Before he died, Beethoven asked that doctors conduct a postmortem examination to find out why he had gone deaf. The autopsy took place in Beethoven's house the day after his death on 26 March 1827, with Dr. Johann Wagner presiding. Also present was Beethoven's physician Wawruch. In addition to examining Beethoven's auditory apparatus, they looked into what might have killed him. He died after a 4-month illness marked by diarrhaea and emaciation: the latter being especially, and poignantly signalled by Wagner and other witnesses.

Astonishingly, a record of the procedure exists, signed by Wagner. I am not a doctor, so I cannot interpret what Wagner saw: and perhaps the sometimes primitive terminology of Beethoven's day makes things hard to interpret even for a professional. It snowed the evening Beethoven died, so although decomposition must have gotten underway, it was at any rate not aided by great heat.

In an examination of the exterior of Beethoven's ears, they found that the auditory canal "was covered in shining scales, particularly in the area of the tympanum, which was concealed by them." Wagner then dissected Beethoven's head, examining the composer's auditory apparatus, eustachian tube, and related structures. "Dimpled scars" were to be seen near the orifice of the eustachian tube and the tonsils; the tube itself was swollen and somewhat constricted.

Beethoven's facial nerves were of "unusual thickness." They must have looked to create a basis for comparison with the auditory nerves, which were "shriveled and destitute of neurina." The arteries associated with them were "dilated more than the size of a crow quill," and the left auditory nerve was attenuated to "three very thin greyish striae," while the right had "one strong clear-white stria from the substances of the right ventricle."

They had a look at Beethoven's brain: "the convolutions of the brain were full of water, and remarkably white; they appeared very much deeper, wider, and more numerous than ordinary."

The thoracic organs were normal, but in the abdominal cavity "four quarts of grayish brown turbid fluid were effused." The liver was shrunk to half-size and greenish-blue, "and beset with knots, the size of a bean, on its tuberculated surface, as well as in its substance. All its vessels were very much narrowed, and bloodless."

Beethoven had gallstones, and an enlarged, darkened, and "firm" spleen, as were the pancreas. Wagner reports that the stomach and bowels were greatly distended with air (beginning of gas buildup from decomposition?). "Both kidneys were invested by a cellular membrane of an inch thick, and infiltrated with a brown turbid fluid; their tissue was pale and opened out. Every one of their calices was occupied by a calcareous concretion of a wart-like shape and as large as a split pea."

Wagner's report ends with the sad remark "the body was much emaciated."


Bibliography.

Schermann, Thomas K, and Biancolli, Louis. 1972. The Beethoven Companion. Doubleday. (An abridged form of Wagner's report: pp. 1099-1101.)
Thayer, Alexander Wheelock. 1967. Thayer's Life of Beethoven, revised by Elliot Forbes. Princeton. (Death and autopsy description, p. 1050-1052; and Wagner's full report, pp. 1059-1060.)

Bibliographical note.
Forbes refers to a medical study (to which I don't have access): S.J. London, M.D., "Beethoven, Case Report of a Titan's Last Crisis," in Archives of Internal Medicine 113 (1964): 442-448.
One of the writeups at decomposing composers states that an exhumation suggests lead poisoning as the cause of Beethoven's fatal illness.
And, of course, there is the diagnosis of renal failure published by Mauler directly below.

This evidence suggests that Beethoven died of complications resulting from renal papillary necrosis, more commonly known as kidney failure. A common cause of papillary necrosis is diabetes, but Beethoven did not suffer from that condition to our knowledge. Other common causes include hypertension or analgesic nephropathy, which is essentially a fancy term for abusive overuse of painkillers. Beethoven also clearly had severe cirrhosis of the liver, a condition which is comorbid with papillary necrosis (the cirrhosis was likely due to Beethoven's known alcohol abuse, and possibly also hepatitis).

Beethoven was known to suffer from a variety of aches and pains late in his life, and seems to have had a fondness for painkillers. One of the commonly used painkillers at the time was salicin (dried, powdered willow bark - an early form of aspirin), which has been shown to cause papillary necrosis if taken in large amounts. It is fair to say then, that in the absence of any other evidence of hypertension or diabetes, Beethoven likely died from papillary necrosis (end-stage kidney failure) resulting from a combination of liver cirrhosis and analgesic nephropathy.

As for Beethoven's deafness, it was probably otosclerosis, an abnormal growth of the bones in the middle ear whose causes are not entirely understood but seem to be at least partially hereditary.


Yay, my girlfriend is in medical school.

Log in or registerto write something here or to contact authors.