History of Medicine

      

      

NAPOLEON'S CHIEF MEDICAL OFFICER 

AND THE PLAGUE IN EGYPT      

     Napoleon made efforts to ensure good medical care for his troops. His chief surgeon, Dominique Larrey, is justly famous for his skills and compassion for the wounded. Less well known is Napoleon’s chief medical officer, René-Nicolas Dufriche-Desgenettes, a man of depth and courage.   

René-Nicolas Desgenettes (Wikipedia)

     Desgenettes was born in 1762 into a monied family in Rouen. After training in the classics, he switched to medicine and studied in Paris, England, and Italy, absorbing literature and art along with his medical pursuits. In Siena he befriended Paolo Mascagni, a great anatomist who mapped out the human lymphatic system for the first time. When Desgenettes eventually obtained his MD degree in Montpellier, he wrote his dissertation on the lymphatic system.

The Lymphatic vessels of the Back
(from Mascagni's Atlas, Hathi Trust)

     The French revolution was underway at that time and since Desgenettes’ wealthy background put him in danger, he sought refuge as a physician in the army. He met Napoleon by chance during a campaign near Nice and impressed the 24-year-old artillery officer with his intelligence and knowledge. Later, when Napoleon planned his invasion of Egypt, he asked Desgenettes, now a professor at the French military medical school, to be army’s chief medical officer. The chief surgeon, Dominique Larrey, worked under him.

Dominique Larrey (Wikipedia)

     Napoleon’s forces landed at Alexandria, Egypt, in July 1798, and fought their way to Cairo. The health problems encountered were almost as bad as the fighting. Dysentery sent many to the grave. Trachoma, the “Egyptian eye disease,” inflamed the eyes of almost everyone. Heat prostration and dehydration drove men to drink unfiltered water, often inhabited by tiny thread-like creatures. They were leeches that attached themselves to the pharynx, became engorged with blood, and provoked coughing, difficulty breathing, and sometimes hemorrhage. They could be detached with gargles of vinegar and saltwater or extracted with forceps. Smallpox, fevers, venereal diseases, and plague assailed the troops at various times. After fresh supplies from the sea were cut off by Admiral Nelson’s fleet, scurvy set in. 

     The cause of almost all these maladies was unknown. Desgenettes instituted regulations on hygiene, clothing, food and water, waste disposal, etc. and clamped down on prostitution, but much of the army still suffered from disease. Larrey established a camel-based ambulance service for wounded troops.

Larrey's ambulance service in Egypt. The lower portion shows the wounded man fitting into the compartment. (from Description de l'Égypte, courtesy New York Public Library)

     The disease that instilled the most terror, though, was plague. The role of fleas and rats was unknown at the time and the army treated it simply as a contagious disease. Plague first broke out in Egyptian coastal cities. Desgenettes thought that inadequate perspiration impaired recovery and encouraged wearing clothing in bed at night. To allay fear, he downplayed plague's importance but ordered the  burning of contaminated clothing and implemented isolation of patients and quarantines. 

     Napoleon soon lost his fleet to the British and learned that the Ottomans planned to move in from the northeast. Feeling trapped, he began an offensive into Syria (now Israel and Palestine) to neutralize the Ottoman front. During vicious fighting at Jaffa, plague broke out in force and sick troops soon overwhelmed the hospital set up in a Greek Orthodox monastery. Up to 15 soldiers died per day, according to Larrey.

     Napoleon believed that fear of the plague made one more likely to die from it. To allay such fear, he walked through the plague hospital, and, according to Desgenettes, spoke to “almost all the soldiers conscious enough to hear him.” In a small ward he helped to carry “the hideous corpse of a soldier whose torn uniform was soiled by the spontaneous bursting of an enormous abscessed bubo.” The action stunned the troops and boosted morale. The dramatic scene inspired a painting by Antoine-Jean Gros, a former pupil of David, finished in 1804 (see below). 

