Victoria Wapf - The Disease of Chopin. A comprehensive study of a lifelong suffering

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 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 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 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 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 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 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 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 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 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 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.

Ganche (1935) lists other medications and remedies prescribed to Chopin: foxglove (digitalis), monkshood (aconite), creosote, protioduret , jelly lichen (collema), gum water (diluted acacia sap that was a popular prescription for phthisis 87 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 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 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.

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 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 91 Wüst, H. W. (2007), “ Frederic Chopin ”. Bouvier Verlag. at some points – in 1835, and, probably, in 1838, too – dropping below 45 kg 92 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 93 Erlinger, S. (2010), “ Frederic Chopin and Michael Jackson: What could they have in common?”, Gastroenterologie Clinique et Biologique 34 (4—5), 246—249. .