Prior to the 18th century, the means used to transport the sick and the wounded, in both military and civilian life, were haphazard and unpredictable, where they existed at all. Even armies lacked the most rudimentary medical transport and services. Wounded soldiers might be left to die of hunger or thirst, if they did not succumb to their wounds, or their friends did not carry them to safety. Occasionally, some effort was made to tend the wounded, such as organizing the regimental band to perform this task. 
A revolution in the care and transport of military casualties began in 1792 when Dominique-Jean Larrey, MD, "invented and constructed the ‘ambulance' or flying hospital, for the purpose of affording assistance to the wounded on the field of battle."  During the Napoleonic campaigns, Dr Larrey developed a system of casualty transport that served as a model for military medicine of his day as well as for future armies. This article will examine what influenced Larrey to develop such a system and trace the evolution of its design (particularly of the "ambulance") from its inception to its final production, use, and modifications.
First, it is necessary to provide some background on the state of casualty transportation prior to Larrey's system. Before the flying ambulance, there was very little organized transportation of the wounded from the battlefield. In fact, little had changed from the days preceding the use of firearms in battle. During earlier times, when swords and arrows created the majority of battlefield injuries, individuals usually took care of their own wounds. Sometimes, a doctor or barber would give additional aid to such injuries, but usually much later, well after the hostilities had ceased. However, with the advent of deadlier weapons utilizing gunpowder (and the rapid propulsion of more lethal projectiles), more serious wounds with greater amounts of devitalized tissue were produced. Such wounds were more susceptible to infection and required faster and more involved treatment by medical specialists. Thus, the old system of self-aid and inconsistent professional treatment after a battle, had proved to be grossly inadequate by the end of the 18th and the beginning of the 19th centuries. 
The term "ambulance" has evolved through the ages. Although wagons and carts have been recorded in history as means of transporting the sick as early as 900 A.D., the term "ambulance" was not used until its introduction by Queen Isabella of Spain in the 15th century; however, during that period it referred more to the military field hospitals and tents for the wounded rather than to the means of transporting wounded and dead from the fields of battle. Not until the time of Baron Larrey would "ambulance" take up its more current meaning of "a specially equipped motor vehicle, airplane, or ship for carrying sick or injured people, usually to a hospital." 
Dominique-Jean Larrey was born in July 1766 in Bordeaux, France, to bourgeois parents. [See note on Baron Larrey's birthplace immediately following this paragraph.] At the age of 14, he started his medical training, courtesy of his uncle, Alexis Larrey, a distinguished professor at the College of Surgery at Toulouse and Chief of Surgery at l'hospital Saint-Joseph de la Grave. Dominique enrolled at the College de l'Esquille, performing well academically, particularly in the field of anatomy. By the age of 21, he began his formal studies in surgery in Toulouse. During this time, Larrey was well-known to his professors and colleagues for his superior intelligence, maturity, and discipline. He later left Toulouse to further his medical studies and gain clinical experience in Paris. Larrey then went to Brest, in 1787, to serve on the Royal Frigate Vigilante for 7 months as the ship's doctor, traveling as far as Newfoundland.  During that voyage, he learned many important skills and ideas, especially about the crucial importance of hygiene and the treatment of various ailments. Larrey later returned to Paris to practice at l'Hospital Royal des Invalides and various other institutions. Working and teaching in Paris during some of the most turbulent years of the revolution gave him invaluable experience in treating battle-type wounds and injuries produced by the riots and fighting of that period. Larrey's good work was noticed, and he was appointed surgeon-major of the Army of the Rhine in 1792. 
Note on Baron Larrey's birthplace: On 25 February 2007, I received an e-mail from M. Philippe Pebay, a native of Beaudean, France, who informed me that Baron Larrey was born in Beaudean, a small village in the Frenc pyrenees, and not in Bordeaux, as is stated above. M. Pebay states that Baron Larrey's birthplace home still survives in Beaudean and can be visited. In addition, M. Pebay was kind enough to provide a small photograph of a portion of this picturesque village.
