http://www.ageofvictoriapodcast.com/ep009-god-save-surgeons-knife/ 

 

If you’ve been listening to recent episodes you will know that we have just covered the 100 campaign and the absolute hell that was the Battle of Waterloo. As I said at the end of the last episode, I’ve tried to give you the human cost without national gloss at least as far as possible. You might have noticed a curious omission. Despite all the detail I’ve gone into, I’ve barely mentioned the care of the wounded or the doctors. The reason is that I wanted to do a deep dive on what would have been called “the butchers bill” I am doing this, partly for completeness, because it is fascinating and it is a sharp contrast with some of the immense advances of the Victorian era, but also because it is often barely touched on in films & books on Waterloo in any kind of detail. There is a notable anniversary  book on Waterloo that relegates the medical issue to basically a page, gives the tiniest summary, gets the causes of an amputation wrong, then skips on to an anecdote. Medical care is a crucial part of war. It isn’t separate from it, or an after thought. How troops and generals viewed and provided medical care was a major dimension of warfare. 

The Napoleonic Wars created a mass of wounded and sick men in need of care. They also maimed thousands of horses that required veterinary attention. I’ve had a lot of great feed back from everyone on how much they’ve enjoyed the Waterloo episodes and the personal perspectives I try to give to history, but some have said they found the descriptions a bit traumatic. So I need to give you a fair warning that this medical episode is going to have come fairly graphic content. There will be descriptions of amputations and other painful injuries so if you are particularly squeamish about medical issues, you should probably skip this and wait for the next minisode.

Still with me? Good, because the C19th is not for the faint of heart. There were significant casualties to treat after Waterloo. How were the armies going to respond? Would they respond? Remember it is a modern ideal that all life is precious and sacred. Through much of human history, a lot of human lives have been considered disposable. Some armies in history would have perhaps abandoned their wounded to whatever ad hoc care that they could beg for themselves. Others might have regarded medical care as useful only if the soldier in question could be quickly returned to the fight. Of course some armies prided themselves on medical care, notably the Ancient Greeks and Roman Legions. 

Even armies that adopt a harsh attitude, perhaps like the Spartans, or the medieval English, are not immune to the feelings of the soldiers themselves. Soldiers liked to know that they would be helped if they were injured. They didn’t like watching comrades die if they could be saved. They often fought better if they could have confidence that there was going to be some kind of medical provision.

By 1815, not only was this being recognised, but other factors were coming into play. Enlightenment ideals about medicine as a science were becoming established. The early nation states began to realise that soldiers were a valuable asset and perhaps treating them was better in the long run than letting them die and having to train new ones. Many amateur medical staff began to view themselves as serious professionals, and took pride in their craft. 

In a rough total there were around 45,000 dead and wounded to deal with after Waterloo. It is crucial to remember that there are an almost infinite number of ways to injury a human in battle. Simplistically we could say soldiers suffered gunshot wounds, cannon wounds, cuts, breaks, sword blows both slashes and thrusts, and burns. That list is of course an almost meaningless summary. A man might be grazed across the side of his jaw by a spent bullet and therefore be described as having a gunshot wound, but then he receives a sword cut from a French cavalrymen that lands on his upper arm cleaving the bicep muscle down to the bone. Of the two it is actually the sword cut that is much more serious, but the problem is that to a modern person it is easy to mentally assume gunshot is more serious just because we are more used to hearing about them.

Also I want you to remember as we discuss wounds, treatment and general medicine today that you need to leave a lot of modern baggage at the door. First, don’t make the mistake of thinking of these weapons as primitive. They are less technically complicated than today’s weapons and sometimes less lethal, but they were still all highly effective implements of war. Easily capable of killing or inflicting the most horrific wounds. Swords were well designed and deadly. Cannon were absolutely murderous, and muskets have killed hundreds of thousands of people since they were introduced.  

