The Old Prussian Military Medical Service

The outward appearance of the armies of the Ancien Régime was exceedingly splendid, but that still tells us nothing about the actual living conditions of the soldiers in colorful coats at that time. In view of the high attrition rates from bloody losses and diseases in the campaigns and battles of the 18th century, the quantity and quality of the medical services of the Old Prussian army should be considered here — a gloomy chapter that at the same time documents that the various efforts by those responsible, up to and including the king, were not sufficient and were sustainably limited by the medical boundaries of the time.

Each infantry regiment had a regimental surgeon (Regimentsfeldscher) and 12 company surgeons (Kompaniefeldschers)¹. In addition, the care of the sick was part of the duties of the Capitain d’Armes, who was assisted in maintenance and care by a “Krancken-Knecht” (sick attendant)². The surgeons had to remain with their companies at all times in order to be able to render aid quickly in an emergency³. Even under the Great Elector (1640–88) each company had had a surgeon. Above them was the regimental surgeon, but only under Frederick I was it determined that company surgeons should in future be examined and accepted by the regimental surgeon⁴. Thus a professional selection was ensured. Although the position of regimental surgeon was elevated in the period 1712–1725⁵, the knowledge and skills of the company surgeons remained inadequate — they typically came from the barber trade⁶ and lacked any scientific training. This deficiency was a serious shortcoming of the medical service of that time, and the intensive efforts of the Prussian kings were therefore mainly aimed at raising the educational level of these “surgeons.”

In 1713 King Frederick William I endowed the anatomical theatre in Berlin, founded the “Collegium professorum medico-Chirurgicum” in 1724 and established the well-known “Charité” in 1726, a combination of hospital and military hospital. A contemporary city description says of the “Charité house”: “It lies at the outermost northwestern end of Berlin. King Frederick I had a pest house built here in 1710 when the plague began to rage in the Mark. When the danger was past, it was devoted to a hospital and workhouse. King Frederick William dedicated it in 1726 as a general hospital and at the same time as a school for physicians and surgeons. He had it significantly enlarged in 1727, had all necessary economic buildings erected, and endowed it with considerable capital.... In 1785 King Frederick II had a wing added on the side toward the Invalidenhaus...”.

The “Collegium professorum medico-Chirurgicum”, which emerged from the anatomical theatre, was an educational institution and since 1725 also examined the regimental surgeons. Eight so-called pensioners were regularly instructed there; they also practiced in the Charité, ensuring practical training. These pensioners were potential candidates for the position of regimental surgeon, but such a professional prospect existed only if they had served for a time with the Guard (No. 6 or No. 15) and had proven themselves there. Under the Soldier King, surgeons were seconded to the Russian army during the Turkish War (1737/39) to gain practical experience⁸. Frederick the Great arranged scientific study visits for surgeons to Holland and France and called French surgeons to Berlin as instructors⁹. On 02 Aug. 1795 the Pepiniere was founded in Berlin with the aim of providing not only regimental but also company surgeons with a scientific foundation and thereby improving the quality of their services¹⁰.

Frederick William I decreed in 1713 that regimental surgeons should in future be “treated” like subordinate officers. The regimental surgeon of an infantry regiment received a total salary of 82 Thlr., 2 Gr., which also included an allowance of 61 Thlr., 2 Gr. and medical funds amounting to 10 Thlr. Salary rates in the cavalry differed and amounted to 67 Thlr., 14 Gr. for cuirassiers, 54 Thlr., 14 Gr. for dragoons (applies to a regiment of 5 squadrons) and 83 Thlr., 10 Gr., 6 Pf. for hussars. For garrison infantry his pay was 61 Thlr., 13 Gr., 6 Pf.¹¹.

Per campaign the regimental surgeon received a separate budget of 200 thalers, as well as forage pay for 4 horses. However, he had to maintain the company surgeons and the medical chest. He was supervised in this by the Generalchirurgus. Since he managed on a lump-sum basis at his own expense, his position in his domain corresponded to that of a company owner. In addition to supervising the company- and squadron surgeons under his command, the duties of the regimental surgeon included the “care and treatment of all internal and external illnesses and injuries of the persons belonging to a regiment’s establishment, their wives, children and domestics (servants)” and “medical and surgical practice for civilians in the place where the regiment is garrisoned, and in the surrounding area”¹². He was responsible both for those on duty and those on leave. He received no remuneration for treating enlisted soldiers on the roster, since this was already covered by the medical funds¹³. In all service matters the regimental surgeon was subordinate to the regimental chief or commander; otherwise he was subordinate to the “General-Staff-Surgeon.”

