June 18, 1815. Napoleon’s attempt to rebuild his empire, after escaping exile on the island of Elba and regaining control of France, came to an abrupt and disastrous end near a place called Mont Saint-Jean, which has gone down in history as the Battle of Waterloo. During the retreat, Prussian soldiers captured him while trying to escape to the French border and prepared to execute him on the spot. However, a military surgeon intervened at the last moment, warning them that he was not the emperor but a fellow physician who indeed bore a physical resemblance: Dominique-Jean Larrey, famous for creating the first field ambulance service.

Nevertheless, Larrey was on the verge of a dire fate. The soldiers believed that, in any case, he was an enemy officer and did not deserve mercy. But the doctor insisted and managed to spare him with an indisputable argument: Larrey had once saved the life of Franz Ferdinand Joachim, the son of Gebhard Leberecht von Blücher, the Prussian marshal who had just achieved victory in the battle alongside Wellington thanks to the frenetic march he imposed on his troops to reach Waterloo in time to aid him. Blücher’s son had been seriously injured near Dresden in 1813, and it was the French surgeon who treated his wounds. Now the favor was returned, as Larrey was invited by the marshal to his table and later released with clothing and money.

Larrey was born in Beaudéan (a town in the Pyrenees that still preserves his family home, now converted into a museum) in 1766. He was the son of a shoemaker who later moved to Bordeaux and died prematurely, leaving him an orphan at the age of thirteen. The young Dominique-Jean had to be raised by the parish priest Abbot Grasset, who, thinking the boy was sharp, sent him to Toulouse to be under the care of his uncle Alexis, the chief surgeon of the Hôpital de Saint-Joseph de La Grave, an institution founded in the Middle Ages to treat plague patients and later accommodating the sick, beggars, and people without resources.

Larrey's birthplace in Beaudéan, now a museum
Larrey’s birthplace in Beaudéan, now a museum/Image: Sotos on Wikimedia Commons

Alexis provided public education, and Larrey, along with other future prestigious doctors such as Jacques-Mathieu Delpech and Jean-Étienne Esquirol, obtained the title of Professeur élève and wrote a thesis on caries that received local distinction. Around that time, he also joined the Masonic lodge of Écossais fidèles. Six years later, his uncle sent him to Paris to study medicine under Pierre-Joseph Desault, a distinguished anatomist and surgeon who would later be in charge of treating the son of Louis XVI during his revolutionary captivity but was currently working at the Hôtel-Dieu Saint-Jacques, where he personally handled emergencies.

Later, in 1787, Larrey accepted the position of naval surgeon and went to Brest to embark on the frigate La Vigilante, becoming the youngest medical officer in the Royal Navy. The ship crossed the Atlantic, destined for the protection of Newfoundland, and while in America, Larrey dedicated himself to studying everything related to that land: flora, fauna, tides, climate, customs, and more, all of which he would later document in his memoirs. The term “land” should be taken literally, as he tried to stay ashore as much as possible due to suffering from seasickness.

This was not an ideal perspective for a career as a ship’s doctor, which is why upon returning, he chose to leave the Navy and work at the Hôtel des Invalides. This establishment, as its name suggests, was a hospital and residence for retired French soldiers and military personnel, built by Louis XIV in 1670 (today it is a complex housing the Military Museum, the Order of the Liberation founded by De Gaulle – which also has a memorial there – and the Mausoleum of Napoleon, among other attractions). At Les Invalides, he coincided with other prestigious surgeons, such as Raphaël Bienvenu Sabatier (renowned anatomist), Jean-Nicolas Corvisart (who would become Napoleon’s personal physician from 1804), and Xavier Bichat (the father of modern histology, who had been a student of Desault).