According to his memoirs, Larrey first noticed serious disparities between the battle conditions of his day and the care and transport of casualties during the Campaign of the Rhine in 1792. During the sacking of the city of Spire, Larrey writes,
"I now first discovered the inconveniences to which we were subjected in moving our ambulances or military hospitals. The military regulations required that they should always be one league distant from the Army.  The wounded were left on the field, until after the engagement, and were then collected at a convenient spot, to which the ambulances speeded as soon as possible; but the number of wagons interposed between them and the Army, and many other difficulties so retarded their progress that they never arrived in less than 24 or 36 hours, so that most of the wounded died for want of assistance...this suggested to me the idea of constructing an ambulance in such a manner that it might afford a ready conveyance for the wounded during battle. I was unable to carry my plans into execution until some time later." 
During this particular engagement, the advance guard was overpowered so suddenly that the distant French field hospitals had no chance of recovering the wounded. In contrast, Larrey was impressed by the sight of the wheeled French artillery's ability to quickly mobilize and escape from the hands of the advancing enemy.  This observation inspired Larrey to "propose to the general (Custine), and to the commissary general (Villemansy)... the plan of an ambulance, calculated to follow the advanced guard in the same manner as the flying artillery... called the flying ambulance."  After considering many designs (including one which carried wounded on litters strapped to horses), Larrey's practicality and experience favored the use of horse drawn carriages as central to the casualty transport system he would develop.  Such a simple, yet revolutionary idea, was the origin of today's meaning of the term "ambulance."
Larrey was eventually given the opportunity to implement his idea during an engagement near the Rhineland City of Limbourge. Larrey and his superiors were so impressed by the magnificent performance of his flying ambulances in this battle that Larrey himself was soon rushed to Paris to spread his system to other French armies.  However, other duties distracted him from completing such plans until 1797. 
Before proceeding, it is necessary to note that Larrey, while playing a crucial role in developing the first truly effective ambulance system, was not the first to recognize the fundamental problems in casualty transportation of his time. In fact, in 1788, a royal ordinance was issued requiring the creation of better transportation for the battle wounded. On 12 November 1792, the National Convention declared the need to construct "suspended carts for the transportation of the sick and wounded of the armies."  By 1793, this issue increasingly became a political one, and a prize was offered in Paris for the transportation design which best fit a commission's specifications. Among these specifications was the requirement for the carriage to be "light, solid, suspended, and comfortable for carrying four or six casualties lying down, eight at most."  However, after 8 months of considering over 29 designs, the commission realized that its specifications were unrealistic. The political leaders at the time, nonetheless, insisted on developing a design by committee but only succeeded in producing an ambulance that was too heavy and impractical for the battlefield.  Such politically driven efforts only served to delay the widespread implementation of Larrey's more effective ambulance design, which had already been successfully field-tested. 
In May of 1797, Larrey was ordered by the Minister of War (at the request of Napoleon Bonaparte) to depart for Italy and aid in the medical affairs of the military campaign. Among his duties was to help establish military hospitals and to organize medical staffs of various French expeditions originating from Italy. While in Milan, Larrey was ordered by General Villeansky to develop a flying ambulance system.  Once again, Larrey implemented his ambulance designs into the French armies in Italy and developed training programs essential for the widespread use of his casualty transport system.
Larrey's system was composed of "a legion of 340, comprising officers, sub-officers, and privates." It was further broken down into three divisions of 113 men, with each division commanded by a chief surgeon. Each division had 12 light and four heavy carriages—each carriage manned by a crew of about seven men. Included in the chain of command of each division were:
"One surgeon-major of the first class, commanding, with two surgeon's mates of the second class, 12 junior mates of the third class, two of them serving as apothecaries, a lieutenant, steward of division of ambulance, a sub-lieutenant, inspector of police acting as under steward, a quartermaster general of the first class of ambulance, two deputies of the third class of ambulance, a bearer of surgical instruments with a trumpet, 12 soldiers on horseback as overseers to take care of the wounded; among them a farrier, a saddler, and a bootmaker [sic], a commissioned sergeant major of the first class, two commissioned officers of the second class to precede the ambulance, three corporals retained for the performance of various errands, a lad with a drum carrying surgical dressings, and 25 foot soldiers as overseers to take care of the wounded." 