Secondly, modern assumptions about pain and people’s expectations of treatment are very different. In fact it is almost impossible to quantify the difference in mind set. The C19th was an age were many jobs and professions left people horrifically maimed. Disease was rampant in civilian as well as military life. Don’t assume that just because someone was deemed treated effectively, in a way that sounds shocking today, that they would have been unhappy with the result. 

Thirdly, expectations about pain control were very, very different. If you’ve worked in the medical field you will be familiar with the idea that pain is actually a relative concept. People experience pain differently. One persons mild bump can be another’s crippling agony. A stubbed toe is nasty to a child, but can perhaps be a hospital trip for a 90 year old. I would like you to also remember that there is no right or wrong way to react to pain. It is a subjective experience. That’s why people are asked to rate their own pain on a scale of 1-10 relative only to their own feelings. Some people have a higher tolerance and some people have a lower one and will be unable to carry out day to day functions. The mistake is to think that either approach can be objectively wrong. In fact I bet a lot of people listening have the idea that somehow pain control is a bit wrong. That people should endure as much as possible and avoid drugs. This is very much a cultural value judgement. Pain is just your bodies way of signalling that something is wrong. It doesn’t have a moral dimension. It just tells you “Hey you rammed your toe against a hard object, damaged it and you really need to refrain from walking or running for a while whilst the bodies damage control systems repair things” You however have a cultural expectation. Your boss doesn’t care that you are in agony, or that getting to work is now extremely hard. She doesn’t care you have trouble carrying stuff out from the stock room. All she cares about is that you are making annoying noises that distract her, and that you need to move at your usual speed to keep productivity high instead of nearly crying at each step. She applies the standard management remedy of threatening you with loss of pay or the job, certain that you just require better motivation to heal more quickly. Again this is entirely a social response. Modern society views most claims of sickness as some kind of attempt to rob a company of productivity, and that if people toughened up they wouldn’t get injured or sick so this is their moral failure. Arguments like this have raged in one way or another throughout history. 

In the aftermath of Waterloo, there were a lot of badly injured people. By any standards, this was a huge medical disaster to cope with. A modern example of how difficult this can be is people responding to the tragic mass shooting in Las Vegas recently. Hundreds of people were in need of help. Think about how difficult it was to get that help to the right people. How were they located and identified as needing help? Hospitals and ambulances had well drilled routines. The modern medical system has an ocean of resources just waiting for these kind of events. Even with all this. Even with the heroic efforts of first responders, brave police, modern roads and structures, it was still a huge undertaking. Above all there is a knowledge and recognition of a “golden hour” after treatment, when medical treatment makes the greatest impact. The idea’s for that would actually be based on knowledge that was being gathered during the Napoleonic wars.

At Waterloo this massive system of support was entirely absent. If a modern doctor walked onto the field of Waterloo straight out of a time machine, and was told “well go on, help people” he or she might have a panic attack. Where to start? Even all the modern knowledge he or she has about infection, pain control and anatomy and genetics, these would be of limited help without the mass of complex resources and systems that enable modern medicine. 

Now I’m going to focus on the British medical services in the main. The British did indeed treat medicine seriously in the main. They considered themselves a modern nation with highly educated gentlemen, who had the tools, skills and knowledge to perform incredible feats of medicine and science. As always though, the reality was a lot more complicated. Attitudes varied up and down the social class structure. There was immense local variation in what treatment was available or desired. A small village might be reliant on an apothecary of some sort, plus local treatments and folk memory. Injuries were often farming or drink related and disease was common, probably various forms of fever. In a large city like London, a wide variety of disease and injury were available to the local population, including the diseases of cramped cities as well as increased levels of STD’s. Balanced against this, it was possible to find more varied medical treatment. Apothecaries vied with early pharmacists and barber surgeons. 

