|
MILITARY SURGERY by
In casting about for a subject for this occasion, we have endeavored to avoid the well beaten path of the great torch bearers with whom you are already familiar. If, in presenting a smaller luminary, or one with whom you are acquainted, we have sacrificed a measure of your interest, we ask your forbearance in leading you so far afield. The history of Europe during the last days of Louis XVI, the short life of the Consulate and the scintillating era of Napoleon is so replete with manifold interests to all the Caucasian races that it occurred to us that the relationship of medicine and surgery to these stirring events might hold your attention. On further study, the material seemed so vast that we were forced to confine ourselves to military surgery. Of the surgeons who played a part in this drama, by far the most colorful and the most worthy of attention is Baron Larrey. To follow him through all the campaigns would be too long a task, so we will try to direct your attention to certain episodes of various campaigns as portrayed by a surgeon. The narrative will be foremost, and surgery incidental. Jean Dominique Larrey was born in 1776 at Baudeau in the Pyrenees. At the age of 13 years he left his native village for Toulouse. Here he studied under the direction of his uncle, Alexis Larrey, who was Surgeon Major and Professor at the Hospital of Grave. After six years of diligent work Larrey went to Paris to complete his studies. A vacancy occurred in the French Navy. He stood the examination successfully and proceeded to Brest where he embarked to accompany an expedition designed to protect the fisheries of the Newfoundland Coast. During his stay in North America, he interested himself with studies in Natural Science, especially the case of a cow which became enciente following the forcible, midnight attentions of a bull moose which broke into the stable where she was stalled. He was again in Paris at the beginning of the winter of 1789. That was an eventful time. Larrey was an eye-witness of the early troubles of the Revolution and had occasion to take care of the first victims of those sad days, at the Hotel Dieu, under the orders of the surgeon Desault. It was in that vast hospital and at the Hotel Royal des Invalides that Larrey acquired knowledge sound enough to enable him to serve with distinction, three years later, in the Army of the Rhine. On April 1, 1792, Larrey joined the headquarters of the Army. Larrey here became sensible enough of the inconvenience of the French Ambulances as they were constructed at that time. According to the regulations, these ambulances were obliged to remain about a league from the army, while the wounded were also obliged to remain on the field of battle until after the combat. Depressed at the sight of the privations to which the wounded were exposed, Larrey invented a 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 advanced guard with as much speed as flying artillery. A dispatch written by General Beauharnais to the convention commends him thusly; "I ought not to omit mentioning the Surgeon-Major Larrey and his comrades with the flying ambulances, whose indefatigable care in treating the wounded has diminished those affecting results to humanity which have generally been inseparable from days of victory, and has essentially served the cause of humanity itself in presenting the brave defenders of our Country." He was sent to Paris to superintend construction of ambulances, but hardly had he arrived in Paris when he received the appointment of Surgeon-in-Chief of the Army of Corsica. He journeyed to Toulon where he presented himself to the chiefs of the French Army among whom was the General Napoleon. As the number of English cruisers which were watching the port of Toulon rendered it hazardous for the French Army to go to sea there, Larrey went by land to Nice. He then served during the short war in the eastern part of Spain. In the year 1797, he was ordered to join the army of Italy for the purpose of organizing the flying ambulance. He arrived at the time of the signature of the preliminaries of peace. This proclaimed the downfall of Venice, and terminated the power of the last of the one hundred and twenty-two Doges. He saw taken down from the top of one of the columns of the place St. Marc the Lion of Paris. He was also eye-witness of the surrender of the famous Horses of Corinth which surmounted the front of the Cathedral and which more lately adorned the Arc-de-Triumphe in Paris. At Venice he organized the Health Service of the expedition being fitted out against Coffu. After the peace of Campo Formio, Napoleon caused the Flying Ambulance Corps to maneuver before him. He then said to Larrey: "Your work is one of the most happy conceptions of our age; it will suffice for your reputation." Larrey proceeded with his inspections of hospitals, first at Venice and next at Padua. At the latter place he paid his respects to the celebrated professor, Scarpa. Larrey now became surgeon and chief of the expeditions against Egypt. It was to be commanded by the young hero who had conquered for France some of the finest provinces of Italy. At Ciaro, opthalmia attacked large numbers. Larrey there adopted a treatment which was so successful, that among 3000 soldiers, no one lost his eyesight. Bleeding in the neck, application of leeches to the temple and baths for the feel, along with the use of boiling decoctions of emollient substances for the parts affected, all combined at discretion, with purgatives and bitters constituted the remedy which Larrey ordered to be used in the French Army. Tetanus was frequent among the wounded. The remedy which he directed to be used was the extract of opium combined with camphor and the nitrate of purified potash. The salt thus obtained was dissolved in a small quantity of emulsion made with cold seeds of cucumber or of melon, or with bitter almonds. He amputated the limb when a wound of the extremities was the cause of tetanus. Larrey saw in the Egyptian temples the basreliefs representing surgical instruments very nearly resembling those which were used in France at that time. After continued success in Egypt, Bonaparte embarked for France, leaving General Kleber in command. One insurrection after another broke out. Larrey thought that so many fatigues and privations under a burning sky excited liver trouble which degenerated into abscesses, and said, "Very desperate may appear the remedy which was then applied sometimes in order to save a life. It was no less that plunging a sharp instrument into the belly in order to five a free course to suppuration. After the landing of a force of English at Aboukir, reverses and sickness attended the French Arms. A Capitulation followed. On his arrival in Marseilles Larrey learned of his appointment as Surgeon-in-Chief of the Consular Guard. Bonaparte was now first Consul and in a short time this title became Napoleon the First, Emperor of the French. At the time of the alleged breach of the treaty of Amiens by the English, Napoleon concentrated 80,000 men at Boulogne expecting the arrival of the Spanish and French Fleets, to carry them to British shores. The news arrived of the annihilation of the fleets at the battle of