What Killed Jane Austen?: And Other Medical Mysteries (13 page)

And, if that was not enough, the third possible tribulation was of a cutting, chopping or piercing variety of injury from swords, lances or bayonets. This was very much the era of dash and elan, and the later recounting of tales of hand-to-hand fighting, especially if having taken place in scarlet jackets and tight trousers, was the stuff for romantic interludes in front parlours for years to come—if you lived, that is. You may recall Byron on ‘Brunswick’s fated chieftain’ who:

He was one of those felled on a tiny four-kilometre front. The Battle of Waterloo itself was the third and final encounter in the three days of the brief campaign, the exhausting culmination of a quite bloody frenzy.

It lasted just the one day, getting off to a late start at 11 a.m., when the muskets had dried out, and ending at sunset with the final defeat of the Old Imperial Guard. In that time the combatants managed to inflict 47,000 casualties on each other.

If wounded, but you survived, what would be your likely injury?

On the head and neck, chopping injuries were common, compound skull fractures frequent and death the rule. True, portions of the impacted bone were removed and skin flaps replaced, but the ensuing meningitis or cerebral abscesses with fits heralded the inevitable. There was the odd exception, of course, and he dined out on the story for years.

Penetration of the chest wall by ball or bayonet resulted in contaminated sucking wounds and drains had to be inserted. Your chances were pretty thin. It was thought at the time that if the man survived a glancing blow, any later onset of breathlessness was due to electricity from the passing ball. In fact, it was almost certainly due to bleeding within the lung.

Abdominal wounds were also usually fatal. If the bowel was divided it was sutured to the abdominal wall in the vain hope of preventing contamination of the peritoneal cavity. A musket ball could lodge in the bowel and at least one soldier is recorded as having passed the shot by way of the rectum at a later date. It is to be hoped that the po-faced warrior kept it.

That leaves us with the limbs, and here, you will be glad to know, there was a glimmer of hope. Many tales are told of the survivors of chopping injuries and of those with limbs torn off. One sergeant rode upright the 19 kilometres to Brussels after his left arm had been torn off at the shoulder. He lived for another 43 years.

One famous limb injury occurred during the heat of battle. Cavalry leader Henry Paget (then Lord Uxbridge, and later to become the Marquess of Angelsey) was at the receiving end of a famous interchange while riding with the Duke of Wellington. It seems a cannon ball whistled just over the Iron Duke’s horse and struck the knee of the disconcerted Paget riding by his side. Paget is reported to have suddenly looked down and said: ‘I have lost my leg, by God.’ To which Wellington replied: ‘By God, have you?’ He then turned and got on with running the battle.

The shattered leg was later removed under fire to complaints from Paget that the knife was blunt. But then he added that he had had a pretty good run and this would give the younger men a chance. (He was actually referring to the boudoir, not to the regiment.) Despite all his vicissitudes, Paget lived until the age of 86, and the wooden leg which saw him through all those years remains with the family to be still touched and marvelled over.

Surgical thinking at the time was that the surest way to save the life of a person with a compound fracture was to amputate, and the sooner the better. If left, sepsis, gangrene and tetanus could prove fatal. Incredibly, approximately 500 amputations were carried out during the period of the battle, and about 12 per cent of those with a limb injury had the limb removed. No doubt many amputations were unnecessary, but hesitancy had no place with bullets flying about, so the motto was: ‘when in doubt, amputate’. Mortality following immediate amputation was about 30 per cent, but if amputation was left until later at a base hospital, the deaths amounted to about 45 per cent due to fever and gangrene. So there was probably something in the clinical catch phrase, but either way you were pretty well on a hiding to nothing.

The actual operation was done by a kind of guillotine method and the skin edges brought together by sutures or tape. Speed of operation was the hallmark of the skilled practitioner and the drama took anything from a few minutes to quarter of an hour. As there were no anaesthetics available it must have been the longest few minutes in the man’s life.

