Dominique-Jean Larrey, baron

Napoleon's war surgeon

"Larrey was the greatest military surgeon in history"
(Garrison-Morton).

Dominique-Jean Larrey's parents were so poor that he obtained his preliminary education only through the kindness of the village priest. After the death of his father, when the boy was thirteen years of age, he was sent to his uncle, Alexis Larrey (1750-1827), a successful surgeon and director of the École secondaire de médecine in Toulouse. Dominique's elder brother was Claude-François-Hilaire Larrey (1774-1819), an able surgeon and writer on surgery.

Young man goes to sea
At the age of twenty-one, after studying and serving as his uncle's surgical apprentice for six years, Dominique went to Paris where he studied under Antoine Louis (1723-1792) and Pierre Joseph Desault (1744-1795), chief of surgery at the Hôtel-Dieu. The latter taught him the principles of wound debridement. In 1787, after a brilliant competitive examination, he was appointed surgeon to the royal navy and participated in a cruise to the north American waters, visiting Newfoundland as a surgeon on a man-of-war, the frigate Vigilante. However, he soon had to resign because of chronic seasickness and returned to Paris where he worked as aide-chirurgien under Desault in l'Hôtel-Dieu, and as field surgeon at Les Invalides. By 1790, he had established himself as assistant Senior Surgeon at Les Invalides,

The flying ambulances
Not long after serving in the army, Larrey met Napoleon Bonaparte who was then commander of an artillery brigade. In 1792 he joined the Army of the North – the army of the Rhine – as Chirurgien aide-major.

It was with the army of the Rhine Larrey observed the great shortcomings of the organization of the battlefield, as victims died before they could receive any medical assistance. He suggested the introduction of «ambulances volantes» – flying ambulance. The flying ambulances were horse drawn wagons for collecting and carrying the wounded from the battlefield to base hospitals. He described this concept in minute detail in a report from the Italian Campaign of 1797. It consisted of a system of transport of medical supplies and supporting personnel. The personnel included a doctor, quartermaster, non-commissioned officer, a drummer boy (who carried the bandages), and 24 infantrymen.

From then the flying ambulances were always present with the avant-garde of the army and even tended to the wounded on the battlefield, even under fire. They boosted the morale for the rank and file officers of the French Revolutionary Armies, but it's most revolutionary aspect was Larrey's attention to the wounded on both sides of the battlefield. A noble concept that survived to modern times in the form of the Red Cross.

Desert surgeon
In 1797, following the campaign in Italy, Larrey became professor at the École de Médecine Militaire at Val-de-Grâce. Peace, however, never lasted long with Napoleon. Already the following year Larrey was appointed Officier de santé en chef for the Egyptian campaign then being planned. During this campaign he collaborated with Baron Réné Nicolas Dufriche Desgenettes (1762-1837).

Larrey's indefatigable energy served him well in the enormous hardships during the campaign in Egypt and the Middle East. He built military hospitals in Egypt, Sudan, Syria, and Palestine. It has been said that even in the harsh desert terrain, his flying ambulances would collect the wounded in less than 15 minutes. In 1799, at Accra, he himself performed 70 amputations and seven trephinations. He also found time to write about endemic diseases such as typhus, bubonic plague, leprosy, and trachoma.

On his return from Egypt in August 1799 Larrey became Chef-Chirurgien to the hospital of the Consular-guard and, in 1803, eventually found time to become doctor of medicine, with a dissertation written already in 1797. In 1805 he became Inspecteur-genérale du service de santé des armées, in which position he participated in the major campaign the following years.

The cold in Spain is colder in Russia
During the War in Spain (1808), Larrey had ample opportunity to study leg amputation. The Spaniards mined the roads of retreat resulting in a large number of casualties and lower extremity injuries. As senior field doctor in both Corsica and Spain, he learned and perfected his technique of leg amputation as well as the treatment of frostbite. This experience was later to prove valuable in the disastrous Russian campaign in the winter of 1812.

