Monday, 2 March 2020

Louis XVII - "Pathographie"

This post translates/summarises a set of three reports published by the palaeopathologist Dr  Pierre Léon Thillaud in the context of the 1979 excavations:

In September 1979 a investigation carried out in the immediate area of the church of Sainte-Marguerite resulted in the exhumation of a  number of human bones.  A Commission, consisting of professors Huard and Grmek, and Dr Pierre Léon Thillaud was asked to examine them and give an expert osteo-archaeological opinion, with a view to perhaps identifying the remains of the child who died in the Temple in 1795.  These articles, originally published in the review Cahiers de la Rotonde in 1983, were written by DrThillaud in fulfilment of that protocol.

Dr Thillaud's first paper considers the autopsy findings of 1795 and the second evaluates the reports  from the 1846 and 1894 exhumations.  Since it seems unlikely that the remains themselves will be re-examined in the near future, Dr Thillard's literature reviews continue to represent the most impartial, expert assessment available.

Paper 1: The "pathography" of Louis XVII in the Temple (August 1792-June 1795)

The autopsy

"Louis-Charles Capet" died between 2 pm and 3 pm on 8th June 1795, aged 10 years and 2 months.  The autopsy was carried out on the following day, by the doctors Pelletan, Dumangin, Jeanroy and Lassus.  Philippe-Jean Pelletan, professor of surgery, had replaced Desault as Louis XVII's doctor on 5th June; on 7th June he had invited Dumangin to attend as a consultant.  Both men were seconded by a colleague of their choice.  All four practitioners enjoyed well-established reputations.

The results of the autopsy

The procès-verbal of the autopsy appeared in the Moniteur for 14th June 1795 and is reproduced by Dr Thuillard.

The report followed the standard format for the time. The lack of numerical data was perfectly usual. It should also be emphasised that the purpose of an autopsy was to establish cause of death, NOT to identify the body.

The pathology is described with "remarkable precision". The "tumeurs" observed on the right leg and elbow can be identified as "tumeurs blanches", that is swellings of the joints (and whitening of the skin) characteristic of tuberculosis of the bones. On opening the abdominal cavity, the doctors uncovered considerable erosion and numerous tubercles; a large quantity of pus was released. This establishes beyond reasonable doubt that the cause of death was  acute peritonitis, contracted in the context of chronic tuberculosis.  Pelletan and his colleagues referred to the disease as scrofula or "le vice scrophuleux", which was the current name at this time for all forms of non-pulmonary tuberculosis.

Previous medical history

Dr Thuillard now reviews Louis XVII's medical history, which confirms the diagnosis and shows the progression of his disease.

When he arrived in the Temple on 13th August 1792, the dauphin Louis-Charles was 7 years old. His older brother Louis-Joseph, had died of tuberculous spondylitis (Pott's Disease) in June 1789.  Marie-Antoinette described her younger son to Mme de Tourzel in July 1789, as in good health if prone to nerves, though there were contradictory rumours: in April 1789, when Louis-Joseph lay dying in Meudon, the lawyer Brillat-Savarin informed a correspondent that "the duc de Normandie is also in very poor health".  At first, however, the dauphin's health seems to have been satisfactory. The first signs of illness come from the period after the execution of Louis XVI.

The duchesse d’Angoulême recounted in her memoirs that in May 1793 her brother had complained of a pain in his chest that prevented him laughing.  He subsequently suffered a fever, with breathlessness and headaches.  He  recovered but from this time onward his health declined. The doctor Thierry de Bussy confirmed that the fever had lasted for twenty-one days and was more acute in the evenings. 

The symptoms described - chest pain, shortness of breath exacerbated by pain, fever at the end of the day  - are consistent with a respiratory infection, more specifically pleurisy. The persistence of the pain and fever suggests that the disease passed from an acute to a chronic phase.  The autopsy, which found that lungs adhered to the pleura, diaphragm and pericardium, supports this diagnosis.

A memoir by the apothecary Robert gives details of drugs prescribed to the dauphin at this time. Dr Thillaud concurs with the 1953 study by Louis Hastier, that these were standard 18th-century remedies against scrofula. Family history, plus poor sanitary conditions, could only have reinforced Louis-Charles's susceptibility to tuberculosis.

TB is at first latent, but as the bacilli begin to spread slowly through the blood, it gives rise to variety of clinical manifestations - pleurisy, arthritis, peritonitus.  This pattern is particularly common in young children.

