WhiteCoat

Death by Wallpaper, Medical Malpractice, or Both?

Hello all, it’s ERP from Erstories.net. Haven’t done a post here in a while so I thought I’d put up one on a subject I find pretty fascinating.

Having read Dr Grumpy’s fascinating historical posts and being an avid history buff myself, I thought I would give one a try.  I don’t have his encyclopaedic knowledge of military history oddities, but remember reading a great medical-historical story a while back and thought I’d share it with you.

In 1821, “Le petit Caporal” (The Little Corporal) died in Longfellow House on the remote island of St Helena.  Of course The Little Corporal (also known as Boney by the Brits) was Napoleon Bonaparte. Having finally lost at Waterloo to Arthur Wellesley (the First Duke of Wellington) and Coalition forces in 1815, Napoleon was finally banished to the island where he eventually would die 6 years later.   There has been nearly endless amounts of speculation as to the cause of his death since the 1960’s (and likely shortly after his death as well) when sentimental souvenirs of the dead Emperor, locks of his hair, were analysed.  High levels of Arsenic were found leading to historians to question the original cause of death from a cancerous gastric ulcer (as recorded by physicians who performed his autopsy).

Napoleon famously stated in his will that he had been “murdered by the British Oligarchy”. Suddenly, this actually seemed possible.  In a way, they may have, albeit unintentionally – but more on that shortly.   Arsenic is a deadly poison used for centuries to commit murder – but it also had many legitimate medical and commercial uses.  Namely, elemental aresnic is grey  but compounds of it can produce a brilliant green dye – used for centuries until synthetic green dyes were invented at the early part of the 20th century.  Medically, it had been used for a whole host of ailments (and still occasionally is), and when given in small quantities, is not so dangerous and has some positive effects.  Most commonly it was used for psoriasis,haemorrhoids, breathing ailments,  it still can be used in treating certain kinds of leukaemia and trapanosomal infections).  In fact, finding some arsenic in his hair likely would not be that unusual given that many people were prescribed arsenical treatments in the early 19th century.  However, his levels were quite high so some enterprising people set out to prove or disprove this notion.

An interesting phenomenon had been previously discovered – one that explained the notion of “The sick room”.  This was a room that when one spent time in it, felt ill (although the term also means a room where you put people who are sick).  I guess it could have been from the general odouriferousness of one’s company back then, but a better theory is that of Arsine vapour.  When subjected to certain chemical reactions, solid arsenic compounds can be turned into toxic gas (notable trimethyl and dimethyl arsine). This was used to deadly affect during World War I in the form of gas warfare. In fact, the British developed a form of it that they called Lewisite – hence the reason that the antidote for Arsenic poisoning is called BAL or British Anti-Lewisite.   Anyway,  we come to the idea of death by wallpaper.

Wallpaper made in the 18th and 19th centuries often contained toxic compounds to produce the brilliant colours favoured by those with the $$ to decorated their houses with it.   Bright green was created by arsenic compounds (like copper arsenite).  This was normally no big deal (unless you ate the paper) in temperate climates.  However, under certain environmental conditions – notable those with high levels of moisture, organisms can grow in the walls and wallpaper. These moulds can process the arsenic and turn it into arsine gas.   As this accumulates in a small room that may not have good ventilation, those in it can become ill.  This actually has a name – Gosio’s Disease.  In the 1980’s a researcher discovered something amazing; an actual sample of the wallpaper that was in the Longfellow House on St Helena.   A lady in the UK had a scrap book that had been handed down to her through the generations – it catalogued someone’s trip to St Helena in 1823, and amazingly contained a scrap of wallpaper that this souvenir hunter had taken off the wall of Napoleon’s drawing room.   This paper was analysed and found to contain Scheele’s Green pigment – copper arsenite.  The researcher in charge now had evidence as to how Napoleon could have accumulated the arsenic.  He visited the island to confirm his suspicions.    Tiny 6 x 8 mile St Helena is an extremely remote island in the south Atlantic, 700 miles from the nearest land, 1000 miles from Africa and 1000 miles from South America.  It is tropical and  mould of the type that can convert copper arsenite to arsine gas thrives there.   The area of Longwood House is extremely damp and in fact every few years the wallpaper there has to be replaced due to moisture-related damage. Thus, he was not INTENTIONALLY poisoned with arsenic – but rather the Brits who had manufactured the paper (much less dangerous in the British Isles) had unknowingly contributed to the Little Corporal’s demise!  Now, one may ask, how come the other people in his house did not all die from this?  Well, the fact is that as Napoleon aged, and as authorities grew more and more fearful that he might escape, he was largely confined to his drawing room and bed room.  He often kept the shutters closed.   He wrote memoirs and kept to himself.  The others in the house frequently left and thus were not so exposed (although they were noted to again describe a “bad air” and felt ill when they spent prolonged periods at Longwood House).