The regimental surgeon appointed, paid and dismissed the company surgeons and was responsible that they were “capable” men who “had good knowledge of internal and external diseases”. The prospective surgeons were sworn in and had to pledge “to serve faithfully as long as their capitulation with the regimental surgeon lasts, to be diligent with the sick and wounded, and to submit to the subordination of the regiment”¹³.

The surgeons were obliged to shave the non-commissioned officers and privates belonging to the company or squadron, to visit sick soldiers in the hospital or in their quarters, to administer the medicines prescribed by the regimental surgeon and to provide for their maintenance and care. Occasionally they had to visit sick soldiers on leave or seconded in the countryside or other towns. Company or squadron surgeons were not allowed to treat civilians. Their status was that of a non-commissioned officer and their pay varied from 3 Thlr. for garrison infantry to 6 Thlr., 14 Gr. for the cuirassiers.

The king opposed the premature dismissal of surgeons with an order dated 25 Jan. 1740: “My dear Lieutenant General von Marwitz. I have observed that the regiments often let go and dismiss the company surgeons, when they then go abroad and especially to Russia. Since this is harmful, I will not permit it further, but order you to not allow the company surgeons of the regiment who are country-born to go away, but to keep them until they are either taken as regimental surgeons or set up as barbers in My towns. The foreign company surgeons, however, who do not wish to stay, you may let go. I am etc.”¹⁴.

If the surgeons had served 30 years, they were to be provided for. A glimpse of their social status in the army is given by a regulation “for the Royal Prussian light infantry” from 1788, which states: “His Royal Majesty does not want the surgeons to be treated improperly and punished with canes by the officers; rather, if an officer has cause to complain about a surgeon, he must be arrested and reported to the chief of the battalion.” In 1788 the position of battalion surgeon was additionally created in the grenadier, fusilier and 3rd musketeer battalions; at the same time it was stipulated: “If the company surgeons are faithful and diligent in all their duties, and strive to become more skilled in their art, then in peacetime they shall be exempt from shaving, since it must be of more concern to the battalion and the company to have skilled people to heal the sick than ignorant barber-surgeons.”

In 1790, at the urging of Johann Anton Christian Theden, the name “Feldscher” was abolished and replaced by the designation “Chirurg” (surgeon).

The distinction between the actual physician, who treated internal diseases, and the wound surgeon remained. The first director of the Pepiniere was the Generalchirurgus Johann Goercke. The position of Generalchirurgus goes back to Frederick William I, who in 1724 appointed Ernst Konrad Holzendorff as superior of all army surgeons and thus as the first head of the military medical service who was accountable only to the king¹⁵.

The Generalchirurgus was responsible for the examination and appointment of regimental surgeons and their supervision; later he was also responsible for directing the institutions for pension surgeons and the surgical Pepiniere in Berlin. After 1740 the offices of 2nd and 3rd Generalchirurgus were created. Holzendorff’s successors as 1st Generalchirurgus were: from 1741 Johann Heinrich Bonneß (1700–1758), from 1758 Johann Leberecht Schmucker (1712–1786), from 1786 Johann Anton Christian Theden (1714–1797, who celebrated his 50th anniversary of service in 1787) and from 1797 Johann Goercke (1750–1822). Since 1805 he was Chief of the General Staff Medical Service and sole head of the medical service.

Beside the Generalchirurgus there was until 1805 also a Generalstabsmedikus at the head of the medical service: in 1735 Dr. Johann Theodor Eller (1689–1760) became Generalstabsmedikus and received supervision over the field and garrison physicians and, together with Generalchirurgus Holzendorff, over the hospitals. Christian Andreas Cothenius (1708–1789), born in Anklam in 1708 as the son of a Swedish regimental surgeon, succeeded him in 1760. Dr. Cothenius, known as the king’s personal physician, was appointed by Frederick the Great as “General-Staff-Field-Physician of all his armies” and in this capacity had to concern himself with the organization of the war hospitals¹⁶.

He established laboratories in all hospitals and reorganized after 1763 the Berlin Court Pharmacy founded in 1585, which, in addition to the Charité and the Invalidenhaus, had to supply the units of the Berlin garrison (until 1742, thereafter only the guard formations) with medicines. His further successors were Riemer until 1804 and Formey until 1805.

The dualism between physician and surgeon also existed at regimental level, since each regiment should, if possible, have a trained field physician in addition to the regimental surgeon. In larger garrisons there were also garrison physicians and garrison surgeons.

