What Was the Real Cause of Chopin's Death?

Interview on new examinations

By The Fryderyk Chopin Institute

Professor Michał WittThe Fryderyk Chopin Institute

Michał Witt is a geneticist, molecular biologist and professor of medical sciences. He has been the Director of the Institute of Human Genetics of the Polish Academy of Sciences since 2016 and the Head of the Department of Molecular and Clinical Genetics of the Institute for many years.

Portrait of Fryderyk Chopin (19th Century) by UnkownThe Fryderyk Chopin Institute

In 2014, he participated in the examination of Chopin’s heart as one of the two medical professionals present there. Among other participants of the examination were directors of the Chopin Institute and representatives of secular and ecclesiastical authorities.

Postcard showing the place where the urn with Fryderyk Chopin's heart was placed (20. Century) by The Fryderyk Chopin Institute, Workers' Publishing Cooperative "Prasa"The Fryderyk Chopin Institute

Paweł Siechowicz, Fryderyk Chopin Institute: During World War II, Fryderyk Chopin’s heart was taken out of Warsaw and hidden outside the city. In 1945, it was brought back to its previous location in the crypt of the Holy Cross Church in Warsaw. Since then up until the year 2014, it remained hidden from anyone’s view. You are one of the two medics who participated in the examination of Chopin’s heart carried out in April 2014. How can you describe that experience?  

Urn with Frédéric Chopin's heart (21st Century) by Mariusz KoszutaCultural Center of Milanówek

Professor Michał Witt: It was a colossal experience that I will remember till the end of my life. An unusual atmosphere and scenery of the closed, dark church where only the pillar with the crypt containing Chopin’s heart was brightly lighted. Everybody was aware of participating in something unique: we were to see the remains of our greatest, legendary composer.

In the solemn atmosphere magnified by the scenery one could feel a clear tension. Although everything was planned and went according to the plan, we could not predict every problem that could possibly arise. The opening of the crypt was a particularly emotional moment. First, in the crypt niche, we saw a brown box wrapped in packaging paper that, as I understand, served to fill the space that was left around the box.

After removing it, we found out that there was another box inside. This time it was black. The emotions were very intense, magnified by the fact that we were proceeding in a rhythm having a certain gradation: first, removing the stone, then, taking out the box and opening it, then the same with the second box… The tension that accompanied the whole process was a result of the fact that we did not know what we would find inside.

Postcard with a reproduction of the portrait of Fryderyk Chopin (20. Century) by The Fryderyk Chopin Institute, Workers' Publishing Cooperative "Prasa"The Fryderyk Chopin Institute

PS: Correct me if I am wrong, but I suppose that the culmination came in the moment, when you saw the jar containing Chopin's heart. As far as I know, it was not opened. 

Transfer of the urn with Frédéric Chopin's heart (21st Century) by Mariusz KoszutaCultural Center of Milanówek

MW: Yes, that is correct. It was the condition we set at the very beginning. I asked specifically that the object of examination should not be infringed in any way. There are biological, chemical and microbiological reasons for it.

When we eventually saw the heart itself, we felt relief. Chopin’s heart is preserved perfectly. Anything could have happened to it since 1945 when it was seen for the last time. Fortunately, nothing bad occured.

Transfer of the urn with Frédéric Chopin's heart (21st Century) by Mariusz KoszutaCultural Center of Milanówek

PS: You described Chopin’s heart as enlarged. Metaphorically speaking, a big-hearted man is someone good. Is an enlarged heart a good sign from the standpoint of medicine as well? 

The last chords of Fryderyk Chopin The last chords of Fryderyk Chopin by Józef Męcina-KrzeszThe Fryderyk Chopin Institute

MW: As a medical doctor I have to say that a big heart, an enlarged heart is a pathological symptom typical of chronic lung diseases. Medicine calls it a lung heart, cor pulmonale. Heart is one big muscle. Such pathological changes can be easily understood if we remember how blood circulates in our body.

Blood that is pumped by the left ventricle goes from the heart through the aorta to reach all the organs and tissues of the organism. Blood that is pumped by the right ventricle is directed to the lungs. If the lungs are engaged in a chronic disease process, the respiratory resistance rises.

The right heart needs to perform harder work. To effectively make the blood flow in the pulmonary circuit, it has to increase the force of blood release, which in turn causes the hypertrophy of the muscle. In this way, the heart becomes enlarged which in medicine we call cardiomegaly. And this is what Chopin’s heart looks like.

Postcard with a reproduction of the portrait of Fryderyk Chopin (20. Century) by The Fryderyk Chopin Institute, Workers' Publishing CooperativeThe Fryderyk Chopin Institute

PS: As I understand, this means that Chopin’s lung disease was chronic. 

Chopin's Death (1888) by Félix-Joseph BarriasThe Fryderyk Chopin Institute

MW: Yes, it lasted for many years. This is also confirmed by testimonies of witnesses and Chopin’s own descriptions of the symptoms he observed, as well as the suffering he experienced. 

