Famous French diabetics

by C. Régnier, France

Christian Régnier,MD
Practicien Attaché des
Hôpitaux de Paris, Société
Internationale d’Histoire de la
Médecine, 9 rue Bachaumont
75002 Paris, FRANCE
(e-mail: dr.christian.regnier@wanadoo.fr)

In medicine, the systematic use of laboratory tests in patients is a modern phenomenon that is less than half a century old. Diagnosing diabetes now largely depends on the qualitative or quantitative measurements of blood glucose, glycosuria, and acetonuria. If one excludes insulin-dependent diabetes that rapidly progresses toward death, type 2 diabetes often manifests itself by its complications: chronic or recurrent infections, loss of sight, tuberculosis, and cardiac, kidney, or vascular disease. Given the absence of laboratory tests in the past, we are unable to say, with absolute certainty, whether a historical figure was diabetic. Unfortunately, old medical files—where they exist—are comprised of information that is too imprecise to confirm a retrospective diagnosis. However, what we can do is compile a body of diagnostic evidence based on the examination a historical character’s life, dietary habits, and the illnesses that ultimately brought about his or her death. This historical analysis indicates that Louis XIV and his musician, Lully, who both died from gangrene, were probably diabetic. It is even more likely that the famous novelist Honoré de Balzac, who had the clinical characteristics of Cushing syndrome, was too. Jules Verne, the most read of all French writers, was known to have died of a diabetes-related illness. The famous French painter Paul Cézanne, the doctor Odilon Lannelongue, and Marshal Joseph Joffre were all thought to be similarly afflicted, although the clinical and biological evidence is too uncertain to be sure.

Medicographia. 2009;31:316-323 (see French abstract on page 323)

In 2003, according to the World Health Organization (WHO), diabetes, in all its different forms, affected 194 million people worldwide, two thirds of whom live in developing countries. In 2008, the number of diabetics was estimated at 246 million and diabetes was ranked the fourth largest cause of mortality. In developed countries, diabetes mostly affects those over 65 years of age; elsewhere, it affects those in the 35-60 age range. In 2030, it is estimated that there will be 370 million diabetics, 80% of whom will live in developing countries. According to WHO experts, the progress of diabetes is linked to sedentary lifestyle and social and economic development. Certain ethnic groups seem more susceptible, such as the American Indian population, the Japanese, and the populations of the Middle East and North Africa. In certain hunter-fisher-gatherer peoples who have had their diets abruptly modified, diabetes has taken a heavy toll: 50% of the Pima Indians of Arizona, 40% of Micronesians from the Island of Nauru, and 20% of urbanized Australian Aboriginals are diabetic. In Europe, the prevalence of diabetes is highest in the south (Greece, Italy, Portugal, and Spain) and in Scandinavia (Sweden and Finland).1 In France, a report published by the Institut de Veille Sanitaire (Institute for Public Health Surveillance) in November 2008 reported nearly 2.5 million diabetics, of whom 90% had type 2 diabetes. The prevalence is approximately 4% in the general population and 13.3% in those over 65. Regional disparities exist between the north, the east, and the overseas territories (a higher prevalence between 4.25% and 7.81%) and the west and the southwest of France (a lower prevalence between 2.52% and 3.81%). Nearly 11% of French people over 65 are affected by the disease.2,3

Diabetes—from the Greek diabetes meaning “to pass through”—has been around since the dawn of time, but was ignored for a long time by doctors and patients alike. Physicians did not understand its pathophysiology and were helpless to treat it, while patients were often subjected to severe regimes that no one was really able to explain.