At the top of the social & medical pecking order though sat the physician. A physician was university educated and usually a wealthy gentlemen. He would have read the classics, including the ancient medical texts of Galen and the various Arab physicians. He would almost certainly read and written in English and Latin, plus perhaps Greek. Whilst he would have obsessions that might seem strange today, such as a focus on bleeding, he would have probably known a lot of more up to date medical literature. If he was especially forward thinking he might even keep case notes, and pass his experience on. Many, probably most, considered themselves serious professionals who were invested in keeping patients alive and healthy and not just for the income. Men like the famous Dr Larrey of the French Imperial Guard were internationally regarded for their medical brilliance. Notice that I am saying he. Women would not really have become physicians at this time, with one or two extremely exceptional cases such as disguising themselves as men. This, plus the high cost of university effectively limited the profession to the sons of rich gentlemen, which severely limited the pool of talent to draw on.

Don’t forget as we go along, that the most advance medicine of any time, will always appear primitive in hindsight. In the 1950s, people thought they were in a golden age of medicine, yet those same techniques look so backwards today.

The social attitudes carried over into the army and navy. The actual profession of medicine was steeped in snobbery. As a result of their education, the physicians felt themselves superior to others in the medical field. They could command high wages, unlike many of the army surgeons, although they weren’t always viewed as completely respectable. Much depended on who the physician was treating. Clearly the Royal Physician would have considerable social standing. 

The high cost of becoming a physician deterred many. Qualified physicians were sometimes hesitant to actually practice hands on medicine, leaning more towards some esoteric theory. Even fewer physicians were actually willing to join the army. The army simply didn’t have a high enough social standing before Waterloo. Joining the army took them away from lucrative civilian practices. Worse was the risk of ending up in what was considered an “unhealthy station” like the Caribbean or somewhere on the African coast. Death from Yellow Fever was as much of a risk for a highly educated physician as it was for a regular soldier. A lot of these military postings were in countries that were known during the Victorian period as “the white man’s graveyard” due to the enormous mortality rates caused by various diseases.

 The consequence of this was that the fully qualified physician was a rarity and not commonly encountered by regular troops. Social snobbery meant that experienced army surgeons were barred from being promoted to physician so there was an acute lack of practical experience with military disease amongst the physicians, until the old ruling was abolished in 1811. The back bone of the army medical profession was to be the army surgeon. Social snobbery meant that progression was difficult for army surgeons, but many made real strides even if the profession evolved haphazardly. You’ve probably all heard that barbers and surgeons were interchangeable in the middle ages. Well by the Napoleonic Wars changes were sweeping through the ranks of the surgeons. No longer were they associated with barbers. Surgeons could often by committed, professional men, seeking advancement in the military and helping patients. They were assisted by surgeons mates, who varied in quality from aspiring surgeons to drunken incompetents, sometimes regarded by the army as ranking below the horses. 

Treatment depended very much on who you were, where you were, what provisions the armies senior officers had decided to provide, and crucially if your mates were around to help you. If you suffered an incapacitating wound, you became reliant on your immediate friends to move you if possible or get help. If your battalion had been forced to retreat, and you got left behind, well things could turn very nasty for you. You could be left unnoticed to die of blood loss, dehydration and infection. Or a miracle might happen and an enemy might decide to care for you. Social standing played a large part. Ideally you were a officer who had been spotted performing something heroic, and a romantic enemy officer might decide to get you recovered in an act of chivalry. This was more common if an enemy general was captured. If you struck gold, perhaps Napoleon heard of your case, and your high rank meant you might get attention from Dr Larrey himself. Since he was probably one of the finest doctors in the world, a forward thinking professional, you might actually get better care than you would have got in your own army. For most though, this would have been like winning the lottery twice. The reality for most was that they would be looted by passing enemy soldiers, and probably just bayoneted or left to die. If the battlefield looting was survived, it was essential for the injured soldier to drag himself to somewhere off the battlefield and get help. 

Injured soliders who remained on the field if the army had moved on were now in terrible danger. Local peasants and other civilians would flood the battlefield to ruthlessly loot the fallen. Many soldiers were stripped naked, and a knife quickly drawn across the throat. In the pre-modern age, everything had value from boots to buttons to teeth. If the injured soldier was alive, the looter might be in a hurry and not kill them. Sometimes a solider might be wearing a ring that was hard to take off. Alive or dead, a looter could very well chop the fingers off. Teeth were also valuable and if the looter didn’t want to get blood on the clothes from stabbing a wounded man, then they might rip the teeth out of a living injured soldier. 

