Forgive me if I reproduce a review of this book that I did in 2013 for a medical journal that I help to edit.
Guthrie's War; A Surgeon of the Peninsula and Waterloo.
Michael Crumplin
Pen and Sword Books Ltd (2010)
ISBN 978 1 84884 245 8
Price £19.99 GBP
Indulge me, for once, with a review nothing to do with ENT, but an inspiring read for any surgeon. The Bicentennial of Waterloo approaches and we all have our obsessions with moments in history. For me, for some reason I can never fathom, mine centre on 18.06.15 and 07.12.41. Many a trudge through muddy fields south of Brussels results from the former date. Never have yet got to Oahu.
There is no harm in our trainees learning how it was for surgeons in those distant days. The current generation would not know Wegener from Wagner (accepting that both are very politically incorrect now). This was brought home to me by a young medical student in theatre, who admitted to having never heard of the Dambusters, but worse, on further enquiry, Bobby Moore meant no more to her!
Napoleonic battlefield surgery conjures an image of thousands awaiting your attentions, armed with no resources, authorities that care not a fig and procedures of very limited effectiveness. Actually that sounds very familiar.
There are several books on the subject currently, best known "Napoleon's Doctors" and "Wellington's Doctors" by Dr Martin Howard both describing the efforts in establishing some medical care in a society seemingly indifferent to military suffering and generals who had to give priority to the needs of campaigning. This book is different and a better read for those unfamiliar with the era or military matters. The author is a retired surgeon and both curator and archivist at the London College of the RCS England and adds much useful explanation of terms for the lay reader. This book shows, in numerous anecdotes, what the human body can withstand on occasion, this despite contemporary treatment. Most trauma and shock was handled with Venesection, Leeches, Blistering, "a low diet" and Calomel (the mercury compound blamed for Napoleon's death), yet some patients with depressed skull fractures, peritonitis and fistula still survived to see home once more.
The author draws on Guthrie's memoirs and earlier biography. He is clearly an expert on the period and I struggled till page 142 determined to find any technical error. He has the calibre of French artillery at Waterloo wrong, despite using Adkin as a reference, but you'll forgive that, surely. 6 and 12pdrs with some howitzers, in the second edition please, no 8pdrs by then.
There is an excellent account of Guthrie's early career and the career disadvantages due to his remarkable youth. The tale of access to the front entrance of the RCS I'll leave you to read, as highly entertaining for any Fellow. Post war he worked at the Westminster and served as President of the RCS for three terms. It is amusing to read of the impoverished poor chap returning to London in 1815 and setting up in Jermyn St, with a grand total of two private patients. A Daguerreotype, a very early form of photography, reminded me of the only such image of the Duke himself and haunting they both are.
Guthrie saw remarkable war service and felt more than one roundshot within feet of him. It is interesting to read the author's deduction that Black Bob Crauford could have been saved, at Cuidad Rodrigo, by a trochar and cannula to drain a pyothorax.
Guthrie's contributions to understanding of military surgery are very well summarised at the end of the text. He worked to avoid upper limb amputations, he avoided tourniquets (controversially) in treating vascular damage, he recognised compartment syndrome, to name but a few. John Hunter and Charles Bell are better known, as they wrote extensively and with great authority, despite very limited experience of battlefield surgery. Little has changed then and Bell seems to have spent as much time sketching the unfortunates as treating them. Larrey, for France, remains the icon, but you only met him if you were in the Imperial Guard! It surprised me that senior surgeons under Wellington did spend as much effort on treating a lowly private as on the gentry. Uxbridge, Hussey Vivian, Halkett and Picton (Jack Hawkins post laryngectomy in the film) all seem to have waited their turn for the saw or dressings. The accounts of surgery are numerous and brilliantly written.
I read this in a day, as I found it impossible to put down (and the sun was blazing). This is a tale of old fashioned surgery and a surprisingly scientific approach to developments and audit of outcomes. Highly recommended.
