History of Urology Forum
Presentation Authors: Varun Talanki*, Colin Ryan, Howard L. Adler, Stony Brook, NY
Introduction: The management of wounded soldiers on the battlefield has always been a challenge. While the Byzantine army had corpsmen who were paid for each rescued casualty, there was no interest in evacuating the wounded for many reasons. This situation remained true until the late 18th century when Dominique-Jean Larrey developed the first system of triage and rescue. We sought to explore the life of this brilliant man.
Methods: An internet search was carried out using multiple search engines.
Results: Dominique-Jean Larrey was born in July 1766. At the age of 13, he left home to study medicine under his uncle in Toulouse. He joined the French Navy as a ship’s surgeon. Larrey, as a staunch supporter of human rights, was part of the mob who stormed the Bastille. While treating the wounded, he noted a higher mortality rate among those who waited longer for amputations. This concept remained with him as a surgeon during the Napoleonic wars and led him to create the Ambulance Volantes (Flying Ambulances) – a light horse-drawn wagon which carried supplies and medical personnel into the battlefield and carried wounded soldiers out in 15 minutes even in the harshest terrain. Larrey also established the first field hospitals just outside the battlefield and treated patients based on the severity of their injuries as opposed to rank and nationality. This was all done at personal risk as there was no Red Cross for protection from enemy soldiers. Larrey remained under Napoleon’s command in his Grand Army. He received the Legion d’Honneur and was then made Inspector-General of the Army Medical Services and Chief Surgeon to the Imperial Guard. In October 1809, Larrey was made Baron of the French Imperial Court. After the Battle of Waterloo, Larrey returned to France where he cared for wounded veterans. He is credited with publishing 4 volumes of Memoires de chirurgie militarie et campagnes. In his memoirs, he describes the management of penetrating bladder trauma and external genitalia injuries, the course of tetanus, the pathophysiology of cold injury, the control of hemorrhage, the drainage of empyema and hemothorax, the aspiration of pericardial effusion, and the packing of sucking chest wounds. Interestingly, no other nation utilized Larrey's advancements until the American Civil War. The development of the medical helicopter (a true flying ambulance) in the Vietnam War represented the culmination of his work. Larrey died at the age of 74 in 1842.
Conclusions: Dominique-Jean Larrey laid the foundations of trauma management for the wounded patient. Military and civilian patients still continue to benefit from his innovations.
Source of Funding: None