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The Long Suffering of Frederic Chopin
The Long Suffering of Frederic Chopin
(CHEST 1998; 113:210-16) had three sisters. Isabella (1811-1881) led a healthy
Frederic Chopin, the half-Polish, half-French
composer and virtuoso pianist, used the piano to
life and died at age 70 (cause of death unknown).
Ludwika (1807-1855), who suffered recurrent respi¬
express his thoughts and feelings as perhaps no other ratory tract infections throughout her life, died at age
composer has done before or since.the piano was 47 of a respiratory condition. Finally, Emilia (1813-
his means of communication, his other self. His 1827).she was a frail, thin child who suffered
frailty and ill health from a very early age, together
with his conviction that he would not live to an old
recurrent coughing, breathlessness, weight loss,
pneumonia, "asthma," and recurrent hematemesis
age, meant that he was denied many of the usual from the age of 11 years. She died of a massive upper
outlets for his emotions. These factors, however, GI hemorrhage at age 14.
combined with his extraordinary gifts, probably re¬ To our knowledge, the only unusual family medi¬
sulted in a legacy of music for the pianoforte (as the cal history is the illness and early death of Emilia.
instrument was then known) which has been and will
continue to be a source of delight to countless music Chronic 111 Health
lovers throughout the world. Despite his ill health
and short life, the legacy of music he left the world In his teens, Chopin suffered from respiratory
included 27 piano etudes, 25 preludes, 19 nocturnes, complaints, recurrent diarrhea, and weight loss.4 The
52 mazurkas, 4 impromptus, 2 concertos, 3 sonatas, onset of his illness was reported by George Sand (a
and a barcarolle. female friend and lover) and Franz Liszt (a friend
and famous composer) to have started well before
Family History puberty. In 1826 (at age 16), he had an illness lasting
6 months, in which respiratory complaints, severe
Many dates have been given as the exact date of headaches, and cervical adenopathy were prominent
birth of Frederic Francois Chopin. March 1st, symptoms.5 He suffered similar complaints while in
March 5th (St. Frederic's day), and February 22nd Vienna in 1830 (at age 20).
are possible dates; the latter has the greatest histor¬
ical support.1 Chopin was born in the village of
Chopin lived in Poland and developed his musical
genius there, but the desire to become famous and to
Zelazowa-Wola, near Warsaw, in the year 1810. The learn more music, coupled with political instability in
course of his boyhood was not particularly marked by Poland, made him leave for France. He left for Paris
anything extraordinary, except that he was "sickly
and delicate"2 and that the attention of his family was
on November 2nd, 1830. This was a highly emotional
heart. .did not disclose pulmonary consumption The g^AT gene has been mapped to the distal
. .
.lung changes of many year duration. .a disease portion of the long arm of chromosome 14.12 It is
was not previously encountered."9 associated with degenerative lung disease (panacinar
.
Figure 3. Cast of Chopin's hand, taken after his death, shows no finger clubbing.
214 Special Report
80% of homozygotes develop symptomatic respira¬ the skin, the soft tissues, the throat, and other areas
tory disease.14 The incidence ofthe presence of this susceptible to bacterial colonization. We do not believe
phenotype is around 1:1,000 in Western Europe,
while the number of heterozygous carriers is around
that Chopin had this disease, because his disease was
4% ofthe population; both are at an increased risk of
invariably limited to the chest and the GI tract.
4. Pulmonary TB: it could be argued that Emilia
developing respiratoryis problems. (Chopin's sister) suffered from TB, though that
This, we believe, a very credible diagnosis. It would not explain her death from massive GI hem¬
would explain Emilia's death at the age of 14 from orrhage. This may have resulted in transmission to
massive upper GI hemorrhage secondary to portal her brother. However, it seems unlikely that with no
hypertension caused by liver cirrhosis. It would also
account for Chopin's recurrent chest infection,
treatment, someone would have over 24 years of
recurrent tubercular infection. Chopin's hemoptysis
weight loss, and GI symptoms, all of which were could have been caused by TB, but the lack of finger
chronic and early in onset. clubbing and recurrent hematemesis tend to suggest
However, it is worthy of note that a history of a different diagnosis. Chopin's doctors, including Dr.
chronic diarrhea associated with axAT deficiency- Cruveilhier, seemed to be convinced that he suffered
induced pancreatic insufficiency was not obvious. from consumption, but it is worthy of note that
Furthermore, should oqAT deficiency be the cause although Dr. Cruveilhier's post mortem report was
of Chopin and Emilia's deaths, it is surprising that never found, the second hand reports of its contents
portal hypertension giving rise to variceal bleeding seem to suggest that he was persuaded that his
was not associated with jaundice or ascites. However, patient did not have TB. If this was the case, his
the absence of these signs does not exclude the belief must be taken seriously because he was an
possibility of this diagnosis. authority in pathological anatomy and TB.
Rronchiectasis. This is a pathological dilatation of 5. Allergic bronchopulmonary aspergillosis, a disease
the airways associated with respiratory infections in that occurs due to sensitivity to the fungus Aspergillus
childhood, especially whooping cough, measles, and fumigatus: this organism thrives in warm, wet condi¬
TB. The following are causes of bronchiectasis: tions, and therefore its symptoms tend to occur in
1. axAT deficiency (see above). Autumn. This disease may occur as simple, asthmatic¬
2. Cystic fibrosis (CF): this is a multi-system disorder like attacks, but eventually it leads to eosinophilic
associated with bronchial obstruction due to inspissated infiltrates with consolidation. Mucus impaction can
mucus. It is one of the most common autosomal lead to proximal bronchiectasis and upper zone fibrosis.
recessive diseases (incidence of 1:2,000, with 1:22 of It often occurs early in a patient's adult life as worsen¬
the general population being carriers).16 This condition ing asthma associated with production of rubbery
commonly is associated with recurrent pneumonia. brown or green sputum plugs and is treated in modern
Death from overwhelming infection and cor pulmonale medicine by prednisolone. This disease would explain
(right heart failure) occurs in the first decade of the
child's life. This was especially true in the pre-antibiotic
Chopin's respiratory symptoms well, but may not ex¬
era. The exocrine gland dysfunction leads to pancreatic
plain his other disorders or easily explain his early
demise. Moreover, wheezing appeared not to have
insufficiency, causing diarrhea (steatorrhea). Liver cir¬ been prominent in Chopin's complaints and would
rhosis, polyarthropathy, and infertility are uncommon have been in a patient with allergic aspergillosis. There
complications of CF. and It is possible to explain most of are other, less common causes of bronchiectasis (Kart-
Chopin's symptoms signs by CF, but it seems agener's syndrome and pulmonary fibrosis) that we do
unlikely that Chopin had CF, since survival of patients
with this disorder beyond a very early age was very rare
not believe Chopin had.