The Disease of Chopin. A comprehensive study of a lifelong suffering

“…repeated episodes of productive cough, asthenia, fever and hemoptysis…at that time, he has an illness lasting 6 months, with respiratory complaints, and severe headaches”.

Kubba and Young (1998), describing the same episode, noted that this illness has even endangered Chopin’s life[25 - Kubba, A., Young, M. (1998), “The long suffering of Frederic Chopin”, Chest 113 (1), 210—6]. Chopin was described as “frail, slim, with sunken cheeks”. He was said to “die early as many geniuses before him did”, and he was always coming after physical activity “tired and without any breath”[26 - Majka, L., Gozdzik, J. (2003), “Cystic fibrosis – a probable cause of Frederic Chopin’s suffering and death”. J Appl Genet. 2003;44 (1):77—84, referring to Sieluzycki (1981).“Frederick Chopin’s diseases. Their pathogenesis and treatment”. Arch Hist Med (Warsz). 1981;44 (3—4):237—56 44 (3—4), 237—56.]. On February 12

1826 Chopin writes to his friend Jan Bialoblocki that he is sick (as “everybody else”) and his glands are swollen[27 - Chopin, F., Scharlitt, B. “Friederich Chopins gesammelte Briefe”. Leipzig: Breitkopf & Härtel, 1911, as cited in Franzen, C. (2010), “Frederic Chopin, Robert Schumann und Gustav Mahler: Musik und Medizin zwischen Romantik und Moderne”, DMW – Deutsche Medizinische Wochenschrift., Dec, 2010. Vol. 135 (51/52), pp. 2579—2587. Thieme Publishing Group. and in O’Shea, J. (1987), “Was Frédéric Chopin’s illness actually cystic fibrosis?”. Med J Aust. Dec 7—21;147 (11—12), 586—9.]. However, Chopin fully recovers from this ailment and his swollen glands (that were interpreted by some authors as cervical lymphadenopathy[28 - Kubba, A., Young, M. (1998), “The long suffering of Frederic Chopin”, Chest 113 (1), 210—6]) are healed by September 1826 without sequelae. His later episodes of illness tend to take the same course – always a full recovery, but the next strike of a disease follows after some time.

On November 2

1826, in another letter to Jean Bialoblocki[29 - as cited in Ganche, E. (1935), “Souffrances de Frederic Chopin. Essai de médecine et de psychologie”. Paris: Mercure de France, p. 116.], Chopin writes that he is not going to school and that he finds it a pinnacle of absurdity to rest for six hours a day, while the German and Polish-German doctors have prescribed him as many walks as possible. This letter also gives a glimpse into Chopin’s treatment: emetic drinks (upon a prescription by Dr. Malcz) and a diet of oatmeal. Chopin’s therapies will be further discussed in Chapter, “”.

In 1830, Chopin left Warsaw for a trip, including Vienna, Munich, and Stuttgart, to Paris. One of his Viennese encounters, a professor of music, Václav Würfel (1790 – 1832) suffered from tuberculosis. Chopin’s nose swelled embarrassingly with a prolonged cold and at times even forced him to cancel concerts[30 - O’Shea, J. (1987), “Was Frédéric Chopin’s illness actually cystic fibrosis?”. Med J Aust. Dec 7—21;147 (11—12), 586—9.]. However, Wilfred (2010) argued that there is no evidence that Chopin, aged twenty-one, was in “poor health or affected by the illness that would plague him in later life”[31 - Wilfred, N. (2011), “Chopin’s heart”, Hektoen Int’l Volume 3, Issue 1, referring to Long, E. (1956), “A History of the Therapy of Tuberculosis and the Case of Frederic Chopin”, Lawrence: University of Kansas Press, 1956.].

