When studying any healthcare system, fundamental questions to ask are: how large is the system and how effective is the system? With the help of a unique archival source and two visualizations derived from it, I hope to answer these two questions for France’s military-medical system at the outset of the Napoleonic Wars. We know that armies during the Napoleonic wars were the largest yet seen on the European continent. Furthermore, historian David Bell has called these wars the first “total wars.” Is it then safe to assume that given such large armies, and given the commitment of European nations to wage war at all costs, that a large healthcare system arose?

Unfortunately, the data needed to support this assumption are rare in the archival record. In my research I have come across few instances of hard numbers for military hospitals. Luckily an important report from the years 1803 and 1804 survives in the French war archives that can tell us approximately how many men passed through the military’s hospitals in those years. It presents detailed numbers on men entering, exiting, and dying between September 24, 1803 and September 23, 1804. I have only used the data for sedentary hospitals, which were permanent hospitals operated directly by the state. The source also details other types of hospitals, so any findings presented below are not definitive.

Images

Here are the two visualizations derived from the aforementioned archival document.

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In the first visualization, we see circles of varying sizes centered on the location of each hospital. The size of the circles corresponds to the number of men passing through the hospital over the course of the year. This helps use to get a general sense for the size of each hospital.

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The second visualization adds new layers of information. Not only are the relative sizes of each hospital given by the size of circle, but so too are the numbers of men who left the hospital healed, the numbers of men who died at the hospital, and finally the number of men who remained at the hospital at the end of the year. This information is conveyed via pie charts. The red slice of the pie equals the number of men who died. The green slice represents the number of men who existed the hospital presumably in good health. And the yellow slice represents the number of men who remained in the hospital at the end of the year.

If you follow the links under each visualization, you should be taken to an interactive map that allows you to hover your cursor over each pie chart and see the exact numbers more clearly.

Historical Background

1803-1804 was one of the few peaceful years of the Napoleonic wars. While war had been declared between France and England, campaigning had not yet begun in earnest. Napoleon was busy building and training his Grand Armée, and Britain was busy gathering allied nations in order to form the Third Coalition, which would eventually include Russia, Austria, and Sweden. Most of the fighting would occur in 1805 when Napoleon turned his attention to Austria and Russia culminating in the climatic battles of Ulm and Austerlitz. This means that the men in these hospital were probably sick from common military diseases like intermittent fevers, typhus and dysentery. Injuries sustained in battle likely represented a small minority of hospitalizations.

Analysis

While not representative of the totality of the army’s medical system, we can see a glimpse in these visualizations of how big hospitals were, and where they were located. The smallest hospital was located in Colmar and it only served 350 men over the course of the year. The largest was located in San Benedetto (modern day Italy) and it served 12,624 men. The average number of all hospitals was 4,576.

Not included on this map was the average stay of each soldier. The total number of men in these hospitals throughout the year was 77,800 and the total number of days spent in the hospitals was 2,178,496, which leads us to an average stay in the hospital of 28 days. If we divide the average number of men per hospital per year (4,576 men) by the average length of stay (28 days) we see that the average number of men in each hospital at a given time was about 163 men. This is significant because it suggests that the average size of each hospital ranged between 150 and 200 beds. The largest hospital might have had as many as 450 beds, while the smallest would have had just 12.

The location of the hospitals is also telling. Most are located along France’s northeastern frontier. These border regions had seen frequent conflicts since at least the reign of Louis XIV. Unsurprisingly, France built the highest concentration of military hospitals here and the establishments at Lille and Strasbourg and Metz were hold overs from the ancien régime. Other hospitals like the ones at Aix-la-Chapelle and Mayence lay outside of France’s borders. These locations resulted from French conquests into Belgium and Germany during the wars of the First and Second Coalition. Other hospitals are also located in regions that had seen fighting in the past and were still garrisoned with French troops, such as the hospitals at San Benedetto in Italy and at Alexandria in Egypt.

Conclusions

These visualizations show that the military medical system took care of tens of thousands of soldiers in peacetime, and that the average size of a military hospital was around 163 beds. Hospitals were located in areas that had seen military action in the distant or more-recent past. Most men were probably sick with a common military disease and left the hospital presumably healed. Only about 4% percent of men died while in the hospitals in peacetime. We can gather that the hospital system was widespread, and given that I have not accounted for every type of hospital, we can assume that many more men passed through hospital doors each year. In the future, I hope to create another visualization that includes all hospital types.