with the history of the introduction of the ligature as a substitute
for the cautery iron or boiling oil, previously in use for the
checking of hemorrhage, and for his teaching concerning the nature of
gun-shot wounds, which had been previously and universally considered
as necessarily poisoned wounds; but his new practice and his new views
in these respects were but a small part of the general services which
he rendered. It is not worth while to try to even epitomize here
to-day the history of the ligature; though while its introduction
has been widely credited to Paré, you must not forget that it was
in use many centuries before his time, and was frequently mentioned
by the early writers. What Paré really did was, first, to abolish a
barbarous and unscientific method of dealing with hemorrhage, and then
to re-introduce or promote the employment of the ligature as a far
preferable substitute, more humane, more clean, and more desirable.
And so rather than do scant justice by incomplete reference to Paré's
actual contributions to knowledge I prefer rather to speak of the other
side of this great man's character, and to remind you of some of the
many ways by which he secured such marvellous influence over those
around him, and made his remarkable personality of the greatest use.
As he passed through one campaign after another his reputation became
more and more firmly established, and inspired surgeons the world over
with the desire to visit him. In almost his every act his sagacity was
conspicuously displayed, while, whenever they were called for, his
personal courage and absolute lack of fear were equally apparent.
Deprived of the benefits of early and liberal training he probably, on
that very account, developed his power of thought, his memory and his
analytical powers all the more keenly, inasmuch as these were made to
take the place of what he might have learned from books.
The following anecdote will serve to illustrate, for instance, the
general esteem in which he was held. In October, 1552, the army of
Charles V. was besieging the city of Metz, and Charles himself came to
take command. In the beleaguered city were gathered the nobility and
the bluest blood of France, while at the head of the defending forces
was the Duke of Guise. The imprisoned soldiers and civilians suffered
alike from the onslaughts of the enemy, the rigors of a frightful
winter, the lack of food, and the presence of disease. The Duke had
established two hospitals for the soldiers, which he put in charge of
the barber surgeons of the city, and furnished them with money with
which to procure supplies, but owing to the wretched incompetence of
these same barber surgeons nearly all the wounded perished, and the
horrible suspicion arose that the soldiers were being poisoned. The
Duke sent word to the King of France that the place could hold out for
ten months, but that they needed more medicines. The King then sent
for Paré, gave him money, ordered him to take all the medicines and
other supplies he deemed necessary, and further aided him by bribing
an Italian captain to permit the celebrated surgeon, in some way,
to enter the besieged city. Braving all dangers, and being finally
successful, Paré entered Metz two months later. He had at this time
been with the armies for at least sixteen years, and was known by
sight to officers and soldiers alike. On the day after his arrival the
Duke of Guise dramatically presented him, on the ramparts, to all his
officers, who embraced him, and hailed him with loud acclaim, while
by the soldiers he was received with shouts of triumph. "We shall not
die," they exclaimed, "even though wounded, for Paré is among us." The
effect of this great surgeon's appearance was to give new vigor to the
defenders, and to it was due the fact that the city was saved.
In his time Paré met with success such as to-day would be pronounced
most extraordinary. He inspired the wounded with utmost confidence,
and displayed, always and everywhere, remarkable firmness. Not the
least notable feature in his personal history is it that he should have
so long retained favor at court with such outspoken independence of
character.
Equally reputable among army surgeons of the past, and one of the most
commanding figures in history, medical or other, was Baron Larrey. For
more than fifty years he was an army surgeon, and for a great part of
that period he stood really closer to Napoleon than almost any of the
men whom the latter attached to his person by one or another of those
traits that made him such a remarkable figure. That one of the greatest
murderers and one of the greatest life-savers of all time should
have been so closely drawn to each other, constitutes one of the most
noteworthy incidents of history. Alike in many respects, so unlike in
so many others, it is one of the most creditable features of Napoleon's
career that he should have accorded to Larrey that recognition which
he early gave and never withdrew. Never was such tribute more signally
deserved nor worthily bestowed. Though he passed through twenty-six
campaigns, "from Syria to Portugal, and from Moscow to Madrid," and
though his wonderful courage never failed him under the most trying
surroundings of carnage and conflict, it may still be questioned
whether it did not take a higher degree or order of courage to face
Napoleon in his tent, or tell him plain truths in the Tuilleries.
