Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

Napoleon Bonaparte's gastric cancer: a clinicopathologic approach to staging, pathogenesis, and etiology

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Investigations Evaluation of Napoleon's clinical history, original autopsy reports, and of historical documents.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 Analysis of the available historical documents indicates that Napoleon's main risk factor might have been Helicobacter pylori infection rather than a familial predisposition.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

Relevant articles

Open Access articles citing this article.

Access options

Buy article

Get time limited or full article access on ReadCube.

$32.00

All prices are NET prices.

Figure 1: Macroscopic pictures of gastric lesions.
Figure 2: The association between tumor size and tumor stage in data from surgical resections of 135 gastric cancer patients.

References

  1. Antommarchi F (1825) Les derniers moments de Napoléon, en complément du mémorial de Sainte-Hélène [French], edn 1. Bruxelles: H Tarlier

    Google Scholar 

  2. Lemaire JF et al. (2001) Around the poisoning of Napoleon (Autour de l'empoisonnement de Napoléon) [French]. Paris: Nouveau Monde Editions

    Google Scholar 

  3. 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

    CAS  Article  Google Scholar 

  4. Sokoloff B (1938) Predisposition to cancer in the Bonaparte family. Am J Surg 40: 673–678

    Article  Google Scholar 

  5. Forshufvud S et al. (1961) Arsenic content of Napoleon I's hair probably taken immediately after his death. Nature 192: 103–105

    CAS  Article  Google Scholar 

  6. 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

    CAS  Article  Google Scholar 

  7. Mari F et al. (2004) Channelling the Emperor: what really killed Napoleon? J R Soc Med 97: 397–399

    Article  Google Scholar 

  8. Lugli A et al. (2005) Napoleon's autopsy: New perspectives. Hum Path 36: 320–324

    CAS  Article  Google Scholar 

  9. O'Meara BE (1824) Napoléon en exil ou l'écho de Sainte-Hélène [French]. Bruxelles: Arnold Lacrosse

    Google Scholar 

  10. Verling JR and Nicholls G (1998) Journaux de Sainte-Hélène [French]. Paris: Librairie Historique F. Teissedre

    Google Scholar 

  11. Fremeaux P (1902) With Napoleon at St Helena, being the memoirs of Dr John Stokoe, naval surgeon. New York: John Lane

    Google Scholar 

  12. Wilson JB (1975) Dr Archibald Arnott: surgeon to the 20th Foot and physician to Napoleon. Br Med J 3: 293–295

    CAS  Article  Google Scholar 

  13. De Las Cases E (1935) Le mémorial de Sainte-Hélène [French]. Argenteuil: Bibliothèque de la Pleiade

    Google Scholar 

  14. Bertrand H (1951) Cahiers de Sainte-Hélène [French]. Paris: Editions Albin Michel

    Google Scholar 

  15. Gourgaud GB (1944) Journal de Sainte-Hélène 1815–1818 [French]. Paris: Flammarion

    Google Scholar 

  16. Montholon MLG (1847) Récits de la captivité de l'empereur Napoléon a Sainte-Hélène [French]. Paris: Paulin, Librairie-Editeur

    Google Scholar 

  17. 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

    Google Scholar 

  18. Saint-Denis LE (2000) Souvenirs sur l'empereur Napoléon [French]. Paris: Arléa

    Google Scholar 

  19. Tulard J (2005) La petite fiancée de Napoléon. Souvenirs de Betsy Balcombe [French]. Paris: Tallandier Editions

    Google Scholar 

  20. Tulard J et al. (1991) Nouvelle bibliographie critique des mémoires sur l'époque napoléonienne écrits ou traduits en francais [French]. Genéve: Librairie Droz SA

    Google Scholar 

  21. Tulard J (1999) Dictionnaire Napoléon [French]. Paris: Librairie Arthème Fayard

    Google Scholar 

  22. Tulard J et al. (2006) L'histoire de Napoléon par la peinture [French]. Paris: L'Archipel

    Google Scholar 

  23. Lugli A and Terracciano LM (2006) L'autopsie de Napoléon I. Révue de l'Institut Napoléon [French]. Editions SPM 192: 10–26

    Google Scholar 

  24. Ng JC et al. (2003) A global health problem caused by arsenic from natural sources. Chemosphere 52: 1353–1359

    CAS  Article  Google Scholar 

  25. Maresch W (1978) Der pathologisch-anatomische Befund bei Arsenikvergiftungen [German]. Beitr Gerichtl Med 36: 41–45

    CAS  PubMed  Google Scholar 

  26. 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

    CAS  Article  Google Scholar 

  27. Hindmarsh JT (2002) Caveats in hair analysis in chronic arsenic poisoning. Clin Biochem 35: 1–11

    CAS  Article  Google Scholar 

  28. Macé J (2000) L'honneur retrouvé du général de Montholon. De Napoléon I à Napoléon III [French]. Paris: Editions Christian

    Google Scholar 

  29. Lewin KJ and Appelman HD (1996) Tumors of the esophagus and stomach. Atlas of Tumor Pathology, Third Series. (Ed AFIP) Washington DC: Fascicle 18

    Google Scholar 

  30. Ming SC and Goldman H (1998) Pathology of the gastrointestinal tract. Baltimore: Williams and Wilkins

    Google Scholar 

  31. Fuchs CS and Mayer RJ (1995) Gastric carcinoma. N Engl J Med 333: 32–41

    CAS  Article  Google Scholar 

  32. Wanebo H et al. (1993) Cancer of the stomach: a patient care study by the American College of Surgeons. Ann Surg 218: 583–592

    CAS  Article  Google Scholar 

  33. Karpeh MS Jr and Brennan MF (1998) Gastric carcinoma. Ann Surg Oncol 5: 650–656

    Article  Google Scholar 

  34. 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

    Article  Google Scholar 

  35. Hamilton SR and Aaltonen LA (2000) Pathology and genetics of tumours of the digestive system. Lyon: IARC Press

    Google Scholar 

  36. Roder DM (2002) The epidemiology of gastric cancer. Gastric Cancer 5 (Suppl 1): 5–11

    Article  Google Scholar 

  37. Alberts SR et al. (2003) Gastric cancer: epidemiology, pathology and treatment. Ann Oncol 14 (Suppl 2): ii31–ii36

    PubMed  Google Scholar 

  38. 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

    Article  Google Scholar 

  39. El-Omar EM (2001) The importance of interleukin 1β in Helicobacter pylori associated disease. Gut 48: 743–747

    CAS  Article  Google Scholar 

Download references

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

Authors

Corresponding author

Correspondence to Robert M Genta.

Ethics declarations

Competing interests

The authors declare no competing financial interests.

Rights and permissions

Reprints 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

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1038/ncpgasthep0684

Further reading

Search

Quick links

Nature Briefing

Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily.

Get the most important science stories of the day, free in your inbox. Sign up for Nature Briefing