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through Vienna, take away Venice and all Ambroise Paré (1509–1590) is properly of Italy which remained in Austrian hands, considered the first military surgeon in and chase the Bourbons from Italy. Hav- France. King Henry IV (1589-1610) was ing pacified the continent, he would return instrumental in developing surgeons as an to the ocean and work anew at a maritime integral part of the army, and his adviser peace.
Sully (1560-1641) was the first to organize As the fleet never came, Napoleon was hospitals for the wounded. He introduced compelled to give up his plans of the inva- the “ambulance,” which was a mobile hossion of England and to turn his attention pital where early treatment could be given; to other matters. He left Boulogne for the stationary hospitals were placed well back last time on September second, 1805, and of the lines for later treatment. Richelieu was soon followed by all troops except three (1585-1642) created regimental surgeons, regiments and a few other men who stayed and after 1731, when the Académie royale to protect the boats and stores which were de Chirurgie was founded, all French surabandoned. As a final note to the history geons of repute went through a certain of the expedition, it is interesting that Ful- amount of military training. ton came to Boulogne in 1805 and attempt
EARLY MILITARY AMBULANCES ed to convince Napoleon that the army should be sent across the channel by steam- The French Army Medical Corps, or boat. Inasmuch as the “Clermont” moved “Service de Santé,” was developed further upstream on the Hudson River two years during the reign of Louis XV (1715-1774). later, it is probable that the necessary Army medical schools were established at machinery was nearly perfect when offered which army officers were taught. There to the French, and that the idea was not were seventy military hospitals to which so ridiculous as it first seemed.
“ambulances” were attached and to which As might be expected with such a large vere allied charity civilian hospitals. In military project on hand and with such times of war a mobile hospital received the genius for detail as Napoleon always show- wounded and evacuated them as quickly ed, his plan of medical administration for as their condition allowed to a stationary the Boulogne camp was remarkably com- military hospital somewhere near the front. plete and had been logically evolved. These hospitals in turn evacuated their
cases to the nearest charity civilian hospiMILITARY SURGEONS IN THE 16TH CENTURY
tal in the interior. Up to the end of the sixteenth century The ambulance wagons used for the momilitary surgeons were unheard of in bile hospitals were heavy vehicles which France, possibly owing to the lack of or- carried an immense amount of equipment. ganized armies. The different seigneurs paid Each one was drawn by forty horses and private surgeons to accompany them on had a personnel of 134 men. Of these, 41 campaigns. These surgeons treated such were surgeons, and 31 were supposedly men as needed care more or less at hap- trained nurses. Each mobile hospital was hazard, and when the campaign was over detailed to look after 20,000 men. The great returned to their villages to resume civil objection was that it was unwieldy in bad practice. Many of the wounded who had roads and that it had to stay at least three been abandoned on the wayside were treat- miles behind the fighting. The wounded reed by charlatans following the army, and mained on the field until the day's battle were eventually left to the mercy of friend- was over when they were collected in a ly peasants or monasteries.
group. The ambulance approached at its
convenience, which was often twenty-four hours later. Many of the wounded died through lack of immediate care and were abandoned in case of a retreat.
Napoleon had two remarkable surgeons in his command who made notable progress in the systematization of military surgery. Larrey (1762–1842) realized the necessity of helping the wounded on the field of battle and of removing them under fire. He formed the legion of mobile ambulances (Légion de l'ambulance volante). Each legion consisted of three units under the command of a major with two aids, twelve junior surgeons, and an administrative and working force of 340 men. Each unit operated twelve light ambulances and four heavier ones. The light carriages were drawn by two horses and carried two stretcher cases. The heavier ones were drawn by four horses and held four stretcher cases. The wagons were well ventilated and were so constructed that a wounded man could be put inside on a stretcher in horizontal position. Bandages and instruments were part of the equipment. An officer or nurse could drive anywhere for the wounded, dress them on the field when necessary, place them in the ambulance, and gallop off at top speed to a mobile hospital outside the battle zone. Percy (1754-1825) modified Larrey's system by sending out trained stretcher-bearers to render first aid to the wounded and to collect and carry them back.
back to permanent stationary hospitals outside the battle area for treatment until they recovered.
The most modern touch to this system was added in Boulogne by Napoleon himself. In 1803 he wrote a letter to the commanding general of the Saint Omer Camp, recommending that all the sick should be retained in hospitals in the town. He felt that there was nothing worse for sick soldiers than travel. Furthermore, men once sent away from their own units were lost as effective soldiers for long periods of time.