Trafalgar, and Austria declared in favor of England. Napoleon threw his Army through Prussia into Austria by forced marches. The battle of Austerlitz Saxony and Prussia with the sanguinary battle of Eylau now followed. The second campaign in Spain and the second in Austria seem barren of opportunities to picture to you the liaison of Larrey with the Military operation. In the latter campaign, he was made a Baron of the Empire. At the height of his power, Napoleon now undertook the conquest of Russia. After twenty years of military surgery, Larrey had three quiet years in which to complete his memoirs. In 1812 he joined the Grand Army which soon assembled on the left bank of the Vistula. It numbered 400,000 men and was equally divided between infantry and cavalry. These soldiers consisted of French, Spaniards, Neapolitans, Italians, Austrians, Prussians, Bavarians, Wirtenbergers, West Phaliens, and Saxons. The advance guard entered Wilna without encountering much resistance. On the day preceding their arrival, the Emperor Alexander was still remaining in this town and had not the most distant idea that the French were approaching with such rapidity. Among the wounded, Larrey saw some singular phenomena. The first was a Polish officer, who was wounded 24 hours previously. His body was inflated to an extreme degree by a general emphysema and the skin so distended as to render the limbs stiff and inflexible; the folds surrounding the joints were also effaced and the eyes entirely closed by the turgesence of their lids. The lips acquired a prodigious thickness and impeded the passage of liquids into the mouth. The pulse and respiration had nearly ceased. The spear of a Cossack had penetrated obliquely under the inferior angle of the left scapula into the thorax effecting at the same time a wound of the intercostal muscles. Its edges were united with exactness, by means of adhesive plaster. The air, continually issuing from the lung, escaped through the aperture in the thorax and spread itself into the cellular tissue. In the treatment of this case, he, in the first instance, removed the adhesive strap, laid open the wound and brought it on a line with the perforation in the thorax. Dry cups were immediately applied to its edges and kept in their relative situation by means of linen dipped in warm camphorated wine; cups with scarifications were applied over the surface of the body but chiefly to the thorax and extremities. The officer had completely recovered on the return of the army from Moscow. After the battle of Witesph, 45 amputations of the arm, thigh, or leg were performed in his presence. Those operated in the first 24 hours were generally successful. He details a case in which he disarticulated the thigh at the hip in 4 minutes, with a happy outcome. T he Army soon reached the heights of Smolensk. It was necessary to assault and carry then in succession by the bayonet. The execution of this object, though effected with very great difficulty in consequence of the position and tortuous defiles through which it was necessary to pass, was completed in 24 hours. The town was attacked and taken by storm on the succeeding day. The enemy made a most vigorous resistance in all quarters. The capture of Smolensk will be regarded as one of the most glorious exploits of the whole campaign. Several parts of the city and suburbs being fired during the attack there ensued a conflagration which was rendered more horrible in consequence of most of the houses being built of wood. The storming of Smolensk was one of the bloodiest fights he had ever witnessed. The passages through the gates, bre ches and principle streets were filled with the dead and dying, nearly all of whom were Russians. About 6000 French were wounded and 12,000 killed. The urgent necessity of securing the benefits of surgery to about 10,000 Russian and French wounded in Smolensk, forced Larrey to send the sixth and last ambulance back to Smolensk with the wounded from an advance guard engagement. Information was not obtained that the Russians were in position on the heights of Moscow. Preparations for a grand battle were immediately made. For the purpose of obtaining surgeons to aid him, Larrey withdrew all the surgeons from the line excepting a Surgeon Major and assistants for each corps. This procured him 45 surgeons and assistants. We will picture the subsequent events in the words of Larrey: "After a march of thirty-six hours, we found ourselves in the presence of the Russian Army. It was stationed and entrenched on the top of a circular hill, extending from Calouga and the grand road to Moscow on our left, to the distant forests on our right. At the base of the hill there ran a deep stream, difficult to be forded, and giving this position immunity from an attack. The want of sustenance and forage, particularly of oats, had nearly reduced both soldiers and horses to a state of exhaustion. Arriving on the field of battle, the army was destitute of species of food. There was even a great scarcity of water, which it was necessary to obtain from the above mentioned stream in the very face of the enemy. The troops of our advanced guard in the meantime displayed their ranks and attacked, September the fifth, at two o'clock p.m. the first line of the enemy, which fell back on the second. Some redoubts were carried by our cannon. The enemy's forces were giving way in all quarters and everything indicated a glorious issue for our arms, when the combatants were suddenly surrounded by the shadows of night and both parties compelled to interrupt the fight and resume their respective positions. I caused our wounded to be dressed during the night, and removed immediately to the abbey of Kolloski, where the general ambulance of retreat had been established. The day of the sixth was spent in recruiting the troops, and in a strict reconnoitering of the enemy's lines. I availed myself the opportunity to have dressings prepared and placed on duty 36 surgeons, who were under my immediate control. All the materials of the ambulances were likewise arranged by my direction. The positions to be occupied by the ambulance of headquarters and the guard were designated by Napoleon himself. Previously to repairing to this bivouac, I passed through the whole line, the ambulances of the corps and divisions. Accompanied by the ambulances, I proceeded, before the dawn of day, to the appointed place. It was a square space of about three thousand feet and in the vicinity of the tents of headquarters. The battle commenced by a general attack at the rising of the sun. Prince Eugene commanded the left wing. Prince Pontiatowski the right, and Prince Murat the center, in which situation were stationed the corps of the guard and the Emperor. Upwards of two thousand pieces of artillery, appertaining to the two armies, were simultaneously discharged. Our Battalions advanced boldly across the enemy's fire, in order to seize upon the first redoubts and break through their lines. The left wing routed a column, which defended one of the strongest positions on the road to Moscow, and advanced hastily on Mosaisk. The center, under the immediate command of Marshall Ney, after standing a very brisk fire from the numerous batteries and redoubts which