Abstract
Background Numerous hypotheses on the cause of Napoleon Bonaparte's death have been proposed, including hereditary gastric cancer, arsenic poisoning, and inappropriate medical treatment. We aimed to determine the etiology and pathogenesis of Napoleon's illness by a comparison of historical information with current clinicopathologic knowledge.
Investigations Evaluation of Napoleon's clinical history, original autopsy reports, and of historical documents. The clinicopathologic data from 135 gastric cancer patients were used for comparison with the data available on Napoleon.
Diagnosis At least T3N1M0 (stage IIIA) gastric cancer. Napoleon's tumor extended from the cardia to the pylorus (>10 cm) without infiltration of adjacent structures, which provides strong evidence for at least stage T3. The N1 stage was determined by the presence of several enlarged and hardened regional (perigastric) lymph nodes, and the M0 stage by the absence of distant metastasis. Analysis of the available historical documents indicates that Napoleon's main risk factor might have been Helicobacter pylori infection rather than a familial predisposition.
Conclusions Our analysis suggests that Napoleon's illness was a sporadic gastric carcinoma of advanced stage. Patients with such tumors have a notoriously poor prognosis.
This is a preview of subscription content, access via your institution
Access options
Subscribe to this journal
Receive 12 print issues and online access
$209.00 per year
only $17.42 per issue
Buy this article
- Purchase on Springer Link
- Instant access to full article PDF
Prices may be subject to local taxes which are calculated during checkout
References
Antommarchi F (1825) Les derniers moments de Napoléon, en complément du mémorial de Sainte-Hélène [French], edn 1. Bruxelles: H Tarlier
Lemaire JF et al. (2001) Around the poisoning of Napoleon (Autour de l'empoisonnement de Napoléon) [French]. Paris: Nouveau Monde Editions
Hindmarsh JT and Corso PF (1998) The death of Napoleon Bonaparte: a critical review of the cause. J Hist Med Allied Sci 53: 201–218
Sokoloff B (1938) Predisposition to cancer in the Bonaparte family. Am J Surg 40: 673–678
Forshufvud S et al. (1961) Arsenic content of Napoleon I's hair probably taken immediately after his death. Nature 192: 103–105
Weider B and Fournier JH (1999) Activation analyses of authenticated hairs of Napoleon Bonaparte confirm arsenic poisoning. Am J Forensic Med Pathol 20: 378–382
Mari F et al. (2004) Channelling the Emperor: what really killed Napoleon? J R Soc Med 97: 397–399
Lugli A et al. (2005) Napoleon's autopsy: New perspectives. Hum Path 36: 320–324
O'Meara BE (1824) Napoléon en exil ou l'écho de Sainte-Hélène [French]. Bruxelles: Arnold Lacrosse
Verling JR and Nicholls G (1998) Journaux de Sainte-Hélène [French]. Paris: Librairie Historique F. Teissedre
Fremeaux P (1902) With Napoleon at St Helena, being the memoirs of Dr John Stokoe, naval surgeon. New York: John Lane
Wilson JB (1975) Dr Archibald Arnott: surgeon to the 20th Foot and physician to Napoleon. Br Med J 3: 293–295
De Las Cases E (1935) Le mémorial de Sainte-Hélène [French]. Argenteuil: Bibliothèque de la Pleiade
Bertrand H (1951) Cahiers de Sainte-Hélène [French]. Paris: Editions Albin Michel
Gourgaud GB (1944) Journal de Sainte-Hélène 1815–1818 [French]. Paris: Flammarion
Montholon MLG (1847) Récits de la captivité de l'empereur Napoléon a Sainte-Hélène [French]. Paris: Paulin, Librairie-Editeur
Marchand L (2003) Mémoires de Marchand. Premier valet de chambre et éxécuteur testamentaire de l'empereur Napoléon. Publiés par Jean Bourguignon et le commandant Henri Lachouque (Ed. Napoléonienne, B) [French]. Paris: Tallandier Editions
