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   Vienna, around 5:45 p.m. on Monday, 26 March 1827: Ludwig van Beethoven dies at the age of 56. The death certificate records the cause of death as “abdominal dropsy“.

In the morning of 27 March, an autopsy was performed. The report lists, among other things, a massive oedema of the abdomen, a fully developed cirrhosis of the liver and - after the head had been sawn open - the removal of the inner ears. These remained undiagnosed and soon got lost forever.

Beethoven’s corpse was laid out for three days, and amongst those who were allowed to see it was a fifteen-year-old student of music, who snipped a lock of the master’s hair, which belongs to four members of the American Beethoven Society today.1 

Beethoven’s grave at the Währinger cemetery was then dug up twice - the first time in 1863 when he was reburied, and a second time in 1888 when his remains were transferred to his honorary grave at the central cemetery of Vienna.

At the first exhumation, the skull was found in nine fragments that had to be reassembled first before a replica of the skull could be made. A professor for history of medicine, who took part in this procedure, somehow came into possession of two skull fragments, which are now owned by his descendants in the USA.

In 2005, the cranial bones and the hair were matched by DNA tests.

Already in 1996, tests showed the hair to contain approx. 80 times the normal concentration of lead, and the examination with very powerful x-ray beams of a skull sample in 2005 provided solid evidence that Beethoven suffered from a toxic overload of lead since his early twenties.2 

In 2007, the Department of Analytical Chemistry of the University of Natural Resources in Vienna examined three of Beethoven’s hairs more closely: two hairs (1.57 in. and 3.66 in. with roots) from the USA and one 5.9 in. long hair from the Beethoven memorial in Vienna-Jedlesse.
The tissue was exposed to a microscopically thin laser beam to vaporize it, and the smoke was then analysed with a mass spectrograph. As it turned out, the lead in the hairs is not uniformly distributed: There is no contamination with lead at all from the ~425th until the ~360th day; in the period between the ~360th and the ~200th day there are several sections with lead; then again there are approx. 60 days with no traces of lead - and finally in the last ~111 days before Beethoven’s death there are many excessive concentrations of lead.

Besides that there are no traces of cadmium nor mercury nor of painkillers like opium, which could have eased Beethoven’s distressful end. From the researcher’s point of view, this determines that Beethoven did not suffer from syphilis, usually treated with mercury compounds in those days.

Regarding the origin of the lead in his bones, one can only speculate. It could have been that Beethoven had a metabolic disorder that prevented him from excreting the lead - and then he had many opportunities to poison himself: water pipes made of lead, China ware and pewter ware contaminated with lead, leaden bottle caps, wine sweetened with sugar of lead, lead-containing medicines, etc.3 

However, lead was certainly not the only reason for Beethoven’s life-long diseases. His abdominal ailments and mood swings are symptoms that match those of lead poisoning, but in cases of severe lead poisoning a loss of hearing4 is only rarely documented, whereas motor dysfunctions of the extremities commonly occur - which was not the case at Beethoven, the piano virtuoso.

Beethoven’s deafness could rather be explained as an unhealed inflammation of the middle ear, or as a labyrinth disease, which had its origin in the brain...

The reason for his cirrhosis of the liver - that naturally had been hastened by his alcohol consumption - was presumably his viral hepatitis, which he had contracted in 1821 and never completely recovered from.

Stone-deaf and weakened in body and soul, Beethoven launched into his last ~111 days: At the beginning of December 1826, he came down with severe pneumonia, which the physician Dr Andreas Wawruch apparently treated with lead salts that have an expectorant effect.5 A massive accumulation of fluid in the abdominal cavity developed as a side effect, with the result that the patient could “hardly breathe”. Consequently, the abdomen had to be perforated in order to drain the fluid (24.3 pints)6 - which was very risky as it could cause peritonitis that was invariably fatal in those days. Between 20 December and 27 February, as many as four punctures had to be performed, and the wounds were presumably covered with a lead-containing ointment to prevent infection.7 

In the early evening of 24 March, Beethoven fell into a coma, and two days later he was dead.8 

Now, by comparing the peaks in the hair’s lead concentration to Beethoven’s medical history, the chemical analyses indicate that there was a massive rise in the lead concentration in Beethoven’s hair when the physician started to treat the pneumonia and every time when a puncture was performed.9 For Beethoven’s cirrhotic liver, this was soon too much . . .

