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260 pp Price £25 ISBN 1-86227-143-7 (h/b)
Staplehurst, Kent: Spellmount, 2002 .
For many years I have been a pacifist and only in extreme circumstances do I see any justification for acts of aggression. Perhaps naively I always hope that political discussion can avert war. Clausewitz's philosophy that war is merely an extension and continuation of politics is chilling. However, few would doubt, at least here in Britain, that Napoleon's advance across Europe had to be stopped. And of course this was achieved by Wellington at the Battle of Waterloo in 1815. But at what cost in loss of life and suffering on both sides? In his well-written and well-referenced book, Martin Howard details the organization of the British Army medical services during the Napoleonic Wars, concentrating on the role of the physician and more importantly the surgeon in caring for the wounded and sick at the battle front.
From 1808 the British Army fought numerous battles against the French culminating in Waterloo. Casualty figures during these wars were around 5500 officers and 84 000 other ranks killed or wounded. The overall fatality rate for those serving was around 1 in 20. Dr Howard describes in much detail the way in which British field hospitals were organized to take care of casualties. Transport of the wounded was very difficult. The French, mainly through their great military surgeon Dominique Jean Larrey, introduced triage and are credited with developing a form of ambulance service. On the British side such transport was often left to local Portuguese or Spanish peasants who could offer wagon carts and the like. The conditions were very uncomfortable and the wounded were often exposed to the elements. Furthermore the hospitals were frequently primitive in the extreme. Drinking water was unavailable and sanitary conditions were appalling. From statistical tables in the book it seems that in nearly three-quarters of those who died in regimental and general hospitals the cause was an infectious disease such as dysentery or typhus. Such conditions had changed very little by the Crimean War, when Florence Nightingale famously visited the military hospital at Scutari in 1854. Tolstoy described similar conditions in the Russian Army in War and Peace.
But it is when Dr Howard details the wounds inflicted and their treatment, often quoting from contemporary sources, that one realizes the real horror of the conflict. On occasion civilian doctors helped. One such was Charles Bell, the famed surgeon and anatomist who had no passport but at the port of entry merely showed his surgical instruments to officials. Many of his water-colour paintings of the wounded, some of which are reproduced in the book, are exhibited at the Royal College of Surgeons in Edinburgh. A quotation from Bell gives the flavour:
‘At six o'clock [in the morning] I took the knife in my hand, and continued incessantly at work till seven in the evening; and so the second and third day. All the decencies of performing surgical operations were soon neglected; while I amputated one man's thigh there lay at one time thirteen, all beseeching to be taken next; one full of entreaty, one calling upon me to remember my promise to take him, another execrating. It was a strange thing to feel my clothes stiff with blood, and my arms powerless with the exertion of using the knife.’
There were of course no anaesthetics. The pain of an amputation must have been excruciating. Speed was therefore of the essence and none at the time matched the speed of James Syme, an Edinburgh surgeon, some years later, who could amputate a leg in little more than a minute. A surgeon during the Napoleonic Wars was more likely to take half an hour. The mortality rate among those undergoing a primary operation at the battle site varied from 5% for a forearm to 35% for a thigh. Most serious head wounds were not considered for treatment at all.
An interesting sideline to this commentary on the medical services at the time was that overuse of alcohol was almost the rule among the troops. This was encouraged by the prevailing views that it actually gave protection against disease and was important for maintaining morale. As a reflection on contemporary health and nutritional standards in the communities from which recruits came, around one-third of applicants were considered unfit to serve on medical grounds.
This detailed analysis of the British Army medical services in the Napoleonic Wars will provide a rich source of information for medical historians. A suitable epitaph might be taken from Wellington himself, who, after Waterloo commented:
‘Well, Thank God, I don't know what it is to lose a battle; but certainly nothing can be more painful than to gain one with the loss of so many of one's friends.’
Many even today would agree with these sentiments.