For this reason civilian looters were regarded as scum by soldiers throughout the Napoleonic and Victorian periods. A soldier might regard himself as entitled to loot because he had risked his life in battle, but a civilian had no such entitlement as far as a soldier was concerned. Looters were often chased off, or run down by cavalry, or stung up from a tree, or given a good beating as a warning. Wellington had very strong views on looting and maintained a strict system of Provost Marshals to keep order.

There was another slim hope for the incapacitated soldiers. Sometimes the army remained in place. Musicians were often employed during battle as primitive stretcher bearers and would often search the battlefield for injured who might still be alive.

As you can see though, for the injured getting off the battlefield and getting treated was vital. It could often a case of looking out for yourself. Men performed feats of endurance that sound shocking to us today.

That first big problem of getting off the field was complicated just by the logistics of it. Men performed feats of endurance that sound shocking to us today. Men with lost limbs would force themselves up, and to travel to get help must have been agonising. Most regiments had some form of band and would employ bandsmen as stretcher barriers. These were not the modern, lightweight easily portable versions we know today. Some were canvass with long heavy poles. They were hard to handle and very heavy. They were an encumbrance. Some regiments used a simply canvass sling under a light weight pole. This was more comfortable and quicker, but it swayed and compressed the injured body.  Neither method was waterproof, nor did it keep the injured warm and stop them going into shock.

For Scottish regiments, the long sashed kilt might be a very useful alternative. An officers kilt could be used as a soft carrying blanket. A popular senior officer supported in his kilt by four strong Scotsmen could be moved fairly quickly off the field and in some comfort. Of course an unpopular officer might find it difficult to attract attention and end up dying a lonely death. Carts were common off the battlefield, but not on it. The forward thinking French experimented with ambulances.

Treatment naturally depended on the nature of the injury. As this was the age before the discovery of infection or antibiotics or anaesthesia, treatment tending to be more based on surgery and home remedy than what we would consider appropriate today. Surgeons should have had a personal kit containing their favoured surgical implements although difficulties on campaign sometimes left them without their kit. These kits were usually boxes or rolled hand bags or grips, usually contained a knife or scalpel of some kind, a saw, various hooks and retractors, and the only really effective pain killer of the day an opiate called Laudanum (containing approximately 10% powdered opium by weight, equivalent to 1% morphine). This was an opiate, but nothing like as effective as modern morphines, or ethers, or even cocaine or chloroform. When and how to intervene was very much based on the judgement of the individual surgeon; there were no standard clinical guidelines. Some surgeons, particularly very clever ones with good analytical data to back it up (like Dr Gutherie) were convinced immediate intervention was essential, as quickly as possible with only a small pause to stabilise the patient. Others preferred to wait longer to allow the patient to recover more before surgery, especially in the case of amputations. This was risky either way. Lacking saline, the patient was at risk of immense fluid loss, and delays could exacerbate the problem. Besides waiting increased the risk of infection. Of course, the surgeon was unlikely to sterilise his implements or even wash his hands between operations, so infection during surgery was frighteningly common. It was a common prayer across the various armies “god save me from the surgeons knife.”

None of this should mislead you into thinking that surgery was mere butchery. It most certainly wasn’t. Circulation was well understood, and there would be no recourse to magic, or horoscopes or balancing of humours as might have been the case until fairly close to the period. Bones could be set with skill, and even fractured skulls could be repaired. If you have seen the film “Master and Commander” or read any of the excellent Jack Aubrey books, there is an excellent scene where Dr Maturin replaces a fragment of skull in a comatose patient with a piece of coin. This is based on historical accounts and was a surprisingly complicated operation.

