What Killed the Great and Not So Great Composers?

      What killed Mozart? What caused Beethoven’s deafness? Did Schubert die of advanced syphilis? Was Gershwin’s brain tumor malignant? These and similar questions have been raised about various illnesses suffered by some of the great classical musicians, but surprisingly, many remain unanswered. Why should this be such a continuing problem?

      Recollections of past events, unless carefully documented and verified, often have a tendency to blur, fade and even disappear with time. To put together the medical histories of composers who lived hundreds of years ago, one must contend with missing or destroyed factual material, statements no longer verifiable and the general ignorance of medical matters prevalent in earlier times. Retrospectively constructing a medical history is akin to piecing together a complicated jigsaw puzzle. If all pieces are present, a bit of skill and patience eventually allows assembly of individual parts into a recognizable picture of a composer’s ailments. However, lost or distorted factual material and the difficulty of sorting out historical details can lead to a skewed or erroneous view of a subject’s medical story. When sifting through the maze of available historical material, the old admonition caveat emptor should be invoked but modified to convey a slightly different warning: let the reader (and writer) beware of unsubstantiated facts.

      While primitive recordings of medical matters can be traced back to cave graffiti from the Upper Paleolithic Period (between 40,000 to 10,000 years ago), systematic patient-oriented medical records were not widely accepted or used until the 20^th century. Many illnesses experienced before this time were treated at home, where little or no permanent documentation of methods or outcomes survived. Most information about ailments of composers who lived centuries ago has been pieced together from available letters, memoirs, diaries or other pertinent documents. Prior to the advancement of medical technology in the mid-to-late 19^th century, physicians relied primarily on their physical diagnostic ability, a skill frequently limited by inconsistency and error. Autopsies performed in earlier times often were restricted by the expertise of individual prosectors and the technological advancements available to them. Some of these post mortem examinations, because of these shortcomings, generated as much controversy as enlightenment.

      Fortunately, a good number of musicians carried on a lively correspondence with relatives and acquaintances, penning in detail their indispositions and injuries. Occasionally, descriptions of illnesses were recorded decades after the fact, raising the possibility that time distorted some of the memories. In a number of instances, details appear to have been significantly altered to either enhance or detract from the perception of a composer’s stature or to exaggerate the writer’s association with that person. During the last decade of Ludwig van Beethoven’s life, questions and comments from friends and colleagues were written in conversation books to facilitate communication with the deaf composer (see Chapter 7). After Beethoven’s death, his “biographer” and sometime valet Anton Schindler destroyed a number of these volumes (some say as many as half) and altered others so that a somewhat idealized portrait of his employer might be perceived from the extant copies. Barry Cooper in his Beethoven Compendium writes that “... [Schindler’s] propensity for inaccuracy and fabrication was so great that virtually nothing he has recorded can be relied on unless it is supported by other evidence...”

      To cloud the picture further, descriptions of potential factors responsible for Beethoven’s terminal illness seemed to vary from individual to individual. The composer died of liver failure complicating cirrhosis, a disease often associated with alcohol abuse. Although many factors contribute to liver injury, the degree of alcohol consumption, if pertinent, also becomes a major issue in the progression of the disease. Karl Holz, one of the composer’s friends, commented: “... he drank a great deal of wine at table, but could stand a great deal, and in merry company he sometimes became tipsy.” In an 1827 conversation book entry, Schindler countered: [Holz] said… that you always drink more than a quart of wine at lunch, and other untruths.” Dr. Andreas Wawruch (1773-1842), who attended the composer in his last days, stated: “... At no time accustomed to taking medical advice seriously, [Beethoven] began to develop a liking for spirituous beverages, in order to stimulate his decreasing loss of appetite and to aid his stomachic weakness by excessive use of strong punch and iced drinks...” The valet apparently removed some of the unflattering entries made by Wawruch during the final stages of the composer’s illness. Schindler influenced Franz Wegeler, Beethoven’s boyhood friend from Bonn, to write: “By and large Beethoven lived very moderately, and as far as I know, not one of his friends and acquaintances ever saw him intoxicated.” Was Beethoven an alcoholic whose destructive habit resulted in cirrhosis, or did he drink in moderation, dying from an otherwise indiscernible injury to the liver? The answer probably never will be known with any certainty. The truth undoubtedly lies somewhere between these two extremes. Similarly disputed or altered details littering other composers’ medical histories must raise flags of caution when they are used to bolster pet hypotheses about causes of illness and death.