Journal of the Royal Society ofMedicine Volume 72 August 1979
621
The failing health of Napoleon' James 0 Robinson MD MChir St Bartholomew's Hospital, London ECIA 7BE
Napoleon Buona Parte, later to become Bonaparte, was born on 15 August 1769 at Ajaccio on the Island of Corsica. One year before his birth the island had been sold to France, but it was not finally given over to France until one month before he was born; he was thus an Italian, born on French soil. His mother had 13 children, 8 of whom survived, and Napoleon said that if his father had not died at the age of 38 there would have been a family of nearly 20 children. At the age of 15 his father took him to Paris and entered him at the Ecole Royale Militaire at Brienne. He was a mere weed of a boy, who was ridiculed by fellow students for his small thin stature, his shabby attire, and for being a Corsican who spoke French with an appalling accent. The father visited the Queen's physician, Dr de La Sonde, for indigestion; he was to die a year later in the lovely town of Montpellier, of carcinoma of the pylorus as proved on autopsy. Napoleon was nearly influenced to go to England and join the Royal Navy. How history would have changed! He was, however, fearful of water; his mother had nearly drowned when he was still in utero. He was commissioned as 2nd Lieutenant at the age of 16 and entered the crack artillery regiment of France which was then stationed at Valence. Here he found his first love, Caroline du Colombier, a young daughter of the people with whom he was billetted. In 1788, when back in Paris, he met a girl of the streets under the arches of the Palais Royal. He wrote about and to her - a curious and puzzling relationship. Later that year he developed malaria and a condition which was diagnosed as neurodermatitis. In Marseilles he met the famous Desiree Clary, the daughter of a wealthy merchant who subsequently married one of his friends. For Desiree's sake he subsequently made her husband, Bernadotte, a general and a marshal of France. At the battle of Toulon he was wounded in the face and suffered a bayonet thrust on the inner side of his left thigh about which he was to complain until his dying day. He received many wounds (one from a jealous lapdog of Josephine's, which shared the matrimonial bed on their wedding night), 19 horses were shot beneath him in battle, but he was convinced he would never be killed. He had fantastic fearlessness and death defiance. At the age of 24 he became a general. He stood 5 ft 6 in high and was extremely thin, with delicate pointed hands; his skin was white and clear. In October 1795 he met Josephine Marie de Beauharnais who was then a widow of 32, with two children. They were married six months later. Napoleon loved Josephine, in spite of the fact that she was a Creole from Martinique and had had gonorrhoea (perhaps the only dowry she brought into the marriage). He suffered dysuria shortly after the wedding, and she was promiscuous throughout her life. He divorced her because he believed she was infertile; possibly her tubes had become sealed by gonorrhoeal scars. In November 1799, at the age of 30, he was made First Consul of France. At this stage of Napoleon's life a change began which was to totally alter his appearance, and there was no doubt that he was concerned about his health. There is a record of a conversation between Josephine, Napoleon and his personal physician, Jean Nicolas Corvisant. When asked to what ailment was Napoleon most susceptible Corvisant replied: 'He will die of an aneurysm of the heart'. Was he hinting that he thought Napoleon had syphilis? He then began to have pains in his right abdomen, and kept talking about growing fat, although he was neither a gourmet nor a gourmand: he even used to pour water into his favourite wine. He had repeated chest 1 Paper read to Section of Urology, 23 February 1978 0 1 41-0768/79/080621-03/$Ol .00/0
4"
1979 The Royal Society of Medicine
622
Journal of the Royal Society of Medicine Volume 72 August 1979
infections with haemoptysis, but his post-mortem did not show any evidence of tuberculosis, the second commonest disease at that time. These health problems did not, apparently, affect his love life or, perhaps more correctly, his sexual appetite. During an escapade with Mademoiselle George, an actress, he suddenly fell back unconscious and went into a violent convulsion. It was thought to be epilepsy. He had done this before inflagrante delicto. It was said that the veins of his neck stood out like great cords and that he had violent convulsions. Was it the heat offlagrante or the shame of delicto? A year later Josephine was to witness the same attack in her own bed. Napoleon was now becoming worried about having no heir. Was he or Josephine infertile? He had certainly tried enough but there are no recorded offspring of his many affairs, though many of his mistresses had children by other men. There is one doubtful case. Louis, his brother, had married Josephine's daughter, Hortense, and they had a son called Charles. The love and affection which Napoleon poured on this child aroused suspicion that it might be his own, but all his life he had a tremendous loyalty to his family. In 1806 he met Elenora Denielle de La Plaigne, a 'reader' to the children of his sister, Caroline Murat. Napoleon arrived at the house, he saw, he conquered: and 9 months later a son, Charles