Cover designer Julia Kravchenko

© Victoria Wapf, 2017

© Julia Kravchenko, cover design, 2017

ISBN 978-5-4483-1531-2

Created with Ridero smart publishing system

Acknowledgement

This book wouldhave been impossible to complete without a great deal of help and support ofmany people from around the world. That is why I am glad to seize thisopportunity and express my gratitude to those who, in one way or another, helped me to reach the goal.

First of all I want to thank my family. They have not only granted me spare time to work on the manuscript, but also kept encouraging me along the way, nurturing my confidence and scientific curiosity.

Many thanks to Professor Tadeusz Dobosz, Head of the Molecular Techniques Unit of the Forensic Medicine Department at the Medical University of Wroclaw (Poland) – for his precious comments and deep appreciation of my work.

Sincere gratitude  to Mr. Piotr Mysłakowski, publisher and researcher in the field of genealogy and biographical sciences, a renowned architect and designer – for his valuable notes and corrections in regard of Chopin’s genealogy.

I am thankful to Dr. Lorenzo Käser from the Department of Graduate Education in Human Medicine, Zurich University – for providing an excellent learning and teaching environment and serving as a brilliant example of a physician, mentor and educator I always wanted to be.

A special thanks go to Prof. Wolfgang Jungraithmayr of the University Clinic of Thoracic Surgery in Zurich. A talented pianist and violinist, he infected mewith the idea to research the medical history of Frederic Chopin.

And, of course, I can not thank enough Julia and Maria, who assisted me with proofreading and graphicdesign, because without them all my efforts would be worthless. Both of themput every effort to create a book of a truly good quality.

I also thank my dear friends and colleagues Dr. Maria Bär, Dr. Iryna Cranny, Dr. Alexander Garmaev, Dr. Heiko Frühauf, Dr. Ursina Jansen, Dr. Yves Jaccard, Prof. Dmitry Kazakov, Ina Ladnar, Dr. Barbara Lütolf, Fahim Mozaffari, Nora H. Gräni, Dr. Elisabeth Hohenstein, Prof. S. Vavricka, Dr. Elisabeth Rushing, Bota Tynybekova, Philip Twaites, Dr. Matthias C. Walter, Cyril Wechsler, Pamela Wible, Priyatharsan Yoganathan und Nishanththan Yogarajan – who appreciate and support my eagerness to learn new things every day.

Abstract

Introduction

The life of the Polish-French pianist and composer Frédéric Chopin (1810—1849) was, to a great extent, influenced by his disease. Nevertheless, the diagnosis and differential diagnoses of his suffering remain a matter of debates in numerous biographical studies on the composer’s life. This study shall conduct a systematization and overview of Chopin’s medical history, in an effort to outline pathways to his most probable diagnosis.

Overview of methods

In this paper, the medical literature on Chopin’s disease was examined to weigh up the existing evidence in the light of today’s medical knowledge and to define possible ways to extend such evidence with modern diagnostic methods. The literature search included three steps. First, a thorough search for available publications was conducted to identify and acquire all medical documents describing F. Chopin’s status and disease (s). The second step involved sifting of the reference lists in the articles retrieved from the first step. The third step was aimed at the retrieval of complementary documents of interest (for example, biographic, demographic or historical documents authored by specialists other than medical professionals) that may help to understand Chopin’s disease in its historical, cultural and social context.

Results

Based on the existing data, it was found that the diagnosis of tuberculosis still outweighs the cystic fibrosis version in Chopin’s case. However, various noxious factors during his life may have shaped the course and severity of the disease. Fully inadequate – by today’s standards – and often potentially harmful treatment (including bloodletting, herbal remedies or other potentially toxic substances) as well as a prolonged exposure to tobacco smoke (passive smoking) could have played a crucial role in Chopin’s pathology, bringing the pianist and composer closer to his death.

Conclusions

The total body of evidence gathered from the current and historical literature allows for a strong presumption of tuberculosis as Chopin’s diagnosis. However, other primary diagnoses, comorbidities, as well as consequences of an iatrogenic exposure should still be regarded and may not be fully discounted.

An analysis of existing tissue specimens could yield additional valuable information and help to resolve the decades-long discussion about Chopin’s diagnosis.