The history of campaigning affords innumerable incidents illustrating
heroism under fire, or equally trying circumstances, and it is
difficult and perhaps unjust to single out a few for individual
mention. Bravery is confined to no epoch and to no race; it is simply
a God-given trait, not by any means possessed by all men. Take, for
instance, one incident in the career of Larrey. During the landing of
the English on the shores of Aboukir Bay, when General Silly had his
knee crushed by a bullet, Larrey appreciated that immediate amputation
was imperative, and gaining consent performed it, in three minutes,
under the enemy's fire. Just as he was finished the English cavalry
charged upon them; in his own words, "I had scarcely time," he said,
"to take the wounded officer on my shoulders and carry him rapidly
toward our army which was in full retreat. I spied a series of ditches
across which I passed, while the enemy had to go around by a more
circuitous route. Thus I had the happiness to reach the rear guard
of our army before this corps of dragoons reached us. I arrived at
Alexandria with this honorable, wounded officer, where I completed his
cure."
Perhaps under no circumstance did Larrey's courage and zeal show to
better advantage than in the awful retreat from Moscow. For example,
after the terrible battle of Borodino, Larrey made two hundred
amputations, practically with his own hands, where there were neither
couches nor coverings of any kind, when the cold was so intense that
the instruments often fell from the benumbed fingers of the surgeons,
and when food consisted of horse flesh, cabbage stalks and a few
potatoes. And all this while the savage Cossacks were hovering around
equally ready to kill both surgeons and patients. Soon after came the
passage of the Beresina, with its attendant horrors. General Zayonchek,
over sixty years of age, had his knee crushed, and was in need of
immediate amputation, which Larrey performed under the enemy's fire,
amid the falling snow, with no shelter except a cloak, held by two
officers over the patient while the operation was being performed. The
General recovered, and died fourteen years later as Viceroy of Poland.
It was after this passage of the Beresina by the Imperial Guard that
it was discovered that all the requisites for the sick and wounded had
been left behind and on the other side. Larrey at once recrossed the
river, and found himself amidst a furious, struggling crowd, in danger
of being crushed to death, when suddenly the soldiers recognized him.
Immediately they took him up in their arms, crossed the river with him,
crying, "let us save him who saved us," and forgot their own safety
in their regard for him whose merciful kindness they had so often
experienced.
Another incident in Larrey's career: Ever faithful to Napoleon, his
adored master, through victory or reverse, Larrey stood one night with
a small group of medical men gazing over the field of Waterloo, and
upon the wounded and dying who lay groaning around him. Suddenly they
were charged by a squadron of Prussian Lancers, at whom Larrey fired
his pistols and galloped away, but was overtaken by the Prussians, who
shot his horse, sabred him, and left him for dead. After a while he
recovered his senses, and tried to make his way across lots to France,
but was again captured by another detachment of cavalry, who robbed
him of everything, and then took him to headquarters, where it was
ordered that he be shot. Think of such a fate for one who had saved so
many lives! But the order would have been carried out promptly had not
one of the Prussian surgeons recognized Larrey, having attended his
lectures several years previously. Accordingly he was brought before
Bülow, and finally before Marshall Blücher, whose son had been wounded
and captured by the French in the Austrian Campaign, and whose life had
been saved by Larrey's exertions. You may imagine that it did not take
long to reverse that order for execution.
Praise from Napoleon was most rare, but of Larrey he made this remark
in his will, along with a bequest of 100,000 francs, "He is the most
virtuous man I have ever known."
