The health service of the Great Army
by
Xavier Riaud*,
FINS, Medal of Honour, Member of the Legion of Merit.
The Health Service was officially created in January 17, 1708 under Louis XVth. A permanent army health care corps gathering the precise number of 300 doctors and surgeons was established. It was stationed in the border regiments and in war harbours. Those practitioners were under the authority of organizers and war commissioners.
After 1792, the time had come for war movement and offensive. If it abolished the training hospitals and school medicines, the Legislative Assembly, then the National Convention organized mobile and garrisoned hospitals which badly answered to the demand while wounded soldiers kept increasing. To overcome the dramatic shortage in the number of staff and education, the government called back the doctors who were dismissed in 1788 and so were civil doctors and students without any decent training. Even though the number of practitioners significantly increased, the medical mediocrity was obvious (Sandeau (a), 2004).
On February 22, 1794, the Minister of Defense implemented a central council of health which was made up of 9-12 health officers belonging either to the navy or the infantry in equal numbers. They were under the supervision of war commissioners gathered into monitoring and administrative committees and were divided into three identical categories: doctors, pharmacists and surgeons. Those commissioners controlled everything that concerned the hospitals: organization, location, hygiene, transfers and continuing education of the health care staff, etc. On May 19, 1794, this law was modified. The health council was repealed and substituted by health inspectors under the Ministry’s authority. Even though the health council was abolished, the commissioners subsequently gained power. The experience in the field of so many great military surgeons such as Percy, Desgenettes or Larrey was totally overlooked and while they often lacked common sense, those civil servants arbitrarily continued to transfer, promote and dismiss doctors, to implement new hospitals or to govern campaign military medicine (Ducoulombier, 2004; Percy, 2002).
From August 12, 1800, the Consulate voted budget cuts because war came to an end. This remained so until the promulgation of the Empire. The law of August 12, 1800, restricted hospitals to the number of 30. Four training hospitals (Lille, Metz, Strasbourg and Val-de-Grâce in 1814) were maintained but their health care teams were reduced at a minimum. The law of December 7, 1801, only kept 16 military hospitals including Rennes, Toulouse, Bayonne, Bruxelles and Aix-la-Chapelle. Numerous health officers were dismissed without taking into account the knowledge and skills they learnt on the front. The shortage of military health staff was so important that numerous soldiers had to be transferred to other civil medical structures likely to welcome them. During all the wars led by Bonaparte, the number of hospitals on the French territory suffered from a significant insufficiency in infrastructures and staff which, on the long term, was extremely detrimental to the Great Army. These hospitals kept on being subjected to ill-adapted and incongruous regulations for military health trainings laid down by the Directory and then, the Consulate. For instance, under Percy’s injunction, it was only in 1809 that the nursing staff saw the implementation of a nursing corps within the army. Before, civilians were in charge of that position and especially people with suspect morality since they were more preoccupied with the content of the pockets of the wounded soldiers than the care and medical training they were supposed to give (Sandeau (a), 2004; Ducoulombier, 2004; Percy, 2002).
The management of hospitals was given to war commissioners but also to the administrative councils of hospitals which were under the authority of the central Directory of hospitals which was located in Paris. Those war commissioners were highly criticized. Indeed, despite the health staff being regularly transferred, they had to supply the hospitals with equipment and medical supply. Indeed, the allocated budget was very often embezzled for their own benefit. Even if the orders were sometimes made, they were far from reaching their initial destination and found unexpected locations. Unfortunately, military hospitals were lacking equipment. The lack of hygiene was preeminent and the sick as well as the wounded often slept in the same bed without caring to distinguish their pathologies. A typhic could sleep in the same bed as a wounded soldier. There was a disastrous outcome: no food, no therapeutic means, no bandages, etc. The premises were ramshackle. Nobody checked upon the wounded soldiers: they were not treated, washed, changed and fed. Gangrene spread as well as epidemics. There was a growing high rate of mortality and it worsened when convoys of wounded soldiers came back from the front (Spain (1808), Germany (1813), etc.). In 1808, such were the hospitals of Bayonne and Toulouse which were overwhelmed and had to get rid of the excess of patients on other cities of Southern France. As nobody would give the wounded decent treatment, those hospitals finally became mere hospices where wounded people would come and die (Sandeau (a) and (b), 2004; Museum of the Army, no date; De Kerckhove, 1836).
