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Illness of Frederic Chopin

The illness of Frederic Chopin and the cause of his premature death in the age of 39 remain a mystery. Although the composer was diagnosed with the tuberculosis and treated for this disease, since his death in 1849 many alternative diagnoses were proposed.

History of disease
Frederic Chopin was frail and unhealthy since early childhood. He was under the guidance of physicians from an early age. In the early adolescence he developed intolerance of fat meals (particularly pork): it caused abdominal pain, diarrhoea and the loss of weight. Later in his life he avoided these symptoms by diet of honey and bran. Chopin was 170 cm high (25. percentile) and in the age of 28 he weighed 45 kg (under the 3. percentile).

It’s known that in the age of 22 he had no facial hair: as he wrote in the winter of 1832, he had only one-side whisker. In 1826 he suffered from six month long sickness, with the swelling of the neck lymphnodes and headaches. In 1830 a protracted cold caused a swelling of his nose, which contributed to the cancellation of his performances in Vienna. In Paris in 1831 21-age old composer had his first episode of haemoptysis. During two months of 1835 he was seriously ill because of laryngitis and bronchitis, and the cessation of his correspondence with Warsaw in this time was the source of the rumors of his death. In the early adulthood he began to be treated with belladonna. The cough, from which he had suffered for years, was treated in the last decade of his life with opium on sugar. The cough produced a large amount of sputum, particularly in the mornings, about 10 a.m. . The pianist drank alcohol occasionally, he smoked sometimes, and - as some authors noticed - he was exposed to passive smoking while spending time with his Parisian friends. In the last year of his life he suffered from untreatable diarrhoea, due to cor pulmonale or exocrine pancreatic insufficiency (see below)

On October 17, 1849, 2 a.m., after a sudden attack of cough, Chopin died in his 39 year. Jean Cruveilhier confirmed the death of composer, holding a mirror to his mouth and illuminating the pupils with a light of a candle. Under the will of deceased he carried out the autopsy. The report from postmortem examination was destroyed during the II WW or in the fire of Paris in 1871; it’s known, that the death certificate gave the tuberculosis of lungs and larynx as the cause of Chopin’s death. The conclusions from this report are second-hand. Wojciech Grzymała in his letter to Auguste Leo dated on October, 1849 wrote, that the autopsy didn’t confirm the tuberculous changes in the lungs, and that the disease of composer wasn’t known to contemporary medicine. The results of post-mortem examination were known also to Ludwika Chopin, Adolf Guttmann and Jayne Sterling, and their communciations on this were consistent with the conclusions cited above.

Chopin’s physicians
The number of physicians taking care on Chopin is not certain; various authors put up the number of 14, 31 or "nearly 50" doctors. Besides, the composer had friendly relations with some other physicians, which may ocassionally provide him with the professional help.

In Warsaw the physicians of Chopin were Jan Fryderyk Wilhelm Malcz, Franciszek Girardot and Fryderyk Adolf Roemer. In Vienna the medical care to Chopin was provided by Johann Malfatti. Among physicians of Chopin in Paris were Aleksander Hofman, Jean-Jacques Molin, Andre Francois Cauviere, Jan Matuszyński, Adam Raciborski, Pierre Gaubert, Gustave Papet and Coste. During his 1848 stay in London – Mallan and James Clark. In Paris in the years of 1848 and 1849 he was treated by Léon Simon, Fraenkel, David Koreff, Louis and Roth. The last physician of Chopin was Jean Cruveilhier.

Family history
Little is known about the health of Frederic’s father. Mikołaj Chopin lived up to age of 74, and he had several times respiratory infections. The mother had no chronic illness and has achieved the age of 87. Of three Frederic’s sisters, Izabela died in 70 and had no illness; Ludwika suffered from recurrent respiratory infections and died in 47; the youngest Emilia was of frail health since an early age. She suffered from recurrent cough and dysponea. Since 11 she started to have haemorrhages from upper gastrointestinal tract and she died because of a massive hemorrhage in the age of 14.

Tuberculosis
During his life Chopin was diagnosed with tuberculosis and treated for this disease accoriding to contemporary views: with bloodletting and purging, among others The diagnosis of tuberculosis infection was figured out in his death certificate, despite (allegedly) the lack of typical organ changes. The critics of the alternative hypotheses regarding the disease of Chopin point out the abundant evidence for the tuberculosis. Chronic cough and haemoptysis are common symptoms of the tuberculosis; its complications may be both pericarditis, causing right-heart insufficiency, and bronchiectasis, manifesting with productive cough and respiratory failure.