Portret Fryderyka Chopina (ok. 1844) by George Sand (Aurore Dudevant)The Fryderyk Chopin Institute

PS: Since you have mentioned it, I would like to ask what can be said of the suffering that Chopin experienced? Was his disease equally oppressive all the time or did it exacerbate from time to time?

Chopin Frederik Francois 1810-1849.LIFE Photo Collection

MW: We know from the description of Chopin, George Sand and his friends that the disease advanced constantly. As it often happens in case of chronic diseases, there were particularly bothersome periods of exacerbation that would become more and more frequent as the disease advanced.

Chopin Frederik Francois 1810-1849.LIFE Photo Collection

The suffering caused by the chronic lung disease can be described only by those who experience the dramatic symptom of not being able to take a breath. This is a symptom of various chronic lung diseases. In addition to coughing and suffocation, after some time Chopin began to spit blood which also happened more and more often over time. 

Piece of Frédéric Chopin's bust with family manor house in Żelazowa Wola in the background (21th Century) by Mariusz KoszutaCultural Center of Milanówek

PS: In what you are saying, I find the link with the experience that has recently become common for all the globe. I meant the coronavirus disease. There is also another link between Chopin’s biography and our times: he arrived in Paris during a cholera epidemic and he could not advance his career quickly because all the concert venues were closed. You say that Chopin was most probably infected with tuberculosis, a disease much more common in his time than it is today.

Postcard with a reproduction of the portrait of Fryderyk Chopin (20. Century) by The Fryderyk Chopin Institute, Workers' Publishing Cooperative "Prasa"The Fryderyk Chopin Institute

MW: The diagnosis of tuberculosis is not surprising. I can remember we were learning about it in Polish schools. What we saw confirmed clearly that Chopin’s main disease was most probably chronic lung tuberculosis. Tuberculosis was an endemic disease in Northern Europe inthe first half of the 19th century. That means that it occurred in the region in a much larger quantity of cases than elsewhere.

Children and youngsters in that part of Europe were commonly infected with tubercle bacillus, which was to be discovered as a causative agent of the disease several dozen years later by Robert Koch. Clinical diagnosis of tuberculosis was nevertheless clear – the disease was called consumption back then. Up to 90% of people aged under 18 suffered from it. This is a dramatically high percentage! Tuberculosis was the cause of one-quarter to one-third of all the deaths. In medicine, we call tuberculosis the disease of the poor.

Reproduction of 'The last chords of Fryderyk Chopin' (20. Century) by Paulussen and Co.The Fryderyk Chopin Institute

We cannot say that in the case of Fryderyk Chopin but given the enormous civilizational, cultural and material gap that characterized the society at that time, the risk of the development of disease outbreaks was very high. The transmission to richer, better educated and better nourished people was also very easy.  

Portrait of Emilia Chopin (1826/1827) by Unknown authorThe Fryderyk Chopin Institute

PS: Tuberculosis is a contagious disease and we can assume that the deaths of his friend Jan Białobłocki and his little sister Emilia were also caused by that same disease. Perhaps that was when Chopin himself got infected. 

Portrait of Fryderyk Chopin at the piano (c. 1826) by Eliza RadziwiłłównaThe Fryderyk Chopin Institute

MW: Apparently, the symptoms of tuberculosis occurred when Chopin was a teenager. We have a description of a swelling of his neck at the age of sixteen that can be interpreted as scrofula or the tuberculous inflammation of neck lymph nodes, typical of a tuberculous infection. 

Epitaph with Chopin's heart in Holy Cross Church in Warsaw (21th Century) by Mariusz KoszutaCultural Center of Milanówek

PS: Let’s get back to the heart that can tell the most about Chopin’s disease. We know that it was enlarged. We also know that it looks as if it was covered with frost. 

Plaque commemorating preservation of the urn with Frédéric Chopin's heart (21st Century) by Mariusz KoszutaCultural Center of Milanówek

MW: On the surface of Chopin’s heart, on the epicardium, there are two clearly visible characteristic morphological elements. The first one can be described as the covering of the whole surface of the heart with a mosslike silvery fibrinous tarnish, truly resembling frost. The tarnish is spread evenly. This symptom can be interpreted as the result of the fibrinous tuberculous inflammation of the pericardium. 

On the surface of Chopin’s heart one can also see three pearl-white nodules of oval shape that can be found on the left ventricle wall. It fits well into the whole pathological picture, because this is exactly what tuberculomas look like. These are morphological formations that can appear on the heart surface in case of tuberculous infection, although in very rare cases. 

Searching for similar descriptions, I found an American article from 1948 presenting a similar change on the surface of the heart muscle of a person severely infected with tuberculosis. 

