The two most distinguished military surgeons in Europe during the eighteenth and nineteenth centuries were Desgenettes and Baron Larrey, both of them natives of France.

AimÉ-Nicolas Dufriche Desgenettes was born at AlenÇon, France, in 1762. His early medical training was obtained at the University of Montpellier, and the degree of Doctor of Medicine was bestowed upon him in 1789. Four years later he entered the French military service and participated in the campaign of Egypt and Syria, during which he rapidly rose to the position of Chief Physician in that part of the army which was officially designated as the Army of Italy. In 1802, after the close of the campaign, he was appointed First Physician of the Military Hospital at Paris, and at the same time was given the position of General Inspector of the Health Department of the Armies. From that time to the year 1814 he visited, in his official capacity, Russia, Prussia and Spain; and amid scenes of carnage and destruction he never failed to display the character of a high-minded physician, a benevolent and guardian spirit. His career as a medical officer was largely that of a man of action, who exhibited at the same time a keen sympathy for those who stood in need of his services. To quote the words of his biographer, “he extended his cares to the sick of all nations,—to the Turk and the Christian, to the men of the South as well as to those of the North, and, as disinterested also as the Great Hippocrates, he retired poor from his labors, though he might easily have made himself rich. Often placed in opposition to military power and faction, he always exhibited an unwavering inflexibility and energy of character. His thorough knowledge of men and things, his skill in the practice of his art, and his vigorous and unbending mind distinguished him for more than twenty years at the head of the medical service of the French armies.”

This splendid showing, I venture to remark, could scarcely have been realized if Bonaparte had not been endowed with two admirable traits of character. In the first place, he seemed to possess almost infallibly correct judgment in his choice of men who were to act as generals or as chief surgeons of his various armies; and then, in the second place, he was in the habit of supporting these men loyally whenever, later on in their career, disputes arose as to the wisdom or patriotic purpose of their decisions. The history of the wars that occurred from 1793 to 1814, between France and the different European nations which opposed her, abounds in instances that confirm the truth of what I have just stated. Corvisart, it is also highly probable, deserves much of the credit for Bonaparte’s loyal treatment of his chief army surgeons.

The biographer of Desgenettes relates two occurrences which throw additional light upon the nobility of character of this admirable physician. These occurrences are briefly narrated as follows:—

A contagious disease appeared in the Army of the East and spread rapidly from one man to another. The soldiers were struck with terror and despair, and were ready to die, merely because they considered death imminent and inevitable.... Monsieur Desgenettes assured them that the hideous buboes with which they were covered were not symptoms of the plague, and he proved it. How? By the following heroic experiment. He took the matter of these buboes and inoculated himself in the presence of the soldiers. This proof was conclusive in their eyes, hope was again kindled in their bosoms, and the mortality diminished. Here is one of those brilliant actions which history delights to preserve and transmit from age to age.

On another occasion Desgenettes manifested equally great courage. The occurrence is narrated by his biographer in these words:—

Made prisoner in the retreat from Russia, he demanded boldly his liberty, not as a favor, but as a right; he invoked the sacredness of his ministry and in particular the cares which he had lavished alike on the Russians and on the French. An imperial ukase immediately rendered him his liberty. The Emperor Alexander called him into his presence and expressed to him his sentiments of high esteem and regard. He received soon after from Sweden the order of the Polar Star.

Desgenettes’ death occurred in 1837. He made no contributions to medical literature; and his enemies brought against him the charge that, when he delivered a lecture, he spoiled it by telling too many anecdotes about the different wars in which he took part.

Jean-Dominique Larrey was born in 1776 at BaudÉan, a French village at the foot of the Pyrenees. At the age of thirteen years, shortly after the death of his father, he quitted his native village and came under the care of his uncle, Alexis Larrey, who was Surgeon-Major and Professor at the Hospital of Grave, near Toulouse. Under the wise and kindly guidance of the latter he pursued his studies so earnestly and with such intelligence that he was able, on attaining his twentieth year, to pass successfully the examinations required for an appointment to the position of Assistant Surgeon in the French Navy.

The sloop-of-war “La Vigilante,” the vessel in which he gained his first experience in the naval service, met with disaster and Larrey was nearly shipwrecked. As soon as possible after this thrilling experience he went to Paris and took service in the great Hospital of HÔtel-Dieu, under the orders of the famous surgeon Desault. This was at the beginning of the severe winter of 1789, an eventful time in the history of France. The Revolution was now in full swing, and Larrey not only was an eye-witness of the troubles which characterized its early stages, but he also had the opportunity, under the orders of Desault, to render professional service to the first victims of those tragic days. Three years afterward, while serving in the Army of the Rhine, under the command of Marshal Luckner, he was able to put to good use all the admirable surgical training which he had received under Desault at the HÔtel-Dieu.