Diabetes developed during the warming of the Earth’s climate 10 000 years ago (at the end of the Würm glaciation period). The temperate climate at that time supported the growth of plants providing slow-release carbohydrates (eg, sweet chestnuts and walnuts) and simple carbohydrates (eg, berries). During the glacial periods, these types of plants were absent, so man consumed large quantities of animal protein (wild game and fish). Cro-Magnon man was physically active, as shown by the powerful muscle insertions on the remains of excavated skeletons. Their daily calorie intake must have been close to that of modern man (approximately 3000 kcal). Interestingly, excess weight was a problem even then. Paleolithic art depicts excess weight of the gynoid, rather than the android, type. Less than 10 000 years ago, the practice of farming and animal breeding modified the diet of man, whose lifestyle was becoming sedentary. The production of grain, the consumption of cattle, and the use of salt for preserving meat brought about an enormous upheaval in the human diet. From 10 000 to 5000 years BC, the world’s population benefited greatly from this first big food revolution, increasing from 5 to 50 million inhabitants.4,5

In Gaul, the techniques brought by the Celts developed rapidly: soil fertilization, crop rotation, crossbreeding of animal species, the mechanization of farm equipment, and soil marling and liming. The cooked meats of Gaul—according to the chronicles of Caesar—were famous throughout the Roman Empire. The Gauls were big consumers of bread and boiled grain (spelt, wheat, and oat). Meat—pork, beef, lamb, and poultry—was consumed frequently, but in modest quantities. Lard, butter, and cheese were regularly used in cooking. They drank milk, fruit syrups and juices, beer, and mead. Apart from regional variations, the food of Gaul points toward what the French diet would become in the future: a carbohydraterich diet.6,7

The Capetians: a great family of diabetics

In the Middle Ages, the diet of the nobility and their court was particularly rich. In Paris in the 12th century, a population of one million inhabitants consumed 40 000 cows, 400 000 sheep, 70 000 calves, and 25 000 pigs each year.7

Philippe I (1052-1108): The fourth king of the Capetians conquered Vexin and Gâtinais by defeating the Duke of Normandy, William the Conqueror. He was apparently not very suited to handling weapons; Philippe I was described by Suger (1080-1151), the Bishop of Saint-Denis, as obese, apathetic, and a big eater. He suffered from pruritic dermatoses and recurring gingivitis, and died disabled.8

Doctors administering medicine with a spoon at The Sick Bed of Louis VI “Le Gros” (1080-1137). Vellum, French School (14th century). British Library, London, UK. © British Library Board. All rights reserved/Bridgeman-Giraudon.

Louis VI (1081-1137), known as “the Fat one” or the “the Fighter”, was the son of Philipe I. He was a large, corpulent man with a pallid complexion. His reign was marked by the assertion of royal power over the mighty lords of the Ile de France. He was reputed to be a “big eater and drinker”. By the age of 40, his obesity was already so severe that it prevented him from riding a horse. It is likely he died of a lingering thigh wound sustained seven years before his death.8

Other sovereigns with large appetites who died of strokes or acute, rapidly developing infections also showed signs of having diabetes-related metabolic disorders. Such was the case with Philippe (IV) the Beautiful (1268-1314), Charles V (1338- 1380), and Louis XI (1423-1483).

Burial of Philippe Le Bel (1268-1314) at St Denis. Vellum, French School (14th century). Bibliothèque Nationale, Paris, France. © Bridgeman-Giraudon.

The death of Louis XI (1461-1483) from the Memoires de Philippe de Commines. Vellum, French School (15th century). Musée Thomas Dobrée, Nantes, France. © Bridgeman-Giraudon.

Louis XIV (1638-1715): The Sun King had many ailments during his lifetime consistent with diabetes: suppurating periostitis (1678), dental abscesses (1696), recurring boils, fainting spells, gout, dizziness, hot flushes, and headaches (cephalalgias). From 1647 to 1711, the three successive archiatres (chief doctors to the king) recorded, in detail, all the health problems of the sovereign in the Journal de Santé du Roi (Journal of the King’s Health), which makes it possible to follow the sovereign’s state of health on a day to day basis. Antoine Vallot (1594-1671), Antoine Daquin (~1620-1699), and Guy Crescent Fagon (1638-1718) kept this journal. On November 18, 1686, Louis XIV underwent a successful anal fistula operation, performed by the surgeon Charles Felix de Tassy (1635-1703), who prepared a curved scalpel especially for the occasion. In spite of the success of the operation, the wound took more than two months to heal, and the surgeon needed to drain it three times. The King’s Superintendent of Music, Jean-Baptiste Lully (1632-1687), composed a Te Deum at the time to celebrate the sovereign’s recovery.