In Paris (1831) Chopin had an episode of hemoptysis and fever but recovered very quickly[32 - O’Shea, J. (1987), “Was Frédéric Chopin’s illness actually cystic fibrosis?”. Med J Aust. Dec 7—21;147 (11—12), 586—9.]. On Christmas Day, 1831, he wrote to his friend of many years (and once a love interest) Titus Woyciechowski, « [O] utwardly I am cheerful but inside me I am tortured with all sorts of forebodings.” Chopin does not associate his premonitions with any particular physical ailment, but subsequent letters speak of ill health with increasing frequency[33 - Hedley, A. “Selected correspondence of Fryderyk Chopin”. London: Heinemann; 1962, as cited in Wilfred, N. (2011), “Chopin’s heart”, Hektoen Int’l Volume 3, Issue 1.]. No known medical records dated 1832 through 1835 shed further light on Chopin’s health[34 - Ganche, E. (1935), “Souffrances de Frederic Chopin. Essai de médecine et de psychologie”. Paris: Mercure de France, p. 120.]. He seems to have has a quiet phase for nearly five years and this is probably the happiest period of his life. Various sources show that between autumn of 1835 (following a resort stay in Karlsbad) and autumn of 1838, Chopin has had bouts of bronchitis and suppurative laryngitis. Though those bouts always resolved, they recurred again after some time[35 - a) O’Shea, J. (1987), “Was Frédéric Chopin’s illness actually cystic fibrosis?”. Med J Aust. Dec 7—21;147 (11—12), 586—9. b). Chopin F, Scharlitt B. (1911). “Friederich Chopins gesammelte Briefe”. Leipzig: Breitkopf & Härtel, as cited by Franzen C (2010), “Frederic Chopin, Robert Schumann und Gustav Mahler: Musik und Medizin zwischen Romantik und Moderne”, DMW – Deutsche Medizinische Wochenschrift., Dec, 2010. Vol. 135 (51/52), pp. 2579—2587. Thieme Publishing Group.].

According to those sources, in autumn of 1835, Chopin suffered of cough, fever and hemoptysis[36 - Chopin, F., Scharlitt, B. (1911). “Friederich Chopins gesammelte Briefe”. Leipzig: Breitkopf & Härtel, as cited by Franzen C (2010), “Frederic Chopin, Robert Schumann und Gustav Mahler: Musik und Medizin zwischen Romantik und Moderne”, DMW – Deutsche Medizinische Wochenschrift., Dec, 2010. Vol. 135 (51/52), pp. 2579—2587. Thieme Publishing Group.]. Most likely, his condition was unusually serious at that time and Chopin may have suffered from depression. This was the time when he composed his famous “Funeral March” from his “Sonata in B Flat Minor” and prepared his testament.

In February 1837, Chopin caught an “acute grippe” with high fever and hemoptysis. At the same time he also experienced hallucinations, hearing “knocking on his door and seeing death standing there”[37 - Szulc, T. (1999), “Chopin In Paris: The Life And Times Of The Romantic Composer”. Da Capo Press, as cited in Caruncho, V. M. & Fernandez, B. F. (2011), “The hallucinations of Frederic Chopin”, Medical Humanities 37 (1), 5—8.]. Around that time Chopin met Amantine-Lucile-Aurore Dupin (better known under her artistic name George Sand), a famous French novelist. This acquaintance has evolved into an intimate relationship.

The November 1838 trip to Mallorca together with George Sand and her children became a disaster. This journey was described by Sand in a book “Un hiver à Majorque” (A Winter in Mallorca). According to her, Chopin had all signs of pneumonia and the island inhabitants grew suspicious and distant to the couple, as they believed that Chopin has had a contagious disease. The fact that Sand and Chopin were not married did not help their popularity among Mallorcans either. That is why it was all but impossible to obtain a better dwelling than the one where Chopin and Sand have stayed. Both two-story chambers they occupied at the monastery Sa Cartoixa de Jesús Natzarè in Valldemossa were barely heated and damp. Sand wrote that Chopin coughed up sputum “by the bowlful”. That winter Chopin was seen by at least three Mallorcan doctors. As George Sand recollected, the recommended treatment included application of plasters at various intervals during the day and consumption of milk. However, no milk was available there[38 - O’Shea, J. (1987), “Was Frédéric Chopin’s illness actually cystic fibrosis?”. Med J Aust. Dec 7—21;147 (11—12), 586—9.] – likely due to the resentment of local inhabitants who did not want to have a potentially contagious patient to be around. In addition of all those hardships and his health continuing to deteriorate, Chopin’s piano has got stuck with the Spanish customs, so he did not compose much till the end of December 1838: “Meanwhile my manuscripts are sleeping whereas I cannot sleep”[39 - Letter to Fontana on December, 14, 1838 in Niecks, Vol. II, p. 27.]

