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Journal Issue: 
Volume 36: Issue 3: 2006




There  is  dispute  about  the  cause  of  Beethoven’s  death;  alcoholic cirrhosis, syphilis, infectious  hepatitis, lead  poisoning, sarcoidosis  and  Whipple’s disease  have  all  been  proposed.   In  this  article  all  primary  source  documents related  to  Beethoven’s  terminal  illness  and  death  are  reviewed.  The  documents include his letters, the report of his physician Andreas Wawruch, his Conversation Books, the autopsy report, and a new toxicological report of his hair. His  terminal  illness  was  characterised  by  jaundice,  ascites,  ankle  oedema  and abdominal pain. The autopsy data indicate that Beethoven had cirrhosis of the liver, and probably also renal papillary necrosis, pancreatitis and possibly diabetes mellitus.
His lifestyle for at least the final decade of his life indicated that he overindulged in alcohol in the form of wine. Alcohol was by far the most common cause of cirrhosis at  that  period.  Toxicological  analysis  of  his  hair  showed  that  the  level  of  lead  was elevated.   During  the  eighteenth  and  early  nineteenth  centuries, lead  was  added illegally to inexpensive wines to sweeten and refresh them.  These findings strongly suggest  that  liver  failure  secondary  to  alcoholic  cirrhosis, associated  with  terminal spontaneous bacterial peritonitis, was the cause of death. This was complicated in the end stages by renal failure. If the presence of endogenous lead was verified by analysis of Beethoven’s skeletal remains, it would suggest that the lead was derived from wine that  he  drank.  Lead  poisoning  may  account  for  some  of  his  end-of-life  symptoms. There is little clinical or autopsy evidence that Beethoven suffered from syphilis.