Medicine and The Count of Monte Cristo: Dumas and a clinical revolution

‘That is as if you were to wish on the physician nothing but migraines, measles and wasp stings, only ailments that are skin-deep. If, on the contrary, you wish to see me as crown prosecutor, you should wish on me those fearful illnesses that bring honour to the doctor who cures them.’

The Count of Monte Cristo by Alexandre Dumas

Learning objectives

1. Review the portrayal of illness and disease within The Count of Monte Cristo

2. Examine how Dumas might have gained clinical experience and an understanding of medicine

3. Consider the context of the French Revolution and the changes in the cultural understanding of illness


The Count of Monte Cristo by Alexandre Dumas is a mid-19th Century novel with themes of adventure, vengeance, love and forgiveness. Initially released as a roman-feuilleton, it proved immensely popular and has since been adapted numerous times in various media and languages. The characters and story have woven their way into modern culture, even today making appearances in reinvented forms.

The Shawshank Redemption is often the top rated movie of modern times in viewer polls and contains themes and ideas inspired by The Count of Monte Cristo.

For a book so well read, understandably there has been intrigue (especially within medical circles) regarding the nature of the health problems encountered by some of the key characters. Two insightful articles are already available (one by Williams and the other by Murray) and I hope to examine and expand on these issues further within this blog and future posts. There will probably be spoilers of some kind or another, so stop reading this and instead read the book.

But before we look into the fascinating portrayals of illness and health care in The Count of Monte Cristo, it has been noted that Dumas’ descriptions are, for a fictional novel of the time, unexpectedly detailed and accurate.

There has been speculation that Dumas may have developed an understanding of medicine from one or more of his acquaintances. One possible vector of knowledge was his friend Bixio, a medical student who he met at the barricades:

‘My name is Bixio… Profession – medical student. If I get killed, here is my card; have the goodness to see that I am carried home. If you are wounded, I will put my scientific knowledge at your disposal’…I fought a duel in 1834, and Bixo was my second: he was a medical student at the time, and, feeling my pulse just after I had taken up my pistol, it only indicated sixtynine pulsations to the minute, two beats faster than normal.

My Memoirs (1802-1833) by Alexandre Dumas
Construction of a barricade in 1830
Image from: https://commons.wikimedia.org/wiki/File:Construction_d%27une_barricade_28_juillet_1830.jpg

Questions

Do physicians have a tendency to be rebellious?


The role of physicians in historical revolutions has been noted. From Jean-Paul Marat (and many other medical professionals in the French Revolution) through to Che Guevara, the sometimes popular image of the conservative leaning doctor can be challenged by such political activism. The GMC state that although doctors are entitled to their own personal political opinions, they must not express personal beliefs (including political, religious and moral beliefs) to patients in ways that exploit their vulnerability or are likely to cause them distress.

I don’t know whether Bixio was subject to similar regulations (or if he was, whether he cared). In any case, beyond the barricades, he is also reported to have acted as Dumas’ second in a number of duels. Despite his presumably useful medical knowledge in this situation, he perhaps has his own reasons for witnessing such engagements as is later recalled in a fanciful newspaper story:

When Alexandre Dumas, the elder, went to fight a duel with Gaillardet, who was accompanied by his friend   Bixio,  a doctor, who said to him: “Shall you hit Gaillardet, do you think?” “I don’t know,” replied Dumas. “Well, try to,” said the doctor. “I shall certainly try: but do you dislike him?” “Not at all; I don’t even know him.”   “Then why are you so anxious?” “Well, have you read Meirmee’s Etruscan Vase?” “Yes.” “Then, don’t you   remember that he says every man killed by a bullet turns round before he drops? I want to see if it’s true.” He had no opportunity of seeing on this occasion, for the duel was fortunately harmless; but the pendant to this story is that Bixio himself was shot some years afterwards at a Paris barricade, shot to death and, as he fell, turning, he cried, “Ah, one does turn, then!”

The Bulletin, 1883
Cover of the Illustrated Petit Journal depicting a duel (although not one involving Dumas)
Image from: https://commons.wikimedia.org/wiki/File:Duel_Deroulède-Clémenceau.jpg

This revolutionary backdrop is important to consider when exploring Duamas and his works. The Napoleonic era instigated many changes, including within medicine. In the 19th Century, Paris was an important, if not the important, centre of modern medicine. Indeed, it has been said that Paris itself became a patient. Foucault later examined some of the consequences of this medical revolution within The Birth of the Clinic.


Questions

What factors influence the societal expectation of physicians, illness and disease?


