Wilfred Arnold
Kansas, United States

In celebration of the 200th anniversary of Chopin’s birthday

Frédéric Chopin was born near Warsaw, Poland in 1810. From 1831 he lived mostly in France, where he achieved international acclaim for his music despite a debilitating and life-shortening illness. He first began to cough up blood in 1835, and this eventually became persistent; yet his correspondence indicates that he experienced periods of alternating remission and relapse for the following fourteen years. He died in 1849, and his body was interred in Père Lachaise Cemetery, Paris. His heart, however, was preserved in cognac, sealed in a crystal urn and taken to his native Poland, where it reposes in the Holy Cross Church in Warsaw. Before burial, Dr. Jean Cruveilhier (1791-1874) performed an autopsy, the findings of which confirmed tuberculosisⁱ of the lungs and larynx, as well as cachexia.¹ Yet anecdotes from contemporaries suggested that the pathologist was surprised by greater cardiac, rather than pulmonary, involvement in the evolution of the disease. Autopsy documentation, however, was lost during the Franco-Prussian War, leading to subsequent speculations which have confused the cause of Chopin’s fatal disease.

In 1987 and again a decade later, a novel analysis of Chopin’s medical information led to the suggestion that Chopin may have suffered from cystic fibrosis.^2,3 This attracted numerous letters-to-the-editor, which for the most part supported the original diagnosis of tuberculosis. However, in 2006 a group of Polish biologists⁴ not only adopted the diagnosis of cystic fibrosis, but also attempted to justify genetic analysis on a sample of Chopin’s heart in order “to deepen our knowledge about the great Polish composer, but foremost to give hope and meaning to those who nowadays suffer from genetically inherited disorders.”ⁱⁱ Their formal request in 2008 for a tissue sample generated international attention. To date, Polish authorities have refused DNA testing on the alcohol-preserved organ as “the government said experts found the chances of successful testing were low.” The current view, indeed, is that the clinical and pathological evidence for tuberculosis remains much more compelling than that for the cystic fibrosis.

Vita

The life and legacy of Frédéric Chopin have been described in many books on his career as pianist, composer, theorist, collegial artist, and social celebrity. Chopin took his first piano lessons from Adalbert Zywny in 1817 and published his first piece of music the same year. In 1818, at the age of eight, he made his first public appearance as a pianist. From 1822 to 1829 he received music lessons from Joseph Elsner in Warsaw. He studied in Vienna 1830-1831, performed in Germany, and arrived in Paris in September, 1831. The early years were full of precocious achievement and consistent acclaim.

In Paris, he was quickly embraced and elevated by the best musical performers, composers, and aficionados of the day. He mingled in circles of established artists and writers and enjoyed support from well-placed and wealthy patrons. From 1832 until his last months, he was sought after as a piano teacher, and his pupils often helped propel his career forward. He never returned to his politically-beleaguered Poland, but he did engage in fundraising performances to aid his homeland.

In 1848 Chopin accepted invitations to England and Scotland, where he enjoyed further successes, but he returned to Paris the following year. He died there on the morning of October 17, 1849. The embalmed body was first taken to a vault of the Madeleine Church in Paris and then buried at Père Lachaise Cemetery after a thirteen-day delay.

The Chopin’s early illness

Chopin came to Paris in 1831 with letters of introduction from Dr. Johann Malfatti, an avid patron of the arts and a distinguished Viennese physician whose patients included Emperor Francis II and Beethoven.^5,6 There is nothing in the record to indicate that he considered Chopin, then twenty-one, to be in poor health or affected by the illness that would plague him in later life.⁶

But other correspondence suggests that his health was precarious. On Christmas Day, 1831, he wrote to Titus Woyciechowski, “[O]utwardly I am cheerful but inside me I am tortured with all sorts of forebodings.”⁵ Chopin does not associate the foreboding with any particular physical ailment, but subsequent letters speak of ill health with increasing frequency. When he developed hemoptysis in 1835, Chopin’s friends as well as his physicians were aware of these episodes and the possibility of consumption was frequently raised. In Paris at this time hemoptysis was not considered a sign of tuberculosis, but rather a possible forerunner of the disease,⁶ and the diagnosis was neither formally declared, nor formally acknowledged by Chopin, in spite of his own growing concern. On the other hand, the people of the island of Mallorcaⁱⁱⁱ—during Chopin’s disappointing four month rest in 1838-39 in the company of George Sand—viewed to Chopin’s illness as tuberculosis and insisted on isolation, subsequent rehabilitation of the premises, and burning of his domestic articles.^5,6

Tuberculosis versus cystic fibrosis

Tuberculosis has been known since ancient times as one of the scourges of man.^7,8 It remained a major scourge of mankind, often affecting the young in the prime of their life, so that in the year of Chopin’s death (1849), 18 percent of deaths in Paris were ascribed to tuberculosis. The suggestion of cystic fibrosis as an alternative diagnosis, first made by O’Shea² in 1981 and later supported by Kubba and Young,³ was provocative at the time but has found few supporters.

