Napoleon I Hand‐in‐Waistcoat: Stomach Pain? No, Pure Aesthetics. An Example of Icono‐Diagnosis by Excess

1.

Iconographic representations (mainly painting and engravings) of the French Emperor Napoleon I are often stereotyped: his right hand is placed on the epigastrium, several fingers (except the thumb) placed against the shirt passing between two buttons of the vest, the elbow at a right angle pressed against the torso (i.e., hand‐in‐waistcoat). The explanation most commonly accepted by historians, art historians and medical historians is that this posture allowed the emperor, through pressure with the palm of his hand, to relieve his related epigastric pain linked to a chronic stomach ulcer, then to his possible cancer which killed him at the age of 51 on May 5, 1821 (his father, Charles Bonaparte, having died of stomach cancer at the age 38 in 1785, confirmed by autopsy) (Lugli et al. 2021; Vergé‐Franceschi 2023).

In reality, Napoleon I is far from being the only one to have adopted this posture, and it is also very far from being pathognomonic for chronic epigastric pain. An iconographic inventory (Table 1) shows that numerous male portraits have, over a very long chronological period (17th–19th centuries), arranged their upper limb (mainly right, but not always their dominant limb) in a comparable way. To name just a few: Chateaubriand, Champollion, Lincoln and Baudelaire.

TABLE 1.

Some examples of representations of personalities with their hand in their waistcoat (17th–19th c.).

Personnalities		Portraits
Names	Dates of birth‐death	Nature of the work	Date	Artist/Author	Title of the work	Accession number	Place of conservation
Townshend, Charles	1674–1738	Painting, oil on canvas	1690	KNELLER, Godfrey	TOWNSHEND, Charles (2nd Viscount Townshend)	NPG 1363	National Portrait Gallery, London, UK
Colston, Edward	1636–1721	Gravure	1722	VERTUE, George	Edward COLSTON	NPG D27544	National Portrait Gallery, London, UK
Le Dauphin Louis Ferdinand	1729–1765	Pastel on paper	1744	DELATOUR, Maurice, Quentin	Portrait de Louis de France, duc de Bourgogne, dauphin (1729–1765); Dauphin Louis Ferdinand (1729–1765)	INV 27621, Recto	Musée du Louvre, Department of Graphic Art, Paris, France, not on display
Franklin, Benjamin	1706–1790	Painting, oil on canvas	1746	FEKE, Robert	Benjamin Franklin (1706–1790)	H47	Harvard Art Museum, Cambridge, MA, USA
Louis XVI	1754–1793	Painting, oil on canvas	1776	DUPLESSIS, Joseph Siffred	LOUIS XVI, ROI DE FRANCE ET DE NAVARRE (1754–1793)	MV 3966; INV 4303; AC 1306	Musée national des châteaux de Versailles et de Trianon, Versailles, France
Washington, Georges	1792–1799	Painting, oil on canvas	1784	PEALE, Charles Willson	Washington, Lafayette Tilghman at Yorktown	MSA SC 1545–1120	MSA Maryland State Archive, Annapolis, USA
Prince Nikolai Saltikov	1736–1816	Painting, oil on canvas	1785	Tischbein, Johann Friedrich August	Portrait of Prince Nicolai Saltykov	ГЭ‐5812	Hermitage Museum, St Petersbourg, Russie
Don Ignacio Leonel Gomez Cervantes	1762–1813	Painting, oil on canvas	1788	Unknown artist	Mexican. Don Ignacio Leonel Gómez Cervantes	52.166.6	Brooklyn Museum, New York, USA, not on display
Napoleon	1769–1821	Painting, oil on canvas	1812	DAVID, Jacques‐Louis	The Emperor Napoleon in His Study at the Tuileries, 1812	1961.9.15	National Gallery of Art (Samuel H. Kress Collection), Washington, USA
Champollion Jean‐François	1790–1832	Painting, oil on canvas (Figure 1)	1834	COGNIET, léon	Portrait de Jean‐François Champollion (1790–1832), dit Champollion le Jeune	INV 3294; LP 6939	Louvre Museum, Paris, France, not on display
Vacquerie, Auguste	1819–1895	Photography	1853	VACQUERIE, Auguste	Autoportrait de face à mi‐corps, la main droite passée dans le gilet	PHO 1984 65 28	Musée d'Orsay, Paris, France, not on display
Lincoln, Abraham	1809–1865	Lithography (Figure 2)	1862	Unknown artist	Abraham Lincoln, ca.1862, Lithography.	2002717219	Library of Congress, Washington, USA
Marx, Karl	1818–1883	Photography	1870	MAYALL, John	Karl Marx	NPG x126366	National Portrait Gallery, London, UK
Dutertre de Veteuil, Félix	1810–1877	Photography	1900	Atelier NADAR	Dutertre, auteur dramatique	ark:/12148/btv1b530506755	Bibliothèque Nationale de France, print and photography department, FT 4‐NA‐235, consultable online: http://catalogue.bnf.fr/ark:/12148/cb43557879z
Baudelaire, Charles	1821–1867	Photography	1861–1865	CARJAT, Etienne	Portrait de Charles Baudelaire (1821–1867), poète	PH46885	Musée Carnavalet, Paris, France
Chateaubriand, François rené	1768–1848	Painting, oil on canvas	First quarter of 19th century	GIRODET DE ROUCY‐TRIOSON Anne Louis (workshop,?)	Portrait de Chateaubriand	1983.7.7	Saint‐Quentin; Musée des beaux‐arts Antoine Lécuyer
Gouvion Saint CYR, Laurent	1764–1830	Painting, oil on canvas	First quarter of 19th century	VERNET Horace	Laurent, Marquis de Gouvion‐Saint‐Cyr, maréchal de France (1764–1830)	L 3925; INV 8391; L 3925	Musée national des châteaux de Versailles et de Trianon, Versailles, France
Berryer, Pierre Antoine	1790–1868	Print	No date	LEMOINE, Auguste, Charles; PETIT, Pierre	“BERRYER”.	ark:/12148/btv1b53017053b	Bibliothèque nationale de France, print and photography department, RESERVE QB‐370 (122)‐FT4, consultable online: http://catalogue.bnf.fr/ark:/12148/cb387931267
Raspail, François Vincent	1794–1878	Lithography	No date	Unknown artist	Raspail, François Vincent (1794–1878)	CIPB1357	BIU Santé, Paris, France
duc de Persigny, Jean Gilbert Victor Fialin	1808–1872	Print	No date	Unknown artist	“F. de Persigny” [print]	ark:/12148/btv1b53019282k	Bibliothèque nationale de France, print and photography department, RESERVE QB‐370 (130)‐FT4, consultable online: http://catalogue.bnf.fr/ark:/12148/cb38793134v

