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

Ganche (1935) lists other medications and remedies prescribed to Chopin: foxglove (digitalis), monkshood (aconite), creosote, protioduret <of mercury>, jelly lichen (collema), gum water (diluted acacia sap that was a popular prescription for phthisis[87 - Long, E. (1956) “A History of the Therapy of Tuberculosis and the Case of Frederic Chopin”. Lawrence: University of Kansas Press, p.10.]). Most of those remedies are known for their toxicity, but little is known on how Chopin’s treatment may have influenced his symptoms. Caruncho and Fernandez (2011) discussed opium toxicity as a possible reason for Chopin’s mental problems, only to dismiss it on the grounds that the symptoms (particularly hallucinations) were present before Chopin began receiving the treatment on a regular basis and that the hallucination pattern differed from that of toxicity. The authors point out that the exact treatment chronology remains unknown. Chances are, the symptoms’ onset might, in fact, have preceded or coincided with Chopin’s treatment. Certainly, a simultaneous occurrence does not equal to causality, but it is possible that at least some of Chopin’s pathology might be explained with toxic effects of the remedies he was treated with[88 - Caruncho, V. M., Fernandez, B. F. (2011), “The hallucinations of Frederic Chopin”. Medical Humanities 37 (1), 5—8.].

Foreign travel

At various periods of his life Chopin has visited geographic areas that today are known as Germany, Poland, France, Austria, United Kingdom, and Spain[89 - Baur, E.G. (2012), “Chopin” DTV Deutscher Taschenbuch.]. Following diseases were present in those parts of Europe in the 19th century and/or caused outbreaks of a significant importance:

– typhus

– scarlatina

– measles

– smallpox

– cholera

– smallpox

– tuberculosis

– influenza

However, the course of Chopin’s disease does not match the spread and the magnitude of those epidemics. For instance, neither his gastrointestinal symptoms nor his pulmonary problems were aggravated or first present at the times of cholera or influenza outbreaks, respectively.

Exposure to environmental pathogens

With an exception of a regular exposure to biomass (wood) home heating and passive smoking (as many of Chopin’s friends and family were heavy smokers), no particular environmental exposures are known.

1.6 Review of systems

According to ample verbal and visual evidence Chopin had asthenic habitus. In his travel passport, used for the journey to England in 1837, his height is stated as 170 cm[90 - 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.], weight – 50 kg[91 - Wüst, H. W. (2007), “Frederic Chopin”. Bouvier Verlag.]at some points – in 1835, and, probably, in 1838, too – dropping below 45 kg[92 - O’Shea, J. (1993) “Music and Medicine”. London: JM Dent, p.140, as cited by Kuzemko, 1994.]. Both parameters substantially deviate from population averages (see Appendix). Chopin’s body mass index (BMI) varied between 16 and 17, which is considered underweight (normal range BMI ranges between 18.5 and 24.9). A number of sources depict Chopin’s poor exercise tolerance and failure to gain weight[93 - Erlinger, S. (2010), “Frederic Chopin and Michael Jackson: What could they have in common?”, Gastroenterologie Clinique et Biologique 34 (4—5), 246—249.].

Musculoskeletal system

What reliable evidence might help to assess Chopin’s appearance from a clinical viewpoint? Obviously, various verbal and graphic depictions are always to some extent subjective and may sometimes be rather a telltale of their creator, not so their object. Various portraits, inclusive photographs are consistent in portraying of asthenic, thin-faced man. The written sources convey an image of a man who is ‘whiskerless, beardless, fair of hair, and pale and thin of face … <and has> a prominent aquiline nose[94 - Bone, A. (1848) “Sir James Hedderick”. Glasgow: Sterling, 73—4, as cited by Kuzemko, 1994.]. But it is barely possible to draw a clinically relevant conclusion based on something as trivial as a caricature[95 - O’Shea, J. (1987), “Was Frédéric Chopin’s illness actually cystic fibrosis?”. Med J Aust. Dec 7—21;147 (11—12), 586—9, referring to a 1844 sketch by Pauline Viardot (s. Appendix 3),]. For example, based on a sketch by P. Vairdot, Kuzemko (1994) suggests that Chopin has probably had emphysema, since he become apparently barrel-chested in his early thirties. However, that very sketch – as fairly pointed out by other researchers – shows Chopin with a disproportionally giant head, too.

