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COPYRIGHT 2002 Science Reviews Ltd.
The fact that Napoleon 1st died from gastric cancer seems to be well established. Arguments for the hypothesis of chronic arsenic poisoning have recently been developed in the literature. This study, focused on the gastrointestinal diseases of Napoleon in Saint Helena, is based on a confrontation between the clinical semiological anamnesis and the anatomical data in the autopsy report by F. Antommarchi. Napoleon presented several gastrointestinal diseases: gall-bladder lithiasis complicated with angiocholitis, chronic colitis and certainly a gastric cancer. Death was consecutive to perforation of the gastric lesion leading to haemorragic vomitis and multiorgan failure. The description of the gastric lesions during autopsy is consistent with the diagnosis of cancer. The course of the clinical events is closely correlated with the anatomic lesions. There is strong evidence that Napoleon died from an acute complication of his gastric disease.
Introduction
One hundred and eighty one years after the death of Napoleon I, the circumstances of his death remain very controversial. Until relatively recently, it was assumed that he had died of stomach cancer. This diagnosis was essentially supported by the data in the remarkable autopsy performed and reported by his last doctor in Saint Helena, Francesco Antommarchi (1). The fact that his father Charles Bonaparte had died of the same disease is, for some people, an argument for this hypothesis although the hereditary character of this pathology has been formally proven only in familial multi-centric forms. (2)
After the memoirs of Napoleon's Saint Helena valet, Marchand (3) were published in 1955, in 1961, the Swedish dentist Sten Forshuvud (4) advanced arguments in favour of chronic arsenic intoxication. This theory was then repeated by Ben Weider both in the general press and in scientific journals. (5) In the current literature, there is still much disagreement between the supporters of the poisoning theory, on one hand, supported by the great amount of arsenic in Napoleon's hair immediately taken after his death. (6-8) and on the other hand, those who believe that this information should be treated with caution given the clinical and environmental conditions of the period. (9,10) Indeed, the current medical debate still centres on the hypothesis of chronic arsenic poisoning with the aim to credit or discredit this theory.
While there have been numerous hypotheses on Napoleon's illnesses in Saint Helena, including some really crazy ones, there have been no systematic studies on his digestive pathology. In such a debate, it is fundamental to confirm or reject the reality of stomach cancer and to evaluate its responsibility in triggering the terminal phase that would make the other causes of his death anecdotal.
The present study is a critical analysis of the clinical signs Napoleon presented in Saint Helena. It is based on a confrontation between the clinical semiological anamnesis and the anatomical data in the autopsy report by F. Antommarchi which is the only diagnostic reference available.
Methods
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