Diagnosing Chopin: Uncovering a Life of Illness

ostatnie_akordy_chopina_polona.jpg, default, J. Męcina-Krzesz, ‘Chopin’s Last Chords’, 1920, photo: Polona National Library

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He spat out bowls of blood, overused opium, and was constantly sleep-deprived. What ailed Fryderyk Chopin?

Poland’s most famous composer had been prone to sickness since childhood. He was oversensitive to stimuli and often tormented by small infections, colds, and digestive problems. Young Fryderyk was sickly, pale, delicate and fragile – and he was similarly described throughout the rest of his life. As Stephen Heller noted in 1829, ‘Frail, thin, with hollow cheeks; it was generally believed that, just like many geniuses, he’d die young’.

Hector Berlioz said that Chopin ‘was dying his whole life’, and it’s difficult to disagree. Chopin led a lavish and opulent lifestyle enabled solely by his own income. He would only have guests if they seemed interesting to him, even when he was severely weakened by illness. He himself was a socialite. As George Sand recalled, ‘There were about 20 or 30 salons which he had to frequent and delight the guests with his presence’. He suffered terribly, but his suffering did not prevent him from composing music. In a letter to his family dated December 1845, Chopin wrote, ‘I’ve outlived so many people stronger and younger than me that I now think I must be immortal’.

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Zbigniew Zbig Rybczynski,The Orchestra (fragment), Funeral march, Chopin

The representation of Chopin as suffering, consumptive, and dying has been strongly inscribed into our cultural imagination. Andrzej Żuławski based his film La Note Bleu on the image of the constantly ill artist. There are also countless artistic representations of Chopin’s death. At the beginning of the 20^th century, the post-mortem cast of the pianist’s hand became a popular postcard motif. Along with the gravestone in the Parisian cemetery Père-Lachaise, Chopin also has a Polish gravesite – a crypt in the Church of the Holy Cross on Warsaw’s Krakowskie Przedmieście. We can hear melancholic, sorrowful, nocturnal tones in many of Chopin’s works, which is perhaps why we like to imagine him dwelling in the realm of Thanatos?

One of them said I’d died

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Józef Kurowski, ‘Fryderyk Chopin Making a Toast’, 1837, photo: Polona National Library

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As far as we know, Chopin’s first doctor was Franciszek Gerardot, who prescribed him a countryside vacation. Following doctor’s orders, Chopin spent summer 1824 in Szafarnia, where he took pills daily and drank half a carafe of tyzana (a brew made of linden and ground oats or barley), diluted sweet wine, and coffee made with roasted acorns. On top of that, he took energising baths infused with oak bark.

In 1826, Chopin fell over when ice-skating, which was one of Warsaw children’s favourite leisure activities. Young Fryderyk smashed his head and injured his leg slightly, which caused him to have to walk using crutches for some time. To increase his fitness, he was advised to attend carpentry classes at the University of Warsaw, where he made his own chess set.

A few weeks later he was ‘affected by murr’. His doctor at the time was Fryderyk Adolf Roemer, who prescribed putting leeches on his throat. It was an incredibly popular medical solution, to the point that the term ‘leechmania’ was coined to describe a trend that appeared in the late 18^th century when leeches started being used to cure almost all ailments. How did Chopin catch the cold? ‘It’s true that during Shrovetide, I was out until 2 a.m. from Thursday to Saturday, but that’s not the cause, as I always got enough sleep on the next day’, he wrote in a letter to Jan Białobłocki. It was already in his teenage years that Chopin started to lead a very irregular lifestyle, often getting no sleep at night.

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Illustrations for Fryderyk Chopin’s music, 1913, photo: Polona National Library

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The Chopin family’s next doctor was Jan Fryderyk Wilhelm Malcz, a world-renowned specialist. He conducted research on cholera and shared his results with British medics, who at that time struggled to tame an epidemic of this illness in colonial India. The method proved effective, and Malcz received a written thank-you note from Queen Victoria.