Portrait of Louis XI (1423-1483).
Oil on panel, French School (17th century). State Collection, France. © Bridgeman-Giraudon.

It was during a rehearsal of this work at the Theatre des Feuil- lants on rue Saint Honoré in Paris in January 1687, that the composer—perhaps diabetic—wounded himself in the toe with his “conducting stick”. This particular stick, a precursor of the modern orchestra conductor’s baton, was a heavy cane decorated with ribbons and topped with an ornate knob, which was used to keep time by striking it against the floor. Lully refused to have his toe amputated, gangrene set in, and the musician died at his home on March 2, 1687, at the age of 54.

A portrait of King Louis XIV of France by Hyacinthe Rigaud (1659-1743). Oil on canvas (49.336.0 cm), 1701. Musée Condé, Chantilly, France. © RMN/René-Gabriel Ojéda.

The feasts of Louis XIV, another sovereign with a large appetite, took their toll on his health. As he became obese toward the end of his life, the Sun King was confined to bed on the August 13, 1715; gangrene had appeared in his left leg. On September 1, the sovereign’s life came to an end; an autopsy carried out the following day in the presence of the Dean of the Faculty of Medicine in Paris was revealing:

On the outside, the entire left side appeared to be gangrenous, from the tip of the foot to the top of the head. The epidermis was coming off the whole body on both sides. The right side was gangrenous in several places.

The hypothesis of type 2 diabetes was put forward by biographers of Louis XIV. Even though the English doctor Thomas Willis (1621-1675) had already observed that the urine of diabetics had a sweet flavor, as if it contained “honey or sugar,” the King’s doctors did not carry out this test. The Dictionnaire Universel de Médecine (The Universal Dictionary of Medicine), published in 1743 by James, defined diabetes as follows:

The disease is characterized by a copious amount of micturition in which drink passes through the body immediately after ingestion without change and like water.” The work specified: “The sagacious Willis has taught us that this disease is much more common in us than it was in our predecessors.8-11

In Le Médecin Volant (The Flying Doctor) published in 1650, Molière (1622-1673) alluded to this urinary tasting when the fake doctor, Sganarelle, brought the urine of Gorgibus’s daughter to his lips:

Sganarelle: … Here is the urine that indicates a great heat and a great inflammation in the intestines; but, it is not too bad.
Gorgibus: What! Are you going to swallow it, Sir?
Sganarelle: Don’t be so surprised. Ordinary doctors would be satisfied to look at it, but I, no ordinary doctor, will drink it because the taste will help me discern the cause and the course of the disease. But, to tell you the truth, there is too little of it to make a proper decision. We’ll have to make her pass water again!


Honoré de Balzac: hypertension and diabetes

Honoré de Balzac (1799-1850), an obese man nicknamed the “Merry Wild Boar” and author of La Comédie Humaine (The Human Comedy), died at 51 from heart failure. “I am as beautiful as a marble statue and as strong as a tree,” he said proudly. Balzac used to work for 18 hours at a stretch without a break, eating bread piled with sardines mashed in butter and consuming large quantities of sweetened coffee (close to one pound per week). Outside these periods of nonstop work, the large-framed Balzac ate giant, Pantagruelian meals and traveled a lot. According to his contemporaries, however, he did not smoke and only drank alcohol in moderate quantities.