20-years history of haempotysis is rare observed in the tuberculosis, but not impossible; similiarly, cavernous tuberculosis is rare in childhood, but cannot be excluded in the case of Emilia Chopin. Frederic could contract tuberculosis from his younger sister. Against the diagnosis of phthysis stand the fact that some physicians taking care on Chopin did not diagnosed him with this common and well-known disease. The argument against this hypothesis would be also lack of organ manifestations typical for tuberculosis in the Cruveilhier’s report and coexisting gastrointestinal symptoms, that could not be explained with tuberculosis.

In the monograph on the historical methods of treatment of tuberculosis, individual treatments were discussed on the case of Frederic Chopin, bacause his history of disease well illustrated the contemporary views on tuberculosis treatment in the middle of XIX cetury.

Cystic fibrosis
The hypothesis that Chopin suffered from cystic fibrosis was presented for the first time by O’Shea in 1987. It was supported and popularised by physicians from the Medical University in Poznań. Arguments for cystic fibrosis as the main cause underlying Chopin’s complaints are: the onset in early childhood, possible familial occurence (Emilia), gastrointestinal symptoms, intolerance of fat-rich meals, recurrent infections of lower respiratory tract, also suppurative, with exacerbations in winter, recurrent infections of upper respiratory tract (laryngitis, sinusitis), barrel-shaped thorax (visible on some photographs and cariactures), low tollerance of exercise, the episode of heatstroke (more frequent among the people with CF), caries (more pronounced in the course of this disease), putative infertility. There is no evidence for the clubbed fingers - the symptom of hypertrophic osteoarthropathy, frequent in the cystic fibrosis – but the arthralgia of hands and ankles in his last year of life mat be related to this condition. It was suggested, that Chopin suffered from milder form of CF, with the course worsened by coexisting tuberculosis or other mycobacteriosis. The confirmation of this hypothesis could be obtained with exhumation and genetic tests of preserved body tissues, but so far scientists were not granted with permission to obtain samples of the heart of composer, kept in the Warsaw Church of the Holy Cross.

Alfa1-atitripisin deficiency
The hypothesis on the Alpha 1-antitrypsin deficiency was presented by Kuzemko in 1994. According to this hypothesis the deadly hemorrhage of Emilia was caused by ruptured esophageal varices secondary to liver cirrhosis in the course of alfa1-antitripsin deficiency. The Frederic's symptoms of liver insufficiency would be hypoproteinemia, feminisation features (no facial hear) and gastrointestinal bleedings. His death would be explained by liver failure and respiratory failure due to chronic obstructive pulmonary disease.

The supporters of cystic fibrosis hypothesis argued against some statements of Kuzemko, showing, that cystic fibrosis explain Chopin’s symptoms as well. Kuzemko himself admitted that typical symptoms of liver cirhosis in the course of alfa1-antitripisin deficiency would be jaundice and ascites.

Kuzemko’s hypothesis was recalled by Reuben and Eriksson in 2003.

Mitral stenosis
Mitral stenosis as possible, but not very reliable cause of the artist’s complaints was discussed by Kubba and Young in 1998. The most important argument against this hypothesis is the lack of evidence that Chopin suffered in childhood from the rheumatic fever, the most common cause of mitral valve stenosis.

Other diseases
Kubba and Young pointed out a number of diseases, besides cystic fibrosis and alfa1-antitripsin deficiency, which could serve as possible but unlikely diagnoses: Churg-Strauss syndrome, allergic bronchopulmonary aspergillosis, hypogammaglobulinemia, idiopathic pulmonary haemosiderosis, lung abscesses, pulmonary arteriovenous malformations.

Infertility
Chopin was sexually active since early adulthood, however, he left no descendant. Some authors consider this as the premise to his infertility which would strengthen the cystic fibrosis hypothesis.

Depression and other mental conditions
The biographers of the artist write often about his depression, however, this issue was rarely undertook by psychiatrists. One of the few studies on Chopin’s mental condition is Onuf-Onufrowicz 1920 work. The author presented statements of composer’s biographers concerning his character and psyche, and pointed out some symptoms which may indicate the manic-depressive disease (today bipolar disorder) and dementia praecox (today schizophrenia), emphasizing, however, the lack of information on the symptoms of severe psychosis and the fact that the single symptoms may only suggest the predisposition to these mental ilnesses.