Les Pestiferés de Jaffa (Wikipedia) In a preliminary sketch Gros had depicted Napoleon carrying a dead soldier, but changed the composition to the above. Napoleon points to a bubo. Desgenettes' head is just to the right of Napoleon's. An army doctor is dying in the lower right and a robed Ottoman physician kneels near him. The monastery setting has been changed to that of a mosque.

     Napoleon ordered Roman Catholic and Armenian Christians to perform nursing duties in the plague hospital, and the Greek Orthodox to work in a hospital for the wounded. In general, though, hospital attendants were “the scum and disgrace of society,” recruited from prisons and galleys (Desgenettes). They were poorly paid but profited from the sale of clothing and effects taken from the dead or dying, despite rules to burn those articles. Napoleon had ordered any caught in such behavior to be shot, though how many were executed is unclear.

     Further north, during a siege in the ancient city of Acre, Desgenettes set up another plague hospital. Like Napoleon, he sought to reduce fear among the troops. One day, to reassure them, he plunged his lancet into a patient’s bubo and made small incisions with it in his groin and axilla, then washed himself with soap and water. Aside from mild inflammation he came to no harm. He also drank from a glass offered by a dying patient. The mood of the troops is said to have improved greatly. These attempts to show that plague was not dangerous or contagious may well have enhanced further spread, as soldiers relaxed hygienic and isolation habits. Treatments, including bleeding, blistering, emetics, and medicines were useless. 

Desgenettes inoculating himself with plague (from Chururgiens et Blessés a Través l'Histoire, 
by Cabanés, Hathi Trust)

      Napoleon was unsuccessful in subduing Acre and ordered a humiliating retreat back to Cairo. Returning through Jaffa, he faced a hospital filled with plague-infected troops, some of whom were near death and unable to make the blistering desert journey ahead. He recommended that Desgenettes administer large doses of laudanum to ease the hopeless ones into a rapid, painless death and avoid Ottoman cruelties. Desgenettes refused, though the doses were administered by someone else. Estimates are that between 15 and 50 men were dispatched this way.

     On arrival in Cairo, about 700 men had been lost to the plague, 4000 men overall.

     Napoleon evidently appreciated Desgenettes’ adherence to the Hippocratic oath. He kept him on as chief medical officer during his invasion of Russia and at Waterloo, and even made him a baron. Desgenettes acted courageously and humanely during a brutal Egyptian campaign but made no new discoveries about the diseases crippling his troops.

     

SOURCES:

Burleigh, N. Mirage: Napoleon’s Scientists and the Unveiling of Egypt. 2007; Harper Collins.

Herald, J. C. Bonaparte in Egypt. 1962; Harper & Row.

Richardson, R.G.  Larrey: Surgeon to Napoleon’s Imperial Guard. 1974; John Murray.

Gazel, L. Le Baron Des Genettes (1762-1837): Notes Biographiques. Thesis, 1912, Henry Paulin, Paris.

Eimas, Richard. “The Great Anatomy of Paolo Mascagni.” 1983; Books at Iowa no.38. available at: https://ir.uiowa.edu/bai/vol38/iss1/5/

Russell, T G and Russell T M. “Medicine in Egypt at the Time of Napoleon Bonaparte.” 2003; BMJ v327 (Dec 20-27): 1461-4.

Riaud, Xavier. “René-Nicolas Dufriche, baron Desgenettes (1762-1837), surgeon of the Great French Army.” The Napoleon Society of Ireland, at: http://napoleonireland.com/napoleon/academic-papers-articles/surgeon-to-the-great-army/

Kelly, C. "Medicine and the Egyptian Campaign: The Development of the Military Medical Officer during the Napoleonic Wars c. 1798-1801." 2010; Canad Bull Medical Hist 27: 321-42.

Roberts, A. Napoleon: A Life. 2014; Penguin Group.

English translation of: Larrey, D J. Memoirs of Military Surgery and Campaigns of the French Army, vol I. 1814; Joseph Cushing, Baltimore.