One facet of these changes was that illness was perceived differently and had developed a new kind of status, sometimes even a fashionable one. Consumptive chic is a term sometimes now used to describe this ‘tubercular moment’. Perhaps this was one of the reasons Dumas was keen to include interesting case studies within his works. Indeed, he is reported to have said:

It was the fashion to suffer from the lungs; everybody was consumptive, poets especially; it was good form to spit blood after any emotion that was at all sensational, and to die before reaching the age of thirty.

Tragic artists and their all-consuming passions

With Dumas feigning tuberculosis to improve his image as a fashionable writer, Murray reports he met a new University of Paris medical graduate, Dr Thibaud.

Plan des hôpitaux et hospices civils de la ville de Paris. Gravure de Jacques-Étienne Thierry. Dans Plans des hôpitaux et hospices civils de la ville de Paris. Paris, 1820.
Image from: https://journals.openedition.org/insitu/13923

Indeed, Dumas’ medical insight may have been gained from Thibaut (rather than Bixio), who would not just become his physician but friend. Furthermore, Dumas would on occasion accompany Thibaut on his medical rounds, Dumas himself recalling:

I had made the acquaintance of a young doctor, by name Thibaut. Thibaut knew exactly all these things that I did not know, and he undertook the rough task of my education. We passed most of our evenings together in a little room in the Rue du Pélican, looking out over the Véro-Dodat passage…. In the mornings I sometimes accompanied Thibaut to the Charité hospital, and did a little physiology and anatomy – though I could never overcome my repugnance to operations and corpses. From these visits came a certain amount of medical or surgical knowledge, which has more than once been of use to me in my novels… In the mornings, then,  between six and seven o’clock, I often went with Thibaut to the hospital; in the evenings we studied physics and chemistry in his room.

The Memoirs of Alexandre Dumas by Alexandre Dumas

The Hôpital de la Charité
Image detail from: https://wellcomecollection.org/works/c9jqc6a3

There doesn’t appear to be much information about the life Dr Thibaut (please contact me if you know more!) but The Charité Hospital itself has another intriguing connection with Dumas: His father, Thomas-Alexandre Dumas was a Revolutionary general under Napoléon and the first professor of medicine at The Charité hospital was Napoléon’s primary physician, Jean-Nicolas Corvisart.

Corvisart, who annoyed his parents when switching from law to medicine while a student, remodelled the The Charité Hospital to accommodate the major changes to medical practise and learning at the time. Indeed, aimed to “demonstrate that the chief aim of medicine should be not to elicit by sterile curiosity what post-more peculiarities might be found, but to strive to recognise the presence of particular disease by their appropriate signs and symptoms.” Indeed, this is the challenge that Dumas himself presents us with in The Count of Monte Cristo.

Jean-Nicolas Corvisart (1755-1821) envelope image. The classic clinical facial appearances of cardiac insufficiency or aortic regurgitation are sometimes called Corvisart’s facies.
Image from: https://commons.wikimedia.org/wiki/File:Corvisart,Jean_Nicolas(1755-1821)_CIPB1551.jpg

As well as having an extraordinary plot, The Count of Monte Cristo is also character heavy. The passages of emotions and internal struggle engage the reader. The description of the characters, including their medical ailments are used not to simply plump the volume of text but serve to reveal and enhance our understanding of what is happening. This is analogous to the physician examining the patient for external signs of disease to decipher the nature of the internal disease. The Count of Monte Cristo and its analysis is an outrageous grand round.

Medicine and the exercise of clinical diagnosis at the time Dumas was writing was seen not only through the emerging prism of reason but it also had the additional backdrop of societal and medical revolution. When examining his texts, we must remain insightful not only of the wider context of this changing world but also take care in our own interpretation with all the modern sensibilities and the now well-trodden dance of clinical behaviour and attitude.

In future posts, we will examine some of the clinical case studies Dumas presents to us within the pages of The Count of Monte Cristo. Therefore, in the style of serialisation, to be continued…

Image from: https://commons.wikimedia.org/wiki/File:Campbell-Playhouse-Count-Monte-Cristo.jpg

Summary

The Count of Monte Cristo is a well-known work that has permeated into the culture of society. Key players within the book have medical issues that have perplexed and caused intrigue for those of a clinical disposition. Dumas himself gained first-hand experience of medicine through his acquaintances and used this knowledge to bolster the authenticity of his characters and engage his audience. This new vogue for the clinical portrayal and understanding of illness came at a time of revolution, both politically and medically with a resonance that is still felt today.


Further resources

Medicine in Alexandre Dumas père’s The Count of Monte Cristo
https://dalspace.library.dal.ca/bitstream/handle/10222/47649/02_01_Murray_Dumas_en_cont.pdf?sequence=1

Cerebrovascular disease in Dumas’ The Count of Monte Cristo
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC539579/

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