But already by mid-January 1839, Chopin sends the Preludes op. 28 to Fontana with an instruction to pass them to Mr. Pleyel, a music publisher[40 - Letter to Fontana on January, 12, 1839 in Niecks, Vol. II, pp. 30—31.]. A very productive phase followed and Chopin wrote, corrected or finalized during his stay on Mallorca following works, to name a few: Polonaise in C-minor, op. 40, Mazurka in E-minor, op. 41 no. 2, Scherzo in C-sharp minor, op. 39 (drafts), Nocturne in G-minor, op. 37, no., Tarantella op. 43 (draft), and Sonata in B flat minor, op. 35[41 - Adamczyk-Schmid, B. (1986—1990), “Les variantes du texte de Frédéric Chopin dans les manuscrits musicaux de la collection d’Anne-Marie Boutroux de Ferrà’s Collection in Valldemossa” in: “Chopin Studies” 3, The International Musicological Symposium “Chopin and Romanticism” Warsaw, 17—23 October 1986, Warsaw 1990, {Adamczyk-Schmid 1990}, cited by Institute Chopin (PL), retrieved on August 18, 2014 from http://www.chopin.pl/majorca.en.html#8.]. Most of those pieces were done by Chopin which has not yet fully recovered from the disease on “a poor Mallorcan piano…”[42 - Sand, G., Letter to Mme Marliani, January 15, 1839 in Niecks, Vol. II, pp.31—32.]

Later in 1838 he experienced pulmonary problems again[43 - Sand, G. “Winter in Majorca”. Graves, R., transl. 1956:135—45, as cited in Kuzemko, J. (1994), “Chopin’s illnesses”. J Roy Soc Med 87, 769—772.]. After three months on the island, Chopin and Sand with her children left Mallorca on the 13

of February 1839. On their way back to Paris, in Marcel, Chopin recovered, at least for a while. His strength was back, there were no more hemoptysis and he started to gain weight again[44 - O’Shea, J. (1987), “Was Frédéric Chopin’s illness actually cystic fibrosis?”. Med J Aust. Dec 7—21;147 (11—12), 586—9.]. Nevertheless the very same author, referring to G. Sand, says that for the next few years, Chopin continued to have cough bouts with dyspnea and intermittent fevers. Sand’s recollections show that he was then never absolutely well and experienced a slow progressive decline in his health.

Chopin was successfully treated with ‘oats and honey’ and often “courses of belladonna. which he continued to take through most of his life”[45 - Kuzemko, J. (1994), “Chopin’s illnesses”. J Roy Soc Med 87, 769—772.]. Belladonna has centuries-long history of use as a medicine[46 - Ebadi, M. (2007). “[битая ссылка] Pharmacodynamic Basis of Herbal Medicine”. CRC Press. p. 203. [битая ссылка] ISBN [битая ссылка] 9780849370502.], however it is not clear who, when, and for what purpose exactly prescribed or recommended it to the pianist. Kuzemko (1994) argues that a diet may have had a positive influence on the course of Chopin’s disease, citing the composer’s letter to his parents from Berlin, written on September, 27, 1828[47 - Kuzemko, J. (1994), “Chopin’s illnesses”. J Roy Soc Med 87, 769—772.]: “I am quite well… as long as I avoid meats, sauces, soups”[48 - Kuzemko, J. (1994), the same as above.]. However, this very same letter is quoted differently by another source (text in bald – VW):

“I am quite well, and have seen all that [was] to be seen. I shall soon be with you again. In a week, from the day after tomorrow, we shall embrace […] I count among the great events of my visit here the second dinner with the scientists, which took place the day before the conclusion of the Congress, and was really very lively and entertaining. Several very fair convivial songs were sung, in which all the company joined more or less heartily. Zelter conducted, and a large golden cup, standing on a red pedestal, in front of him, as a sign of his exalted musical merits, appeared to give him much satisfaction. The dishes were better that day than usual, they say, “because the scientists have been principally occupied during their sittings with the improvement of meats, sauces, soups, etc…”[49 - Karasowski, M. (1906),“Frederic Chopin: His Life and Letters”.]