defended the most important part of the enemy's line, carried fortifications and made itself master of this formidable and almost inaccessible position. General Caulaincourt, commander of the assaulting column, was killed on the first redoubt. The Generals Morand and Lausnaberg, who succeeded him in command were wounded on the same spot. The latter died a few days after the reception of his wounds, which were caused by the passage of a ball through his abdomen, and involved the intestines. The loss of these officers retarded the progress of this column, and it was with some difficulty that these troops retained possession of the redoubts and position.l Prince Poniatowski marched with an equal degree of boldness on similar success. Their whole line tottered, and their first position was carried. They would doubtless have been totally destroyed, had the reserve been capable of aiding the central column, or space occupied by the infantry and cavalry, already very much fatigued, been less extensive; and in short had not the day been so far spent. It was for some moments doubtful which party would prove victorious. Our battalions, however, close up and animated by a new impulse, moved on with rapidity and possessed themselves of the whole field of battle, vigorously driving the Russian Army before them. The bold resistance made by the latter proved fatal to many, and the remainder of the precipitately retreated to Moscow. They made no halt in this place, but continued their march hence to Calouga. This bloody battle continued from sic o'clock a.m. to nine o'clock p.m. We had 40 generals killed and wounded, and from about 12,000 to 13,000 men, both officers and soldiers, placed hors de combat. The number of wounded amounted to 9500. The loss of the enemy was estimated at upwards of 20,000. It would be difficult to describe the scenes of horror presented during this dreadful fight, in which more than 600,000 combatants were engaged in a space of about a league square. Two thirds of the above mentioned wounded were located in our general ambulance, the whole army being made aware of its position by the order of the day, and its vicinity to the tents of headquarters. I had scarcely made the necessary preparations when the wounded arrived in a crowd and much confusion would have ensued had I not pursued the order of dressing arrangement, observed by me in all battles, and detailed under its principal heads in my first campaigns. I owe much praise and many thanks to my estimable assistants, to M. Laubert, chief pharmaceutist of the army, and to several of his juniors, for the zeal with which they aided me in this memorable battle. The limited number of my assistants, high in rank forced me to perform personally all the difficult operations. It was also necessary that I should exercise an active supervision over this ambulance and all those of the line. Two or three hours had elapsed since the commencement of the battle, when I was called to the assistance of General Monthbrun, commander of one of the cavalry corps, who was mortally wounded. It was requisite that his wound should be dressed on the spot where it was received. The loins were traversed, from side to side, by the projectile. Little could be done, death was certain and not far distant. I applied dressings and caused this general to be conveyed to a small village in the vicinity, where he died a few hours subsequently. During the dressings of this wound, my situation was one of very great peril, some horses, which were behind us, being killed by a ball. I returned to my ambulance to which I was recalled for the purpose of bestowing my services on the Generals Nansouty, Lausnaberg and Romeuf. The first had the internal side of the right knee traversed by a ball, which fortunately had not injured the articulation. I laid open the wound, applied a suitable dressing and placed the patient under the charge of chief-surgeon Bancel, who attended him, until he was perfectly cured. I have already made known the wound of the second. It presented no other indication than that of simple dressing and subsequent care, which was prodigally bestowed upon him with the greatest zeal, but unhappily, proved unavailing. Being unable to fall in with the latter of these generals, I did not see him until the succeeding day. He had been dressed on the field of battle and conveyed to the same village to which General Montbrun had been carried. The very great injury, caused by a spent ball, in the right hip and lumbar region of the same side, without any interior mark, was not recognized. A long incision made immediately in the skin of this region, which was disorganized and distended by a large quantity of extravasted blood, revealed to me the whole of the interior disorder. The muscles of jelly and the innominatum and corresponding lumbar vertebrae fractured; the commotion which the abdominal viscera must have experienced, may be imagined. General Romeuf died on the same night. It was impossible to exhibit more valor and courage than was displayed by these noble sufferers whose names deserve to be recorded in the annals of history. I speedily returned to the general ambulance, where I continued without permission, the performance of difficult operations until late in the night of the following day. Our duties were rendered proportionately more laborious by the very cold and frequently cloudy weather. The north, northeast or northwest winds which prevailed constantly during the whole month were very violent, in consequence of the approach of the equinox. It was with great difficulty that a wax taper was kept burning before me during the night. I had no absolute need of it but for the application of ligatures and arteries. The surgeons, without exception, gave the most single proofs of courage and devotion in this battle. The ambulances of the corps and those of the regiments were at their posts and perfectly fulfilled their duties. Only two-thirds of the individuals, upon whom I performed the operation of amputation at the shoulder joint during the first, died during the removals, as I was subsequently informed. The others arrived cured in Prussia and Germany, previously to our return to those countries. The most remarkable of those wounded individuals was the chief of battalion, attached to one of the regiments of infantry of the line. Immediately after the operation had been performed he commenced his journey, mounted on his horse, which he speedily lost. This circumstance did not impede his progress; he pursued his way uninterruptedly to France, where he arrived cured three months and a half after he received the wound. I was much occupied with the execution of another delicate operation. My allusion has reference to amputation of the thigh with a flap. This member was found disorganized in the persons, of many soldiers of all classes, sufficiently high to prevent the performance of the circular amputation and yet not disorganized to such a degree as to render necessary the extirpation of the limb. I was obliged, in every case, to amputate on a level with the great trochanter and at a very short distance from this apophysis. There was, however, among the wounded a sub-officer of dragoons whose injury necessitated a removal of