In every garrison where at least a regiment or a battalion was stationed, a hospital had to be available for cases of illness even in peacetime. If one or more companies were located in a garrison, “a certain house should likewise be adapted as a lazaret”¹⁷. Thus most garrisons and units gradually received corresponding military hospitals; here are some examples: on 28 Apr. 1735 the royal order was issued that the town of Köslin should be supported in establishing a hospital. The plan to build a lazaret in Königsberg was rejected by the king on 28 Mar. 1740 to Generalfeldmarschall Erhard Ernst von Röder (1665–1743, chief of No. 2) because of excessive cost, but he was at the same time instructed to set up a “royal house” as a lazaret.

On 20 Nov. 1747 Frederick the Great wrote to Major General Johann Christian Roelemann Freiherr Quadt von Wickradt und Zoppenbroich (1699–1756, appointed 1747 Major General and chief of No. 9): “Concerning the burned-down house in Hamm where the garrison had its lazaret and which you find necessary to rebuild, you shall have a proposal drawn up with attention to every possible economy and send it to Me, whereupon I will order what is necessary...”.

General Gottfried von Einsiedel (1690–1745, since 1740 Major General and chief of No. 6) was entrusted in 1742 with the supervision of the hospital system in Potsdam. In Breslau General Gustav Bogislaus von Münchow (1686–1769, chief of No. 36) distinguished himself during the First Silesian War in caring for the wounded. In 1788 General Johann Leopold von Thadden (1735–1817, chief of No. 3) established a lazaret in Halle; the king approved 1,136 thalers for this on 16 Mar. 1788.

The well-known leader of a free corps, Johann Jakob von Wunsch, later General of the Infantry and from 1763 for 25 years chief of No. 12, built a lazaret for the garrison in Prenzlau on his own initiative, which he sold to the town for 1,450 thalers on 14 May 1772 for the stated purpose. In Stettin the construction of a lazaret was begun in 1804/05; King Frederick William III. acceded to the request of General Karl Philipp von Owstien (1736–1811, chief of No. 7) for support by order of 11 July 1805. Thus regiment owners and commanders in particular endeavored to establish military hospitals in their areas of responsibility, partly out of their own interest, since even in peacetime epidemics and plagues repeatedly threatened the effective strength of the units and thus the fighting power of the army.

Military literature also shows that the importance of adequate health care was recognized; for example, General Friedrich August von Fink demands in his “Thoughts on Military Matters”: “In the quartering places lazarets must be built into which the sick soldiers can be brought. When laying them out one must see to it that the rooms can be provided with fresh air at all times; for from bad exhalations a healthy man becomes sick, but no sick man becomes healthy. One must also not put too many sick in one room, and the sick must be separated according to their illnesses, etc.”¹⁸.

In practice, however, few lazarets probably matched these ideals. Before the outbreak of the Seven Years’ War, a member of Infantry Regiment No. 13, for example, described the garrison hospital in Berlin as follows: “... and then we went to the hospital to G. and B. — to see there the saddest spectacle under the sun, where one, unless completely insane, must soon lose the desire for debauchery: in these chambers, as spacious as churches, where bed after bed is ranged, in each of which a miserable son of man awaits death in his own way and only a few expect recovery, here a dozen who under the hands of the surgeons raise a pitiable wailing, there others who writhe under their blankets like a half-crushed worm; many with limbs rotted on and off, and so on. Mostly we could stand it only a few minutes and then went out into God’s air again...”¹⁹.

In connection with preparations for future campaigns, the fitting out of hospitals was part of the duties of the Generalintendent²⁰. In the field a lazaret was set up “in the nearest town for the sick of the army”. Each battalion sent its sick there to be cared for, accompanied by a detachment consisting of a surgeon and 2 “Krancken-Knechte” under a Capitain d’Armes. Since the permanent lazaret had its own staff, the surgeon returned to the unit after delivering the sick soldiers²¹. When the army marched, a reliable non-commissioned officer with funds remained with the sick²². The lazaret in that town was also attached to the field pharmacy, where 8 surgeons served. However, the field pharmacy did not distribute medicines to the regimental surgeons, because the latter had their own budget for an “medicine chest” and were responsible for providing medicines and instruments for their area of responsibility²³.

A distinction was made among war hospitals: main hospitals (permanent buildings in Breslau, Glogau, Stettin, Dresden, Torgau, Wittenberg) and ambulant (mobile) hospitals that accompanied the troops on the march and into battle and were tent structures.

For an army of 30,000 men there was one “mobile” lazaret and one field pharmacy. These facilities were each headed by a hospital director, assisted in his work by 2 inspectors and 6 hospital commissioners. The personnel of the “mobile” lazaret comprised 2 field physicians, 1 general surgeon, 2 staff surgeons and 12 hospital surgeons. Three field apothecaries served in the field pharmacy. The lazaret and the field pharmacy had their own vehicles, including drivers. In 1756 the financial expense for establishing the hospital of the Schwerin army is given as 12,000 Thlr.

