IN THE NEWS: Death by "Modern Medicine"

New research suggests that, far from dying of natural causes, Ludwig van Beethoven was hastened to his end by his doctor. And he is not the only prominent figure to have suffered such a misfortune. Tony Paterson reports 30 August 2007

By the standards of today's medicine, Ludwig van Beethoven's death was a horrible and degrading affair. On 26 March 1827, the deaf composer met his end after spending more than four months in agony lying on a filthy straw mattress in a Viennese apartment, his skin jaundiced yellow from the liver cirrhosis he had contracted. He was 56.

In the days that followed, Beethoven's friends and admirers made pilgrimages to the open coffin bearing the body of the great composer to pay their respects. As was the custom in the early 1800s, several removed locks of their dead friend's hair as keepsakes.

The surviving brittle grey strands, 180 years on, that were sheared from Beethoven's head have provided new and convincing evidence that the composer did not die as a result of his worsening illnesses. He appears to have been killed – albeit inadvertently – by his own doctor.

"Beethoven's death was due to the treatments he was given by his own physician," said Christian Reiter, a forensic scientist and author of a new study on Beethoven's hair, yesterday. "The treatments amounted to lethal doses that permeated Beethoven's ailing liver and ultimately killed him," he added.

The locks have their own story. Back in 1989 a group of American Beethoven enthusiasts bought some of the hair at an auction held by Sotheby's. Then 160 strands were handed over to San Jose State University, California. Scientific research on those locks established that, among his other ailments which included deafness and cirrhosis, Beethoven also suffered from lead poisoning which may have contributed and ultimately led to his death. This fact was further underlined following scientific analysis of the composer's remaining bones two years ago which also pointed to lead poisoning.

It was not until the San Jose locks were placed in the hands of Mr Reiter in Vienna late last year that another additional cause of Beethoven's death – namely the composer's physician – began to emerge.

Mr Reiter went to Vienna University's Institute for Chemical Analysis, which has decades of experience in forensic research on hair, to study the locks. The strands were exposed to a microscopically thin laser beam. The resulting smoke was put through a spectrograph and analysed.

Two of the hairs provided evidence of the last 267 days of Beethoven's life, but it was the final 111 days that produced the crucial findings that support Mr Reiter's theory that the composer was inadvertently killed by his own physician.

Beethoven's demise started around 1796, aged only 25, when he began suffering from a severe form of tinnitus, a ringing in his ears that made it difficult for him to listen to, let alone appreciate music. By 1802, his condition was so severe total deafness was certain.

Ironically, it was the composer's decision in that year to move to the small Austrian town of Heiligenstadt, where he wrote an impassioned testament or public letter on his condition, that led to the subsequent extensive research into his illnesses and ultimately the causes of his death. Unusually for that era, Beethoven gave permission in his will for his remains to be handed over to medical research so that the causes of his debilitating illnesses might be established.

After Heiligenstadt, the 32-year-old Beethoven resolved thereafter to continue living for his art. However, by the time of his Ninth Symphony, his deafness was advanced. Eyewitness accounts of the premiere report that the composer had to be turned around on his chair to witness the tumultuous applause that followed the performance. Beethoven could hear nothing and wept tears of frustration.

His hearing loss did not affect his ability to compose music, but his role as a pianist, from which he gained much of his income, was increasingly handicapped. Even when composing, he used a rod attached to the soundboard of his piano which he could bite, enabling him to feel the vibrations of the notes he played and increase his perception of his own music.
By 1814, aged 44, Beethoven was totally deaf and forced to keep "conversation books" in which friends wrote down what they were saying to him. He often responded in writing. Today the composer's conversation books provide a vital insight into how he felt his music should be played.

As well as being deaf, Beethoven never married. His father objected to the only woman he was engaged to and his only other recorded love affair lasted for just two years. By the late 1820s, drinking heavily and after losing custody of his nephew Karl, he went into physical decline that eventually led to his death during a thunderstorm in Vienna in March 1827.
The composer had been spending October and November of 1826 in the small Austrian town of Gneixendorf. Records show that, at around this time, Beeth-oven had developed a liking for sweet Mosel wines. Research has shown that this could have also contributed to his illnesses: at the time vintners adopted the habit of "refining" their produce with a "sugar" containing lead particles that sweetened the taste of otherwise dry wines.

At the end of November he began his return to Vienna, travelling in an open, horse-drawn carriage in wet weather. He spent one night of his return journey soaking wet from a downpour, in an unheated room at an inn.