TB also often affects the genitals.  In the summer of 1793 Louis-Charles suffered a characteristic pain in the scrotum and swelling of the testicle. He was said to have injured himself playing with a stick in June 1793, though this is perhaps unlikely given how ill he was in May. There was no need, however,  for trauma or abuse to produce these symptoms.

On 26 July 1793 Thierry de Bussy treated his patient for a "maladie vermineuse";  the prince reportedly brought up a large quantity of worms.  Treatment continued until late August.  It seems  however, that the pleurisy and genital condition subsided. The last visits of the doctory Thierry took place in January 1794.  On 19th January the commissaries affirmed that the prisoner was "in good health".  On 30 July 1794 Laurent, newly appointed to Louis-Charles's care, wrote in the Temple log that the prisoners were well ("se portent bien").

Suddenly, however, in the following year, the prince became worryingly ill. On 6th May 1795, the Committee of General Security, warned of Louis-Charles's poor state of health, instructed Joseph Desault to attend him.  Desault prescribed anti-scrofulous remedies, as well as improved diet, light and air.  This treatment regime continued on similar lines under Pelletan and Dumangin after Desault's sudden death.

On the evening of the 7th June 1795 the two gaolers Lasne and Gomin alerted the doctors to the crisis, which was to end in the dauphin's death the next day.  The final observations of  his distended and tender stomach, plus diarrhoea, confirm the diagnosis of peritonitis, established from the autopsy report.

The Cemetery Sainte-Marguerite: Analysis of the first excavations (November 1846 and 4th June 1894)

The Exhumation of 1846

The original scientific report for the 1846 exhumation has not been found. However Dr. Thillaud reproduces a letter from Dr Milcent to the abbé Haumet, dated 3rd Febuary 1847,  in which he indicates his initial findings.  Milcent observes that the bones belonged to "a very young subject".  They showed a delicacy and "disproportionate length", characteristic of a "weak, scrofulous constitution" or poor hygienic conditions.  There were signs of decay on the bones of the left leg.  The skull had been sawed open in a manner consistent with an autopsy and there were remains of long red hair (similar to the long luxurious hair reported by the commissary J.-P. Harmand).  Milcent had at first thought that the legs were too long for a child of 10 years, but he notes that Harmand had remarked on the dauphin's elongated limbs.

In his later book, Dr Milcent concluded that the individual was indeed the one autopsied in the Temple, but that  Louis XVII was excluded on grounds of age.


The identification of the skeleton

Milcent's identification of the skeleton as the child in the Temple is crucial as his conclusions are still accepted by many historians today.  His judgment rests on four factors, none of which Dr Thullier considers to be conclusive:

Two are forensic:

  1. "Traces of decay" on the extremity of the bones forming the left knee joint.  The autopsy, however, mentions only the right knee and left wrist.
  2. The hair colour. The state of forensic analysis of hair samples in 1846 makes this marker useless.

Two are historical:

  1. The location of the coffin, specified by the "authentic tradition" of Bertrancourt and Decouflet. Michel Fleury has dismissed Bertrancourt's reliability.  (In any case, the argument is circular: Bertrancourt's testimony is true only if the skeleton proves to be the child in the Temple, therefore it cannot itself be used for identification purposes.)
  2. The testimony of the deputy Harmand de la Meuse  - on the extraordinary length of the dauphin's limbs, the colour of his hair, the swellings at his joints.  Historians do not consider Harmand a credible witness; his authority should certainly not be preferred over the formal autopsy report.

The age of the subject and integrity of the skeleton 

Milcent asked his colleague Récamier to determine the age of the subject. Récamier's conclusions rest on "a strict anthropological analysis" and are more nuanced than those of Milcent:

  1. The limbs and teeth appeared to be those of a 15-16 year old.
  2. The head,  trunk and the sutures on the skull, suggested a younger subject, about 12 years. The diameter of the head and the detailed dimensions of the face were not those of an adult.  The ribs and clavicles belonged to a very young child.

Récamier considered the bones to have come from two, possibly three, different individuals.  This crucial fact was omitted from Milcent's final report. 
(The abbé Bossuet, who witnessed the exhumation, also reported that those present were immediately struck by the "strange disproportion" between the arm and leg bones and the rest of the skeleton: the body was that of a child, the limbs those of someone much older..  However, they were later persuaded that the prince's "scrofulous complaint" had resulted an abnormal growth pattern.)