The famous doctor sent the Chopin family – mother, Justyna, sisters Ludwika and Emilia, and Fryderyk – to treatment in Duszniki, a spa town in southwestern Poland. The young artist was medicated with goat milk whey, Laubrunn (‘hypoosmotic acidulous waters, ferruginous, and containing sodium bicarbonate’, explains Marlena Radwańska) and emetic waters (an emetic solution used as a vomitive and expectorant drug). On top of that, he took saline water baths and went on walks. In a letter to Wilhelm Kolberg, he wrote:

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Admittedly, I walk in the mountains surrounding Reinertz, frequently enchanted by the sight of the valleys. I get down with displeasure, sometimes on all fours, but I haven’t yet been where everyone goes because I’ve been forbidden. Here, in the vicinity of Reinertz, there’s a rocky mountain called Heuscheuer, a spot with breath-taking views but unavailable to some patients because of the unhealthy air on top; and unfortunately, I happen to be one of them.

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The garden of the house where Chopin and George Sand lived during their stay in Valdemoza, photo: Polona National Library

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Chopin’s serious health issues started in 1835, when the composer suffered from acute bronchitis. Perhaps this was the beginnings of tuberculosis? The worst crisis came in 1838, when he and George Sand went to Mallorca. Despite the favourable aura, he started coughing soon after the first walk. Once the weather worsened, his condition deteriorated, and his oppressive cough bothered all the inhabitants of the villa where they stayed, which lacked a fireplace. There was no way for Chopin to warm himself up; he got weaker and weaker, had a high fever, coughed out blood, experienced searing pain in his chest and could barely speak. Sand called for the three best doctors on the island. In a letter dated 22 November 1838, Chopin wrote:

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Three doctors, most famous on the entire island; one sniffed what I spat out, one auscultated to find where the cough came from, the third one palpated me and listened to me spit. One said I’d died, one – that I was dying, […] a grace Providence, now I’m like new.

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The first doctor diagnosed him with consumption and prescribed no cure. The second issued a medical opinion diagnosing him with laryngeal tuberculosis and advised him to leave a piece of cotton or linen in the wound in order to cause inflammation. The third medic prescribed bloodletting and a vesicant (a patch made from cantharidin, causing blisters). Thankfully, neither cure was actually tried. Chopin did follow instructions to stay in bed, drink herbal infusions (made with thyme and violets), bandage his chest, and use mustard plasters. The doctors also informed local authorities about the composer’s infectious disease, which led to his quarantine in a Carthusian monastery in Valldemossa. The monastery was very damp, and Chopin’s health continued to deteriorate.

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24 Préludes, Op. 28: No. 15 in D-Flat Major "Raindrop"

For the last four years of his life, Chopin was practically unable to walk on his own. He was fully dependent on servants and friends who took care of him; he was carried down the stairs and would lie down during meetings with his students. In the mornings he suffered from exhausting coughing fits, coughing out thick, sticky, bloody sputum. As Sand described it, ‘Chopin spits out entire bowls of blood’.

It’s worth emphasising that Chopin had never been an easy patient. He went against medical advice by dressing light, sleeping irregularly and not enough. Additionally, his nutrition was insufficient and unhealthy, although he had little control over that. A lot of foods, especially fat meats, caused him severe intestinal distress. He enjoyed eating bread and sweets the most, and he complimented his diet with fish and lean poultry.

Moreover, the composer took bigger and bigger doses of opium in the form of drops dissolved in water and a morphine sulphate solution. Indeed, alkaloids derived from dried poppy seeds could be beneficial in tuberculosis treatment, but they stopped working for him eventually.

Damned phantasms

The definition of ‘mental health’ is quite fluid; behaviours considered perfectly normal in Chopin’s times may seem odd to us now. Diagnosing mental health issues in those who lived centuries ago makes little sense, but important figures from the world of culture are often ‘psychiatrised’ nevertheless. With what mental health conditions has the composer from Żelazowa Wola been diagnosed in the time since his death?

