, rank or social position of his patients. Upon both classes he bestowed freely the fruits of his knowledge, experience and skill.

The first mention, in medical literature, of a fracture through the neck of the femur close to the joint, is to be found in Chapter 21,