Amputation

Amputation

BY WENDY HUGHES

Next time you see an ambulance in the street, spare a thought for the person who developed the first effective ambulance, Baron Dominique-Jean Larrey, the greatest French military surgeon of his time. To him we owe the development of ambulances, clearing stations and base hospitals, yet today he is a forgotten hero.

Dominique-Jean was born on 8 July, 1766, in Beaudean, a little village set high in the Pyrenees. His family had lived in the area for generations, and his great-grandfather was the first in the family to take up medicine, becoming a senior surgeon in the town of Tarbes, a few miles north of Beaudean. One of his sons, Dominique, followed in his footsteps, and he in turn had two sons, the younger, Alexis studied medicine in Toulouse, whilst the elder Jean, Dominique’s father, stayed at the family home to help his father and later became a master shoemaker.

Larrey's Flying ambulance

Larrey’s Flying ambulance

The young Dominique attended the village school, and like many boys became fascinated by the world around him. When he was 13 his father died, and he was sent to his Uncle Alexis, now a chief surgeon in Toulouse, to continue his education. On 10 May 1780, a very sad Dominique, set off dressed in his Sunday best, to walk the 70 miles to Toulouse, to enrol at the college of Esquille where he received an excellent grounding in medicine. In fact, he proved to be such an outstanding pupil that at the age of 19 he passed out as a house surgeon, and a year later produced a thesis on bone decay that was so good that the University of Toulouse awarded him a medal.

In August 1787 the Royal Academy of Surgery held a public examination to recruit a number of naval surgeons, and the chance of adventure and a regular meal appealed to Dominique. He decided to enter, passed, and was posted to the Vigilante, an 18-gun ship, as first surgeon. Under the command of Captain Saques de Toures the ship set sail for Newfoundland in April 1788 with a crew of one hundred and twenty-three. Throughout the entire journey, Larrey suffered badly from sea sickness, but in spite of being incapacitated, he managed to treat twenty-four sick and contained minor outbreaks of smallpox and typhus. After seven gruelling months, he was discharged and returned to dry land.

Bronze statue of Larrey oin the courtyard of Val-de-grace military hospital

Bronze statue of Larrey oin the courtyard of Val-de-grace military hospital

On his return to Paris he worked at the clinic of the great French surgeon Desault, and at the Hotel Dieu, as well as working as a field surgeon at Les Invalides, where he became an assistant Senior Surgeon. Not long after serving in the army, Larrey was sent to Toulon where he met Napoleon Bonaparte for the first time who was then, commander of an artillery brigade.

In 1792 war was declared and Larrey joined the Army of the Rhine as a field doctor with the rank of Major. The battles were fierce, and Larrey was appalled to see

that casualties were denied immediate medical treatment, and risked his life to treat the wounded on the battlefield. Once the wounded were treated Dominique needed some way of moving the men to safety, and noticed that the advance guard were supported by highly mobile artillery, giving him the idea of a flying ambulance.

Jean Larry

Jean Larry

Larrey sought permission to construct the celebrated Ambulance Volante, knowing exactly what he wanted – a light carriage, well sprung and capable of being drawn swiftly onto the battlefield by two or four horses, so that the wounded could be treated before being taken to base hospitals. He described his idea in great detail in a report from the Italian Campaign of 1797, which consisted of a system of transport, medical supplies, and supporting personnel including a doctor, quartermaster, non-commissioned officer, and a drummer boy (who carried the bandages) and 24 infantrymen. His idea was a huge success and not only served to boost the morale of the rank and file officers, but also allowed the wounded instant treatment, increasing their chances of survival

During a brief period of peace Larrey became Professor of Surgery at the military hospital at Val-de-Grace where his statue stands today.

In the next battle, against the Austrians, Larrey dressed the wounded on the field, exposing himself to terrible risks. This was the first time that surgeons went to the wounded, offering vital first aid before sending them to the clearing stations and base hospitals. Larrey accompanied Napoleon on his expeditions to Egypt, Palestine and Syria and in 1805 was appointed Surgeon-in-Chief to the French Army. He followed Napoleon to Germany, Poland, and the assault on Moscow and was made a ‘Commandeur of the Legion d’honneru on 12 May 1807. He was made a Baron in 1810 by Napoleon after participating in twenty-five campaigns and over sixty battles, and making a significant contribution to military medicine of the day. He was one of the first to perform amputations at the hip, and his name remains associated with an amputation of the shoulder joint to this day. He co-led the surgical team who performed the pre-anaesthetics mastectomy on Frances Burney in Paris in 1811. He was mentioned in dispatches for his care of the wounded and saving many a gallant soldier. Never before had a military surgeon received formal acknowledgement of services from his general and government, and this was regarded as a milestone in military history.

However it is for his skills in amputations that Larrey is best remembered. It is said that he performed 200 amputations in a 24-hour period after the Battle of Borodino in 1812, and that at the Battle of the Berezina during the retreat from Russia, he performed 300 more amputations. At the battle of Aspern-Essling he operated on Marshall Jean Lannes and amputated one of his legs in just two minutes.

