Thursday 19 November 2015

German Sausages and Flying Ambulances

I'm excited to welcome Sarah Mallory to the salon today to discuss German Sausages and Flying Ambulances – medical matters during the Napoleonic Wars!
German Sausages and Flying Ambulances – medical matters during the Napoleonic Wars
When I first saw the term "flying ambulance" I thought it was something that had originated in Africa, or in the Australian outback, a vehicle for flying doctors. In fact it goes back much further than that. To the Napoleonic Wars, as I discovered only recently.
I was researching the Battle of Waterloo for my book, A Lady for Lord Randall, and it was impossible not to think about the casualties. More than 40,000 soldiers died on the battlefield and given the state of medical knowledge at that time, it is debateable which was worse, to be killed outright or seriously wounded. Dr Howard Martin has written two wonderfully detailed books on the subject (Wellington's Doctors and Napoleon's Doctors) if you want to find out a lot more fascinating details. One thing that became clear to me is that in the treatment and care of injured soldiers during the Napoleonic Wars the French had the advantage. Bonaparte was very forward-thinking when it came to the health of his army. He preferred prevention to medical treatment, he advocated good food, good hygiene, fresh air and high morale. He also supported the use of quinine and vaccination. And it was one of Bonaparte's surgeons-in-chief who invented and developed the flying ambulance.

Weapons of war changed very little during the 18th century. The effectiveness of the lead musket balls varied widely depending on range. They could kill a man, or they might inflict superficial bullet wounds that caused little immediate pain. There are reports of soldiers digging out the balls themselves. Howard tells of a French volunteer in 1792 who was shot in the hip. He dug out the ball and re-used it, shouting "look, this is how republicans fight!"
Soldiers facing cannon had greater worries. A soldier in the path of round shot was usually killed outright, or had major injuries that often required amputation because bones and tissues were so badly damaged.
So, maybe you think you would prefer to face a sword? Straight swords were used for thrusting and caused deep internal injuries, usually to the chest and abdomen, whereas a curved sabre was used for slashing at the head and arms. The heavy cavalries wielded a broad sword that was capable of breaking bones and severing limbs.
Then there was the risk of being crushed by falling masonry, if you were sheltering in a building or behind a wall, or being trampled by horses, or burned by exploding shells or the fires that often broke out.
And if you survived all the above, then there was still the risk of disease.
Normal practice in the 18th century was to leave the wounded on the battlefield until the end of the battle, then send out litter-bearers to carry anyone still alive to field hospitals situated a mile or so from the site, where the doctors would remain safely away from the fighting. Many of the litter-bearers preferred to become looters and never brought their injured comrades off the field. Or, conversely, a wounded man might suddenly find that a dozen or more of his comrades would rally round to remove him and themselves from the fighting. This latter option did not find favour with the officers.
Dominique Jean Larrey
Dominique Jean Larrey
However the French Revolution had brought the welfare of the rank and file to prominence. By 1793 the French Revolutionary Authorities were ordering army doctors to remain with their men in battle or risk a charge of desertion. Many medical men were happy to comply, and two of the most prominent of these dedicated doctors were Pierre-Francois Percy and Dominique Jean Larrey. They were both surgeons-in-chief to Napoleon, and with the support of many of their colleagues they pioneered the idea of taking medical help to the wounded men during the battle, and then removing the most seriously injured from the field as quickly as possible.
By 1772 the French were already using heavy medical wagons drawn by as many as 50 horses. These were large "ambulance hospitals" with hundreds of medical personnel to cater for up to 2,000 injured soldiers. In 1793 the National Convention even set up a competition to design a carriage for transporting the sick and wounded. None of the designs were practical, but it demonstrates that the provision of medical help was a concern. However, the doctors themselves were making progress.
In 1792 Percy was the surgeon in charge of the Army of the Rhine and he formed a number of old soldiers and disabled men into a corps of stretcher bearers. The men worked in pairs to remove the wounded from the field and take them to the nearest mobile hospital. Then, when all the wounded had been collected, the corps assisted the surgeons in the hospitals. Percy also designed an elongated vehicle with four wheels that was filled with surgical instruments, dressings, elastic sticking plasters etc. The top was rounded, covered in leather and provided saddle-like seating for up to ten surgeons and their assistants to sit astride. They were known as "wursts", the German for sausage, which is what they resembled. Wursts had supplies enough to deal with upwards of a 1,000 casualties. However, the lack of logistical support and a shortage of horses and supplies greatly hampered these vehicles.
A wurst
A wurst
These wursts were praised by officers but were never in widespread use on the battlefield. Larrey could see their limitations and he designed a much smaller, lighter vehicle that was able to travel quickly over the ground. It could bring medical aid to men during the fighting and could carry away two patients lying down. He envisaged not just a vehicle, but a whole medical organisation dedicated to treating the wounded and removing them from the battle field as quickly as possible. 
These "flying ambulances" were a full complement of 340 men and over 30 wagons split into three divisions with surgeons, assistants, orderlies etc. each with their own role to play. Great attention was given to the medical equipment carried and the uniforms. Larrey was supported by the medical men of the day and in 1797 he received official approval for his idea. He had the opportunity try out his ambulance system in Egypt in 1798 – and when there was a shortage of draught animals he used camels to transport the wounded.
British doctors could only look on in envy at this advanced system of medical care. Today it seems a very logical idea, but it was 60 years after Waterloo that the British set up their trained ambulance corps.
Larrey not only had excellent organisational skills, he was also a brilliant and compassionate surgeon. The Duke of Wellington is said to have commended his valor and compassion in treating the wounded at Waterloo. However, he was captured by the Prussians after Waterloo and sentenced to death. A German physician who had been Larrey's pupil at one time, recognised the surgeon and pleaded with Marshall Blȕcher to spare him. Fortunately, Blȕcher's son had been wounded in a skirmish with the French and his life had been saved by Larrey, so he was sent back to France with a Prussian escort. 
A Lady for Lord Randall
Larrey died in 1842, aged 76, having become a legend in his own lifetime. One of his aims was that hospitals should be inviolable during times of war. This was a novel concept and one that was much later taken up by the Red Cross and the Geneva Convention.
Research is always fascinating, but very little of it makes its way into my books – I did include a surgeon in A Lady for Lord Randall, but it was only a minor character and I was so taken with Larrey's story that I have since used him as the model for my hero of another book which I have just completed – Return of the Runaway, which will be published in 2016.