It would have been unusual for Chopin to have lived thirty-nine years with untreated cystic fibrosis, nor is the suggestion⁹ of a superimposition of tuberculosis on cystic fibrosis likely. Some scholars have suggested that recurrent diarrhea in the last year of the composer’s life was due to pancreatic insufficiency² related to cystic fibrosis. Given the evidence, however, it is more likely that Chopin suffered from tuberculous enteritis,⁶ in which the tuberculosis has spread to the bowels, an event commonly associated with chronic pulmonary tuberculosis.

O’Shea² and Kubba and Young³ claim that Frédéric Chopin had a barrel chest, a feature of a variety of respiratory illnesses (including those secondary to cystic fibrosis), but they rely upon an 1844 caricature by Pauline Viardot, which represents Chopin with a large chest but an even larger head! The arms are abnormally long; the legs are tiny. On the other hand, contemporaries were unanimous in describing Chopin as pale, frail, and very thin. Furthermore, we see no indication of an enlarged chest in the photograph by Louis-Auguste Bisson, taken towards the end of Chopin’s life.

Cruveilhier’s last advice

On July 10, 1849, Chopin wrote to his friend Wojciech Grzymala in Paris, “I am terribly weak. I have some sort of diarrhea. Yesterday I asked Cruveilhier’s advice and he prescribed nothing and merely told me to remain quiet. He said that if homeopathic [medicine] did me good in Molin’s time it was because he [Dr. Jean Jacques Molin, circa 1843] did not overload me with medicines and left a great deal to nature. But I see he [Cruveilhier] regards me as a consumptive for he prescribed a teaspoonful of something containing lichen.”⁵ Medical reference books of the 19th century listing the virtues of lichens and usage were sufficiently extensive to explain the patient’s insight. For example, an English medical dictionary¹⁰ of 1819 describes Lichen plicatus as useful for pulmonary hemorrhages. Lichen islandicus is listed as a tonic, but two consultants also recommend it for coughs and consumptions, dysentery and diarrhea, and a third praises its use in phthisis attended with haemoptoe [hemoptysis] and pituitous [mucus] discharges. Chopin was probably given Lichen islandicus. The homeopathic dose of one teaspoonful suggests that Dr. Cruveilhier offered little more than a placebo.

Chopin’s last years

In the last years of Chopin’s life, correspondence between the composer, his friends, and professional associates frequently reference hemoptysis.⁵ Chopin returned to Paris at the end of November 1848 in an exhausted state after his working tour of England and Scotland. During the preceding ten years he had weakened considerably and had developed cough and expectoration, occasional hemoptysis, emaciation, and growing shortness of breath. During the winter of 1848-1849 he was confined to his apartment and spent much of his day in bed. Several physicians made calls. In July, persistent diarrhea appeared as a new symptom, possibly a manifestation of intestinal tuberculosis, a common complication of the disease in the advanced stages. In August, he was attended by three established physicians—Pierre Louis, Jean-Gaston Blache, and Jean Cruveilhier.

Dr. Louis (1787-1872) was the most distinguished authority on tuberculosis at that time. He was already famous for his introduction of a statistical approach to the study of diseases which would be of great value in the future, but in terms of therapy, his prescriptions were plant infusions and opiates, both ineffective in saving life. Louis called in Dr. Blache (1799-1871), a pediatrician who was also recognized for his writings on phthisis. Dr. Cruvielhier (1791-1874) held the chair of pathology at the University of Paris and had a large practice in general medicine. Cruveilhier was a follower of René Laënnec (1781-1826), who suffered for 23 years from consumption. Laënnec, the inventor of the stethoscope, claimed he could detect pectoriloquy, or increased resonance, in his lungs, a sign that was almost pathognomonic for established phthisis. But even in the year of Laënnec’s death, other physicians were unable to detect this abnormality.

Chopin’s last attending physician was Cruveilhier, who made a simple procès-verbal on the cause of death for Chopin to the office of the Commissioner of Police: “tuberculosis of the lungs and larynx, and cachexia.” Cruveilhier, best known for his gorgeous two-volume atlas on human pathology,¹¹ was famous in forensic circles for his precise methods of autopsy, leaving little doubt regarding his diagnostic conclusions. But an anecdote ascribed to Franz Liszt, (1811-1886) quoting Cruveilhier as saying “Chopin’s lungs were affected less than his heart” has lead to unjustified interpretations.^2,3 Other scholars have suggested that Cruveilhier did only a partial necropsy with the primary objective of removing the heart, as requested by Chopin.⁶ For Cruveilhier, on this one occasion, perhaps Chopin’s lungs were of less interest than his heart; however his attentiveness to detail would not have allowed him to mistakenly ascribe a tuberculosis diagnosis where it did not exist.