Obviously, Larrey spared few details in establishing and perfecting his casualty transport system. Everyone in his system had a specific duty an role to play. The ambulances were even organize to travel in a set order, and procedures were established for the management of the dead. 
In his memoirs, Larrey described the various uniforms of his medical staff. While such descriptions are not directly relevant to this paper, they do give us valuable information on the instrument and other resources carried into battle by his ambulances; such information also gives us more subtel insights on the daily work and challenges faced by Larrey's men. For example, the surgeons each "carried a small cartouch box...divided into several compartments, containing a case of portable surgical instruments, some medicines, and articles necessary for affording immediate assistance to the wounded, on the field of battle..."  In addition officers were supplied with courier bags on their saddles, which contained field dressings instead of pistol holsters.
The 12 light carriages in a division had either two or four wheels, the former for use on level ground, and the latter for use in mountainous terrain. Larrey described his basic ambulance design as follows:
The frame...resembled an elongated cube, curved on the top: it had two small windows on each side, a folding door opened before and behind. The floor of the body was moveable; and on it were placed a hair mattress, and a bolster of the same, covered with leather. This floor moved easily on the sides of the body by means of four small rollers; on the sides were four iron handles through which the sashes of the soldiers were passed, while putting the wounded on the sliding floor. These sashes served instead of litters for carrying the wounded; they were dressed on these floors when the weather did not permit them to be dressed on the ground. 
The only significant difference between the two and four wheel carriages, apart from the number of wheels, was mainly their size (especially their comparable height and length). Both, "were 32 inches wide, and were drawn by two horses." Their advantages, according to Larrey, were Similar. They could both carry two patients lying at full length, and the window allowed for proper ventilation. There were compartments on the sides of the carriages for the storage of bottles, medicines, and other useful articles. In addition, various other tools, such as a handcart, could be attached to the carriage. Of course, the carriage design was not always initially suitable for all the missions and environments it faced and had to be periodically adapted to each situation at hand. For example, in rugged mountains, it had to be supplemented with mules for carrying supplies. Likewise, in the deserts of Egypt, camels were employed by Larrey to augment casualty transport. With such adaptations, Larrey took great pride in his basic ambulance design as "united solidly with lightness and elegance."  Apparently, Larrey was not the only one pleased with his flying ambulance, as he received much praise from Napoleon himself, as well as the commanding general at Padua. 
The larger ambulances "were drawn by four horses and had two drivers."  They also had a compartment in the back for carrying forage for the horses and were capable of carrying four men with their legs slightly folded.
In the following passage, Larrey succinctly expressed his observations of the practical advantages of his flying ambulances in combat:
"With these ambulances, the most rapid movements of the advanced guard of an Army can be followed up, and when necessary, they can separate in a great many divisions, every officer of the medical staff being mounted, and having command of a carriage, a mounted observer, and every [sic] thing necessary for affording the earliest assistance on the field of battle." 
Furthermore, Larrey's ambulance also boosted the morale of the French troops since "they all felt confident that they would receive succor at whatever moment they might be wounded."  In sum, the ambulance system devised by Larrey proved to be both mobile and flexible enough to mirror the fluid battlefield of the Napoleonic age, while also providing rapid and competent medical care to the widest area possible. 
In his memoirs, Larrey is very explicit about the necessity of his flying ambulances in the the [sic] treatment of wounds requiring prompt amputation. He writes:
"When a limb is carried away by a ball, by the burst of a grenade, or a bomb, the most prompt amputation is necessary. The least delay endangers the life of the wounded....I may even assert, that without the assistance of the flying ambulance...a great number would have died from this cause alone." 
