A Touch of France: French doctors in Egypt with Napoleon






Christian RÉGNIER, MD
Praticien Attaché Consultant de l’Hôtel-Dieu de Paris
Société Internationale d’Histoire de la Médecine
9 rue Bachaumont 75002 Paris
(e-mail: dr.christian.regnier@wanadoo.fr)

French doctors in Egypt with Napoleon



“The time draws nigh when we shall feel that to truly destroy England we must seize Egypt.” Thus wrote Napoleon Bonaparte to the French government one year before his army entered Alexandria in July 1798. Marked by battles won and lost, revolts and reprisals, propaganda and backlashes, the French occupation of Egypt lasted but three years. What remains of its martial ambitions may perhaps be traced in the pages of military manuals, but its legacy is not the work of men of war, but of doctors, scholars, and scientists—the Description of Egypt—a multivolume work on Egyptian antiquities, flora and fauna, geology, climate, diseases, town planning, politics, and economics. Bonaparte himself supervised the medical and sanitary preparations for his Campaign of Egypt. On the ground, his medical men strove to overcome a host of difficulties that beset the troops: dehydration, cholera, ophthalmia, plague, and more. By setting up hospitals and lazarettos (quarantine stations), studying diseases, and implementing hygienic initiatives, the French medical corps enjoyed some measure of success. At the newly created Institut d’Égypte in Cairo, presided over by the mathematician Gaspard Monge, French scientists and doctors held scientific meetings and published their findings. Meanwhile, subject to increasing pressure from British and Ottoman forces, the French military capitulated at Alexandria in August 1801 and were expelled. Muhammad Ali, the “Father of Modern Egypt,” took power and instituted sweeping military, cultural, and economic reforms. Among his preoccupations were the organization of military and civilian medicine and the health of his people, and for this he recruited doctors and medical instructors from France to help modernize health care in Egypt. One such, Antoine Barthélémy Clot, a doctor and surgeon in Marseille, embarked in1825 for Egypt, where he spent over a quarter of a century. Soon after his arrival he cured Muhammad Ali of gastroenteritis, became his personal physician, and later was appointed chief health care administrator, and so by creating medical schools and hospitals laid the foundations of modern medical instruction and care in Egypt.

Medicographia. 2013;35:113-123 (see French abstract on page 123)






The Egypt Napoleon Bonaparte invaded in 1798 had been part of the Ottoman Empire for nearly three hundred years. The Ottomans ruled through the Mamluks, dynasties of emancipated slaves captured in Turkestan, southern Russia, and eastern Europe (Georgians, Slavs, Greeks). The Mamluks had held sway over the country since the 13th century, their power rooted in an elaborate military organization and in control of the spice trade with the European powers.

Dream and substance in the Orient: the French in Egypt

Bonaparte prepared the Campaign of Egypt in the utmost secrecy (in relation to the British). The Directory (a body of five directors that held executive power) made available to him—a young general not yet 30 years old—considerable wherewithal: 355 ships manned by 16 000 sailors to transport 38 000 men (and 340 women). In part perhaps because, as has often been remarked, the Directory was not averse to a lengthy absence of the Emperor from French soil: “He is gone, the saber is receding,” proclaimed the parliamentary deputy Paul Barras when the squadron left Toulon in May 1798.1,2

The campaign was not only military, since 167 scientists and artists embarked with their instruments and books. The expedition was designed to ensure an enduring French presence along the banks of the Nile,1,3 and Arab-speaking savants and printers spread French culture throughout Egypt by printing bilingual books (the Arabic characters had been recovered from the presses of the Vatican). French scientists and doctors reported that health care organization in Egypt was woeful, with people in thrall to charlatans and ignorant barber-surgeons. Recent historical studies though tend to belie these peremptory assertions by late 18th-century Westerners.

Egyptian doctors, surgeons, midwives, oculists, bonesetters, and barber-surgeons were organized in guilds, and—at least the most erudite among them—referred to the same principles of humoral medicine as their European counterparts. This is borne out by the fact that 78% of the remedies employed in Egypt were identical to those administered in France in the same indications, including bloodletting and cupping therapy. In Egypt, the doctor was a learned man who studied the great medical texts of the ancient world and of the Arab tradition, as well as astronomy, physics, and botany. The training and studies for the diploma of doctor were, it is true, more theoretical than those required of French doctors, who had already turned to clinical anatomy following the wide-ranging reforms of medical teaching implemented in Revolutionary France. Medical practice, though, was the work of Egyptian artisans whose training was more rudimentary, but whose deftness was often recognized, notably in the case of oculists. Alongside this decentralized medical organization, healers, exorcists, and magicians were tolerated because of their substantial contribution to the healing of patients.3-7 Such was the state of medical education and care in Ottoman Egypt when the French entered Alexandria in the summer of 1798.



