Napoleon's Poisoned Chalice

by Dr Martin Howard

  The Governor asked Dr Arnott whether it might be advisable to excite General Bonaparte in some way, to procure some change for him – to get him into the new house, for instance. Oh, said Dr Arnott immediately, anything occurring to break the present association of ideas would doubtless have a good effect. If, for example, a seventy-four [a ship of the line] was to arrive from England to take him away, I have no doubt he would soon recover. This would put him on his legs again directly.

  Lowe pointedly asked whether the air on St. Helena had exacerbated this affliction. The surgeon reassured him that the disease would be just the same in a prison elsewhere.

  On 22nd April, only a week before Napoleon became moribund, Arnott repeated the same message to Lowe.

  General Bonaparte’s malady was hypochondriasis – having many dyspeptic symptoms; – the cure probably tedious because he, Dr Arnott, could not give him that which would set him right. On asking Dr Arnott what that was, he immediately replied, liberty …

  The Emperor, Arnott continued, had improved over the previous week; he acknowledged this himself. He had complained of his liver, crying out ‘le foie’ and complaining of the ‘chaleur’ over it, but this, the doctor observed, was a symptom of hypochondriasis. Antommarchi stated that the patient was now very ill with fever and had difficulty in swallowing but Arnott thought him ‘decidedly not worse’. Lowe was becoming a little uneasy. Were swallowing problems, abdominal pain and vomiting really symptoms of mental disease? Arnott reassured him that they were. The Governor ordered the doctor to consult him immediately if there was any deterioration so that he might obtain a second medical opinion. He wrote to Bathurst that Arnott had repeatedly told him that the prisoner was in no immediate danger.

  Napoleon, at least whilst he remained alert, understood Arnott’s thoughts. He discussed his disease with Montholon and Bertrand. He informed the latter that he knew that Arnott did not believe him to be dangerously ill, whereas Antommarchi did. Word that the Emperor’s symptoms were being exaggerated was also passed to the British officers in the vicinity. Lutyens had regular contact with Arnott and was repeatedly informed that the patient was ‘better’. Charles Harrison wrote home on 22nd April:

  I don’t know what to think of the invalid, but I now begin to firmly believe it is all humbug. He still continues confined to his bed, but from what I can collect is considerably better. His new doctor [Arnott] attends him twice a day regularly, and he tells me he is the most extraordinary man he had ever had to deal with in his life, and the conviction on my mind is, that if he were to be told there was a 74 arrived to take him back to France he would find the use of both his mental and bodily faculties.12

  No patient ever died of hypochondriasis, a morbid fear of non-existent disease. We may ask at what point Arnott was forced to relinquish his diagnosis. He was certainly less optimistic in his conversations with Antommarchi than he was in his reports to the Governor and his communications with the other Longwood residents. As early as 18th April, the two doctors discussed the seriousness of the situation. Arnott opposed Antommarchi’s proposal that all treatment was now useless but when his Corsican colleague challenged him to justify his bullishness – ‘You are always spreading hopes amongst us; on what are they based?’ – Arnott had no satisfactory answer. Antommarchi writes cryptically in his memoirs that the British surgeon ‘soon gave up a conviction which he had not held’. In their private discussions, Arnott had also admitted the possibility of hereditary gastric cancer.

  When Napoleon’s condition deteriorated between 25th and 27th April with increasing debility and signs of bleeding from the stomach and bowel, Arnott was forced to backtrack and publicly acknowledge that he was attending a patient with a life-threatening disease. On the 28th, the Governor wrote to Admiral Lambert telling him that Arnott had that morning informed him that Bonaparte had become considerably worse than he had ever seen him before and that the disorder ‘bore a very serious aspect’. By 1st May Arnott was in constant attendance and reported to Lowe that the patient was delirious; ‘I think he rather raves more than he did in the morning.’ On the 2nd, he finally admitted that Napoleon was probably dying. ‘Danger is to be apprehended in the course of the day … allowing the probability is that he may last until tomorrow or the next day.’ His reports still contained surprising notes of optimism – for instance, at 9pm on 4 May, less than 24 hours prior to death, he insisted that the patient was better than a day earlier and that he had taken a ‘considerable quantity of nourishment’.