While Larrey enjoyed the success of better amputation survival rates with the advent of his flying ambulances, the English were still suffering high mortality rates from similar wounds. When Larrey was given the opportunity to visit a British hospital in Egypt, he was surprised to discover that despite having excellent and clean medical facilities, the English had as little as three survivors out of a large group of amputees. In contrast, the French surgeons were enjoying much greater survival rates following similar operations. Whether or not the presence of the French flying ambulances and, hence, more immediate amputations, or the greater skill and more advanced medical doctrine of the French (the British were still performing delayed amputations during this period) were the critical factors at such disparities in mortality rates remains unclear. However, one can certainly extrapolate that Larrey's system of ambulance transportation, combined with his particular emphasis on performing amputations expediently, played significant roles in the superior success of the French doctors in such cases. 
Larrey noted the importance of early amputation of certain battle wounds as early as 1792. After observing several cases where fatalities occurred after amputations were either not performed or delayed (several days after sustaining a wound), Larrey developed his "24-hour principle." This established the standard to amputate a shattered limb within a day of its onset, if not "as soon as possible after the wound was incurred."  Such a principle likely was a great influence on the development of Baron Larrey's ambulance system as well as its rapid implementation by Napoleon.  Furthermore, this system allowed for greater success in more complicated operations such as multiple amputations. Wrote Larrey, "Before the erection of the flying ambulance...we seldom saw men who had lost both legs and arms: because the operation was delayed too long." 
Around the same time that Larrey was developing his flying ambulance system, another great French military physician, Baron F.P. Percy, was introducing a rival casualty transport system of his own. While comparisons between the ambulances of these two great men certainly favor Larrey's system, due credit must be given to Baron Percy for making the first improvements in casualty transport in the French Army. He was the first to introduce "a regularly trained corps of field litter bearers, soldiers regularly formed and equipped for the duty of picking up the wounded...and carrying them on stretchers to the place where means of surgical aid were provided."  The differences between Percy's and Larrey's systems lay in their fundamental objectives. Percy's ambulance served mainly as a means of transporting surgeons and their instruments close to the engaged elements. In turn, stretcher-bearers could radiate from such proximity to retrieve the wounded. In contrast, Larrey's flying ambulance, a much lighter and swifter carriage, was designed to follow the advanced guard and provide initial treatment to the wounded (by applying dressings on the field of battle) while emphasizing the need to rapidly transport the more critically injured away from the battlefield. Wounded were, thus, evacuated to points in the rear where surgeons could more effectively perform lifesaving procedures.  Indeed, elements of both systems were harbingers of principles and procedures used even today in such fields as emergency medicine and in current military medical doctrine.
While including ink plates and rudimenary descriptions of Percy's ambulances in his memoirs, Larrey offered very few comparisons to his own ambulance design. He described Percy's ambulance as a "kind of wurf, the staff officers attached to it being on horseback, in the same manner as the flying artillerists; it also carries instruments and preparations for dressing."  When he wrote "wurf," Larrey probably meant the German word wurtz which refers to a "thick and short sausage...when combined with 'wagen' signified a long wagon..."  Beyond such a simple description, Larrey made few, if any, references to Percy's ambulance system.
Percy also drew few comparisons between his ambulance system to that of Larrey. He did, however give a good account of the evolution of his system. In the fall of 1792, Perch, then the Consulting Surgeon of the French Army of the North, began to seriously consider improving battle casualty care and transportation. Certainly, he was partly motivated by the political pressures of his time. He also noted the delayed medical care administered to the wounded, particularly during retreats. His solution was to develop an ambulance that carried the surgeons and their instruments close to the battle. Furthermore, Percy's ambulance was light and quick enough to keep up with armies constantly on the move, both in advances and in withdrawals. In essence, Percy's ambulance was a mobile hospital which could carry as many as 10 persons (surgeons and assistants) with equipment, to critical points in a fluid battlefield.  The wounded were then brought to the surgeons, by foot, by a corps of stretcher-bearers. Such duty was not only quite strenuous and dangerous, but also was militarily significant: it relieved the common infantryman of the arduous task of caring for their own wounded.  While these were great innovations of this time, Percy's ambulance system never saw widespread battlefield implementation, and thus, never achieved the operational significance of Larrey's system. 