But in truth, it was not quite so bad as you would think, for the shattering nature of the injury had an important surgical consequence, which was not lost on the surgeons, even if the sufferer had his reservations. The blow numbed the limb and relaxed the muscles for a few centimetres above and below the injury, and as the blood pressure was low from shock, so bleeding was reduced. Another advantage of early operation, but not realised at the time, was that a dirty wound was converted into a relatively clean one which would travel and heal better. Further, it did not need dressing for several days and if the victim fell into the hands of itinerant sawbones keen to make a quick financial killing (if not one of any other sort), at least the operation had already been done by a skilled person. So carrying out surgery on the field of conflict could be defended.

Amputees were agreed that the most painful part was the skin incision and the clamping of the arteries together with their accompanying nerves. It was described as a powerful burning sensation. What they did not know was that it was better to be one of the early cases, while the knives were comparatively clean if not actually sterile.

Lord Fitzroy Somerset had the presence of mind to call for his arm to be brought back after amputation as he had forgotten to take off his signet ring. Another story for the boudoir. He later became Lord Raglan and lent his name to a type of sleeve which has no shoulder seams, the sleeve extending up to the neck, perhaps done to accommodate his injury. He lived for another 40 years.

Musket balls were probed for and removed and skin wounds brought together with either tape or sutures of waxed linen or twisted gut. The overall mortality of these procedures was about nine per cent.

Wounded men sometimes lay for days on the field of battle and occasionally for weeks in adjacent barns. For some survivors such a delay may have saved their limb, as there was some medical reticence about vigorously treating malodorous lesions.

For those who were picked up, the roads were choked with wounded making their way to Brussels, where six hospitals catered for about 2,500 wounded. The overflow of a similar number went on to Antwerp and beyond.

With the breaking of the news in England, many civilian surgeons journeyed to Belgium to help not only with the wounds but the gangrene, dysentery, and fulminating infections which were the inevitable consequence of most of the injuries.

However, not all things medical at Waterloo were of a traumatic nature. In his pursuit of Blücher, Napoleon uncharacteristically hesitated at what proved to be a crucial moment in the proceedings. He returned to his quarters and became preoccupied not with deep strategy, but with a pressing need to ease an acute attack of prolapsed piles. Having been in the saddle all day, doubtless he found this less than amusing. Indeed, the fact did not come to light until 50 or so years later when his servant, previously sworn to secrecy, told all. Ultimately, of course, his mundane lesion proved to have a more far-reaching importance than all the desperate surgical heroics being carried out at the same time all round Waterloo.

It is also said that the Little Corporal had a fit the night before the encounter, and his doctor left him to sleep in. He had had one previously, while locked in the arms of his mistress during a particularly strenuous sexual joust. On that occasion, the lady fled in hysterics when she feared her gyrations and excesses had killed the chief.

As it has been speculated that Napoleon died of cancer of the stomach six years later, his night before the battle may also have been disturbed by the odd twinge of indigestion too. It is not recorded.

The man who let Napoleon sleep in was his chief medical officer, Baron Dominique-Jean Larrey, and as he was the dominant medical figure in the otherwise oppressive military bravura of Waterloo. We ought to digress slightly and take a closer look at this remarkable man and his background.

Since the invention of the cannon and other gunpowder-propelled firearms in the 14th century, battles had become bigger and casualties numbered thousands rather than hundreds, or even tens.

With few exceptions, notably Ancient Rome, medical officers were not found in the army before the 18th century. Some went as servants to the nobility, but the rank and file looked after themselves, were tended by local inhabitants or treated by itinerant charlatans or camp followers. Logistically the wounded posed no real problem; they either tagged along with the baggage wagons as best they could, or were abandoned. Ambroise Pare in 1537 witnessed an old soldier calmly cut the throats of three men who were badly wounded; the old soldier then turned to Pare and said he hoped the same would happen to him if he were similarly wounded.