the thigh. A bullet had traversed this member from the external side of the fold of the groin to the great trochanter. The muscles along tract of the projectile were destroyed and the bone shattered as high up as the hip joint. The crural artery, however, though very contiguous to the wound, was not injured. The patient lost little blood and no serious symptom as respects the internal organs, presented itself. His condition, in short, was highly favorable (the local disorder being excepted) to the operation, which I undertook, though on the field of battle, with a greater degree of boldness inasmuch as the patient requested its immediate performance. The internal flaps had already been formed by the course of the wound; it was merely smaller than it would have been had it been made of uninjured parts. The pectineus muscle being separated from it, I left it in its situation, and without removing this portion of the soft parts, cut under this muscle the inter-articular ligament, which retained a part of the head of the bone in its cavity. The operation was terminated in the ordinary manner. Having applied the ligatures, I approximated the two flaps and maintained them in their relative position by adhesive straps and suitable dressings. The surgeon-major who received him in Orcha informed me by letter this sub-officer had recovered perfectly from the operation. I know not what has since become of him. If gunshot wounds of the thigh, accompanied by fracture of the os femoris, in general, render necessary the amputation of the limb, there is an injury of this character which strongly demands this operation or else the patient is doomed to perish, after having endured excruciating torture. Little is known about it and indeed it is one of those wounds which appear the most favorable to the preservation of the limb, since it does not indicate, by any exterior mark, the danger which accompanies it. A ball, with all the violence of its impulse, pierces the thigh in an antero-posterior direction immediately above the patella. The femur is broken transversely above the condyles and the two apophysis are separated from each other by a vertical fracture which extends into the joint. The patient loses his equilibrium and falling immediately aggravated the internal injury. The series of unfavorable symptoms which are developed, and necessary termination of such a wound, may be easily of the lesion. Should the ball have terminated its course without affecting a rupture of the popliteal artery, the two wounds, at first sight, present nothing serious in their nature. There is scarcely any or no displacement of the bony fragments and the patient suffers little during the first hours succeeding the accident. But tumefaction soon supervenes and renders further examination impracticable. Thus. on one hand, a surgeon is led to believe that the wound is not of so serious a character as to require amputation of the limb; and on the other, the nature of the cause which produces these consecutive symptoms is not known. This circumstance may doubtless have frequently led practitioners into error and I, myself, have been deceived in cases of individuals laboring under this kind of wound, whom I hoped to be capable of curing without an operation. Experience has taught me to decide, in a precise manner, upon those cases of gunshot wounds of the thigh accompanied by fracture or a shattered condition of the femur. In order that we may be able to treat fully this question, we will give an account of our observation on this point in the battle of the Moscow. The first wound of this character, which presented itself in this battle, the seriousness of which I was so fortunate as to discover, was observed in the person of Count Sackoveninsk, Colonel of the Regiment of Cuirassiers, belonging to the Russian Imperial Guard, Officer of very fine appearance, strong constitution and considerable abonpoint. This soldier, of superior rank, was brought to the general ambulance. He had been wounded by a ball above the left knee. This projectile, after having fractured the femur above the condyles, was arrested under the skin of the ham, from which it was extracted by our chief-surgeon, M. Bancel, who was making arrangements for the application of a fracture apparatus to the injured thigh. I was called in the meantime, for the purpose of examining the wound, which, at first sight, did not appear to be of an unfavorable nature. A very careful examination revealed to me, besides the complete fracture of the inferior extremity of the bone, the separation of the two condyles by a vertical division which appeared to communicate with the articulation. I did not hesitate to propose the amputation of the limb. The surgeons present did not approve of it and the patient was not decided on this point. But, after some moments of reflection he consented and requested me to operate on him immediately. I performed the circular amputation above the seat of injury. My method was conformable to rules pointed out in several articles of my campaigns. The patient was removed from our ambulance, and conveyed with other prisoners to a neighboring village. The objections which were raised against the operation led me to have the detached limb dissected immediately. The bone was divided, as its union with condyles, by a transverse fracture and the two apophyses separated in a vertical direction. The articulation was filled with black albuminous blood, the popliteal artery lacerated and the muscles of the leg in a state of engorgement. It is indeed imperiously the operation of amputation which is necessary. We will again speak of this patient on our return from Moscow. Three cases nearly similar presented themselves in this battle. The same phenomena were observed in the examination of the amputated limbs, which was conducted by one of my pupils. On entering Mosaisk, we found several quarters of the city on fire. All the inhabitants had abandoned it, and the principal houses were filled with the wounded Russians, who were incapable of following the army, and were left without any kind of succor. Nearly all of these unfortunate individuals had their limbs mutilated and consequently were unable to procure sustenance by their own exertions. If their wounds be excepted, they suffered most acutely from burning thirst. This affection appears to me to have contributed a great deal to the death of a large number of these ill-fated soldiers, whose bodies were permitted to lie for a time in the midst of the living. Ten of these patients had lost a limb by amputation, performed by the Russian surgeons. The first two had had their arms extirpated at the shoulder joint. Two flaps had been formed, a superior or scapular, and an inferior or axillary. Several ligatures passes through the substance of the latter, for the purpose of embracing the axillary artery and two flaps were maintained in their relative situation by several points of suture. In the case of one of these two wounded individuals, the stump became very much tupefied; irritation and gangrene developed on the same day and the patient died on the following, notwithstanding the precaution, adopted by, to cut the ligatures. We found the second patient expiring in consequence of the