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Military Surgery MILITARY SURGERY by John T. Bate, M.D., Professor of Surgery University of Louisville, School of Medicine, 1928 In casting about for a subject for this occasion, we have endeavored to avoid the well beaten path of the great torch bearers with whom you are already familiar. If, in presenting a smaller luminary, or one with whom you are acquainted, we have sacrificed a measure of your interest, we ask your forbearance in leading you so far afield. The history of Europe during the last days of Louis XVI, the short life of the Consulate and the scintillating era of Napoleon is so replete with manifold interests to all the Caucasian races that it occurred to us that the relationship of medicine and surgery to these stirring events might hold your attention. On further study, the material seemed so vast that we were forced to confine ourselves to military surgery. Of the surgeons who played a part in this drama, by far the most colorful and the most worthy of attention is Baron Larrey. To follow him through all the campaigns would be too long a task, so we will try to direct your attention to certain episodes of various campaigns as portrayed by a surgeon. The narrative will be foremost, and surgery incidental. Jean Dominique Larrey was born in 1776 at Baudeau in the Pyrenees. At the age of 13 years he left his native village for Toulouse. Here he studied under the direction of his uncle, Alexis Larrey, who was Surgeon Major and Professor at the Hospital of Grave. After six years of diligent work Larrey went to Paris to complete his studies. A vacancy occurred in the French Navy. He stood the examination successfully and proceeded to Brest where he embarked to accompany an expedition designed to protect the fisheries of the Newfoundland Coast. During his stay in North America, he interested himself with studies in Natural Science, especially the case of a cow which became enciente following the forcible, midnight attentions of a bull moose which broke into the stable where she was stalled. He was again in Paris at the beginning of the winter of 1789. That was an eventful time. Larrey was an eye-witness of the early troubles of the Revolution and had occasion to take care of the first victims of those sad days, at the Hotel Dieu, under the orders of the surgeon Desault. It was in that vast hospital and at the Hotel Royal des Invalides that Larrey acquired knowledge sound enough to enable him to serve with distinction, three years later, in the Army of the Rhine. On April 1, 1792, Larrey joined the headquarters of the Army. Larrey here became sensible enough of the inconvenience of the French Ambulances as they were constructed at that time. According to the regulations, these ambulances were obliged to remain about a league from the army, while the wounded were also obliged to remain on the field of battle until after the combat. Depressed at the sight of the privations to which the wounded were exposed, Larrey invented a carriage hung on springs, uniting great strength and solidity with lightness. Such indeed was its lightness, that it was able to follow all the movements of the advanced guard with as much speed as flying artillery. A dispatch written by General Beauharnais to the convention commends him thusly; "I ought not to omit mentioning the Surgeon-Major Larrey and his comrades with the flying ambulances, whose indefatigable care in treating the wounded has diminished those affecting results to humanity which have generally been inseparable from days of victory, and has essentially served the cause of humanity itself in presenting the brave defenders of our Country." He was sent to Paris to superintend construction of ambulances, but hardly had he arrived in Paris when he received the appointment of Surgeon-in-Chief of the Army of Corsica. He journeyed to Toulon where he presented himself to the chiefs of the French Army among whom was the General Napoleon. As the number of English cruisers which were watching the port of Toulon rendered it hazardous for the French Army to go to sea there, Larrey went by land to Nice. He then served during the short war in the eastern part of Spain. In the year 1797, he was ordered to join the army of Italy for the purpose of organizing the flying ambulance. He arrived at the time of the signature of the preliminaries of peace. This proclaimed the downfall of Venice, and terminated the power of the last of the one hundred and twenty-two Doges. He saw taken down from the top of one of the columns of the place St. Marc the Lion of Paris. He was also eye-witness of the surrender of the famous Horses of Corinth which surmounted the front of the Cathedral and which more lately adorned the Arc-de-Triumphe