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Case Reports
. 2021 Nov;171(15-16):356-362.
doi: 10.1007/s10354-021-00833-x. Epub 2021 Mar 25.

Beethoven's death-the result of medical malpractice?

Christian Reiter  1 , Thomas Prohaska  2
Affiliations
Case Reports

Beethoven's death-the result of medical malpractice?

Christian Reiter et al. Wien Med Wochenschr. 2021 Nov.

Abstract
in English, German

Two different strands of hair taken from Beethoven's head after his death were examined for heavy metals using scanning electron microscopy (SEM) and laser ablation-ICP-MS (inductively coupled plasma-mass spectroscopy). The results revealed the presence of small lead particles on the surface of Beethoven's hairs and fluctuating lead levels in hair medulla along the length of the hair due to alternating lead exposure, with an average lead exposure of 100 times the normal value. The time-line attached to the peaks of these fluctuating values correlate with the pneumonia treatment and the paracenteses performed, including the subsequent treatment of the procedure wounds. While the administration of lead-containing drugs and treatments had been proven to resolve the pneumonia, it had simultaneously caused massive liver failure, accelerated by pre-existing cirrhosis. The question as to whether Beethoven's death was a case of malpractice can only be answered from a forensic point of view ex ante, since the state of the medical knowledge of the time has to be taken into account.

Zwei verschiedene Haarsträhnen, die postmortal vom Kopf Beethovens entnommen worden waren, wurden mittels REM (Rasterelektronenmikroskop) und Laserablation-ICP-MS („inductively coupled plasma–mass spectroscopy“) auf Schwermetalle untersucht. Die Ergebnisse zeigten das Vorhandensein kleinster Bleipartikel auf der Oberfläche der Haare und eine Bleibelastung des Haarmarks aufgrund fluktuierender Bleiexposition, wobei die durchschnittliche Bleiexposition das 100-fache des Normalwerts betrug. Der zeitliche Verlauf der Spitzenwerte dieser ondulierenden Messergebnisse korreliert mit der Behandlung der Lungenentzündung und den durchgeführten Parazentesen sowie den anschließenden Wundbehandlungen. Während die Anwendung bleihaltiger Medikamente und Behandlungen die Pneumonie nachweislich zum Abklingen brachte, bewirkte sie gleichzeitig ein schweres Leberversagen, das durch die bereits vorbestehende Zirrhose beschleunigt wurde. Die Frage, ob Beethovens Tod die Folge ärztlichen Fehlverhaltens war, kann aus forensischer Sicht nur ex ante beantwortet werden, da der Stand des medizinischen Wissens der damaligen Zeit zu berücksichtigen ist.

Keywords: Hair analysis; Iatrogenic lead intoxication; LA-ICP-MS; Ludwig van Beethoven; SEM.

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Conflict of interest statement

C. Reiter and T. Prohaska declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Numerous tiny lead particle deposits on the surface of Beethoven’s hairs. SEM
Fig. 2
Fig. 2
The appearance of laser ablation on Beethoven’s hair as a function of energy used. SEM
Fig. 3
Fig. 3
Time-dependent lead loading of the hair “Guevara 1” combined with the dates of medical measures taken
Fig. 4
Fig. 4
Time-dependent lead loading of the hair “Rollett 2” combined with the dates of relevant events during the last months of Beethoven’s life. The green base represents today’s standard value of lead burden in hair
See this image and copyright information in PMC

References

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