G.C.S.E. WJEC Specification B and Edexcel Specification C The influence of Renaissance ideas on medicine Surgery: Ambro

1. G.C.S.E.WJEC Specification BandEdexcel Specification C The influence of Renaissance ideas on medicine Surgery: Ambroise Pare STUDY IN DEVELOPMENT HEALTH AND MEDICINE, c. 1345 onwards Image courtesy of the United States National Library of Medicine

2. The aim of these materials is to: * Provide a little information upon Pare’s background – the factors that influenced his development as a surgeon and his techniques within surgery * Introduce his major works, especially The Apology * Provide an opportunity for students to discuss some of Pare’s main achievements and ideas and debate their significance in relation to the development of surgical techniques. ** This should all be viewed in the context of The Renaissance – the changes and developments that were taking place, especially within art, science and religion. Many thanks go to the U.S. National Library of Medicine who have allowed us to use some of the images found upon their website We would also like to express our thanks to Clendening, History of Medicine Library, University of Kansas Medical Centre

3. Click here to explore the title page ofThe Collected Works of Ambroise Pare Click here to find out more aboutRenaissance Surgery and the work of Pare

4. You could use the Whiteboard Pen and Highlighter here Worksheet Questions Image courtesy of the U.S. National Library of Medicine

5. Questions: • What is the title of this text? • 2) What does the top right hand picture show? • 3) What does the top left hand picture show? • 4) Why do you think that the human skeleton and figure have been placed at the centre of the title page ? • 5) Describe some of the operating tools seen on this page Worksheet Questions Image courtesy of the U.S. National Library of Medicine

6. The first edition of Pare’s Collected Works was published in 1575. The work was attacked by the Faculty of Physicians – which was made up of many of France’s most well known medical figures. Pare had the King’s (Henry II) support however, and the book was actually reprinted three times before Pare’s death in 1590. Click here to explore the title page of Pare’s Collected Works in more detail. Image courtesy of the U.S. National Library of Medicine

7. 1. Explore the illustration by clicking on areas that you would like to know more about. 2. When you have finished taking notes complete the extension activity by clicking on the button below Image courtesy of the U.S. National Library of Medicine

8. Try and work out what the text within the boxed off section says Click here when you think you know

9. Try and work out what the text within the boxed off section says Click here when you think you know TheWorksof the famousSurgeonAmbose Parey (Ambroise Pare)Translated out ofLatin and compared with the French

10. What does the picture show? Why do you think that it has been added to this medical text?

11. In one text in particular entitled Les Monsters, Pare describes cases of abnormalities in detail. Many of the descriptions appear to be exaggerated, either springing from popular myth or Pare’s own imagination. Pare describes different beasts and how many creatures could take on the characteristics (features and actions) of different animals. Many of Pare’s publications refer to abnormalities (something that is not normal)and malformations (something that has not formed correctly).

12. What type of surgical instruments can you see? What do you think each instrument was used for?

13. Tools of the Surgeons trade.* Knives to open and split flesh* Forceps to pull the flesh apart and to extract parts of the body* Saws for cutting through bone* Hammers for driving in instruments or breaking bone* A needle and thread for sewing up wounds Pare maintained that the patient should gather strength before an amputation by eating ‘meats, yolks of eggs, and bread toasted and dipped in wine’. A ligatureshould then be tied above the area where the operation (cutting) is to take place. The flesh should then be cut with a sharp, preferably crooked knife down to the bone. You then saw through the bone with a small saw (one foot and three inches long), then smooth the front of the bone with a file, or some same instrument. Click here for more information upon amputation

14. Pare maintained that you should only cut away what is necessary – the diseased or infected area of the body. Pare also advised that the veins and arteries be allowed to bleed a little before being tied up as quickly as possible. Pare used a crows beak (which looks like a set of crooked pliers) to pull out the arteries and veins. He then used a double silk thread to tie them off.Pare had, before developing this method, used hot irons to seal the wound and stop the bleeding. But, as he states in Of Amputations, which appeared in his Collected Works, he wastroubled by the ‘great and tormenting pain’ that this caused patients. Courtesy of the Clendening History of Medicine Library, University of Kansas Medical Centre He left ‘this old and too cruel way of healing and embraced the new ’.

