Accusations of foul play have swirled around Napoleon Bonaparte's death for nearly two hundred years, despite the original autopsy findings, which said the French emperor had succumbed to stomach cancer.
Now a comprehensive medical study says evidence for the original diagnosis—and not poisoning—is overwhelming.
"I think that is accurate," said Owen Connelly, author of several books on Napoleon and history professor at the University of South Carolina.
"The same thing killed his father and one of his sisters, Pauline," added Connelly, who was not involved in the study.
Arsenic and Cold Case
During his reign of more than a decade, Napoleon at times controlled most of Europe, was defeated and exiled, escaped, reclaimed his title, met his final military defeat at Waterloo, and was exiled again to the Atlantic Ocean island of St. Helena. He died there six years later in 1821.
Ever since, the circumstances of his death have inspired spirited debate.
Some experts argue that powerful men—French, English, or maybe a combination—feared the ex-emperor might escape exile again and retake France.
Some of these conspiracy proponents suggest that Napoleon was slowly poisoned with arsenic, perhaps in his wine or food.
Studies of Napoleon's hair have revealed high levels of arsenic, but critics say medicines and even hair tonic of the era sometimes contained the toxic element. [Arsenic used to be in many everyday items].
CSI: St. Helena
To attempt to solve the puzzle, the international team behind the new study used current medical techniques to analyze the writings of Napoleon's doctors, his family's medical records, and eyewitness reports—some of which have only recently come to light.
The researchers found nothing to indicate arsenic poisoning, such as hemorrhaging inside the heart, in the historical data.
What they did find was strong evidence of gastric cancer: rapid weight loss, a stomach filled with a grainy substance indicative of gastrointestinal bleeding—and something of a smoking gun.
The 19th-century doctors had detailed a large lesion on the exile's stomach.
After cross-referencing the old descriptions with modern pictures of 50 harmless ulcers and 50 gastric cancers, the researchers reached their conclusion.
"It was a huge mass from the entrance of his stomach to the exit," said Robert Genta, a pathology and internal medicine professor at the University of Texas, in a statement.
"It was at least ten centimeters [four inches] long. Size alone suggests the lesion was cancer," said Genta, senior author of the new study, which appears in this month's issue of the journal Nature Clinical Practice Gastroenterology and Hepatology.
Now the question remains: What caused the cancer?
Despite Connelly's suggestion of genetic predisposition to the ailment, study author Genta says the jury is out on what exactly killed Napoleon's father and sister.
Based on autopsy reports, Genta said, it is impossible to determine conclusively that the tumor that reportedly killed Napoleon's father was cancerous. And none of Napoleon's siblings were subject to autopsy, making his sister's stomach cancer diagnosis dubious.
Instead, Genta said, Napoleon's lesion points to chronic infection by Helicobacter pylori, a bacteria that can cause stomach inflammation and increase the likelihood of gastric cancer.
An 18th-century soldier's diet—short on fresh meats, fruits, or vegetables—may have boosted that risk even further, Genta added.
Napoleon historian Connelly agreed that food might have played some role. "Diet was not all that good in those days. They pretty much ate whatever tasted good."
Still, he said, Napoleon's diet was better than the average. On military campaigns, Connelly said, "I think he had more fresh food than ordinary soldiers. His flunkies would go out and get fresh chickens and what have you for him."
And the emperor was not known for gluttony, Connelly added.
"Napoleon was very abstemious. He even watered down his wine," he said. "And he was famous for eating a meal in 15 minutes, standing up. He was the original multitasker."
Whatever the cause of the emperor's alleged cancer, his enemies need not have worried about a possible return to power.
Study author Genta said, "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.
"Even if treated today, he'd have been dead within a year."