Larrey, Dominique-Jean

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LARREY, DOMINIQUE-JEAN

LARREY, DOMINIQUE-JEAN (1766–1842), French surgeon.

Soldiers in the Revolutionary and Napoleonic era encountered the same perils that had governed the battlefield since the gunpowder revolution began three centuries earlier. Bullets shattered bone, shredded soft tissue, and usually remained embedded in the wounded man, thus creating the conditions for infection, particularly if foreign objects such as pieces of the uniform entered the wound. Saber cuts ripped flesh from bone, while lance thrusts lacerated organs and arteries. Round shot and grape often tore limbs from bodies and decapitated men where they stood. Disease, malnutrition, poor sanitation, and physical exhaustion usually claimed more lives on campaign than actual combat; a typical army lost over 10 percent of its combat effectiveness to the sick list.

The French Revolution and Napoleonic era ushered in a new age of warfare. The massed batteries, deep attack columns, and massive frontal assaults that became common in Napoleonic battles claimed unprecedented numbers of casualties. Military medical services, which had stagnated for much of the eighteenth century, needed revolutionary innovations to keep pace. Unfortunately, improvements in the medical services lagged far behind changes in warfare.

Most armies campaigned with an accompanying hospital that stood far behind the front lines. The wounded either depended on comrades to help them get to the rear or had to make their way to the hospital, often bloodied, disoriented, and in excruciating pain. Severely wounded soldiers had to remain on the field until combat ceased, sometimes waiting days before they received aid. If the wounded managed to reach the hospital, available medical services afforded little comfort. Surgeons often used their fingers to probe a wound for bullets and shell fragments. Primitive instruments and unclean conditions made attempts at extraction risky. Amputation remained the primary method of treating limb trauma. Gangrene, an ever-present concern, could develop if the surgeon failed to remove all of the dead flesh from around the wound. Shock and infection, the usual consequences of surgery, had to be treated in hospitals rife with contagions that claimed more lives than the enemy.

Most associated with the improvement of medical services during the Revolutionary and Napoleonic era is the French surgeon Dominique-Jean Larrey. The young Larrey began his medical studies in Toulouse. After completing his formal training in Paris, he secured his first position in the medical field in 1787 as a surgeon on the French frigate La Vigilante. When the Revolutionary Wars began in 1792, Larrey volunteered as an assistant surgeon in the Army of the Rhine. He saw firsthand the need to reform the method of evacuating the wounded from the battlefield. Under Larrey's direction, the French established a system of "flying ambulances" that carried wounded in light, horse-drawn carts from the battlefield to mobile field hospitals, where surgeons could begin treatment immediately. Such a system proved invaluable because the speed of treatment often determined if a wounded soldier would recover. Larrey's ambulance corps launched his career. After Larrey received a professorship at Paris's new school of military medicine at Valde-Grâce in 1796, young General Napoleon Bonaparte summoned him to implement his ambulance system in the French Army of Italy. Two years later, Larrey accompanied the French Army of the Orient to Egypt, Palestine, and Syria, where he and his assistants refined the technique of evacuating the wounded and performing lifesaving procedures on the field of battle. In 1805, now Emperor Napoleon I promoted Larrey to inspector general of the Service de Santè(Office of Army Health), and later, in 1812, chief surgeon of the Grande Armèe.

Although he showered Larrey with gifts, Napoleon refused to sanction the existence of a permanent medical corps and actually mistrusted doctors in general, claiming that their inexperience did more harm to his army than the enemy's artillery. Larrey and others struggled to create a permanent medical corps, but could not overcome the low priority that Napoleon placed on medical needs. Prior to the war against Prussia in 1806, Larrey assigned a flying ambulance detachment to each of the six corps that made up Napoleon's army. Because of Napoleon's refusal to acknowledge the importance of medical officers by granting them full equality with other officers, Larrey could not field a full complement of surgeons. In 1812 Larrey formed eleven flying ambulance detachments to accompany the French army into Russia. This number, however, proved woefully inadequate to support the 500,000 men who crossed the Russian frontier. Although the emperor made sure that his elite Imperial Guard had the very best medical services, the rest of the French army suffered from Napoleon's detached regard for life. This can be especially seen in the 1813 and 1814 campaigns, when poor supply, health care, and sanitation contributed just as much to the defeat of French forces as the enemy coalition.

See alsoArmies; Disease; French Revolutionary Wars and Napoleonic Wars; Napoleon; Nightingale, Florence.