The Exhumation of 1894

In June 1894 the skeleton was again examined, at the instigation of Me Georges Laguerre.  For eight days several "leading experts in anthropological science" examined the bones. Three separate reports were produced.  They followed strict medical and anthropological protocols.

 The principal conclusions were as follows:

Report by Backer, director of the Revue de l'Antisepsie and Bihaut, children's surgeon:
  • The subject was masculine.
  • He was at least 14 years old. This age was established from the epiphyses, the length of the limbs, the cranial cavity.  It was also corroborated by dental data.
  • The skeleton showed signs of ill-health: a slight scoliosis, lack of development in the thorax and knock-knees.

Report by Magitot, former president of the Société d'anthropologie, and Manouvrier,  a professor of anthropology:
  • The subject was probably masculine, 1m 63cm in height and aged 18 to 20 years.
  • The skeleton could not be that of the dauphin who was a child of 10 years and 2 months at the time of his burial.

Report by Professor Amoëdo, of the École odontotechnique de Paris, and professor Poirier, anatomist:
  • Again, the skeleton belonged to an individual of at least 18 years of age.

The investigation benefited from a dossier of photographs.

Laguerre concluded much more cautiously than Milcent, "If we have recovered the child buried in 1795, that child was not Louis XVII"


The age of the individual

Methods for determining the age of the skeleton had been refined since 1846.  The estimated age was now higher.  For the first report, the subject was at least fourteen, for the second, an adolescent of between eighteen and twenty, and for the third  "at the least" eighteen.

A single skeleton?

The presence of disparate bones was officially confirmed for the first time by Backer and Bilhaut who noted the  intrusion of part of an humerus belonging to another subject. It is also recorded that a M. Pascal, who was present at the excavations,  observed "two shoulder blades and ribs belonging to a child" .

However, the experts made their estimates of age on the assumption they were dealing with a single individual. Bilhaut directly addressed the question of whether the leg bones and skull belonged together and concluded that they did. The bones were similar in colour.  The degree of ossification and the length of the arm and leg bones were broadly consistent; indeed estimates of height based on different bones gave roughly similar results. Dr Tillaud comments that the colour of a skeleton has no indicative value since it depends on soil conditions.  However, the measurements, together with the anthropological indications furnished by Magitot and Manouvrier, seem to him conclusive.  Tillaud can only "express reservations" about the conclusions of 1846 which suggested that several individuals were represented.


The 1894 reports did not mention any "traces of decay" but noted only the slight scoliosis and genu valgum (knock-knees).
This photograph, and the ones above are reproduced from
Backer et Bilhaut's  report of 1894.

The postmortem saw marks

Pelletan declared in 1816 that he had "sawed the skull transversely, at the level of the orbits". In 1846 Maurice Garçon noted that the marks on the skull were a lot higher, well above the brow ridge. However, there is no real issue here: the "orbit" encompasses the whole area occupied by the eyes and it was standard practice, indeed anatomically necessary, to saw this high. 

Conclusions of Dr Thillaud:

The bones belonged to an adolescent of 18-20 years old. They cannot therefore be those of Louis XVII.  Nor can they belong to a substitute, since the autopsy conducted on the child in the Temple found him to be aged "about 10 years".  In addition, the child was buried in a wooden coffin, not in a lead one.

Dr Thillaud finishes by observing that modern techniques of x-ray and biochemical analysis could answer all the outstanding questions concerning the unity of the skeleton, the age of the subject and any possible bone pathology.

The Cemetery Sainte-Marguerite: Analysis of the finds excavated in September 1979

The third report in the series concerns the findings of 1979.  The Commission received two sets of human bones for evaluation and specifically sought markers which would identify the bones as those of the child in the Temple.  We are given a bone by bone analysis but, as noted previously, there were no likely candidates for Louis XVII: the remains probably belonged to several different individuals, most of them adult; there was no evidence for a pathology of tuberculosis and no postmortems had been carried out.

Dr Thuillaud ends his analysis by reiterating the official findings. 

Articles by Pierre Léon Thillaud, originally published in Cahiers de la Rotonde, 1986.

Reading - the autopsy report
Report of the examination of the body of the son of Louis Capet, made at the Temple tower, at three o'clock, A.M., this 21st Prairial.

