The famous order of Napoleon Bonaparte on the "Great Army", dated June 22, 1812, contained the following lines:
“Soldiers … Russia swore an oath of eternal alliance with France and vowed to wage war with England. She now breaks her vow … She confronts us with a choice: dishonor or war. The choice is beyond doubt. So, let's go ahead, cross the Neman, bring war on its territory …"
Thus began the famous war that put an end to Napoleon's "Great Army" and glorified Russian weapons. And medicine played an extremely important role in this war.
By 1812, the military-sanitary organization in the Russian army was reconciled and deprived of its previously inherent multi-power. The initiator of the reform of military medicine was the Minister of War Mikhail Bogdanovich Barclay de Tolly, who on January 27, 1812, after an agreement with the Emperor Alexander I, issued an important document "Institution for the Management of the Large Army in the Field." It designated the organization of seven departments, one of which was the medical one for the first time. The structure of the department included two departments, one of which was engaged in medical affairs, the organization of the hiring of doctors and their dismissal, as well as the training and distribution of paramedics. The second branch of the medical department was engaged exclusively in pharmaceutical affairs and the supply of medical equipment to the troops. The department was headed by the Chief Military Medical Inspector, to whom the field staff generals-doctors were subordinate (one per army). Lower in rank were corps staff doctors (chief doctors of field hospitals), divisional headquarters doctors, and in the regiments - senior doctors. The supply of the army's medical institutions was in charge of the quartermaster general.
Since 1806, he was in charge of the entire medical service of the Russian army, "the chief inspector of the medical unit for the Military Land Department under the command of the Minister of Military Land Forces," and also the director of the medical department, Yakov Vasilyevich Willie. He was a Scotsman by birth (his native name was James Wiley), who worked as a life surgeon for three emperors: Paul I, Alexander I and Nicholas I. Jacob Willie actually created the military medical service in the form in which it appeared before the invasion of Napoleon. For thirty years he headed the Medical and Surgical Academy, and in 1841 he was awarded the highest rank for a medical worker - a real privy councilor. Willie's major achievement was the organization in St. Petersburg in 1796 of the Instrumental Plant, which was engaged in the production of medical equipment and medicines. Under an outstanding doctor and organizer, a new evacuation model of treatment appeared in Russia, which was called drainage treatment in Russia (until 1812, doctors around the world worked with the wounded almost on the battlefield). Key ideas of the concept of evacuating the wounded from the battlefield are still used in the medical services of the armies of the world.
With the participation of Jacob Willie, the "Regulations on delivery and mobile hospitals of the army" and "Regulations for temporary military hospitals with a large active army" were developed, which for many years became a guide to action for military doctors of Russia. True, Willie was unable to change some of the issues in the second provision concerning the division of medical workers into doctors and surgeons according to the Western model, which did not exist in Russia before. In addition, the doctor, according to many historians, was against the excessive complication of the structure of mobile and delivery hospitals, but all these protests were not heard. In the army under Will, a wagon with a doctor and a basic set of primary health care equipment appeared for the first time. This was the result of Willie's desire to create a system for the evacuation of the wounded from the battlefield as the main resource for effective treatment. It is noteworthy that the idea of a mobile infirmary was "spied" by Willie from his French colleague Jean Dominique Larrey, who is considered by many to be the "father of the ambulance". French flying infirmaries - "ambulances" proved to be excellent on the battlefields in Europe even a few years before the war of 1812. To each such infirmary of the French army was assigned a doctor with two assistants and a nurse.
Jacob Willie took an active part in the battles of the Patriotic War: he operated, monitored the health of the highest ranks of the army, and also supervised the military medical service. The work of the doctor was highly appreciated by the commander-in-chief Mikhail Illarionovich Kutuzov. In a presentation addressed to the emperor, the commander wrote:
“The chief military medical inspector for the army, the actual state councilor, Willie, throughout the entire continuation of the campaign, with tireless activity, was engaged in the general management of his unit. In particular, in any case, showing zealous care in the care and bandaging of the wounded on the battlefield itself at Borodino, Tarutin, Maly Yaroslavets, Krasny, and before that at Vitebsk and Smolensk. In all these matters, Monsieur Willie, being in person, set an example for all doctors and, we can say that just like skillful operations, under the guidance of his perpetrated, no less than his care in general for all patients saved a large number of officers and lower ranks. All this obliges me to subject Monsieur Willie to an all-merciful view and to ask him for a benevolent rescript."
Drainage evacuation system
A feature of the military medicine of the Russian Empire until the beginning of the 19th century was a powerful system of disease prevention, the beginning of which was laid back under Suvorov. The commander himself was wary and distrustful of hospitals, calling them "almshouses." In the army, there was a cult of personal hygiene, neatness, cleanliness, as well as hardening, training and saving strength in field conditions. However, in the conditions of a new "artillery" war, it was impossible to manage mainly with preventive measures. The war with Turkey in 1806-1812 showed some weakness of Russian military medicine: at that time only one mobile hospital was provided for the entire Danube army, designed for 1,000 wounded and two stationary ones with 600 beds in each. They had to resort to emergency measures and involve the Odessa and Kiev hospitals far from the theater of military operations. The need for reform was evident and, to the credit of the military leadership, it was carried out at an opportune time before the French invasion. As a result, a complex multi-stage system of evacuation and treatment of the wounded appeared in the Russian army by the beginning of the war with Napoleon.