In Saché on the June 26, 1836, he became dizzy, lost consciousness, and collapsed next to a tree. Upon awakening, the writer reported experiencing some “buzzing” in his ears accompanied by some slight trouble with his balance. Four months later, Balzac wrote to Ewelina Hanska (1801-1882), whom he married a few months before his death:

I sometimes lose the sense of what is up and what is down (located in the cerebellum) even in my bed. It seems like my head is leaning to my left or to my right, and, when I rise, I feel moved by an enormous weight in my head…

The family physician, Jean-Baptiste Nacquart (1780-1854), a former military doctor in the Rhine army, recommended that he pay more attention to his lifestyle and invited him to take a break in Touraine. In May 1840, the writer described “cerebral neuralgias”; Nacquart pronounced Balzac was suffering from “an engorgement of the large vessels”. Leeches were used as well as vesicants, enemas, and seltzer water.

From 1842 to 1848, Balzac reported frequent dizzy spells, heartburn, headaches, problems with his vision, and diplopia. Nacquart diagnosed “arachnitis,” chronic meningitis linked to excessive mental strain. On his return from Poland at the end of 1848, he had effort dyspnea and a spasmodic cough. According to Guérin, the writer was suffering from high blood pressure complicated by cardiac insufficiency, episodes of angina pectoris, and pulmonary edema. On April 30, 1849, while still residing in Poland, he wrote to his sister Laure:

An iron band around his chest was getting tighter and tighter. He spent his nights fighting for breath (…) His legs swelled and oozed. The edema spread to his stomach and thorax, but he neither complained nor despaired,” reported Mirabeau.

Honoré de Balzac (1799-1850), author of La Comédie Humaine,
Eugénie Grandet, and Le Lys dans la Vallée. © Hulton-Deutsch Collection/CORBIS.

Doctor Nacquart’s clinical examination found evidence confirming “hypertrophy of the heart” (a term used in the 19th century to indicate cardiac failure), hepatomegaly, cardiomegaly, pulmonary edema, and albuminuria. In addition, a varicose ulcer had appeared on his left leg. One of Balzac’s servants told Victor Hugo’s wife, who had come to visit Balzac, that “he has a sore on his left leg. Gangrene has set in. (…) last month, Sir collided with an ornate piece of furniture, his skin tore, and all the water in his body ran out”. In spite of the care of three competing surgeons, who administered leeches and drained the wound, and in spite of the administration of potassium iodide, henbane, and digitalis by Nacquart, Balzac’s state of health gradually deteriorated. He died during the night of Sunday, August 18, 1850, while calling the doctor from la Comédie Humaine (The Human Comedy), Doctor Bianchon, to his bedside: “Ah! yes! … I know … I need Bianchon. Bianchon will save me, him!”

Among the retrospective diagnoses of what disease brought Balzac’s life to an end is Cushing syndrome, which would explain his physical appearance: obesity of the trunk, face, and neck, described by Théophile Gautier (1811-1872) as “the face and the neck of an athlete or bull, round like a section of a column”. Likewise, the various illnesses from which the writer, like his characters, suffered, included bipolar disorder, high blood pressure (supposed), skin infections, diabetes (possible), and sexual impotence (probable). From the time of Balzac onward, diabetes became characterized by an abundance of poorly defined and confused symptoms. The most dreaded complication was pulmonary tuberculosis (phthisis). The only objective diagnostic criterion for doctors keen on chemistry remained the use of litmus paper, which reddened in the presence of urine containing “grape sugar,” a name often used for glucose (isolated in 1838). After many etymological debates, the term “glucose” was adopted around the year 1890, after which “glycose” and “gleucose” were abandoned. The Greek word gleukos, “sweet wine” or “must,” and the adjective glykys, “of a sweet flavor,” were the origins of the final term. In Adelon’s Dictionnaire de médecine (Dictionary of Medicine) published in 1835, the recommended treatment for diabetes remained empirical: camphor, licorice lozenges, coral dye, iron mineral waters, mercury preparations, and cow bile.14-17

Balzac by Auguste Rodin (created 1891-1898). © Gian Berto Vanni/CORBIS.

Jules Verne: strokes and diabetes

The master of anticipation suffered from multiple diseases about which he complained bitterly in his correspondence: facial paralysis, attacks of spasmodic colitis, writer’s cramp, diabetes (probably), and strokes (two).

