Medicine in Egypt at the time of Napoleon BonaparteBMJ 2003; 327 doi: https://doi.org/10.1136/bmj.327.7429.1461 (Published 18 December 2003) Cite this as: BMJ 2003;327:1461
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In the article Medicine in Egypt at the time of Napoleon Bonaparte
published in the penultimate December issue of BMJ (1) the authors deal
with health records of the people in Cairo during Napoleon’s expedition.
Those records were collected by various physicians and surgeons, amongst
them Dominique-Jean Larrey (1766-1842) one of the most famous French
doctors of the time. Referring to Larrey’s Memoirs and observations
concerning several illnesses published in the book Description de l’Egypte
in 1823, the authors listed principal illnesses to exemplify the
epidemiology in the area the 19th century. What attracted our attention
was the picture of persons with elephantiasis in the above paper: a 16
year old boy, and a 30 year old woman with a large mass between her
legs. The penis of the boy has become completely engorged in the scrotum,
while the huge tumours protrude from the woman’s vulva each resemble the
head of a child (1). We wondered what type of pictures these were, prints,
We recently published aquarelles from Vienna of the
1840s, by the Viennese surgeon-painter Carl von Rzehaczek (1816-1897),
produced for Hebra´s department of dermatology (2). Among those aquarelles
genital elephantiasis was also portrayed as Elephantiasis labii pudendi
sinistr (Fig. 1). Similar to the cases described by Larrey our aquarelle
is also very explicit in showing a giant oedema of the left labium
(majus?). The artist’s intention focussed on the tumour and the changes of
the skin on the surface of it, but does not convey a message as to the
anatomical region. Is it really in the genital area or perhaps the head of
a person? This could confuse the observer at the first sight. We are thus
left with speculations regarding the age of the patient, the general state
of health as well as the possible etiopathology.
The pictures from
Larrey´s report (1) as well as the painting from Vienna (2)(Fig 1)
although done in different techniques and in different parts of the world,
convey an impressive testimony of elephantiasis whatever the underlying
causes were, unknown at the time. Egypt would raise speculations of human
filarial infection, endemic in many insect-ridden lowlands and costal
plains of the tropics. Although the parasites were found already in
ancient mummies, the epidemiological breakthrough came only with Patrick
Manson’s (1844-1922) discovery of parasite vectors, producing enormous
swelling of the limbs and genitalia by obliteration of the lymph vessels,
thereby proving for the first time that an insect was shown to be the part
of the natural cycle of a disease – Filariasis (3).
Historical reports like the two quoted above serve to alert also the
present-day physician of conditions as much as do pictures, which however,
might be misleading, or at least misleading in the beginning. Even tele-medicine cannot replace clinical experience because one must have seen
e.g. a giant scrotum where urine leaks from a capillary space somewhere on
its surface, to recognize the organ as that which it really is.
1. Russell GT, Russell MT. Hazardous journey.Medicine in Egypt at the
Time of Napoleon Bonaparte.BMJ, Dec 2003; 327: 1461 - 1464.
2. Fatovic-Ferencic S., Plewig G., Holubar K: Skin in Water-colours.
Oxford :Blackwell, 2003 p.54-55.
3. Porter R. The Greatest Benefit to Mankind A Medical History of Humanity
from Antiquity to the present. W.W.Norton & Company, Inc. New York
Fig.1 Elephantiasis labii pudendi (?), water-color by Carl von Rzehaczek,
Vienna 1842, depicted in ref.#2. Reproduced with permission of the Institute for the History of Medicine and of Blackwell
Competing interests: No competing interests
Dr Russell quote '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.)
Dr Campbell Clark(1895) , a victorian alienist took great pleasure in
employing attendants(now called nurses)who could play an instrument .
Plays were encouraged and all patients were required to take part in
theatre.Drama therapy and music therapy has been used on and off in the
previous century but there are no long term studies to indicate that
revolving door patients will be benefit, cetainly most wards have T v and
stereos in them.
The correspondence of Archibald Campbell Clark: A 19th-century physician
Psychiatr. Bull., Nov 2000; 24: 423 - 425.
Competing interests: No competing interests