January 17, 2007
Stomach Cancer Likely Killed Napoleon
By MATT CRENSON
NEW YORK - Napoleon Bonaparte died a more prosaic death than some people would like to think, succumbing to stomach cancer rather than arsenic poisoning, according to new research into what killed the French emperor.
But the latest review of the 1821 autopsy report just after he died concludes the official cause of death - stomach cancer - is correct.
The autopsy describes a tumor in his stomach that was 4 inches long. Comparing that description to modern cases, main author Dr. Robert M. Genta of the University of Texas Southwestern Medical Center at Dallas and an international team of researchers surmised that a growth so extensive could not have been a benign stomach ulcer.
"I have never seen an ulcer of that size that is not cancer," said Genta, a professor of pathology and internal medicine.
Further analysis suggested that his stomach cancer had reached a stage that is virtually incurable even with modern medical technology. People with similar cancers today usually die within a year.
The autopsy and other historical sources indicate that the rotund French leader had lost about 20 pounds in the last few months of his life, another sign of stomach cancer. His stomach also contained a dark material similar to coffee grounds, a telltale sign of extensive bleeding in the digestive tract. The massive bleeding was likely the immediate cause of death, Genta and his colleagues concluded.
Historical sources also don't mention many typical signs of arsenic poisoning, such as discoloration of the fingernails, pre-cancerous blemishes on the feet and hands, cancers of the skin, lung and bladder and bleeding from the wall that separates the heart's lower chambers.
"Can we rule out the arsenic theory? I think we have some evidence against it," Genta said. "We cannot exclude it 100 percent, but I think we are pretty confident it's unlikely."
Dr. Steven B. Karch, who has also studied the case, believes Napoleon still could have been killed by arsenic or one of several medicines he received in his final days. Arsenic alone or in combination with other substances can cause fatal heartbeat irregularities, he said.
Napoleon died at age 52 while in exile on the South Atlantic island of St. Helena where he was banished after his defeat at Waterloo.
"I would say this was death by medical misadventure," said Karch, who works as an assistant medical examiner in San Francisco.
Some medical historians have pointed out that Napoleon's father died of stomach cancer or something like it, suggesting a possible family history of the disease. But Genta and his team speculate that Napoleon's cancer was most likely triggered by an ulcer.
He could have been infected by the ulcer-causing bacterium Helicobacter pylori during one of his military campaigns, when a diet high in salted meats and low in fresh vegetables would have made him particularly susceptible.
The study appears in the January issue of Nature Clinical Practice Gastroenterology & Hepatology, which is available online. Besides Genta, study authors include researchers from the University Hospital of Basel and the Canton Hospital of Aarau, Switzerland; and McGill University in Montreal.
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