It is beyond of scope of this study to assess the biographic precision of both sources and to define which translation conveys a better sense of Chopin’s letters (they were originally written in French). Both sources do not specify whether that “quite well” description referred to Chopin’s digestive or respiratory issues. However, according to the authors in favor of the cystic fibrosis version, those gastrointestinal symptoms were not new for Chopin. Yet during his early adolescence he developed intolerance to ‘fatty foods’ which resulted in recurrent prolonged episodes of diarrhea and weight loss[50 - a) Marek G. (1978) “Chopin”. New York, 1978:15, cited in Kuzemko, J. (1994), “Chopin’s illnesses”. J Roy Soc Med 87, 769—772. b). Majka, L., Gozdzik, J. (2003), “Cystic fibrosis – a probable cause of Frederic Chopin’s suffering and death”. J Appl Genet. 2003;44 (1):77—84,].

The slow decline of Chopin’s health continued for the next four years until (in winter 1843/44) he become severely cachectic and so weak, that he could no longer go upstairs by himself and had to be carried up[51 - Franken, F.H. (1959), “Das Leben grosser Musiker im Spiegel der Medizin: Schubert, Chopin, Mendelssohn”, Stuttgart, as cited in Böhme, G. (1981), “Medizinische Portrats berühmter Komponisten: Wolfgang Amadeus Mozart, Ludwig van Beethoven, Carl Maria von Weber, Frederic Chopin, Peter Iljitsch Tschaikowski, Bela Bartok”. (German Edition), G. Fischer.]. 22 June 1849 Chopin had two episodes of hemoptysis in one night[52 - According to Chopin’s letter to his friend Grzymala, as cited in Ganche, E. (1935), “Souffrances de Frederic Chopin. Essai de médecine et de psychologie”. Paris: Mercure de France, p.78.] (according to Chopin’s letter to his friend Grzymala, as cited by Ganche, p.78). At that point he had less than four months to live.

1.4 Family anamnesis

Some scholars, especially those in favor of the cystic fibrosis hypothesis find the genetic disposition of the Chopin’s family problematic[53 - Such as Majka, L., Gozdzik, J. (2003), “Cystic fibrosis – a probable cause of Frederic Chopin’s suffering and death”. J Appl Genet. 2003;44 (1):77—84.]. Both his father and two of his sisters – Emilia and Ludwika – had reportedly had pulmonary symptoms. Other authors view the family health as quite robust. For example, Myslakowski (2010) underscores the fact that Chopin’s mother, father and one sister (Izabella) have lived well into their 70s, which is about 30 years more than the average life expectancy at that time[54 - a). Mysakowski, P. (2010), “Fryderyk Chopin: The Origins”. The Fryderyk Chopin Institute. b). Myslakowski, P. (2010), “Was Chopin born 200 years ago?”. Magazyn Chopin.]. This view of Chopin’s family is echoed by Neumayr (2007) who suggests that the Chopins enjoyed a good health and fully dismisses a possibility of a genetic disorder[55 - Neumayr, A. (2007), “Berümte Komponisten im Spiegel der Medizin” Ibera; Auflage: überarb. Neuaufl. (19. November 2007).], without addressing, for instance, an existing possibility of Chopin being a “mosaic” gene defect carrier with variable phenotypic expressions[56 - Kumar, V., Becker, T., Jansen, S., van Barneveld, A., Boztug, K., Wölfl, S., Tümmler, B. and Stanke, F. (2008), “Expression levels of FAS are regulated through an evolutionary conserved element in intron 2, which modulates cystic fibrosis disease severity”, Genes and Immunity., Aug, 2008. Vol. 9 (8), pp. 689—696. Nature Publishing Group.]. In fact, it is difficult now to draw a valid conclusion about the true health status of Chopin’s immediate family, and more so for the distant relatives. While an extensive, tedious research work was done for the paternal side of Chopin’s family shortly after the World War II, little, if anything, is known about his maternal ancestors[57 - Baur, E.G. (2012), “Chopin”. DTV Deutscher Taschenbuch.]. Many documents that could have helped an evaluation of genetic patterns in Chopin’s family are either lost – such as birth and death records – or intentionally destroyed (for example, personal letters) or, most likely, never existed (detailed medical histories).

