The death of Napoleon

Abstract

It was with fascination that I read the paper ‘Channelling the Emperor: what really killed Napoleon?’(August 2004 JRSM1), but I must emphasize that despite its title it is only concerned with the immediate cause of Napoleon’s death. As indicated in my 1996 paper on Napoleon’s health,2 the Emperor first complained of nausea and upper abdominal discomfort after food in July 1820. The dyspepsia worsened to give loss of appetite, constant nausea, frequent vomiting, upper abdominal pain and constipation. There were periods of remission but the pain and vomiting became increasingly insistent. He lost weight and by the end of January 1821 could only manage fluid nourishment, finally taking to his bed on 17 March. On 27 April he vomited blood and his condition deteriorated with further bleeding and lapses into unconsciousness before death on 5 May. At necropsy in front of sixteen observers including seven British doctors, of whom five signed the official report, the external surface of the stomach appeared healthy. On opening, however, it contained altered blood and almost its entire lining was cancerous: a scirrhous cancer had converted the stomach into a leather-bottle stomach with spread to the adjacent lymph nodes and with a perforation that had become sealed off. There was a family history of gastric carcinoma, and Napoleon realized he was dying of the same disease as his father and grandfather, remarking on 15 April, ‘I know the truth and I am resigned’. Clinically the cause of death was clearly gastric carcinoma, but on the publication of my paper in 1996, I received abusive letters with accusations that Napoleon had died from deliberate arsenical poisoning. This theory had received encouragement in 1961 when some, though not all, samples of his hair were found to contain abnormal amounts of arsenic. Arsenic was used in medicaments such as Fowler’s and Donovan’s solutions, and liquor arsenicalis was still in use as a general tonic and for loss of appetite when I qualified. The drawing room at Longwood House in St Helena was redecorated in 1819, but a specimen of the wallpaper applied at that time contained only low levels of arsenic when analysed in 1982. As the immediate cause of death from, say, carcinoma of the prostate may be cardiac failure, so the immediate cause of Napoleon’s death has now been explained to those who still believe he died from arsenic toxicity and not from a carcinoma of the stomach.