Postcard showing the death mask of Fryderyk Chopin (20. Century) by The Fryderyk Chopin Institute, Workers' Publishing Cooperative "Prasa"The Fryderyk Chopin Institute

PS: When we speak about the inflammation of the heart muscle, we refer to the last stage of Chopin’s disease and the direct reason for his death. What might the last moments of his life have looked like? 

Colonade in Reinerz (19th Century) by Anstalt von Mercier & LoeillotThe Fryderyk Chopin Institute

MW: In Chopin’s times, there was no treatment for tuberculosis which could only be alleviated. All one could hope for was a dubious relief of their ailments. Chopin was advised to drink goat’s milk whey, doctors prescribed him climatic treatment. That was the reason for the fame of places like Davos in Switzerland, magnificently described in The Magic Mountain by Thomas Mann, and Duszniki-Zdrój that teenage Chopin visited with his family to breathe fresh air. 

Portrait of Fryderyk Chopin Portrait of Fryderyk Chopin (19th Century) by Teofil KwiatkowskiThe Fryderyk Chopin Institute

There was no treatment of the causes of the disease which advanced irrevocably, and its increasing symptoms deteriorated the sick preson’s health. The exhaustion of the organism resulted in weakness, dyspnea, physical inefficiency and high morbidity caused by various infections.

Oppressive, exhausting cough was a constant symptom. Chopin also had intestinal problems that can be attributed to tuberculous infection of the bowel, not a rarity either. In Chopin’s heart, we saw the effects of a chronic advancing lung tuberculosis that had led to the enlargement of the heart muscle. At a certain point, a complication occurred in the cardiovascular system in the form of a rapidly advancing tuberculous inflammation of the pericardium.

Chopin on His Deathbed Chopin on His Deathbed (19th Century) by Teofil KwiatkowskiThe Fryderyk Chopin Institute

There are romantic descriptions of the last moments of Chopin’s life. Seemingly, all the Paris society felt obliged to visit Chopin on his deathbed in the last days of his life. It was certainly true, since that was the custom at that time; however, we can imagine that the last days of Chopin’s life might have been dominated by dramatic symptoms in the form of cardiorespiratory failure, rapidly advancing and finally leading to death. 

Chopin Frederik Francois 1810-1849.LIFE Photo Collection

PS: In your research, I have found an interesting description of Chopin’s hand. We usually look at the cast of his hand looking for the solution to the mystery of his piano skills. It appears that it also contains some interesting information for a medic.

Postcard showing a cast of Fryderyk Chopin's hand (20. Century) by The Fryderyk Chopin Institute, Workers' Publishing Cooperative "Prasa"The Fryderyk Chopin Institute

MW: It is connected to the hypothesis that Chopin did not have tuberculosis but a mild form of cystic fibrosis. Dyspnea and expectoration of sputum are uncharacteristic symptoms that occur in many various respiratory tract diseases. Cystic fibrosis is one of such diseases. It differs from tuberculosis in that it is not contagious but genetic. Since we know that Chopin’s sister Emilia died from a similar disease, one could search for its family, hereditary roots.

There were more arguments supporting that hypothesis. First, Chopin had stomach aches, second, he did not have children despite of many possible affairs and a long-standing relationship with George Sand. Of course this does not mean that he was infertile. However, it increases the probability of the alternative hypothesis. One of the symptoms of the advanced cystic fibrosis is the occurrence of the so-called clubbed fingers.

A cast of Fryderyk Chopin's left hand by Tadeusz ŁopieńskiThe Fryderyk Chopin Institute

This is a characteristic change of the finger endings and fingernails that is a result of the hypoxia of the distal parts of the body. Finger clubbing is very characteristic and cannot be mistaken with anything else, but one cannot find any such elements in the beautiful contour of Chopin’s slender hand. 

Portrait of Fryderyk Chopin (20. Century) by UnknownThe Fryderyk Chopin Institute

PS: I want to ask the last question not only to a doctor, but also to a sensible man and a music lover. Do you think Chopin’s disease influenced the character of his works? 

Chopin Frederik Francois 1810-1849.LIFE Photo Collection

MW: The problem of physical suffering as a motor of artistic creativity was described repeatedly. Even if we limit ourselves only to composers, the array of examples will be wide. The most explicit is perhaps the case of Ludwig van Beethoven who suffered seriously from many ailments, but the list is long, one can mention Schubert, Schumann, Smetana, Tchaikovsky, Mahler…

How deep was the influence of suffering and illness on Chopin’s works? Of course we don’t have a control group and there is no way to study or measure it, but we can imagine that the course of the disease that causes such dramatic effects and such level of suffering, increasing over time, was bound to have effects for the person such sensible as one of the greatest composers of all time. 

Postcard showing the tombstone of Fryderyk Chopin (20. Century) by UnknownThe Fryderyk Chopin Institute

The array of feelings expressed in the Preludes and other Chopin’s works is extraordinary. Of course such suffering and such illness must have had a ripple effect on the things that he gave to us all. 

Music was the best tool of communication that he had, although, as we know very well, he was also very good at writing. 

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