One of the other big tools missing from the surgeons arsenal was his ever present companion of the future – the Anaesthetist. The anaesthetist does far, far more than put a patient to sleep. They perform many essential functions; keeping a patient deeply asleep, with muscles chemically relaxed to the point where unaided breathing would be impossible. This state of muscled relaxed unconsciousness, along with antibiotics & pain control is one of the great foundations stones of sophisticated modern medicine. Without it, surgery is extremely difficult. 

Still, the surgeon did have some other tools at his disposal. There was the trusty wooden spoon and gag to ensure that a patient didn’t bite their tongue off during the operation. Alcohol was eagerly sought by patients. A bottle of rum or pint of brandy or even both would be considered as good for the pain as anything else. Some surgeons still used tar or hot iron for cauterisation but it was dying out. Fine silk stitches were used to close arteries and even hold falls of skin over the exposed ends of the stump of an amputation. Various poultices were used, some of which were honey based and could be surprisingly effective as honey is anti-bacterial. Leeches were dying out, but that’s actually a pity as they and maggots could be used to remove dead tissue or reduce bleeding. Drums were sometimes beaten during surgery as the noise and distraction could help. If all else failed, surgeons often exhorted soldiers not to show weakness in front of captured enemy soldiers, and to be quiet so they didn’t let their country down.

False teeth could be crafted to help with primitive dental surgery, and of course wooden legs or fake hands were created for patients. The richer the patient, the more elaborate the finished product might be. 

The later you reached the surgeon of course, the more tired he was likely to be. This meant more mistakes, with knives and saws getting more and more blunt, and all the implements getting increasingly dirty. Some surgeons after Waterloo were awake and operating for days in a row, often by lamp light. Patient mortality rates were enormous. Busy surgeons were known to hold their surgical knives between their teeth to free up hands to tie off arteries. 

Whether intentional or not, triage systems were adopted by almost all surgeons. No surgeon could afford to spend hours of time trying to save a hopeless case. In the time wasted on a patient that couldn’t be helped no matter what, he might lose other patients that could have been helped. Whilst sensible, it was hard on the doctors to have to leave soldiers to die, often alone in agony. 

Walking wounded would sometimes be dispatched back to full hospitals in cities like Brussels. Typically in a battle, a regiment would set up a dressing station close to where the battalion was deployed. There would be large field style regimental or army hospitals behind the main lines. The bulk of the casualties would be aiming to be dealt with either at the dressing station or the regimental field hospital. Going to a main army hospital was not necessarily a good idea. They were sometimes well equipped but some were little better than death traps. Unsanitary and often made up of buildings like monasteries occupied for the purpose, infection and disease ran rampant in them. The quality of medical staff varied wildly, ranging from competent to unqualified drunken orderlies who had somehow got themselves appointed “surgeons assistants” or “surgeons mates.” These men would be an eclectic mix of ambitious, but poor soldiers without the money, education and influence to become regimental surgeons, or they were sometimes the purest dregs who preyed on the helpless to rob or rape.

Rich officers would sometimes prefer to get comfortable private lodgings and a personal physician to attend them. This greatly increased their odds of survival. Rank did interfere with the triage system as well. Some surgeons would instinctively leave wounded troops to treat senior officers. Often this was because they recognised that the senior officer was more important to the overall war at that moment. No one could sensibly argue that if Wellington or other vital officers were injured then they shouldn’t take priority. The loss of Wellington would have meant the destruction of the Allied army. What was considered less appropriate was surgeons leaving off treatment of NCO’s and officers to treat lightly injured generals – usually to secure professional advancement or a lucrative source of income. 

Like all men under fire, some surgeons or assistants would not be willing to move forward to treat injured men. This is understandable. Humans in battle get flooded with adrenaline. They often suffer from a kind of tunnel vision. Creative thought becomes more difficult and the mind defaults to the practiced and well known. It isn’t a case of cowardice. These were soldiers under fire; they were simply facing the immense stress of battle. In some cases it would be clear that moving to help would be suicide anyway. Cannon fire couldn’t distinguish between medical staff and active combatants, so the exposed forward slopes were a risky proposition for anyone at Waterloo. Even if cannon fire wasn’t a problem, it was accepted that pretty much anyone on the battle field was a legitimate target for the enemy, so riding down a group of soldiers treating the injured would be considered good sport by many cavalry. 