Tricolor sash worn by Napoleon during the Campaign
of Egypt,
around 1798. Cashmere and wool, 2×0.6 m.
Malmaison, Châteaux de Malmaison et Bois-Préau.

© RMN–Grand Palais/Daniel Arnaudet.


A long-cherished ambition to conquer Egypt

Already mooted before the Revolution, the French had long seen the conquest of Egypt as a means of cornering trade with the Levant and of driving the British out of the Mediterranean while threatening their colonial empire through control of the trade route from India.

Influenced by Count Volney’s accounts of his contemporary travels in the Middle East, Bonaparte admired the civilization of ancient Egypt and had even once considered putting himself at the service of the Sublime (or Ottoman) Porte (a reference to a gateway used as a place of assembly at the Topkapi Palace in Istanbul, and as such a metonym for the government of the Ottoman Empire). Inspired by Enlightenment philosophy, the impetuous general dreamed of bringing to the peoples of the Orient the principles of the French Revolution so as to restore the lost grandeur of the ancient civilizations. Like the French government and its diplomats, the young Bonaparte thought that the Sultan of the Ottoman Empire, Selim III, whose artillery and fleet the French were reorganizing, would look favorably upon the reining in of the Mamluks, Egypt’s de facto rulers.

Bonaparte himself oversaw the health care organization of the expedition by assuming that one man in ten risked falling ill, one in 25 would likely be wounded, and that well-planned supplies of medical remedies would be necessary. In March 1798, Bonaparte ordered Simon de Sucy, the chief paymaster of the army in Egypt, to take as many surgeons and doctors as possible, either from the army in Italy or from wherever he found himself, because “you will never have too many […] procure two or three hundred nurses, eight or ten good hospital directors.”

In all, Sucy managed to find 168 “second-class doctors” (who, after passing certain examinations, had completed an apprenticeship of six years with a doctor or of five years in a hospital or three years’ study at a medical school), 108 of whom were surgeons (young and unversed), that is one doctor for 1530 soldiers and one surgeon for 350. Bonaparte’s chief medical officer, René-Nicolas Dufriche Desgenettes, invited his doctors to familiarize themselves with the diseases encountered in Egypt by reading Count Volney’s book on his travels in Syria and Egypt. Also taken along were 190 pharmacists, 142 hospital administrators, and 9 staff to run the lazarettos for epidemiological surveillance. Each military division had an ambulance, wound dressing equipment, surgical instruments, and medicines. The vessels of Bonaparte’s fleet were equipped with a sick bay and three were fitted out as floating hospitals. Some ships though never reached their destination. Le Patriote struck a reef west of Alexandria and sank, taking with it flexible stretchers, boxes of surgical instruments, and other equipment. The Bienfaisance too foundered with its boxes of surgical dressings and scientific apparatus.2,3,8,9

“The most virtuous man I ever knew »

Such was Bonaparte’s opinion of his Chief Surgeon, Dominique- Jean Larrey. During the Italian Campaign, a year before the invasion of Egypt, Bonaparte said to Larrey “Your work is one of the greatest creations of our century, and alone suffices to secure your reputation.” Later Napoleon, by then Emperor, also said “If the (French) army ever erects a monument to express its gratitude, it should do so in honor of Larrey.”

Larrey’s reputation knew no borders, and as Napoleon’s reign was nearing its end, at the Battle of Waterloo (1815), the Duke of Wellington ordered his soldiers not to aim in the direction of Larrey, who was working under fire to perform amputations, dress wounds, and evacuate the injured. The Duke doffed his hat and, in response to the enquiry “Who are you saluting?” pointed at Larrey with his sword saying “I salute the courage and devotion of an age that is no longer ours.”

Such was the measure of Dominique-Jean Larrey.

Larrey revolutionized battlefield medicine. He devised and developed the famous ambulances volantes (literally “flying ambulances”), field ambulances for rapid collection and evacuation of the sick and wounded, even in the heat of battle. These were purpose-built carriages, horse-drawn vehicles, or, in the desert, dromedaries bearing wooden stretcher-like compartments. This in an era when the wounded, if not simply abandoned to their fate, were tipped pell-mell onto local bullock carts for transportation.

