National Post (National Edition)
Medical giant’s Canadian connection
On a lighter note — actually, this is a light-ish column with a grim origin — I became interested in the history of medical triage a few days ago, for reasons that will not elude your imagination. The acknowledged father of triage is the same person who invented the ambulance: the Napoleonic battle surgeon Dominique Jean Larrey (1766-1842). Larrey is still one of the great innovator-saints of the medical profession. He is one of those rationalist, utilitarian figures of the French revolutionary period to whom we are still indebted, whether or not we approve of the revolution itself.
The ambulance and the concept of triage — sorting patients into numbered categories for the purpose of giving immediate care to those most likely to benefit — were devised together, going hand in hand. The rough idea of triage existed beforehand, but it was Larrey who imposed explicit, optimized procedure upon the job of plucking mangled bodies off the battlefield and rushing them into treatment. He designed the litters used to carry the patients; he had a defined task for every person in an ambulance crew. He was a crucial link between folkloric medicine and the modern empirical variety.
When you read his memoirs, the in-between-ness jumps out at you. Larrey had a high regard for authority: if Ambrose Paré did something in a particular way in the 16th century, Larrey counted that as a huge point in its favour. But he was fearless in contradicting his masters on the basis of experience, and he invented a cornucopia of new techniques and instruments.
His theories of disease are comical to anyone who knows what a virus is. He went on and on about warm baths and stimulating literature being dangerous; he thought seasickness was caused by having a “large and soft” brain prone to sloshing. Larrey was flying blind on disease etiology, but as Napoleon’s surgeon-general he endured periods in which he treated 200 mutilated soldiers a day. It is hard to imagine anyone knowing the business of wounds and gangrene too much better.
That is not why he remains honoured. He probably didn’t really invent triage, but he pushed it to its universalist conclusions. He applied it indiscriminately to all ranks of soldier, and placed injured enemies in the same queue, on the same terms, as Frenchmen. We take it for granted that doctors will not show national favouritism, but this idea had to be invented, and Larrey was one of the inventors. (It helped save him at the Battle of Waterloo: the Prussians captured and almost executed him before a German colleague spotted the physician who had saved one of Gen. Gebhard Leberecht von Bluecher’s sons in French captivity.)
But I am rambling about medicine in a column meant to be about the magic of old books. The delightful thing about Larrey’s memoir for the Canadian reader is its very beginning: Larrey’s first job as a military surgeon was a 1788 cruise to the Grand Banks and the French settlement of Baie du Croc (now Croque) aboard the frigate Vigilante.
On the soil of Newfoundland, we see the future medical scientist as a young yarn-spinner. After saving some shipwrecked sailors, collecting a boatload of cod and avoiding the boat-attacking “white sea bear,” Larrey and his shipmates embarked to marvel at “a kind of large stag which is called caribou.” He testified that one of them impregnated a French cow during his visit, with results he could not stay to behold.
He had a brief, respectful encounter with some of the “Esquimaux of Labrador,” overcoming his fears of the men called “anthropophagi” (cannibals) in the books he had read for research. The natives were shy, and no translator was on hand, but there was an exchange of food and gifts. Larrey was even given a drink of what might have been the “Labrador tea” now found in health food stores. Scurvy was rampant in the settlement, but Larrey claimed success in tackling it with herbs and cod’s-head broth. No Canadian can fail to sympathize with the surgeon’s dismay when he encountered “a species of gnat, called musquito,” which “is very troublesome, and produces by its sting, local inflammation and fever, which are but ephemeral.”
There was a moment that captures Larrey’s sober, single-minded spirit well. “We often saw in the harbours of Newfoundland,” Larrey writes, “those dazzling lights which appear during the nights, and in particular when the weather is warm, about the oars and wake of vessels.” This must be a reference to marine phosphorescence, but the doctor does not linger over the romance.
“The observations which I have made lead me to believe that these lights are the result of the presence of a large quantity of phosphorick animalcule and putrid animal matter mingled with the water. The situations where these lights appear most brilliant are consequently unwholesome if persons continue long in them.” By “animalcules” Larrey means microorganisms, and if his later career in Napoleon’s menagerie of genius did not convince us of his intelligence, let it be noted that his guess about bioluminescence was arguably more accurate than the one Darwin made 40 years later aboard HMS Beagle.
HE PUSHED IT (TRIAGE)
TO ITS UNIVERSALIST CONCLUSIONS.