In February 1850, Jules Verne (1828-1905) was struck with an attack of facial paralysis that was treated with electricity, according to the therapeutic principles set out by Duchenne de Boulogne (1806-1875). He testified to his satisfaction with the treatment to his mother, saying: “It is the electricity that cured me; there is no doubt about it. But what was extraordinary was that every time I used it, I became feverish.” Five years later (in March 1855), a second attack of facial paralysis caused him considerable suffering. On the recommendation of his friend, Dr Victor Marie, he consulted Jean- Martin Charcot (1825-1893) at the Hôpital de la Salpêtrièrie, but, unfortunately, no good came of this consultation.

On March 9, 1886, his nephew Gaston, in a moment of insanity, shot a bullet into the ankle joint of Verne’s left foot. This injury caused pain, a secondary infection, and gave him a limp until the end of his days. Everyone thought that his diabetic condition prevented the wound from healing. On November 21, he wrote: “As for my foot, the big toe has sustained an evil white (whitlow) and here I am again unable to walk for a few days. It will never end!”

Around 1894, he lamented his poor state of health even more, describing incessant dizziness, tinnitus, scotomata (a sign of arterial hypertension [?]), gastralgia with attacks of aerophagia, diabetes (?), and a cataract in the right eye. He submitted to a milk-based diet. “Living only on a diet of milk and eggs, I feel neither good nor bad, ovarian, lactarian, or even vegetarian,” he wrote in a letter dated March 4, 1898. Two years later, he developed bilateral cataracts.

Jules Verne passed away one week after suffering a hemiplegic stroke that initially paralyzed his right side and then spread to his left. His sister Marie witnessed his last moments in Amiens on March 24, 1905:

He could not say anything coherently, and it became apparent that this was indeed the end. The paralysis was spreading, and when I left at five o’clock, he was no longer our brother and his beautiful intelligence was no longer there; there was nothing but a body and a slowly departing soul. (…) In short, our poor Jules has succumbed to diabetes that we were not monitoring. Last year, he suffered a bad episode, but after recovering, we thought no more about it. Although his wife looked after him admirably, she did let him do whatever he wanted.

The medical file of Jules Verne contains few precise details. It is not known whether he ever had a urine glucose test, a technique developed in France by Apollinaire Bouchardat (1809-1886), author of the famous treatise De la glycosurie ou diabète sucré (On Glycosuria or Diabetes Mellitus), published in 1875, in which diabetic retinopathy is described. This test was known to have been available from the beginning of the 19th century. The Dictionnaire de thérapeutique médicale et chirurgical (Dictionary of Medical and Surgical Therapy) by Bouchut (1867) confirmed:

It is impossible to recognize specific symptoms at the onset of diabetes. Its development is never known about until revealed belatedly by feelings of malaise, great muscular weakness, thickening of the tongue, thirst, bulimia, dyspepsia (…) visual weakening, and frequent micturition of sweet urine that makes clothing and fingers sticky.

Caricature of Jules Verne (1828-1905), from the magazine L’Algérie Comique et Pittoresque, studying life at the bottom of the sea. Color lithograph, 1883. Bibliothèque de l’Arsenal, Paris, France. © Archives Charmet/Bridgeman-Giraudon.

At that time, “modified undernourishment” combined with physical exercise was recommended as a treatment for diabetes. Bouchardat prohibited sugar, fruits, jams and jellies, starchy foods, and milk (a source of lactose) and advised alcohol (calorie intake), green vegetables, meats, fish, and bread with gluten. He also prescribed the “Bouchardat potion,” containing ammonia carbonate, rum, and sugar syrup (!) or “bowls of Bouchardat,” containing theriac (Venice treacle) and opium extract.11,18-20

A self portrait of Paul Cézanne (1839-1906). Oil on canvas (6049 cm), 1890-1894. Bridgestone Museum of Art, Tokyo, Japan. © Bridgeman- Giraudon.

Other famous French diabetics

Paul Cézanne (1839-1906): One of the founding fathers of the impressionist movement, nicknamed “the good God of painting” by Henri Matisse. He was a friend of Emile Zola, Camille Pissaro, and Tristan Bernard, who recorded his frequent spells of weakness.

