Napoleon's Poisoned Chalice

by Dr Martin Howard

  The post-mortem findings are also against poisoning as the cause of death. Characteristic autopsy features of fatal arsenic ingestion – skin and nail changes, haemorrhage into heart muscle, multiple tumours – are all absent. Devotees of the murder hypothesis also claim that Napoleon could not have died of cancer as he did not have the weight loss inevitable in the terminal stage of this disease. Sten Forshufvud, the Swedish doctor and Napoleonic buff who started the debate in 1961, writes,

  There is one thing which, first of all, makes the diagnosis of cancer very shaky. Napoleon did not show the characteristic condition of cachexy – that is extreme weight loss of flesh and wasting away – found, generally speaking, in persons who die of cancer.

  French historians, René Maury and François de Candé-Montholon (a descendant of the alleged murderer), writing forty years later, perpetuate this view. They quote Walter Henry’s post-mortem observations.

  On exposing the contents of the abdomen, the omentum was seen loaded with fat of which the quantity was very great … The kidneys were embedded in an immense quantity of fat … The heart was small but proportional to the size of the body, at least before it became bloated and oppressed with fat.

  This objection to the proposed diagnosis of cancer is not unreasonable and it provoked a group of pathologists in Basle to make a study of Napoleon’s weight over the last twenty years of his life. They first used an ingenious method reliant on the waist measurement of trousers worn by the Emperor at different times. Four pairs worn before the exile were measured at the Musée National du Château de Fontainebleau and five pairs worn on St. Helena were measured at Fontainebleau or at Malmaison. Three more trouser waist sizes were obtained from Napoleonic authorities and the Fondation Napoléon making a total of twelve measurements up to the time of his death.

  Modern data confirm a close correlation between trouser waist size and the subject’s body mass index. As Napoleon’s height is known (167 cm) it was possible for the researchers to derive a model which allowed calculation of his weight at different dates. To double check his weight at his death, a second method based on autopsy abdominal subcutaneous fat measurement was also used; Antommarchi recorded this as one and a half inches. The trouser size model suggested a weight increase from 67 kilograms to 90 kilograms by 1820. This reflects the well known transformation of slender General Bonaparte into the corpulent Emperor Napoleon. The trousers worn at the time of his death were consistent with a weight loss of 11 kilograms (to 79 kilograms) in the last year of his life. The abdominal fat calculation gave a similar figure (76 kilograms) to the trouser method. Taking the results of both techniques together, it is fair to state that Napoleon lost between 11 and 14 kilograms during his final illness. This is a substantial amount and quite in keeping with what is seen in modern patients suffering from the disease. The post-mortem fat observed by Henry and others simply reflected the fact that the Emperor was obese before his last illness and that his body had retained significant fat deposits despite his alarming weight loss.7 So the poison theory is all mouth and no trousers.

  We can assume that when Archibald Arnott entered Napoleon’s bedroom on 1st April 1821, he was about to consult with a patient in the last stages of a fatal malignant disease. It was 9pm and, according to Marchand, the scene was only dimly lit by a covered lamp in the adjacent room. The valet lifted the mosquito net and Arnott approached Napoleon. Antommarchi was also present but said nothing. Bertrand acted as an interpreter. The British doctor said a few words and then felt the patient’s pulse and performed a summary examination of the abdomen. He commented that he wanted to discuss the ailment with Antommarchi and asked for permission to return the following morning. He immediately reported back to Lowe.

  The room was dark so that I could not see him but I felt him or someone else. I examined his pulse and state of skin. I perceived that there was considerable debility, but nothing that indicated immediate danger.

  Arnott believed himself to be duty bound to keep the Governor fully informed. Equally, he was suspicious of the French, intimating that the room was darkened deliberately in order to conceal the patient’s identity. This initial impression of deception may have coloured the surgeon’s conclusions regarding Napoleon’s illness.8

  After this inauspicious start, Arnott visited the Emperor once or twice daily during the last month of his life. At first, both men were cautious. Arnott did not attend spontaneously but preferred a formal summons from Longwood. Bertrand guessed that this was not due to any lack of zeal on the doctor’s part but that he was afraid of the Governor. The Emperor, accustomed to the intimacy of a small group, was nervous at the introduction of an outsider. According to the Grand Marshal, the slightest unfamiliar thing upset him. During his early visits, the doctor noted that his patient’s pulse always quickened upon his arrival and that he grew calmer with time. This awkwardness soon abated, the meetings became more open and candid, and a good relationship formed between the two old soldiers.

  Napoleon believed that he had met Arnott previously but although the doctor had once seen the great man in Paris during a sightseeing tour, he had not been presented to him. A cloud threatened rain and, as he was only lightly dressed, he thought it better to head for his lodgings. When Arnott related this anecdote, Napoleon commented, ‘Ah, a far-seeing Scot’. The Emperor appears to have genuinely enjoyed the company of the surgeon and he paid him a number of compliments, referring to him in chats with Bertrand as a ‘brave, sensible and observant man’. He instructed Antommarchi that he did not want any English medical man to touch him after death but that, if this was unavoidable, it was Arnott alone who was to be employed in the task. Napoleon was, however, reserving judgment as to his new doctor’s medical prowess; on one occasion, he commented to Antommarchi, ‘You are much inferior to Dr Arnott … I don’t know whether he is a good doctor but he has a good manner and I will receive him.’