Larrey portrayed by Anne-Louis Girodet de Roussy-Trioson
Larrey portrayed by Anne-Louis Girodet de Roussy-Trioson/Image:MOSSOT on Wikimedia Commons

Larrey served as an assistant surgeon to Sabatier, gaining experience. This brings us to 1792, the year when the political tension in the country overflowed, leading to the outbreak of the French Revolution. For Larrey, who actively participated by organizing an ambulance to transport the wounded from the Storming of the Bastille, an idea he would soon apply to other contexts, it was also the year he met Marie-Élisabeth Charlotte, daughter of René Delaville-Leroulx, the Minister of Contributions and Public Revenues of Louis XVI.

The revolutionary movement faced hostility from the rest of Europe – except Spain, allied through the Pacte de Famille– and in that same year, the First Coalition was formed, declaring war on France. Larrey enlisted in the Armée du Rhine (Army of the Rhine) and traveled to Mainz, where he collaborated with Samuel Thomas von Sömmerring, a learned man of his time with knowledge in chemistry, physics, astronomy, philosophy, anthropology, and paleontology (later, he would invent an electrochemical telegraph and a telescope, in addition to describing the pterodactyl), but, above all, medicine and neuroanatomy.

Larrey rose from assistant to chief surgeon and, with increased responsibilities, planned to reform the military health organization, which he considered outdated and deficient. He understood that the wounded (the French wounded, to be precise) could not be left lying on the battlefield until the battle ended, as was the practice until then, because often this meant death or gangrene for them. Even when they were finally evacuated, they had to be transported to the field hospital, which was usually several kilometers away, and by the time they arrived, it was often too late.

Replica of a flying ambulance exhibited at the Musée Larrey in Beaudéan
Replica of a flying ambulance exhibited at the Musée Larrey in Beaudéan/Image: Sotos on Wikimedia Commons

Therefore, it was necessary to devise a system that allowed for first aid on the spot and then rapid transfer. A skirmish near Liburgo prompted him to propose the implementation of an ambulance service with several teams, each led by a doctor and composed of twenty-four soldiers, an administrative officer, a non-commissioned officer, and a drummer responsible for carrying the equipment. They were equipped with twelve stretchers and four heavy ones, plus a specially designed cart: enclosed, with two wheels, and pulled by a pair of horses, inspired by the mobile artillery carts, which he called ambulance volante.

These ambulances and their attendants were to follow the troops to tend to the fallen on the move, before collecting and sending them to the rear, to the field hospital. Marshal Nicolas Luckner granted him permission to start, and he debuted in the Battle of Landau (Metz), where Larrey himself was wounded in the leg but received praise for his idea. During his recovery in Paris, he was tasked with extending the service to the entire army. In 1793, the general superintendent, Jacques-Pierre Orillard de Villemanzy, ordered a national competition to design a prototype of the ambulance volante.

This delayed the process by a couple of years, exacerbated by Orillard’s defection – he switched sides, wary of the bloody turn the revolution was taking – but eventually, all French armies incorporated the new health system, which included other contributions from Larrey: triage or a method of classifying the wounded by severity to prioritize the seriously injured regardless of their rank and the admission of treatment for enemies, who were previously ignored or finished off. All of this would prove beneficial because France was already immersed in a war frenzy that would not stop for two decades, as the revolutionary era transitioned into the Napoleonic era.

Marie-Guillemine Benoist, Larrey's sister-in-law, made this portrait of him in 1804
Marie-Guillemine Benoist, Larrey’s sister-in-law, made this portrait of him in 1804/Image: public domain on Wikimedia Commons

It was during this time that he met Bonaparte – when the latter was still a mere artillery commander in 1794 in Toulon, the port from which the contingent tasked with reconquering Corsica from the British was about to sail, and where he created a school of surgery. It was the same year he married his girlfriend, Marie-Élisabeth. Later, he passed through Spain, where he fell ill, forcing him to spend a period of recovery in a quieter position in Paris, teaching anatomy at the Hôpital d’instruction des armées du Val-de-Grâce. This continued until 1797, the year he returned to active service in the Armée d’Italie.