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Lev Oborin - Nocturne in C sharp minor No.20, Op. Posth (Chopin)

The symptoms resembling depression first appeared in Vienna, at the beginning of Chopin’s life as an emigrant. The sense of longing for his homeland was accompanied by the worrying news about the failure of the November Uprising in 1830-1831 and the Tzar’s army marching into Warsaw. The signs of depression returned in Mallorca. Biographer Bronisław Edward Sydow notes that Chopin complained that his world had started to become as dark as his heart. During Chopin’s stay in Mallorca, his productivity and willingness to work decreased, and for the first time in his life, he started to suffer from chronic insomnia. Having noticed his own weakness and lack of interest in life, he said that old monks have got more fire in them than he (as recorded in Sydow’s biography of the composer). He compared his monastery cell to a large coffin, and he summarised his sense of hopelessness with an unusual comparison: ‘It’s no fault of mine that I’m like this mushroom looking like a champignon, the one that poisons you when you dig it out and taste it, having taken it for another – I know I’ve never been of any use to anyone – nor have I been of any use to myself’. George Sand, in turn, wrote, ‘One more month in Spain and depression would have killed him’.

Axel Karenberg noted:

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From the perspective of psychopathography, it’s very telling that his physical symptoms – cough, sputum, fever and pneumorrhagia – were preceded by a deterioration of his mental health.

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Thumbnail — Narcisse Edmond Joseph Desmadryl, 'Portrait of George Sand', 1839, photo: Polona National Library

We are aware of a few instances of Chopin hallucinating. His student Nannette Streicher recalled a lesson during which he was particularly focused as he played, completely detached from the surrounding world. Suddenly he stopped playing, all his hair stood on end, he shouted something and started crying. It only lasted for a short while.

During his fateful stay in the monastery in Valdemoza, he thought that he was surrounded by spectres and phantoms, even when he was feeling better. ‘I found him at 10 p.m. by the piano, pale, with wandering eyes and hair standing on end’. Sand recalled. In Historie De Ma Vie, she describes one more situation related to Chopin’s delirium. One day, when Sand came back from a few hours’ trip, Chopin saw her, got up, looked at her with crazy eyes and said, ‘Ah! I knew full well you were dead!‘”. Waiting for her return, he had a dream, and at some point, he stopped distinguishing between reality and fiction. He calmed himself down by playing the piano, almost falling asleep by the instrument, believing at the same time that he was dead. He saw himself drowned in a lake.

It wasn’t the first time he imagined his own death. The first such situation happened when he was suffering from a strong tooth infection in 1844, which coincided with the death of his father and his close friend from school, Jan Matuszyński. Sand recalled:

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Catholic dogma throws on death horrible terrors. Chopin, instead of dreaming [of a better world for his father’s soul], had only dreadful visions, and I was obliged to pass very many nights in a room adjoining his, always ready to rise a hundred times from my work in order to drive away the spectres of his sleep and wakefulness. The idea of his own death appeared to him accompanied with all the superstitious imaginings of Slavonic poetry. As a Pole he lived under the nightmare of legends. The phantoms called him, clasped him, and, instead of seeing his father and his friends smile at him in the ray of faith, he repelled their fleshless faces from his own and struggled under the grasp of their icy hands.

In September 1848, he paused his concert in London. In a letter to Solange Clésinger, Sand’s daughter, he wrote:

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I was about to begin a march when suddenly I saw the same fateful phantoms that appeared before me one gloomy evening in the convent rising out of the half-opened piano.

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Chopin’s hallucination often appeared alongside fever and a general deterioration of his health.

Some scholars and critics have attempted to interpret the famous composer’s works through the lens of psychoanalysis. S. Roschietta attempted to discover the repetitive sounds of coughing in the rhythm of the funeral march from the Piano Sonata No. 2. André Michel, in turn, wrote that the motif of a lullaby, recurring in Chopin’s music, might be a sign of an unconscious longing for the mother’s breast.

Right ventricular failure

Chopin’s final days were filled with suffering. He was in agony for four days before he died in his apartment on Place Vendôme 12. His face was swollen and bruised. Throughout his last night, he was tormented by convulsions, severe pain, and a choking cough. By 2 a.m. on this final day, he lost his sight and was delirious. An hour later he stopped breathing. The post-mortem was conducted by the doctor and anatomist Jean Cruveilhier, who allegedly claimed that Chopin died of an unknown illness. Why allegedly? The examination protocol was burnt in the fire of the Parisian police archive in 1971, so all we know is based on Jane Stirling’s oral testimony.

