Anticipating the Ambulance

By Courtney Foster BA, MSc

The rate of recovery for battlefield casualties depends on the work of skilled medical personnel and the availability of efficient transport vehicles. During the entirety of the Napoleonic Wars, the Army Medical Department was ill-equipped to transport sick and wounded soldiers effectively. This frequently resulted in a heavy reliance upon local authorities to provide the necessary resources. Thus, by default, the same transportation methods used to supply food and other equipment also conveyed the sick and wounded. Availability ultimately dictated choice; hence, bullock carts and, to a lesser degree, waggons were commonly used to transport soldiers in ‘sick convoys’1 especially during the Peninsular War. With few exceptions, such carriages were consistently unreliable; carts and waggons were prone to breaking down usually as a result of bullocks dying from exhaustion or starvation, rocky roads left vehicles in disrepair, and local drivers had little to no protection against marauders. By comparison, the Royal Waggon Train, supplied with spring waggons from Britain, was more sophisticated. It was certainly better than no provisions at all, but the Royal Waggon Train did very little to alleviate suffering largely due to a lack of supply and its inability to cope with torturous terrain.

Depending on terrain, inclement weather and medical logistics, the evacuation of casualties could, at times, prove impossible; thus soldiers, unable to help themselves, were left to perish on the battlefield or were forsaken by the roadside. Although conditions slightly improved during the last years of the Peninsular War, largely as a result of Sir James McGrigor’s work as Chief Inspector of Hospitals for Wellington, a sufficient supply of medical carriages was never fully guaranteed. Despite McGrigor’s recommendations, problems procuring medical transportation vehicles persisted long after the Peninsular War. Thus, casualties from the Battle of Waterloo suffered accordingly.

While mules, horses, ox-carts, and spring waggons were commonly used for evacuating the sick and wounded, the French had a unique advantage: the ambulance volante. Baron Dominique-Jean Larrey, credited with creation of the ambulance volante, described it as having great strength and being as speedy as flying artillery. According to his memoirs, these ambulances consisted of two and four wheeled carriages, and mobilized 340 men in three divisions.2 Arguably, the different designs of these ambulance volantes allowed medical supplies and personnel to reach casualties faster while providing a more comfortable mode of transport for soldiers. Therefore, the French had a more systematic means for transporting the sick and wounded. For the British, the lack of a similar evacuation system negatively affected morale no less than death rates.

The consequences of inefficient evacuation methods varied. The journey from battlefield to hospital or elsewhere, if not fatal, was excruciating. Firsthand observations, from officers and medical personnel, express just how agonizing it was to be transported as a sick or wounded soldier.

There were several reasons why commonly used medical vehicles, namely, spring waggons and bullock carts, were particularly unbearable. Several men were often piled into each cart or wagon. This could prove unnecessarily painful depending on specific maladies. Certain afflictions necessitate specific postures in order to regain health. For example, a recumbent position would be the most advantageous for severely wounded soldiers who also suffered from excessive bleeding, faintness, and shock; but it was also cumbersome. 3 For a soldier to lie down while traveling, more space in each carriage was required. This would, in turn, allow fewer men to be transported per vehicle. Considering the overall insufficient supply of transport, this could be problematic. To maximize space and supplies, soldiers with wounds that necessitated recumbent positions may have been forced to sit cramped alongside other casualties. As expected, officers were afforded preferential treatment. If available, they were provided with more comfortable forms of transport when they fell sick or became wounded. Even McGrigor benefitted from his position; after severely injuring his knee in Salamanca, McGrigor was transported by Wellington’s own personal carriage.4 Sedan chairs, litters, and personal carriages were strictly reserved for officers and NCOs.

The mountainous terrain of certain countries, especially Spain and Portugal, also made transporting casualties rather torturous. Such routes made waggons and carts jostle violently up and down en route to hospitals and other destinations. Henry Milburne, a surgeon who served in the Peninsula, provided one of the most thorough descriptions:

A more inconvenient, ill constructed, clumsy carriage cannot be well conceived…the shocking inconvenience of such a jolting conveyance for sick and wounded…added to which the noise they make is the most disagreeable possible.5

Moreover, bullock carts could only travel at a speed of up to two miles per hour. This resulted in long journeys that could last for weeks depending on proximity between pick up and drop off locations. The condition of casualties often worsened as a result of such a journey. Captain William Swabey observed a sick convoy in 1812 after the army retreated from Burgos to Ciudad Rodrigo:

The unfortunate beings, more fit for their death beds than for being moved from one place to another…on cars without springs; every jolt of which is sufficient to fracture a limb.6

While serving in the Forty-Third Regiment, Captain Cook described witnessing a similar convoy:

When we passed Arévalo, one of the narrow streets leading to the plaza was choked up with cars from the city Burgos, crammed to overloading with exhausted, speechless and wounded Highlanders, covered with hot sand and many of them slumbering unto death; their pallid countenances portended the speedy dissolution of their lingering sufferings, while their sable plumes and torn tartans hung loosely on the pointed stakes which formed the temporary sides of rude vehicles.7

Thus, bullock carts and, to a lesser degree, spring waggons became notorious among soldiers.

