The Day the Universe Changed - James Burke [99]
The most famous of French battle surgeons, D. J. Larrey, inventor of the ambulance, kneels to staunch a wound. His few instruments are in the box on the ground.
The first was that all medical organisations were compulsorily closed during the revolution, leaving the country in a state of medical anarchy at a time when the profession was most urgently needed. Doctors were members of the upper classes, so they were to be re-educated. But by the same revolutionary token, surgeons were craftsmen, and as such to be elevated by the new ideology.
The surgeons had enjoyed minor improvements in their social condition for some time before the storming of the Bastille. In 1743 they had been permitted to enter university, to take MA degrees and to be addressed as ‘Doctor’. This met with the greatest opposition from the physicians, who did their best to see that the surgeons’professional opportunities were limited strictly to those hospitals where patients were poor. The university faculty of medicine offered condescending advice: ‘Let the hospitals serve as your libraries and cadavers as your books.’The surgeons took the advice. They also went out into the towns and villages which were too small to provide adequate revenue for physicians. As a consequence, when the wars broke out after the revolution there were many more surgeons than physicians in France.
The second factor of importance in the medical situation was the numerical superiority of the surgeons at a time when they were most needed, on the battlefield, where their practical training in anatomy put them at a distinct advantage over the physicians. Whereas the physician went to war with his potions, symptom lists and bedside manner, the surgeon was equipped only with a knife and some bandages. When the physician exhausted his supply of remedies there was no available source of replacements. Soldiers were often too shocked by their wounds to talk, let alone describe their symptoms. The surgeons, on the other hand, learned rapidly. There was a great variety of wounds to deal with. There were clean wounds, such as those inflicted by sabre or bayonet, or dirty wounds caused by gunshot, when pieces of clothing were forced into the flesh. Lead ball shattered bone and stayed in the flesh. The different size and shape of wounds produced different symptoms and pains.
It soon became clear to the surgeons that any object left in the flesh would become a source of infection. Wound cutting was developed, to open up and clean the area around the trauma. There was much improvisation. Fingers or simple tweezers were used to pick out fragments. Thumbs were as effective as tourniquets. Grass and moss were used in the absence of lint. Simpler, less wasteful bandaging techniques were developed. Shortages stimulated other new solutions. Cauterising with hot iron, often too general a treatment for most conditions, killed as often as it cured. A new, more efficient method was adopted using a device known as a ‘moxe’, which consisted of a small cylinder or open-ended cone holding combustible material which could be selectively applied to the wound. It burned as deep as was needed for as long as necessary.
An English doctor burning out spots with a moxe. Note the medicinal brandy on the table and the evident distress of the patient.
In the absence of ointment, water was widely used to treat wounds. Cold water was recommended for sabre, bayonet and sword cuts as well as shock. Warm