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Napoleon probably died of stomach cancer

BMJ 2005; 330 doi: (Published 05 May 2005) Cite this as: BMJ 2005;330:1044
  1. Roger Dobson
  1. Abergavenny

    Theories that Napoleon was betrayed, poisoned, or a victim of inappropriate medical treatment have been undermined by new research based on the emperor's trouser collection. The research has shown that his weight loss in his final year is consistent with a severe progressive illness. It lends credence to the idea that Napoleon died of stomach cancer, which was the cause of death specified in the original autopsy.

    Napoleon died in exile on the island of St Helena and almost since the day of his death in 1821 there have been conspiracy theories about the cause. There have also been suggestions that chronic exposure to arsenic and medication errors were involved, while the theories that he had been poisoned was given a considerable boost in 1961, when a raised arsenic concentration was found in his hair.

    “This finding elicited numerous theories of conspiracy, treachery, and poisoning. Most recent reports even suggested inappropriate medical treatment may have contributed to the exiled emperor's death,” say researchers in Human Pathology (2005;36:320-4).

    Suggestions that Napoleon had indeed died of stomach cancer were confounded by reports of apparent obesity at the time of his demise. But, say the researchers, the weight changes over the course of his life, noticeable from contemporary iconography, have never before been systematically analysed.

    To test the hypothesis that Napoleon's weight at death could be compatible with a diagnosis of terminal gastric cancer, the researchers, from the University Hospital of Basel and the University of Zurich, did a series of studies to determine Napoleon's weight at death and to see what changes in his weight occurred in the last two decades of his life.

    For the necessary measurements, the researchers used a collection of 12 different pairs of trousers worn by Napoleon between 1800 and 1821, the year of his death in exile.

    Modelling trouser sizes with control data suggested that his weight did increase over part of the period, as contemporary reports had suggested. It went up from a low of 67 kg to reach 90 kg by 1820. But measurements of the trousers worn at the time of death suggested a subsequent weight loss of 11 kg during the last year of his life, reducing his weight to 79 kg.

    The weight found from the trouser tests were then confirmed by the results of a second approach to weight measurement, using the subcutaneous fat measurement that was done at Napoleon's autopsy. The measurement—1.5 inches (3.8 cm)—was then compared with a control group of 270 men dying from various causes.

    “Napoleon's terminal weight loss of more than 10 kg is suggestive of a severe progressive chronic illness and is highly consistent with a diagnosis of gastric cancer,” conclude the authors.