#12 1797 · Napoleon's Grande Armée · Military medicine
Napoleon's surgeon treated the worst wounds first, whatever the rank
the problem
The wounded were treated by seniority
background
Standard military medical practice treated officers first, regardless of how badly a common soldier nearby was bleeding — rank, not wound, decided the queue. Larrey had seen the cost of this from his first campaign in 1792: wounded men left on the field for a day or more, waiting not for a surgeon but for their social position to come up.
He proposed instead that the most dangerously wounded be treated first, "without regard to rank or distinction," and built light, sprung horse-drawn carriages — "flying ambulances," modelled on the speed of horse artillery — to bring surgeons to the wounded during the battle itself rather than after it ended. Napoleon personally approved the system; by the time of the Russian campaign, Larrey had used it across 25 campaigns and hundreds of battles and engagements.
the move
Surgeon Dominique-Jean Larrey treated the wounded strictly by severity, ignoring rank, and built 'flying ambulances' to reach them during battle.
the payoff
The word and practice of triage; the ordering principle every emergency system since inherits.
what came after
At Borodino in 1812, Larrey performed over 200 amputations in 24 hours; his ambulance system is credited with cutting the delay between wounding and treatment from 24-36 hours down to roughly one hour, and swift amputation reduced mortality from over 90% to under 25%. Other militaries were slow to copy it — Britain took roughly 60 years to adopt a comparable system, and the US did not begin organised battlefield evacuation until after 1862 — but Larrey's two ideas, sort by severity and bring care to the wounded rather than waiting for them to arrive, remain the basis of emergency medical services today.
filed under
references
- [1]Dominique-Jean Larrey (1766-1842): The Founder of the Modern Triage SystemPMC / National Library of Medicine, 2024pmc.ncbi.nlm.nih.gov
- [2]Baron Larrey – Napoleonic inventor of ambulances, triage and MASHThe Conversation, 2016theconversation.com