Neurosurgical work during the Napoleonic wars: Baron Larrey's experience.

OBJECTIVES

Considered as the most famous French military surgeon, Dominique-Jean Larrey (1766-1842), who joined all the campaigns of Napoleon, wrote his memoirs and several medical articles. This paper discusses how in the Napoleonic times, Larrey dealt with neurosurgical diseases or injuries.

PATIENTS AND

METHODS

We reviewed four main publications of Larrey published between 1812 and 1838 and analyzed the type of neurosurgical cases presented and their treatment.

RESULTS

These works include his practice of what we call now "neurosurgery" since most injuries described concern the skull or spine. He seemed to treat patients with humanity, integrity and perseverance. Larrey dealt with many aspects of neurosurgery, such as cranial or spinal trauma surgery, and also infectious diseases. He saw many head injuries inflicted not only by muskets or artillery, but also with spears and sabers. Unlike some others, Larrey advocated the use of trepanation in many situations as practiced, for instance, in the treatment of depressed fractures or in presence of subdural collections. On the other hand, this surgeon who saw thousands of amputees during his career did not mention the phantom limb phenomenon in his memoirs. Similarly, the issue of cerebral localizations is only mentioned in his last work, published in 1838.

CONCLUSIONS

In his work, Larrey (and all his contemporaries) dealt essentially with "cranial" surgery, as in skull fractures where the brain could potentially have been injured by bone fragments. The time for brain surgery had not come yet.