The valet’s diaries
However, when the diaries of Napoleon’s valet, Louis Marchand, were first published in 1955, they fuelled some concern that the emperor may not have died of natural causes. These diaries described symptoms of Napoleon’s illness in St Helen, many of which incidentally correspond to those found in arsenic poisoning (vomiting, dry cough, nausea, drowsiness, headaches, excessive thirst). The valet’s journal shows that symptoms often came and went and were followed by periods of general well being.
In 1961, Dr. Sten Forshufvud argued that the emperor’s symptoms coincided with those of chronic arsenic poisoning in his book, Who killed Napoleon? Forshufvud obtained a lock of hair that had been cut from Napoleon’s head after his death and asked the British Atomic Energy Establishment to analyze it. The results of the study showed that the hairs contained an amount of arsenic ten times above normal. The arsenic also showed irregular distribution along the length of hair, with peaks and troughs along the strands, suggesting the victim went through a pattern of arsenic intake (in line with the periods of wellbeing described in the valet’s journal).
Similar conclusions were reached in June 2001, by Pascal Kintz of the Strasbourg Forensic Institute in France who analyzed hair samples that had been taken from Napoleon while he was still alive (in 1805, 1814 and 1821). The analysis showed abnormally high levels of arsenic, and Kintz concluded that the emperor may have been poisoned.
A study by Jones and Lendingham (JonesDE, Ledingham KW. Arsenic in Napoleon’s wallpaper, Nature, 1982, 299:626-7) suggests that Napoleon may have been accidentally poisoned by copper arsenides present in his wallpaper. This was painted in Scheele’s green (or Paris green, as the compound was used in Paris sewers to kill rats) which was a mixture of copper arsenides. Moreover, some moulds may have been present and may have volatized arsenic fumes. Measurements of a wallpaper sample taken from Napoleon’s room in St Helen show arsenic in substantial concentration. The paper argues that death by poisonous wallpaper was well documented as early as the 1890s.
In May 2004, Lin, Alber and Henkelmann examined several strands of hair, two pieces cut the day after his death in 1821 and two pieces cut in Elba in 1814. They used instrumental neutron activation analysis (INAA) and the results showed that the hairs did have an elevated concentration of arsenic, as well as 18 other elements. This suggests that exposure to arsenic may have started as early as 1814.
A team of forensic pathologists led by Steven Karch, of the Medical Examiner Medical Examiner Department in San Francisco believe that it could have been the treatments administered to the emperor that actually killed him, not arsenic poisoning. In their paper, Channeling the Emperor: what really killed Napoleon? (J R Soc Med. 2004 August; 97(8): 397–399), they suggest that the immediate cause of Napoleon’s death could have been a rare form of ventricular tachycardia (torsade de pointes) brought about by hypokalemia (low concentration of potassium in the blood). They have observed that treatment in patients with promyelocytic leukemia using arsenic trioxide have occasionally resulted in ventricular tachycardia and sudden death.
The valet’s and phisician’s journals show that because Napoleon suffered from nausea, he had been administered tartar emetic regularly. This is an antimony potassium tartrate and could have eventually led to low potassium levels in the blood, according to Dr. Karch’s team. On the day before Napoleon’s death, he was administered a very high dose of calomel (mercury chloride), which was not absorbed by the gastrointestinal tract as suggested by the fact that the journals report significant bouts of diarrhea. This in turn may have caused dehydration and a sudden drop in potassium levels, bringing about the torsade de pointes and sudden death. They argue therefore that Napoleon’s death was caused by “medical disadventure” and not directly by arsenic poisoning.
Finally, in a more recent case study presented to Nature Clinical Practice Gastroenterology & Hepatology in 2007, Robert Genta (professor of pathology and internal medicine at UT Southwestern) and other researchers presented their evaluation of Napoleon’s available clinical history and original autopsy and compared this with clinicopathologic data from 135 gastric cancer patients. They concluded that Napoleon is likely to have suffered from chronic gastritis and that this in turn may have led to the development of an ulcer which later became cancer. Therefore, according to this study, Napoleon died of gastrointestinal bleeding caused by very advanced gastric cancer (see, Napoleon Bonaparte’s gastric cancer: a clinicopathologic approach to staging, pathogenesis, and etiology, Nature Clinical Practice Gastroenterology & Hepatology (2007) 4, 52-57).
The jury is therefore still out on whether Napoleon was murdered, whether his physicians over-administered arsenic or whether he died of cancer. All arguments so far have been presented very convincingly. Whatever the truth, we agree with Robert Genta: whether Napoleon succeeded in escaping St Helena (as he had done in 1814 when he fled Elba), his existing ulcer would have prevented him from ever becoming a threat to European peace as he would not have lasted much longer past 1821.