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

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 … a prominent aquiline nose 94 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 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 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 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 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 99 Erlinger, S. (2010), “ Frederic Chopin and Michael Jackson: What could they have in common?”, Gastroenterologie Clinique et Biologique 34 (4—5), 246—249. , 100 100 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 101 101 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 102 102 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 103 103 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 104 104 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 105 105 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 106 106 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 107 107 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 108 108 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 109 109 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) 110 110 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” 111 111 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.

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