The other authors describe Chopin as having “thin, long and barely muscular limbs, very slender, delicate hands[96 - 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.]. Those extraordinary thin limbs might probably be interpreted as an early sign of emaciation[97 - Liszt, F. as cited in O’Shea, J. (1987), “Was Frédéric Chopin’s illness actually cystic fibrosis?”. Med J Aust. Dec 7—21;147 (11—12), 586—9.]. Almost all observers noted the extreme thinness of his limbs. Here is one fact that let us think that Chopin may, indeed, have had a distorted musculoskeletal development that goes beyond a mere asthenic habitus. While travelling in horse-drawn carriages, Chopin feared he may fracture his frail limbs[98 - O’Shea, J. (1987), “Was Frédéric Chopin’s illness actually cystic fibrosis?”. Med J Aust. Dec 7—21;147 (11—12), 586—9.]. Both Erlinger (2010) and O’Shea (1987) hypothesize that this could be due to his pulmonary hypertrophic osteoarthropathy, that manifested itself by painful swelling of distal joints and soft tissue[99 - Erlinger, S. (2010), “Frederic Chopin and Michael Jackson: What could they have in common?”, Gastroenterologie Clinique et Biologique 34 (4—5), 246—249.],[100 - O’Shea, J. (1987), “Was Frédéric Chopin’s illness actually cystic fibrosis?”. Med J Aust. Dec 7—21;147 (11—12), 586—9.]. Quite evidently (see Appendix 10.7,“Postmortem hand cast”), Chopin did not have digital clubbing (finger clubbing). Though finger clubbing is most commonly seen in patients with bronchiectasis (as well as in those with cystic fibrosis and bronchial carcinoma) and not commonly seen in patients with pulmonary tuberculosis[101 - a). Cheng, T. O. (1998), “Chopin’s Illness Revisited”, CHEST Journal 114 (6), 1796. b). Cheng, T. O. (1998), “Chopin’s Illness”, CHEST Journal 114 (2), 654, referreing to the Merck Manual.], this sign is neither specific nor particularly sensitive for lung pathology[102 - Kuzemko, J. (1994), “Chopin’s illnesses”. J Roy Soc Med 87, 769—772.] and cannot be reliably used for a differential diagnosis in Chopin’s case.

Throughout most of his adult life, Chopin frequently suffered of pain in the ankles, feet and hands[103 - Kuzemko, J. (1994), the same as above.]. During the terminal phase of his illness, he also developed severe pain in his wrists and ankles, which was relieved partially by massage and sometimes worsened at cold and wet weather. The hot weather was also poorly tolerated: according to O’Shea (1987), Chopin had frequently experienced prostration and hyperhidrosis in summer[104 - O’Shea, J. (1987), “Was Frédéric Chopin’s illness actually cystic fibrosis?”. Med J Aust. Dec 7—21;147 (11—12), 586—9.]. As mentioned above, at least once in his life – namely in winter of 1826 – Chopin had nodal swelling that Kubba and Young, referring to Chopin’s letter dated February 12, 1826 to his friend, physician Jan Bialoblocki[105 - 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. and by O’Shea, J. (1987) in “Was Frédéric Chopin’s illness actually cystic fibrosis?”, Med J Aust. Dec 7—21;147 (11—12), 586—9.], regarded as a cervical lymphadenopathy. Cervical lymphadenitis is a common (about 15%) manifestation of extrapulmonary tuberculosis, especially in patients with compromised immune system[106 - Eyselbergs, M., Snoeckx, A., Op de Beeck, B., Spinhoven, J. M., Parizel, P.M. (2011), “Cervical tuberculous lymphadenitis”, JBR-BTR 94 (3), 120 – 121.]. A nodal regression is possible indeed, but only under chemotherapy[107 - Polesky, A., Grove, W., Bhatia, G. (2005), “Peripheral Tuberculous Lymphadenitis”, Medicine 84 (6), 350—362.]. Other infections or neoplasia, and rarely, drug reactions may also cause a nodal enlargement that in some cases can resolve untreated[108 - Ferrer, R. (1998), “Lymphadenopathy: differential diagnosis and evaluation”. Am Fam Physician 58 (6), 1313 – 1320.].

Respiratory system

Chopin’s lung problems are dated back to his adolescence with prolonged episodes of cough and lymphadenopathy. There are reports of Chopin’s repeated exacerbations of nasal infection with substantial blockage of air passage (i.e. a possibility of polyps), pulmonary infections with productive cough, hemoptysis and recurrent fevers, later chronic dyspnea[109 - 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.]. O’Shea (1987) and Kuzemko (1994) citing G. Sand argue that a cavitating lesion was not found during an auscultation of Chopin’s chest (by Dr. Papet)[110 - Sand, G. (1838) “Histoire de ma vie”. Vol XX.:155.].

The bouts of cough and dyspnea accompanied Chopin throughout most of his adult life. Long (1956) describes the episodes of hemoptysis consisted of blood streaking purulent sputum as “a picture of bronchiectasis or chronic bronchitis”[111 - Long, E. (1956) “A History of the Therapy of Tuberculosis and the Case of Frederic Chopin”. Lawrence: University of Kansas Press, 1956, p. 20, a picture of brochniectasis or chronic bronchitis.]. Two noteworthy facts about the course of his disease: first, despite of his repeated bouts of cough and periods when his condition was very serious, virtually each time Chopin was able to recover fully, relatively quickly, and without sequelae. Between the bouts, he seemed to be practically disease-free. For instance, the years between about around1833—1835 seem to have been the happiest ones for Chopin. He had won a great appraisal as a composer and a pianist and his health seemed to be good. At least two supporting documents are quoted by Leichtentritt (1905). One compatriot of Chopin, Mr. Orlowski, wrote in 1834 that Chopin’s was healthy and vigorous. Similarly, Chopin’s intimate friend, physician Jan Matuszyński, 1834, who shared dwellings with Chopin, and could observe him daily, did not report anything pathological, rather vice versa: “He [Chopin] became strong and big, I hardly recognize him[112 - Leichtentritt, H., Reimann, H., ed. (1905) “Berühmte Musiker: Lebens- und Charakterbilder. Einführung in die Werke des Meisters. Chopin”. “HARMONIE” Verlagsgesellschaft für Literatur und Kunst, p. 62.].