Wednesday, April 29, 2015

Almost 500 years ago: boiling oil for bullet wounds

In the sixteenth century, helping wounded soldiers on the battlefield became increasingly difficult and daunting. A new, deadly kind of weapon - firearms - had come into wide use, and military surgeons had to treat wounds of a kind not seen before. Since deep bullet wounds often led to gangrene, the belief arose (mostly in Italy and France) that the residue of burnt gunpowder on a bullet "poisons" the victim's entire body. To combat the supposed poison, boiling elderberry oil was poured into fresh wounds. Soldiers treated in this brutal fashion complained of terrible pain, but only rarely survived.

The man who put an end to this barbaric practice was Ambroisé Paré (1510-1590; pictured below), a French army surgeon. The son of a poor craftsman, he was apprenticed to a barber surgeon. In those times, a barber was a medical practitioner of a lower rank as compared to a physician. With no university education, possessing only sharp blades and dexterous fingers, barbers not only cut clients' hair and shaved their beards, but also performed a range of minor surgical procedures: bloodletting, tooth extraction, abscess drainage, stitching wounds, setting fractures and dislocated joints. They routinely accompanied armies, treating all sorts of injuries sustained on the battlefield. After Paré had learned this craft, he worked for three years as an assistant at the renowned Paris hospital, the Hôtel-Dieu.

In 1536 he became a military surgeon. During a campaign in the Duchy of Savoy, injured French soldiers were, of course, treated by scalding their wounds with smoking-hot oil - and, doubtless, rarely recovered. By a fortunate accident, Paré managed to discover just how useless and harmful this practice was. After a great battle, he had to attend to such a large number of wounded men that his supply of oil ran out. Dismayed, he treated the remainder by anointing their wounds with a salve prepared from egg yolks, rose oil and turpentine. On the next day, he found that - contrary to his expectations - the soldiers treated with boiling oil were all feverish and suffered terrible pain, while those treated with the improvised ointment were quite comfortable, and their wounds subsequently healed without complications. From that day on, Paré became an opponent of the "poisoning" theory, and the barbaric practice of scalding bullet wounds with oil eventually died out.

Paré is also credited - among other things - with crafting prostheses for men who had lost their upper or lower limbs (a not uncommon fate for a soldier in those days, since the only "cure" for a severely wounded arm or leg was amputation). Those prosthetic limbs were fashioned from articulated metal plates, like armor, and could be bent or moved, incorporating such cunning elements as mechanical knees, gears, catches and springs. Clearly, he was far ahead of his times in his thinking. However, it's a common but completely false stereotype that medical practitioners 500 years ago had few means at their disposal except bloodletting and prayers!

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