Case Study | Published:

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

Nature Clinical Practice Gastroenterology & Hepatology volume 4, pages 5257 (2007) | Download Citation

Subjects

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Investigations Evaluation of Napoleon's clinical history, original autopsy reports, and of historical documents.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 Analysis of the available historical documents indicates that Napoleon's main risk factor might have been Helicobacter pylori infection rather than a familial predisposition.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

Access optionsAccess options

Rent or Buy article

Get time limited or full article access on ReadCube.

from$8.99

All prices are NET prices.

References

  1. 1.

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

  2. 2.

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

  3. 3.

    and (1998) The death of Napoleon Bonaparte: a critical review of the cause. J Hist Med Allied Sci 53: 201–218

  4. 4.

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

  5. 5.

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

  6. 6.

    and (1999) Activation analyses of authenticated hairs of Napoleon Bonaparte confirm arsenic poisoning. Am J Forensic Med Pathol 20: 378–382

  7. 7.

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

  8. 8.

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

  9. 9.

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

  10. 10.

    and (1998) Journaux de Sainte-Hélène [French]. Paris: Librairie Historique F. Teissedre

  11. 11.

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

  12. 12.

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

  13. 13.

    (1935) Le mémorial de Sainte-Hélène [French]. Argenteuil: Bibliothèque de la Pleiade

  14. 14.

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

  15. 15.

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

  16. 16.

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

  17. 17.

    (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

  18. 18.

    (2000) Souvenirs sur l'empereur Napoléon [French]. Paris: Arléa

  19. 19.

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

  20. 20.

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

  21. 21.

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

  22. 22.

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

  23. 23.

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

  24. 24.

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

  25. 25.

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

  26. 26.

    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

  27. 27.

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

  28. 28.

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

  29. 29.

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

  30. 30.

    and (1998) Pathology of the gastrointestinal tract. Baltimore: Williams and Wilkins

  31. 31.

    and (1995) Gastric carcinoma. N Engl J Med 333: 32–41

  32. 32.

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

  33. 33.

    and (1998) Gastric carcinoma. Ann Surg Oncol 5: 650–656

  34. 34.

    and (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

  35. 35.

    and (2000) Pathology and genetics of tumours of the digestive system. Lyon: IARC Press

  36. 36.

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

  37. 37.

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

  38. 38.

    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

  39. 39.

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

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

Affiliations

  1. A Lugli is an Attending Physician, G Singer is an Associate Professor and an Attending Physician, and LM Terracciano is a Professor of Pathology and the Head of the Molecular Pathology Division at the Institute of Pathology, University Hospital of Basel, Switzerland.

    • Alessandro Lugli
    • , Gad Singer
    •  & Luigi M Terracciano
  2. I Zlobec is a PhD student in the Department of Pathology, McGill University, Montreal, Canada.

    • Inti Zlobec
  3. A Kopp Lugli is a resident in anesthesia at the Kantonsspital Aarau, Switzerland.

    • Andrea Kopp Lugli
  4. RM Genta is a Professor of Pathology and Medicine (Gastroenterology) at the University of Texas Southwestern Medical Center at Dallas and the Chief of the Department of Pathology at the Dallas Veterans Affairs Hospital, TX, USA.

    • Robert M Genta

Authors

  1. Search for Alessandro Lugli in:

  2. Search for Inti Zlobec in:

  3. Search for Gad Singer in:

  4. Search for Andrea Kopp Lugli in:

  5. Search for Luigi M Terracciano in:

  6. Search for Robert M Genta in:

Competing interests

The authors declare no competing financial interests.

Corresponding author

Correspondence to Robert M Genta.

About this article

Publication history

Received

Accepted

Published

DOI

https://doi.org/10.1038/ncpgasthep0684

Further reading