  By the time of Arnott’s attendance, the Emperor had low expectations. ‘I know the truth, and I am resigned’ he calmly remarked. Despite this pessimism as to the final outcome, Napoleon retained a keen interest in the details of his disease. This only faded in the final days when he became first confused and then frankly delirious. In response to the patient’s direct enquiries as to the state of his health, Arnott adopted the familiar strategy of bland reassurance. Napoleon was too astute to be fobbed off with platitudes. He was convinced that his disease was fatal. On 17th April, he complained of lassitude and refused all food. Bertrand witnessed the consultation.

  ‘It is true that Your Majesty is weaker,’ Dr Arnott said, ‘but I have seen many patients in an even weaker state than you make a recovery. You must therefore have hope.’

  ‘Words, words and phrases fit for women and children,’ Napoleon said wearily, ‘but to men and especially to soldiers like us, you should speak the truth.’

  ‘I have told you the truth,’ Arnott rejoined. ‘I have said what I think.’

  ‘What is the strongest remedy you have? Mercury?’ Napoleon asked.

  ‘In certain cases, but it is useless in cases of weakness,’ Dr Arnott replied.

  ‘Mercury? Opium? Quinine?’ the Emperor repeated.

  ‘Yes, in certain illnesses, but in other cases to let blood is one of the strongest remedies.’

  ‘You English, you let too much blood,’ Napoleon remarked.

  This exchange must have reminded the Emperor of his conversations with Warden on the Northumberland. His scepticism was entirely justified. A bleeding would have very likely caused harm, leaving him more debilitated. The Emperor concluded the consultation by declaring that, although he had none of the symptoms of immediate death, he was so weak that it would not take a cannon ball to kill him – a grain of sand would suffice.

  Whilst he retained his mental faculties, Napoleon enjoyed engaging Arnott in wider conversations. Bertrand records a number of these in his journal. For instance, on 24 April, a relatively good day for the patient, the two had a discussion lasting an hou
r in the morning and again in the evening. Napoleon’s boundless curiosity was still in evidence; he quizzed Arnott on all sorts of matters including the relative merits of British and French medicine, drinking habits in England, the bravery of British and French soldiers undergoing surgery, and the beauty of London compared to Paris. The Emperor was particularly interested in Arnott’s pay and expenditure. The surgeon had gained a reputation on the island for being careful with his money. He laughed when Napoleon quipped, ‘All Scotsmen are misers!’9

  It was in the course of one of these friendly exchanges that Napoleon informed the doctor that he had decided to present a book on the campaigns of Marlborough to his regiment. The Emperor had always admired the British General and the very fine book had been presented to him in the previous October by Robert Spencer, an opposition politician who briefly visited the island. The three separate volumes were luxuriously bound and contained the Imperial title. After telling Arnott to put them in his regimental library, the Emperor added, ‘If I have consented to see you, doctor, it is to satisfy the people around me, and because you are a man of honour, respected by the officers of your regiment.’ Marchand says that Arnott was visibly moved by the present and Bertrand, who had translated his master’s words into English, expressed the surgeon’s gratitude in French.

  On the following day, the Emperor asked Arnott what his fellow officers had said regarding the book. The doctor replied that they had not yet had a chance to read it. ‘Does not some committee look after the library?’ the Emperor enquired. Arnott responded that it was administered by a commissioner. Napoleon smelt a rat – it was obvious that appreciation of such a generous gift was not dependant on a thorough reading of the text. He later commented to the Grand Marshal that Arnott must have been rebuked by Reade for receiving the book. The Emperor was correct to suspect foul play although it was actually Lowe who had intervened. The volumes had originally been left in the room of the Orderly Officer, Engelbert Lutyens, who was informed of Napoleon’s intent by Arnott. Both men were nervous of censure and Lutyens therefore immediately informed the Governor of the gift. Lowe instructed Major Jackson, who was in temporary charge of the 20th, to return the book to Montholon. It could not be given to a British regiment because it contained the Imperial title and it had been donated through improper channels.

  Lutyens was so irritated by the confiscation that he behaved in a manner that was judged to be insubordinate and was removed from his post. Lowe, concerned that Arnott might be becoming another O’Meara, wrote to the doctor.

  The attempt to make you the channel of communication in such matters, they well know, is foreign to your professional duties, and it will probably, therefore, not have been made without some ulterior design in view.

  This episode reveals Lowe at his worst. Forsyth is forced to concede that, in refusing to allow the gift, the Governor had ‘acted with an overstrained sense of duty’. Young describes Lowe’s action as ‘ungracious’ and acknowledges that he was adhering too rigidly to regulations. As on other occasions, the Governor had insight into his own unreasonableness but was ultimately unable to restrain himself. He raised the affair with Gorrequer.