hemorrhage, which supervened a very short time after the extirpation of the limb. He had been operated upon according to the same method, and it appeared that all the arteries had not been tied. As in the former case, however, the union of the flaps was exact, and the points of suture even more multiplied. I have not learned anything as to the fate of the remainder of these patients, upon whom amputation had been performed. Assisted by some soldiers of the guard, whose humanity I frequently put to the test, I provided, in the first place for the most urgent necessities of these unfortunate persons. Water and biscuit, which I discovered covered in a storehouse, were distributed to them by my direction. I then caused the dead to be removed. All the wounded, who had not been dressed, had this attention immediately paid to them. The churches and public houses were place in proper condition for the reception of the wounded French. The Russians were located in the houses of merchants, and I left with them the few surgeons that remained with me, under the supervision of a chief-surgeon, preferring to await the successive arrival of those who were in the rear. We reached, in the evening of the 14 of September, in the suburbs of Moscow, and there learned, that the Russian Army, in its passage through that city, had taken along with it all the citizens and government, so, that in passing through the principal streets of this grand city, we scarcely met any one. All the houses were totally abandoned, but we were very much surprised at seeing several remote quarters of the city on fire, whether our soldiers had yet repaired and especially the bazaar of the Kremlin, a very extensive building, ornamented with porticoes, which bear some resemblance to those of the Palais Royal in Paris. When comparing the city of Moscow with what we had witnessed in our march through Russia minor, we were astonished at its grandeur, its numerous churches, and palaces, the splendid architecture of its edifices, the commodious arrangement of its principal houses, the richness of their furniture, and the objects of luxury observed in the greater part of it. The streets were spacious, regular, and well paved. There appeared nothing in this city which was discordant with its general character. Everything indicated its opulence and very extensive trade in the products of the four quarters of the globe. The varied construction of the palaces, houses and churches added to the beauty of the city. There were portions of it which, by the kind of architecture of the different houses, signified by what nation they were generally inhabited. Thus the quarter occupied by the Franks was easily distinguished, and that of the Chinese or Indians, and Germans, known without difficulty. The Kremlin centre of the city on an elevated piece of ground, surrounded by a wall with battlements, and defended, at intervals, by towers armed with cannon. The bazaar, to which we have alluded, ordinarily filled with the merchandise of India and precious furs, had become a prey to the flames. No relief could be obtained, but from these articles, which were stored away in the cellars. Into these vaults our soldiers penetrated after the conflagration, which consumed nearly the whole exterior of this splendid edifice. The palace of the emperors, that of the senate, the archives, arsenal, and two very ancient temples, occupied the remaining part of the Kremlin. These structures of rich architecture, presented a majestic appearance around the arsenal. An individual would imagine himself transported to the public square of ancient Athens, admiring the one, the Areopagus and temple of Minerva, in the other, the academy and arsenal. Between the two temples there arose a cylindrical tower in the form of a column, and designated by the name of the tower of Ivan. It was properly speaking, an Egyptian minaret, in the interior of which were suspended several bells of varied grandeur. At the base of this tower one was observed in immense size, to which allusion is made by all historians. The whole city and its environs, when seen from this elevation resembled a star with four bifurcated branches. The variety of color in the roofs of the houses, the gold and silver which covered the domes and capitals of numerous steeples, gave to this city the most picturesque appearance. Nothing could equal in splendor one of the temples of churches of the Kremlin. It was the tomb of the emperors. Its walls were overlaid with plates of gold and silver gilt from five to six lines in thickness, on which were represented in relief the history of the old testament. The candlesticks and chandeliers of massive silver were particularly remarkable for their extraordinary size. The hospitals, which attracted my especial attention, were not unworthy of the most civilized nation of the world. I divide them into military hospitals and civil monkish institutions. We had scarcely possessed ourselves of the city, and extinguished by our exertion the flames in its most beautiful quarters, when, in consequence of two more powerful causes, the conflagration was renewed in a more violent manner, was propagated with rapidity from one section of the city to another, and totally destroyed it. The first of these was justly attributed to the evident voluntary acts of a certain class of Russians, who were said to have been confined in the prisons, the doors of which were opened on the departure of the Russian Army. These wretched individuals, excited to the deed either by orders from a superior source, or influenced by their own desires, and having in view doubtless pillage of the city, went from palace to palace, in view of every body, and from house to house, for the purpose of setting fire to them. The French patrols, though numerous and frequent, could not prevent the execution of their purposes. I saw several of these persons taken in the act of perpetrating their schemes; they held in their hands lighted matches and combustible materials. Death, which was inflicted on those who were caught in this flagrant offence, had no effect on the rest, and the conflagration raged incessantly for three days and three nights. It was without avail that our soldiers pulled down houses with the view of arresting it. The flames spread beyond their intervals, and in a moment, the buildings thus isolated were wrapped in this destructive element. The second cause of the renewal of this conflagration may be found in the impetuosity of the equinoctial winds, which are constantly very violent in these countries. By their influence the fire increased and spread with extraordinary rapidity. The superior commanders, attached to the army of the enemy, indulged our chiefs with the hopes of peace, and the signature of the preliminaries was postponed from day to day. In the meantime, large bodies of Cossacks hovered around our encampments and daily cut off many of our foragers. General Kutosoff drew together the remnant of his army and strengthened it with recruits from all quarters. His advanced guard, gradually and under the guise of peaceful motives, approached our troops in the van. The period fixed upon for the expiration of the negotiation had at length arrived, and at the time when the French