Let us mention a few other instances. For example, Surgeon Thomson, who
during the Crimean war, after the battle of the Alma, volunteered, with
his servant, John McGrath, to remain behind on the open, unsheltered
field, with five hundred Russians so wounded as to be disabled or even
at the point of death. For three days and nights these two Englishmen
remained practically alone upon that field, covered only with dead and
dying, among foreign foes, none of them able to help themselves, or
even to speak in a language that could be understood.
At the battle of Inkerman Assistant Surgeon Wolesley had established
his field hospital in that awful place of slaughter, the Sandbag
Battery. When its defenders were reduced to 150 men, and were forced to
leave it, most of them retreated in one direction to find, only thirty
paces away, a Russian battalion blocking their path. There was not one
competent officer left, so this surgeon took command. Seizing a bayonet
because he had no sword, he spoke hurriedly to the men, and explained
that their next fight was not merely for victory, but for their own
lives; then he led them in a charge that tore so fiercely through the
Russian detachment that but half of them reached the other side alive.
During the South African campaign the papers recorded (but how few read
of it?) the fate of Surgeon Landon, who was shot through the spine
while ministering to the wounded on Majuba Hill. Paralyzed below the
waist, he had himself propped up, and continued his work as best he
could until his strength failed, when he said, "I am dying; do what you
can for the wounded."
It may be of interest to devote here a few minutes to the consideration
of conditions obtaining at the time of our Revolutionary War. In
1776 the barber surgeon still had a place in the armies of the world
and was even then regarded as scarcely more than a menial. Never
was he accorded the respect or the honors of a gentleman, nor was
he allowed to carry a sword. On the other hand, he was subjected to
corporal punishment, and could be caned by his colonel, or almost
anyone else, whenever such an act was provoked. It may be said that
the English troops were somewhat better equipped than were the hired
Hessians, while the French, who came to our aid, brought with them
some far better men, who were in many respects a revelation during our
revolution and an inspiration to our own so-called surgeons. But our
colonial and general governments dealt very stingily with our army
medical department, and their professional equipments were of the most
meagre; in fact, the history of surgery of those days, either in the
army or in civil life, is practically the history of a few prominent
individuals, most of whom had spent the time and money required for
study abroad, and who had come home bringing back with them the best
of their day, such as it was. For instance, there were the Warren
brothers, in Boston, of whom the elder, Joseph, started Paul Revere on
his famous ride. He was elected President of the Provincial Congress,
and just before the battle of Bunker Hill was made Major General of the
Continental forces, a position which he preferred to that of Physician
General, which he had been offered. During the battle he fought with
a musket, as though a private, and was shot down just as the conflict
ended. The younger brother, John, lived to achieve fame and reputation,
and transmitted them to his posterity.
During the war some colonial regiments even came into camp without any
surgeon, or the slightest provision for disease or injury. In 1776
Congress ordered that there should be one surgeon and five assistants
to each 5,000 enlisted men, the former being paid $1.66 per day,
the latter $1 a day. Imagine the attention that could be bestowed
upon 5,000 soldiers by six men whose services were thus compensated.
Camp hygiene, hospital corps, and ambulance service were undreamed
of; nevertheless John Warren, then only twenty-three years of age,
accomplished a great deal in building up a medical corps, while as much
more was done by Benjamin Church, of Boston, who was styled Director
General and Chief Physician, and who was paid $4 a day. Unfortunately
Church was detected in traitorous correspondence with the enemy,
was court-martialed, imprisoned for a year, then allowed to leave
the country, and was probably lost at sea. He was succeeded by John
Morgan, of Philadelphia, who had to fight the politicians as well as
the foreign enemy and, failing to satisfy them, was dismissed from the
service, though acquitted from all blame. Thus you see that even in
those days the politicians made it hard to secure adequate and proper
care for our sick and wounded soldiers. Everywhere at that time were
unrest, excitement, and suspicion, and their demoralizing effects
showed in every department of military as of civil government. After
Morgan came Shippen, who held office from 1777 to 1781, under whose
guidance affairs in the medical department improved very much. Smallpox
had been perhaps the greatest scourge of the soldiers, as well as of
the people in general, but this was kept in subjection by the practice
of inoculation, which had been generally accepted in this country by
nearly all men from Washington down.