Dreaded nearly above all was the amputation, especially of the leg. An arm could be surprisingly easy to lop off. Especially below the elbow. Some men declined the offer and preferred to live with a shattered hand or arm, and take their chances on gangerine developing later. Surgeons didn’t immediately jump to amputation. Arm wounds especially were managed without amputation if at all possible, since they had a better chance of positive recovery, although opinions were mixed. Dr Larrey said 

[QUOTE] If it should be said that the amputation of a limb is a cruel and dangerous operation, and one always fraught with grave consequences for the patient who is left in a mutilated condition, and that for these reasons there is more honour to be gained by preserving the limb than by amputating it, however skilfully and successfully done, the reply which admits of no denial is that amputation is an operation which offers a chance of recovery to an unfortunate individual, whose death appears certain by any other method of treatment.[END QUOTE]

A good example was Wellingtons staff aide Fitzroy Somerset, who lost his arm at Waterloo, but carried on a military career. He would eventually become Lord Raglan and his incompetent command in the Crimean War would lead to thousands of unnecessary casualties. 

Cases where there were extensive joint injuries, complex compound fractures near joints, or where there lacerated vessels and nerves, were all high priorities for amputation. Leaving the limb intact would guarantee infection and death. You can see that the doctors in the profession were acutely aware of the risks of various outcomes and genuinely wanted to do the best they could for their patients. Some debated whether to amputate immediately on the battlefield, or wait till the patient was stabilised and then operate a few days later. 

Cavalry swords and cannon shot sometimes did such a neat job of taking off an arm, that the surgeons main job was just tidying up, and monitoring for signs of fever or infection. Men like Nelson lost arms and eyes and continued to have distinguished military careers. The Royal Navy almost certainly never sent out a warship where at least some officers hadn’t lost body parts. 

But many injuries were far worse. These were the terrible leg wounds that could require an amputation well up the limb, or worse at near the hip. The leg has the great femoral artery in it. A high amputation required that artery to be cut. Bleeding would be massive and the operation itself could be hugely traumatic.  There’s a harrowing quote from Sgt Thomas Jackson in Spain.

[QUOTE] They had got me fixed upon the end of a large barrack room table, sitting upright, with my legs having down. A basin was brought for me to drink out of it. I said, Sir let me have a good draught. He poured me out nearly a pint of rum which I eagerly drank off. In an instant, it raised my spirits to an invincible courage. The sergeant was preparing to blindfold me. Oh no I said, I shall sit still and see as well as the rest. One of the surgeons sat on a stool to hold the leg steady, the second ripped up my trousers and took down the stocking low enough, then he waited on the head surgeon. The tourniquet being placed painfully tight above the knee, he put his hand under the calf of the leg and setting the edge of the knife on the shin bone, at one heavy, quick stroke, drew it around till it met the shin one again…. the blood quickly following the knife spread around and formed like a beautiful red fan, downwards. Next the surgeon with his hand forced the flesh up towards the knee to make way for the saw. When the saw was applied, I found it extremely painful; it was worn out. It stuck as a bad saw would when sawing a green stick. I said Oh Sir have you not a better saw? He said he was sorry he had not, as they were all worn out. The bone got through, the next thing to be done was still more painful. That of tying up the ligatures. Then followed the drawing down of the flesh to cover the end of the bone, and tightly strapped there with strips of sticking plaster. After this strongly bandaged. And thus ended the operation which lasted about half an hour. [END QUOTE]

