PARÉ AS A NEUROSURGEON

The Cowlishaw Collection gives a splendid representation of the works of Ambroise Park (1510–1590). His Complete Works , in the great French edition edited by J. F. Malgaigne, are essential in any study of Paré's achievement, but the 1649 English edition provides a good basis for consideration of Paré's practice in what would now be termed neurosurgery. Paré had a large clinical experience in head injury management. His patients included Henri II King of France, who died from a penetrating orbital wound, and he described a number of other craniofacial wounds sustained in war or in warlike sports. His surgical instruments and operative techniques do not appear very innovative, but were doubtless good in their day; his methods of trephination compare favourably with those of the English surgeon John Woodall, his younger contemporary. He operated on head injuries and cranial infection, but had no capacity to treat intradural conditions, such as cerebral abscesses and tumours: his technical limitations are obvious, and the physicians on whom he had to rely could give him no guidance in neurological diagnosis. He was keenly interested in developmental malformations, and described several conditions that would now be referred to a paediatric neurosurgeon. Paré is of great historical importance as an outstanding Renaissance surgeon, whose influence extended throughout the literate world, and as far as Japan. With him, France replaced Italy and Spain in leadership in European surgical progress, a position that France retained at least until the age of Hunter.