Despite the lack of sufficient supplies for evacuating the sick and wounded, arrangements for medical transport did exist, to a certain degree, and were organized around the establishment of hospitals. In general, large numbers of soldiers in need of medical evacuation were organized into sick convoys for convenience. These groups of men were assembled for transport to the general hospital or to return to active duty. To reintegrate convalescents back into their regiment, the necessary transportation was acquired only after consent was given. Besides the general hospitals, regimental, intermediate, and receiving hospitals were also established. Regimental hospitals were smaller than general hospitals, closer to the battlefields, and under regimental control. In theory, this allowed for wounded and sick soldiers to be treated with their regiment which would promote comfort and thus reduce recovery time. It is important to note that a significant and recurring debate, regarding the differing degree of care provided by the general and regimental hospitals, persisted throughout the Napoleonic Wars. Intermediate and receiving hospitals were similar to general hospitals but had more specific functions. Receiving hospitals initially received sick and wounded soldiers, and administered first aid according to triage. Intermediate hospitals linked the general and regimental hospitals by providing care to soldiers in transit to general hospitals or men returning to active duty.

Hospitals were not always created according to need. The establishment of certain hospitals was highly politicized. For example, the Army Medical Board, an administrative body, was divided into three offices following the death of John Hunter. The regulations for these new officers stated that “the Physician General, Surgeon General, and Inspector of Hospitals shall each have his distinct Province of business, and of recommendation.”8 While Thomas Keate, acting as Surgeon General, was a supporter of the general hospitals, Francis Knight, the new Inspector General of Hospitals, believed they were a waste of money. This debate eventually influenced legislation that did not favour general hospitals and resulted in their overall reduction. In 1809, when the army arrived in Corunna with over 4,000 sick soldiers that had to be transported to England for treatment, there were no beds available “owing to Knight’s senseless policy of closing the general hospitals at Gosport, Plymouth, and Deal.”9 Thus, the availability of hospitals could have a detrimental impact on medical transport procedures.

The advancement or retreat of the army also heavily effected the management of transport for the sick and wounded; transportation routes and hospital stations had to fluctuate accordingly. Such flexibility did not always inhibit medical care. In 1811, the creation of hospitals at Coimbra and Celerico were a direct result of a changing military situation. Transportation routes were then established in accordance to these new hospitals; however, as McGrigor recounted in his journal, the quality of transport had not improved.

The sufferings of the sick and wounded on this route were very great: a distance of miles, particularly from Celerico to Coimbra…as the sick and wounded were conveyed on this route almost always only on bullock carts…meeting little cover on the route and…not unfrequently without comforts. The loss on the road was…immense…of those who died on the evacuation. They suffered so much by the transport that many particularly of the wounded and those ill of dysentery arrived in so bad a state as only to survive a few days or hours after their reception into the hospitals at either Celerico or Coimbra.10

With the arrival of Sir James McGrigor to the Peninsula in 1812, existing hospitals were thoroughly evaluated and recommendations were made in order to improve how they functioned. McGrigor was an adamant supporter of regimental hospitals. Despite Wellington’s overall reluctance, McGrigor was eventually given permission to increase the number of regimental hospitals in the Peninsula. McGrigor’s tireless effort to improve the medical services was successful with the exception of securing an efficient evacuation service similar to the French ambulance system. According to McGrigor’s autobiography, Wellington notoriously refused his request for an increase in medical transport vehicles, claiming that it would interrupt the movement of the army and its weaponry.11 On the other hand, Wellington was not solely responsible for supplying medical transport or allotting money for their usage.