A word or two must also be said about that remarkable man, Benjamin
Rush, with his many-sided, versatile, erratic, obstinate and querulous
character, who nevertheless constituted in his day the most prominent
figure in the profession; who served two years in Congress; who signed
the Declaration of Independence; and who, in the same year, got his
first army medical experience. It was perhaps not strange that, with
his peculiar temperament, he failed to come under the influence of
Washington's peculiar personal magnetism, and that their personal
relations were not at all to Rush's credit, since he endeavored in many
ways to belittle his Commander-in-Chief, and suffered therefor a rather
ignominious exposure.
The temptation is always to place most stress upon accounts of heroism
which happens to be most publicly performed. While this is not
unnatural it is often an injustice, since an act of courage may be
performed in the lime-light of publicity, with a regard for notoriety,
that would be lost were it done in private. It perhaps is not kind
to think that anyone would ever be more courageous in public than in
private, and yet it is to be feared that human nature is not always
free from temptation of this kind. But the real silent heroes of
military or civil medical life are those who engage in duties which
nevertheless have even more of danger about them than spectacular
performances upon the battle field. Take for instance, the work done by
Major Reed and Dr. Carroll, who devoted themselves for months to the
study of yellow fever. Many a man will stand upon the field of battle
permitting himself to be fired upon, but how many will deliberately
submit to being bitten by insects believed to be carriers of the germs
of yellow fever. Dr. Carroll had this quiet kind of bravery, and
allowed himself to be bitten by a mosquito that twelve days previously
had filled himself with the blood of a yellow fever patient, and in
consequence suffered from a severe attack, barely escaping with his
life. Dr. Lazear permitted the same experiment upon himself, but was
not at that time infected; but some days later while in the yellow
fever ward he was bitten by a mosquito, made careful note of the fact,
acquired the disease in its most hideous form, and died a martyr to
science, as true a hero as ever died upon fortress or man-of-war.
Others, too, willingly exposed themselves, but there was at that time
no other fatality to record. But realizing the value of the service
rendered, the indisputable proof of the nature of the disease, and
the method by which it is carried, the value of the demonstration
becomes inestimable, since a true prophylaxis was demonstrated, and a
means furnished of ridding the community of this fearful pestilence.
Moreover, it was shown how unnecessary it is to destroy valuable
property, it being only necessary to kill the mosquitoes, and do away
with their breeding places. Major Reed died a few years after he had
led in this fight against the dread disease, but no monument, or other
testimonial which can be erected to the memory of Reed, Carroll and
Lazear can adequately express the value of the service which they have
rendered to the world.
"Peace hath her victories no less than war." This epigram is as true
of the conflicts in which the medical profession engage as of any
other. This same sentiment has been put in other words. It is said,
"That peace hath higher tests of manhood than battle ever knew." For
instance, in New York there is a simple tablet commemorating, in loving
remembrance, the death of eighteen young physicians who, one after
another, attended a ship load of emigrants sick of typhus fever on
Quarantine Island. They fought their good fight and were buried without
martial music, adding eighteen names to the innumerable list of victims
who have fought the silent battle of dealing with disease, public
gainers only in this, that someone has been thoughtful enough to record
their names in this semi-public fashion.
Taken again the case of Dr. Franz Muller, of Vienna, who contracted
the bubonic plague while working in the laboratory with its germs.
Just so soon as he realized that he himself was infected he locked
himself in an isolated room, and pasted upon the window pane a sheet
of paper containing this message, "I am suffering from plague. Do not
send a doctor to me, as in any event my end will come in four or five
days." He refused to admit those who were anxious to do for him, wrote
a letter to his parents which he placed against the window, so that it
could be copied from the outside, then burned the original, fearing
that if sent through the mail it might carry the elusive germ. Was not
this equal to any instance of valor under the excitement or the stress
of battle and cannonade? Could anyone more worthily win a Victorian
Cross, or any other emblem of courage and heroism?