Leon, was born. The guinea-pig had been put to the test and given a positive result. Napoleon was fertile. A year later he met his wondrous Marie Walewsca, aged 22, whose husband was 70. She had a son, Alexander Florian, by Napoleon and 3 years later whilst in the beautiful palace of Schonbrunn in Vienna she conceived again. By now Napoleon's face was becoming rounded, his cheeks almost plump, his jaw more square, his collar was filled with flesh; the fire in his eyes dimmed, and the expression became dulled. The body began to broaden, the buttocks to fatten, and the hips to widen. The hair began to recede and the skin became smoother and softer. Were these signs of pituitary dysfunction? He was known to have brachycardia; he had occasional attacks of vomiting followed by stupor almost to unconsciousness, sham rages and sudden sexual impulses. Was this Fr6hlich's syndrome? Many believe it may have been, but there is insufficient evidence, and Fr6hlich's syndrome presents at an earlier age. It is unlikely that it was an isolated gonadotrophin deficiency. It is more likely to have been an aquired primary hypogonadism resulting from an orchitis which led to slow testicular atrophy, with impotence and the feminism of this condition. It is just conceivable that the changes could have been due to a slowly growing pituitary tumour but there were never any localizing signs of pressure on the optic nerve and it must be remembered that he was a voracious reader while in exile, some 3370 books being found in his library at Longwood, St Helena. Time was running out if he wanted a true heir. Josephine must go, and he must find someone else. This was the 18-year-old daughter of the Emperor of Austria, Marie Louise, grandniece of Marie Antoinette. They were married in 1810 and one year later a son was born, who was given the title King of Rome, Napoleon II, Duke of Reichstadt, L'Aiglon (the eaglet). Was it Napoleon's son? Marie Louise was known to be a nymphomaniac and she detested the child. Artificial insemination has been suggested by Shaw Desmond. It had been used by the Arabs for horse breeding in the 14th century, and the earliest human case is attributed to Bartolomeo Eustachio around 1550. Napoleon could have used one of his brothers to maintain the Bonaparte likeness. Who knows? From hereon the road of the Emperor was full of troubles. On the way to Moscow, at Borodino, he had an acute attack of dysuria, his urine came only in painful drops, thick with sediment, and his legs began to swell. On the eve of the battle of Moscow he was febrile with rigors. His doctors recorded that several years earlier he had had similar attacks which were cured with repeated hot baths. The battle of Waterloo was worse for him: not only did he have further attacks of dysuria, but the piles from which he had suffered for over 18 years thrombosed. He had never lost a battle when he was personally in command on the field, but now he was in pain, he was indecisive. When Marshal Ney saw that he had victory at his fingertips and asked Napoleon for the Imperial Guard, the reply was: 'Troops? Where do you expect me to get them from . . . do you expect me to make them?'
Journal of the Royal Society ofMedicine Volume 72 August 1979
623
His five-and-a-half-year exile in St Helena was a tragedy of illhealth. At times he was seen leaning against a wall or a tree, passing his water with difficulty and pain, in a small dribbling stream. He would mutter and groan 'This is my weak spot - it is by this I shall die'. He suffered from recurrent dysuria, abdominal pain, constipation, vomiting, haematemesis and melaena. Where these the signs of advancing uraemia? They may have been. Certainly only a few of these symptoms are likely to have been related to his carcinoma of the stomach. On 5 May 1821 he was released from his misery. The post-mortem, which was recorded by Antonmarche, first Prosector to Paslo Mascagni in Florence, and Dr Walter Henry, acknowledges that he died of carcinoma of the stomach, like his father. The body was feminized. It was covered by a deep layer of fat; the skin was white and delicate, as were the hands and arms. There was scarcely any hair on the body and there were well marked breasts and a mons veneris; the shoulders were narrow, the hips broad and the genitalia exceedingly small, suggesting testicular atrophy. The teeth were healthy, but stained black from the habitual chewing of liquorice. There was a slight peculiarity in the formation of the left kidney, which was one-third larger than the right. The kidneys were never opened, but might have shown urine mixed with pus. The urinary bladder was small and contained a few gritty particles of gravel, and the mucosa was thickened, with numerous red patches. Perhaps if the urethra had been sectioned the key to the slow decline which was started in Napoleon's late 30s would have demonstrated a small circular scar, too tight to allow for the passing of even small stones. It would seem from all this that the Emperor Napoleon was probably of low potency and subfertile. The feelings of sexual inadequancy which have led sane men to suicide nearly led Napoleon to world conquest. He compensated for these deficiencies by his aggression. He himself admitted that he was feeble at the game of love ('faiblesse dans le deduit amoureux'). Bibliography Brown R L (1974) History of Medicine 5, 4 Kemble J (1957) Napoleon Immortal. John Murray, London
