Napoleon Bonaparte and Stomach Cancer: A Diagnosis From History

A 200-year-old autopsy, reread by pathologists

Napoleon Bonaparte lost at Waterloo in 1815. He was sent into exile on the island of St. Helena. He died there on May 5, 1821. His own doctor, Francesco Antommarchi, did an autopsy the next day. It took place at Longwood House, in front of a French and a British group.

Two hundred years later, a group of gut pathologists went back to the paperwork. Their report ran in the journal Virchows Archiv in 2021. It did something unusual for a historical mystery. It sorted the surviving accounts by how much medical weight each one earns.

Two documents were rated strong. One is Antommarchi's first report. The other is the official British report. Doctors wrote both, at or just after the autopsy. Notes by an assistant surgeon, turned into a letter two years later, were rated moderate. A diary and a valet's memoir were rated weak, since neither man was a doctor. A second report Antommarchi published in 1825 was set aside. In 2006 it was found to closely match a journal article printed in 1823.

The consortium's conclusion was direct: the two 1821 reports "show strong medical evidence and allow a final diagnosis: advanced malignant gastric neoplasia associated with upper gastrointestinal bleeding as cause of death."

What the reports could and could not settle

The authors are careful about limits, which is the most useful part of the paper.

There is no tissue. Histology means looking at cells under a microscope. Without it, the team writes, the subtype cannot be known. They did compare the look of the stomach with images of untreated gastritis and of gastric cancer. It matched the cancer pattern, not the inflammation.

The paper also touches the poisoning theories. Napoleon's health had been falling since October 1820. That fits cancer progression. He was tachycardic, meaning his heart was racing, before May 3, 1821. On that day his doctors gave him calomel, a mercury compound. The authors read the calomel as a trigger for bleeding from a tumor that was already advanced. They do not read it as the cause of death.

One more observation points somewhere modern. A malignant stomach tumor sitting alongside a perforated ulcer, the paper notes, may point to cancer arising from Helicobacter pylori gastritis.

The bacterium nobody in 1821 could have seen

H. pylori is a bacterium that colonizes the stomach lining and can stay for decades, usually silently. It was not identified as a cause of ulcers and cancer until the 1980s.

The National Cancer Institute's fact sheet states that the majority of cases of gastric adenocarcinoma and gastric MALT lymphoma are attributed to H. pylori infection. Researchers think the long-running inflammation it causes pushes stomach lining cells toward becoming cancerous.

The practical result is remarkable. NCI reports that wiping out H. pylori lowers the risk of gastric cancer. That holds for people with no symptoms. It holds for people at higher risk from family history. It holds for people who have already had surgery for early gastric cancer. The treatment is a course of antibiotics plus a drug that suppresses acid.

Napoleon's doctors saw bleeding, wasting, and a hard mass. They had no bacterium, no endoscope, no biopsy, and no antibiotic.

What gastric cancer is, in current terms

NCI states that gastric adenocarcinoma accounts for 90% to 95% of all gastric malignancies. Adenocarcinoma means the tumor arises from gland cells in the stomach lining.

NCI's clinician guidance lists other risk factors. They include older age and male sex. They include a diet low in fruits and vegetables, and one high in salted, smoked, or preserved food. They also include chronic atrophic gastritis, intestinal metaplasia, pernicious anemia, stomach polyps, family history, and smoking.

Risk factors describe populations. They never explain one person's illness.

When to get checked

NCI states the central difficulty plainly. Early on, stomach cancer usually has no symptoms, and symptoms usually begin after the cancer has spread.

Early signs NCI lists are indigestion and stomach discomfort, a bloated feeling after eating, mild nausea, loss of appetite, and heartburn. Advanced signs include blood in the stool, vomiting, unexplained weight loss, stomach pain, jaundice, ascites, and trouble swallowing.

The 2021 paper points to the current World Health Organization list for advanced gastric cancer. It names weakness, indigestion, vomiting, weight loss, trouble swallowing, feeling full quickly, and anemia. Those, the authors note, are the symptoms Napoleon's companions described in his last months.

Thresholds worth using:

• Indigestion or heartburn that is new and has persisted more than a few weeks without settling on over-the-counter treatment.
• Feeling full after a few bites, again and again.
• Weight loss you did not intend, especially with a shrinking appetite.
• Unexplained anemia found on a blood test, particularly in an adult man or a woman past menopause.
• Black or tarry stools, or vomiting blood. That is an emergency today, not next week.

There is no general stomach cancer screening program in the United States. If indigestion is a fixture in your life, an H. pylori test is worth asking about.

What is available now that was not then

NCI describes surgery as the main treatment. A subtotal gastrectomy removes the affected part of the stomach with nearby lymph nodes. A total gastrectomy removes the whole stomach. The surgeon then joins the esophagus to the small intestine, so a person can still eat.

Chemotherapy, radiation, targeted drugs, and immunotherapy are all used. Biomarker testing of the tumor guides the choice. Stents can relieve a blockage.

What the modern numbers look like

These are population figures and describe no individual.

The American Cancer Society projects 31,510 new stomach cancers in the United States in 2026, about 1.5% of all new cancers, and 10,740 deaths; SEER publishes those projections next to its own measurements. Five-year relative survival across all stages is 39.8% for people diagnosed from 2016 to 2022, and the disease is most often diagnosed between ages 65 and 74.

Stage still decides most of it. SEER records five-year relative survival of 78.1% for localized disease, 39.0% for regional disease, and 8.1% for distant disease. NCI adds that more than half of patients with localized distal gastric cancer can be cured. But early-stage disease is only 10% to 20% of cases diagnosed in the United States.

That pairing is why a two-century-old autopsy still repays reading. The medicine has changed enormously. The habit of waiting for symptoms to become unmistakable has not.

Sources

• Virchows Archiv (2021): The gastric disease of Napoleon Bonaparte — brief report for the bicentenary of Napoleon's death on St. Helena in 1821
• PubMed record for the Virchows Archiv bicentenary report
• NCI: Gastric Cancer Treatment (PDQ) — Health Professional Version
• NCI: Symptoms of Stomach Cancer
• NCI: Treatment for Stomach Cancer
• NCI: Helicobacter pylori and Cancer Fact Sheet
• SEER Cancer Stat Facts: Stomach Cancer