At the commencement of the Waterloo campaign, not much had improved in regards to the medical transport system. However, now attached to each regiment was a spring wagon for medical purposes. Nonetheless, there still remained an insufficient supply of transport vehicles just as equally unfit to comfortably evacuate the sick and wounded. While in Quatre Bras, a visitor observed the following:

Coming from Waterloo passed forty waggons of wounded crying out…many died instantaneously, others were in a putrid state—a kind of living death.12

Edward Costello also observed the wounded in Quatre Bras, the day after Waterloo:
In the morning the scene passed all imagination and baffled description: thousands of wounded French, Belgians, Prussians, and English; carts, waggons and every other attainable vehicle were continually arriving heaped with sufferers. The wounded were laid on straw…and nearly destitute of surgical attendance.13

Following the battle of Waterloo, the wounded and sick, unable to endure the twelve mile journey to the general hospital at Brussels, lie waiting all night for treatment. Some cases could be transported by carriage but it still took several days to evacuate the wounded from Mont St Jean. Although there were hospitals open in Ghent, Burgos, and Ostend, spare beds could not be filled, largely due to a lack of efficient transport. A field hospital was eventually opened in a village near Mont St Jean which somewhat rectified the problem. When carriages were not available, other forms of transport were utilized; while less sophisticated, other modes of transportation were immediate and, at times, more practical.

Bullocks and mules were not only used to pull carts and waggons. During the Peninsular War, mules were commissioned to carry supplies which included tents, kettles, the officers’ baggage and other necessities; each regiment had approximately fifty mules at their disposal.14 When necessary, some mules also transported the sick and wounded. Considering that they were often in short supply, it was difficult to procure mules for medical purposes. On the other hand, in the Pyrenees, mules were the primary mode of transport to hospitals because the inhospitable landscape was not conducive to transporting soldiers safely in carts and waggons. When he was responsible for escorting the wounded in the Pyrenees, George Bell recounted his experience travelling to the hospital at Elizondo:

The only conveyance for the poor cripples with broken arms and legs and shattered shells were some mules sent up by the Commissary. Two men were placed on each mule, with their broken limbs bandaged up in a way and dangling down. No help for it; no cart-roads in the Pyrenees, and the poor fellows were groaning with their sufferings all the way.15

Being transported by mule may have been just as harrowing as travelling in a bullock cart. Both forms of transport were so terrible that some preferred to travel by foot.

Not every injury or illness warranted prompt evacuation by carriage. Those who were able walked to receive treatment. Depending on weather, condition of the roads, distance travelled, and supply of proper footwear, walking could easily aggravate a soldier’s condition. At Agueda, McGrigor recounted that “the men’s feet, which from the hard and watery roads, with want of shoes, were much inflamed and covered with sores.”16 The shortage of proper footwear and its ill effects on the medical conditions of ailing soldiers is often overlooked. Festering sores and bloody soles increased the likelihood of infection and thus fever. This served only to compound the problems of ill and wounded soldiers.
Inadequate shoes, cheap and poorly constructed, made traveling on foot less endurable. During the retreat through Galicia by Moore’s army, footwear was abandoned altogether. Thick mud and slush cemented boots to the ground. As a result, “hundreds of men were forced to march barefooted, leaving bloody trails in the snow as testament to their boots’ inadequacies.”17 In his journal, Sergeant D. Robertson recalled the terrible conditions faced by the retreating army:

There had once been a good road but it was so destroyed by heavy rains…that we could not go a step without sinking to the knees in mud.18

After witnessing the condition of Moore’s army in England, Marc Isambard Brunel made several enquiries to determine the loss of men as a result of poor footwear. Figures revealed that the lack of proper footwear heavily contributed to the overall death toll. Generally, army boots were layered with clay to fasten together the inner linings and the outer soles; the clay dissolved easily in water and mud. To combat this problem, Brunel (father of the famous engineer) developed a more durable boot. Although the British government did supply the army with Brunel’s boots, the issue was ordered only during the last years of the Peninsular War. However, at Waterloo, the Imperial Guard benefitted greatly from Brunel’s boots.19 The wounded and sick that were capable of walking, even when equipped with proper footwear, could hardly travel unaccompanied for long distances.

After witnessing the condition of Moore’s army in England, Marc Isambard Brunel made several enquiries to determine the loss of men as a result of poor footwear. Figures revealed that the lack of proper footwear heavily contributed to the overall death toll. Generally, army boots were layered with clay to fasten together the inner linings and the outer soles; the clay dissolved easily in water and mud. To combat this problem, Brunel (father of the famous engineer) developed a more durable boot. Although the British government did supply the army with Brunel’s boots, the issue was ordered only during the last years of the Peninsular War. However, at Waterloo, the Imperial Guard benefitted greatly from Brunel’s boots.19 The wounded and sick that were capable of walking, even when equipped with proper footwear, could hardly travel unaccompanied for long distances.