ambassador expected a final decision, the corps, commanded by Prince Joachim, was surrounded. Our ambassador found much difficulty in overcoming the obstacles which opposed his return to Moscow. Some of our troops, and several pieces of cannon had already been captured. The different corps of the vanguard, however, being in the first instance put to flight, rallied and broke through the Russian column which surrounded it. They took possession of a favorable position and rushed in their turn on the numerous cavalry of the enemy, which they repelled with violence, seizing on the cannon and soldiers that were taken in the first attack. The arrival of General Lauriston and wounded rendered us certain at headquarters, of the renewal of hostilities. Orders were immediately issued for the speedy departure of the army, the general beating of drums was heard and all the troops prepared for the execution of the precipitate movement. They hastily provided themselves with sustenance and commenced their march on the nineteenth of October. You all know the details of this retreat. Only a small number of the grand army of 400,000 men reached Koenignberg. Many of these died shortly after entering warm rooms, because gangrene of the feet and hands set in a soon as warmed. The French, Portuguese, Spaniards, and Italians had the smallest losses. Strangely, nearly all the individuals belonging the the Northern allies of Germany, Hanover, and Holland, perished at an early hour." An epidemic of catarrhal ataxia now destroyed many of those who reached this haven. The descriptions would suggest epidemic meningitis. The 19th of October may be regarded as a memorable day in the life of Napoleon. It was a day on which fortune appeared to desert him, and on which the tide of conquest, which had hitherto flowed almost uniformly in favor of the French arms, began to turn against them and to flow in an opposite course. The glory of the French arms was not obscured, but though it often shone amid disaster, yet most of the victories which Napoleon gained after the month of October were both costly and fruitless. We will follow Larrey through the second Campaign of Saxony. When the sun had set on the field of Waterloo, and on the fortunes of Napoleon, the pursuit, commenced by Blucher's 30,000 fresh troops at the close of the day, way sweeping and rapid, merciless and sanguinary. It swept before it the remains of the French Army as forcibly as the angry wave of the ocean dashes against the wreck of some noble vessel. Night came and Larrey was far away from his countrymen, except some medical officers and also French soldiers who lay weltering on the field of Waterloo. He was wandering about with some French surgeons when suddenly they were overtaken by a squadron of Prussian Lancers. The enemy discharged their carbines, wounding the horse of Larrey, which upset the rider. As Larrey was lying on the ground he received two saber cuts which rendered him insensible. The Prussians, who believed him dead, galloped off after fresh victims. In endeavoring to escape to French soil he was captured and sentenced to be shot. A Prussian Surgeon-Major recognized the lecturer at Berlin in the person of Larrey. Larrey was conducted before Field Marshal Blucher. That introduction was fortunate, because in the campaign of Austria the son of the Marshal had been badly wounded and had been saved by the exertions of Larrey. So, in grateful recollection of his Samaritan benevolence, Blucher not only canceled the sentence of death against Larrey, but granted him an escort to Brussels. At this time he refused high appointments in the Russian Army offered by the Czar Alexander. The Monarchy was not fully restored. Larrey was deprived of his appointments but was later made Chief Surgeon of the Hotel des Invalides. A few selected abstracts from his surgical memoirs will serve to show the state of surgical knowledge at this time. In the treatment of Aneurysms he preferred to apply a metallic ring to the artery and tighten it every day until pulsation was obliterated. This seems to be an early forerunner of the method now associated with Halstead's name. Experimental work by Baron Percy and M. Bugonet showed the artery could be completely obliterated in four days so that nothing could be forced through the lumen. In the case of a penetrating wound of the abdomen with escape of omentum, contained in Larrey's campaigns, he pointed out the advantage of suffering this adipose membrane to remain exterior to this cavity, provided it could not be reduced at that moment, and before swelling has supervened in the protruding part, and leaving it to the resources of nature alone. He enveloped it in fine linen spread with cerate for the purpose of preventing its adhesion to the integuments around the wound and guarding it from air. If this portion of omentum be strangulated in consequence of the contracted state of the wound which gave passage to it, he laid it open to an extent sufficient for the liberation of this membrane from all restraint. This rendered it capable of returning into its cavity when nature recalled it to its ordinary situation. After the 15th day, the omental swelling usually subsided and the omentum returned to the abdomen, the rapidity depending on the youth and vitality of the patient and the distance of its attachments in the abdomen from the wound. From his writings, we infer that he thoroughly understood the advantages of waiting for the patient to react from shock before operating. In regard to joint mice, he writes; "The formation of cartilaginous bodies which remain loose and floating in certain ginglmoid articulation, is a disease that has not been noticed by the ancients, perhaps, because its diagnostics were obscure, or because when they had discovered these concretions they had not courage to make an incision into a joint to extract them, for they held an opinion that all wounds, penetrating into cavities of the joints were highly dangerous. The first well attested case that we have is reported by Ambrose Pare. In 1558 this celebrated surgeon, while opening an imposthume knee, found one the size of an almond. Perhaps the exciting causes are blows, falls, violent shocks. To remove the symptoms and prevent unpleasant consequences, it is indispensably necessary that these foreign bodies should be removed by incision." In cranial wounds he wrote: "To avoid repeating what the authors have written on wounds of the head, we will confine ourselves to pointing out: 1) Those cases in which trephining is indispensable, and the period at which this operation should be performed, 2) Those instances in which the trephine, though strongly recommended by the authors, is useless and even injurious, and the means that may be adopted, under some circumstances, as substitution for this operation, 3) What is expedient in hernia of the brain, 4) the causes of abscesses of the liver succeeding wounds of the head. In wounds of the head, accompanied by fracture of the cranium, should the fragments of bone be displaced and driven internally so as to injure the brain and dura matter, the trephine in indispensable. When the foreign body, which has caused the wound, is enclosed between the pieces of bone, or has penetrated