by Xavier Riaud (*), FINS
After the battles, the ground was strewn over with bodies and wounded soldiers. The battlefield was such forlorn, terrible scenery and particularly during bloody battles such as Wagram (1809) that even Napoleon was known to have shed tears. The Emperor did not want the people who did not fight to hamper the walk of soldiers. Consequently, he required that they stayed behind. The soldiers who had minor wounds and who could walk had a chance to fight their way through and to reach the nearest ambulance. The others, who were affected in the stomach, who lost their blood, who were hit in the lower limbs, were only picked up hours later, if not days after the end of the battles. In other words, most of the time, they died in atrocious pain, alone, in the cold, whereas many of them could have been saved by a more efficient medical service (Sandeau (b), 2004).
Percy and Larrey interceded with the Emperor to let him know how intolerable the situation was. In 1797, Larrey succeeded in imposing his mobile ambulance which was launched with the army of Italy. As a matter of fact, there were two types of vehicles: the first which was tethered to two horses and the second which was pulled by four horses and four men. On the sides, there were bags which carried medical equipments (instruments and bandage). In 1812, after the campaign of Russia, this system was spread in all army corps. Only the Imperial Guard was sufficiently equipped during the Empire (Marchioni, 2003).
In 1799, Percy implemented the Wurtz with the French army of the Rhine. It was a box intended for the artillery, covered with leather and which was aimed at carrying up to 8 surgeons, at giving emergency care to the wounded soldiers as well as supplying medical equipment. Upon their return to the camps, the soldiers who had minor wounds could be evacuated thanks to the stretchers contained in the box. It totally disappeared in 1810 since it was very uncomfortable, did not allow repatriating seriously-wounded soldiers and it was extremely expensive for the war commissioners since it was towed by 6 horses (Percy, 2002 & Ducoulombier, 2004).
During the Napoleonic wars, the wounded soldiers were neglected, abandoned to their own destiny. After the battle of Eylau in 1807, Percy, who was aware of that fact, demanded the creation of army nurse corps. A first company was formed in Spain, in 1808. On April 13, 1809, Napoleon formalized the creation of army nurses. They amounted to 125 men and were divided up into 10 ambulance battalions run by a man, the “centenier”. In September 1809, 5 companies were created in Vienna, 2 in Italy and 3 in Spain. They had to pick up the wounded soldiers, repatriate them to the back of the front and protect them if necessary (Sandeau (b), 2004; Percy, 2002 & Ducoulombier, 2004).
Surgeons were working in appalling conditions: insanitary units, a total lack of hygiene and asepsis, cursory bandages without follow-up, overwhelmed surgeons by the increasing number of wounded men, a total contempt of men and Humanity in general were daily.
Surgeons performed amputations very quickly. Larrey was well-known for this appalling sight of quick amputations: the piling up of limbs cut into slices soon to be attacked by battalions of insects. There was no anaesthesia. The soldiers were held on a chair by two assistants. From time to time, they could drink a glass of hooch before the operation. The wounded soldiers were most of the time plunged into silence during which they were subjected to terrible events. Sometimes, they fainted. They were banded with the tools they had at hand. Most of the time, the sullied bandage of a dead soldier was reused. The lack of linen and lint was real (Sandeau (a) and (b), 2004 & Army Museum, no date). Then came the time to evacuate the soldiers to the hospitals at the back of the front which were makeshift shacks located in appropriate places. The wounded soldiers, who were transferred and who were supposed to be convalescing, were piled up in carts without any care of their respective pathologies. Travelling to the hospitals took several days. Bandages were not changed and the wounded soldiers had inadequate food, no water, no blanket to cloak themselves from the cold and had no chance to leave the cart to answer nature’s call. Upon arrival, most of them were dead instead of being alive. Those country hospitals were places to die which were deprived of everything. There was no hygiene, no asepsis. Many epidemics occurred in these places and gangrene proliferated. Those epidemics appeared sporadically in the first campaigns of the Great Army, everywhere where misery and dirt could develop. It was the case of typhus which followed the Great Army during all its adventure. From 1812, this disease harassed the French soldiers on a daily basis (Sandeau (a) and (b), 2004).
Moreover, archaeological studies proved it. In December 1812, the Great Army retreated to Vilnius.