The human and indefatigable exertions of the fair ladies of Brussels however, greatly made up for this deficiency; numbers were busily employed-some strapping and bandaging wounded…many occupied themselves stripping the sufferers of their gory and saturated garments, and dressing them in clean shirts.22

These were not the only forms of transport used for medical purposes; however, they were the most common in the Peninsula and Waterloo. Terrain and available resources determined which modes of transport were pressed into medical service; much to their detriment, the British would never develop anything as sophisticated as the ambulance volante during the Napoleonic Wars.

The Peninsular War and the Battle of Waterloo served as a lesson, largely ignored, in the necessity of improving the medical transport system of the army. Several medical personnel who served during the Napoleonic Wars later expressed the need for a system similar to le corps d’ambulance. William Fergusson, a physician who served in the Peninsula, wrote the following:

their ambulance or field hospital system I believe to be greatly superior to ours, and that it contains much that we might copy with great advantage…our means of transporting sick and wounded have ever been deficient and cruel, as all can testify who attended the bullock cars of the Peninsula. We have indeed a few spring waggons, but not a tithe of what an army engaged on actual service would require.23

George Ballingall, a surgeon who had served during the Peninsular War, delivered a series of introductory lectures at the University of Edinburgh, dedicating an entire lecture to the necessity of improving the army medical transport system; he even used Larrey’s innovation as his primary example.24 Because the British defeated Napoleon, the need to innovate the army medical transport system was not a priority. Indeed, similar problems persisted into the Crimean War. As a result, countless wounded and ill soldiers needlessly perished. Clearly, distressingly little was learned from the Peninsular War and Waterloo about the adverse impact of an inefficient medical evacuation system.

Footnotes

Howard, Martin, Wellington’s Doctors: The British Army Medical Services in the Napoleonic Wars, Kent, 2002, p.69. ↩
Larrey, Dominique-Jean, Mémoires de Chirurgie Militaire, et Campagnes, Vol. 1, Paris, 1812, pp. 151-152. ↩
Longmore, Sir Thomas, (ed. W Morris), A Manual of Ambulance Transport, London, 1893, p. 93. ↩
McGrigor, James Sir, The Autobiography and Services of Sir James McGrigor, London, 1861, p. 315. ↩
Milburne, Henry, A Narrative of Circumstances Attending the Retreat Under the Command, London, 1809, pp. 94-95. ↩
Swabey, William, (ed. F A Whinyates), Diary of Campaigns in the Peninsula for years 1811, 1812, and 1813, London, 1984, p. 151. ↩
Cooke, J.H., ‘The Personal narrative of Captain Cooke of the Forty-Third Regiment, Light Infantry’ in Anon. (ed,), Memoirs of the Late War, London, 1837, I, p. 213. ↩
The National Archives, WO26/37, London, pp. 358-363. ↩
Cantlie, Neil Sir, A History of the Army Medical Department, Edinburgh, 1974, p. 307. ↩
McGrigor, J., GB 0817 AMCS 4/1/3/1, Sir James McGrigor Papers, Aberdeen Medico-Chirurgical Society, 1811. ↩
McGrigor, J., The Autobiography and Services, p. 265. ↩
Cantlie, Neil Sir, A History of the Army Medical Department, Vol.1, Edinburgh, 1974, p. 390. ↩
Costello, Edward, (ed. A Brett James), The Peninsular and Waterloo Campaigns, London, 1967, p. 155. ↩
Howard, Martin, Wellington’s Doctors: The British Army Medical Services in the Napoleonic Wars, Kent, 2002, p. 75. ↩
Bell, George, (ed. B Stuart), Soldier’s Glory, London, 1956, p. 81. ↩
McGrigor, J., GB 0817 AMCS 4/1/3/10, Journal 10, 1813. ↩
Fletcher, Ian, Wellington’s Foot Guards, Oxford, 1994, p. 28. ↩
Robertson, David, The journal of Sergeant D. Robertson, late 92nd…, Perth, 1842. ↩
Fletcher, I., Wellington’s Foot Guards, p. 28. ↩
Crumplin, Michael, Men of Steel, England, 2007, p. 98. ↩
Ibid. ↩
Costello, E., The Peninsular and Waterloo Campaigns, p. 155. ↩
Fergusson, William, Notes and Reflections of a Professional Life, London, 1846, p. 61. ↩
Ballingall, George, Introductory Lectures to a Course of Military Surgery, London & Edinburgh, 1830, pp. 189-227. ↩