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Dominique Jean Larrey (1766-1842) and His Contributions to Military

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Dominique Jean Larrey (1766-1842) and His Contributions to Military Historical Vignette Dominique Jean Larrey (1766e1842) and His Contributions to Military Medicine and Early Neurosurgery Rebecca C. Ramdhan1, Rabjot Rai1, Katherine N. Brooks2, Joe Iwanaga2, Marios Loukas1, R. Shane Tubbs1,2 Key words Dr. Dominique Jean Larrey was a pioneer in the field of military surgery. His - Biography creative innovation and drive to improve the quality of medical services avail- - Dominique Jean Larrey - Emergency medicine able to those injured during war guided his achievements in medicine. Dr. Larrey - History has often been referred to as “the father of emergency medical services” and - Military medicine “the father of modern military medicine.” His contributions to medicine continue - Neurosurgery to live on in common procedures and healthcare systems today, such as aspi- From the 1Department of Anatomical Sciences, St. George’s ration of pericardial effusion and drainage of hemothorax and empyema. Based University, Grenada, West Indies; and 2Seattle Science on his own writings, he treated multiple cases of intracranial injury, making him Foundation, Seattle, Washington, USA an early, but often forgotten, pioneer of neurosurgery. To whom correspondence should be addressed: Joe Iwanaga, D.D.S., Ph.D. [E-mail: [email protected]] Citation: World Neurosurg. (2018) 120:96-99. Invalides. The years he spent learning at for wounded soldiers were often unable to https://doi.org/10.1016/j.wneu.2018.08.159 these hospitals provided him with the arrive for days; thus, with no medical Journal homepage: www.WORLDNEUROSURGERY.org skills and knowledge that would guide his attention, soldiers died of wounds and Available online: www.sciencedirect.com surgical career. injuries that could have been treated. fi ’ fi 1878-8750/$ - see front matter ª 2018 Published by Elsevier His work and experiences in battle eld Larrey s experience on the battle eld led Inc. medicine were linked to the military ef- him to create a system to triage patients forts of Napoleon from 1797 to 1815. After and create the “ambulance volante,” a Napoleon’s downfall at Waterloo in 1815, flying ambulance.1,3 This innovation INTRODUCTION Larrey spent the remainder of his life consisted of horse-drawn vehicles equip- Dominique Jean Larrey (1766e1842; dedicated to civilian medicine and writing ped with padded mattresses, suspension, Figure 1) was born in Baudéau Hautes- about his experiences.5 and essential medical tools that would help Pyrénées, a renowned French village that Larrey died of pneumonia on July 25, transport the critically injured to the base was known since Roman times for the 1842 in Lyons, France at the age of 76. He hospitals. This allowed soldiers to be medicinal qualities of its waters.1,2 had been given the title of baron a few transported more quickly to the base hos- Larrey’s father died when Larrey was 3 years before his death.1,3,6 A culmination pitals. This innovative contribution by Lar- years old. He was then taken under the of his innovations, accomplishments, and rey is still recognized and practiced by the wing of the parish priest, l’abbé success earned him the titles of “the father Red Cross.1 As a medical professional, Grasset.2 At 13 years old, he left his of emergency medical services” and “the Larrey worked among the front lines in home village and traveled to Toulouse to father of modern military medicine.”4,7 unrelenting battlefield conditions: rampant join his uncle, Alexis Larrey—a surgeon- The sternocostal triangle of the dia- explosions, dry weather conditions, and major and professor at the Hospital of phragm was named in his honor, and 2 the risk of infection. His overpowering Grave. Dominique Jean Larrey studied monuments were built in dedication to his humanity led him to act in the best surgery and began honing his surgical advancements in medicine: 1 at a military interests of the wounded despite their rank skills, in a few years becoming house hospital in Paris called Val-de-Grâce court in the army. He even showed the same surgeon. When he turned 21, Larrey and 1 at the hall of the Academy of devotion and compassion to enemy moved to Paris and was accepted as an Medicine.1,8 soldiers.1 assistant surgeon in the French Navy and Many soldiers during this time experi- was assigned to the frigate Vigilante.1,3 enced hypothermia-related injuries that ’ Larrey’s first sailing adventure to LARREY S WORK IN BATTLEFIELD often resulted in death. Through his time Newfoundland ended after only 6 months MEDICINE AND CONTRIBUTION TO spent observing such soldiers, Larrey because he resigned owing to severe CURRENT MEDICINE recognized that those who remained on seasickness.1 While serving as a surgeon in the Army of duty in snowy environments with tempera- On returning to Paris in 1789, the revo- the Rhine (1792), Larrey witnessed