This does not completely prove that Napoleon died from arsenic poisoning – he probably died WITH arsenic poisoning.  It may have hastened his death but likely did not cause the actual demise.   It certainly helps shoot the theory to pieces that his staff or others intentionally poisoned him.  However, the final cause of death is another interesting story.   From the autopsy report and his known constant upper GI complaints, Napoleon was clearly suffering for a while with gastric ulcers.  Ultimately one became cancerous (as discovered at autopsy) and pushed him down the inevitable road to the great Arc de Triomphe in the sky.  As often is the case in the era before modern medicine, treatments for ailments were often more dangerous than the ailments themselves! Doctors really did unknowingly hasten death (maybe a good thing in some cases), at times killing people who might have otherwise recovered had they been left alone!  Toxic compounds, elixirs, poultices, etc were frequently given – often with the idea to induce vomiting and diarrheoa to “purge” the system of the illness.  Of course this caused at the very least volume depletion and dehydration, but also other problems.   Notably, potassium is lost when one has severe diarrhoea.    The Emperor was in fact treated with tartar emetic and calomel which is made of highly toxic mercuric chloride.  The day before he died, he was given a huge dose of this stuff.  Additionally, he was treated with a Quinine-containing substance called “Jesuit’s Bark”.  This, in addition to arsenic compounds that he had been unintentionally accumulating, cause QT prolongation (a measurement on the EKG between the Q and T waves).  QT prolongation is also caused by electrolyte imbalances such a low potassium and magnesium (both caused by the purgatives he was getting). In this setting,  one can go into the arrhythmia Torsades De Pointes (Twisting around the point), and die very rapidly.

Thus there is good evidence Ole’ Boney would have eventually died from cancer (probably would have just wasted away, unable to eat when the mass caused an obstruction), but was actually killed by both his wallpaper and medical malpractice. Albeit both unintentional.

I originally read about his story in a fascinating book called The Elements of Murder by John Emsley.  He is a Cambridge-based Chemist who talks about the historical use of toxic chemicals to comit murder. There is a whole chapter on all the Arsenic killers as well as ones on Mercury, Thallium, Copper, and others.  I highly recommend it.

Additional references include

“David E. Jones and Ken Ledingham, ‘Arsenic in Napoleon’s wallpaper’, Nature, 1982,. 299: 626-7.”  (this is the researcher who found the wall paper and travelled to St Helena in the 80’s)

This Article describes the possible final cause of the Emperor’s Death by Torsades.

13 Responses to “Death by Wallpaper, Medical Malpractice, or Both?”

  1. WhiteCoat says:

    Very interesting post, ERP.
    It makes me wonder how many of the things we are doing to “treat” medical conditions now will be looked at in the future as actually hastening the death of our patients.

    • KYERRN says:

      CSI St. Helena. Love it.

      WhiteCoat, I can think of one thing that we already know is harmful, yet we do over and over again.

      CT scans. In our ED, every headache and tummy upset (that isn’t GYN related) is scanned.

      I wonder how many of those patients will be back in someone’s ED in a few years with a REAL problem.

      • Aaron says:

        That’s a good one. What about more basic things like Foleys or NSAIDs. The problem with CTs is that since the first half of the twentieth century ionizing radiation has been a known hazard. What is being done now that no one suspects yet… That’s the real mystery.

  2. STW says:

    I’d never heard the final conclusions of the hair analysis. Nice to get it wrapped up so neatly.

  3. ERP says:

    Right WC. I am sure a lot of chemo treatments will be viewed that way.

  4. Sarah G says:

    I greatly enjoyed reading this. I’ll be sharing it with some mystery-writing buddies of mine. Truth is stranger than fiction…

  5. Anonymous says:

    But if you can’t actually die from arsenic by itself, wouldn’t you die from organ failure and wouldn’t that be pretty obvious in an autopsy?

  6. [...] This post was mentioned on Twitter by Mario id.gd Perez, Sarah Glenn. Sarah Glenn said: WhiteCoat: Death by Wallpaper, Medical Malpractice, or Both? http://fb.me/IiXJX4dy [...]

  7. ERP says:

    You can die from Arsenic poisoning alone – but it is also easy to have a chronic simmering toxicity without actually dying from it if the dose is not high enough.

  8. ladyk73 says:

    ……how does one die of copper? I guess I am going to google that!!!! Good post!

    This website:
    http://thereifixedit.failblog.org/

    one of the many related to failblog, does historic Kludges on thursdays

  9. Mallory says:

    Another point with arsenic and wallpaper, is that it wasn’t just used in dyes. In the 1700s and 1800s, arsenic was often mixed into the wallpaper paste when the wallpaper was hung, for the purposes of detering vermin. This practice could have meant far higher levels of arsenic than accounted for by the wallpaper pattern alone.

    Women of the period (especially) would also consume small amounts of arsenic and lead to improve their complexions.

  10. [...] of Murder by John Emsley.  You may remember when I blogged here a while back about the cause of death of Napoleon.  My interest in this subject was piqued by reading this [...]

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