Gunpowder, the Prince of Wales's feathers and the origins of modern military surgery

Background: The history of military surgery claims many forebears. The first surgeon‐soldiers were Homer's Machaon and Podalirius, followed a thousand years later by the Roman surgeons‐general, Antonius Musa and Euphorbus; and later, e.g. Ambrose Paré, John Hunter and Sir John Pringle; and the 19th century innovators, Dominique‐Jean Larrey (France), Friedrich von Esmarch (Prussia) and the Russian, Nikolai Pirogoff. The singular feature that distinguished modern military surgery from its earlier practice was the use of gunpowder. It was one of two inventions (the other was printing) that by the empowerment of individuals, lifted Western humankind from the medieval to the modern era. Methods: Research of primary and secondary archives. Results and conclusion: Gunpowder was first used in European warfare at Algeceras (1344–1368). Hitherto, the destruction of tissue had been the result of (relative) low‐energy wounding with tissue damage caused by incisional or crushing wounds. The founder of modern surgery, Master John of Arderne (1307–1380), wrote of his experience gained as a military surgeon on the battlefield at Crecy (1346). Following Crecy, Arderne was the only chronicler who described the origins of the Prince of Wales's feathers as a royal and later commercial symbol, and the motto ‘Ich Dien’, ‘I serve’, as that of hospitals in the Western World. Later advances in military surgery incorporated both clinical experimentation and the innovation of new systems of pre‐hospital battlefield care.