A spiral-shaped bacterium that can grow in the human stomach may answer a question that has puzzled historians and scientists for 200 years. An investigation into Napoleon I’s cause of death published in January’s Nature Clinical Practice Gastroenterology & Hepatology identifies the great general as a cancer victim.

A team of US, Swiss, and Canadian researchers has applied modern pathological methods and tumor staging to historical documents to find that Napoleon, who died at 52 in 1821, had a very advanced case of gastric cancer apparently stemming from a Helicobacter pylori infection in his stomach.

Led by US pathologist Robert Genta, the scientists compared the descriptions of a lesion in Napoleon’s autopsy reports with modern images of 50 benign gastric ulcers and 50 gastric cancers. (Because of the figure’s importance in his time, there are detailed accounts of his health, including the notes of his physician, Francesco Antommarchi, as well as the medical histories of family members.) They determined that no ulcer could look like the lesion described in the autopsy and that it was therefore cancer.

For years, Napoleon was thought to have been poisoned. This was based on a 1961 study (also published in Nature) in which a strand of Napoleon’s hair was analyzed and shown to have elevated levels of arsenic. But autopsy and physician descriptions revealed none of the telltale signs of arsenic poisoning, such as hemorrhaging in the lining inside the heart. Although the patient could obviously not be examined, and there was no histological examination of the lesion, the study concludes that H. pylori “might have led” to Napoleon’s gastric cancer. Gastric cancer was once considered a single entity. Now, epidemiologists divide this cancer into two main classes: gastric cardia cancer (cancer of the top inch of the stomach, where it meets the esophagus) and non-cardia gastric cancer (cancer in all other areas of the stomach). This classification was adopted because the two have different risk factors and different patterns of occurrence. H. pylori has been established as a strong risk factor for non-cardia gastric cancer, whereas its association with gastric cardia cancer is controversial. Gastric cancer is the second most common cause of cancer-related deaths in the world, killing approximately 700,000 people per year.

As reported in Nature in February, H. pylori has attained yet another distinction as a marker of early human migration. From a single origin in East Africa 58,000 years ago, the bacterium conquered Europe too, and it now infects hundreds of thousands of people - although usually without causing ulcers or cancer. - Peter Winter