On the side of the road, men who had begun the journey but were unable to go on cried out. “Mercy, please!” they shouted or called out their unit number looking for a mate. There were attempts at humor. One man called out to a soldier whose lower leg was mangled, “If thy foot offend thee, cast it away!” But mostly men cried for water, doctors, and their mothers in a half dozen languages.
The surest way to find a doctor would have been to follow one’s nose: a putrid smell meant bodies, and bodies meant hospitals. The odor carried for hundreds of yards, a mix of the smell of clotted blood, of putrefying flesh, of feces and the musty stench of filthy dressings. The flying ambulances from the battlefields, which looked like large coffins fixed to the back of two-horse wagons, could guide the soldiers but they rushed ahead, too fast for anyone to keep up with. Every house on the road to Moscow, no matter how ramshackle, were filled with wounded. But only a few had doctors.
Imagine the journey of a wounded soldier staggering from the battlefield on September 8 and coming upon one of these hospitals. When at last the destination came into view, it would most likely have been a local nobleman’s house or a church, the most substantial structures around, taken over by the army to house the wounded. Men clustered around the entrance, begging to be let in. Corpses littered the yard in front; some of their shirts had been torn off to use as bandages. Others were naked and dogs had gotten to their exposed flesh. Horses lay disemboweled in the mud, pieces of their flanks cut away for food. There was shouting and cries of pain coming from inside the building. Orderlies carried in men with their heads drooping off the ends of the stretchers.
There was a standing order in the Grande Armée stating that any man with serious wounds was to be saluted—a remnant of the original Revolution’s fervor for the common man. It had long fallen into disuse; the numbers were too overwhelming. And the decree that stated that enemy soldiers were to be given equal treatment, which was symbolized in the doctors’ uniforms with the word “Humanité” inscribed on the buttons, was also void. Around the back of the hospital, Russian patients had been dumped into the garden to die.
If you were an officer, you would have stood a better chance of making it inside the typical hospital. Rank and birth, whatever Napoleonic rhetoric stated, still mattered. The men stumbled through the lines of patients littering the floor. Some lay on filthy straw taken from nearby barns, others used corpses as pillows; in places men had toppled on unconscious soldiers and lay there, too exhausted or sick to move.
Those sick with typhus would have desperately looked for a place to lie down. The energy had been sucked out of their muscles and they felt faint, their heads splitting with headache that made it difficult to open their eyes. They collapsed anywhere they could. But after a battle, the wounded took precedence over the ill when it came to medical attention. Typhus patients would be among the last to be seen, and the grunts and cries from the next room told them that the surgeon was busy with casualties from Borodino.
The surgery would have been the center of the typical hospital. Pale men still in shock, their limbs sometimes hanging from a ribbon of flesh or muscle, flowed toward it in a steady stream, and bandaged or dead men flowed out. At the center of the room was a stout wooden table surrounded by assistants. Amputations were almost the only thing on offer. Some leading doctors advocated waiting a day or two before operating on a damaged limb, but Dr. Larrey and his staff were firm believers in amputating quickly. The patient was often already in shock from the wound and would feel less pain, and the impact of the wound actually lowered the blood pressure, meaning he would bleed less during the operation. The risk of gangrene—deadlier to the soldier than the bullet itself— would be minimized if the limb was gotten off quickly. Speed was highly prized.
The table would have been covered in blood, bits of tissue, and uniforms. The surgeon didn’t wash his hands between operations, or clean his instruments; perhaps he dipped them in a bowl of bloody water between procedures, but that was it. Beside him on the table were his tools. The typical traveling surgeon’s case of the early nineteenth century would have contained everything from scalpels to elevators used to lift bones in skull fractures to trepanning braces and drills for penetrating into the skull to spreaders for peeling back the rib cage, encompassing twenty to thirty instruments in all. But the French doctors, prodded to be quick, had reduced it to the bare minimum: On the table lay different-size knives for cutting through skin and major muscles, a large bone saw made of steel and horn with a stout solid blade for cutting through femurs and humeri, and a smaller version for tibiae, fingers, and more delicate work.