Queen Isabella of Spain (1451–1504) had provided bedded wagons to transport the wounded after the battle had passed. The Duke of Wellington during the Peninsular War of 1804–14 thought bedded wagons a confounded nuisance and would allow nothing to interfere with the movements of his army. At that time French regulations stated that so-called ambulances should wait three miles to the rear. These were huge cumbersome vehicles known as
fourgons
and needing up to 40 horses to pull them. With the usual mud and road confusion, it could take 24 to 36 hours to reach the collection point to where the wounded had been manhandled, by which time those in need were either dead or in extremis. Many were left on the field to be swooped on by camp followers, stripped, robbed and mutilated; friend or foe it made no difference.

Someone was needed with medical skill and a will to stand up to military authority and get some order into caring for the wounded. Dominique-Jean Larrey was that man.

He was born in 1766 and joined the army as a medical officer in 1792. Besides his drive and enthusiasm, he had another crucial asset—he was a superb surgeon, a skill soon recognised by the highest authority. Larrey insisted on attending to the surgical needs of soldiers regardless of rank or nationality. For the era he displayed a quite unique humanity towards his fellow man.

At the beginning of his career he joined the army on the Rhine and chaffed at the rear. He thought he could get the wounded onto panniers slung on horses, but it proved to be impractical. The following year he sought out the commander, General Custine, and pointed out that while the infantry had the support of very mobile artillery, the same was not true for the wounded. He sought permission to construct a vehicle on similar lines to the gun carriages, and which he christened ‘flying ambulances’.

Custine was a 50-year-old aristocrat; Larrey was a 26-year-old provincial doctor. Normally Larrey would have been sent packing with a flea in his ear for such a hare-brained scheme, but by significant chance the Terror was in full cry, and it struck the officer it would never do for the National Convention to learn that one of its generals had turned down a plan to help its citizens. So, amazingly, young Larrey got the nod.

The ambulance, Larrey insisted, had to be a carriage, well sprung and light. He got his wish, and each division was equipped with 12 carriages, eight with two wheels for use in flat country, the others with four wheels for mountainous terrain. The smaller carriage resembled an elongated cube with two small side windows and doors at each end. The floor was able to be slid out over four central rollers and was provided with a horsehair mattress and bolster. The side panels were padded for about 25 centimetres above the floor and four metal handles were set into the floor so they could be pulled out and used as stretchers. At 110 centimetres wide, it could take two patients at full length. It was drawn by two horses, one ridden.

The four-wheeled variety was longer and wider, though externally it looked similar. The floor was fixed, but the left side opened for almost its whole length by means of two sliding doors, so the wounded could be laid inside. It could accommodate four if they bent their legs slightly. A wheelbarrow was slung underneath to act as the forerunner of a trolley. The whole was drawn by four horses, two ridden.

Thus Larrey devised one of the greatest advances in emergency military medicine, initiating the principle of rapid evacuation of casualties which is still a cardinal rule today. It was a masterstroke.

Meanwhile, back at Waterloo, Larrey was actually in the French line during the final denouement and was observed at work by the commander of the enemy forces, the Duke of Wellington.

When told who it was, Wellington remarked: ‘Tell them not to fire on him. Give the brave fellow time to pick up his wounded.’ Then, wheeling his famous horse, Copenhagen, the commander-in-chief raised his hat in a distant greeting to the Frenchman, telling his aide: ‘I salute this honour and loyalty you see yonder.’ Then it was on with the slaughter.

The Waterloo campaign was a close-run military victory for the British and their allies, even the Iron Duke himself admitted as much. Drawn and haggard, Wellington rode through the field of battle the day after. It was littered with the dead, and he silently wept.

It proved to be the bloodiest battle of Wellington’s long career. During the action Wellington lost 29 per cent of his army, and out of his 63 commanders, 11 were killed and 24 wounded.

But, as Dr Haddy James, assistant surgeon to the Life Guards, had it:

… was the real valour displayed more in the face of the enemy or by those who watched the long torture of bullet probing or saw the agony of an amputation, however swiftly performed, knowing that their turn was to come? Those who regained their native shores deserved the prayers and the ovation of the population.