While there were few comparisons in the ambulance systems of Larrey and Percy in their own writings, other historians were less reserved in noting both the similarities and the key differences between them. The English historian, T. Longmore, noted that both systems had similar objectives. For example, they both created a specialized ambulance corps, which relieved the common foot soldier of the chores of caring for their wounded comrades. Furthermore, both systems created greater mobility for the physicians and their tools, although in slightly different ways. In Percy's system, the surgeon's tools were in the ambulance in which he traveled; Larrey's medical officers carried their instruments in the saddlebags of their mounts as well as in the accompanying ambulance. Finally, both systems sought to boost troop morale by the very nature of their effectiveness.  Writes Larrey, "Even the sight of these ambulances, which are always attached to the advanced guard, animates the soldiers and inspires them with the greatest courage." 
However, one major difference, according to Longmore, is in the vulnerability to enemy or friendly fire in battle. For example, since all the surgeons and major medical instruments of a unit were transported in one carriage in Percy's system, a loss of a single carriage could cause a major setback in the medical support on the battlefield. On the other hand, a disabled ambulance would be a relatively minor setback in Larrey's system, since only a single surgeon or minor pieces of the casualty transport system were lost. Furthermore, Larrey's ambulance was a much more rapid and efficient means of transporting wounded from the dangers of the battlefield compared to the stretcher-bearers employed by Percy. Larrey's system also had doctors, either on horseback or with the carriages, bringing only the most necessary instruments to the field. Their intent was to only perform stabilization and lifesaving procedures in the heat of battle so that the patient could rapidly be transferred to the rear for more definitive procedures. Thus, Larrey's flying ambulances had the advantage in safety, mobility, and flexibility and, as a result, were more effective and expedient in providing effective care to the wounded foot soldier than Percy's system.  The principle of rapidly transporting casualties from the perils of battle to locations where major surgery could be performed, as advocated by Larrey, was a harbinger of the medical evacuation systems later developed in Korea and Vietnam with helicopters.
The particular designs of the ambulances in these two systems were the basis of their relative efficacies. For example, Larrey's ambulance was lighter and smaller than Percy's and, thus, more maneuverable, faster, and better adaptable to rough terrain. On the other hand, the relatively heavier ambulance of Percy (as well as the philosophy of his system) inhibited it from rapidly pulling the wounded from the battlefield as well as from effectively gathering its casualties and fleeing in the event of a rapid retreat.  One historian even suggested that Larrey's ambulance was more comfortable than Percy's.  In the end, history itself seems to be the final judge of these two systems, since it was eventually Larrey's that became the standard of medical evacuation for Napoleon's armies.  In contrast, Longmore's [sic] ambulance lived a rather ephemeral existence, which did not extend beyond supporting limited actions of the Army of the Rhine. 
The efficiency of Larrey's casualty transport system, as well as the adaptability of his ambulance, are demonstrated by their effectiveness in a wide variety of geographic locations and conditions. During Napoleon's victory in Aboukir, Egypt, in 1799, Larrey observed, "The wounded, after this affair, received the most prompt and effectual assistance from the surgeons of the ambulances and of the line; none were left more than a quarter of an hour without being dressed."  Larrey also supplemented his ambulances with camels, used as both pack animals and litter-bearers because of their particular adaptability to the desert environment.  Furthermore, Larrey's mobile ambulance's flexibility in design was proven time and again in its successes in even the most inclement of weather and in practically any geographic location: ranging from the mountains of Spain and the Steppes of Russia, to the hills of Poland and the deserts of Africa. His ambulance design was so well conceived and revolutionary that "while ambulance wagons were modified and adapted both for civilian and military use...few major changes were made for the next 100 years, until the motor ambulance came into common use in the early 1900s." 
