Hazardous Journeys

Medicine in Egypt at the time of Napoleon Bonaparte

BMJ 2003; 327 doi: https://doi.org/10.1136/bmj.327.7429.1461 (Published 18 December 2003) Cite this as: BMJ 2003;327:1461
  1. Thomas G Russell (T.Russell{at}ed.ac.uk), senior house officer1,
  2. Terence M Russell, reader2
  1. 1Department of Anaesthetics, Ipswich Hospital, Ipswich IP4 5PD
  2. 2School of Arts, Culture and Environment, University of Edinburgh, Edinburgh EH1 1JZ
  1. 1Correspondence to: T M Russell

    The scientists and doctors who accompanied Napoleon to Egypt in 1798 undertook a survey that is one of the great intellectual achievements of the 19th century. It left a record of the health and wellbeing of the people, especialy in Cairo

    In 1798 Napoleon Bonaparte conquered Egypt with an army of 55 000 men. With his army was a party of 300 men of science and letters whose objective was to record the culture of Egypt. The result was an extensive series of writings and engravings known as the Description de L'Égypte.1 Part of this great work was devoted to recording the health and wellbeing of the people of Egypt, as observed by Bonaparte's surgeons and physicians. In this article we draw attention to some of their achievements.2

    French men of medical science

    Fig 1
    Fig 1

    Claude Louis Berthollet, the distinguished surgeon and chemist who was responsible for recruiting the men of science who accompanied Napoleon Bonaparte on his Egyptian campaign. The decoration in his lapel is that of a Grand Officer of the Order of the Legion d'Honneur

    The scientists were selected by Claude Louis Berthollet, who studied medicine and served on scientific committees during the French Revolution (fig 1). He placed in charge of the army's medical core Dr René-Nicolas Desgenettes, who was the expedition's chief medical officer. In Egypt, Desgenettes busied himself with the welfare of the French army and the wellbeing of the Egyptian people. He also read papers to the French Institute at Cairo on the causes of ophthalmia and infant mortality. Remarkably, he inoculated himself with pus from a suppurating bubo to fortify himself against bubonic plague. Desgenettes outlined ideas for a new hospital, a pharmacy, and a school of medicine at Cairo.

    The celebrated French naturalist and anatomist Georges Léopold Cuvier was invited to participate. He declined because he was about to start his series of studies of comparative anatomy, published in 1800 as Leçons d'anatomie comparée. In his place went one of the most revered men of French medical science, Dr Dominique-Jean Larrey. Bonaparte called him “the most virtuous man I have ever known.” One of Larrey's contributions to military medicine was the ambulance volante (flying ambulance) that enabled wounded men to be transported from the scene of conflict (fig 2). Larrey published his Egyptian medical researches as Mémoires et Observations sur plusieurs Maladies. He was later appointed doctor in surgery and medicine at Paris and was subsequently elevated to a peerage with the titles Monsieur Le Baron and Chevalier de la Légion d'Honneur.

    Fig 2
    Fig 2

    The field ambulance of Dominique-Jean Larrey. The surgeon (standing) has just amputated the lower leg of a man (sitting, with remarkable composure). Larrey's camel ambulance waits nearby to take the patient to hospital

    Tribulations of the military

    The French army had to march through the desert to Cairo. The soldiers were maddened by thirst, and their torment was increased by the image of a lake—their first experience of the illusion of a mirage. On reaching the Nile, the troops gorged themselves on watermelons, which carried their own hazards; scores of men became afflicted by waterborne bacteria and developed chronic diarrhoea and dysentery. Bonaparte had to issue an order of the day stating: “Officers will urge soldiers to eat few water melons unless they are cooked.” Marching in the blinding sunlight also took its toll. Men developed eye disorders and acute ophthalmia, and some went blind. At Cairo, higher on the infantry's list of misfortunes were the classic scourges of syphilis and gonorrhoea. Prostitutes were numerous, and 400 of them were decapitated in an attempt to control the spread of disease. The only medical treatment was the application of mercury paste—giving rise to the saying, “One night with Venus and six with Mercury.”

