The inventor of the “Triage”: Jean Dominique de Larrey, Napoleon's surgeon


It is impossible to refer to the First Aid in case of "catastrophic" events, of any nature and origin, where the number of victims far exceeds that of rescuers, not to remember the inventor of the System to face in terms of effectiveness, efficiency and this type of adverse events characterized by the discrepancy between request and offer of assistance. As often happens in human history, from dramatic and bloody events, to exclusive anthropic responsibility such as wars, competent and happy intuitions of men and / or "special" women about the way of dealing, "domi bellique" (in peace as in war), the devastating effects of critical situations that have little or nothing to do with war! If today we know how to best deal with high magnitude impact disasters it is due to one of these "meritorious": Jean Dominique de Larrey.

He was born the 8 July 1766. At the age of thirteen he began his medical studies. Arrived in Paris towards the end of 1787, he was selected as an auxiliary surgeon on board the "La Vigilante" frigate. The treatment provided in cases of illness and the precautions taken by him on hygiene during the trip were so successful that, on his return, the ship had not lost a single man!

When, in the 1792, France went to war against Austria, and Citizen Larrey replied to Leva in Massa to help "La Patrie en danger", where ideology "not only mobilized manpower for the regular armies, but also inspired ordinary people to fight on their own account."1. He was appointed head surgeon of the army of the Rhine. Here he entered for the first time in contact with the military world, being deeply affected by the gap between the real needs and the effective organization of the system. This discrepancy was all the more evident in the care and transportation of the wounded by wagons arriving on the battlefield even days after the clash. When they arrived, the severely wounded men were almost all dead. Under such circumstances, the commanders became more interested than ever in preserving their numerical strength, and the military health services assumed an entirely new importance in the war economy. To put an end to these situations, Larrey devised a system of "flying" ambulances with which the military surgeons could follow all the troop movements and give immediate help to the wounded. With such a system available, Larrey had the opportunity to organize the first triage system2 directly on the battlefield. The injured could either be treated on the spot (currently we talk about "stay & play") and, possibly, be immediately sent back to fight, or recovered and transported ("scoop & run") in good time to the backward health facilities. Each ambulance was specifically designed and equipped with medical and paramedical personnel and the necessary first aid materials according to an "ante litteram" evacuation policy. This ambulance functioned as the first emergency medical unit.

Over ten campaigns, Larrey worked constantly on the battlefield making notable discoveries, for example, he modified the shape of the suture needles to allow them to be handled better, and having the opportunity to demonstrate, against the opinion of famous surgeons, the need for immediate amputation in order to avoid the onset of infections that very often, at that time, led to death. In 1796 he was appointed professor at the Military School of Medicine and Surgery in Paris. Due to the amazing results obtained, Napoleon himself wanted Larrey to be directly employed by him during all subsequent military campaigns.

The surgeon then returned to active service, starting the 1º May 1797 towards Italy. After visiting the conquered provinces, Larrey inspected the hospitals and established surgery schools in several cities; he organized the ambulances and formed a special Health Corps that was adapted to the needs of the "modern" war of the people "and to the Napoleonic expansionist politics. Between the "little corporal" and his head surgeon, from this moment on, a deep bond will be created.

In 1798 Larrey was followed by Napoleonic troops in Egypt and Syria. In 1802 he was appointed general practitioner of Guardia dei Consoli, while in 1804 he received the cross of officer of the Legion of Honor and in 1805 was appointed Army Inspector General of the Army.

Once Emperor, Napoleon called him on the battlefield: Larrey will take part in the battles of Ulm and Austerlitz, in the countryside of Poland, Spain. At Wagram, after the battle, Napoleon received Baron's title. In 1812 he was appointed surgeon in charge of Grande Armée with which he took part in the disastrous campaign of Russia. Particularly in the battle on the outskirts of Moscow, deprived of personnel and means, he tried to restore the order by establishing his general ambulance in the middle of the battle line, where two thirds of the wounded passed, practicing during the first 24 hours more than two hundred amputations of one of the four arts despite missing gauze, blankets, supplies, killing the horses for the nourishment of the wounded, the majority of whom died later during the retreat. Remaining loyal to the Emperor, he returned to France and also followed him during the adventure of the "100 days" culminating in the definitive defeat of Napoleon at Waterloo. Larrey followed the retreating army. He was captured by Prussian soldiers and ran the risk of being shot. The commander-in-chief of the Prussian army, General von Blucher, whose son had been rescued by the surgeon during the Austrian campaign, prevented his execution and freed him. Considered as one of Napoleon's most devoted supporters, at the fall of the Emperor, he was deprived of his title as baron and of the retribution of inspector general of military health; he also lost pensions and income from the Legion D'Onore. He only retained the post of chief surgeon at the military hospital. In the 1818 a law reinstated it and this gave him the courage to rebuild his school. He published a fourth volume of his campaigns, wrote the treaty of "Clinical Surgery", in 1820 he was elected a member of the Academy of Medicine and in the 1829 he was called to the Academy of Sciences. After a trip to Belgium in the 1832 to organize the military health service of that country, resumed the post of Chief Surgeon at Hôtel des Invalides in Paris and was appointed Member of the General Council of Health.

He died returning from a study trip to Algeria, the 25 July 1842. His bronze statue is located in the outer courtyard of the Paris Military Hospital. Larrey has left the world of medicine different works, born above all from a series of direct observations during the active medical service on the battlefields.

Luisa Carini, Enzo Cantarano, Federico Bizzarri



1 Townshend C. The Oxford History of Modern War. p. 177 ISBN - 0 - 19 - 280645 - 9

2 Triage, a French term that means "sorting, sorting") is a system used to select the subjects involved in accidents according to increasing urgency / emergency classes, based on the severity of the injuries reported and their clinical picture. It is also put into practice whenever there is insufficient means and personnel compared to those who need help. This case can occur both in the Territory, in case of calamity, disasters or major events, as in a hospital emergency room. In the event of extraordinary situations, typical of Catastrophe Medicine, triage is functional to ensure that the entire rescue system works efficiently to save the greatest number of people, sometimes having to choose to direct treatment only to those who are rescued promptly , is more likely to survive and not even to victims who, due to the severity of their condition, have no hope of survival Townshend C. The Oxford History of Modern War. p. 177 ISBN - 0 - 19 - 280645 - 9


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