Other concerns and resolutions

Chopin’s will has not survived, and we are reduced to filling the gaps as best we can from surviving correspondence. He wrote to his friend Wojciech Grzymala in Paris from Edinburgh on 30 October 1848: “on the day I received your good kind letter I wrote a sort of list of instructions for the disposal of my stuff in case I should happen to expire somewhere.”⁵ Shortly after Chopin’s death, Grzymala wrote to Auguste Léo, in Paris, October 1849: “our Chopin is no more . . . he gave instructions for his body to be opened, being convinced that medical science had never understood his disease; and in fact it was found that the cause of death had been different from what was thought, but that nevertheless he could not have lived.”⁵

Indeed, after the autopsy, the urn containing the heart preserved in cognac arrived in Warsaw, and according to reports in the popular press, the specimen has been viewed only during periods when it has been removed from the church for safeguarding during World War II, and at no other time. Technically, the tissue in the urn should be suitable for nucleic acid analyses, but societal and religious reasons against invasion of the relic have been made. I would like to suggest that gross inspection of the unopened urnⁱⁱⁱⁱ might reasonably be authorized and might indicate, for example, tuberculous pericarditis.¹² Perhaps this is what Jean Cruveilhier might have observed on Chopin’s heart, leading to the anecdote of the heart being more involved than the lungs!

Acknowledgements

The book⁶ by Esmond R. Long (1890-1979) provided much insight for this essay. It evolved from his 1956 lecture at Kansas University Medical Center. At that time he was director of the Phipps Institute for the Study, Treatment and Prevention of Tuberculosis, University of Pennsylvania—established in 1903 with a grant from Henry Phipps, a former business partner of Andrew Carnegie. While a second-year medical student, Dr. Long experienced his first severe pulmonary hemorrhage and identified the tubercle bacilli in his sputum, in his own laboratory.¹³

Pursuit of literature was facilitated by Dawn McInnis of our Logan Clendening History of Medicine Library. Dr. Enrique Chaves and Dr. Loretta Loftus provided valuable medical insight.

Notes

1. In this essay, older names such as “phthisis” and “consumption” have been retained in quotations, and on occasion have been used for historic flavor but should be read as synonymous with the 20th century term of tuberculosis.
2. To suggest that discovering a famous person with the same disease would bring understanding or solace to current patients seems to the author to be a specious argument.
3. They were indeed following the Italian influence about contagion, formally dated to an edict from the Republic of Lucca in 1699, which turned out to be accurate.
4. There would also be considerable interest in the general condition of the relic, without the societal and religious concerns of taking a sample of tissue.

References

1. Hedley A. Chopin. rev. ed. Brown MJE. London: Dent; 1974. [First published 1947, rev. 1963]
2. O’Shea JG. Was Frédéric Chopin’s illness actually cystic fibrosis? Med J Aust. 1987;147:586-589.
3. Kubba AK, Young M. The long suffering of Frédéric Chopin. Chest 1998;113:210-216.
4. Majka L, Gozdzik J, Witt MJ. Cystic fibrosis—a probable cause of Frédéric Chopin’s suffering and death. Appl Genet. 2003;44:77-84.
5. Hedley A. Selected correspondence of Fryderyk Chopin. London: Heinemann; 1962.
6. Long ER. A history of the therapy of tuberculosis and the case of Frédéric Chopin. Lawrence: University of Kansas Press; 1956.
7. Flick LF. Development of our knowledge of tuberculosis. Philadelphia:Wickersham; 1925.
8. Waksman SA. The conquest of tuberculosis. Berkeley: University of California Press; 1964.
9. Persson, Wikman B, Strandvik B. Frédéric Chopin — the man, his music and his illness. Przegl Lek. 2005;62:321-325.
10. Parr B. London Medical Dictionary. Philadelphia: Mitchell Ames White; 1819.
11. Cruveilhier J. Pathologic anatomy of the human body. [Anatomie pathologique du corps humain.] Paris: JB Bailliere; Tombe I: 1829-1835; Tombe II: 1835-1842.
12. Burrows, G. On tubercular pericarditis, with pathological and practical remarks. Med Chir Trans. 1847;30:77-93.
13. Stowell RE. Esmond R. Long, MD, 1890-1979. Am J Pathol. 1980;100:321-325.