In 1801, Larrey became The Surgeon General of the Imperial Guard, Napoleon's elite personal guard and shock reserve. It was with this unit that Larrey served in over 26 campaigns and earned the reputation as both a great field commander as well as physician. He was not only quite popular among the soldiers of the Imperial Guard, but was so esteemed by Napoleon that he was made a baron during his brilliant and distinguished service in the 1808 campaign in Spain.  Such was his fame and popularity that, as Napoleon's troops were fleeing Russia over the last bridge crossing the Berezina River in November of 1812, Baron Larrey was quickly recognized and specially lifted overhead by the crowd of troops, so that he could get safely across before them. While this paper focused mainly on Larrey's revolutionary advancements in casualty transport, one must not overlook the great strides he made in other areas. For example, he was the first surgeon to succeed in amputating a leg at the hip, made a multitude of innovations in the treatment of leg fractures, and was one of the most proficient physicians of his time at performing routine amputations. 
In multiple campaigns, Larrey commanded his ambulances with the control and coordination of the seasoned field commander that he was. For example, at Austerlitz in 805, he skillfully posted and directed his ambulances such that the wounded "were almost all dressed on the field of battle."  Larrey attributed most of the effectiveness of his carriages in the heat of battle to their speed, allowing them to follow even difficult cavalry movements. Furthermore, their mobility allowed them to travel over most ground, particularly on roads either in great disrepair, or in poor weather conditions.  For example, during Napoleon's campaigns in Poland, where mud and rain bogged down much of the Army's movements, the flying ambulances were able to better overcome such challenging conditions than most other Army components. The flexibility of these ambulances also allowed many operations to be performed on the battlefield, with Larrey using them to travel anywhere his help was needed. 
The praise that Larrey and his corps of ambulances received was universal. Many private letters expressed great admiration of the courage and devotion of these men. They repeatedly risked their lives to save others, frequently under heavy fire and in adverse circumstances.  Even enemy commanders held Larrey's efforts in great esteem and admiration. At the Battle of Waterloo, the Duke of Wellington even purposely directed his cannon fire away from Larrey's ambulances to give them time to collect their wounded. 
The development of an effective French combat casualty transport system during the Napoleonic Wars was essentially the result of one man's perceptiveness, initiative, humanity, and organizational skills (Larrey) combined with the strong support of a very talented battlefield commander (Napoleon). In many ways, the impact of Larrey's ambulances in decreasing combat mortality and morbidity in his day is comparable to that of helicopters in modern warfare. Unfortunately, subsequent armies did not always learn from such lessons, thus contributing to unnecessarily large fatalities in later conflicts in Crimea and in the United States. Future military doctors must take note and effectively study relevant military medical history. There is, undoubtedly, much to learn from such great men as Baron Dominique-Jean Larrey, who certainly earned the distinction of being called the "first modern military surgeon." 
1. Horn AT. The Professionalization of Ambulance Services. Ann Arbor, MI: University Microfilms International; 1984:p 2.
2. Larrey DJ, MD. Memoirs of Military Surgery and Campaigns of the French Armies translated by Richard Wilmott Hall, MD. vol I. Baltimore, MD: Joseph Cushing/University Press of Sergeant Hall; 1814:ix.
3. Longmore T. A Treatise on the Transport of Sick and Wounded Troops. London, Her Majesty's Stationary Office; 1868, p 26. Also see E.T. Marten, "Modern Ambulances Came From Rude Beginnings." The Modern Hospital. 1934:XLII(2):43.
4. Flexner SB, Ed in Chief. The Random House Dictionary of the English Language. 2d ed. New York: Exposition Press; 1978, pp 13-15.
5. Dible JH. Napoleon's Surgeon. London: William Heinemann Medical Books Ltd; 1970:p 1.
6. Blaessinger ME. Quelques Grandes Figures de la Chirurgie et de la Medecine. Militaires. Paris: J.B. et Fils, Editeurs; 1947, pp 105-110.