into the interior of the cranium, without being removed from the vault of the cavity, the case is again one which demands the application of the trephine. Finally, when the surgeon is assured of the existence of effused fluid under the cranium, this instrument is also indicated. But previously to performing this operation, it is important to know, whether or not the symptoms, characteristic of lesions or compressions of the internal parts, actually exist. One of the principal symptoms of compression is paralysis of a greater or less extent, seated in the side to that in which the wound is inflicted." It is customary to excise the brain tissue which herniated through a wound. Larrey recorded cases to show this brain tissue would return to the cranium if dresses conservatively. He had abundant experience with wounds of bladder. The ancients considered wounds of the bladder to be fatal. This opinion is found expressed in the aphorisms of Hippocrates. Though the causes of wounds have become more complicated since those remote times, surgery by the progress it has made, and by its success in the operation of lithotomy and treatment of wounds of the bladder, has proved that this aphorixm is not constantly true. Nothing complete, however, on wounds of this organ can be found in authors. Should the bladder be empty it is rarely injured by sharp instruments, or a ball which may traverse the pelvis. In order that it may happen, the bladder must necessarily be distended, as is generally the case with combatants. Their ardour in action, and the continence of the fight diverts them from emptying it, so it offers to large a surface in the pelvis, that the wounding instrument cannot enter this boney case without touching or cutting this viscus. In a bull-fight, which the troops witnessed on their entrance into Spain in 1808, a soldier, slightly intoxicated, was anxious to provoke and content with the bull in the arena after the manner of the torrerors. The animal, already much irritated, rushed on the unfortunate soldier at a moment when he wished to escape him by bending to the ground. He was impaled by one of the bull's horns and thrown some distance backwards. A universal shout was heard and one of the intrepid combatants leaned upon the animal, pierced him with his sword and left him dead on the spot. Larrey leaped the barrier and ran to the succor of the unhappy soldier. He discovered a lacerated wound about an inch and a half in extent in the upper portion of the right buttock, extending obliquely from behind forward, and somewhat externally towards the groin on the same side. After having torn through the cellular tissue and inguinal glands, the horn had passes under the crural arch, and penetrated into the pelvis where its extremity had come in contact with the corresponding side of the bladder. It had not been pierced but was weakened at this point, for a part of this membraneous sac protruded under the crural arch, so as to present a tumor the size of a hen's egg. Larrey administered a small amount of pure coffee with the view to reanimating his vital powers. He then enlarged the external opening, passes a catheter into the bladder through the urethra and reduced the cystocele. On Larrey's return from Madrid six months subsequently the man was cured. He gives another case of a lancer whose bladder and rectum were both pierced by a Cossack's spear. He inserted a catheter into the bladder. Both fistulae healed completely. In tetanus, he believed that emprosthotonos followed wounds on the anterior part of the body, while opisthotonos followed those on the posterior part of the body. His essay on anthrax is interesting and thorough but it is too long for us to consider here. At length the ashes of Napoleon arrived from St. Helena. The 15th of December, 1840, was the day appointed to do honour to those mortal remains. Notwithstanding the severity of the cold, Baron Larrey attended those remains the whole way from Courbevoie to the gate of the Hotel des Invalides. Even the courtiers of Louis Philippe beheld with interest the old surgeon of the Grand Army, clad in his uniform of the Imperial Guard, bent with age and with melancholy souvenirs, walking with head uncovered though the snow fell heavily, close to the funeral cortege. To him that cold day was a day of the deepest interest, and at the close of it he said to a friend, "Never has my heart, which, though I am old, is not hardened, been more agitated." Let us glance for a moment at the man Napoleon, who held such sway over Larrey, the army and France and who carried untold numbers to anguish and death from the foot of the pyramids to Steppes of Russian, as shown from his own remarks. Bourriene asked Napoleon before the expedition started, if he had really intended to risk his fate in Egypt. "Yes," was his reply, "If I stay here, I shall have to upset his miserable government and made myself king. But we must not think of that yet. The pear is not ripe. I have sounded, but the time is not yet come, I must first dazzle these gentlemen by my exploits." When at Auxome, Napoleon and some subordinate officers were quartered at the house of a barber. Napoleon, as usual when off duty, shut himself in his room and devoted himself to study. The other officers amused themselves by coquetting with the barber's pretty wife, who was much annoyed that her charms had no power to draw Napoleon from his studies. Afterwards, when in command of the army of Italy, Napoleon passed through Auxome, on his way to Marengo. He stopped at the barber's door, and asked his former hostess if she remembered a young officer by the name of Bonaparte, who was once quartered in her family. "Indeed I do," she replied pettishly, "and a very disagreeable young man he was. He was always shut up in his room, and if he did walk out, he never condescended to speak to anyone." "Ah! My good woman!" Napoleon rejoined, "had I passed my time as you wished to have me, I should have been in command of the Army of Italy." At the first interview between Napoleon and the veteran generals whom he was to command, Rampin undertook to give the young commander some advice. Napoleon, who was impatient of advice, exclaimed; "Gentlemen, the art of war is in its infancy. The time has passed in which enemies are mutually to appoint the place of combat, advance hat and say, ' Gentlemen, will you have the goodness to fire?' We must cut the enemy, to pieces, precipitate ourselves, like a torrent, on their battalions, and grind them to powder. Experienced generals conduct the troops opposed to us. So much the better! Their experience will not avail them against me. Mark my word, they will soon burn their books on tactics and know what to do. Yes, Gentlemen, the first onset of the Italian Army will give birth to a new epoch in military affairs. As for us, we must hurl ourselves on the foe like a thunderbolt and smite like it. Disconcerted by our tactics, and not daring to put them in execution they will fly before us as the shades of night before the rising sun." Traveling through Switzerland, Napoleon was greeted with such enthusiasm that Bouriene said to him, "It must be delightful to be greeted with such demonstrations of enthusiastic admiration." "Bah!" replied Napoleon, "this