There were around 50 hospital staff in Brussels before Waterloo, some of whom had recently been on campaign elsewhere in the Low Countries. Other regimental doctors came over with their battalions, as did other hospital staff members (physicians, apothecaries, purveyors, and dispensers).  At the time of Waterloo, there was no anaesthesia, no knowledge of or protection from bacterial infection, and hospital and daily care were still rudimentary.

A 19th-century surgical illustration detailing amputation at the thigh. Credit: Wellcome Library, London. CC BY 4.0

 

Most battalions at Waterloo had a regimental medical officer and two assistants, the senior of whom would usually go into line and perform first aid – applying tourniquets, bandaging, splinting, suturing (stitching), giving water, and getting casualties out of the combat zone where feasible. The wounded would be carried off the field of battle by bandsmen or colleagues. Often casualties would then have to just fend for themselves.

Many regimental surgeons and some assistant surgeons and staff surgeons collected at Mont-St-Jean Farm, about 400 metres behind Wellington’s line. This was the 1st Corps hospital, under the command of Dr John Gunning. Here wounds were redressed and cleaned, fractures were ‘reset’, and amputations and trepanning (skull surgery) performed.

Larger hospitals and garrison and divisional services were staffed by Deputy Inspectors of Hospitals, the most senior rank of military doctor, staff surgeons (equivalent to today’s hospital consultants), assistant staff surgeons, orderlies, and a few nurses.

The four-day campaign had given them around 63,000 casualties to care for. Many had to struggle to a nearby aid-post or hospital. The rest waited (and many died) for comrades to collect them, taking most to the farm buildings of Mont-St-Jean. Wounded Frenchmen were anxious to avoid capture and imprisonment on the notorious British prison hulks. But priority, anyway, was given to the British and Allied wounded. About 40 springwagons were hired from Brussels to bring in the casualties from the battle

Most wounds were inflicted on limbs (around 75%), and two-thirds were caused by small-arms fire from low-energy, smoothbore, muzzle-loading fusils, carbines, and pistols. After 50 metres or so, the lead missiles lost kinetic energy, since they were heavy and round. Also, loading and powder quality were often substandard. Thus many injuries were caused by ‘spent’ balls. Discs of bacterially contaminated clothing were also frequently driven into the depths of these wounds by the missiles. To repair the damage, the surgeon first explored the wounds, using his finger. This preceded removal of debris, using probes, bullet scoops, or forceps.

Wounds from heavy iron cannon-shot – between 3lbs and 24lbs in weight – were usually fatal if received centrally or on the head and neck. Many limbs were avulsed (torn off) by round-shot. Tangential strikes by large balls could cause severe internal disruption. Quartermaster Sir William Howe de Lancey was hit a glancing blow on his right loin by a round-shot. He took a week to die. At post-mortem, it was found that eight ribs had been avulsed from his spine, and he had suffered muscle, lung, and renal injuries. His new wife Magdalene nursed him until he died. Few contemporary surgeons believed in ‘the wind of the ball’ as a potential cause of injury

Most gaping wounds were left open and dressed with moist lint, or in the case of burns, non-adherent oily or waxed dressings. Rolled linen bandages (‘rollers’) were applied to limb and trunk wounds. Although débridement (thorough wound-cleansing) as we know it today was rarely employed, surgeons often removed some dead tissue or foreign material. Other wounds, such as those caused by sabres, lances, or, rarely, bayonets, were closed with linen or silk sutures or adhesive tapes.

Roughly 2,000 amputations were carried out during or after the four battles (Ligny, Quatre Bras, Wavre, and Waterloo), with perhaps 500 Allied limb removals on the day of Waterloo. Sitting upright and restrained by assistants, the unfortunate victims had a screw tourniquet applied to the damaged limb, and the soft tissues were pulled up and cut around in a series of sweeps of a large knife, followed by bone division. The arteries were then tied off and the wound was dressed. The whole operation took about 15-20 minutes. No alcohol or painkillers were administered before surgery.

prince of orange

William of Orange was wounded in the shoulder at Waterloo.

 

The most notorious amputation after the battle was that performed on Paget, Lord Uxbridge, after a serious knee injury. Wellington’s personal physician Dr John Hume (who was well rehearsed in surgery) performed a flap amputation (as opposed to a guillotine operation) after seeking a second opinion on his illustrious patient, who commanded the British cavalry and was brother-in-law to the Duke. At one point, the saw jammed as the bone became angled on the saw.

The inpatient mortality at Waterloo was around 9% – a seemingly very good result, until we realise how few serious casualties ever reached hospital. In April 1816, ten months after the battle, of 6,831 admitted casualties, 5,068 (74%) were able to rejoin their unit, 506 were discharged from service, 854 were still inpatients, 236 survived amputation, and 167 joined veteran battalions.

Many casualties became in- or out-pensioners at the Royal Hospital Chelsea or at Kilmainham in Ireland. Prosthetic limbs were issued from these hospitals, but often a local artisan would construct an artificial part for an amputee.

Many medical lessons gained from this long war were forgotten in the two generations of soldiering that followed. Parsimony, complacency, and gross mismanagement were to blight the British Army in the years 1815 to 1854, setting the stage for the medical disaster of the Crimea.

Mick Crumplin is a retired surgeon, curator, and archivist at the Royal College of Surgeons, and author of The Bloody Fields of WaterlooThis is an extract from an article that appeared in issue 72 of Military History Monthly.



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