Ergo: “Although Dr Wawruch had acted according to his best knowledge and conscience and according to the contemporary state of medicine, he had nevertheless thereby caused Beethoven’s death.” (Diagnosis: Univ.-Prof Dr Christian Reiter, head of the Department of Forensic Medicine at Vienna’s Medical University.)10

1 Artist made sketches of Beethoven’s head as well as a death mask and plaster casts of his hands. Two artists and several dependents cut hair from his head. Locks of hair attributed to Beethoven are located in the Library of Congress, Washington, D.C.; the University of Hartford, Connecticut; the British Library, London; the Beethoven-Haus, Bonn; the Gesellschaft der Musikfreunde, Vienna . . .
2 See the website of the Ira F. Brilliant Center for Beethoven Studies, San José State University, California, USA.
3 Although it was already illegal, sugar of lead [lead(II) acetate] was widely used to sweeten sour wines. Despite of its recognized toxicity, lead acetate was used in the treatment of cholera, dysentery, diarrhoea, bronchitis, asthma, whooping-cough, pneumonia, skin diseases, boils, wounds, etc. Beethoven was not an alcoholic, but he liked drinking, and he had a preference for sweet wines. His abdominal ailments were treated with various remedies . . .
4 Beethoven’s hearing gradually deteriorated beginning in his late twenties, and from 1818 on, he was stone-deaf. Conversation with Beethoven had to be conducted largely with the aid of writing. He spoke, but his dialog partners had to write down their questions and answers in his “conversation books”.
5 Sadly, Dr Wawruch's medical review gives no details of his "strong anti-inflammatory medical treatment". It is not possible to "prove" what he actually administered to Beethoven, but considering the practices of his time, one can assume it was lead-containing medicine. Only assume. But the lead is there, and the credit belongs to Prof Reiter for showing that the lead concentrations in Beethoven’s body correlate with the therapy by his doctor.
6 A baby shortly before birth - including the placenta, the umbilical cord and the amniotic fluid - equates approx. 15 pints.
7 The puncture was performed by the surgeon Dr Johann Siebert who also took care of the bandages. During the night, the bandages slipped off, and the wound became inflamed. Dr Wawruch treated it successfully by "keeping it meticulously dry". There were no such complications following the three other operations (all performed by Dr Siebert). Sadly, Dr Siebert left no report, and this is why Prof Reiter cannot present the "proof" that a lead-containing ointment was applied to Beethoven's wounds.
8 In the morning Beethoven was given his last rites, and around 1 p.m. the shipment of fine Mosel wine from Germany arrived. Beethoven, looking at the bottles, mumbled his last reported words: “Pity, pity - too late!” [The day before he had shocked his contemporaries with the request: Plaudite, amici, comedia finita est!" ("Applaud, my friends, the comedy is over!")] Late in the afternoon he lost consciousness, and during the remaining two days he emitted a dreadful death rattle . . .
9 With hair there is the problem of contamination from outside material such as shampoos. There is also the possibility that medicine has the effect of unbinding old lead stored in the bones for years. Samples from hair analysis are not considered very reliable, but Prof Reiter’s research is as accurate as it can possibly be.
10 See the Reiter Article on the Internet or The Beethoven Journal, vol. 22, No. 1, 2007 (American Beethoven Society).

Shortly after the article had been published in August 2007, a number of reports appeared in the popular media: 
Who Killed Beethoven News
The Washington Post
The Independent 

And of course, it didn’t take long for some scholars to enter their objections:
Was Beethoven Lead-Poisoned?


Comment

   Brilliant, Professor!
But „according to his best knowledge and conscience“ - that can’t be left as it is.

Dr Wawruch wasn’t Beethoven’s general practitioner; Dr Wawruch was called after two other physicians had refused to come. Beethoven had alienated numerous doctors and, in the hour of need, he put himself at the mercy of this Dr Wawruch, who describes his condition as follows: “I found B. afflicted with grave symptoms of inflammation of the lungs; his face glowed, he spat blood, when he breathed he threatened to choke, and a shooting pain in his side only allowed him to lie in a tormenting posture flat on his back . . .