In autumn 2001, a communal grave containing bones of hundreds of French soldiers was exhumed. The research was entrusted with the national centre for scientific research. The team started with the excavation of the area, its anthropological study and the analysis of the uniforms. The samplings of soil, cloth and teeth were given to the Rickettsies Unit as well as the emerging pathogens of the national centre for scientific research . The scientists succeeded in separating out the lice from the samplings with a special technique they invented. They found five different types of lice. Three of them contained the bacterium Bartonella quintana , carrier of typhus, which they isolated. Then, they moved on with the study of the dental pulp taken from the teeth of thirty-five soldiers. This pulp, which was made into powder after the research of the national center for scientific research, allowed determining the existence of bacteria which had infected the soldiers: Bartonella quintana in seven bodies and Rickettsia prowazekii in 3 others. In other words, after several examinations, they were able to say that 30% of the soldiers buried in Vilnius had suffered from diseases caused by lice and that they subsequently had died from them. Those insects which had carried typhus played a major role in the retreat of Russia (Raoult, 2001-2010).
In 1805, the Great Army, made up of 100,000 men, was victorious. The battle of Austerlitz was the climax of a campaign that they had dealt with briskly. Only 2,000 men died and 2,000 were wounded. All the wounded soldiers were picked up and treated. 50% of them survived. However, after the cheerful victory of Austerlitz, a typhus epidemic killed almost 12,000 men in the hospitals of Vienna and Brünn (Sandeau (a) and (b), 2004 & Meylemans, 2010).
In 1806, 16,000 men were injured and sick. Although the twin battles of Jena and Auerstedt were major victories, they had cost many lives. The lack of hygiene, proper food and treatment caused the death of half the soldiers (Sandeau (a) and (b), 2004 & Ducoulombier, 2004).
In 1807, the battle of Eylau killed 3,000 men and injured 7,000 soldiers who were mostly abandoned on the battlefield or treated in appalling conditions. One third of them died because of major traumatisms. On the same year, even though the battle of Friedland was also a victory, it was as bloody and the loss of soldiers was similar to that of the previous battles (Sandeau (a) and (b), 2004 & Marchioni, 2003).
In 1809, at Essling, 7,000 men were treated directly on the spot. In Wagram, the casualties were transferred to the hospital of Vienna which was quickly overwhelmed. There, the situation was still rather precarious.
The war of Spain caused the loss of 400,000 men. In 1808, there were 30,000 sick men out of the 250,000 soldiers present on the Iberian Peninsula (Sandeau (b), 2004).
In 1812, even if the campaign of Russia seemed to unfold favourably, it turned out to be an absolute disaster. The casualties were left alone on the battlefield. The Cossacks murdered all the men they could find along their way: injured and sick soldiers, health officers who could not be easily replaced, etc. 6,000 men were injured at Smolensk, 10,000 during the battle of Moskowa; a great number of them who were carried in the neighbouring villages died there (Sandeau (a) and (b), 2004).
Despite successive victories, each of the battle weakened progressively the Great Army which melted like snow under the burning sun. Their retreat from Moscow to Smolensk killed 3/4 th of the casualties and the sick. During the Battle of Berezina, they were left behind. With the soldiers fleeing in disarray, no treatment could be given even if some surgeons sacrificed themselves to stay next to their patients (Riaud (b), 2010). Typhus proliferated. In Vilna, 25,000 casualties were divided up and sent to the hospitals of the town. 3,000 of them survived. According to Oleg Sokolov, 300,000 men died during the campaign of Russia. Statistically, 5 men were said to have died following a disease out of one during battles (de Faber du Faur, 1812; Marchioni, 2003; Muylemans, 2010).
22,000 soldiers, who got injured during the Campaign in Saxony in 1813, were sent to hospital in the retreat towns: Ulm , Leipzig, Bautzen, etc. There, Typhus was ubiquitous. On October 1, 1813, the disease struck in Mainz. 4,500 soldiers were hospitalized in this town. Around 1,130 soldiers died there because of Typhus. According to Desgenettes, who stationed in the citadel of Torgau from October 1813 to January 1814, the garrison of 25,000 men saw 13,448 of its men die without being able to shoot anyone (Meylemans, 2010). The casualties and the sick from the campaign in France were left behind on the battlefield. The peasants closed their door on those soldiers carrying Typhus.
The battle of Waterloo was colossal. Around 15,000 Frenchmen died. No-one came to pick up the casualties. A total rout is what followed (Sandeau (a) and (b), 2004).
Briefly, here are some operative techniques/ remedies:
Wounds/traumatisms (under the supervision of surgeons):
Haemorrhages >>> digital compression (+ (not always) tying with oilskin teeth thread or lead).