    The Institute of Egypt at Cairo

    Fig 3
    Fig 3

    The Institute of Egypt at Cairo. The president of the institute, the mathematical genius Gaspard Monge, is shown welcoming Napoleon Bonaparte (vice president) to the inaugural meeting of the institute on 22 August 1798. Claude Louis Berthollet is standing immediately behind Bonaparte

    Bonaparte established the Institute of Egypt at Cairo to house the Commission of Sciences and Arts (fig 3). The scientists had a laboratory for the study of anatomical and zoological specimens and a reference library. The institute published its own papers and leaflets on printing presses removed from the Vatican. Scientists undertook field trips to the neighbouring temples and rock-cut tombs, where they collected and recorded specimens. Among these were human mummies that had escaped the tomb robbers (fig 4). Such remains were known in the West, but the French medical scientists were the first to subject them to modern forensic analysis. The scientists were incredulous that human remains could be so well preserved:

    Fig 4
    Fig 4

    Human mummified heads. Head of a man (top): his sexual parts were covered in gold leaf. Head of a woman (bottom): her finger nails were gilded. To facilitate mummification of the head, brain tissue was first removed through the nasal cavities with the aid of a surgical instrument

    Nothing has more capacity to astonish, when the wrappings of a mummy have been removed, than the state of preservation of the forms of the face. In the best-preserved mummies, the characteristics are recognizable [although] the flesh is a little collapsed. The eyelids, lips, ears, nose, cheeks and all the fleshy parts have an appearance approaching their natural state.3

    The secretary to the Scientific Commission was Jean-Baptiste Fourier, renowned for his work on mathematical series and heat. He was editor of the Courrier de L'Égypte, in which the scientists published their researches. When Fourier returned to Paris he became eccentric and lived swathed like a mummy in overheated rooms—to no great effect; he died aged 62.

    Public health

    The French medical statisticians accumulated a mass of information. The following observations are derived from the writings of Desgenettes:

    The extreme sobriety of the Egyptians, the regularity of their way of life and the moderation which characterises the greatest number, contribute to well-being and to prolong existence in this country—as do air and water. One is able to regard the country as very healthy, despite the regrettable maladies that frequently afflict it in the form of plague, dysentery and small pox. The most common affliction of all, affecting a third of the population [at Cairo], is some form of disease of the eye; no other town contains so many sightless. [The ophthalmic causes of this blindness are discussed in a Mémoire by Dr Savaresy entitled Sur l'optalmie d'Égypte.] About every four or five years, the plague [cholera] escalates in Cairo in a violent manner. The history of Egypt presents examples of appalling plagues and epidemics that exceed belief. In 1801 there died in Cairo about 10,000 individuals in a month.

    A practice prevailed in Cairo that the French considered disastrous for the health of the city. This was the burial of the dead within the town itself. The annual inundation of the Nile increased the likelihood of waterborne infections. The French hygienists commented: “The stagnant waters of the inundated places are no less noxious to public health than the burial grounds.” Of the total mortality of Cairo's population of 260 000, the death of children accounted for more than half; the ravages of smallpox explained much of this.

    Drugs

    The physician M Rouyer collected and edited Egyptian manuscripts to compile a Materia Medica in the style of that of the Greek Dioscorides. Rouyer published a pharmacopoeia that is of interest to the historian of pharmacology. He lists and describes the dietetic and medicinal uses of 81 drugs, citing their Arabic and Persian derivations.4

    Mortality

    The French physicians maintained daily records of the deaths recorded at Cairo during their occupation of Egypt (table). Men fared better than women, but children were the most vulnerable. This group had a catastrophic average mortality of 582 deaths a month—a grim reminder that plagues could reduce the population by as much as a third.

    Summary of deaths recorded at Cairo for the period 1799-1801

    View this table:

    Care of mentally disturbed people

    Mentally disturbed people were cared for at Cairo in an institution called the Mouristân. This was a form of general hospital in which rooms were designated for the treatment of particular illnesses. Men and women were admitted to separate parts of the establishment. The physician in charge provided a pharmacy for making up the medications prescribed. Special treatments were available for privileged patients.

