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1 Reader in Clinical Pharmacology, Department of Clinical Pharmacology,
Radcliffe Infirmary, Oxford OX2 6HE
2 Fellow in Paediatric and Young Adult Orthopaedics, The Royal National
Orthopaedic Hospital, Stanmore, Middlesex and Great Ormond Street Children's
Hospital, London, UK
Correspondence to: Manoj Ramachandran E-mail: manojorthopod{at}gmail.com
Gustave Doré (1832-1883) was France's greatest illustrator. He first came to prominence through his illustrations for Rabelais's Gargantua et Pantagruel (1854) and Balzac's Contes Drolatiques (1856). Other works that he illustrated included Dante's La Divina Commedia, starting with the Inferno in 1861 and adding the Purgatorio and Paradiso in 1886-1888, Don Quixote de la Mancha (1862), the Bible (1865), Paradise Lost (1866), Raspe's Adventures of Baron Munchausen (1866), La Fontaine's Fables (1867), and Coleridge's Rime of the Ancient Mariner (1870). Although primarily a humorous illustrator, Doré was attracted by the darker side of Dickens's works and illustrated them in sombre engravings. Those who have seen Roman Polanski's recent version of Oliver Twist will have appreciated the use that he made of Doré's work as backdrops to the opening titles. Doré's interest in London was stimulated by Blanchard Jerrold, the son of the writer Douglas Jerrold, who in 1869 commissioned him to produce a portrait of the city, resulting in the 180 engravings that were published in London: A Pilgrimage in 1872.
In Perrault's Contes, which Doré illustrated in 1862,1 we read the adventures of Le Petit Poucet (Hop o' my Thumb), who, as fairy-tale characters often do, meets an ogre, who prepares to kill him and his six brothers. The ogre's wife, however, persuades him to put off the deed until the following morning. Overnight, Poucet exchanges the brothers' bonnets for the crowns worn by the ogre's seven daughters. When, in the middle of the night, the drunken ogre decides to kill the brothers he kills his daughters instead. Doré's horrific illustration shows him about to perform the act.
The most striking feature of the ogre is his exophthalmos, or proptosis, to give it its older, less specific, name. His peripheral vasodilatation is presumably due to alcohol. Exophthalmos is surprisingly uncommon in works of art. Its most notable occurrence is in The Last Judgment by Michelangelo, where it features in a woman who has been identified as Saint Monica; the painting is in colour and her eyes have all the features of exophthalmos due to thyrotoxicosis.2
Exophthalmos is most commonly associated with Graves' disease, but Doré's ogre does not look thyrotoxic. Could he have had Graves' disease that burnt out leaving him myxoedematous? He is certainly overweight, his hairline is receding, his eyebrows are sparse, and he has bouts of restless violence, all features that were described by Richard Asher in patients with the psychosis that can occur in severe hypothyroidism.3 He also gets very tired in his seven-league boots, although Perrault does say that that is a feature of the boots. And exophthalmos can persist even when thyrotoxicosis resolves.
Other causes of bilateral exophthalmos include lymphoma,4 multiple myeloma,5 Wegener's granulomatosis,6 Erdheim-Chester disease (a form of histiocytosis),7 myasthenia gravis,8 and acute orbital pseudotumour;9 some of these are possible diagnoses. Alternatively, perhaps the ogre can protrude his eyeballs at will, as has occasionally been described in individuals with abnormal extraocular muscles.10
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  T. A McLoughlin Gustave Dore's Ogre J R Soc Med, November 1, 2006; 99(11): 546 - 547. [Full Text] [PDF]
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