Also the life expectancy might not be that informative as an indicator of health, because by definition it is an arithmetic mean. An age-specific death rate or median life duration of the population could be more helpful for such evaluation. Indeed, according to the data of the National French Institute of Demographic Studies, the average life expectancy in France in 1810 – the year Chopin was born – was thirty-seven[58 - Retrieved from http://www.ined.fr/en/everything_about_population/graph_month/life_expectancy_france/ on February 10 2014).]. That figure was already a part of an increasing trend – the life expectancy at the time when Chopin’s parents were born, was even lower – twenty-five to thirty years. Based on those figures alone, one may arrive to a conclusion that even Chopin himself has lived quite a long life – that is, almost ten percent longer than an average French citizen! Of course, such conclusion would be certainly misleading. Two factors influenced the life expectancy in the early 1800s greatly: the neonatal mortality and Napoleonic wars. The wars took their toll, claiming many lives of younger men, thus decreasing the average life expectancy. At the same time, many children died at an early age, but as soon the child lived up to the age of ten; his or her chances to reach a very advanced age were improved greatly. Actually, as soon as a child survived to the age of twenty, his/her life expectancy was nearly equal to the average life expectancy in the twentieth century.

Hence the presumption that the Chopins were such a healthy kin, that their life duration was double of that of an average European of their time – may be wrong. While several members of the family lived well into their seventies, the others died at an early age (for example, one or more siblings of Chopin’s mother see Appendix). Those early childhood deaths might well be attributable to innate pathological processes, including genetic defects, but at least equally well – to a lack of basic hygiene or insufficient health care in the 19th century Europe.

Parents

Nicolas Chopin (Mikolay Chopyn, Nicolai Choppe) was Frederic Chopin’s father. French by origin, he was born on April 15, 1771 in Maraiville-sur-Madon. He died on the 3rd of May, 1844 in Warsaw. His parents were Francois Chopin and Marguerite Delfin[59 - Hazard, J. (2005), “The adventures of doctor Jean Matuszinski, friend of Frederic Chopin, from Warsaw in 1808 to Paris in 1842”, Hist Sci Med. 39 (2), 161—8.]. A pipe smoker[60 - Kuzemko, J. (1994), “Chopin’s illnesses”. J Roy Soc Med 87, 769—772.], he was prone to develop infrequent respiratory tract infections and became very ill on at least two documented occasions[61 - Karasowski, M. (1938) “Frederic Chopin: His Life and Letters”. 3

edn. p. 9, as cited in Kuzemko, J. (1994), “Chopin’s illnesses”. J Roy Soc Med 87, 769—772.]. Nicholas Chopin’s presumable cause of death was lung disease (allegedly tuberculosis) at the age of 73[62 - Caruncho, V. M., Fernandez, B. F. (2011), “The hallucinations of Frederic Chopin”, Medical Humanities 37 (1), 5—8.]. He was buried in the catacombs of the Powązki Cemetery on May 6, 1844. In 1948, after the catacombs’ destruction, Nicolas’ and his wife Justyna’s coffins was transferred to a new grave at the back of the church of St. Charles Borromeo, where they remain to this day. A thorough anthropological examination was undertaken on the occasion of exhumation, which may allow establishing Nicolas and Justyna’s appearance.

Tekla Justyna Krzyzanowska (Justyna de Krzyżanowskie, as in F. Chopin’s baptismal record), Frederic Chopin’s mother was of Polish origin. Her exact date of birth is unknown, but it must have occurred shortly before September 14, 1782, the date she was christened at the parish church of Izbica, receiving the Christian names of Tekla Justyna, She died on October 1, 1861[63 - Niecks, F. (1889) “The Life of Chopin”. Novelle, as cited in Kuzemko, J. (1994), “Chopin’s illnesses”, J Roy Soc Med 87, 769—772.]. Throughout her whole life, Chopin’s mother reportedly remained in good health[64 - [битая ссылка] Mysłakowski, P., [битая ссылка] A. Sikorski (January 2006), The Frederic Chopin Institute. Retrieved Jan 26, 2014 from [битая ссылка] http://web.archive.org/web/20101022022619/http://en.chopin.nifc.pl/chopin/persons/detail/id/6362).]. Tekla Justyna’s parents were Jakub Krzyżanowski (ca. 1729—1805) and Antonina Kołomińska; both most likely came from the noble class. Justyna was born at least ten years after her parents were married and had at least two elder siblings: brother Wincenty, born in 1775, who died in infancy, and his sister Marianna, born in 1780. Some unverified sources (amateur genealogy forums) mention other siblings of Tekla Justyna, who died as young children, but no documented evidence was found in this respect.

