For medical doctors specialized in gastrointestinal diseases, these statements are very suggestive for the diagnosis of an advanced malignant gastric neoplasia (gastric carcinoma and/or gastric lymphoma) associated with a covered perforated ulcer and upper gastrointestinal bleeding.
Nevertheless, since Napoleon’s autopsy, the diagnosis of gastric cancer was questioned several times in the medico-historical literature. In 1961, an elevated arsenic concentration in Napoleon’s hair taken after his death suggested arsenic poisoning . This hypothesis was finally dismissed by a study published in 2008 showing an elevated arsenic content in the hair of Napoleon during his childhood as well as in the hairs of Napoleon’s son and Joséphine . This study along with others excluded an arsenic poisoning with criminal intent [3, 7, 11, 12]. In 2012, a medico-historical book challenges gastric cancer again and a chronic gastritis associated with gastrointestinal bleeding and anaemia was suggested as Napoleon’s cause of death instead . The following clinico-pathological aspects clearly show why this hypothesis stays on an extremely shaky ground:
Based on the WHO classification of digestive tumours (5th edition 2019), common symptoms of gastric cancer, especially in advanced stages, include asthenia, indigestion, vomiting, weight loss, dysphagia, early satisfaction of appetite and anaemia . According to historical, sources Napoleon showed quite several of these symptoms, especially in the last few months of his life [4,5,6, 8, 14]. Additionally, the anaemia may be simply tumour-related.
On May 3, 1821, 2 days before his death, Napoleon was given Calomel (mercurous chloride) by his doctors leading to the hypothesis of an iatrogenic drug–induced cause of death. Napoleon was already tachycardic before May 3  which supports along with the postmortal findings his advanced malignant gastric neoplasia being the cause for the gastric bleeding and Calomel just a trigger. Napoleon’s health status was decreasing since October 1820 which is in line with cancer progression and makes an “unnatural” component  unlikely.
The macroscopic description in the two original autopsy reports does not favour chronic gastritis at all. In previous publications, the macroscopy of Napoleon’s stomach was compared with several pictures of non-treated gastritis and gastric cancer  . None of the gastritis pictures were in the least comparable to the description in Napoleon’s autopsy reports in contrast to the macroscopic aspect of gastric cancer Borrmann subtype III. The description of Saint-Denis in his memoirs stating “There was a perforation in the stomach and around this perforation many little holes as made by lead shots of a pistol” , may be well-intentioned, but clearly incomplete and not medically sound.
There is a strong evidence for an association between tumour size and tumour stage in gastric cancer [11, 14]. Indeed, Napoleon’s gastric lesion is associated with an advanced gastric cancer even according to the autopsy report of 1821 by Antommarchi and the one signed by the British doctors, respectively [11, 14]. Having excluded Antommarchi’s autopsy report of 1825, the lack of evident metastases in the autopsy reports from 1821 is still not surprising as often loco-regional lymph node metastases are only detected microscopically. Since histological confirmation of the cancer is not available, we cannot be sure of the histological subtype. However, the metastatic pattern of both intestinal and diffuse type gastric cancer is often associated with (distant) lymph nodes and peritoneal metastases (with or without ascites) which may be easily missed during the autopsy. Nevertheless, according to Siddharta Mukherjee’s book “The emperor of all maladies. A biography of cancer”, there is strong evidence that cancer was a known entity before 1821 .
The co-existence of malignant gastric neoplasia (carcinoma and/or lymphoma) and gastric ulcer with perforation may suggests a Helicobacter pylori gastritis associated carcinogenesis .