What the man doesn’t mention is the fact that Beethoven’s abdomen was severely swollen and his skin and his eyes were jaundiced yellow even at this stage. During his first visit on 5 December, Dr Wawruch may have overlooked this fact, but according to his medical review, he noticed it on 12 December at the latest: ". . . his feet were tremendously swollen. From this time on dropsy developed, the segregation of urine became less, the liver showed plain indication of hard nodules, and there was an increase of jaundice."I

Dr Wawruch knew about the side effects of his medicine, and he was aware that it was attacking an already diseased liver, but he wouldn’t change the treatment.II

Beethoven’s nephew Karl described Dr Wawruch as „aloof & unconcerned”. His uncle, he reported, disliked Wawruch and during a home visit even called him “ass”.III

Sadly, one will never know why Beethoven didn’t ask for another physician . . .IV

When the advancing dropsy heralded the failure of the organ, it was too late in any case. Beethoven’s abdomen had to be punctured and the wounds covered with a lead-containing ointment. Heavy metals such as lead, mercury and arsenic took the place of antibiotics; their toxic side effects were seen as a lesser evil when compared to peritonitis.
A good physician, however, would have treated Beethoven’s pneumonia with herbal remedies . . .

In short: Ludwig van Beethoven received the wrong remedy at the wrong time from the wrong doctor; i.e. this "ass" sent Ludwig van Beethoven to kingdom come.

A murder conspiracy? Nonsense. What killed Beethoven was carelessness and stupidity or maliciousness.

I Beethoven's “swollen abdomen and ankle oedemas” had already been noted by his brother Johann that autumn (diary). Since he visited him every day, Dr Wawruch must have recognized Beethoven’s general state of health before 12 December.
II Anton Schnindler, Beethoven’s secretary and first biographer, reported that Dr Wawruch ruined the master with too much medicine (“75 bottles and various dry chemicals until mid January”). Gerhard von Breuning, Beethoven’s young friend and biographer, also complained about Wawruch’s overload of drugs.
III Beethoven’s biographers may have given conflicting and sometimes even phony information, but they all agreed that Beethoven and Dr Wawruch had a miserable relationship. Sadly, more documents are missing because the conversation with Beethoven on his deathbed was largely conducted by means of a slate.
Beethoven as I Knew Him (Anton Schindler)
Impressions by His Contemporaries 
IV In January, Beethoven called for Dr Johann Malfatti, who had been his friend and physician until they parted because Beethoven thought he had been mistreated. Dr Malfatti came for a visit and prescribed punch ice cream that seemed to be helpful for a few days. But by then Beethoven was already in a state beyond recovery, and Dr Malfatti was not prepared to start an argument with Prof Dr Wawruch.
Sketch by Joesph Danhauser (28 March 1827).
Copper engraving by unknown artist.
Prof Dr Andreas Ignaz Wawruch (1782-1842), Professor of Pathology and Therapy of Internal Illness at Vienna University, director of the medical clinic for surgeons in Vienna, member of the Imperial Medical Society, author of several scientific publications on infectious pathology and parasites, a jolly good cellist . . . . Shortly after his death, his Medical Review on the Final Stage of L. van Beethoven’s Life (dated 20 May 1827) was first published in the Vienna Magazine for Art, Literature, Theatre and Fashion.


Antithesis 

   Sadly, the poor doctor hasn't a chance to defend himself.
Beethoven was deadly sick by the time Dr Wawruch arrived. Who wants to blame this reputable representative of the art of healing? Who can say whether Beethoven would have survived the pneumonia without his damn medicine?
Probably, somebody should rewrite the whole story.
Title: The Twilight of a Titan.
First line: “Pity, pity - too late!”

Reportedly, Dr Wawruch was called by Beethoven’s friend, the violinist Karl Holz. On 5 December, Beethoven wrote a letter to Holz, asking for attendance and leaving behind this little musical score:
We all err, but each one errs differently.
Lyrics: Georg Christoph Lichtenberg (1742-1799)

Top: Beethoven portrait by Carl Friedrich August von Kloeber, 1818
ISBN 978-3-9502548-4-6

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