When Larrey was about twenty-one years old and while he was attached to that part of the French Army which was then stationed in the vicinity of Milan and Venice, he interested himself actively in the establishment of an army ambulance service. Already three or four years earlier he had become sensible of the inconveniences of the French ambulances which were then in use. In the first place, these vehicles were of such a type as to be ill-suited to the work which they were intended to perform; they were too heavy to be driven with reasonable speed to and from the battlefield, and they were also so rigidly constructed that at every irregularity in the ground over which the wheels passed the wounded soldier experienced a painful jolt. Then, in the second place, aside from the faulty construction of these vehicles, the regulations governing their management were so badly planned as to leave the wounded lying unaided on the battlefield sometimes for several hours together. It was customary, for example, to station the ambulances at a spot about three miles distant from the troops who were shortly to engage in combat, and they were not despatched to the battlefield until after the fighting had ended. In this way hours often elapsed before the wounded could receive any aid whatever from the surgeon.

In working out a solution of this complex problem Larrey’s very practical mind quickly reached certain conclusions: first, that it was most important to remove the wounded from the battlefield to a place of safety much earlier than had hitherto been the custom; and, second, that the type of ambulance then universally employed was altogether too heavy and too rigid to serve well the purposes for which it was needed. He realized fully that this last part of the problem was the more important part, and that, if he could invent a less ponderous and at the same time more elastic vehicle for use as the field ambulance, he would by this very act be placed in a position where he could effect in a large measure a solution of the second half of the problem.

Larrey promptly set about the work of providing a new type of field ambulance and in a short time was successful in obtaining a most useful vehicle for the purpose. It is described by his biographer in the following words:—

This invention of Larrey’s was a kind of carriage hung on springs, uniting great strength and solidity with lightness. Such indeed was its lightness that it was able to follow all the movements of the advance guard with as much speed as flying artillery. These ambulances volantes, as they were called, were first used by the French in a defile of the Rhine near Koenigstein. Here the ambulances invented by the talented and benevolent French surgeon bore the wounded rapidly away from the neighborhood of the enemy instead of leaving them either to die or to sustain a protracted agony on the field of battle.

In this work of inventing a field ambulance of a greatly improved pattern Larrey revealed an exceptionally fine trait of character, viz., a strong desire to utilize his talents and the opportunities afforded by his official position for the benefit of his fellow men, both the wounded of the French army and those of the enemy forces. He revealed the same trait in many other ways—as, for instance, when he took infinite pains, after a battle, to provide proper shelter, food and care for the wounded in the town or village nearest to the site of the conflict, and that too in a part of the country which belonged to the enemy. He revealed it again in the fighting which took place in Eastern Prussia and in the course of the numerous retreats which Napoleon’s army was forced to make in the Russian campaign.

Among the incidents which occurred during that long and disastrous retreat of the remnants of Napoleon’s army from Moscow there was one which reveals in a very clear light the high sense of duty that characterized Larrey’s actions as Surgeon-in-Chief of the French Army and the complete faith which the individual soldiers composing that army—or at least the better disposed among them—placed in his disinterested and loyal service in their behalf. The incident to which I have reference occurred while the disorganized French troops were crossing the Beresina River and is thus described by Larrey’s biographer:—

The Russian general arrived at the head of 50,000 men and began the fire among the division of General Partonneaux, the soldiers of which division immediately wished to cross the Bridge all at once. The conveyances collided with one another, and some of the unfortunate men were crushed, while others, losing all spirit, threw themselves into the stream.... There was throughout a frightful mixture of imprecations, of clashings, and of strugglings, whence arose indescribable disorder and a breaking of the overloaded bridge. The Russian Army approached, and with its formidable artillery tore the ranks of the French mob of soldiers.... In this immense disaster what had become of the distinguished Surgeon-in-Chief of the Grand Army? After having crossed over the Beresina with the Imperial Guard, he discovered that requisites for the sick and wounded of his countrymen had been left on the opposite bank. With equal humanity and heroism, he recrossed the river, and hardly had he done so when he was surrounded by a wildly excited crowd. He was almost suffocated in the midst of it.... No sooner was he recognized than he was carried back with great rapidity in the arms of the soldiers across the river. On all parts was heard the cry, in nearly these words, “Let us save him who saved us!” The soldiers almost forgot their own safety in their desire to preserve an officer whose tender kindness they had so often experienced.

I believe that I have now shown with sufficient fulness of detail what were the prominent characteristics of Larrey as a man and as an executive army medical officer. It still remains for me to furnish some evidence of the excellent judgment which he displayed in his work as a practical surgeon.