  At the end, Arnott’s actions were motivated by a desire to accommodate Lowe’s directive that everything possible should be seen to be done. The Governor had written to Montholon, ‘In short, M. le Comte, I am strongly desirous that English medical science should at all events have the chance of saving his life.’ Lowe was influenced by the case of a sick sailor treated at Plantation House who had been declared beyond hope by O’Meara but who had been unexpectedly restored to health by the exertions of Baxter. Arnott must also have been embarrassed by his diagnosis of a mental disorder, now so dramatically disproved, and he was keen to restore his credibility with some decisive action. On 3rd May the Emperor was too weak to swallow and the surgeon suggested an enema. Bertrand writes in his journal,

  On the subject of the enema, Arnott said that professional men would be unable to understand his having left the Emperor for three days without a motion. It was therefore absolutely necessary to obtain one, either by means of medicine or by means of an enema. He did not think that this would save the Emperor, as he was certainly in the greatest danger, with almost everything against him, but that nevertheless as a professional man and for the sake of his own reputation, he had to induce a motion. It was absolutely necessary, and it was possible, without moving the Emperor and by leaving him on his back, to lift his legs and to put a sheet folded in four or in eight under him to receive …

  Antommarchi opposed this useless procedure and Napoleon was spared the indignity.13

  Arnott’s medical reports to Lowe are not the only account he made of Napoleon’s illness and death. In 1822 he published a book, now very hard to find, entitled An Account of the Last Illness and Decease and Post Mortem Appearance of Napoleon Bonaparte. In the introduction, Arnott says that he was solicited to write the work by his friends in England. The slim volume contains a series of daily medical reports in which are documented both the chief symptoms and the means adopted for their relief. If the entries in the book are compared with Arnott’s reports to Lowe, it is immediately evident that there are significant differences. In his contemporary bulletins, Arnott clung to a diagnosis of hypochondriasis until only a week or so before Napoleon’s death; as late as 22nd April he claimed that an offer of freedom would restore his patient’s health. Whilst he remains reluctant to offer a specific diagnosis in his later book, he describes, in the archaic medical language of the day, serious symptoms quite incompatible with a mental disorder. Furthermore, these alarming symptoms and signs were present from the outset.

  A few selected quotes from his book make the point. As early as 2nd April, Arnott notes that Napoleon was ‘remarkably pallid’ and in a ‘very exhausted state’, and he added that the stomach was very ‘irritable’; the patient was unable to take food or medicines. On the 4th he was feverish and ‘much distressed’ with ‘tension of belly’.

  Three days later there was persistent fever and vomiting and ‘very profuse perspiration’, and then, on the 10th; ‘nausea and vomiting returned … His strength appeared to be sinking rapidly’. By the 13th we learn that he was ‘seized with a paroxysm of vomiting’, and two days later ‘his strength had shrunk considerably; he was covered with a cold damp perspiration … the skin has a clammy feel.’ For 17th April – still several days before Arnott’s final bulletin to Lowe confirming hypochondriasis – Arnott records in his book,

  There was an aggravation of all the symptoms; the vomiting increased and his strength sunk, the pulse was small, frequent and irregular; the whole surface
was cold. He was comatose, and, when roused, complained of a sense of suffocation.

  He continues to describe the relentless deterioration with vomiting of blood on the 27th and the appearance of ‘tarry stools’ the following day. On occasion he notes that the patient rallied a little, even becoming ‘cheerful’, but these are only brief respites and the overall picture is that of a man struggling against a terminal disease. Arnott concluded the substantial part of his work with a description of the Emperor’s death. He also appended an account of the post-mortem examination and a letter to Lowe but these add little to the main text.