Larrey's _Ambulance

Larrey’s _Ambulance

At the battle of Waterloo in 1815 Larrey was shot and left for dead, and trying to escape to the French border he was captured by the Prussians who wanted to execute him on the spot, but Larrey was recognised by one of the German doctors who had been a student at Val-de-Grace. He pleaded with Marshal Gerhard Blǘicher for Larry’s life, ad fate intervened when it was learned that Blǘicher’s son had once been wounded near Dresden and taken prisoner by the French, but his

life had been saved by none other than Dr Larrey. He was pardoned, invited to Blucher’s home for dinner and sent back to France with money and some decent clothes.

After the death of Napoleon, Larry continued his career in the army as chief-surgeon, and also devoted his time to medical writing, which, to this day, is still regarded as a valuable source of surgical and medical knowledge. Between 1800 and 1840 twenty-eight books or articles were published. In 1826 he visited England and was well received by the British surgeons and in 1829 was appointed to the Institut de France. In 1842 he went to Algiers with his son, but became ill and sadly died on 25th July 1842, at the age of seventy-six on his way back to Lyon. His body was taken to Paris and is buried at Pere-Lachaise.

Spring wagons were not used by the British for the transfer of the wounded until the Peninsular War, and then only at the instigation of Sir James McGrigor, Inspector of Hospitals, but were not developed because the Duke of Wellington refused to agree to set up the British equal to the French Ambulance Corps.

The first ambulance unit of the British Army Corp didn’t arrive until 1854. It was called the Hospital Conveyance Corps, and went into service during the Crimean War. The Corps had no medical training, and consisted of military pensioners who maintained the ambulance service by acting as stretcher bearers and orderlies in field hospitals. There was no attempt to provide a civilian ambulance service until the founding of the Ambulance Association of the British Wounded in 1877. Originally, the association only offered first aid, but about a year later, an Ambulance Corps was established at Margate in Kent, with a single wheeled stretcher for transportation.

In November 1905, a motor ambulance was acquired by the Royal Army Medical Corps for £465, and the first civilian ambulance came into force on 16 December 1905 at the Ambulance Station of the Metropolitan Asylums Board, transporting patients suffering from scarlet fever to the isolation hospitals.

Larry was well respected and it is said that at the battle of Waterloo his courage under fire was noticed by the Duke of Wellington who ordered his soldiers not to fire in his direction so as to ‘give the brave man time to gather up his wounded’. Napoleon once said of Larrey that he was ‘the most virtuous man I have ever known.’ Here he uses the word virtuous in its ancient sense – virtus, an old Latin word meaning fearlessness in defence of one’s male honour, courage and valour. A most touching and fitting accolade to a man who gave so much to mankind.

 

About Wendy Hughes

Wendy turned to writing, in 1989, when ill-health and poor vision forced her into early medical retirement. Since then she has published 26 nonfiction books, and over 2000 articles. Her work has appeared in magazines as diverse as The Lady, Funeral Service Journal, On the Road, 3rd Stone, Celtic Connections, Best of British, and Guiding magazine. She has a column in an America/Welsh newspaper for ex-pats on old traditions and customs in Wales. Her books include many on her native Wales, Anglesey Past and Present, The Story of Brecknock, Brecon, a pictorial History of the Town, Carmarthen, a History and Celebration and Tales of Old Glamorgan, and a book on Walton on Thames in the Images of England series, a company history and two books on the charity Hope Romania. She has also co-authored two story/activity books for children. Her latest books are: Haunted Worthing published in October 2010, a new colour edition of The Story of Pembrokeshire published in March 2011, and Shipwrecks of Sussex in June 2011 and Not a Guide to Worthing in 2014. She is working on a book entitled A-Z of Curious Sussex which will be published in 2016 Wendy also works with clients to bring their work up to publishable standard and is currently working on an autobiography with a lady that was married to a very famous 1940’s travel writer. Wendy has spent many years campaigning and writing on behalf of people affected by Stickler Syndrome, a progressive genetic connective tissue disorder from which she herself suffers. She founded the Stickler Syndrome Support Group and raises awareness of the condition amongst the medical profession, and produces the group’s literature, and has written the only book on the condition, Stickler The Elusive Syndrome, and has also contributed to a DVD on the condition, Stickler syndrome: Learning the Facts. She has also writing three novels, Sanctimonious Sin, a three generation saga set in Wales at the turn of the century, Power That Heal set in the Neolithic period entitled Powers that Heal, and a semi biographical book entitled New Beginnings which deals with two generations coping with blindness and a genetic condition. She has also had a handful of short stories published, and in her spare time is working on several at the moment. She also gives talks on a variety of subjects including Writing and Placing Articles, Writing Local History, Writing as Therapy, Writing your first novel, etc, and runs workshops on the craft of writing – both fiction and non-fiction. She is a member of the Society of Women Writers and Journalists, and a member of the Society of Authors.