in Paris. At Venice he organized the Health Service of the expedition being fitted out against Coffu. After the peace of Campo Formio, Napoleon caused the Flying Service of the expedition being fitted out against Coffu. After the peace of Campo Formio, Napoleon caused the Flying Ambulance Corps to maneuver before him. He then said to Larrey: "Your work is one of the most happy conceptions of our age; it will suffice for your reputation." Larrey proceeded with his inspections of hospitals, first at Venice and next at Padua. At the latter place he paid his respects to the celebrated professor, Scarpa. Larrey now became surgeon and chief of the expeditions against Egypt. It was to be commanded by the young hero who had conquered for France some of the finest provinces of Italy. At Ciaro, opthalmia attacked large numbers. Larrey there adopted a treatment which was so successful, that among 3000 soldiers, no one lost his eyesight. Bleeding in the neck, application of leeches to the temple and baths for the feel, along with the use of boiling decoctions of emollient substances for the parts affected, all combined at discretion, with purgatives and bitters constituted the remedy which Larrey ordered to be used in the French Army. Tetanus was frequent among the wounded. The remedy which he directed to be used was the extract of opium combined with camphor and the nitrate of purified potash. The salt thus obtained was dissolved in a small quantity of emulsion made with cold seeds of cucumber or of melon, or with bitter almonds. He amputated the limb when a wound of the extremities was the cause of tetanus. Larrey saw in the Egyptian temples the basreliefs representing surgical instruments very nearly resembling those which were used in France at that time. After continued success in Egypt, Bonaparte embarked for France, leaving General Kleber in command. One insurrection after another broke out. Larrey thought that so many fatigues and privations under a burning sky excited liver trouble which degenerated into abscesses, and said, "Very desperate may appear the remedy which was then applied sometimes in order to save a life. It was no less that plunging a sharp instrument into the belly in order to five a free course to suppuration. After the landing of a force of English at Aboukir, reverses and sickness attended the French Arms. A Capitulation followed. On his arrival in Marseilles Larrey learned of his appointment as Surgeon-in-Chief of the Consular Guard. Bonaparte was now first Consul and in a short time this title became Napoleon the First, Emperor of the French. At the time of the alleged breach of the treaty of Amiens by the English, Napoleon concentrated 80,000 men at Boulogne expecting the arrival of the Spanish and French Fleets, to carry them to British shores. The news arrived of the annihilation of the fleets at the battle of Trafalgar, and Austria declared in favor of England. Napoleon threw his Army through Prussia into Austria by forced marches. The battle of Austerlitz Saxony and Prussia with the sanguinary battle of Eylau now followed. The second campaign in Spain and the second in Austria seem barren of opportunities to picture to you the liaison of Larrey with the Military operation. In the latter campaign, he was made a Baron of the Empire. At the height of his power, Napoleon now undertook the conquest of Russia. After twenty years of military surgery, Larrey had three quiet years in which to complete his memoirs. In 1812 he joined the Grand Army which soon assembled on the left bank of the Vistula. It numbered 400,000 men and was equally divided between infantry and cavalry. These soldiers consisted of French, Spaniards, Neapolitans, Italians, Austrians, Prussians, Bavarians, Wirtenbergers, West Phaliens, and Saxons. The advance guard entered Wilna without encountering much resistance. On the day preceding their arrival, the Emperor Alexander was still remaining in this town and had not the most distant idea that the French were approaching with such rapidity. Among the wounded, Larrey saw some singular phenomena. The first was a Polish officer, who was wounded 24 hours previously. His body was inflated to an extreme degree by a general emphysema and the skin so distended as to render the limbs stiff and inflexible; the folds surrounding the joints were also effaced and the eyes entirely closed by the turgesence of their lids. The lips acquired a prodigious thickness and impeded the passage of liquids into the mouth. The pulse and respiration had nearly ceased. The spear of a Cossack had penetrated obliquely under the inferior angle of the left scapula into the thorax effecting at the same time a wound of the intercostal muscles.
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