15. What do you think Pare is doing here? What can you find around the room to support your theory?

16. People had mixed herbs and plants to create ointments and medicines for thousands of years before The Renaissance. Apothecaries opened shops and sold these mixtures that were often based upon remedies that had been handed down over generations. Tinctures (liquid made with alcohol), Poultices (solids mixed into a paste and applied to wounds and bruises) and Infusions (boiling water poured over leaves or flowers) were all used by apothecaries. Pare himself mixed together Rose Oil, Turpentine and Egg Yolk into an ointment which he applied to gunshot wounds, instead of using the traditional method of cauterising, or burning the wound with hot oil. Plants that were made into a plaster and applied for joint pain. Courtesy of the Clendening History of Medicine Library, University of Kansas Medical Centre

17. What do you think these instruments are used for?

18. The Renaissance was a time of experimentation and discovery. The mixing of herbs and different substances was not new, but the technology throughout The Renaissance allowed for new methods of heating, mixing and purifying liquids to be used. Courtesy of the Clendening,History of Medicine Library, University of Kansas Medical Centre What do you think the picture above shows?What could it have been used for?

19. What kind of operation are the surgeons performing here?

20. Trepanning, or trephining is when a circular disk of the skull (cranium) is removed. This was usually done in the Renaissance to relieve pressure on the brain. In The Middle Ages it was thought that trephining could cure madness. In the Renaissance many doctors thought that this surgical process could cure recurring migraines (headaches). A hand drill and/or circular saw was used to complete the process. Images to the left:Buch der Cirurgia Hantwirckung der Wundartzny, Hieronymus Brunschwig, 1525 Courtesy of the Clendening History of Medicine Library, University of Kansas Medical Centre

21. Courtesy of the Clendening History of Medicine Library, University of Kansas Medical Centre Trepanning equipment as illustrated in one of Pare’s publications. The instrument worked in the same way as a hand drill. As the handle was turned so the ‘bit’ at the end would spin and cut into the cranium.

22. Why do you think that the images of the human body have been added to the cover of this text?

23. Vesalius had mapped out the human body and provided a complete human anatomy by 1543 with the publication of the Fabric of the Human Body. Knowledge of the structure of the body is invaluable to surgeons whose job it is to repair the body. Many surgeons still relied upon descriptions of anatomy given by Galen and other ‘earlier’ anatomists, yet many were willing to accept new descriptions of the structure of the body, written by anatomists who had and were carrying out many human dissections. Pare appreciated the need to test and prove atheory and to share those theories with others. This illustrates the Renaissance attitude ofmany doctors and scientists of the time.

24. Andreas Vesalius had accurately illustrated the body layer by layer. Surgeons made great use of these illustrations and referred to drawings that depicted likely areas of infection and malformation. In this way they were able to better operate on areas of the body where tumours, growths and abnormalities formed. By knowing what lay beneath bone, skin and tissue, surgeons could perform more accurate surgery and repair the body afterwards in a much more efficient way. Students of surgery could also study surgical methods before, during and after lectures and dissections.

25. I was born in France in 1510. My father was a Barber Surgeon and I followed in his footsteps by training as a Barber Surgeon myself in 1533. However, in 1534 I became surgeon to the Hotel-Dieu, the only public hospital in the whole of France. I left the Hotel-Dieu in 1537 to become a military surgeon. It was during this time that I learnt a lot about surgery as I had to deal with many terrible wounds – often caused by muskets.

26. In 1552 I was appointed surgeon to King Henri II of France. I now had official royal approval for my work and continued to write medical texts. In 1545 I published my first work upon the Method of Treating Wounds. In 1575 my Collected Works was published and in 1585 The Apology and Treatise of Ambroise Pare. This last text was based upon my own life experience and the methods of treatment I had adopted . I was born in France in 1510. My father was a Barber Surgeon and I followed in his footsteps by training as a Barber Surgeon myself in 1533. However, in 1534 I became surgeon to the Hotel-Dieu, the only public hospital in the whole of France. I left the Hotel-Dieu in 1537 to become a military surgeon. It was during this time that I learnt a lot about surgery as I had to deal with many terrible wounds – many caused by muskets.

27. Extension:Describe and explain the connection between the images in your own words.(What do they tell you about Pare’s work?) Your Thoughts