FIGURE 1.

Portrait de Jean‐François Champollion (1790–1832), dit Champollion le Jeune; Léon Cognier; 1834; Musée du Louvre, Paris, France; INV 3294; LP 6939.

FIGURE 2.

Abraham Lincoln, ca.1862, Lithography; unknown artist; 1862; Library of Congress, Washington DC, USA; 2002717219.

The explanation is not medical, but purely aesthetic: slipping your hand into your waistcoat, when the suit does not have a pocket, gives gentlemen and soldiers a presence consistent with etiquette and the rules of decorum which prohibited keep your arms hanging or cross them over your chest, as indicated by the priest J.B. de la Salle, doctor of theology and teacher of the brothers of the Christian schools, in his work “The rules of propriety and Christian civility” (1695, then republished countless times): “It is a fault to cross the arms on the chest, to interlace them behind the back, to let them hang nonchalantly, to swing them while walking, under the pretext of relief as is customary if one walks with a cane; in the hand, the arm which is without support is placed lightly against the body, and that it receives an almost imperceptible movement, without however letting it fall to the side if one has no cane, nor sleeve, nor; gloves, it is quite ordinary to place the right arm on the chest or on the stomach, putting the hand in the opening of the jacket, at this place, and to drop the left by bending the elbow, to facilitate the position of the hand, under the basque [falling part] of the jacket. In general, one must hold the arms in a situation which is honest and decent.” (de La Salle 1875).

General at 24, then first consul, king of Rome and emperor of the French, Napoleon I only reproduced this ultimately very classic posture, without any particular link with his pathology. He held this pose in his first portraits well before having the slightest gastrointestinal symptoms (Figure 3).

FIGURE 3.

The Emperor Napoleon in His Study at the Tuileries, 1812; Jacques‐Louis David; 1812; National Gallery of Art (Samuel H. Kress Collection), Washington DC, USA; 1961.9.15.

This example reminds us that an icono‐diagnosis cannot be made without following a rigorous scientific methodology, otherwise there is the risk of establishing a false diagnosis (Charlier et al. 2023).

Author Contributions

P.C. and S.J.‐B. wrote the first version of the article, after an idea of P.C., with strong critical input from P.B. All authors are ok with the last version of the manuscript.

Conflicts of Interest

The authors declare no conflicts of interest.