The soldier’s friends would have hoisted the injured man onto the table and held him down. The doctor then examined the wound, sometimes probing the hole with his filthy finger to see if the bullet was close to the surface. If the wound was to an arm or a leg and the patient was conscious, the doctor rattled off a quick diagnosis, usually recommending the limb come off. Officers were typically given the choice of amputation or a patching-over of the wound. In counseling one general whose arm had been shattered by a musket round, Dr. Larrey spelled out the options: “Doubtless we might have some chance of success if we tried to save your arm,” he explained. “But…numberless fatigues and privations still await you and you’re running the risk of fateful accidents.” Namely, infection. (The general refused the amputation.) Average soldiers, however, could find their limb removed without any kind of consultation. If the soldier insisted on keeping his limb, the doctor simply shrugged, patched the wound with a bit of linen, and nodded for the man’s friends to take him to nearby rooms, where he was lowered into a bed or, more likely, a bit of straw on the floor. When the soldier agreed to an amputation, a leather tourniquet was tied around the top of the limb, cinching off the major blood vessels, and the other end was tied to a leg of the table. The man was given a bullet or a bit of wood to bite on; officers were offered a quick shot of liquor if any was available.
Growling for the friends to grip the man tight, the surgeon would have cut down to the muscle with one of the knives, making the incision all around the circumference of the limb. Then he grasped the larger knife and, leaning into the patient’s body, began sawing to the bone. Some patients cursed and bucked from the pain, but others, tensed and stoic, only stared up at the ceiling. It was considered bad form to scream.
The amputation of a leg at the thigh would have taken around four minutes, but if one got to the operating table late in the day after the surgeon had worked on dozens of men, the bone saw would have been perceptibly dulled and the operation would have taken much longer. Unconscious men came to in the middle of the procedures and began screaming. One British officer whose arm was amputated during the Napoleonic Wars raged at the surgeon as the blunted blade of the saw took twenty minutes to cut through the bone. Many of the heavy Russian balls had not only cut through muscle and broken bones but also shattered them, sending shards into the tissue. The doctors had to probe the wounds for these pieces. “The muscles were lacerated and reduced to the consistency of jelly,” Dr. Larrey observed in a typical patient suffering from a wound from a musket ball.
Once the limb was off, the surgeon would have sewn the flaps of skin together with black thread to give the man a stump that stood a fair chance of healing. Then a piece of linen or cloth dipped in water was wrapped around the stump and the man was lifted off the table and sent out of the room. The limb he left behind was tossed into a pile with the others: by the end of the day, the jumble of arms and legs would reach the ceiling.
The propensity of the artillery balls to bounce waist-high through a regiment resulted in countless disembowelments, and men would have been brought into the hospitals holding their intestines in their hands. The bloody mess was simply cleaned off as best as possible and stuffed back in the body cavity, then covered with a wrap of linen. In a torso injury, any wound where the bullet had penetrated deeper than the length of the doctor’s finger was deemed inoperable. An injury
caused by a ball to the chest, the lungs, or the intestines was often waved away as being too dangerous for surgery. The hopeless cases—“horribly disemboweled or mutilated …motionless, with hanging heads, drenching the ground with their blood”—were left to die.
Surgeons worked nonstop as more patients were brought in. Dr. Larrey himself performed 200 amputations in twenty-four hours after Borodino, an average of 8 per hour, but he would have been examining patients, triaging, and supervising the field hospital at the same time, and a good surgeon working steadily could have easily doubled that number. Larrey recorded some exceptional cases in his memoirs, including one Russian colonel who had his nose cut off by a musket ball and a soldier who had a piece of mortar shrapnel hit him in the right calf, ricochet and travel upward through the thigh muscles, and then shoot out of the top of the leg, having sheared the man’s calf muscle off and shattered both bones of the leg. But the vast majority of what a surgeon did at Borodino was butcher’s work.