  The profound difference between Arnott’s complacent contemporary account of the disease to Lowe and Reade and the retrospective description in his book can only be explained in one of two ways. One possibility is that the surgeon genuinely believed that his patient had hypochondriasis and the later work was a belated attempt to restore his medical reputation. The second is that the book version is his true assessment and that his contemporary reports were fabricated for political and personal reasons. In the first case, he can be charged with medical incompetence. In the second, he is open to a charge of cowardice, as he presumably played down Napoleon’s illness to please the Governor and his deputy. Arnott was aware that O’Meara and Stokoe had been hunted down by the British authorities for daring to state that Napoleon was seriously ill.14

  There is no evidence to suggest that Arnott was an incompetent doctor. He was the possessor of a medical degree from Edinburgh and used clinical methods which were state of the art in the early nineteenth century. For instance, he regularly recorded his patient’s temperature. This is routine now, but the technique of ‘clinical thermometry’ was not much used in England until fifty years after Napoleon’s death. Arnott had probably learnt to use a thermometer during his attachment to the prestigious Royal Infirmary at Edinburgh. There are clues in the Longwood memoirs that the experienced British doctor understood the severity of Napoleon’s disease. Arnot not only discussed the nature of the symptoms with Antommarchi but he admitted to Bertrand, on 1st April, that he agreed with his medical colleague that the Emperor was ‘dangerously ill’.

  The best evidence that Arnott was acting duplicitously comes from the pen of Gorrequer. In his diary, the Military Secretary repeated the comments not only of the Governor but also of his wife.

  And on the 4th [April] [Lady Lowe] having said also loud at pranzo to Ego [Gorrequer] that Medico 20th [Arnott] would take care to make out the case of our neighbour [Napoleon] as much better than it really was. Represent him in much better health that he really was because he knew it would please, and he was much too much of a Scotsman not to be regulated by what he knew was desired or expected.

  This conversation took place only a few days after Arnott first met Napoleon. On 7th April, a week after the first consultation, Gorrequer writes the following.

  Mach’s [Lowe] talking to Medico 20th [Arnott] respecting our Neighbour’s [Napoleon’s] complaint, laying it down that it was a disease of the mind, and not of the body. Medico had for some time (probably to give Mach satisfaction) declared it to be hypochondriasis, having often been told by Mach it was the state of his mind. [And that it was] the reflection of his [Napoleon’s] impolite conduct here, and his behaviour to him [Lowe], (and how differently he would play his game now, if he had to play it over again) that he was more suffering from. And he [Lowe] added with a furious satisfaction and the grin of a tyrant: ‘If a person was to go in there (his apartments) and make a great clamour, it would be the most likely thing to revive him. Depend upon it.’ This was the cure he prescribed for rousing him from the state of despondency and hypochondriasis Medico represented him in.

  At least one British historian has represented Arnott as a victim; a man brainwashed by Lowe. The French are less generous. Gilbert Martineau describes the doctor acting out of ‘political sagacity’. He concludes that he had a grave responsibility for the Emperor’s death. He was as ignorant as Antommarchi but more malevolent. This is arguable, as we have seen that Arnott was not ignorant, and to blame him for the Emperor’s demise is unfair. By the time of Arnott’s consultations, no medical intervention could have saved Napoleon’s life. This would be the case today. Some have suggested that the treatment adopted by Arnott – the administration of the toxic drug calomel – hastened the death. This may be the case but is impossible to prove.

  Arnott was not Napoleon’s executioner but neither was he an innocent bystander. His attempts to win favour from the Governor succeeded. Gorrequer tellingly compares the official treatment of Arnott with that of Stokoe. Arnott attended Bertrand’s house without authority and he there informed the Grand Marshal of Napoleon’s condition. He regularly referred to Napoleon as ‘the patient’ in his reports. All this was done with impunity.

  The secretary was in no doubt that Arnott was in the Governor’s pocket. He also believed the doctor to be actively exploiting this connection for his own ends. It was one of Arnott’s duties to make medical inspections of the ships in the harbour.

  Medico 20th [Arnott] not withstanding that he frequently got the bastiments [ships] boarded by his deputy [Rutledge, Assistant Surgeon of the 20th], pocketed the guinea; whilst he was at the same time receiving a pound daily for attending Neighbour [Napoleon] and 10 shillings for health medico. Notwithstanding his activity in the conspiracy, always a guest of Mach [Lowe], and enjoying every mark of favour; no remonstrance with him, evidently however to have him in reserve, by this attention and kindness, in case any future need or emergency in explaining matters respecting Neighbour’s health satisfactorily.