Larrey also operated a system of triage, treating casualties according to the severity of their wounds and the urgency of the need for medical care, regardless of rank, friend and foe alike.

Vomiting root, maggots, and mercy killings

On arrival in Egypt Bonaparte ordered his staff to replace his soldiers’ uniform, which he deemed unsuited to the climate, by loose-fitting garments in white cotton, akin to those worn by the Mamluks. In the event, only the regiments mounted on dromedaries were kitted out in this way.



Portrait of Baron Jean-Dominique Larrey, Chief Surgeon of
Napoleon’s army in Egypt. Oil on canvas, 65 ×55 cm, by Anne
Louis Girodet de Roucy-Trioson. Paris, Musée du Louvre.

© RMN–Grand Palais (Musée du Louvre)/Thierry le Mage.



Apart from scorpion stings and dehydration, the French doctors were soon confronted by dysentery. The intestinal parasitoses endemic in Egypt at the time, such as amebiasis and shigellosis, were unknown to doctors of the late 18th century. Treatment, which on occasion was effective, involved rehydration and administration of quince jelly combined with the South American vomiting root (ipecacuanha or ipecac root, from the flowering plant Carapichea ipecacuanha). Ophthalmia (inflammation of the eye), aggravated by the blazing sunlight and windborne sand, was either gonococcal or chlamydial (caused by the Gram-negative bacterium Chlamydia trachomatis), in which case it came to be known as Egyptian ophthalmia (trachoma). In twenty-four hours the cornea was eroded, resulting in irreversible lesions. Desgenettes reported that one third of the population of Cairo was affected, writing “No other town has as many blind people.” Larrey wrote a remarkable description of ophthalmia, and advocated treatment by direct application to the eye of a poultice or cataplasm of aluminum sulfite and camphor.



Model of horse-drawn “flying ambulance” invented in the
1790s by Larrey, so named after the speed with which wounded
soldiers could be transported from the battlefield to field hospitals
to perform emergency surgery. Two stretched patients could fit
inside.

Wellcome Images © Science Museum, London.




Special camel-drawn version of Larrey’s “flying ambulance” adapted for Napoleon’s
Egyptian Campaign. Sketch in: Mémoires de Chirurgie Militaire et Campagnes, by Jean-
Dominique Larrey, Paris, France: published by J. Smith, F. Buisson, 1812.

© BIU Santé, Paris.




Amputation of the arm, as sketched by Jean-Dominique Larrey. In: Clinique Chirurgicale,
volume 2, plate 12, published by Gabon, in Paris, 1829.

© Wellcome Library, London.



The French largely escaped the ravages of smallpox, but 150 000 inhabitants of Cairo fell victim in 1801. Malaria was treated by the massive and haphazard administration of quinine (from the bark of the cinchona tree, Cinchona officinalis), which yielded spectacular results. Syphilis and gonorrhea were faithful camp followers throughout the campaign, and in a brutal, and vain, attempt to control their spread four hundred prostitutes were decapitated. Two venereal disease hospitals were opened, one in Cairo the other in Jaffa.

Surgeons made valuable observations of deep wounds made by the keen-edged Damascus steel of the Mamluks’ curved sabers. If a soldier’s injuries did not necessitate amputation, and he was not infected by tetanus, which was always fatal, blowfly maggots were applied to cuts because they release allantoin, which promotes tissue healing.2,8-12

Yet despite the doctors’ preparations, what afflicted the Egyptian Campaign above all was pestilence, the bubonic plague. When the first cases were reported in December 1798 at the medical hospital in Alexandria, drastic quarantine measures and disinfection procedures were put in place. Despite alarming rumors of an epidemic in Syria, 12 000 French troops left for Galilee in February of 1799, and by March 300 stricken soldiers were crammed into the Pest house of Jaffa. The doctors and surgeons there vied with one another in boldness by inoculating themselves with pus from buboes, to prove that the pestilence was not contagious. And they were forbidden from uttering the very name of the disease in front of the soldiers.

