SOFT 2004 Meeting Abstracts - Society of Forensic Toxicologists

C34
CHANNELING THE EMPEROR; WHAT REALLY KILLED NAPOLEON
Francesco Mari l , Elisabetta BertolI, Vittorio Finnechi 2 " Steven B. Karch*3.
IUniversity ofFlorence, Italy, 2University ofFoggia, Italy, Office ofthe Medical Examiner, City & County
ofSan Francisco, CA
Those with an opinion about the cause of Napoleon's death rely largely on the results of hair testing. Over
30 different samples, of reasonable provenance, have been analyzed. Some samples were obtained during
Napoleon's first exile in Elba, years before he arrived on Saint Helena. Others were obtained at autopsy. All
studies have revealed elevated concentrations of arsenic and, in the most recent study, elevated
concentrations of antimony as well. These observations, coupled with written accounts of the symptoms
and signs exhibited by the Emperor, have led to near universal agreement that arsenic poisoning was the
cause of death. For proponents of this view, the only question remaining is whether poisoning was
accidental or intentional. Evidence for intentional poisoning comes from the Emperor's own hand. He wrote
in his will, "I die before my time, murdered by the British oligarchy and its hired assassin." Others maintain
that exposure was environmental. Many sources of environmental contamination have been proposed, but
there is compelling evidence that Napoleon was poisoned by his own wallpaper; it was painted with
"Scheele's green" pigment, a mixture of copper arsenides. It has been known for more than 100 years that
certain molds, some likely to have been present in Napoleon's wall coverings, can volatilize arsenical salts.
Other explanations are possible. Those favoring the poisoning theory tend to minimize the facts that
Napoleon had a rather thorough autopsy. He had requested one because he believed that he, like his father,
might have stomach cancer, and that his children were at risk. The autopsy was performed by one of
Napoleon's personal physicians, a Corsican named Francesco Antommarchi. Five English physicians were
present, but since Antommarchi was the only one actually trained in anatomic pathology, he performed the
dissection. Though some physicians later expressed divergent opinions about the cause of death, none
disputed his anatomic findings: an ulcerated, regionally invasive, carcinoma of the greater curvature,
metastasizing into the regional lymph nodes. Since high levels of arsenic were clearly present at death and,
according to the latest studies, present for many years, the question to be answered is whether Napoleon
died "of" arsenic poisoning, or "with" arsenic poisoning. Recent developments in the treatment of
promyelocytic leukemia (APL) may provide the answer. Treatment with arsenic trioxide is complicated by
the occurrence of QT prolongation, torsades des pointes, and sudden death. Tissue culture studies have
shown that at clinically relevant concentrations, arsenic blocks both I Kr and I ks channels and, at the same
time, also activates kATP channels. The effects cancel each other out, and normal cardiac repolarization is
maintained. The unpredictability ofQT interval prolongation, and the occurrence of ventricular arrhythmias
during arsenic therapy in APL patients, is the result of competing effects, blocking and activating multiple
repolarizing potassium currents. The balancing ofthese forces is clearly a delicate matter, one that could be
disrupted by any number of extrinsic or intrinsic physiologic forces. Napoleon was given a huge dose of
tartar emetic (potassium antimony tartrate) the night before he died. Antimony binds to potassium channels.
It appears that the immediate cause of death was neither gastric carcinoma, nor chronic arsenic poisoning,
but medical misadventure. Had Napoleon not been given the tartar emetic, arsenical effects on cardiac
conduction would have remained balanced; he would have lived to die a natural death, probably from
gastric carcinoma.
Key Words: Arsenic, Napoleon, Channelopathy
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