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The house in Paris where Chopin died, 1920, photo: Polona National Library

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What did Chopin die of? We don’t know, but there are many speculations. Michał Witt suggests:

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Pulmonary tuberculosis, cystic fibrosis, emphysema (alpha-1-antitrypsin deficiency), mitral stenosis, bronchiectasis, hypogammaglobulinemia, aspergillosis, allergic bronchopulmonary aspergillosis, tricuspid insufficiency, Churg-Strauss syndrome, pulmonary hemosiderosis.

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For many years, cystic fibrosis was considered a likely cause of Chopin’s death. It’s a rare congenital genetic disease, that occurs in about 1 in 2500 individuals. It was first described in the 1930s by the American paediatrician Dorothy Anderson, though there are mediaeval sources that mention illnesses with similar symptoms: respiratory and digestive system issues; buboed legs and ankles; progressively increasing fatigue; recurring hoarseness of voice; and trouble expectorating sputum.

In 2018, on the pages of the American Journal of Medicine, a team of Polish scientists published new research regarding the musician’s death. Their hypotheses were made possible thanks to macroscopic and photographic analyses of Chopin’s heart, cut out of his chest immediately after his death and buried in the Church of the Holy Cross on Warsaw’s Krakowskie Przedmieście.

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An epitaph on the urn containing Fryderyk Chopin’s heart in the Church of the Holy Cross in Warsaw, 1939, photo: Polona National Library

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Prior to opening the jar in which the heart is kept, the scientists weren’t certain whether they were going to have anything to work with. Fortunately, the vessel was extraordinarily hermetic, and the level of organ preservation fluid had only lowered by 0.5 centimetre. What did the scientists notice about the organ preserved in a 60% alcohol solution? Again, let’s give the floor to Michał Witt:

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The image of Fryderyk Chopin’s heart testifies to chronic heart failure, especially on the right side. […] The numerous small villi on the surface of the heart are a symptom of fibrinous pericarditis. Three glistening pearly-white lumps constitute another noticeable lesion.

We can probably – in fact, almost certainly – say that Fryderyk Chopin’s chief health issue was long-lasting miliary tuberculosis.

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The death mask of Fryderyk Chopin, 1920, photo: Polona National Library

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Security measures for anatomical specimens held in museum collections rule out the possibility of conducting genetic tests or a CT scan, both of which would enable much more precise conclusions regarding the cause of Chopin’s death. What’s potentially promising is the option of taking a sample of genetic material from the graves of Fryderyk’s parents, Justyna Chopin (née Krzyżanowska) and Mikołaj Chopin, and his sister Emilia Chopin. Might exhuming their remains allow us to discover more details of the master pianist’s medical history?

Originally written in Polish, translated by Anna Potoczny, Oct 2021

Sources: Witt M., Na Co Chorował i Co Było Przyczyną Śmierci Fryderyka Chopina? (The Disease and an Immediate Cause of Death of Frederic Chopin), Nauka (Science) 2/2021; Kijowski M., Powrót Serca Fryderyka Chopina do Warszawy w 1945 Roku: Kontekst Polityczny i Prawnoekonomiczny w Świetle Dokumentów (Fryderyk Chopin’s Heart’s Return to Warsaw in 1945: The Political, Legal and Economic Context in the Light of Documents), Studia Chopinowskie (Chopin Studies) 3/2019; Majka L., Gozdzik J., Witt M., Cystic Fibrosis – A Probable Cause of Frederic Chopin’s Suffering and Death, Journal of Applied Genetics, 44(1)/2003; Karenberg A., Frédéric Chopin and His Neuropsychiatric Problems, Progress in Brain Research, 2015; Caruncho M. V., Fernandez F. B., The Hallucinations of Frederic Chopin, Journal of Medical Ethics, 2011; Radwańska M., Leki Roślinne Stosowane w Leczeniu Fryderyka Chopina (Plant-Based Medicine Used in the Treatment of Fryderyk Chopin), Analecta: Studia i Materiały z Dziejów Nauki (Analecta: Studies and Materials on the History of Science), 2011; Tomaszewski M., Fryderyk Chopin: Szkic do Portretu (Fryderyk Chopin: A Sketch for the Portrait), Annales, 7/2009; Polskieradio.pl

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