621
The failing health of Napoleon' James 0 Robinson MD MChir St Bartholomew's Hospital, London ECIA 7BE
Napoleon Buona Parte, later to become Bonaparte, was born on 15 August 1769 at Ajaccio on the Island of Corsica. One year before his birth the island had been sold to France, but it was not finally given over to France until one month before he was born; he was thus an Italian, born on French soil. His mother had 13 children, 8 of whom survived, and Napoleon said that if his father had not died at the age of 38 there would have been a family of nearly 20 children. At the age of 15 his father took him to Paris and entered him at the Ecole Royale Militaire at Brienne. He was a mere weed of a boy, who was ridiculed by fellow students for his small thin stature, his shabby attire, and for being a Corsican who spoke French with an appalling accent. The father visited the Queen's physician, Dr de La Sonde, for indigestion; he was to die a year later in the lovely town of Montpellier, of carcinoma of the pylorus as proved on autopsy. Napoleon was nearly influenced to go to England and join the Royal Navy. How history would have changed! He was, however, fearful of water; his mother had nearly drowned when he was still in utero. He was commissioned as 2nd Lieutenant at the age of 16 and entered the crack artillery regiment of France which was then stationed at Valence. Here he found his first love, Caroline du Colombier, a young daughter of the people with whom he was billetted. In 1788, when back in Paris, he met a girl of the streets under the arches of the Palais Royal. He wrote about and to her - a curious and puzzling relationship. Later that year he developed malaria and a condition which was diagnosed as neurodermatitis. In Marseilles he met the famous Desiree Clary, the daughter of a wealthy merchant who subsequently married one of his friends. For Desiree's sake he subsequently made her husband, Bernadotte, a general and a marshal of France. At the battle of Toulon he was wounded in the face and suffered a bayonet thrust on the inner side of his left thigh about which he was to complain until his dying day. He received many wounds (one from a jealous lapdog of Josephine's, which shared the matrimonial bed on their wedding night), 19 horses were shot beneath him in battle, but he was convinced he would never be killed. He had fantastic fearlessness and death defiance. At the age of 24 he became a general. He stood 5 ft 6 in high and was extremely thin, with delicate pointed hands; his skin was white and clear. In October 1795 he met Josephine Marie de Beauharnais who was then a widow of 32, with two children. They were married six months later. Napoleon loved Josephine, in spite of the fact that she was a Creole from Martinique and had had gonorrhoea (perhaps the only dowry she brought into the marriage). He suffered dysuria shortly after the wedding, and she was promiscuous throughout her life. He divorced her because he believed she was infertile; possibly her tubes had become sealed by gonorrhoeal scars. In November 1799, at the age of 30, he was made First Consul of France. At this stage of Napoleon's life a change began which was to totally alter his appearance, and there was no doubt that he was concerned about his health. There is a record of a conversation between Josephine, Napoleon and his personal physician, Jean Nicolas Corvisant. When asked to what ailment was Napoleon most susceptible Corvisant replied: 'He will die of an aneurysm of the heart'. Was he hinting that he thought Napoleon had syphilis? He then began to have pains in his right abdomen, and kept talking about growing fat, although he was neither a gourmet nor a gourmand: he even used to pour water into his favourite wine. He had repeated chest 1 Paper read to Section of Urology, 23 February 1978 0 1 41-0768/79/080621-03/$Ol .00/0
4"
1979 The Royal Society of Medicine
622
Journal of the Royal Society of Medicine Volume 72 August 1979
infections with haemoptysis, but his post-mortem did not show any evidence of tuberculosis, the second commonest disease at that time. These health problems did not, apparently, affect his love life or, perhaps more correctly, his sexual appetite. During an escapade with Mademoiselle George, an actress, he suddenly fell back unconscious and went into a violent convulsion. It was thought to be epilepsy. He had done this before inflagrante delicto. It was said that the veins of his neck stood out like great cords and that he had violent convulsions. Was it the heat offlagrante or the shame of delicto? A year later Josephine was to witness the same attack in her own bed. Napoleon was now becoming worried about having no heir. Was he or Josephine infertile? He had certainly tried enough but there are no recorded offspring of his many affairs, though many of his mistresses had children by other men. There is one doubtful case. Louis, his brother, had married Josephine's daughter, Hortense, and they had a son called Charles. The love and affection which Napoleon poured on this child aroused suspicion that it might be his own, but all his life he had a tremendous loyalty to his family. In 1806 he met Elenora Denielle de La Plaigne, a 'reader' to the children of his sister, Caroline Murat. Napoleon arrived at the house, he saw, he conquered: and 9 months later a son, Charles Leon, was born. The guinea-pig