7. About three English miles.
8. Larrey, vol I, 1814, pp27-28.
9. Vess DM. Medical Revolution in France 1789-1796. Gainesville, FL: University Presses of Florida; 1975, p 80.
10. Larrey, vol I, 1814, pp 27-28.
11. Barkley, p 18.
12. Larrey, vol I, 1814, p 35.
13. Longmore, p 28.
14. Monery A. "Les Premiers Transports d' Ambulance de la Republique et de l' Empire." Le Caducce. Nov 20, 1909: 22:301.
15. Ibid, p 301.
16. Ibid, pp 301-302.
17. Vess, p 82.
18. The term flying ambulance appears to have originated from the fact that they often stayed with the "flying artillery," standard part of the French Army at that time. The word "flying" also generally referred to highly mobile, horse drawn units, in which every member either rode a horse or was carried on a vehicle. Barkley, p 19 and comments contributed by Dr Wayne Austerman.
19. Larrey, vol I, 1814, p 79.
20. Ibid, pp 82-83.
21. Ibid, p 80.
22. Ibid, p 81.
23. Ibid, pp 81-82.
24. Ibid, p 94.
25. Ibid, p 82.
26. Ibid, p 83.
27. Longmore, p 27.
28. Ibid, pp 28-29.
29. Larrey DJ. Memoirs of Military Surgery and Campaigns of the French Army, translated by Richard Wilmott Hall, MD, vol ii. Baltimore, MD: Joseph Cushing/University Press; 1814, p 81.
30. Larrey, 1814, vol I, p 396.
31. Marten, p 43. Also see Vess, p 130.
32. Larrey, 1814, vol II, p 107.
33. Ibid, p 350.
34. Longmore, p 26.
35. Ibid, pp 29-3 1.
36. Larrey, 1814, vol I, p 83.
37. Longmore, p 26.
38. Laurent C. Histoire de la Vie des Ouvrages de P.F. Percy. Versailles, Imprimerie Daument; 1827, pp 161-162.
39. Sometimes it took as many as eight soldiers to transport a single wounded comrade off the field, a significant attrition of a commander's force if faced with heavy casualties. See Vess, p 78.
40. Percy PF. Journal Des Campagnes du Baron Percy. Paris: Librarie Plon; 1904, p 3. Also see Vess, pp 78-80.
41. Longmore, p 3 1.
42. Larrey, 1814, vol II, p 107.
43. Note that the mounted surgeons, or even Larrey himself, often did find it necessary to perform amputations or other major surgical procedures on or at the edge of the battlefield.
44. Dible JH. Napoleon's Surgeon. London: William Heinemann Medical Books Ltd; 1970, p 16.
45. Monery, p 304.
46. Longmore, pp 31-33.
47. Triaire P. Dominique Larrey et les Campaignes de la Revolution et de l' Empire. Tours, Maison Alfred Maine et Fils; 1902, p 56. Note that while his design for an ambulance did not survive, Percy's corps of stretcher-bearers did survive and was extensively used in conflicts throughout the 19th and 20th centuries.
48. Larrey, 1814, vol I, pp 223-224.
49. Barkley, p 19.
50. Ibid, p 19.
51. Blaessinger, p 117.
52. Barkley, p 19.
53. Larrey, 1814, vol I, p 410.
54. Larrey JD. Memoir of Baron Larrey. London: Henry Ren55. shaw, p 62.
55. Larrey, 1814, vol I, p 411.
56. Blaessinger, p 111.
57. Ibid, p 118.
58. Brewer LA. "Baron Dominique Jean Larrey (1776-1842 Father of Modern Military Surgery, Innovator, Humanist." J Thorac Cardiovasc Surg. December 1986; 92(6):1096-1098.
Taylor, Blaine. "Napoleon's Faithful Field Surgeon." Mil History. June 1997; pp 46-52.
* Medical Corps. CPT Ortiz is the Chief, U.S. Army Occupational Health Clinic, Umatilla Chemical Depot, Hermison, Oregon (satellite unit of Madigan Army Medical Center).