 The Sgt was lucky. The higher up the leg the amputation, the more likely was death. It should come as no surprise that a leg amputation had an extremely high mortality rate. 40-50% was not unknown. Phantom pain was a problem, infection was almost certain, and complications and ultimately mortification was highly likely. Still, both Dr Larrey and the British surgeon David Brownrigg managed to perform an operation at the hip with a patient surviving. An almost unheard of event. The agony would leave the individual with immense mental trauma. Life long suffering was the result. And all of that, was being done by a doctor trying his best to save your life and help you live in the best condition you could. Today we would regard this as brutal torture, but in 1815 this was state of the art battlefield medicine. Still doctors like Dr Gutherie were using these experiences and collecting statistics on outcomes to make huge advances. Understanding about infection was boosted, as Gutherie demonstrated that mortality rates for early amputation were far lower than in patients who were moved to larger hospitals first. Soldiers were better off having their limbs amputated on the field of Waterloo, rather than being evacuated to a hospital in Brussels where mortality rates climbed sharply. Guthrie was keen on splinting where possible to avoid amputation. If possible wounds were probed with forceps and foreign objects removed, including not just bullets but also coins, clothing and teeth driven into wounds by blast damage. It was exceptionally painful, but if it could spare a man an amputation, deep probing was preferred.

 In any case of damage to the torso or head, amputation wasn’t an option anyway so probing, surgical excision and stitching were the main viable treatment paths. Whilst injuries to the torso, especially lungs were viewed as fatal, surgeons still made valiant efforts with surprising success. Fractured skulls were difficult to treat, but it was done with care and sometimes positive results. Even brain surgery could be attempted, especially in cases where death was otherwise certain. 

Much depended on the skill and ambition of the surgeon, plus how much time he had available. Guthrie and Lowrey both performed complex bowel and abdominal surgery, and Lowrey managed to extract musket balls from men’s lungs, sometimes removing ribs to gain access. In circumstances like this, we can see why soldiers were terrified of the fate that might await them. 

Of course infection was incredibly common. I won’t go into all the types and effects, but this was all before Joseph Lister did his pioneering work on antiseptics and infection control in the mid Victoria era. Dirty instruments and poor dressings were the norm. Surgeons and assistants rarely washed hands between patients, sharing the same instruments used between operations. Face masks and sterile gloves were simply unknown. Often honey based herbal poultices were the best anti infection treatments around. 

So that gives you the picture of what was suffered after Waterloo. Surgeons worked for days on improvised tables under lamp light. They worked till they were dropping with exhaustion. Clothes became stiff with blood and some could hardly move fingers. For every brilliant Dr Guthrie there were hundreds of other competent unsung surgical heroes and hundreds more inept butchers, or complete novices learning surgeon on wounded men under pressure.  

Such was the price to be paid. Mars had wrecked havoc on the men in battle, now they were in the hands of Apollo and Dr Guthrie. Looking at this in reflection, it nearly beggars belief anyone would be a soldier. You can see why Napoleon’s glory was seen as having too high a price in the views of many of the time. 

Fortunately for soldiers of the Victorian age, some immense changes were coming. Books would be written setting out the lessons in surgery and treatment learned at such high a cost. Many surgeons had died with their men in battle like Sir William De Lancey. Others like Dr Lowrey were captured by the Prussians, although fortunately he was released. Guthrie would go on to have a brilliant career, become a fellow of the Royal Society and President of the Royal College of Surgeons. He was offered a knighthood, but pleaded poverty to turn it down. 

The surgeons would see an increasing climb in the respect and influence of the profession, whilst the physicians had to scramble to mend their out of touch, hands off reputation. The field of Waterloo would not be cleared of dead and wounded for 12 days. Many wounded simply died of dehydration. Civilian sightseers were often shocked but I can’t imagine how the surgeons coped and went on to live with themselves in the aftermath of battle. Every doctor wants to preserve his patients life as best as possible but battlefields do not allow that guarantee. Even in modern medicine we cannot guarantee that people will live, but for the surgeons of the time at Waterloo, they had to watch probably hundreds men who were desperate, die. And they couldn’t help them, no matter how good they were with the knife. It must have lived with them for the rest of their lives. I don’t know what impact that might have had on them. Still many many fortunate men like Sgt Lawrence walked towards Paris, doubtless glad that their prayer “God save me from the surgeons knife” was answered. 

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