The Napoleonic Wars: A Medical History
Martin Howard
Pen & Sword Military, hardback
ISBN: 9781399046169
Pages: 280
Illustrations: 30 colour illustrations
This work is a masterly overview of the large and complex medical history of the French Revolutionary and Napoleonic Wars. The preface, acknowledgements and bibliography are a testimony to the depth of research and effort that Martin Howard has enlightened historians and readers as to the challenges facing those serving in the field and at sea.
To comprehend the background of the social conditions affecting Britain and France as they approached the age of science and industrial revolution, Howard takes the reader through the insanitary living conditions, health risks and mortality rates at war and in peacetime in France and Britain. Civilian medical services were generally patchily distributed in quality and quantity. Aside from a multitude of lowly unqualified practitioners, over 80% of university qualified graduates emanated from Scottish Universities. Surgeons in the British army were usually trained by apprenticeship and entered the service with merely a Surgical College diploma. Poor nosology, the absence of the germ theory and lack of reliable statistics hampered therapies. Field medicine much depended on the variability of clinician’s experience and skill. Surgical outcome from giants such as Larrey, Percy, Guthrie and Hennen were sometimes prone to exaggeration and didn’t reflect the performance of the ‘average’ battalion or ship’s surgeon. However, Howard emphasises emerging efforts in preventative medicine (e.g. vaccination, quarantine and lemon juice). After description of wound types, he finishes the first chapter with a brief description of the greatest killer in the armed forces – disease.
There follows a condensed account of the emerging French Service de Santé, previously well-researched in Howard’s Napoleon’s Doctors. This was a service that could have been at the forefront of military medicine, given the nation’s rebirth after the Revolution. It Improved during the Consulate and, innovations over time, included the Ambulances Volante and the Wurst systems of evacuation of casualties, a limited provision of despotats (stretcher bearers/orderlies), the creation of a variety of military hospitals, inoculation and quarantine. However, there was limited provision of decent ambulances, except for the Imperial Guard. Medical support gradually deteriorated with overbearing administrative interference and much indifference by most of the Commissaires des Guerre and the Conseil de Santé and often by Napoleon himself. Further problems were the loss of hundreds of medical staff. Despite disease, dietary deficiencies and climate being the great killers, most staff were surgeons with physicians having a limited role on campaign.
The account of Britain’s military medical support follows, also a brief resumé of some other Allied nations’ medical systems. All nations suffered intermittently with a dearth of surgeons – particularly of the lower rank. A re-organisation of the Army Medical Department after the Walcheren debacle coupled with increasing experience and better governance from 1812, under the direction of Sir James McGrigor, was to lift the British military medical care above that of their foe. The prominence of Scots medical men and their facilities north of the border and the disharmony between ‘civilian’ battalion medical staff and line officers make interesting reading. The author briefly outlines naval medical services in this and the previous chapter.
The following two chapters explain medical issues arising during two major campaigns of the Revolutionary wars in Europe and over 4,000 miles away in the West Indies. There are interesting accounts of overwhelming climatic, disease-ridden armies lacking good medical care, decent hospitals and, particularly in the Low Countries, poor organisation, inadequate clothing, dietary deficiencies and lack of transport for the multitude of sick. In Europe the prominent diseases were dysentery, typhoid, typhus and malaria. In the Caribbean, with troops occupying fever-ridden littoral zones, dysentery, malaria, and especially the scourge of yellow fever took heavy tolls. Treatment was crude, rudimentary, harmful and often ineffectual with the limited knowledge of nosology and aetiology. In both campaigns, medical staff were decimated alongside their charges. Probably around 150,000, British, French and native servicemen gave their lives fighting for the riches gleaned in the West Indies.
Howard’s next deals with the French and British Army’s expeditions to Egypt and Syria in 1801. Campaigning in basting, arid and unhygienic conditions posed new threats – unusually here, more men died of disease not injuries. The author recounts interesting details of wounds, plague sufferers and highly contagious eye infections (including ophthalmia). Innovations included the use of camel ambulances, examples of experimentation with self-inoculation, vaccination and isolation policies with outbreaks of plague. Next, we travel to India. Howard explains the challenges facing the medical staff of both the East India Company and the King’s regiments posted there. He admits that the East India Company doctors could be innovative and tended to employ empiricism in their therapies. Transport of casualties was a recurrent challenge for Wellesley and for the patients. Aside from the usual tropical ailments, venereal diseases and parasitic infestations and the liberal misuse of Arrack were constant problems.
Moving through the European battles at Ulm, Austerlitz, Eylau. Aspern Essling and the Walcheren debacle, the Service de Santé and their adversaries had huge sick and casualty lists. We are regaled with countless individual examples of suffering, shortages, delayed evacuation and a complete swamping of the limited medical systems. The Peninsular War reiterates such challenges, yet Howard explains the gradual improvements in medical care, organisation and clinical outcomes in Britain’s precious army, following the arrival of Inspector General James McGrigor in early 1812. This talented doctor worked well with his commanding officer. We are led to assume from here that as France’s medical service deteriorated, Britain’s improved.
Napoleon’s significant strategic error in invading Mother Russia was disastrous, and the huge ‘French’ force lost thousands of soldiers and medical men from the cold, typhus and other diseases. Surgeon Larrey’s accounts and those of the suffering participants are unimaginably harsh. Over the Atlantic the author goes on to give his well-researched account of medical aspects of the 1812 war against America. The cost of the 1813/14 campaigns in Europe, encompassing a terrible epidemic spread of typhus, covers actions in Germany and finally France and Belgium. The reader is enlightened, with interesting anecdotes and statistics. Finally, we journey through the hastily arranged Waterloo campaign. Here, Wellington and Blücher’s polyglot army were victorious. Wellington was served by less experienced Allied surgical teams than had served in the Peninsula. Yet, despite having a flimsy organisation for casualty evacuation, was well-served by ‘Belgian’ medical staff and civilians in Brussels after the battle.
Howard concludes his work discussing the advances and limitations of medical support for the forces involved. He comments that there were few enough advances in the cure of illnesses, excepting preventative measures such as vaccination, quarantining and hygienic improvements. Sadly, excepting in some large, provisioned hospitals, these measures were infrequently feasible from the sheer volume of sick or wounded men, presented in a short timespan. There were limited lessons learned in the practice of surgery, resulting in some better outcomes. With medical giants such as McGrigor, Hennen, Larrey and Percy, the militarisation of medicine had begun.
It is a significant challenge to have condensed this extensive tale in one book. This book remains an essential work to remind all politicians, military commanders and historians, of the horrific and costly consequences of conflict.
Mick Crumplin
May 2025