Jakub Krzyżanowski, the maternal grandfather of Chopin was most notably acting as a manager of the royal estate. As the archive records show, Jakub was repeatedly involved into quarrels and legal issues over property and money. The family has also frequently changed their place of residence, most likely due to “mixed relations to their employers”. Perhaps this could possibly be seen as a sign of an instable mental state, maybe even a disorder. It is difficult to draw a conclusion now, when no direct evidence may exist. Jakub died in Świętosławice on the 29

of October 1805 at the age of 76. The cause of death was “dropsy”, a major death factor in those times. In modern terms a dropsy (a hydropsy) is a generalized edema, most notably related to a right heart failure. Mercury was frequently prescribed to treat dropsy at the time of Jakub’s death – due to its diuretic effects. As a toxic substance, mercury may have widely contributed to lethality, too[65 - Ventura, H., Mehra, M. (2005), “Management of Acute Decompensated Heart Failure”. CRC Press, referring to John Blackall, 1813.].

Siblings

The older sister, Louise Chopin or Ludwika Marianna Jędrzejewiczowa (April 6, 1807 – October 29, 1855) suffered from recurrent chest infections and died from a respiratory illness at the age of 47 years[66 - a). Kuzemko, J. (1994), “Chopin’s illnesses”. J Roy Soc Med 87, 769—772. b). Caruncho, V. M., Fernandez, B. F. (2011), “The hallucinations of Frederic Chopin”, Medical Humanities 37 (1), 5—8.]. She was outlived by her four children. Chopin’s second sister, Isabelle Chopin or Justyna Izabella [битая ссылка] Barcińska (born on the 9th of July, 1811, died on the 3rd of June, 1881) had reportedly good health, “led an uneventful life and died at 70 years”[67 - Kuzemko, J. (1994), “Chopin’s illnesses”. J Roy Soc Med 87, 769—772.]. Her marriage to Anthony Barcinski remained childless[68 - a). Clavier, A, (1984), “Dans l’entourage de Chopin”. vol. 2, Lens. b). Mysłakowski,, P, Sikorski (2005) A, “Chopinowie. Krąg rodzinno-towarzyski”, Warszawa. c). J. Siwkowska (1986—1996) “Nokturn czyli rodzina Fryderyka Chopina i Warszawa w latach 1832—1881” [A Nocturne. Fryderyk Chopin’s family in the years 1832—1881], vols. 1—3, Warsaw.].

The youngest sister, Emily Chopin (aka Emilia Chopin) lived only fourteen and half years long (1812 – 1827). She was described as a frail child; from the early age her health was a subject of concern. She was underweight and suffered from periodic bouts of cough, breathlessness and ‘asthma’ (episodes of wheeziness). With regards to Emilia’s symptoms, which became especially severe when she was about eleven years old, the biographers opinions vary. Some researchers suggest that she started to have hematemesis and consequently died from a massive gastrointestinal hemorrhage, most likely from portal hypertension due to cirrhosis or severe gastric erosion[69 - a). Kuzemko, J. (1994), “Chopin’s illnesses”. J Roy Soc Med 87, 769—772. b). Marek, G.R., Gordon-Smith M. (1978) “Chopin”. New York: Harper & Row, as cited in Caruncho (2011) and Reuben, G. (2003), “Chopin’s serpin”. Hepatology Volume 37, Issue 2, 485—8, retrieved on 14 Februar 2014 from [битая ссылка] http://web.archive.org/web/20100312185417/http://en.chopin.nifc.pl/chopin/persons/detail/cat/9/id/6368:]. Yet other biographers consider her symptoms mostly pulmonary, noting Emilia’s frequent respiratory infections and syncopes. They refer to Emilia’s blood spitting as hemoptysis, not hematemesis, and suggest that she had pneumonia in her terminal phase:

“From her early childhood Emilia’s health was a matter of growing concern. Early symptoms of an illness (probably tuberculosis) caused a general weakness of the organism… Despite medical attempts (whose efficiency has been questioned and even accused of having speeded up her death) Emilia’s illness quickly developed and she spent her last months coughing with blood and often losing her senses”.[70 - a). Ganche, E. (1935), “Souffrances de Frederic Chopin. Essai de médecine et de psychologie”. Paris: Mercure de France. b) Myslakowski, P. & Sikorski, A. (2006), “Justyna Chopin”.]

