“To Afford the Wounded Speedy Assistance”: Dominique Jean Larrey and Napoleon

Abstract

Dominique Jean Larrey (1766-1842) has been described as the father of modern military surgery and is considered even today as the model military surgeon. He developed a plan of rapid evacuation of wounded soldiers from the battlefield during combat, using flexible medical units which he named ambulances volantes ("flying ambulances"). He won the admiration of Napoleon Bonaparte (1769-1821), who was amazed by the results of Larrey's sanitary system. Larrey spent almost 18 years with Napoleon, accompanying him in 25 campaigns, 60 battles, and more than 400 engagements. Napoleon's enormous military success was due not only to his strategy and skill but also to the medical services provided by Larrey. The surgeon became a master of wound management and limb amputation. In his vivid battlefield journals, Larrey documented the course of tetanus, the pathophysiology of cold injury, the effective control of hemorrhage, the drainage of empyema and hemothorax, the aspiration of pericardial effusion or hemopericardium, and the packing of sucking chest wounds. Larrey established a categorical rule for the triage of war casualties, treating the wounded according to the observed gravity of their injuries and the urgency for medical care, regardless of their rank or nationality.

Treatment of War Wounds: A Historical Review

“…The outstanding military surgeon of the Napoleonic Wars (1792-1815), Baron Dominique-Jean Larrey (1766-1842), generally is regarded as the originator of modern military trauma care and what would become known as triage [131]. He placed surgical teams near the front lines to shorten the time elapsed after injury and instituted specially designed horse-drawn ''flying ambulances'' in which the wounded rode with an early version of emergency medical technicians [67,103].…”

“…Care was prioritized to provide first for the most badly wounded, without regard to the patient's chances of survival or the need to restore less gravely wounded soldiers to the front lines quickly [11]. After Larrey's system was used during the Battle of Metz (1793), he was ordered to organize medical care for the entire French Army [131]. Rapid access to care and immediate amputation reduced morbidity and mortality.…”

A review of the history of the origin of triage from a disaster medicine perspective

“…With respect to military medical care, Larrey categorized triàge into three phases7. In a comparable fashion, French military doctors in World War I and Japanese military physicians in World War II divided sick or wounded soldiers into three categories according to the severity of their illnesses or wounds.…”

“…Triàge would appear to have been developed during the period 1792–1801 because there is a record of triàge having been formally adopted by the French military in 1801 7, 12, 13, 14. There were no wars or events concerning the development of triàge between 1792 and 1797 (Table 1).…”

“…The achievement of the army surgeons Percy and Larrey was in modernizing Napoleonic triàge to help save lives 7, 12, 19…”