Napoleon’s Italian campaign had just begun, and he considered it important to have an efficient system for evacuating and treating the wounded because of its impact on troop morale. A year later, it was the turn of the Egyptian campaign, where Larrey was already serving as chief surgeon. In the Battle of Abukir, amid enemy cannon fire, he evacuated General Jean Urbai Fugière, who had been hit in the shoulder, later establishing a military medical school in Cairo. However, one of the major problems he encountered was soldiers suffering from eye infections due to the intense sunlight reflecting off the sand.

It was in these lands that he organized an imaginative transport of the wounded by placing palm baskets, elongated and with mattresses, on each side of the hump of camels. These animals replaced horses due to their better adaptation to the climate. He also prepared twenty-four ambulances for each division, as the campaign resumed in 1799 towards Syria. During the siege of St. Jean d’Acre, he had to amputate the arm of General Louis Marie de Caffarelli du Falga, although gangrene killed him three weeks later, prompting Larrey to try an alternative therapy: placing worms in infected wounds to eat away the flesh and clean them. Larrey performed an autopsy on Caffarelli and later, he too was injured.

Larrey's uniform coat and sabre, preserved in the Musée de l'Armée
Larrey’s uniform coat and sabre, preserved in the Musée de l’Armée /Image: G.Garitan on Wikimedia Commons

The experience Larrey gained in Egypt and Syria was immense. He devised a method of feeding an officer through a tube and a bottle after having to sew the tongue of the officer; he learned to close chest wounds, disregarding the custom of leaving them open, which dated back to Ambroise Paré in the 16th century, thereby instituting a surgical advancement. During the siege of Alexandria, he found a way to make horse meat a healthy food for the wounded, and he ordered the killing of his own horses for this purpose. In 1800, just before the surrender, he embalmed the body of General Jean Baptiste Kléber – who had taken command when Napoleon returned to France and was assassinated by a fanatic – for further study.

Larrey was one of the last to leave Egypt, in October 1801, as he had been teaching classes in Cairo until the end. On the return journey, he had to attend to General Jacques François de Boussay, who had contracted the plague. All of these adventures, which earned him the nickname “Soldier’s Providence,” he documented in his work Relation historique de l’expédition de l’armée d’Orient en Égypte et en Syrie, which he expanded in 1803 with the thesis Dissertation sur les amputations des membres à la suite des coups de feu. By then, he had already been appointed chief surgeon of the Consular Guard.

Napoleon had become the First Consul and awarded him the Legion of Honor with a special dedication: This is a well-deserved reward. Later, when Bonaparte proclaimed himself emperor, and his guard became the Imperial Guard, Larrey was appointed a baron of the Empire for his conduct in the Battle of Wagram, again with personal praise: If the army were ever to erect a monument to express its gratitude, it should do so in honor of Larrey. Europe was already mired in the Napoleonic Wars, and indeed, in 1807, the surgeon and Bonaparte had witnessed the death of Marshal Jean Lannes, fatally wounded in the Battle of Aspern-Essling, with Larrey’s brilliant amputation of his shattered leg proving futile.

The death of Lannes, by Paul-Émile Boutigny
The death of Lannes, by Paul-Émile Boutigny/Image: public domain on Wikimedia Commons

It’s worth mentioning that limb amputation was the only known way at that time to prevent gangrene and/or tetanus, which often occurred when wounds became infected. This type of operation was performed without anesthesia – it did not yet exist – by either intoxicating the patient if alcoholic beverages were available or having them conscious if not. In the latter case, the patient had to bite down on a stick or whip to endure the pain.

In such circumstances, speed was crucial to avoid suffering, and Larrey excelled in that regard (he even gave his name to a technique): chronicles say that he could amputate a limb in less than two minutes. He performed more than two hundred such operations in the twenty-four hours following the Battle of Borodino and two hundred thirty-four after the Battle of Berezina. However, the most impressive figure was recorded in Spain, in the Battle of Roure (Figueras), with seven hundred amputations in four days.