In a letter to a friend as of March 14

1827, Chopin describes his sister’s sufferings that lasted already four weeks. He also describes Emilia’s anorexia and the treatment she received:

«…the bloodletting, which was done once, twice, innumerable leeches, vesicle-producing plasters, mustard plasters, and herbs, adventures over adventures. During this whole period of time, she did not eat and was so run down that one could hardly recognize her, and only slowly did she somewhat recuperate.”[71 - as cited by Ganche, E. (1935), “Souffrances de Frederic Chopin. Essai de médecine et de psychologie”. Paris: Mercure de France, p.117.],[72 - Kuzemko, J. (1994) and Marek G.R., Gordon-Smith M. (1978) “Chopin”. New York: Harper & Row, as cited by Caruncho, J. (2010) and Reuben, A. (2003), “Chopin’s serpin”, Hepatology Volume 37, Issue 2, 485—8, retrieved on the 14

August 2014 from [битая ссылка] http://web.archive.org/web/20100312185417/http://en.chopin.nifc.pl/chopin/persons/detail/cat/9/id/6368:]

Emilia died less than a month later, on the 10

of April, 1827. There is no sufficient data to say with confidence whether Emilia’s death occurred on the grounds of a pathological process in her lungs with or without portal hypertension or due to a gastrointestinal disease. Depending on the initial pathology, it is possible that her death was caused by cachexia and anemia, both probably exacerbated by the wrong treatment Though chronic iron deficiency may rarely lead to death directly, a severe (or even moderate) anemia can cause sufficient hypoxia to aggravate underlying comorbidities (in Emilia’s case pulmonary and, probably gastrointestinal disorders)[73 - Harper, J., Besa, E., Conrad, M., Sacher, R., Schick, P. (2013), “Iron Deficiency Anemia”, Medscape, retrieved from http://emedicine.medscape.com/article/202333-overview#showall on Tuesday, February 11, 2014.] and become lethal this way.

Speaking of an exacerbating treatment, bloodletting (or bleeding) was widely practiced at that time and, according to Frederic’s accounts, Emilia Chopin underwent this treatment, too. It is important to note that the regular amount of blood extracted on each occasion was substantial: 600 – 1 000 ml. The treatment regime varied and Emilia might lose close to 2 800 ml of blood in three days, or 3 000 ml in 4 days. As much as 6 200 ml of blood could be let over a six day period[74 - a). Ogle, J. (1891), “Concerning bloodletting”, The Lancet 137 (3532), 1029—1032. b). Turk, J. L., Allen, E. (1983), “Bleeding and cupping”, Ann R Coll Surg Engl 65 (2), 128 – 131.]. In total, Emilia was losing blood – both as a result of her disease and her treatment – at least eight week long. Taking into consideration that patients at that time were regularly bled to syncope[75 - Turk, J. L., Allen, E. (1983), the same as above.] and both her nutritional status and food/liquids intake were absolutely inadequate, the cause of death could well be a posthemorrhagic anemia, and not an underlying pulmonary or gastrointestinal disease. With Emilia’s prolonged history of treatment with bleedings, an iatrogenic infection, such as hepatitis B virus (HBV), remains a possibility, too. Such infection may have affected the hepatocellular function, interfering with production of thrombopoetin. The resulting thrombocytopenia could additionally contribute to the Emilia’s hemorrhages, and, finally, to her death.

1.5 Social history

Living arrangements

Chopin’s living arrangements varied greatly. Reportedly, he had never owned a house himself and lived in rented accommodations, at times sharing them with friends. It is likely that many of his dwellings have helped to an exacerbation of Chopin’s pulmonary symptoms and progression of disease:

– Fireplaces and cooking stoves – are all known sources of irritants of the upper airways

– Cold damp dwellings (for example, the one on Mallorca).

– Mold and fungae are regularly present in damp settings and may have contributed to Chopin’s cough bouts, too (Szpilczynski) discussed Chopin’s allergic predisposition in 1961[76 - Szpilszynski, S. (1961) “War Chopin Allergiker?”. Ciba-Symposium 9 (6): 283—289.]).

Marital status / Children

While known for having had numerous sexual relationships – some of them lasted for years – Chopin was never married and no biological children are known.