  As the only British medical man in a position to express a first-hand opinion regarding the Emperor’s illness, Arnott was too important to be allowed to be a free agent. Lowe was determined to control him. Reade was exasperated with the surgeon. The Deputy Adjutant-General warned the Governor that Arnott was ‘much too civil to Bonaparte’s followers’ and that this was ‘in a manner at your expense’. It may be that he was jealous of the doctor’s closeness to Lowe. Gorrequer was also irritated by Arnott’s privileged contact with the Governor. On 1st April, the date of the first consultation, he writes

  Soon after this day Medico 20th began addressing all his reports to Mach, instead of Ego [Gorrequer] about Neighbour in order to conceal them from him. Most likely to turn it to some advantage on his side when necessary.

  It is probable that this relationship between doctor and Governor was based on expediency rather than on any genuine warmth. Whilst Lowe is cautious in his comments regarding Arnott, the doctor, at least in the company of fellow medics, was less discrete. Gorrequer’s diary, 15th August, 1821:

  Medico Longo [Thomas Shortt] also told Ego [Gorrequer] that Old O.P. archy medico [Arnott] had abused both Mach and Sultana [Lady Lowe] through thick and thin, when dining at his house the preceding week.15

  Napoleon was ignorant of the misrepresentation of his illness and he rewarded Arnott for his attendance. Although conspiring with the Governor, the doctor had at least treated his patient with good manners and kindness during his thirty-five consultations. The ailing Emperor took a gold snuff box and laboriously engraved an ‘N’ upon it with the point of his scissors. This box, containing 600 Napoleons, was handed to Arnott by Montholon after the Emperor’s death. Reade commented to the surgeon that he was surprised it was not 1,500 Napoleons; a bad case of sour grapes. When Lowe received a note from Arnott just before 6pm on the 5th containing the words ‘He has this moment expired’, he sent Shortt and Mitchell to confirm the death. Montholon asked that Arnott, the British officer most trusted by the French, should stay in the room until midnight to watch over the body before being relieved by one of his colleagues. At seven o’clock the next morning, Lowe and his staff entered the death-chamber to formally identify the remains.

  Once the autopsy was completed, the body was sewn up. Some sources state that Rutledge was entrusted with the morbid task of guarding the dissected corpse but Arnott was in att
endance for at least part of the time. Marchand says that Arnott had been requested not to leave the Emperor’s body until it was interred and also to keep watch over two vases containing the heart and the stomach. Saint-Denis confirms that Arnott or his ‘substitutes’ were ever-present as the Governor was fearful that the remains might be interfered with or stolen. Arnott later described his nocturnal vigil to the Edinburgh Professor Sir James Young Simpson. He lay in bed with two pistols under his pillow ready to repel any French attempt to seize the post-mortem specimens which were in basins of water. Hearing a splash, he jumped to his feet to find that it was only the Longwood rats trying to get at the flesh. The surgeon then kept the silver dish containing the heart in his bed. The most famous rat anecdote from St. Helena concerns the two animals that jumped out of the Emperor’s hat when he was putting it on but Arnott’s story is the most unpleasant. At the funeral on 9th April, a beautiful winter day, the hearse could not easily reach the tomb in a valley below Hutt’s Gate and the casket was carried by Montholon, Bertrand, Marchand and young Napoleon Bertrand. The British surgeon walked near the front of the procession with Antommarchi.

  Arnott retired from the army in 1826 having completed thirty years service. He lived for the remainder of his life on his estate, Kirkconnel Hall, in Dumfriesshire. In addition to the gifts from Napoleon, he was in receipt of £500 from the British Government. He remained unmarried and died at the age of eighty three. His tombstone in Ecclefechan churchyard carries an inscription:

  At St. Helena he was the medical attendant of Napoleon Bonaparte whose esteem he won and whose last moments he soothed.