At the siege of Saint Jean d’Acre from March to May, 500 men died in combat, 2000 wounded were treated and evacuated by sea and across the desert, and half of the 2000 sick had the plague. Treatments at the time were pitiable: incision of the buboes, scarification of the skin on the neck, administration of acidic drinks. When asked by Bonaparte to administer overdoses of opium to suffering soldiers, Desgenettes refused, but Claude Royer, the chief pharmacist, complied. It is believed there were thirty or so mercy killings of plague victims unfit to be moved; the British, who made political hay of the incident, spoke of 500.2,3, 8,12



Napoleon Visiting the Plague-Stricken in Jaffa.
Oil on canvas, 532×720 cm, by Baron Antoine-Jean Gros, 1804. Paris, Musée du Louvre.

© RMN–Grand Palais (Musée du Louvre)/Thierry Le Mage.



_ The new science of Egyptology
Military ups and downs and the ravages of unexpected diseases turned Napoleon’s expedition into a medical and health disaster. Among the 38 000 soldiers mobilized, Desgenettes counted 4758 who died in action and 4157 who succumbed to disease, 1689 of them to the plague. Rare it was at the time that men killed in battle outnumbered the victims of disease, and this, it may be said, bears witness to the effectiveness of the health measures put in place.2,12 At the hospital in Cairo, Desgenettes opened a school of medicine and pharmacy. Lacking health and sanitary backup after the British destroyed the French fleet at Aboukir on 1 August 1798, the hospital staff suffered increasing shortages of medicines and surgical instruments, whence their attempts to put in place a lasting health care organization by using local human and material resources. French doctors imposed collective (and often unpopular) hygienic measures, such as the setting up of town councils with powers in matters of sanitation, banning burials within towns, removal of stagnant water, and organized refuse collections.2,3,8

In August 1798, Bonaparte founded in Cairo the Institut d’Égypte, which was presided over by the mathematician Gaspard Monge. The Institute’s newspaper, the Courrier de l’Égypte, was copyedited by Joseph Fourier, who is credited with discovering what we now call the greenhouse effect, and who is associated with the eponymous series, transforms, and law he devised. Dedicated to Bonaparte and two of his generals, the three-volume La Décade Égyptienne reported the sessions of the Institut d’Égypte and the communications of the members of the arts and sciences commission, notably articles on diseases observed in Egypt, like ophthalmia, elephantiasis, and filariasis, the plague, and the relations between the Nile floods and the occurrence of epidemics. Chief pharmacist Claude Royer published there a complete review of the pharmacopeia common in Egypt.



Desgenettes, Chief Medical Officer during
Napoleon’s Egyptian Campaign, inoculating himself
with the plague. Color engraving, author unknown.
Château de Malmaison et Bois-Préau.

© RMN–Grand Palais/Daniel Arnaudet.




Portrait of René-Nicolas Dufriche Baron Desgenettes.
Oil on canvas, 18th century. Musée de la Ville de Paris, Musée
Carnavalet, Paris, France.

© Giraudon/Bridgeman Art Library.




Portrait of Muhammad Ali, Viceroy of Egypt (1769-1849) in 1803.
Oil on canvas 93×76 cm, by Louis Charles Auguste Couder, 1840.
Versailles, Châteaux de Versailles et de Trianon.

© RMN–Grand Palais (Château de Versailles)/Gérard Blot.



In addition to conducting the first forensic examinations of Egyptian mummies, Desgenettes published a Medical Topography of Egypt, in which he recounted how it was the custom for wet nurses to ingest a remedy intended for the infants they suckled, anticipating its absorption with breast milk.

Appointed supreme commander of the armies in Egypt, after the departure of Bonaparte on 22 August 1799, General Jean- Baptiste Kléber decided to collect and publish all the observations of the expedition’s scientists in a monumental work entitled the Description de l’Égypte. Published between 1809 and 1828, this limited edition of 1000 copies, 200 of them reserved for the Emperor, comprised nine volumes of text, ten volumes of plates containing 974 engravings, and a cartographic atlas.

The Description de l’Égypte contained plates 1 by 0.81 meters, and was delivered by the imperial (and later royal) printing office with its very own cabinet.13-16 Thanks to the exceptional scientific output of the expedition’s savants in many fields of learning—archeology and ancient history, botany, zoology, medicine, epidemiology, geography, and mineralogy— European fascination with all things of the land of the Pharaohs, its Egyptomania, had now become the new science of Egyptology.







Aftermath and legacy

When the French left Egypt in September 1801 after a series of defeats against the Ottoman Turks and the British, there had been too little time for their praiseworthy attempts at modernization to take root throughout the country. But they had laid the groundwork for the changes and reforms implemented by Muhammad Ali, a commander in the Ottoman military.

