Leadership of the creation of Russian battlefield medicine
Early 19th century Russia had little organised medical profession, its upper echelon hiring doctors from abroad. Battlefield medicine was likewise meagre. The entire army had only 200 doctors, mostly foreigners; some inadequately qualified, too old, or having inadequate Russian language.
Upon joining the army, Wylie found that battalions generally had a sole foreign doctor without auxiliaries; absence of regulations leaving him to act on his own initiative and in accord with his own comfort. Officers were priority: doctors often removing them far from the battlefield and continuing treatment there for as long as they liked. Lower ranks received little treatment; therefore likely to succumb to wounds and diseases. Ambulance services and first-aid posts did not exist; the wounded abandoned on the battlefield.
Wylie always treated rank-and-file soldiers whenever possible, resolving to mandate this.
A key role of his 1806 appointment as Chief Military Medical Inspector was to transform battlefield medicine; his authority reinforced in 1808 when appointed manager of all army medicine; immediately dividing that role among four assistants. To this he brought considerable battlefield experience; a "real genius for administration", and according to colleagues, a practical and scientific approach.
Wylie's team created the prototype for today's system, viz:
Irrespective of rank, wounded soldiers were carried to battlefield dressing stations, deployed immediately adjacent to the fighting troops, for triage and initial attention by regimental medics.
Then, if required, the wounded were forwarded for treatment/evacuation along an echelon of hospitals:
this according to patient's registered status ("forward"; "forward on foot"; "don't forward - movement too damaging").
Each regiment had 20 non-combatants undertaking stretcher transfers from battlefield to dressing station and from there to regimental infirmary:
army intendant Kankrin later streamlined this using spent ammunition carts.
Dressing stations were provided with surgical instruments, ready-made dressings, and pharmaceutical box; all delivered via a regimental cart.
Station locations, denoted via posted flags, were designated within army day orders; military police overseeing subsequent repositionings.
"Mobile Hospitals":
Moving with the army, these were regimental infirmaries plus a hospital at each divisional and corps headquarters.
"Regulations on Procedures for Establishing Hospitals at Foreign Armies" (1807) dealt with providing armies on the move with transport and medical requirements for such hospitals to operate.
Each doctor had an instrument pocket set plus nearby instrument and pharmaceutical boxes matching his hospital category; box contents being routinely reviewed.
Army surgical instruments being inadequate, around 1806 Wylie established supply standards; embedding these within army supply tables and hospital standards. At his own expense, he purchased British instruments as templates for local production overseen by him; providing Russian doctors with almost all known types.
Prior to anticipated battle, each mobile hospital establishes to reserve first aid supplies.
"Regulations for the delivery of mobile hospitals" (early 1812) ratified the above arrangements, treatment standards and hospital capacities.
"Regulations for corps and division hospitals and regimental infirmaries" (1816) standardised numbers of each staffer category within medical teams of each hospital type.
Military police convoys transferred wounded between the mobile hospitals, also further afield; their commander mapping out the routes prior to the battle and overseeing subsequent repositionings.
Wylie established patient categorisation to guide their transition between hospital types; individual classifications frequently reviewed:
retain for treatment – very seriously ill, would not survive transport,
treat at a frontline hospital – can soon return to service,
send to remote hospital – requires prolonged treatment.
"Temporary Hospitals":
In 1807, Wylie had established and equipped multiple military hospitals at Königsberg serving 20,000 wounded Russian and French soldiers gathered there following the nearby Battle of Eylau. These spawned his later "Temporary Military Hospital": a large-capacity hospital located at a safe distance from the mobile hospitals; acting as an evacuation intermediary between them and city hospitals further afield. City civilian hospitals were included; Wylie authorised to assign soldiers there, conduct inspections, and require improvements.
Invasion imminent, he increased temporary hospitals from 29 to 70, all fully equipped.
"Regulations for temporary military hospitals in a large active army" (early 1812), and "Regulations concerning temporary hospitals in the field", outlined their role within the phased treatment/evacuation system, their material supply, and nutritional system.
Requisitioning buildings along the army's 1,500 mile advance between Moscow and the French border during 1812–1813; Wylie created a string of fully-equipped temporary hospitals. From these, via huge feats of organisation, two-thirds of wounded soldiers were returned to their greatly-depleted regiments during the army's 1812–1813 winter pause at the Russian border, and many more during the army's 1813–1814 winter pause at the French border.
To ensure high hospital standards, Wylie conducted detailed personal inspections.
He insisted on hospital cleanliness. Before admission, patients were thoroughly bathed, their clothing sent for fumigation.
He insisted on strict hospital procedures against spread of contagious diseases, including captured physicians and paramedics treating enemy patients.
In 1808, he mandated military hospital doctors maintaining case records, and hospitals and army divisions supplying him annual mortality/morbidity statistics. Similarly, he had his War Department medical team standardise and record medical statistics.
To forestall officers meddling in military doctors' work, Wylie created divisional and corps doctor positions of equal rank to corresponding combat staff; with sole authority over army medicine.
Similarly, he established regulations formalising conscription, recruitment, ranking and promotion for all military doctors, putting them on an equal footing with combat officers.
Funding Russia's army was perennially difficult. In 1810, Wylie, reported widespread malnutrition among rank-and-file soldiers; citing inability to afford supplementing their meagre army rations. Thereafter, infantry soldiers received three free days weekly to earn supplemental income.
Russian military hospitals were in "a deplorable state" on Wylie's arrival in Russia. He later guided their reconstruction along the lines of institutions visited with tsar Alexander at Paris and London in 1814. Saint Petersburg's numerous military hospitals were inspected in detail by a prominent British doctor in 1827 who found them in "very excellent condition".
Russia's first feldsher schools established (1838).
In 1843 he obtained increases in army doctor salaries; increasing by a quarter every five years.
Russian military medicine would become Europe's most progressive by 1814; but Wylie's modified system of battlefield medicine and hospital disposition was still a fledgling at the time of Napoleon's invasion. Nevertheless, at Borodino his doctors worked within an organised, coherent framework; with a high level of organisation in evacuating and treating 19,500 wounded within 3 days. He later stated that 16,000 had been attended within 26 hours; 567 needing amputations. For mobile hospitals, he had readied bullock carts piled with tents, materiel stockpiles, and staff.
To minister Arakcheyev, he reported:" ...two-thirds of the doctors were distributed behind the third line, in front of the deployed corps, while the rest were scattered in various places along the lines. Through this distribution, all those wounded ...received operations and dressings, with the exception of a very small number who strayed off the main road. From here to Moscow, doctors were stationed along the lines both to examine the wounded and to ensure that none of them were left along the route without assistance".
Borodino's wounded were rapidly evacuated to hospitals deployed in Moscow, Ryazan, Kolomna, and Yelatma. When Moscow was abandoned, its 30,000 were quickly relocated beyond harm's way.