The first on the way of the wounded was the regimental or divisional dressing points or “dressing points” located not far from the front and necessarily marked with “a flag or some other sign so that the wounded could find it without wandering.” At each such point, up to 20 non-combatant soldiers with stretchers worked, and the military police and militias were responsible for the delivery of the unfortunate. The medical infrastructure of the regiment worked for the needs of the "dressing place" - a two- or four-horse pharmacy wagon with numerous toolboxes, bandages and lint (linen rags). At the point, they were engaged in desmurgy, stopped bleeding and prepared for transfer to a delivery hospital, where the wounds were already treated and operations were performed. However, in the course of the Battle of Borodino, the functionality of the "dressing places" was significantly expanded.
In the memoirs of eyewitnesses, the following lines are given:
"In the hollows, closed from the nuclei and bullets, there are designated places for dressing, where everything is ready for amputation, for cutting out bullets, for connecting fractured limbs, for repositioning dislocations and for simple dressings."
The injuries were so severe that surgeons had to perform operations at the earliest stages of evacuation. In addition, many civilian doctors, unfamiliar with the specifics of the drainage system, were drafted into the army before the battle in Borodino. Therefore, already at the regimental dressing points, they tried to provide the maximum possible assistance to the wounded. On the one hand, with this feat, they saved many lives of soldiers, and on the other, they could create queues of the wounded requiring treatment.
At the second line of medical evacuation, a delivery hospital, soldiers and officers were fed: 900 grams of rye bread, 230 grams of cereals and meat, about 30 grams of salt and Rhine vinegar for drinking. Also, an evacuation book was set up for the wounded, in which the nature of the injury and the place of further treatment were prescribed. The location of the delivery hospitals was determined before the battle by the commander-in-chief personally. Usually their number was limited to three: 1st central and two flank. During the battle in such hospitals there was a field general-staff doctor, who was responsible for coordinating the work of the institution. Each hospital was capable of receiving at least 15 thousand wounded and was equipped accordingly: more than 320 kilograms of lint, 15 thousand compresses, 32 thousand meters of bandages and 11 kilograms of a connecting plaster. In total, about a thousand horse carts were distributed between the three delivery hospitals in the Russian army for the evacuation of the wounded.
Mikhail Illarionovich Kutuzov, by the way, made a great contribution to equipping and modernizing the infirmary wagons of delivery hospitals. The count ordered to throw bulky wagons to the ground and make platforms on which up to 6 wounded could lie. This was an important innovation, since in the early stages of the war, the Russians retreated and often hospitals did not have time to evacuate on time. What happened to those who were left at the mercy of the enemy? Most often, death did not await the wounded: in those days there was still a code of military honor in its original understanding. The French treated the wounded tolerably, placed them in hospitals along with the soldiers of their own army, and the wounded enemy did not even have the status of prisoners of war. In fairness, it should be noted that the Russian soldiers treated the French left on the battlefield with respect and participation. We can say that such unfortunate conquerors were even more fortunate - the French military medical service lagged behind the Russian in efficiency.
For example, at the first stages of evacuation, French surgeons practiced "without exception" amputation of limbs for any gunshot wounds. It is important to know that in the French army there was a division of medical workers into doctors and surgeons, and this seriously limited the possibilities for treatment. In fact, the French surgeon of that time was not a doctor, but a simple paramedic. Russian doctors were also surgeons, and also had extensive knowledge in anatomy and physiology. Amputations were not abused and resorted to in a case characterized as follows: "… extensive wounds in the calf and thigh, in which the soft parts are completely destroyed and upset, the bones are crushed, the dry veins and nerves are affected."
There were more professional doctors in the Russian army. So, the staffing of medical workers included: a cavalry regiment - 1 senior and 1 junior doctor; cavalry regiment - 1 senior doctor; infantry regiment - 1 senior and 2 junior doctors; an artillery regiment - 1 senior and 3 junior doctors and an artillery horse battery - 1 senior and 4 junior doctors at once. A novelty and, of course, an effective invention of that time - Larrey's "ambulances", the French were provided with only the guards units. In addition, the French for the worse differed from the Russian army in their disdain for elementary sanitary standards. In this regard, the chief surgeon of Napoleon's army, Larrey, wrote:
"Not a single enemy general could knock out as many Frenchmen as Daru, the chief of the commissariat of the French army, to whom the sanitary service was subordinated."
Bonaparte's "Great Army" approached the Battle of Borodino with losses of 90 thousand people, while only 10 thousand were killed or wounded. The rest were mowed down by typhus and dysentery. In the Russian army, the command of the rules of personal hygiene was instilled in soldiers, including in the form of orders. So, Prince Peter Ivanovich Bagration on April 3, 1812 issued order number 39, which he paid attention to the life of the soldiers:
“To anticipate the multiplication of diseases, prescribe to company commanders, so that they observe: 1. So that the lower ranks do not go to bed in their clothes, and especially without taking off their shoes. 2. Straw, on the bedding used, often change and make sure that after the sick it is not used under the healthy. 3. Ensure that people change their shirts more often, and, where possible, arrange baths outside the villages to avoid fires. 4. As soon as the weather will be warmer, avoiding crowding, place people in sheds. 5. Have kvass for drinking in artels. 6. Make sure the bread is baked well. However, I am sure that all the chiefs will make unremitting diligence to preserve the health of the soldier."
The next stage in the evacuation of the wounded by the Russian army was the mobile hospitals of the 1st, 2nd and 3rd lines. Like all other infirmaries, mobile hospitals had to follow the armies both during the offensive and during the withdrawal. In the first and second lines, patients were fed, re-dressings were performed, recorded, operated on, and treated for 40 days. Those who were "long-term illnesses of the possessed, whose cure in 40 days is not foreseen," as well as those "who, even after being cured, will not be able to continue serving," were sent to the rear mobile hospitals of the 3rd line and inpatient main temporary hospitals. These were the final infirmaries for many of the wounded, from which the road was either back to the front, or home due to unfitness for service.