    Patients prone to insomnia were taken to a separate hall where they could hear music rich with harmony, or they could be comforted by trained storytellers who entertained them with tales and narratives. Other patients (of a melancholic disposition) were encouraged to enjoy the spectacle of dancing and theatricality. (We wonder if the NHS would like to adopt these ideas to reduce the relapse rate of modern psychiatric inpatients.)

    Personal wellbeing: baths and bathing in Cairo

    The Egyptians considered a steam bath (hammâm) to be “the first necessity in maintaining personal wellbeing.” In the baths, women could remove their robes and “transact their secret business.” The men could restore their strength and vitality by relaxing in the abundant steam heat that soothed the body, opened the pores, and induced perspiration (fig 5).

    Fig 5
    Fig 5

    An Egyptian bath. A bather reclines on a couch, enjoying a massage, while a fountain splashes nearby. The domed ceiling was pierced with coloured glass to achieve a mood enhancing atmosphere

    The barber and health care

    The Egyptian barber was at the heart of society. He shaved heads, trimmed beards, and practised a little surgery, such as attending to wounds and staunching bleeding (fig 6). The Egyptian barber was also a manicurist, using a razor to trim the fingernails of clients. Barbers mixed potions, which they applied and sold as depilatories. Two basic ingredients of these were quick lime and oxide of arsenic, “which made the hair fall promptly from all the parts of the body to which it was applied”.

    Fig 6
    Fig 6

    Egyptian barbers worked very swiftly and could shave a man's head and trim his beard with great dexterity

    Case histories

    To place these quotations into their context, the following is a summary of the principal subjects listed in Larrey's book5: endemic ophthalmia, traumatic tetanus, plague, “sangsue” (illness promoted by bloodsucking insects), hepatitis, atrophying of the testicles, gross tumours, yellow fever, elephantiasis, and scurvy.

    Elephantiasis and gross tumours of the reproductive organs

    Male patient

    This unfortunate, sightless boy was affected in both legs with elephantiasis that he had sustained for a number of years. His ankles were thicker than the thighs; the feet were monstrous. The skin was smooth, blotchy and traversed with varicose veins. His feet were covered with thick, yellowish crusts disposed in scales separated at intervals by deep ulcerated furrows from which oozed fetid, aqueous pus (fig 7).

    Fig 7
    Fig 7

    Gross tumours and elephantiasis. Right: a sightless, 16 year old boy. Note how the penis has become completely engorged in the scrotum. Left: a 30 year old married woman who had been afflicted with gross tumours for several years

    Female patient

    [This woman], aged about thirty years [had] two enormous tumours that had afflicted her for several years. These tumours were located each side of the vulva; [they were] close at the front and separated behind. They appeared to have their origin in the labia majora. They were about the same size, each resembling the head of a child, were rough [at the front] and smooth at the rear and of a red-violet colour (fig 7).

    Contraction and atrophying of the testicles

    Several soldiers, returning from their campaigns, complained of “the almost total disappearance of their testicles.” Larrey records: “Surprised by this phenomenon, I made some researches to understand the cause of the onset of this affliction.” The following is an extract from his report:

    The testicles lose their sensitivity, become debilitated, gradually diminish in volume and appear to wither. Most commonly, the change affects one then both. The afflicted [person] only notices this destruction, that occurs imperceptibly, when the testicle is reduced in volume; [by then] it is found to be annular in form and of the size of a white haricot bean. It is indolent and of a very hard consistency; the spermatic cord is similarly reduced and experiences atrophying.

    Conclusion

    The Napoleonic survey of Egypt is one of the great intellectual and artistic achievements of the 19th century.1 The French scientists played an important part in this remarkable undertaking. Reflecting on the Egyptian campaign, Bonaparte remarked, “It was the most perfect period in my life.” He also said, “If ever the soldiers erect a statue, it should be to Baron Larrey.” Larrey now has two statues to his memory; one stands in the court of the Val-de-Grâce Military Hospital and the other in the hall of the French Academy of Medicine. The views of the men who lost their testicles are not known.

    Footnotes

    • Contributors TMR conceived, researched, and drafted the paper. TGR advised on medical matters and edited the paper for publication.

    • Funding University of Edinburgh.

    • Competing interests None declared.

    References

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