First Aid on the Battlefield, 1869

By Mark Harrison ~

Originally published in Hidden Treasure: The National Library of Medicine, 2011.

In 1870–71 the Prussian war machine tore through France with ruthless efficiency, eliciting fear and admiration in equal measure. What impressed international observers was not only the power and precision of the Prussian army but also the arrangements it had made for the prevention of disease and the evacuation and treatment of casualties. Whereas the French army suffered more than 200,000 cases of smallpox, the Prussians had fewer than 5,000, and whereas the French wounded often went untended, the Prussians made extensive use of railways to evacuate casualties and dealt with them far more effectively on or near the battlefield.

These vaunted achievements were the fruit of bitter experience. Those who planned the medical evacuations during the Franco-Prussian War included many veterans of earlier conflicts, beginning with the First Schleswig War of 1848–51, when Germans in that duchy attempted to secede from Denmark. The secession, at first crushed by the Danish army, was achieved by force with the support of Prussia and Austria in 1864. Two years later the battle-hardened Prusso-German army went on to defeat Austria, signaling the reemergence of Prussia as a major military power. In these earlier conflicts, German forces had failed to plan effectively for the treatment of their war wounded.

At the heart of this turmoil was Friedrich von Esmarch (1823–1908), who was to become one of the most famous surgeons of his day. Born on the west coast of Schleswig-Holstein, Esmarch was a German patriot who strove for independence from Denmark. He obtained his medical degree from Kiel University in 1848 and shortly afterward enlisted as a surgeon in the army of the Schleswig Germans. His experience as a frontline surgeon led him in 1851 to write a treatise on bullet wounds in which he showed that injured limbs could sometimes be saved, avoiding amputation. When war broke out again in 1864, Esmarch served in the field hospitals of Flensburg, Sundewitt, and Kiel. After war was declared against Austria he was called to Berlin in 1866 to become a member of the hospital commission and to oversee surgery in military hospitals there. This accumulated experience formed the basis of his best-known work, First Aid on the Battlefield (Der erste Verband auf dem Schlachtfelde), 1896.

The pamphlet had enormous influence on first aid in both military and civilian life. It endeavored to make first aid comprehensible to laymen and was included in a kit to be carried by soldiers. This kit famously contained a triangular cloth bandage (pictured here) printed with instructional illustrations for securing injured limbs and reducing bleeding on different parts of the body.

Esmarch went on to make other important innovations in surgery and first aid, including a rubber tourniquet bandage that enabled what he referred to as “bloodless surgery.” His works on surgery and first aid were translated into other languages and went through many editions. As someone who was revolted by what he termed “the terror of war,” Esmarch through his life and work exemplified the complexities of an age in which barbarism and humanitarianism marched hand in hand.

Mark Harrison is Professor of the History of Medicine and Co-Director of the Wellcome Centre for Ethics and Humanities at the University of Oxford. His publications include The Medical War: British Military Medicine in the First World War; Medicine in an Age of Commerce and Empire: Britain and Its Tropical Colonies, 1660–1830; and Medicine and Victory: British Military Medicine in the Second World War.