We, the undersigned, Jean-Baptiste-Eugénie Dumangin, head-physician of the Grand Hospice de L'Unité, and Philippe-Jean Pelletan, head-surgeon of the Hospice de L'Humanité, assisted by citizens Nicolas Jeanroy, professor in the medical schools of Paris, and Pierre Lassus, professor of legal medicine in the Ecole de Santé of Paris, whom we associated with ourselves in obedience to a decree of the Committee of General Security of the National Convention, dated yesterday... for the purpose of proceeding together to examine the body of the son of the late Louis Capet, and verifying its state, have acted as follows:

Having all four arrived at eleven o'clock, A.M., at the outer gate of the Temple, we were received there by the commissaries, who admitted us into the tower. On attaining the second-floor, we found on a bed, in the second suite of rooms there, the dead body of a child, apparently about ten years old, which the commissaries declared to be that of the son of the late Louis Capet, and which two of our number, recognised as that of the child they had been attending for several days. Said commissaries declared to us that this child had expired at about three o'clock, p.m., the day before: on which we proceeded to seek for the signs of death, which we found in the general paleness and coldness of the entire body, the stiffness of the limbs, the dimness of the eyes, the livid spots common in the skin of a corpse, and, above all, by decay having commenced in the stomach, the scrotum, and the inside of the thighs.

Before proceeding to open the body, we remarked a general want of flesh, characteristic of marasmus, and the stomach was very much distended and swollen. On the inner side of the right knee we observed a tumour, the skin not discoloured, and on the os radius, near the wrist on his left side, another smaller tumour. That on the knee contained nearly two ounces of a greyish matter, puriform and lymphatic, between the periostum and the muscles; that on the wrist contained matter of the same nature, but thicker.

When the stomach was opened, there escaped more than a pint of turbulent serum, yellowish, and very fetid; the intestines were swollen, pale, and adhering to each other, as well as to the sides of this cavity; they were covered with a great quantity of tubercles, of various sizes, and which, when opened, were found to contain the same matter as in the external deposits of the knee and wrist.

"The intestines, when laid open to their full extent, were very healthy inside, and contained but a very small quantity of bilious matter. The stomach was in exactly the same state; it adhered to all the neighbouring parts, was pale externally, and covered with small lymphatic tubercles, similar to those on the surface of the intestines; its internal membrane was in a healthy state, as were also the pylories and oesophagus; the liver adhered, on its convex side, to the diaphragm, and, on its concave side, to the viscera which it covers; its substance was in a healthy condition, its size the same as is ordinarily the case, and the vesicle of the gall moderately full of bile of a dark green colour. The spleen, the pancreas, the reins, and the bladder were in a healthy state; the epiploon and the mesentery, destitute of fat, were found covered with lymphatic tubercles, like those we have just mentioned. Similar tumours were scattered over the thickness of the peritoneum covering the inner face of the diaphragm; this muscle was in a healthy condition.

The lungs adhered throughout their surface to the pleura, the diaphragm, and the pericardium; their substance was healthy, and without tubercles; there were some about the trachea and the oesophagus only. The pericardium contained the usual quantity of serosity; the heart was pale but in a natural state.  The brain and its dependant parts were in the most perfect completeness.

All the disorders of which we have just given the details are evidently the effects of a scrofulous tendency, which has long been in existence, and to which we should attribute the death of the child.

"This report was made and closed at Paris, in the above-mentioned place, by the undersigned, at half-past four, P.M., above-named day and year. "J.B.E. Dumangin, P. J. Pelletan, P. Lassus, N. Jeanroy."

This report was completed by M. Pelletan in 1817, who made the following declaration:

"I the undersigned, chevalier of the Royal order of the Legion of Honour, member of the Royal Academy of Science, professor of the Faculty of Medicine, further certify that, after having sawed the skull across, at the line, of the sockets of the eyes, in order to anatomise the skull in the dissection of the body of the son of Louis XVI, as I had been ordered to do, I replaced the scalp on the skull, and covered it with a few strips of skin, which I had separated from it, and which I sewed together; lastly, that I wrapped up the head entire in a cloth or handkerchief, or perhaps a cotton cap, fixed below the skin or nape of the neck, as is done in similar cases. All this will be found, if it be true that it has not been destroyed by putrefaction; but at any rate the scalp of the skull will certainly be found, wrapped up in the remains of these cloths or cotton cap.  Paris, 17th August 1817. PELLETAN
Alcide de Beauchesne, Louis XVII: his life - his suffering - his death, translated by William Hazlitt (New York: 1853),  vol. 2: p.328-331 nt..

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