Saint-Denis LE (2000) Souvenirs sur l'empereur Napoléon [French]. Paris: Arléa
Tulard J (2005) La petite fiancée de Napoléon. Souvenirs de Betsy Balcombe [French]. Paris: Tallandier Editions
Tulard J et al. (1991) Nouvelle bibliographie critique des mémoires sur l'époque napoléonienne écrits ou traduits en francais [French]. Genéve: Librairie Droz SA
Tulard J (1999) Dictionnaire Napoléon [French]. Paris: Librairie Arthème Fayard
Tulard J et al. (2006) L'histoire de Napoléon par la peinture [French]. Paris: L'Archipel
Lugli A and Terracciano LM (2006) L'autopsie de Napoléon I. Révue de l'Institut Napoléon [French]. Editions SPM 192: 10–26
Ng JC et al. (2003) A global health problem caused by arsenic from natural sources. Chemosphere 52: 1353–1359
Maresch W (1978) Der pathologisch-anatomische Befund bei Arsenikvergiftungen [German]. Beitr Gerichtl Med 36: 41–45
Lin X et al. (2004) Elemental contents in Napoleon's hair cut before and after his death: did Napoleon die of arsenic poisoning? Anal Bioanal Chem 379: 218–220
Hindmarsh JT (2002) Caveats in hair analysis in chronic arsenic poisoning. Clin Biochem 35: 1–11
Macé J (2000) L'honneur retrouvé du général de Montholon. De Napoléon I à Napoléon III [French]. Paris: Editions Christian
Lewin KJ and Appelman HD (1996) Tumors of the esophagus and stomach. Atlas of Tumor Pathology, Third Series. (Ed AFIP) Washington DC: Fascicle 18
Ming SC and Goldman H (1998) Pathology of the gastrointestinal tract. Baltimore: Williams and Wilkins
Fuchs CS and Mayer RJ (1995) Gastric carcinoma. N Engl J Med 333: 32–41
Wanebo H et al. (1993) Cancer of the stomach: a patient care study by the American College of Surgeons. Ann Surg 218: 583–592
Karpeh MS Jr and Brennan MF (1998) Gastric carcinoma. Ann Surg Oncol 5: 650–656
Jeandel R and Bastien J (2006) Antonmarchi, last physician of Napoleon: requiem for a forger. Autopsy report published in 1825 is a plagiarism! [French] Med Sci (Paris) 22: 434–436
Hamilton SR and Aaltonen LA (2000) Pathology and genetics of tumours of the digestive system. Lyon: IARC Press
Roder DM (2002) The epidemiology of gastric cancer. Gastric Cancer 5 (Suppl 1): 5–11
Alberts SR et al. (2003) Gastric cancer: epidemiology, pathology and treatment. Ann Oncol 14 (Suppl 2): ii31–ii36
Gonzalez CA et al. (2006) Meat intake and risk of stomach and esophageal adenocarcinoma within the European Prospective Investigation Into Cancer and Nutrition (EPIC). J Natl Cancer Inst 98: 345–354
El-Omar EM (2001) The importance of interleukin 1β in Helicobacter pylori associated disease. Gut 48: 743–747
Acknowledgements
We thank Professor Jeremy Jass, Professor Richard Dirnhofer, and Kristi Baker for their advice on editing this manuscript, and Dr Niels Willi for providing us with macroscopic pictures of gastric ulcers and cancers.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Competing interests
The authors declare no competing financial interests.
Rights and permissions
About this article
Cite this article
Lugli, A., Zlobec, I., Singer, G. et al. Napoleon Bonaparte's gastric cancer: a clinicopathologic approach to staging, pathogenesis, and etiology. Nat Rev Gastroenterol Hepatol 4, 52–57 (2007). https://doi.org/10.1038/ncpgasthep0684
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1038/ncpgasthep0684
This article is cited by
-
Molekulare Pathologie des Magenkarzinoms
Der Pathologe (2012)
-
Role of tumor size in the pre-operative management of rectal cancer patients
BMC Gastroenterology (2010)