However, some hospitals benefited from special treatment from the public institutions which gave them the means they needed to guarantee the greatest efficiency. Therefore, Lille and Strasbourg had a good reputation. Great names in surgery (Desgenettes, Broussais, Larrey) came to practice in the Val-de-Grâce hospital. The National Residence of the Invalids, which was under the responsibility of Coste with the help of Sabatier and Yvan, provided quality treatments. Finally, the military hospital Gros-Caillou which belonged to the Guard was supplied with the most modern equipment of the time. Nothing was too good for this elite corps. There, Larrey practiced as chief surgeon, Sue as chief doctor and Sureau as chief chemist. Soldiers were well-treated there. The medical teams were various and well-supplied. Therefore, in 1813, they were made up of 3 doctors, 15 chemists and nearly 50 surgeons. Moreover, this hospital had its own nursing corps (Marchioni, 2003).
When the Consulate was abolished, the Health Service was understaffed. There was no more than 800 health soldiers, among which were 490 surgeons for the army corps, including 90 surgeons, 30 doctors and 90 chemists in the hospitals as well as 11 surgeons and 4 chemists in the Guard. Not to mention the 6 of the General Inspection (see below), 25 professors and 59 surgeons, 9 doctors, and 30 chemists who were waiting to be transferred (Sandeau (a), 2004). At the beginning of the Empire, the health council was repealed once again and the main authority was still in the hands of the health commissioners which remained in the army headquarters. They kept their authority. When Napoleon’s Great Army went into combat on all the European continent, the health service of the Great Army was inadequate and could not meet the needs of the wounded due to a shortage in staff, medical supply, mobile hospitals, to the suppression of training hospitals, to the absolutism of the war commissioners who had no medical knowledge and who only were interested in making profit at the expense of the wounded, and due to the lack of credibility of surgeons who were more criticized by the brain-trust than respected.
Besides, Napoleon did not give them that much credibility too since he forbade them to go on the battlefield for not interfering with the procedure of operations. The Imperial Guard which benefited from Napoleon’s attention was the only army corps that had its own health service under the responsibility of Dominique Larrey. It was supplied with all the necessary equipment, mobile ambulances in abundance and a health staff of great competence. Its soldiers were repatriated to Paris, at the military hospital Gros-Caillou. Moreover, Napoleon had his own personal ambulance which was under the responsibility of Baron Yvan (Sandeau (a), 2004; Marchioni, 2003).
During the Empire, the most illustrious surgeons did not wait to make them heard and to protest against the medical doldrums they had to face on a daily basis. Their request reached Napoleon himself. They claimed the establishment of a real health corps, a genuine status for the health staff, financial means to implement more hospitals and enough medical supplies. Coste, chief doctor in the Army, wrote reports which criticized the reality so violently that he was made redundant and sent back to the subordinate position of chief doctor of the Invalids. As for Heurteloup, the Emperor finally listened to him after Wagram in 1809. The latter authorized him to run the hospitals in Vienna. Even though Napoleon also listened to Percy’s claims, none of his suggestions led to reality (Ducoulombier, 2004; Percy, 2002).
Health officers were either doctors, either surgeons or chemists. They had no military career and if they were dismissed, they were so without pay or pension. They were not respected by other army corps and were under the absolute control of war commissioners. This relationship froze any particular efficiency within the hospitals and more generally within the health service. There were only three ranks of soldiers: major surgeon or 1st class surgeon, major surgeon assistant or 2nd class surgeon, and finally, “Chirurgien sous-aide major” or 3rd class surgeon. As for doctors, there were only two ranks: the two first previously mentioned. Moreover, their uniform was similar to that of officers. They wore a sword of infantry officers. Their clothes and trousers were blue. Doctors wore blue jackets, surgeons, red ones and chemists wore green ones. Doctors wore black collars, lapels and ornaments. As for surgeons, they wore crimson collars, lapels and ornaments which were green for chemists. The ranks were distinct from one another and could be noticed from the buttons and embroidery on their uniform. The hats were of one colour and had a red plume. They walked with men or among them. Some of them, the Surgeon Majors, had the privilege to have a horse. At night, they slept in the open and sometimes under tents. Sometimes, they were happy to find the ruins of a house to sleep in. As for their feeding, like soldiers, they were fed by the local people. However, Larrey and Percy’s instructions on that matter were unambiguous and it was with their salary that surgeons were supposed to pay them, since looting was condemned in the medical corps (Sandeau (a), 2004; Army Museum, no date).
Those outstanding practitioners were supervised by chief doctors or chief surgeons who were themselves supervised by General Inspectors. Under the Empire, the general inspection included six members: two doctors (Desgenettes, Coste), three surgeons (Heurteloup, Larrey and Percy) and one chemist (Parmentier). This committee, whose principle was established in 1796, was supervised by organizers and war commissioners. This organization constituted the management of the Health Service and was located in the headquarters of the army. It aimed at supervising the organization of country hospitals at the front and at the back of the front, and at controlling the transit of wounded soldiers from first hospitals to second ones (Sandeau (a), 2004; Museum of the Army, no date; De Kerckhove, 1836).