had been put to the test and given a positive result. Napoleon was fertile. A year later he met his wondrous Marie Walewsca, aged 22, whose husband was 70. She had a son, Alexander Florian, by Napoleon and 3 years later whilst in the beautiful palace of Schonbrunn in Vienna she conceived again. By now Napoleon's face was becoming rounded, his cheeks almost plump, his jaw more square, his collar was filled with flesh; the fire in his eyes dimmed, and the expression became dulled. The body began to broaden, the buttocks to fatten, and the hips to widen. The hair began to recede and the skin became smoother and softer. Were these signs of pituitary dysfunction? He was known to have brachycardia; he had occasional attacks of vomiting followed by stupor almost to unconsciousness, sham rages and sudden sexual impulses. Was this Fr6hlich's syndrome? Many believe it may have been, but there is insufficient evidence, and Fr6hlich's syndrome presents at an earlier age. It is unlikely that it was an isolated gonadotrophin deficiency. It is more likely to have been an aquired primary hypogonadism resulting from an orchitis which led to slow testicular atrophy, with impotence and the feminism of this condition. It is just conceivable that the changes could have been due to a slowly growing pituitary tumour but there were never any localizing signs of pressure on the optic nerve and it must be remembered that he was a voracious reader while in exile, some 3370 books being found in his library at Longwood, St Helena. Time was running out if he wanted a true heir. Josephine must go, and he must find someone else. This was the 18-year-old daughter of the Emperor of Austria, Marie Louise, grandniece of Marie Antoinette. They were married in 1810 and one year later a son was born, who was given the title King of Rome, Napoleon II, Duke of Reichstadt, L'Aiglon (the eaglet). Was it Napoleon's son? Marie Louise was known to be a nymphomaniac and she detested the child. Artificial insemination has been suggested by Shaw Desmond. It had been used by the Arabs for horse breeding in the 14th century, and the earliest human case is attributed to Bartolomeo Eustachio around 1550. Napoleon could have used one of his brothers to maintain the Bonaparte likeness. Who knows? From hereon the road of the Emperor was full of troubles. On the way to Moscow, at Borodino, he had an acute attack of dysuria, his urine came only in painful drops, thick with sediment, and his legs began to swell. On the eve of the battle of Moscow he was febrile with rigors. His doctors recorded that several years earlier he had had similar attacks which were cured with repeated hot baths. The battle of Waterloo was worse for him: not only did he have further attacks of dysuria, but the piles from which he had suffered for over 18 years thrombosed. He had never lost a battle when he was personally in command on the field, but now he was in pain, he was indecisive. When Marshal Ney saw that he had victory at his fingertips and asked Napoleon for the Imperial Guard, the reply was: 'Troops? Where do you expect me to get them from . . . do you expect me to make them?'
Journal of the Royal Society ofMedicine Volume 72 August 1979
623
His five-and-a-half-year exile in St Helena was a tragedy of illhealth. At times he was seen leaning against a wall or a tree, passing his water with difficulty and pain, in a small dribbling stream. He would mutter and groan 'This is my weak spot - it is by this I shall die'. He suffered from recurrent dysuria, abdominal pain, constipation, vomiting, haematemesis and melaena. Where these the signs of advancing uraemia? They may have been. Certainly only a few of these symptoms are likely to have been related to his carcinoma of the stomach. On 5 May 1821 he was released from his misery. The post-mortem, which was recorded by Antonmarche, first Prosector to Paslo Mascagni in Florence, and Dr Walter Henry, acknowledges that he died of carcinoma of the stomach, like his father. The body was feminized. It was covered by a deep layer of fat; the skin was white and delicate, as were the hands and arms. There was scarcely any hair on the body and there were well marked breasts and a mons veneris; the shoulders were narrow, the hips broad and the genitalia exceedingly small, suggesting testicular atrophy. The teeth were healthy, but stained black from the habitual chewing of liquorice. There was a slight peculiarity in the formation of the left kidney, which was one-third larger than the right. The kidneys were never opened, but might have shown urine mixed with pus. The urinary bladder was small and contained a few gritty particles of gravel, and the mucosa was thickened, with numerous red patches. Perhaps if the urethra had been sectioned the key to the slow decline which was started in Napoleon's late 30s would have demonstrated a small circular scar, too tight to allow for the passing of even small stones. It would seem from all this that the Emperor Napoleon was probably of low potency and subfertile. The feelings of sexual inadequancy which have led sane men to suicide nearly led Napoleon to world conquest. He compensated for these deficiencies by his aggression. He himself admitted that he was feeble at the game of love ('faiblesse dans le deduit amoureux'). Bibliography Brown R L (1974) History of Medicine 5, 4 Kemble J (1957) Napoleon Immortal. John Murray, London