In order to prevent overfilling the hospitals in the area, he ordered the establishment of a convalescent camp big enough to contain a thousand men. All patients on discharge from the hospital were to be sent to this camp for one or several weeks, after which time they were to be returned to their own units for duty. The men in the convalescent camp were to be properly fed and exercised, were to be given a daily ration of wine and the necessary medicines. The medical care of the men was to be undertaken by regimental medical officers or doctors from the hospitals. The military side of the camp was to be in charge of a senior officer with a sufficient number of junior captains and lieutenants. Hospital TREATMENT AT BOULOGNE
IN 1805 On the whole, the organization of the French camp at Boulogne in 1803-1805 was remarkably comparable to that of the British
camp there in 1914-1918. Both armies turned the city into a military centre and took for army purposes various civilian buildings making them into storehouses, offices, and hospitals. Both armies had numbers of men under canvas on the plateaux at the mouth of the Liane and at Wimereux and Étaples. In 1805 the wounded were collected and dressed on the battlefield, were taken quickly to advanced mobile hospitals, and were later evacuated
NAPOLEON'S MEDICAL ORGANIZATION
Thus when the camp at Boulogne was established, Napoleon's medical organization was somewhat as follows: Trained stretcher-bearers collected the wounded on the battlefield, applying dressings on the spot if necessary, and carried the patients to rapidly moving ambulance wagons. These, in time, took the men to the advanced mobile hospital, where further care was given. Finally, the wounded were sent
helps to illustrate the close fashion in which American, British, and French interests have combined or conflicted during the last two centuries.
to permanent hospitals outside of the battle area. Suitable cases were sent to a convalescent camp in order to be returned to their proper units for duty and so that a man with a minor wound or ailment should not be lost for military purposes. In 1918, the wounded were treated in much the same fashion.
Whether or not Napoleon's proposed invasion of England was feasible as a military project is a debatable question. The history of the Boulogne camp is worth remembering in any event, for it was associated with American development and
REFERENCES “Histoire du Premier Empire.” Hamel. "Histoire du Consulat et de l'Empire." Thiers. “Correspondance du Napoleon Ier.”
“Les Militaires Blessés et Invalides.” De Riencourt.
“Dominique Larrey et les Campagnes de la Révolution et de l'Empire." Duruy.
“Napoleon: A Short Biography.” Johnston.
"A Student's History of the United States." Channing
RHAZES ON THE ONSET OF SMALL-POX
The eruption of the Small-pox is preceded especially an intense redness of the gums. by a continuous fever, pain in the back.
There is a bad and fatal sort of the itching in the nose, and terrors in sleep, white and large pustules, viz., those which These are the more peculiar symptoms of
become confluent and spread, so that many its approach, especially a pain in the back, of them unite and occupy large spaces of the with fever; then also a prickling which the body or become like broad circles, and in patient feels all over his body; a fullness of colour resemble fat. As to those white pusface, which at times goes and comes; an tules which are very small, close to each other, inflamed colour, and vehement redness in hard, warty, and containing no fluid, they both the cheeks; a redness of both the eyes; are of a bad kind, and their badness is in a heaviness of the whole body; a great proportion to the degree of difficulty in uneasiness, the symptoms of which are ripening. And if the patient be not relieved stretching and yawning; a pain in the upon their eruption, but his condition throat and chest, with a slight difficulty in continues unfavorable after it is finished, breathing, and cough; a dryness of the it is a mortal sign. And as to those which mouth, thick spittle, and hoarseness of the are of a greenish, or violet or black colour, voice; pain and heaviness in the head; they are all of a bad and fatal kind; and inquietude, distress of mind, nausea and when, besides, a swooning and palpitation anxiety (with this difference, that the of the heart comes on, they are worse and inquietude, nausea and anxiety are more still more fatal. And when the fever infrequent in the measles than in the small- creases after the appearance of the pustules, pox; while, on the other hand, the pain in it is a bad sign; but if it is lessened on their the back is more peculiar to the small-pox appearance, that is a good sign. than to measles); heat of the whole body, an RHAZES. “De variolis et morbillis.” inflamed colour and shining redness, and
By HARVEY CUSHING
HATEVER may be said of
true also-and this is more rare-of the Sir William Osler in days
members of his profession, for whom, high or to come, of his high posi
low, he showed a spirit of brotherly helpfultion in medicine, of his ness untinctured by those petty jealousies gifts and versatility, to his contemporaries,
which sometimes mar these relationships. love of his fellow-man, utter unselfishness,
“Never believe what a patient may tell you and an extraordinary capacity for friend
to the detriment of another physician” was ship will always remain the characteristics one of his sayings to students, and then he which overshadow all else. Few so eminent would add with a characteristic twistand so industrious come in return to be so “even though you may fear it is true”; widely beloved for their own sake. Most of and he was preëminently the physician to us do well with what Stevenson advises-a physicians and their families, and would go few friends and those without capitulation out of his way unsolicited and unsparingly -but Osler had the God-given quality not
to help them when he learned that they were only of being a friend with all, high or low, ill or in distress of any kind. And no one child or grown-up, professor or pupil, don
could administer encouragement, the essenor scholar, but what is more, of holding such
tial factor in the art of psychotherapy in friendships with an unforgetting tenacity- which he was past master, or could “soothe a scribbled line of remembrance with a the heartache of any pessimistic brother,” playful twist to it, a note of congratulation so effectively and with so little expenditure to some delighted youngster on his first of time as could he. publication, the gift of an unexpected book, During one of his flying trips to America an unsolicited donation for some worthy some years ago, as always with engagements cause (and giving promptly he gave doub- innumerable, he took time to go from Baltily), a telegram to bring cheer or consolation, more to Boston for the single purpose of an article to help a struggling journal to get seeing a surgical friend with literary tastes a footing, a cable such as his last on the day who for some months had been bed-fast of his operation to his old Hopkins friends, with a decompensated heart; and James which was given by them to the press for Mumford, for it was he, always said that the benefit of countless others who shared this unannounced visit was what put him their own anxiety-all this was character- on his feet again. I knew of his doing the istic of the man, whose first thoughts were same thing for an Edinburgh physician of invariably for others.