In one of the French hospitals, during the war, Larrey’s attention was called to a Russian soldier who had been shot in the forehead by an iron ball weighing 217 grammes. This projectile had pierced the frontal bone above and a little to the outside of the right eyebrow, and had penetrated into the interior of the skull. Despite the bulk of this iron ball, the opening which was perceptible in the bone did not exceed six or eight millimeters in diameter, and, by introducing a small probe, one might feel the ball. The smallness of the opening in the bone, says Larrey, may be explained by the elasticity of the osseous fibres, some of which the ball would have to push aside in order completely to penetrate the outer table of the frontal bone, and which consequently would yield instead of fracturing. In the present case the bony angles at the edge of the circular opening were cut away by the surgeon and the opening itself was made large enough to permit the removal of the ball by means of an elevator and pincers. A great quantity of coagulated blood and some small fragments of bone were then evacuated. The brain itself presented at this spot a depression of about seven millimeters in depth. In a short period of time the wound healed, and apparently complete recovery followed.

In order to judge correctly of the credit which rightfully belongs to Larrey for his successful treatment of this case of gunshot wound of the skull and underlying brain, one must remember that in the early part of the nineteenth century it was considered a very bold surgical act to operate upon the injured brain, and particularly so in the almost complete absence of adequate surgical equipment.

As an instance of Larrey’s quickness in meeting an emergency I will narrate here very briefly an experience which he had at Smolensk, Russia. When the French troops entered that city, after a severe battle, they found that the inhabitants had already fled, owing in part to the fact that many of their dwellings had been destroyed by fire. Larrey, as soon as was practicable, converted fifteen of the largest buildings which had not been devastated by the flames, into hospitals for the wounded. Unfortunately, all supplies or stores of any kind had either been destroyed by the enemy or removed by them in their orderly and premeditated retreat. For the large number of wounded there was a deficiency of linen and splints; but Larrey discovered a store of archives in one of the buildings which had escaped the fire, and he promptly substituted sheets of paper for linen and utilized the thick parchment covers for splints. He toiled with little intermission night and day, and the French surgeons generally, in imitation of their chief, were indefatigable in their attention to the wounded, who were about 10,000 in number.

Las Cases, in his “Memorial of St. Helena,” published after he had returned to Europe, reports Napoleon as having uttered the following words on October 23, 1816: “What a man, what a brave and worthy man is Larrey! What care was given by him to the army in Egypt and everywhere! I have conceived for him the highest esteem. If the army were to raise a column to the memory of any one, it should be to the memory of Larrey. He has left in my mind the idea of a truly honest man.” In his will Napoleon wrote: “I bequeath to the Surgeon-in-Chief of the French Army, Larrey, 100,000 francs. He is the most virtuous man I have ever known.”

The reader will pardon me, I am sure, if I furnish here additional proof of Larrey’s sound judgment in questions of a purely surgical nature. He insisted, for example, on the importance of promptly resorting to amputation in cases where the gunshot wound had caused a complicated fracture of the bone or had inflicted serious destruction of the soft parts; and he particularly recommended this course of action in the case of individuals who were cachectic or below par. He expressed himself in favor of the circular incision in preference to that which was intended to furnish flaps. (From “MÉmoire sur les Amputations, etc.,” Paris, 1797.)

In another place Larrey mentions, somewhat in detail, the reasons why primary amputations are to be given the preference in military surgery. They are the following:—

(1) The inconvenience which attends the transportation of the wounded from the field of battle to the military hospitals on badly constructed carriages; the jarring of these wagons produces such disorder in the wounds and in all the nerves, that the greater part of the wounded perish on the way, especially if it be long, and the heat or cold of the weather be extreme.

(2) The danger of remaining long in the hospitals. This risk is much diminished by amputation; it converts a gunshot wound into one which is capable of being speedily healed, and obviates the causes that produce the hospital fever and gangrene.

(3) In case the wounded are of necessity abandoned on the field of battle: In this event it is important that amputation should have been performed, because—when it is completed—they [the wounded] may remain several days without being dressed, and the subsequent dressings are more easily accomplished. Moreover, it often happens that these unfortunate persons do not find surgeons sufficiently skilful to operate, as we have seen among some nations whose military hospitals were not organized like ours. (From Vol. 2 of Larrey’s “Memoirs of Military Surgery.”)

(In judging the quality of the advice given here the reader should not overlook the fact that it was pronounced in the early part of the nineteenth century.)

Larrey’s death occurred on July 24, 1842. A few years previous to this date he had received the title of Baron.

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