With the growth of battles and victories, it became necessary to levy other troops and to try their best to treat the wounded so that they could go back more quickly on the field. Between 1807 and 1808, the number of health officers rose to 2 500 men though it never answered the needs of the Great Army since its strength was multiplied by three. However, the Heath Service kept on developing: 3 800 health officers in 1809, 4 500 in 1810, and more than 5 000 after 1812. The Health Service was in great need of surgeons and had huge difficulties recruiting. Surgeons were in the front line to operate on the wounded soldiers, change their dressings and to watch over their speedy recovery. The chemists were next in the line. They were essential in the delivery of potions, drugs, mixtures and other medicine that they concocted themselves. As for the doctors, they had a thankless role since they had small therapeutic means and often had wrong diagnostics in the first hand. However, they were the first to become aware of the paramount importance of hygiene measures in the context of epidemics which struck down the Great Army. The devotion and self-sacrifice they showed to the sick gave a heroic dimension to the staff of the Health Service. The recruitment mainly took place through requisitioning, commission and conscription.
If great practitioners found themselves practicing on the battlefield, many others were pitiful and received little medical training. Besides, Napoleon rewarded just a few of them. Health officers were rewarded with the Legion of Honour and with the nobility of the Empire (Sandeau (a), 2004; Museum of the Army, no date; De Kerckhove, 1836).
During the Napoleonic epic, the foot soldiers, who moved forward to fight, had priority of treatment. The others, who were wounded or sick and who often fell, disrupted the walk of the first soldiers. They became uninteresting. Sick and wounded soldiers increased higgledy-piggledy in the bivouacs or in the stationed regiments without taking into account their wounds, pathologies, symptoms and gravity because of the miserliness of the running administration which created the subsequent precarity and insalubrity of country hospitals where the lack of treatment, hygiene and appropriate diet was obvious. Epidemics struck down everywhere: typhus, cholera, dysentery, scurvy, yellow fever, etc. Another problem appeared in the European countryside from 1805 to 1810: the lack of supply which from being rather basic at first became really nonexistent. The more the battles were bloody, the more the surgeons were called on the battlefield and among the regiments. They had little resources; the ambulances which had surgical instruments and the lint for bandages were always delayed. Exchanges between practitioners multiplied and were often reduced to basic practices: the saw of the joiner for amputations, the pliers of the cobbler to extract teeth notably or they even used the butcher’s or the cook’s knife, etc. (Sandeau (b), 2004; Ducoulombier, 2004; Percy, 2002, De Kerckhove, 1836).
If the Health Service was extremely well-structured, the main problems were the lack of equipment and supplies. There were no tents and beds, no straw to cover the ground with its army of bugs. The barns, the abandoned or requisioned houses were basic, flimsy and dilapidated. On the battlefield, the wounded soldiers were helped by surgeons from the regiment. A regiment was made of four battalions. There was a surgeon with eight colleagues by regiment to take care of all the soldiers. Each of them had a surgical kit. As for the division, there was also an ambulance division made up of a doctor, six surgeons and four chemists. Its men usually installed the mobile hospitals aimed at the first treatment. The wounded were carried towards the back, away from the battlefield towards the ambulance depots which were equipped in disused buildings (castles, houses, churches, etc.) In a short amount of time, those little organizations were expected to divide themselves into small sections and to reach the front according to the emergency needs. Logically, each regiment had four ambulance boxes at its disposal. Those boxes contained ammunition transferred to the medical service and which carried surgical instruments, 50 kg of lint and 100 kg of bandage cloth, two mattresses and six stretchers. Each also had a first-aid kit with various salves and medicine. Surprisingly, before 1805, the number of these boxes was limited by a decree, and from four regiments, there were reduced to one. They were towed by four horses and driven by a manœuvre (Sandeau (a), 2004; Museum of the Army, no date; De Kerckhove, 1836).
Bibliography:
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Jounieaux Pierre, personal communication, Aix-en-Provence, 2010.
Marchioni J., Place à Monsieur Larrey, chirurgien de la Garde impériale [On Monsieur Larrey, surgeon of the Imperial Guard], Actes Sud (ed.), Arles, 2003.
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Sandeau Jacques (a), « La santé aux armées. L’organisation du service et les hôpitaux. Grandes figures et dures réalités (1ère partie) » [Health and armies. The organization of the health servive and hospitals. Great personalities and harsh reality (1st part)], in Revue du Souvenir napoléonien, January 2004; 450: 19-27.
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(*) Doctor in Dental Surgery (DDS), PhD in Epistemology, History of Sciences and Techniques, Laureate and Associate member of the French Dental Academy, Free member of the French Surgical Academy.