List of abbreviations

AAT – alpha-1-antitrypsin

ABPA – allergic bronchopneumonic aspergillosis

CF – cystic fibrosis (mucoviscidosis)

CVID – common variable immunodeficiency

EGPA – eosinophilic granulomatosis with polyangiitis

GPS – anti-glomerular basement membrane disease (Goodpasture’s syndrome)

HHT – hereditary hemorrhagic telangiectasia

PAH – pulmonary arterial hypertension

PAVM – pulmonary arteriovenous malformations

PCD – primary ciliary dyskinesia

PH – pulmonary hemosiderosis

PID – primary immunodeficiency

SERPINA – serine proteinase inhibitor

GPA – granulomatous polyangiitis

Key words: Frederic Chopin; tuberculosis; cystic fibrosis; lung diseases; differential diagnosis.

Introduction

Chopin – again not seeking gain

But improvising off the wing —

Alone works with chance and clay

From likelihood to one true thing.

B. Pasternak, 1935

Mortui vivos docent

(“the living learn from the dead”)

Latin saying.

Both life and creative endeavors of Frédéric Chopin (1810—1849), a pianist and composer of French-Polish origin, were in many ways shaped by his disease. Chopin’s chronic condition still remains not clearly identified and evokes debates. Given the scarcity of medical-biographic data, Chopin’s symptoms provoked a number of thoughts and discussions both in the historical and medical community. However, despite the obvious interest in this topic, and a number of recent publications – especially around the recent bicentennial (2010) of the pianist/composer – there were no broad review of his possible and probable diagnosis in the recent time. The classic work, Chopin’s pathography by Edmond R. Long (1956)¹ was focused on tuberculosis only. Later scholars explored further possible diagnoses, with cystic fibrosis (O’Shea, 1987)² being the most known. Nevertheless, virtually all reports on the composer’s life and disease were centered on one or two possible pathologies only. In this comprehensive review, the medical and historical literature on Chopin’s disease and on the medicine of that era was examined to evaluate tuberculosis and cystic fibrosis, as well as other possible conditions for their significance in influencing the health of the innovative musician during his lifetime. It was found that though tuberculosis remains the usual suspect, several other hypotheses cannot be discounted either, especially if further exploratory methods may potentially become available. Chopin’s situation is unique, because in his case a tissue specimen could possibly shed further light on his disease, and, consequently, on our understanding of his life and works.

Moreover, the study of Frédéric Chopin’s medical history is an exciting opportunity to gain additional insights into the nineteenth century medicine, in the physician-patient relationships, and to see how the progress of medical science in the newer times has contributed to diagnostic and treatment of formerly fatal diseases. While working on this review, clear preference was given to the studies and interpretations of Chopin’s life and disease done by medical professionals – physicians, medical historians and pathologists. Other sources, such as personal communication of Chopin himself and his family and friends were used as well.

This study is divided into several chapters. It starts with a nearly forensic review of Chopin’s medical history, following a standard pattern of a patient examination. The primary purpose of this chapter is to provide as many clinically relevant data as possible in order to lay a foundation for diagnosis and differential diagnosis. The following two chapters contain information about Chopin’s physicians, their professional profiles, and modes of treatment. A profound understanding of Chopin’s disease history would only be possible with knowing on who treated him and which principles each treatment was based on. As it is often the case throughout the whole human and medical history, a treatment itself may become an aggravating factor or even the cause of the patient’s suffering. Chopin, as a patient with chronic disease (s), had an extensive list of medications, many of them with a potential for toxicity or interactions. That is why his treatment deserved a separate chapter here.

Following the examination of Chopin’s medical history is a discussion on the terminal period and post-mortem exploration of the composer’s disease. Chopin’s case is standing out because at least in theory, a further exploration with today’s instrumental methods is technically possible thanks to the existence of the tissue specimen.

The next chapter is the most crucial one. It is focused on the diagnosis and differential diagnosis of Chopin. Beginning with an outline of two leading hypotheses for Chopin’s most suspected diagnoses, namely tuberculosis and cystic fibrosis, other, less known or less probable diagnoses and discuss possible comorbidities will be reviewed and described in detail. Finally, an attempt to lay out an examination plan with the twenty-first century methods of analysis will be undertaken in order to advance our understanding of Chopin’s disease.