During sieges a rear siege hospital was set up and at the exit of the trenches a “wounded depot”²⁴.

During the battle actual wound care did not take place; only wounded officers were allowed to be carried out of the line of fire by their batmen, and the lightly wounded could reach the dressing station under their own power²⁵. The regulations for post-battle care of the wounded stated: “When the battle is over, the sick and wounded must be collected as much as possible and brought to the nearest villages. In this regard, for the regiments that have suffered most, 3 to 4 senior officers and 6 to 8 non-commissioned officers must be commanded, with other regiments in proportion to the men they have lost”²⁶.

Such a task was entrusted after the bloody Battle of Zorndorf (1758) to the junior officer von Prittwitz serving in Infantry Regiment No. 7; he reports: “Soon after our entry into the camp I was ordered with a number of wagons to the battlefield lying behind us, where the village of Zorndorf had been especially recommended to me in this respect. As I approached the battlefield, what a sight! Horror and terror accompanied me on the walk through this vale of misery and death. Just as I had seen the living standing in their ranks, so I now saw the dead lying prostrate in similar order. On the right Prussians and on the left Russians. One could tell by the latter that they had been fattened by the fat of the land, no less did one see the worn-out hunger and all manner of hardships endured by the former; the corpses differed so markedly that even the undressed could be identified as to which army they had belonged”²⁷.

There are plentiful reports from wounded soldiers and officers; often they received medical help in time only thanks to chance circumstances, others were less fortunate — one thinks only of the fate of the author of the Ode to the Prussian Army after the Battle of Kunersdorf (1759): Ewald Christian von Kleist (1715–1759).

There were no special transport vehicles or dedicated personnel for casualty recovery and transport; only in 1787 was one ambulance per regiment for 8 men introduced²⁸. When necessary, improvisation was used: company and provision (bread) wagons were left or the horses of officers or cavalry formations were assigned for this purpose, as at the Battle of Leuthen (1760). A related order of the Infantry Regiment No. 12 dated 02 Oct. 1756 reads: “... The regiments shall have stretchers made as best as possible for the severely wounded, so that they can be brought to the main lazaret, primarily those whose bones are broken in two.” The staff chaplain Küster vividly describes in his memoirs the march of the Prussian field hospital with the wounded from the night battle of Hochkirch (1758) from Bautzen to Glogau²⁹. After the Battle of Kunersdorf (1759) the wounded were shipped in Oder barges to Stettin.

But not only was the fate of wounded soldiers on the battlefield uncertain, even after admission to one of the war hospitals survival was not guaranteed even with less severe injuries; it is not without reason that the literature speaks of “deadly hospitals”. According to Kopka von Lossow the hospitals were “shunned”³⁰. A wounded officer reports the following about the hospital in Dresden (1756): “The attendant who led me to the sickroom had a new straw sack together with a cushion of the same fabric on his back, which he, when we arrived, laid down on an unoccupied place, and thus my sickbed was made. My dressing gown again proved useful to me, and the comfort thereby obtained far outweighed the trouble I had on its account. Every morning the surgeons visited the sick, albeit in a very cursory manner, and handed out medicines that were often inappropriate or insufficient. The kitchen was worst provided for; only occasionally we received a little piece of raw beef, which we had to prepare ourselves...”³¹.

The inadequate care measures for the soldiers and the inferior quality of the physicians in the hospitals are also lamented in his detailed “Memories of the Last Campaign” (1778/79) by a junior officer of Infantry Regiment No. 51:

“The treatment received by the (note: the wounded) in the hospitals was not good, as the hospital system in general during this war was poorly organized. The fear of the soldiers of becoming ill and then being as it were buried alive in one of the overcrowded hospitals, in my opinion, is in large part the cause of many desertions. The blame does not lie with the king — to whom his opponents very unjustly ascribe stinginess and indifference toward the fate of the common soldiers — but with those employed to take care of the hospital system. Their stupidity and, worse, their dishonesty caused those frightful disorders against which humanity protests. The commissioners and inspectors, and whatever they were called, who were charged with arranging what was necessary, were all well paid, but mostly only employed for the duration of the war; as they had no prospect of remaining in the army but knew they would be dismissed as soon as peace was concluded, they had no scruples about robbing the king and mistreating the sick by withholding what was necessary. Moreover, at the moment the war broke out one was forced to take as doctors and surgeons all who presented themselves, often people who understood nothing but barbering, and one can guess how the nursing of the sick was thereby affected. In Neiße, where to the commander’s indifference, who was also inspector of the hospital, the worthlessness of the subordinate officials and the bad air of the marshy area in which Neiße lies were added, eight out of ten sick usually died”³².