A few years before his death, he complained of having trouble walking (arthritis), dizziness, and recurring headaches. In the latter part of his life, biographers thought that he was experiencing retinal degeneration, which explained—according to them—a change in the style of his painting. In justifying his gradual move away from the realistic representation of shapes, he wrote: “The sensations of color producing light are the reason for the abstraction that prevents the accurate definition of objects or fine and delicate touches.” Cézanne seldom left the region of Aix and refused to take part in exhibitions after his failure at the Impressionist Salon of 1877.

The diagnosis of diabetes was made in 1891 after the loss of his ability to discern the difference between blue and green. Moreover, Cézanne was suffering from severe myopia that he refused to correct with the use of glasses, which he deemed “vulgar things”. Cézanne underwent some treatments and took the waters in Vichy. His contemporaries were aware of his diabetes. In 1928, the poet Léo Larguier (1878-1950) wrote:

I only knew him when he was old and sick with diabetes, after a lifetime of stubborn but disparaged work. I am sure that the least encouragement would have made him a different man; he said it would have given him moral support.

In 1904, during a walk in the Aix countryside with the painter and writer Emile Bernard (1868-1941), an exhausted Cézanne confided: “I am ill with diabetes, but I can scarcely talk about it. I sense that I am in the grasp of an evil which will carry me away.” After a chill sustained while doing an open-air painting of the Sainte Victoire mountain, Cézanne slipped into a diabetic coma on October 15, 1906, and died six days later of pneumonia. A triggering factor of Cézanne’s diabetes was emerald green (copper [II] acetoarsenite) poisoning caused by his painting “à la couillarde”, that is, crude painting (with his fingers).21,22

Odilon Lannelongue (1840-1911): Professor of surgery at the Medical College of Paris and republican representative, then senator, of Gers. He was president of the Society of Surgery (Société de Chirurgie) in 1888, president of the General Association of French Doctors (Association générale des médecins de France) in 1892, and a president of the Academy of Medicine (Académie de Médecine). Lannelongue was the attending physician of Leon Gambetta and Sarah Bernhardt as well as the Presidents of the Republic, Sadi Carnot, Armand Fallières, and Félix Faure.

Montagne Sainte-Victoire by Paul Cézanne (painted from 1887 to 1890, before the deterioration in his blue-green vision). Musée d’Orsay, Paris, France.
© The Gallery Collection/CORBIS.

Montagne Sainte-Victoire by Paul Cézanne (painted from 1894 to 1900, after the deterioration in his blue-green vision) © Francis G. Mayer/CORBIS.

Because of his diabetes, Lannelongue frequently fell ill at the House of Representatives and the Senate, which prevented him from attending meetings and taking part in parliamentary jousts. He looked largely overweight …

…with a complexion that was more than a little flushed with shining cheeks , giving him a rather coarse look. He looked like a rough-hewn barrel; like a corpulent youngster from Gascogny.

On December 22, 1911, Lannelongue died—like many diabetics of the time—from a straightforward lung infection, acute lobar pneumonia.23

Joseph Joffre (1852-1931), Marshal of France and Chief of Staff of the Armed Forces during the First World War (until December 1916), favored “offensive à outrance” or “all-out attack” and was one of the most controversial French military figures. Joffre, who became overweight after 1910, was a big eater and not very inclined to physical exercise. He developed diabetes, which was monitored by the famous professor Raoul Boulin (1893-1958), author of several works on the treatment of diabetes. Joffre was given a “mixed diet”, which contained neither bread nor starchy foods; a diet that he did not follow. Boulin also prescribed carbonate of lime and extracts of dried liver. He started to waste away as a result of the disease, to suffer from arthritis of the lower limbs, and eventually lost his mobility altogether. After several months of inactivity on December 23, 1930, Joffre’s right leg was amputated. He died less than a fortnight later on January 3, 1931, uttering: “I did not hurt anyone.”24,25


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