# Napoleon Bonaparte-A Possible Case of Trench Fever

Éric Faure

► To cite this version:

Éric Faure. Napoleon Bonaparte-A Possible Case of Trench Fever. Emerging Infectious Diseases, 2025, 31 (5), pp.1038. 10.3201/eid3105.240970. hal-05121033

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Submitted on 19 Jun 2025

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# Napoleon Bonaparte—
A Possible Case of
Trench Fever

Éric Faure

Author affiliation: I2M-CNRS UMR 7373, Aix-Marseille University,
Marseilles, France

DOI: http://doi.org/10.3201/eid3105.240970

In 1789, Napoleon Bonaparte reported having a recur-
rent febrile illness that initially subsided for 4 days and
then had multiple relapses of similar duration. A specula-
tive diagnosis of trench fever would be supported by poor
hygiene conditions, prolonged exposure to cold, and the
presence of lice in Napoleon's barracks environment.

Napoleon Bonaparte’s health has been the subject of numerous retrospective studies. He has been thought to have had ≈40 individual diseases (1), and an additional disease should be added to that list. In January 1789, Bonaparte, who served at the Artillery School of Auxonne, France, wrote to his mother: “I have had attacks of persistent fever from time to time. The fever subsides for some four days and then relapses, lasting for about the same time again” (2).

Auxonne was notoriously malarious, and Bonaparte, who had already had intermittent fevers, attributed his illness to miasmas, noxious forms of “bad air” (2,3). However, the periodicity of his fevers would rather suggest a more likely diagnosis of trench fever, a disease caused by *Bartonella quintana*, a bacteria transmitted by infected human body lice. The fever pattern of trench fever is frequently characterized by episodes of fever lasting 4–5 days, with apyretic intervals of 4–5 days between each episode (4). The major predisposing risk factors for trench fever are poor hygiene, louse infestation, immune system compromise, and prolonged exposure to cold (5), all factors likely present at the time of Napoleon's correspondence. The winter of 1788–89 was extreme. Bonaparte had been ill during the summer of 1788 (3,6). In March 1789, Bonaparte wrote that he rarely changed his clothes, which was a habit he had practiced in the past (3). The presence of lice at the School of Auxonne was likely (3).

Trench fever was not recognized as a distinct
clinical entity until 1915 (7). Nonetheless, analy-
sis of DNA extracted from gravesites has provided

evidence of human infection with *B. quintana* since at
least 4,000 years ago (8). Researchers have identified
*B. quintana* frequently in both barrack and field envi-
ronments and have detected its DNA in mass graves
of soldiers from the Napoleonic era in Vilnius, Lithu-
ania, and in Kassel, Germany (8).

Retrospective diagnosis is always a precarious endeavor, particularly without DNA evidence. However, I believe that trench fever should be recognized as among the many ailments that befell Napoleon Bonaparte.

Acknowledgments

The author extends sincere thanks to the 2 anonymous
reviewers whose comments and suggestions helped
improve and clarify this Research Letter.

About the Author

Prof. Faure is a professor at the University of Aix-
Marseille. He is an interdisciplinary biologist who
researches, among other things, the conditions
surrounding the appearance and decline of past epidemics
in Europe. He also works on establishing the timeline for
the emergence of malaria in various regions of Europe.

References

1. Murray JF. Napoleon—of what did he die? S Afr Med J. 1971;45:1005-9.

2. Kemble J. Napoleon immortal, The medical history and private life of Napoleon Bonaparte. Br J Surgery. 1960;47:454. https://doi.org/10.1002/bjs.18004720444

3. Cabanès A. At the emperor's bedside [in French]. Paris: Albin Michel; 1958.

4. Relman DA. Has trench fever returned? N Engl J Med. 1995;332:463-4. https://doi.org/10.1056/NEJM199502163320710

5. Minnick MF, Anderson BE. *Bartonella*. In: Tang YW, Sussman M, Liu D, Poxton I, Schwartzman J, editors. Molecular medical microbiology, second edition. London: Academic Press; 2015. p. 1911-39. https://doi.org/10.1016/C2010-1-67744-9

6. Bizouard JT. History of Auxonne's hospital (1374-1884) [in French]. Dijon, Frnace: H. Grigne; 1884. p. 158-63.

7. Anstead GM. The centenary of the discovery of trench fever, an emerging infectious disease of World War 1. Lancet Infect Dis. 2016;16:e164-72. https://doi.org/10.1016/S1473-3099(16)30003-2

8. Mai BHA, Barbieri R, Chenal T, Castex D, Jonvel R, Tanasi D, et al. Five millennia of *Bartonella quintana* bacteraemia. PLoS One. 2020;15:e0239526. https://doi.org/10.1371/journal.pone.0239526

Address for correspondence: Eric Faure, Aix-Marseille University, CNRS UMR 7373, I2M, 3 Place Victor Hugo, 13331 CEDEX 3, Marseilles, France; email: eric.faure@univ-amu.fr