‘They had no fever…’ Ambroise Paré (1510–1590) and his method of gunshot wounds management

By the fifteenth-century firearms had spread all over Europe, but surgeons had no idea how to cure gunshot wounds. It was generally accepted that high mortality from gunshot wounds could be explained by some kind of ‘gunshot poison’ entering the body with the bullet, but information and practical advice on managing gunshot wounds varied enormously across Europe. There were no appropriate instructions for such a new kind of wound in the ancient medical tradition and more recent ideas were unevenly distributed. Although known in Germany, Hieronymus Brunschwig’s Buch der Wund Artzney (1497) seems to have been unfamiliar in France and instead French surgeons focused on Giovanni da Vigo’s La Practique et chirurgie (1542), which was translated into several languages. Ambroise Paré also followed da Vigo, but in the battlefield he had to revise the generally accepted method of gunshot wound treatment. In response to his experiences he proposed a new version of wound care where cauterisation was replaced with a ligature of the vessels and the use of a healing balm dressing. In his treatise Des Playes faicts par haquebutes et autres bastons à feu (1545) he described the main stages of healing and the principles of wound care he finally adopted. As Paré fell out of fashion, the idea of ‘gunshot poison’ was rejected by the medical authorities, but the technique of cauterising gunshot wounds, abandoned by Paré, was still practiced. Opponents of Paré argued that only a few people were cured by him and that those who were, were not seriously injured. It is of course impossible to know how many soldiers were cured with the help of Paré’s method but it nevertheless served as a basis for a new surgical paradigm. Perhaps most importantly, Paré’s method centred on the wish to reduce pain in the treatment process – an idea that was entirely new and ahead of its time