same unthinking crowd under a slight change of circumstances, would follow me just as eagerly to the scaffold." "Neither the quelling of the sections," said Napoleon, "nor the victory of Montenotte, induced me to think myself a superior character. It was not until after the terrible passage of the bridge of Lodi that the idea entered my mind that I might become a decisive actor in the political arena. Then arose for the first time the spark of a great ambition." "I have, " said Napoleon, "a taste for founding, not for possessing. My riches consist in the glory and celebrity. The Simplon and the Louvre were in the eyes of the people and foreigners, more my property that any private domains could possibly have been." "My title of nobility dated from the battle of Montenotte," said Napoleon, "to the Emperor of Austria." "I am very fond of my wife, Madame," was his laconic reply. Bidding adieu to his troops, Napoleon said, "Soldiers! I leave you tomorrow. In separating myself from the Army, I am consoled with the thought that I shall meet you again, and engage with you in new enterprises. Soldiers! When conversing among yourselves of the kings you have vanquished, of the people upon whom you have conferred liberty, of the victories you have won in the campaigns, say, 'In the next two we will accomplish more!' " The revolutionary government was in the habit of celebrating with great rejoicing the anniversary of the King's death, the 21st of January. Napoleon was urged to honour the festival with his presence. "This fete," said he, "commemorates a melancholy event - a tragedy, and can only be agreeable to few. It is right to celebrate victories; but victims left upon the field of battle are to be lamented. To celebrate the anniversary of a man's death is an act unworthy of a government; it irritates instead of calming it and shakes a government to its foundation instead of strengthening it." "Victory," said Napoleon, 'belongs to the most preserving." AS Napoleon beheld the melancholy of the wounded, after the battle of Marengo, he exclaimed, "We can but regret not being wounded like these unhappy men, that we might share their sufferings." "Rewards are not to be conferred upon soldiers alone," said Napoleon, "all sorts of merit are brothers. The courage of the president of the convention resisting the populace should be compared with the courage of Kleber mounting to the assault of Acre. It is right that civil as well as military virtues should have their rewards; intelligence has rights before force. Force, without intelligence is nothing." On being told that a Soldier's wound was incurable, "Try," replied Napoleon, "it is always well to lose one less." O'Meary once endeavored to persuade Bonaparte to take some medicine. He refused, and raising his eyes to heaven said, "That which is written is written - our days are numbered." "My divorce has no parallel in history. It did not destroy the ties which united our families, and our mutual tenderness remained unchanged. Our separation was a sacrifice demanded of us by reason of the interest of my crown and my dynasty. Josephine was devoted to me. She loved me tenderly. No one ever had a preference over me in her heart. I occupied the first place in it, her children next. She was right in thus loving me, and the remembrance of her is still as powerful in my mind." "You are aware, Doctor" (Napoleon to Antommarchi), "that the art of healing consists only in lulling and calming the imagination. That is the reason why the ancients dressed up in robes and adopted a costume striking and imposing. That costume you have inadvisedly abandoned, and in doing so you have exposed the imposture of Galen and no longer exercise the same powerful influence over your patients." In conversation with Mr. Balcombe, Napoleon remarked, "I have no faith in medicines. my remedies are fasting and the warm bath - at the same time I have a higher opinion of the medical, or rather the surgical profession than any other. The practice of the law is too severe an ordeal for poor human nature." "The man who habituates himself to the distortion of truth and to exultation at the success of injustice, will, at last, hardly know right from wrong. So with politics, a man must have a conventional conscience. The ecclesiastics become hypocrites, since too much is expected of them. As to soldiers, they are cut-throats and robbers. But the mission of the surgeons is to benefit mankind, not to destroy them or to inflame them against each other." To Lord Whitworth, when remonstrating with him against the rupture of the peace of Amiens, "You well know that in all I have done, it has been my object to complete the execution of the treaties, and to secure the general peace. Now is there anywhere a state which I am threatening? Look, seek about. None, as you well know. If you are jealous of my designs upon Egypt, my Lord, I will endeavor to satisfy you. I have thought a great deal about Egypt, and I shall still think more if you force me to renew the war. but I will not endanger the peace which we enjoyed for so short a time, for the sake of reconquering a nation. The Turkish Empire threatens to all. For my part, I shall continue to uphold it as long as possible. But if it falls to pieces I intend that France shall have her share. But be assured I shall not hasten the events. Do you imagine that I deceive myself in regard to the power which I exercise at this moment over France and Europe?Now that power is not great enough to allow me to venture with impunity upon an aggressor, without adequate motive. The opinion of Europe would instantly turn against me. My political ascendancy would be lost. And as for France, it is necessary for me to prove to her that war is made upon me, that I have not provoked it, in order to inspire her with the enthusiastic ardour which I propose to excite against you, if you oblige me to fight." "All the faults must be yours, and not one of them mine. I contemplate, therefore, no aggression. I wanted to establish a barrier against those barbarians, by reestablishing the kingdom of Poland, and putting Poniatowski at the head of it as king, but your imbeciles of ministers would not consent. A hundred years I shall be applauded and Europe, especially England, will lament that I did not succeed. When they see the finest countries in Europe overcome, and a prey to those northern barbarians, they will say, 'Napoleon was right!' " Larrey, Dominique - Jean references 2. Surgical Essays, Translated from the French, by John Revere, Vol. XV-pp16-355. Baltimore, N.H. Maxwell, 1823. 3. Considerations Sur La Fievre Jaune pp 31. Paris Compre Jeune, 1821. 4. On the use of the moxa as a therapeutical agent. Translated from the French, with notes and an introduction containing a history of the substance by Robley Dunglison, 2p. 1 IXXVI - 148 pages. 5. Clinique Chirugical, Exercise Particulierement Dams les Camps et les Positaux Militaires, Depuis 1792 Jusquen 1836. 8V, 8 atlas, Paris, Gabon 1829 - 36. 6. Observations on wounds, and their complications by erysipilas, gangrene, and tetanus, and on the principal diseases and injuries of the head, ear and eye. Translated by E.F. Rivinus, M.D. viii - 322 p 2 pl. Philadelphia, Key, Mielki & Biddle, 1832. |