On August 28, Jon Iverson forwarded an AP article about Christian Reiter, who claims to have diagnosed Beethoven's lengthy decline and eventual death as lead poisoning caused by a salve laced with lead administered by the composer's doctor.
"Worth a news story?" JI asked. I wasn't convinced—after all, I'd read Beethoven's 1827 autopsy report by Dr. Johann Wagner and knew he'd died from massive organ failure caused by . . . . Well, I couldn't remember. So, I pulled out The Beethoven Companion by Thomas K. Scherman and Louis Biancolli and looked up Dr. Wagner's autopsy report.
In 1827, postmortem examinations weren't the rule, but Beethoven had long wanted to know what caused his deafness and in his Heilegenstadt Testament, he addressed his bothers Karl and Johann: "When I am dead, request on my behalf Professor Schmidt, if he is still living, to describe my disease, and attach this written document to his record, so that after my death at any rate the world and I may be reconciled. . . ."
Dr. Wagner and Beethoven's personal physician, Dr. Andreas Wawruch (the man Dr. Reiter accuses of causing his death), examined the composer's ears, noting that the external ear was large and well-formed, but the external auditory canal was covered with "shining scales," which actually concealed the tympanum. Beethoven's eustachian tube was thickened and swollen, while the auditory nerves were "shriveled and destitute of neurina." The auditory arteries were also constricted.
Beethoven's brain was "full of water and remarkably white," Dr. Wagner wrote.
Wagner found Beethoven's chest cavity in "normal condition," but reported "four quarts of grayish-brown turbid fluid" as well as a shrunken liver he described as "of a leathery consistency and greenish-blue color, beset by knots the size of a bean on its tuburculated surface, as well as in its substance; all its vessels were very much narrowed and bloodless." The spleen, Wagner found, "was more than double its proper size, dark-colored, and firm." The pancreas was also hard and firm.
The stomach and bowels, Wagner observed, were "greatly distended with air." Both kidneys were hard, riddled with calceous tissue, and pale.
Wagner also noted that Beethoven was emaciated.
Forgive us for going into such detail, but the abundance of detail is precisely why Beethoven's death has caused so much controversy over the last 180 years.
First, his hearing loss: Debate has raged over whether it was caused by damage to the auditory nerve (Wagner's conclusion, apparently) or by the thickening and immobility of the malleus, incus, and staples—the bones which transmit and amplify vibrations to the ear drum. That is known as otoschlerosis and would be the go-to diagnosis for deafness in a 28-year-old man, if not for the fact that Beethoven's detailed description of the onset of his deafness—specifically, his high-frequency hearing loss—makes that suspect.
When it comes to assigning a cause of death, things have been even less clear. John O'Shea, the author of Was Mozart Poisoned? Medical Investigations into the Lives of the Great Composers, believes it was liver failure due to cirrhosis, citing not only Beethoven's heavy drinking over a 30-year period, but also A. W. Thayer's account of Beethoven dying while shaking his fist at heaven after a bolt of lightning illuminated his room, as reported by Huttenbrenner, who was present at the time of death. Dismissed by many Beethoven scholars as a piece of romantic melodrama, O'Shea cites it as "an accurate clinical observation: people who die of hepatic failure often react in an exaggerated way to sudden stimuli."
Edward Larkin, author of Beethoven's Medical History, agrees that Beethoven's cause of death was long-term hepatitis, but notes that Beethoven's other symptoms—colitis, rheumatism, abscesses, arterial schlerosis, and skin disorders—all point to an auto-immune disease such as lupus. And, Larkin notes, arterial disease "is constant in immunopathy; the atrophy of the auditory nerves could be due to arterial disease."
Larkin observes that Beethoven's portraits showed flushing in his cheeks and nose, a symptom common in lupus, and suggests that heightened color may have "aroused suspicions of heavy drinking." Take that, O'Shea!
Another popular theory is that Beethoven died of kidney failure (papillary necrosis), possibly connected to a reliance on painkillers, including willow bark (salicin, the 19th
Some folks have floated a diagnosis of heavy metal poisoning, caused by the 19th century treatment for syphilis, mercury.
That's one theory that Dr. Reiter does disprove, since mercury would still exist in the composer's hair and bones, and that metal wasn't there, unlike lead, which was, in quantities of 60ppm—100 times the normal level.
Dr. Reitner probably doesn't get to utter a David Caruso one-liner and cue the Who soundtrack, but he has added to what we know about Beethoven's death. That's no small thing.