Sarah Mallory
Award-winning author of nearly forty historical romantic adventures for Harlequin.  She also writes as Melinda Hammond, and you can find out more at her website,

Written content of this post copyright © Sarah Mallory, 2015.


Ann Marie Ackermann said...

How interesting! I only knew about litters. Why did they get the name "wurst"? Did France not have sausages?

Melinda Hammond/Sarah Mallory said...

Thanks for dropping by, Anne Marie. I have no idea why the French should call them "wurst," but maybe it was conjured by French soldiers as a joke on their German counterparts? I find it hard to believe they didn't have sausages of their own!

Anonymous said...

Larrey's fascinating, isn't he? I only came across him a couple of weeks ago, in the Waterloo context and as one of the surgeons who carried out Fanny Burney's mastectomy.

Carol Hedges said...

VERY interesting period is slightly later (the 1860s)...when chloroform was being used...but I did research the Crimean War and the awful conditions at Scutari. The French were so much better...and I believe the first with many medical innovations and practices later incorporated into surgery here.

Melinda Hammond/Sarah Mallory said...

I found him truly inspirational, April, so much so that he was the basis for the surgeon hero of my next book, Return of the Runaway (only I made him Belgian, not French!)

Melinda Hammond/Sarah Mallory said...

I cannot imagine how the wounded coped with the pain of amputations or other operations with no painkillers (brandy, perhaps, if they were lucky). I believe the British military doctors were very envious of Larrey's medical innovations at Waterloo.

Melinda Hammond/Sarah Mallory said...

Thank you for dropping by to red the blog - it is a fascinating subject, and I have only reached the tip of the iceberg... there's so much more to learn!