Many of you have been in, or will go to Havana. It will be worth your
while to make a pilgrimage to the cemetery there, where were buried
sixteen young medical students who lost their lives under peculiar
circumstances, which afford as well an illustration of Spanish tyranny
and injustice. In 1871 one of the professors in the medical school
died, and was followed to his grave by the students whom he had taught,
and who loved him. Unfortunately they committed an indiscretion
by scribbling with a pencil in a public place some criticism on
the government; in consequence they were reported, arrested and
court-martialed. The written paragraphs were evidence sufficient, and
the Governor General ordered the ranks of students to be decimated.
There were 160 students all told, and in accordance with this sentence
sixteen of them were next day shot without any further ceremony. Of
these the youngest was not quite sixteen years old, and his father
offered his entire fortune for his life, but without avail. Later the
citizens of Havana erected a monument of white marble, at no small
cost, to commemorate this sacrifice.
There comes over me, as I prepare these words to read to you, a
feeling of their inadequacy, and of lack of personal justice to many
of my auditors. Brought up in civil life, with but a smattering of
military training, I am rehearsing incidents of which you may read
as easily as I, while at the same time I do not forget that from
the lives of many of my auditors there might be drawn just as many
illustrations of courage, fortitude, endurance and personal valor as
any that the Surgeon General's library records. Unfortunately I am not
familiar with them. They are, happily in one respect, too numerous to
mention, and again are not yet public property, because modesty is
ever the accompaniment of these other traits which we all admire so
much. Hence, gentlemen, if I seem to you to disregard or forget many an
incident in your lives or the careers of your friends, ascribe it to my
ignorance rather than to my intent, and to the fact that I have never
seen a battle, and that my fights with disease have not been fought
in camps, but within the walls of the quiet sick room or hospital
ward. Nevertheless I am never happier than when I can try to compel a
wider public recognition of what you are constantly doing and of your
valorous deeds.
Next to those general improvements in the service which have come about
through natural causes, and as results of a better appreciation of its
needs, and of a generally improved state of the profession, nothing
has come from outside during the past fifty years which has been so
helpful and advantageous as the support afforded by the Red Cross, and
the introduction of skilled nurses; in fact the greatest help which
the medical service of the army and navy can enjoy is that which comes
from this volunteer and outside source. By the way, I wonder how many
of you recall, or are familiar with, the beginnings of the Red Cross
movement? So important has it become that its history should be well
known to all. In June, 1859, was fought the bloody battle of Solferino,
at the conclusion of which some 36,000 French, Sardinian and Austrian
soldiers lay dead or dying on the field. The medical corps was, of
course, absolutely inadequate to the work thrown upon them, and as
usual thousands of wounded men had to care for themselves as best they
could. A Swiss traveler, Henri Dunant, viewing the scenes, and being
profoundly impressed by them, not only assisted in the work of relief,
but wrote a book entitled, "A Souvenir of Solferino," in which he urged
more humane, widespread and speedy aid to the wounded. M. Moynier,
president of the Society of Public Utility, of Geneva, a man of
independent means; Dr. Appia, a wise physician, and M. Ador, an eminent
lawyer of Geneva, also became interested in the movement. The attention
of the General of the Swiss Army was called to it and his co-operation
enlisted. In this way came about, in 1863, the formation of a permanent
society for the relief of wounded soldiers. At a meeting held in
October in the same year men from many countries joined in discussing
the subject, and an international conference was held, which resulted
in calling an international convention, to be held at Geneva in the
autumn of 1864.
Such was the beginning of the Red Cross movement, which has now
extended all over the world, and has afforded an opportunity for all
races, creeds and nationalities to care for those who are made victims
of war or pestilence, or who suffer from any other great disaster
with which private charity is unable to cope. It marks a step in the
evolution of mankind, and has now achieved such universal recognition
that national governments and individual potentates are glad to join
hands in the great work.