the hor- tures of À15C had no complaints but that lution was in full effect, and Larrey enrolled rendous conditions of the wounded. He an increase in temperature to 18Cor in a clinical surgery course at the well- noticed that many injured soldiers died 20C resulted in piercing sensations, known hospital, Hôtel Dieu.4 After his without receiving medical care.9 The numbness, and rigidity of the muscles. training, he worked at Hôtel Royal des common ambulances that were assigned Noticing these changes in temperature led 96 www.SCIENCEDIRECT.com WORLD NEUROSURGERY, https://doi.org/10.1016/j.wneu.2018.08.159 HISTORICAL VIGNETTE REBECCA C. RAMDHAN ET AL. DR. LARREY'S CONTRIBUTIONS TO MEDICINE AND EARLY NEUROSURGERY pericardial interventions in 1810.1 Clinical experience with several patients led him to realize the need to use cadavers for medical research, and his research made him a pioneer in techniques such as aspiration of pericardial effusion and drainage of hemothorax and empyema.11 Larrey had exceptional clinical skills and documented his findings. He made the connection between the consumption of salt-free snow water and the likelihood of the development of goiter and cretinism.2 Serving Napoleon in 25 different campaigns and 60 battles, Larrey always took the time to document his experience and clinical observations, including his experiences with endemic diseases such as syphilis, leprosy, typhus bubonic plague, rabies, tetanus, aneurysms, and elephantiasis scrota.8,14 LARREY’S INFLUENCE ON EARLY NEUROSURGERY During his time as a military surgeon, Larrey treated soldiers with brain and skull injuries from bullet wounds, cavalry sa- bers, and atraumatic causes such as infection.5 Surgeons understood the severity of these injuries and immediately saw soldiers who survived the initial Figure 1. Drawing of Baron Larrey. effects of traumatic wounds, such as bullets and penetrating objects.3 In his own writing, Larrey stated in his memoirs that wounds complicated with him to hypothesize that the variability in the attention to the severely injured during cranial fractures were managed with trepa- temperature, not the actual cold itself, pre- battles. He drained penetrating wounds, nation to prevent bony fragments from disposed the soldiers to develop gangrene.2 reduced fractures, and minimized the risk injuring the brain matter.5 He described the It was later established that after being of infection through debridement.11 Larrey case of a soldier shot in the right temple, affected by hypothermia, the rewarming of advanced the debridement technique by fracturing the squamous portion of the the body must occur steadily at 0.5Ce creating an “inverted cone-like cut,” temporal bone, with the bullet fragmenting 1C/hour to prevent the developed of which permitted the drainage of fluids from into 2 pieces—1 into the cranium and 1 gangrene and permanent damage.10 the wounded area.11,12 Larrey was also the buried within the temporal muscle. Larrey Additionally, Larrey recognized the first to cauterize injuries using a burning wasted no time in dilating the wound and beneficial medical effects of cold weather, piece of iron over necrotic tissue.11,12 beginning the operation, stating, “Isoon including decreased bleeding with snow or Under Napoleon Bonaparte’s command discovered one piece of the ball [bullet] in ice applied and a greater tolerance for in 1794, Larrey served as a chief surgeon of the muscle, and easily removed it. By pain. He applied this knowledge to lower the Army of Italy for 2 decades. Impressed means of an elevator I raised up a large extremity amputations and to improve the by Larrey’s dedication and skill, Bonaparte scale of the cranium, and was so fortunate treatment of frostbite.10 described Larrey as “the most virtuous as to seize the other piece of the ball with a Larrey was a fast surgeon who believed man I have ever known.”6,13 Larrey per- pair of dressing forceps, and extracted it that timing was imperative for performing formed 1 of the earliest methods of car- from its nidus, between the dura mater effective amputations. Many surgeons diopulmonary resuscitation; he created and the cranium.”3 preferred to wait until the injured could be artificial respiration by blowing air into the After the surgery, the patient had an transported from the battlefield; however, lungs and then compressing the chest to extensive open wound, which gradually Larrey performed amputations as soon he promote exhalation.12 Following in the diminished and healed to the point at could after the injury.11 Without concern for footsteps of Francisco Romero, Larrey which he was discharged on the 45th day his own safety, Larrey provided medical became the second surgeon to perform after his injury. However, underneath the WORLD NEUROSURGERY 120: 96-99, DECEMBER 2018 www.WORLDNEUROSURGERY.org 97 Download English Version: https://daneshyari.com/en/article/10215698 Download Persian Version: https://daneshyari.com/article/10215698 Daneshyari.com.
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