A depressing report on the condition of the hospital in Longwy during the campaign against the French in 1793 is also provided by F. Ch. Laukhard, a soldier in Infantry Regiment No. 3³³.

In view of these circumstances, critical voices from contemporaries were not lacking. According to Berenhorst, "the military hospitals are extremely poorly supplied; but the practice of taking in only healthy young men, however beyond boyhood, and keeping them in pure air, and always in the same garrison, makes one very surprised when of fifteen hundred men twenty to thirty are in the hospital"³⁴. The sharpest criticism on this point came from the hussar colonel Warnery; in his collected writings one reads: "Most of the wounded froze to death; this is their usual fate with the Prussians, where the hospitals were so poorly supplied and filled with such foul air that every soldier who was brought in already considered himself dead. One should not be surprised that after such a cruel war there are so few mutilated people to be seen in the states of the King of Prussia. For I know from reliable reports that the overseers and surgeons in the hospitals had orders to let all those die who were so wounded that after their recovery they could not serve again, and this was done to save the costs of their maintenance"³⁵. Besides the former Prussian field physician Ernst Gottfried Baldinger (1733–1804) and the already mentioned General Surgeon Theden, it was above all Tempelhoff who countered this accusation³⁶.

The personal care of Frederick the Great for the sick and wounded soldiers has been documented in detail by Lippe and Schnackenburg. What remains open to criticism, however, is that the King often took a one-sided position in favor of the responsible officers in conflicts between the hospital administration and the military physicians, thereby making medically necessary measures for the sick or wounded more difficult or even preventing them. Thus, on 21.09.1778 by royal order Dr. Johann Ulrich von Bilguer (1720–1796, since 1758 Bilguer was 2nd General Surgeon) was admonished in harsh tones:

"... I learn with the utmost displeasure that the General Surgeon Bilguer dares to arrogate to himself unlimited authority over the field hospital, viewing the veteran officers to whom the direction of the hospital economy is entrusted only as his subordinates and minor servants, ... and by such business neglects his true duty, which consists only in healing the sick and wounded himself, and in keeping the subordinate field-surgeons in order ...", on further transgression he is threatened with the "greatest disgrace" and fortress imprisonment. The King, however, subsequently supported—and aware of the many previous grievances—the effort to obtain suitable and reliable personnel in the hospital sector; thus in 1780 the Upper Collegium-Medicum was instructed:

"To choose the number of field and hospital doctors required by the newly established mobilization plan and to select for this purpose truly solid, skilful and reliable people, who are better than those who were at the hospitals in the previous war." At the same time the monarch did not want to depart from the practice of using disabled soldiers as orderlies; thus he wrote on 10.VI.1786 to General Surgeon Theden: "The intention of your proposal regarding newly employed orderlies for the garrison hospitals, in order to have faithful men later in the field hospitals, is commendable; but its execution is subject to many difficulties and complexities. Moreover, among various garrisons such disabled men are already employed as hospital orderlies, and therefore your proposal is all the less applicable. But just let me do it. I shall see to it that the thefts to be feared from the orderlies are vigorously prevented ..."³⁷.

Even in his year of death (1786) Frederick the Great strove for a reform of field medical services. The physician who treated him last (Ritter von Zimmermann) handed down in his "Fragments on Frederick the Great" a memorable confession of the old King:

"But, said the King, it is not only about prescriptions, but about all the other arrangements one makes for an army. In all my wars my orders regarding my sick and wounded soldiers were followed extremely poorly. Nothing in my life vexed me more than to see these brave men, who so nobly gave health and life for their fatherland, badly cared for in their illnesses and wounds. They were often treated barbarously, and many a poor soldier died for lack of good care. Nothing has ever distressed me more than when I was the innocent cause of anyone's death ..."³⁸.

Under his successor, as a result of these reform efforts, the "Royal Prussian Field Hospital Regulations" were put into force³⁹.

The state of the old Prussian military medical service remained low despite many efforts; the resulting inadequate care for the wounded was bitter reality, but it was an international grievance⁴⁰, and mortality was correspondingly very high in all armies. Even in the American Civil War (1861–65) more soldiers died in hospitals than on the battlefield. Only antiseptic wound treatment (introduced in 1867 by the English physician Joseph Lister), the use of chloroform and ether for painful surgical procedures (1846–48) and the founding of the Red Cross by Henri Dunant (1864) after the Battle of Solferino (1859) represented real progress and only then established humane medical care in the field.

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