It was during the retreat from Moscow that Larrey also observed that those legs frozen stiff felt almost no pain during amputation. Moreover, after amputation, pain was diminished by packing the stumps in ice and snow. He put this knowledge to good use to alleviate the suffering of those wounded. At Borodino, on the march to Moscow, Larrey performed 200 amputations in 24 hours. At the Battle of the almost impassable Berezina River during the disastrous retreat, he performed 300 more amputations.

Larrey's devotion to duty made him a great favourite with Napoleon. For distinguished courage he was made a baron by Napoleon on the field of Wagram in 1809.

Marshal Blücher to the rescue
Larrey was present at all Napoleon's great battles. He was one of the few who stood by Napoleon on his abdication, and was waiting for him on his return from Elba in 1815. He then served his old master during "the hundred days" leading up to the battle of Waterloo (June 18, 1815), where he was at napoleon's side.

At the end of the battle of Waterloo, Larrey was captured and sentenced to death. Fortunately a Prussian surgeon who had attended a lecture of his 6 years previously at Val-de-Grâce recognised him, and he pleaded for Larrey's life with Marshal Blücher. Then fortune intervened. Blücher's son had once been wounded in a skirmish and taken prisoner by the French, and his life had been saved by Larrey. The Baron was released and returned to France with a Prussian escort.

After the fall of the empire Larrey was solicited by the Tsar of Russia (Alexander 1, 1777-1825, reigned 1801-1825) and by Pedro I of Brazil (1798-1834, reigned 1822-1831) to take charge of their armies with high ranks. He refused to leave his native land and became chief surgeon to the royal guard and honorary member of the Conseil de santé des armées. He was elected to the Académie de Médecine at its founding in 1829, and also to the Institut.

Larrey was wounded both at Austerlitz and Waterloo.

A man for all seasons
He was admired by all for his humanity and humour and Napoleon left him 100.000 francs in his will. One of his special pleasures at the end of his life was a meeting with the Abbé de Grace, the preceptor of his early years, whom he held in high veneration. His works have been a favourite study of the surgeons of all nations during the nineteenth century. Most of them have been translated into all modern languages.

Despite his strenuous duties in the campaigns Larrey also found time for extensive writing. Besides war surgery he wrote on rabies, tetanus, aneurysms, elephantiasis scroti, urine atrophy, etc. He was the first to observe that Egyptian ophthalmia (trachoma) and conjunctivitis was contagious, and he published the first description of trench foot. Larrey conceived of several surgical operations, being among the first to amputate at the hip.

He served honourably in 25 major campaigns including 60 large battles during the revolutionary and Napoleonic wars. It has been said that the Duke of Wellington observed and commended him for his energy and valour in tending the wounded during the Battle of Waterloo.

Larrey was a kindly man who devoted much of his life to the well-being of the soldiers, among whom not even Napoleon commanded more love and respect.

He has two monuments, one erected in 1850 in the court of the Val-de-Grâce military hospital, Paris, and the other in the hall of the Academy of Medicine.

Larrey’s son, Félix-Hippolyte Baron Larrey (1808-1895), became a distinguished surgeon.

C'est l'homme le plus vertueux que j'ai connu."
Napoléon Bonaparte

"If ever the soldiers erect a statue it should be to Baron Larrey, the most virtuous man I have ever known." Napoléon Bonaparte

"As an operator he was judicious but bold and rapid; calm and self-possessed in every emergency; but full of feeling and tenderness. He stands among the military surgeons where Napoleon stands among the generals, the first and the greatest."
Cornelius Rea Agnew, American surgeon, 1830-1888.

• Baron Réné Nicolas Dufriche Desgenettes:
  Histoire médicale de l'armée d'Orient. Paris, 1802.
  