Muhammad Ali was born in Kavala in eastern Macedonia to Albanian parents. Contemporary witnesses reported that he spoke only Albanian fluently, but was competent in Turkish, the official language of his court, rather than Arabic. He arrived in Alexandria in the spring of 1801 just after the departure of the French. Through skilled political maneuvering, and with the backing of the Ottoman Sultan, Selim III, he managed to weaken Mamluk influence and had himself appointed Viceroy of Egypt. From 1804 to his death forty-five years later, Muhammad Ali strengthened the independence of Egypt, raised an army by conscription, undertook large-scale infrastructure work (canals and roads), developed cotton growing, introduced social laws, and built modern schools. This great reformer wished to create in Egypt a military health system and to organize medicine so as to improve the state of health of his country’s people. By building on their good work, Muhammad Ali paid indirect homage to Larrey, Desgenettes, and their colleagues, whose selfless toil created the greatest legacy of the Campaign of Egypt. It may be that the most fitting tribute to Bonaparte’s scientists and medical men, and to those who came later, is to be found in the words of the Emperor himself: “True conquests, the only ones untainted by regret, are those over ignorance.” _


References
1. Künzi F. Napoléon et l’Égypte. Lausanne, Switzerland: Éditions Favre; 2005.
2. Milleliri JM. Médecins et Soldats Pendant l’Expédition d’Égypte (1798-1799). Nice, France; Bernard Giovanelli éditeur; 1993.
3. Hutin JF. La Campagne d’Égypte: Une Affaire de Santé (1798-1801). Paris, France: Éditions Glyphe; 2011.
4. Gadelrab SS. Medical Healers in Ottoman Egypt.Med Hist. 2010;54(3):365-386.
5. Moulin AM. La profession médicale dans les pays arabes : vues historiques à long et à court terme. In: Curmi B, Chiffoleau S. Médecins et Protection Sociale dans le Monde Arabe. Beyrouth, Lebanon: CERMOC; 1993.
6. Worth Estes J, Kuhnke LV. French observations of disease and drug use in late eighteenth-century Cairo. J Hist Med Allied Sci. 1984;39:121-152.
7. LaVerne Kuhnke. Lives at Risk: Public Health in Nineteen-Century Egypt. Berkeley, CA: University of California Press; 1990.
8. Millet P. Les plaies de la campagne d’Égypte. Tribune Med. 1896;191:17-20.
9. Russel TG. Medicine in Egypt at the time of Napoleon Bonaparte. BMJ. 2003; 327;7429:1461-1464.
10. Assalini P. Observations sur la Maladie Appelée Peste, le Flux Dysentérique, l’Ophtalmie d’Égypte, et les Moyens de s’en Préserver. Paris, France: Chez l’auteur, 1801.
11. Larrey JD. Mémoires de Chirurgie Militaire et Campagnes de D. J. Larrey. Vo- lume 1, Paris, France: Smith; 1812.
12. Desgenettes RN. Souvenirs d’un Médecin de l’Expédition d’Égypte. Paris, France: Calmann-Lévy; 1893.
13. Luthi JJ. Lire la Presse d’Expression Française en Égypte 1798-2008. Paris, France: L’Harmattan; 2009.
14. Solé R. L’Égypte, Passion Française. Paris, France: Seuil; 1997.
15. Laissus Y. L’Égypte, une Aventure Savante. Paris, France: Fayard; 1998.
16. Bret P. Un autre retour d’Égypte : du Caire à Paris, l’ouverture de la France à la culture du monde arabe. In: Humbert JM et coll. Bonaparte et l’Égypte— Feu et Lumières. Paris, France: IMA et Hazan; 2009.
17. Panzac D. Médecine révolutionnaire et révolution de la médecine dans l’Égypte de Muhammad Ali: le Dr Clot-Bey. Revue du Monde Musulman et de la Méditerranée. 1989;52-53:95-110.
18. Thiers H. Le Docteur Clot-Bey, sa Vie et ses Travaux en Égypte. Paris, France: Imprimerie Balitout; 1869.
19. Euzière J. Petite Histoire d’un Grand Homme : Clot Bey, Docteur de Montpellier, Fondateur de la Faculté de Médecine du Caire. Montpellier, France: Imprimerie de la Charité: 1952.