AS EVENING FELL, wax tapers would have been lit in the dark rooms. Men’s faces were thrown into sudden illumination by the flickering candles and then covered by darkness again. The stench was overpowering: the fetid, rotting-meat smell of gangrene, the sickly odor of suppurating wounds, and the coppery tang of fresh blood, as well as the smell of feces and urine. The rooms were so dark that when orderlies came through with the evening meal, unconscious men lying in the straw were sometimes missed and died from thirst or simple inattention.
As the night progressed, some typhus patients would have entered their own worlds. Long-dead friends appeared and the patients struck up conversations with them, or they screamed at phantoms only they could see, or stared unblinking at sights or visions that, even after they recovered, they found impossible to put into words. Sometimes the patients had never before seen the fever-people that visited them and couldn’t account for how they had pictured them so vividly. Typhus patients had been known to reenact scenes from their past lives: a young cowherd imagined that the other patients were his cattle and called to them constantly with the cry used to move cows into their pens; thieves bragged again and again of the same accomplices, the same heists. A thick noxious film covered their tongues and their teeth turned black; observers remarked on their resemblance to breathing cadavers. The rooms echoed with dry, urgent coughs. Sometimes a man’s cheek flushed a deep red color and then, hours later, the color drained away and appeared in the other cheek. The men often gave off a peculiar odor that smelled like ammonia or “putrid animal matter,” though that could have been an olfactory projection by observers, as it was widely believed that decaying plants and animals caused the infection in the first place.
As the night wore on, infected lice from the dead and dying would have crawled off the bodies and through the straw, seeking warmth. When they found a new host, they would feed almost immediately. Rickettsia feasted on the wounded.
If the doctor had run out of amputations and surgeries to perform, he would have made his rounds and done what he could for the men suffering from typhus. The Belgian surgeon de Kerckhove described what it was like to move among these men who seemed only half alive. “The face was sometimes red,” he wrote, “sometimes pale, the eyes dark and sad, often lifeless or tearful. Their ideas were incoherent, their smell and hearing was weakening, deafness at intervals.” Some of the patients shivered uncontrollably, others tried to tear off their clothing for relief from fever. Men stared, their eyes gleaming in the candlelight, their chests pumping up and down in fast, shallow breaths. “Tendon jolts” sent arms and legs snapping into the air, while other men, overcome by sudden terror attacks, tried to make it to the door, stumbling over bodies and being cursed in guttural voices. Patients cried out for someone to blow their brains out.
The hospital doctor would have moved among them, administering cool drinks where he could, herbs known as “vomitories” to those who seemed strong enough to bring up what were believed to be noxious substances in their stomach. Doctors on the march often veered into the forest searching for tonics, certain barks and plants such as elder blossom and mint. If the doctor had managed to hoard some of his primitive anesthesia such as tincture of opium or Hoffman’s drops (a combination of alcohol and ether), he gave it to the patients raving with pain. The supplies simply hadn’t arrived from Paris, so the surgeons were forced to scavenge what they could. Some of the doctors at Borodino made futile attempts to separate the typhus patients from the wounded. “If it was possible, I put the men suffering from typhus in spacious rooms, well-aerated and cool,” wrote de Kerckhove. But the ancient preventive remedy of quarantine was impossible in mass-casualty situations.
Quarantine had been used throughout history to stop an advancing microbe such as Rickettsia. The practice goes back at least to Justinian’s Plague in 541-2, when the Roman ruler instituted a new law to stop travelers from plague-infected areas from entering unscathed towns. Lepers were regularly isolated from the healthy by societies around the world. In times of plague, vessels from infected regions weren’t allowed to dock in “clean” harbors. Guards were posted on roads twenty miles from town and forced unhealthy-looking peddlers and workers to turn around. Those who tried to skirt the blockade could be executed. Quarantine hospitals were built on the outskirts of cities to house people suspected of having the disease, who were watched carefully for any symptoms for forty days.
