Of Oil and Earthworms

Yesterday evening, I tore a deep, two-inch-long gash in my elbow that required a trip to the emergency room and eight stitches to close. (I dove to save my three-year old from riding his bicycle off the curb; I saved him but lost my elbow in the process.) The doctor irrigated the wound a long time to remove all the gravel embedded in it; today the wound is red and puffy, even though I'm taking antibiotics. This entire episode got me thinking about medical practice in the sixteenth century. How would a contaminated wound like this have been treated in 1550?

I found a fascinating account in the memoirs of Ambroise Paré (1510-1590), royal surgeon to Henri II, Francois II, Charles IX and Henri III. Paré was a physician of great reknown and is credited with introducing the technique of using ligatures rather than cauterization for closing blood vessels during amputations. Educated on battlefields of Italy and Provence during Françcois I's numerous wars against Charles V, he became an expert on the treatment of wounds. He published two treatises on the treatment of wounds from firearms and arrows in 1545 and 1553. He was, however, unable to cure Henri II of the head wound, sustained in a tournament, which killed the king in 1559. Despite this failure, Paré remained in royal service, vivid testimony to his great skill. He became an expert in obstetrics, wrote anatomical treatises, and invented several surgical instruments.

In his memoir, Paré describes how he stumbled upon a novel way of treating gunshot wounds, which tended to become infected due to the embedding of gunpowder in the wound. It appears the traditional way of treating the wounds was to cauterize them with hot oil! Paré's account is so interesting I am going to transcribe it verbatim from an 1899 translation by Stephen Paget:

Now I was at this time a fresh-water soldier; I had not yet seen wounds made by gunshot at the first dressing. It is true I had read in John de Vigo, first book, Of Wounds in General, eighth chapter, that wounds made by firearms partake of venenosity, by reason of the powder; and for their cure he bids you cauterise them with oil of elders scalding hot, mixed with a little treacle. And to make no mistake, before I would use the said oil, knowing this was to bring great pain to the patient, I asked first before I applied it, what the other surgeons did for the first dressing; which was to put the said oil, boiling well, into the wounds with tents and setons; wherefore I took courage to do as they did. At last my oil ran short, and I was forced instead thereof to apply a digestive made of the yolks of eggs, oil of roses, and turpentine. In the night I could not sleep in quiet, fearing some default in not cauterising, that I should find the wounded to whom I had not used the said oil dead from the poison of their wounds; which made me rise very early to visit them, where beyond my expectation I found that those to whom I had applied my digestive medicament had but little pain, and their wounds without inflammation or swelling, having rested fairly well that night; the others, to whom the boiling oil was used, I found feverish, with great pain and swelling about the edges of their wounds. Then I resolved never more to burn thus cruelly poor men with gunshot wounds. (pages 33-34)

How lucky the soldier upon whom the oil ran out! The account gets even more interesting; Paré recounts how in Turin he managed to obtain from a renowned surgeon the secret recipe for a balm to treat gunshot wounds:

While I was at Turin, I found a surgeon famed above all others for his treatment of gunshot wounds; into whose favour I found means to insinuate myself, to have the recipe of his balm, as he called it, wherewith he dressed gunshot wounds. And he made me pay court to him for two years, before I could possibly draw the recipe from him. In the end, thanks to my gifts and presents, he gave it to me; which was to boil, in oil of lilies, young whelps just born, and earthworms prepared with Venetian turpentine. Then I was joyful, and my heart made glad, that I had understood his remedy, which was like that which I had obtained by chance. (pages 34-35)

A mixture of lily oil, dead puppies, earthworms and turpentine: it's a wonder patients did not die of the treatment alone! Reading this, I grew amazed at the human body's resiliency, and very grateful for the novocaine and antibiotics I had received. Even so, I realize we only benefit from these things due to the willingness of men like Ambroise Paré to experiment and push the frontiers of medical knowledge and to the bravery of their patients who would try anything to hang onto life.

Stay tuned: tomorrow I will share a recipe I came across in another book on how to prepare those earthworms Paré was talking about.