Bandages >>> Linen or lint uphold by a sling, a splint, a strap or a belt.
Fractures >>> Larrey required amputation. He used the disarticulation of the limb under consideration and gained a following with his colleagues. If no amputation was carried out, the soldier would die immediately of tetanus or gangrene. Percy and Yvan, who were against the principle of amputation, advocated the conservation of the limb (Marchioni, 2003).
Head or neck injuries >>> Use of trephine.
Open injuries (face, abdomen and thorax) >>> Immediate sutures (stitching of the wound the quickest way possible).
Contusions (by a cannonball) >>> Rub with eau de vie and ammonia.
Gangrene >>> Bandages made of camphor water, amputations and cinchona (depending on the supply) (Sandeau (a) and (b), 2004).
No anesthesia >>> Quick operative reaction and skill required in the surgeon, two glasses of hooch (sometimes), laudanum (in exceptional cases). When he got injured to his foot, Napoleon was treated by Yvan who dressed him with a compress soaked in laudanum (= soaking of opium, saffron, cinnamon and cloves in Malaga wine) (Ducoulombier, 2004 & Percy, 2002).
Diseases (under the supervision of doctors):
Diarrheas >>> Administration of wine and eau de vie.
Stomach aches >>> Administration of a decoction of tea, orange blossom, lime-blossom and ether.
Dysentery >>> In case of diarrheas, De Kerckhove, the doctor of the Great Army, advocated to diet rigorously and to eat starchy food, eggs and rice broths which stopped the disease in almost a week even though recurrences were frequent.
Firstly, in case of chronic dysentery, during a 3-to-4-day period, he would advocate emetics used as repellents, which he would add to hot baths or infusions in case of fever. Secondly, in case of long-lasting disease, he would recommend an absolute diet, with or without bloodletting. For the diet, he would advocate a decoction of rice, sago, barley and salep. He also recommended tepid baths, the application of vesicants and to take laudanum and infusions.
Thirdly, in “the happiest period” of recovery, De Kerckhove (1836) claimed that the patient had to be fed progressively, with precautions and without brusqueness.
Fever >>> One glass of rum with lemon juice and a spoonful of salt and pepper. Cinchona sometimes according to the supply (origin: America).
Scabies >>> Hygienic care, frequent baths, washed and renewed clothes, isolation. Application of salves from sulphur, hog’s lard, ammonia ( Sandeau (a) and (b), 2004).
Venereal diseases >>>Isolation, baths, rubs with mercury, use of Van Swieten’s liquor.
Scurvy >>> In 1788, La Perouse, who was commissioned by Louis XVI, gave his men wine and Prussian beer, beer malt and sauerkraut. Food had to be regularly renewed while stopping frequently in harbors on the way back. Even though it was often required that the patient had to eat fresh fruits, and notably citrus fruits in the British Navy, this was only exceptional from 1795 and during the wars of the Empire (Riaud (a), 2010).
Cough >>> One glass of lukewarm sweet water with around 20 grains of jalap.
Typhus >>> Soon Desgenettes realized that the issue came from dirt and lice. Therefore, he mainly advocated preventive hygienic measures: body hygiene, getting rid of head lice, burning the beds and the clothes of the carriers, airing hospitals and isolating the sick (Riaud (b), 2010; Sandeau (b), 2004 & Marchioni, 2003).
Even though the confrontations were numerous and murderous, the diseases were first and foremost the main cause of the devastation of the European political landscape. It is reasonable to say that the Great Army was mostly defeated by the great deficiency of its Health Service, by the contempt of the administration, and that of the High Command towards this army corps, the lack of hygiene and finally by the diseases than by the battles themselves.
It is highly surprising that Napoleon such an avant-gardist man in his innovations and a society futurist, who had on the one hand such a great reforming vision, had been on the other hand so careless towards doctors, surgeons and pharmacists: “men who could have disrupted the movements of his imperial army.” He totally neglected the major role of men who could have contributed to the greater durability of the Great Army and subsequently the defense of his army. However, despite this particular contempt and a total lack of medical means, those health officers succeeded in saving approximately 40% of their injured and sick men which was highly remarkable in such conditions and circumstances (Sandeau (b), 2004). We have to acknowledge their merit and to pay tribute to those exceptional men.
(*) Doctor in Dental Surgery (DDS), PhD in Epistemology, History of Sciences and Techniques, Laureate and Associate member of the French Dental Academy.