The Revolutionary Surgeon To Napoleon's Armies

Napoleon's genius in managing his Grande Armèe gave rise to 26 marshals, including Ney, Murat, Davout and some other well-known names. However, he is quoted to have said, "If the army ever erects a monument to express its gratitude, it should do so in honour of Larrey."

Baron Dominique Jean Larrey was a French surgeon. He was born in 1766 in the Pyrenees mountains and was trained in medicine in Paris. By the age of 21, two years before the revolution broke out, he had joined the French navy, being the youngest doctor in the service, and took part in the defense of Newfoundland. He subsequently took part and provided medical services in the storming of the Bastille, the French Revolutionary wars and all Napoleonic campaigns including Wagram, Egypt, the invasion of Russia and Waterloo. He remained loyal to the Emperor, even volunteering to accompany him to his first imprisonment on the island of Elba, but Napoleon refused the offer and told him to stay back where he was needed more.

Larrey is remembered the most for introducing ambulances on the battlefield. Ambulances were first used in 1487 during the Spanish (Catholic) siege of (Moorish) Malaga on the Mediterranean coast. The forces of Isabella of Castile deployed dedicated horse carts to lift the wounded to be treated at field hospitals. However, during the fighting, these carts would stay away from the battlefield, and the wounded were taken out only when the battle ceased; causing death of many who could have been saved.

Larrey was recognised by one of the German surgeons, who pleaded for his life, partly because he had saved the life of Blücher's son when he had been wounded near Dresden and taken prisoner by the French. Larry was pardoned, invited to Blücher's dinner table as a guest and sent back to France with money and proper clothes

Dr Larrey was part of the pre-revolutionary French Army of the Rhine and observed the efficiency and speed of the Flying/Horse Artillery against the infantry in the battlefield. The Flying Artillery was an innovation meant to break up the stubborn infantry squares. It consisted of light guns on two-wheeled carriages, pulled by horses that also carried a gun crew of five on their back. It was distinct in operation from field artillery, which was deployed in support of one’s own infantry. Highly proficient batteries could wheel around, unlimber, load, sight and fire in less than a minute. The guns could move around the battlefield easily, firing at the infantry from different angles and softening it up for a cavalry charge. An infantry phalanx of massed troops had proven effective against cavalry since about the 7th century BC, winning Alexander his battles and proving decisive in Battle of Tours (732) between the Arab/Berber army of Amir Abdul Rehman and the Frankish army of Charles Martel. The reputed invincibility of the phalanx had initially been dented by longbows in the 14th-century European wars but the flying artillery rendered it completely obsolete.

It was Dr Larrey’s vision that transformed the destructive power of horse artillery into the humanitarian concept of a horse driven ambulance that could move around the battlefield, pick up the wounded and take them back to a safe place for immediate lifesaving treatment. His innovation saved countless lives that, otherwise, would have been lost. The idea was so innovative that even though the British had watched Larrey and his ambulances in action on the battlefield at Waterloo, they didn't adopt the service till about 60 years after that battle.

At Waterloo, Larrey's 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 the wounded" and saluted "the courage and devotion of an age that is no longer ours."

Another feat of Dr Larrey was the introduction of the concept of triage. The word means 'to separate.' As a medical concept, it implies preliminary assessment of patients to allocate resources and effort based upon the condition of the patients – irrespective of their rank, social status or monetary standing. This led to treatment of urgent wounds first, even if the patient was an enemy soldier. Triage has now become a standard protocol in hospitals and other medical facilities all over the world.

Larrey took part in Egyptian campaign of 1798. There, he treated many patients suffering from ophthalmy, which is the painful inflammation of the eyes; and wrote about the disease. He also introduced dromedary (tall Arab camels) ambulances to cater for the sandy Middle East terrain. One chest on each side of the camel was attached to carry two patients per camel.

He was injured during the siege of Acre and was repatriated in 1801.

Larrey was made a Commander of the Légion d'Honneur on 12 May 1807 (incidentally, this author celebrates his marriage anniversary on this date). In 1809, during the Battle of Aspern-Essling, Larrey amputated the leg of Marshal Jean Lannes on the battlefield in two minutes without anesthesia.

At Waterloo, Larrey's 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 the wounded"

Frances Burney was an English satirical novelist and playwright, and, for a while, the 'Keeper of the Robes' to the Queen. She was married to a French emigre general of the artillery and an ex-adjutant to General Lafayette. The couple went over to France in 1801, where the General rejoined Napoleon’s army. In August 1810, Burney developed pain in her breast, which her husband suspected could be due to breast cancer. Through her network, she was able to engage Dr Larrey and his team for a mastectomy on 30 September 1811. The operation was performed like a battlefield operation under the command of M. Dubois, then accoucheur (midwife or obstetrician) to the Empress Marie Louise and one of the best doctors in France. However, it was Dr Larry who applied the knife, scalpels and scissors. Burney later described the operation in detail, since she was conscious through most of it, as it took place before the development of anesthetics.

"I mounted, therefore, unbidden, the Bed stead – & M. Dubois placed me upon the mattress, & spread a cambric handkerchief upon my face. It was transparent, however, & I saw, through it, that the bedstead was instantly surrounded by 7 men & my nurse. I refused to be held; but when, bright through the cambric, I saw the glitter of polished Steel – I closed my eyes. ..... Yet – when the dreadful steel was plunged into the breast – cutting through veins – arteries – flesh – nerves – I needed no injunctions not to restrain my cries. I began a scream that lasted unintermittingly during the whole time of the incision .... so excruciating was the agony. When the wound was made, & the instrument was withdrawn, the pain seemed undiminished, for the air that suddenly rushed into those delicate parts felt like a mass of .... sharp & forked poniards, that were tearing the edges of the wound. I concluded the operation was over – Oh no! presently the terrible cutting was renewed – & worse than ever, to separate the bottom, the foundation of this dreadful gland from the parts to which it adhered ..... yet again all was not over, – Dr Larry rested but his own hand, & Oh heaven! I then felt the knife racking against the breast bone – scraping it!"

Apart from joining the Revolution and the Napoleonic French army, Larrey served as professor of anatomy at Val-de-Grace (the army medical school and hospital in Paris), Surgeon General of the Revolutionary Army in Italy and Chief Surgeon of the Army. Trying to escape to the French border after Waterloo, Larrey was taken prisoner by the Prussians, who wanted to execute him on the spot. Larrey was recognised by one of the German surgeons, who pleaded for his life, partly because he had saved the life of Blücher's son when he had been wounded near Dresden and taken prisoner by the French. Larry was pardoned, invited to Blücher's dinner table as a guest and sent back to France with money and proper clothes.

Larrey died in Algeria during a visit there. His remains were brought back and buried in Père Lachaise Cemetery, the main cemetery of Paris. In 1992, he was reinterred with honour at the Les Invalides in Paris near the burial place of Napoleon.

The pioneering services of Dr Larry are recognised by NATO. The Dominique-Jean Larrey Award is the North Atlantic Alliance's highest medical honour bestowed annually in recognition of significant contribution in the provision of healthcare in NATO missions. The Wikipedia article on him lists over three scores of books written on his life and work. Dr Larrey’s services to humanity shall be remembered for a long time to come.