whose illness he heard by chance just as he He gave much of himself to all, and was leaving the steamer, in Liverpool. He everyone fortunate enough to have been was due for an address before the British brought in contact with him shared from Medical Association in Oxford, but without the beginning in the universal feeling of hesitation he took the first train to the devotion all had for him. This was true of north and managed to get back to Oxford his patients, as might be expected, and he just in time for the address, blithe and gay was sought far and wide not only because as though he had not spent two nights on a of his wide knowledge of medicine and great train. Indeed he was invariably punctual wisdom, but because of his generosity, sym- and somewhat intolerant of tardiness in pathy and great personal charm. It was others. “Punctuality is the prime essential 1 An amplification of a note on Sir William Osler which appeared anonymously in the Boston Evening Transcript, January 3, 1920.
of a physician-if invariably on time he will succeed even in the face of professional mediocrity.”
The universal devotion he engendered was no less true of those with whom he came in contact outside his profession, and his points of contact through his varied interests were innumerable. Man, woman or child-and in children especially he delighted as they did in him-felt from the first moment of meeting a rare fascination in his personality. In a poem, “Books and the Man,” dedicated to Osler and read before the Charaka Club, March 4, 1905, Weir Mitchell recalls in these three verses their first meeting in London twenty years before.
If you can practice consistently all this, . . and then, if you can bring into corridor and ward a light, springing step, a kindly glance, a bright word to everyone you meet, arm passed within arm or thrown over the shoulder of the happy student or colleague; a quick, droll, epigrammatic question, observation or appellation that puts the patient at his ease or brings a pleased blush to the face of the nurse; an apprehension that grasps in a minute the kernel of the situation, and a memory teeming with instances and examples that throw light on the question; an unusual power of succinct statement and picturesque expression, exercised quietly, modestly and wholly without sensation; if you can bring into the lecture-room an air of perfect simplicity and directness, and, behind it all, have an ever-ready store of the mostapt and sometimes surprising interjections that so light up and emphasize that which you are setting forth that no one in the room can forget it; if you can enter the sick-room with a song and an epigram, an air of gaiety, an atmosphere that lifts the invalid instantly out of his ills, that produces in the waiting hypochondriac so pleasing a confusion of thought that the written list of questions and complaints, carefully complied and treasured for the moment of the visit, is almost invariably forgotten; if the joy of your visit can make half a ward forget the symptoms that it fancied were important, until you are gone; if you can truly love your fellow and, having said evil of no man, be loved by all; if you can select a wife with a heart as big as your own, whose generous welcome makes your tea-table a Mecca; ... if you can do all this, you may begin to be to others the teacher that “the chief” is to us.
Do you perchance recall when first we metAnd gaily winged with thought the flying night And won with ease the friendship of the mind, I like to call it friendship at first sight.
And then you found with us a second home,
And now a score of years has fled away
On Osler's seventieth birthday, just passed, the medical world set out to do him honor-unknown to him, for he was one to elude public testimonials and did not suffer adulation gladly, quick as he was to give praise to others. For this occasion many of his former pupils and colleagues in Baltimore wrote a number of papers containing the sort of things rarely said or written about a man or his work until after his death. Among these papers is one by his present successor there, on “Osler the Teacher” which deserves quoting in full, but which after an enunciation of his traits ends with this picture of the man as his hospital associates and students remember him.
Little wonder that he was idolized by the students. This was natural enough, but he in turn took pains to know them by name, gave up an evening in each week to successive groups of them at his home, learned them as individuals and never forgot them. And it was the same with his hospital juniors, whether they happened to be members of his own staff or not. Preserved among some papers I find this characteristic undated note of circa 1898, concerning an early effort which had been submitted to him. It is scribbled in pencil on a bit of paper.
A. A. 1. report! I have added a brief note about the diagnoses. I would mention in the medical re