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WAS NAPOLEON POISONED WITH CALOMEL ?

By Xavier Riaud(*), FINS

 

In broad outline, while the absorbed liquid mercury slightly penetrates the body, its fumes, however, easily go into the respiratory tracts. As for the mercury salts, they easily circulate in the blood when they are taken through the digestive or cutaneous tracts. Intoxication is often characterized by clinical digestive features: nausea, vomiting, abdominal pain, hemorrhagic diarrhea, state of shock and then death. Mercury is then found in large quantities in the brain, loins, skin, liver, bone marrow, spleen, intestine, lungs and the heart. These symptoms can also be accompanied by behavior disorder, paraesthesia, visual disorder, abnormal gestures and trembling, etc. If this intoxication is acute, death necessarily occurs in the next thirty hours or more. The mercury proportion in the blood then reaches 1,5g when it is mercuric chloride. If it is a chronic intoxication, it increases to more than 200 μg/l in the blood (Goullé J. P. & al., 2003, Goldcher, 2010).

All the doctors prescribed calomel for Napoleon on Saint-Helena. This product had been used as an antiseptic since the Middle Ages. From the XVIIth century, this medicine made of mercury was recommended against exacerbated constipation. However, it is also a diuretic.

Because of his biorhythm, the Emperor had suffered from chronic constipation for years. It was really difficult for him to have a regular bowel movement and it fully contributed to his hemorrhoid crises. This constipation obviously worried everybody and was seen as extremely unhealthy by all. After suffering from all its side effects, from then on, Napoleon had refused to consume calomel in all its forms. This was confirmed in a letter written by Bertrand and sent to Las Cases in 1818. Following the prescription of Doctor O’Meara, Napoleon once again seriously suffered from those side effects, so much so that the Irish doctor inquired the Emperor’s close relatives about it. Seriously affected by this crisis, the captive decided that he would no longer take this medication. This was once again confirmed in a letter dating back to August 2 and written by the Russian commissioner de Balmain who attested the renewed good health of the august sick man but also his weakening and recurrent confinement to bed (Bastien & Jeandel, 2005; Goldcher, 2010).

Napoleon was convinced that these blue pills fully contributed to the worsening of his health. According to Goldcher (2010), « a hundred of British pills contained purified mercury (5g), white honey (4g), crushed white sugar (2g) and crushed red roses (4g). »

As a matter of fact, still according to Goldcher (2010), “When mercury chloride is in contact with gastric juice which is particularly rich in hydrochloric acid, it changes into a soluble mercury chloride. It is particularly corrosive for the mucous membrane of the stomach and toxic for the body after its infiltration into the blood.” Finally, the imperial reticence prolonged his life for a while. This refusal could explain why there was no correlation, no relation with cause and effect between the gastric ulcer noticed after the autopsy and mercury (Goldcher, 2010).

However, during the last days of his life, the illustrious sick man yielded to his doctors who kept on tormenting him. Did he understand that his days were numbered? Did he think of putting an end to his suffering by taking particularly lethal medication? No one knows. The fact remains that the captive decided to yield to the insults of his British doctors by following their recommendations.

Usually, doctors prescribed two grains of calomel per ingestion. The mass of a grain was well-known by then and is equivalent to 53,114 mg. During the last days of his life, the English doctors wanted to generate a final spurt of effort from the Emperor’s tired body. That is why they administered 10 grains of calomel in one take. Antommarchi took up arms and refused this posology that he considered as taking poison. If the considered mass of a grain is equivalent to 53,1mg, then 10 grains do not weigh more than 0,531g. To get a lethal dose, one has to take at least from 20 to 30 grains. We previously said that a lethal dose would be equivalent to 1,5 g in the blood. Therefore, we are wide of the mark and the English doctors also knew it well at that time (Goldcher, 2010).

Moreover, in 2005, the analysis of two hair of Napoleon by the laboratory Chem Tox revealed a mercury rate 2 to 3 times higher than the known norms, which are 3,3ng/mg and 4,7ng/mg. To call it mercury poisoning, the capillary concentration has to go beyond 50ng/mg. Here once again, we are a bit wide of the mark (Goldcher, 2010).

Usually, death follows the taking of mercury between 24 and 30 hours after the absorption. The administration of 10 grains took place on March 3, 1821 at 6 pm. The Emperor died on March 5 at 5:49 pm, in this case 48 hours later the absorption (Bastien & Jeandel, 2005).

Even though the Emperor’s symptoms were analyzed after the taking of calomel, something became obvious. At 11 pm, on May 23, Napoleon had a black dejection “which testified to high bleeding” according to Goldcher (2010). On March 4, at 12pm, his dying body moved in an incredible and uncoordinated way. He tried to stand up and then fell off his bed. Montholon tried with great difficulty to control him.

Normally, the taking of a high dose is responsible of inflammatory lesions, bleeding, ulceration and even necrosis. Toxicity manifests itself through the bowel which can explain the hemorrhagic diarrhea and not black dejection. When it is given as a medical dose, this medication cannot cause corrosive inflammatory lesions but quickens peristalsis favouring dejection (Goldcher, 2010). Let’s not forget that on May 6, 1821, during the postmortem examination, the bowel did not seem to reach the lesion (Antommarchi, 1825).

Given all these elements, it is obvious that the toxic agent which probably killed Napoleon was not calomel. However, given the general context on the island, the isolation of the sick man, the living conditions, his pre-existing and aggravated pathologies which particularly weakened him, it is acceptable to say that this medication did not help him feeling better. Even if I agree to the essential of the analysis and that I subscribe to Dr Goldcher’s objective study (2010), I wish to remain strictly cautious because this prescription was not the most appropriate given such levels of disease and agony.

 

Bibliography:
Antommarchi F., Mémoires du Docteur F. Antommarchi ou les derniers moments de Napoléon [Memoirs of Doctor F. Antommarchi or Napoleon’s last moments] Librairie Barrois L’Aîné, Paris, volumes 1 and 2, 1825.
Bastien Jacques & Jeandel Roland, Napoléon à Sainte Hélène – Etude critique de ses pathologies et des causes de son décès [Napoleon in Saint-Helena- Critical study of his pathologies and the causes of his death] Le Publieur (ed.), 2005.
Goldcher Alain, Autopsie commentée de Napoléon Bonaparte [Commented autopsy of Napoleon Bonaparte], personal communication, Saint-Maur-des-Fossés, 2010, p.218.
Goullé J. P. & al. Encyclopédie Médico-Chirurgicale, 2003, [90-50-0100]

 

(*) Dental Surgeon, Doctor in Epistemology, History of Sciences and Techniques, Laureate and Associate member of the French Dental Academy.