  Works by Baron Larrey:
  
• Mémoire sur l’ophthalmie régnante en Égypte. Cairo, An IX (1800-1801)
  Larrey was the first to observe the contagiousness of trachoma shortly after the successful invasion in 1798. The disease spread to Europe thereafter under the name of "military ophthalmia" or "Egyptian ophthalmia" .
• Relation historique et chirurgicale de l’expédition de l’armée d’Orient en égypte et en Syrie.
  Paris 1803. Translated into English and German.
• Dissertation sur les amputations des membres à la suite des coups de feu, étayée de plusieurs observations. New edition, 1808.
• Mémoires de chirurgie militaire, et campagnes.
  4 volumes, Paris, J. Smith and F. Buisson, 1812-1817.
  Volume 5 entitled: Rélation médicale des campagnes et voyages, Baillière, 1841.
  German translation, 2 volumes, Leipzig, 1813, 1819.
  English translation with notes by R. W. Hall of volumes 1-3 in 2 volumes, Baltimore, 1814. English translation of volume 4 by J. C. Mercer, Philadelphia, 1832.
• Recueil de mémoires de chirurgie. Paris, 1821.
  English translation by John Revere, Boston, 1823.
  German by Jakob Heinrich Robbi (1789-1833), Leipzig, 1824.
  The essays cover both military and non-military medicine including a lengthy account of the uses of moxa, an ancient Oriental cautery.
• Considérations sur la fièvre jaune. Paris, 1822.
• Mémoire sur une nouvelle manière de reduire ou de traiter les fractures des mebres compliquées de plaies. Paris, 1825.
• Clinique chirurgicale, exercée particulièrement dans les camps et les hôpitaux militaires depuis 1792 jusq’en 1829.
  5 volumes plus atlas to volumes 1-3, and atlas to volume 5.
  Paris, Gabon (Volumes 1-3); Paris, J.-B. Baillière (volumes 4-5). Paris, 1829-1836.
  Larrey's most comprehensive treatise, and the only one of his works that is extensively illustrated. Many of the plates concern surgical pathology.
  German translations, by Franz Amelung (1798-1848), 2 volumes, Leipzig and Darmstadt 1831, and by Albert Sachs (1803-1835), 3 parts, Berlin, 1830, 1831.
• Rélation médicale des campagnes et voyages de 1815 à 1840, suivie de notices sur les fractures des membres pelviens, sur la constitution physique des Arabes etc. Paris, 1841.
  Volume 5 of Mémoires de chirurgie militaire, et campagnes. With Larrey's account of the battle of Waterloo and Napoleon's excile. Biographical etc:
• Paul Triaire (1842-1912):
  Dominique Larrey et les Campagnes de la Révolution et de l’Empire. Tours, 1902.
• Eugène Dupeyroux:
  Le Baron Dominique Larrey, sa vie et son oeuvre. Thèse de Paris, 1904.
• John Chalmers Da Costa (1863-1933):
  Baron Larrey, a sketch.
  Bulletin of The Johns Hopkins Hospital, Baltimore, July 1906, 18: 195..
• Peter Bergell and K. Klitscher:
  Larrey, der Chefchirurg Napoleons I. 1812 to 1813. Berlin, 1913.
• Robert E. Wiese:
  Larrey, Napoleons Chef-Surgeon.
  Annals of Medical History, New series 1, 1929: 435-440.
• L. A. Brewer 3rd:
  Baron Dominique Jean Larrey (1766-1842). Father of modern military surgery, innovater, humanist.
  The Journal of Thoracic and Cardiovascular Surgery, December 1986, 92 (6): 1096-1098.
• Miguel A. Faria, Jr., M.D:
  Dominique-Jean Larrey: Napoleon's Surgeon from Egypt to Waterloo.
  http://www.haciendapub.com/jmag2.html
  From Journal of the Medical Association of Georgia (JMAG), September 1990, pages 693-695.
• N. McIntyre:
  The Barons Larrey: Dominique Jean (1766-1842); Hippolyte (1808-1895).
  Journal of Medical Biography, August 2002, 10 (3): 185.