For twenty years, Napoleon ruled Europe at his will, till his ultimate defeat in the battle of Waterloo, in 1815. Imprisoned, he was exiled by the British in St. Helena, one of the most isolated islands in the world, in Southern Atlantic Ocean.
He mysteriously died there in May 5, 1821.
Now, an American-Swiss-Canadian team found - using modern methods and historical accounts - that the emperor died of a very advanced case of gastric cancer due to an ulcer-causing bacterial infection, not a hereditary disposition to the cancer or arsenic poisoning.
"This analysis suggests that, even if the emperor had been released or escaped from the island, his terminal condition would have prevented him from playing a further major role in the theater of European history," said Dr. Robert Genta, professor of pathology and internal medicine at UT Southwestern Medical Center and senior author of the study.
"Even today, with the availability of sophisticated surgical techniques and chemotherapies, patients with gastric cancer as advanced as Napoleon's have a poor prognosis."
At the time of Napoleon's death, the autopsy indicated a stomach cancer as the cause of decease and in 1938 it was found that his father also died of stomach cancer. Rumors of arsenic poisoning sparked in 1961 as an elevated level of arsenic was found in his hair.
The research team combined current medical knowledge, memoirs of the physicians who treated Napoleon on the island, eyewitness accounts and medical records of family members. Autopsy and physician descriptions did not depict arsenic poisoning, like hemorrhage inside the heart or skin, lung or bladder cancers. "Gastric cancer was more likely at fault," Dr. Genta said.
But some regarded the weight loss of Napoleon, at least 20 pounds in the last six months of his life, as a sign of gastric cancer. "The autopsy descriptions show that Napoleon's stomach was filled with a dark material that resembled coffee grounds, an indication of gastrointestinal bleeding that likely was the immediate cause of death," Dr. Genta said.
The autopsy described a large, ulcerated lesion in his stomach, and a smaller ulcerated lesion in another part of his stomach that had penetrated the wall and reached the liver. The researchers could not watch the body, but compared the real descriptions with modern images of benign ulcers and gastric cancers and the descriptions could not have depicted a benign cancer. "It was a huge mass from the entrance of his stomach to the exit. It was at least 10 centimeters long. Size alone suggests the lesion was cancer," Dr. Genta said.
The tumor was at least T3N1M0, or Stage IIIA (IV is the worst), gastric cancer, which is very severe. The cancer was large, lymph nodes were formed around the stomach and the tumor had not expended to other organs.
Even with the modern techniques, only 20 % of patients with Stage IIIA gastric cancer can survive just five years.
The gastric cancer could have been determined by genetic susceptibility, chronic gastritis or infection by the bacteria Helicobacter pylori. "Although genetic susceptibility is a possible cause, it's not likely," Dr. Genta said.
Napoleon's father seems to have died by a tumor that might have been something other than gastric cancer and autopsy was not performed for other members of the family. "Instead, the ulcerated lesion on the emperor's stomach suggests a history of chronic H. pylori gastritis, which might have increased his risk of gastric cancer," Dr. Genta said.
The military life of Napoleon just favored the condition: a diet full of salt-preserved foods but sparse in fruits and vegetables. "Even if treated today, he'd have been dead within a year," he said.