Drug use

Though the composer did not like wine, he occasionally got drunk, likely on social grounds or as an effort of self-medication for his bouts of melancholy[77 - Ganche, E. (1935), “Souffrances de Frederic Chopin. Essai de médecine et de psychologie”. Paris: Mercure de France, p.136.]. Chopin detested tobacco smoke which made him cough. However, chronic passive smoking was an important factor influencing his lung disease. Throughout the most of his life he was surrounded by many cigar and pipe smokers such as George Sand, Liszt and his father Nicolas, to name a few[78 - Kuzemko, J. (1994), “Chopin’s illnesses”. J Roy Soc Med 87, 769—772.].. Fair to note, the adverse effects of tobacco smoking on health were not widely known at that time. A century after Chopin’s time, in the 1920s, a German internist F. Lickint has published the results of his scientific investigations of health issues related to alcohol and tobacco, describing lung cancer and stomach ulcer associated with prolonged smoking[79 - Haustein, K. (2004), “Fritz Lickint (1898—1960): Ein Leben als Aufklärer über die Gefahren des Tabaks”. Suchtmed 6 (3): pp. 249—55.]..

As brief Chopin’s recreational drugs list is, as ample was his usage of medications. He frequently took opiates[80 - Eigeldinger, J.J. (1986) “Chopin Pianist and Teacher as Seen by his Pupils”. 3rd edn. Cambridge, UK: Cambridge University Press, as cited in Caruncho, V. M. & Fernandez, B. F. (2011), “The hallucinations of Frederic Chopin”, Medical Humanities 37 (1), 5—8.]. One such remedy, laudanum, is known to contain [битая ссылка] morphine, codeine, [битая ссылка] morphinan, thebaine, papaverine, and noscapine (narcotine). Laudanum is a [битая ссылка] tincture of [битая ссылка] opium containing approximately 10% powdered opium [битая ссылка] by weight (the equivalent of 1% [битая ссылка] morphine). In the nineteenth century laudanum was widely used “against many ailments”[81 - The same as above.]. Opium was used not only as laudanum tincture and not only as a single medication. It was a part of numerous prescriptions and well as home remedies. It was mixed with virtually anything available: sugar, alcohol, mercury, hashish, cayenne pepper, ether, chloroform, belladonna and so on[82 - Hodgson, B. (2001) “In the Arms of Morpheus: The Tragic History of Laudanum, Morphine, And Patent Medicines”. Diane Pub Co.]. Chopin’s attending physicians have most likely recommended laudanum – and not another tincture – not only due to analgesic and antitussive effects of this medication, or to control Chopin’s frequent diarrhea, or to alleviate his sleep problems, but also because laudanum was a strong emetic. Emetics were popular, (as one can see on the example of Emilia’s treatment) since medieval times they were deemed important as “body cleansers”[83 - Museum of the Royal Pharmaceutical Society, 2007, retrieved from [битая ссылка] http://www.rpharms.com/museum-pdfs/d-melancholiaandmania.pdf on February 13, 2014)]. The emetic treatment is further discussed in Chapter. As Chopin had a pre-existing pulmonary condition, the use of opium tincture was especially dangerous due to the risk of a respiratory depression, even at therapeutic doses[84 - “Opium tincture drug information”, from the Merck Manual for health care professionals. Retrieved from [битая ссылка] http://www.merckmanuals.com/professional/lexicomp/opium%20tincture.html on 13 Feb 2014.]. Opium is also known for releasing histamine from skin and muscle. Histamine, in turn, plays a primary role in the respiratory system as a bronchoconstrictor[85 - Da Costa, J.L., Tock E.P., Boey H.K. (1971), “Lung disease with chronic obstruction in opium smokers in Singapore. Clinical, electrocardiographic, radiological, functional and pathological features”, Thorax., Sep, 1971. Vol. 26 (5), pp. 555—571.].

The composer’s dependence on opium[86 - Breitenfeld, D., Kust, D., Turuk, V., Vucak, I., Buljan, D., Zupanic, M., Lucijanic, M. (2010), “Frederic Chopin and Other Composers Tuberculotics – Pathography”. Alcoholism 46 (2), 101—7.] may explain its frequent use. A number of Chopin’s symptoms can be found on the vast list of opium side effects: drowsiness, headache, malaise, CNS depression, insomnia, mental depression, nausea, vomiting, anorexia, stomach cramps, neuromuscular and skeletal weakness.