Wellington's Doctors: The British Army Medical Services in the Napoleonic Wars (review)

Napoleon invaded Spain and Portugal in 1807. Britain then came to the aid of her allies, sending Lieutenant General Sir Arthur Wellesley, who took command of the army in the peninsula in 1809. He was promoted to field marshall in 1813 and made the Duke of Wellington in 1814. Wellington won in Spain, and in 1815 he defeated Napoleon at Waterloo, ending his reign. This book represents the clinical and patient accounts of the medical system supporting Wellington. It begins with an overview of military medicine in the British army, describing the shambles of central medical direction; the education, various titles, and jobs of the medical staff (civilians with relative rank); and an appreciation of their contributions in the Peninsular Campaign in Spain (1808-14) under Wellington. The author includes medical examples from British forces in the Caribbean, the United States, and India.

The work of the regimental surgeons in battle—often under fire, doing triage by the rank of the wounded, and striving to deliver surgical care with untrained assistants and limited supplies—is nicely described in the patient accounts. The evacuation of the wounded—mainly by horse, mule, or oxcart—was slow, painful, and primitive compared with the envied system of Larry under Napoleon. The contributions of James McGrigor, the senior surgeon (1812-14), are described, but not (in my view) appropriately emphasized: he was a master organizer, and with Wellington's support and confidence he installed what system reforms were possible. Once the sick and wounded reached the rear they were placed in filthy, overcrowded, and understaffed general hospitals, commanded by line officers and holding from 300 to 1,000 patients. By 1812 there were some intermediary flying and passing hospitals, closer to the battlefield. Hospitals were for the enlisted men; officers were usually put up in private homes.

The surgical care was largely limited to amputation, wound closure, and fracture splinting. Senior surgeons like Guthrie and Hennen taught techniques and collected and published data on methodology, on the treatment of gangrene and tetanus, on the timing of operations, and so on. Disease, of course, was the major killer and incapacitator of all armies of the period. Respiratory infection, diarrhea, and dysentery (the leading cause of disease deaths) were accompanied, depending on season and country, by malaria, epidemic typhus, and yellow fever. Overall, wounds caused 15% of deaths; disease, the remainder. Preventive medicine was focused on diet, the relief of overcrowding in barracks, "proper" clothing, quarantine, and some use of vaccination for smallpox. Disease was fostered by close confinement in transport ships, inattention to latrines and "safe" drinking water, and exposure to extremes of heat, cold, and marching fatigue.

From 1808 to 1814, perhaps 9,000 British soldiers were killed and 40,000 were wounded. Officers and enlisted men died in the same proportion. Statistics from a general hospital for 1,294 patients for the period April-June 1814 show that 13% died of wounds, 24% returned to duty, and 63% were well enough to be transferred to the rear. Of 352,300 admissions to general hospitals from 1812 to 1814, 66% were cured, 23% were transferable, and 5% died. The modern reader must remember that there was no germ theory, no antisepsis, no anesthesia, and no imaging, and that the therapies of disease were universally worthless.¹ Thus, the hardiness (or lack of it) of the soldier and the relatively benign natural course of most diseases eventually led to a surprisingly favorable general hospital outcome—but it is essential to remember that the majority of the wounded and many of the sick died before admittance to rear-area general hospitals.

Martin Howard has used a great many published memoirs, autobiographies, biographies, contemporary and modern books, and journal articles as sources. Every chapter has...