  He [Lowe] broke out that it was expected that he should be so delicate, because Neighbour [Napoleon] was said to be dying, it was what he himself had no idea of. [He said] that Neighbour knew very well what his opinion had always been of him, and it would never be on account of his being in a dying state that he would alter his line of proceeding. That he’d be damned, or some such expression, if he’d pursue any other. He cared very little about it.

  Others did care, and not only the French. Bertrand says that the officers of the 20th Regiment were very angry. Captain Lutyens was ashamed. ‘What a cowardly business,’ he exclaimed. ‘The wretch, to rebuff a dying man in such a fashion!’10

  Napoleon’s medical care was shared by Arnott and Antommarchi. It was only near the end of the Emperor’s life, when he was delirious, that Lowe insisted that Thomas Shortt, Physician to the Forces, who had recently arrived on St. Helena, and Charles Mitchell, Surgeon of the flagship Vigo, be sent to Longwood for a consultation. Shortt and Mitchell discussed the case with Arnott but were reluctant to give an opinion without seeing the patient. This was refused. Nevertheless, the consensus of the three British doctors was that Napoleon should be given a strong dose of a purgative (calomel). Antommarchi was unimpressed by the plan as he judged the Emperor to be on the verge of death and he believed all such efforts to be pointless. He was worried that the strength of the medication might make things worse. The Corsican physician has been much criticised and lampooned but he deserves credit for understanding the terminal nature of the disease and opposing futile and distressing treatment.11

  At this meeting, Arnott also conceded that the Emperor’s days were numbered. However, for much of the previous month, he had argued that Napoleon’s problems were more of a mental than physical nature. Astonishingly, he had made a diagnosis of ‘hypochondriasis’. It is difficult to understand how such an experienced doctor could have made such a crass misdiagnosis but the contemporary records are explicit and, if taken literally, allow no other explanation. Arnott’s written and verbal reports (the latter recorded by Gorrequer) to the Governor and Reade are contained in the Lowe Papers in the British Library. These, combined with the eyewitness accounts of those around him, enable us to build a detailed picture of the doctor’s approach to Napoleon’s illness.

  From the start, he wanted to believe that his patient was not sick at all. On 5th April, four days after the first consultation, Bertrand comments in his journal that Arnott was ‘in seventh heaven’ because there was no trace of fever. Although the French were conscientiously reporting the symptoms to him, he was disinclined to listen. Even when his colleague, Antommarchi, reported that the patient had had a bad night, his reaction was sceptical. He wrote to Gorrequer, ‘I did not find him labouring under any of the symptoms there detailed.’ On the 6th, Reade wrote to the Governor.

  Dr Arnott informed me that he had never found him, during any of his visits, in the state of which he had been described by Antommarchi. From what I could learn generally, out of Dr Arnott’s conversation, he appears to think that General Bonaparte is not affected with any serious complaint, probably more mental than any other. Count Bertrand had asked him his opinion of General Bonaparte: he told him that he saw no danger whatever. During his visit this morning he recommended General Bonaparte to rise and get shaved.

  Arnott agreed that Napoleon looked unwell as he was pale and had grown a very long beard. Equally, he denied that the the patient was emaciated; he felt his pulse regularly and he had a ‘stout’ wrist, indeed as fleshy as the doctor’s own. Reade wrote to Lowe that he was persuaded by Arnott’s tone that ‘Bonaparte will be out again very soon.’ It was probably nothing more than a ‘fit of bile’.

  Arnott’s predecessors, O’Meara and Stokoe, had made a diagnosis of liver disease but he was unconvinced of this. Napoleon went so far as to pull up his shirt and point to the region of the liver, asking the doctor to examine him. Bertrand explained to Arnott that the Emperor was sure that this was the site of the problem. The surgeon examined the abdomen and Napoleon complained of some tenderness. Arnott commented to Bertrand that he could find ‘no hardness or swelling whatsoever’. The Grand Marshal translated his words into French and the patient acknowledged them with a disbelieving look before changing the subject.

  On 17th April, Antommarchi noted that Napoleon was suffering from a cold sweat but Arnott was oblivious to this; he found the pulse to be unaltered and there to be no evidence of fever. The Corsican physician believed that ‘the dust of a ball’ would be enough to carry the patient off and Montholon told Lutyens that he could not survive more than a few weeks but Arnott continued to press his original diagnosis, a fact recorded by Gorrequer.

  Dr Arnott remarked to the Governor that if General Bonaparte took no more sustenance than what Dr Antommarchi and his followers said he did, he must
finally sink under it. Dr Arnott added that he became more and more confirmed in the opinion that the disease was hypochondriasis; no symptoms of immediate danger about him, but if some alteration for the better did not take place the ordinary results of the disease might be expected. His mind seemed to be particularly affected. Dr Arnott had remarked a singularity in his manner that morning. He was sitting in a chair and began whistling, when, suddenly stopping, he opened his mouth quite wide, projected it forward, and looked steadily at Dr Arnott in the face for a short time with a kind of vacant stare.