Other doctors in the Grande Armée tried to get as far from the infected men as possible. Among them were the hated cbirurgiens de pacotille (“junk doctors”), cowards from the medical service who grabbed the first lightly wounded man they saw on the battlefield and dragged him to a hospital, their ticket to survival. There was, theoretically, a stiff penalty for cowardice under fire. Napoleon at the beginning of his career had ordered that any health officer caught abandoning a first-aid station in battle or refusing to care for a patient suffering from a contagious illness was to be court-martialed. “Whatever his station,” wrote the emperor, in an edict dripping with contempt for doctors, “no Frenchman shall fear death.” One surgeon who had refused to treat plague patients in Alexandria had been arrested, stripped of his citizenship, and then dressed in women’s clothes and paraded on a donkey through the city streets, with a sign on his back that read “Afraid to die, unworthy of being a Frenchman.”
As he tended to the ill patients, the Belgian doctor de Kerckhove had no doubt what was killing them. He described how the disease appeared among the troops and found it “generally the same as other typhus epidemics that affect armies in wartime.” The symptoms began with a general malaise, then a state of “languidness,” a slow pulse, and then a puffy and affectless visage (what the doctor called “a deterioration of facial features”). The patient became unable to move—the men called this stage of the illness “broken limbs”—and total exhaustion set in. Appetite disappeared, the subject became giddy, a whitish coat covered the tongue, and fever began shaking the patient’s body with pulses of strong heat, followed by the chills; thirst became “inextinguishable” and the brain became “congested.” The vision began to suffer as the disease spilled blood into the brain; the eyes became “dark and sad,” and then simply lifeless. Hearing and even the sense of smell weakened, with some patients going completely deaf. As the days passed, the men became shadows of their former selves. They would whisper in nearly inaudible voices; they became indifferent to their condition or their futures; their breathing speeded up and they suffered from “absolute insomnia.” Giddiness turned to full-blown hallucination and delirium, alternating with sudden fits of panic. Three days after the fever appeared, the men would become completely prostrate, unable to rise or walk. The small purplish spots appeared and spread over the body, along with what de Kerckhove called “black rusts and passive hemorrhages,” bleeding beneath the skin that he half-accurately diagnosed as being “caused by the decrease of vital energy of the vascular system.” In fact, that system was beginning to break down, threatening the heart, lungs, and brain
. He found that the disease was most contagious in the fourth to tenth day.
In the final stage, the burning skin became cooler, the patients appeared better in the mornings but deteriorated at night, and “the eyes were turning off and sinking into eye-sockets.” The face became “deeply altered,” pale with exhaustion. The body began to stink, as if it were decomposing while the man was still alive; indeed, de Kerckhove wrote that the men’s figures had a “dead-body look and seemed ready to dissolve themselves.” The limbs blackened with gangrene, especially where vests or tight clothes prevented blood from circulating.
The physician found that the typhus epidemic, rooted in the “reeking places” the men were forced to occupy, was almost weirdly potent. “Here,” he wrote, “it often happened that men died in a lightning-fast way.” For this, he blamed the exhaustion of the men and the conditions in the hospitals strung back to Poland like a filthy necklace. In a final burst, looking back on those days, he called the hospitals “plague-filled cloacae,” diseased sewers. One feels the even-keeled de Kerckhove straining for vile effect, eager to fleck his reader’s eyes and ears with the awfulness of what he had seen.
Often, those typhus patients in the typical hospital who were seen by a doctor would have been bled and cupped to draw noxious substances away from the vital organs. Bleeding was a classic Hippocratic approach to restoring humors that had gotten out of balance, but it was a particularly awful solution to typhus, where the veins are already having trouble delivering blood to the body. Bark was given when available, as well as water reddened with wine, but there was so little of that to go around that few patients would have received even a taste.
The Illustrious Dead Page 16