By early December 1827, he had pneumonia. A physician called Andreas Wawruch began treating him. His medical notes give details of an "anti-inflammatory" substance that was meted out to the composer to reduce his ailing lungs. Unfortunately, the substance had debilitating side effects.

Lying on a dirty straw mattress, Beethoven's stomach began to fill up with liquid that had apparently drained from his sickly lungs. The volume of fluid was so large it constricted his diaphragm to such an extent that he had severe breathing difficulties.

In order to relieve this condition, Wawruch was forced to pierce the bloated stomach with a lancet in order to drain off litres of fluid. Such methods were dangerous as they risked causing an infection of the patient's stomach which, without antibiotics and proper sterilisation, would have led to almost certain death.

Analysis of 19th century medicines shows that doctors used lead salts to treat lung infections as these were effective in reducing fluid build-up. In general, lead, mercury and arsenic functioned as the antibiotics of the time. Their side effects were considered the lesser evil. Yet for Beethoven, lead appears to have been the primary evil.

According to Mr Reiter's latest findings, the side effect of Wawruch's decision to give Beethoven lead salts was a critical overloading of the composer's cirrhosis-wracked liver which reacted by producing more fluid build-up. Wawruch responded by lancing the stomach to draw off the fluid and applied a lead-paste poultice to the wound – designed to ward off infection.

Mr Reiter's detailed laser analysis of the surviving hairs provided a daily diary of the last three months of life. Beethoven was given four abdominal punctures on his death bed which drained between 7.7 and 14 litres of fluid. Mr Reiter's hair analysis showed a clear correlation as the lead content in the composer's hair rose dramatically after each puncture.

"Dr Wawruch was acting to the best of his knowledge and with a clear conscience, according to the medical standards of the time," Mr Reiter said yesterday, "but as soon as the body began to reabsorb the lead from the poultices, terminal liver failure could no longer be prevented. The lead doses were not poisonous enough to kill a healthy person, but what Wawruch clearly did not know was that his treatment was attacking an already diseased liver."

Yet exactly what caused Beethoven to be poisoned with lead even before Wawruch's treatments has still to be finally established. Some attribute the cause to lead-"sugared" wine, others claim that as a young man the composer drank large amounts of lead-contaminated spa water. "We do not know the ultimate cause – but for years before his death Beethoven was a very sick man," Mr Reiter said.

Other medical mishaps:

Thomas Chatterton (20 November 1752 to 24 August 1770)
The gifted young poet, called "the marvellous boy" by Wordsworth, was widely assumed to have committed suicide by taking arsenic because he was too proud to beg for money or food. However, recent research suggests the poison may have been administered to the 17-year-old Chatterton in an attempt cure a sexually transmitted disease.

Napoleon Bonaparte (15 August 1769 to 5 May 1821)
The exiled Emperor of France died on the island of Saint Helena, with the most widely accepted cause of his death being stomach cancer. However, US research suggests it may have been a treatment by doctors that killed him. Doses of the poisonous salt tartaric acid, also called antimony potassium tartrate, were administered to induce vomiting. However, these would have caused a severe potassium deficiency that might have led to him developing Torsades de pointes, a potentially fatal heart complaint that disrupts the blood flow to the brain.

Johann Sebastian Bach (21 March 1685 to 28 July 1750)
Bach's eyesight began to deteriorate in his later years, so he called on the services of ophthalmologist John Taylor. Taylor carried out two operations on Bach's eyes, both of which were unsuccessful and left the composer completely blind and with failing health. His death less than a year later is seen as a direct consequence of these botched operations.

James Garfield (19 November 1831 to 19 September 1881)
The 20th US President was shot twice by Charles Guiteau, a religious fanatic, but neither bullet which hit him caused his death. Alexander Graham Bell invented a metal detector specifically to locate a bullet lodged in Garfield's spine but it was rendered useless by the patient's metal bed frame. Surgeons instead tried to search for the bullet invasively, using dirty metal tools which poisoned the President's blood and killed him.

George Washington (22 February 1732 to 14 December 1799)
The first US President contracted a vicious sore throat and breathing problems after riding his horse in freezing weather. He died two days later. Modern doctors have diagnosed acute inflammation of the epiglottis. However, Washington's condition was almost certainly exacerbated by having 3.75 litres of blood – more than half his blood volume – taken by physicians in the space of ten hours.