During one of the breaks between battles in 1811, Larrey co-directed in Paris, along with Dr. Dubois (who was the obstetrician for Empress Marie Louise, Napoleon’s second wife), a team that performed a mastectomy without anesthesia on Frances Fanny Burney, a famous English writer admired by Jane Austen, who resided in France because her husband – who was French – served Bonaparte. It was suspected that Fanny had breast cancer, and the seven best doctors in the country were chosen to treat her. Both Larrey and she documented how the operation unfolded.

Napoleon shows gratitude to Larrey for his selflessness and loyalty; "I wish I were surrounded only by men like you"
Napoleon shows gratitude to Larrey for his selflessness and loyalty; “I wish I were surrounded only by men like you”/Image:wellcomeimages.org on Wikimedia Commons

In 1813, after participating in the Russian campaign, he was appointed chief surgeon of the Parisian Gros-Caillou Military Hospital, where he had to prove to Napoleon that many of the recruits accused of self-mutilating their hands to avoid the front lines had actually received combat wounds. This led to a harsh confrontation with Marshal Soult, as he felt that Larrey had undermined him before the emperor; the military leader would never forgive him for such humiliation and would take full revenge decades later.

Larrey offered to accompany the emperor into exile in Elba, but Napoleon did not want to deprive France of his essential services. He joined him ten months later when Bonaparte returned for the Hundred Days Empire and headed to Belgium with his new Grande Armée. Larrey did his job at Waterloo, being wounded and captured, as mentioned at the beginning. In the midst of the battle, Wellington saluted him from a distance, removing his bicorn hat upon learning that the French officer commanding that unusual carriage moving so close to his front line was the famous surgeon who was collecting wounded from the allied side to treat them: I salute the honor and loyalty of such a physician, he said before ordering a ceasefire to facilitate Larrey’s work.

Back in France and with Napoleon far away on Saint Helena, the loyalty Larrey had shown (twenty-five campaigns, sixty major battles, and four hundred minor ones) was not well-regarded, and he was socially marginalized for a while. However, Louis XVIII eventually endorsed his rehabilitation, appointing him chief surgeon of the Military House of the King and making him part of the first class of members of the Royal Academy of Medicine in 1820. Six years later, he visited England, where he was received with honors and continued to receive applause wherever he went.

Larrey's pyramidal tomb in the Parisian cemetery of Père-Lachaise
Larrey’s pyramidal tomb in the Parisian cemetery of Père-Lachaise/Image: Pierre-Yves Beaudouin on Wikimedia Commons

In 1842, as a member of the Army Health Council, he requested to conduct a medical inspection visit to Algeria. While there, accompanied by his son Hyppolite (who would become the chief military surgeon under Napoleon III), he received news that his wife was seriously ill and wanted to return quickly.

During the journey, he contracted pneumonia and died in Lyon shortly after arriving, just a few hours after his wife. He was seventy-six years old and was buried in Père-Lachaise Cemetery because Soult, who had not forgotten his humiliation, denied him a place in Les Invalides, where he had requested to rest in peace.

However, in 1992, his mortal remains were transferred there, near where Napoleon rests. In his will, Napoleon had bequeathed him a hundred thousand francs with a phrase that would serve as a perfect epitaph: He is the most virtuous man I have ever known. He has left in my spirit the idea of a true man of virtue.

This article was first published on our Spanish Edition on February 1, 2024. Puedes leer la versión en español en Larrey, el cirujano francés que creó el primer servicio de ambulancias, recogiendo aliados y enemigos en Waterloo

Sources

Dominique-Jean Larrey, Memoir of Baron Larrey | John S. Haller Jr, Battlefield medicine. A history of the military ambulance from the Napoleonic Wars through World War I | André Soubiran, Le baron Larrey chirurgien de Napoléon | Henri Drouin, Vie du Baron Larrey, chirurgien-chef de la Grande Armée | Jose M. Ortiz, The revolutionary Flying Ambulance of Napoleon’s surgeon | Charles Mullié, Biographie des célébrités militaires des armées de terre et de mer de 1789 à 1850 | Wikipedia

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