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ial report_

The Long Suffering of Frederic Chopin


Adam K. Kubba, MD; and Madeleine Young, MA

(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

concentrated on his health. He studied music under


journey for Chopin who, at that stage, expected to be
in Paris for a year or so.
Fredrik Ziwna, a passionate disciple of Johann Se¬ In 1831 (at age 21), he complained of chest pain,
bastian Bach.
His father, Nicolas Chopin (a Frenchman by birth,
hemoptysis, fever, and headaches. In 1835, he had
bronchitis and laryngitis.
who worked as a bookkeeper and teacher), suffered It was noted when he was as young as the age of 20
from a recurrent respiratory disease but survived that he lacked the growth of facial hair, such that he
until the age of 73 (1770-1844). He died on May 3rd, wrote in 1832, "I have one side-whisker.the other
1844 of "lung disease and weakened heart."3 won't simply grow."6 Chopin never fathered any
Chopin's mother, Justyna (Polish by birth), enjoyed children that we know of, despite his 11-year rela¬
good health and died at age 77 (1784-1861). Chopin tionship inwith George Sand.
*From the Gastro-Intestinal Unit, Western General Hospital,
Early 1837, an epidemic of influenza broke out
in Paris. In February, Chopin fell ill with high fever;
Edinburgh, and The University of Glasgow Library,
UK.
Glasgow, he had hemoptysis and hematemesis. He was ex¬
Manuscript received August 6, 1997; accepted August 7. hausted and listless, and was confined to his bed for
210 Special Report
several weeks. Dr. Gaubert, Chopin's physician, was
adamant that Chopin was not suffering from tuber¬
culosis (TB) and felt that a warmer climate might
help Chopin's condition. This that
because the physician believed
report arose either
Chopin did not
have TB or because it was expedient to deny the
presence of an infectious disease such as TB, which
carried with it social and economic disadvantages.
Chopin was chronically breathless and easily ex¬
hausted; he often had to be carried off after playing
the piano for any length of time. He was compelled
to travel southward to avoid the rigors of winter. He
chose to live in the mild climate of the island of
Majorca. He continued to be ill for weeks after his
arrival on Majorca. On December 3rd, 1837, he
wrote: "These two weeks, I was sick as a dog, I got a
chill despite the temperature of 70, amidst roses,
oranges, palms and fig trees. Of the three most
famous doctors on the island, one sniffed at what I
spewed up, the other tapped at the place from where
I spewed it, the third poked and listened while I
spewed. The first said that I was dead, the second
that I was dying and the third that I would die."7
The natives on the island regarded all pulmonary
diseases as incurable and infectious, and the landlord
demanded that Chopin and George Sand should
leave the house (in writing, because he was afraid to
come near his tenant). He insisted that their furni¬
ture be burned and the house disinfected at their
expense. Chopin and Sand left for Valdemosa, but he Figure 1. A photograph of Chopin taken in the last months of his
did not recover and was troubled with fever, weak¬ life.
ness, and nightmares. This went on till the middle of
January 1839. While they were isolated in Majorca,
Sand reported difficulties in finding the right food the winter he has 2-3 more serious crises lasting 2-3
for Chopin, because fatty food gave him indigestion
and severe diarrhea. In February 1839, he left days each suffering from neuralgia but he has no
lesion of his chest."7
Majorca for Marseilles. By September 1842, he was
back in Paris. The Last Years
Chopin's health, already affected by many The winter of 1847 brought short improvements
changes, visibly declined from the year 1840 onward
and long relapses, and his relationship with George
(Fig 971). He exhibited gross weight loss (weighing
Sand came to an end, which appeared to be a turning
only pounds) and had a parchment-like pallor. A
caricature done by his friend Pauline Viardot in 1844 point in the decline of his health.7
clearly demonstrated that Chopin was barrel chested Although Chopin was described in 1848 as "puny,
thin and pale,"5 he was determined to visit London.
and had extremely thin limbs (Fig 2).
A married sister of Gutmann (a close friend) The trip to Britain appears to have been a mistake.
remembered that in 1843 Chopin already had to be The purpose of this journey was to give concerts.
carried upstairs when he visited her mother. When This, combined with the political unrest in France,
shopping, he never left the carriage and stayed the encouragement of his friends, and his desire to
closely wrapped in his blue mantle.57 recover from the pains of his separation from George
In the winter of 1843 he was very ill again, in pain Sand, were sufficient motives for him to leave Paris.
and very pale. This condition continued until the Some believe that he wanted a new life in London,
spring of 1844. Later that year, his lover George and that this was the reason he carried letters of
Sand wrote to his sister Ludwika: "His illness has not introduction to Englishmen and Poles living in En¬
been greatly different over the last 6 years. In the gland, as though his name alone was not sufficient
morning he has a fairly severe coughing spell. During introduction. Others deny that he ever intended to
CHEST/113/1 /JANUARY, 1998 211
On his return to Paris, he found that his trusted
physician, Dr. Molin, had died. This was very upset¬
ting to him, because he credited this doctor with
helping him out of several relapses, and with saving
his life in the winter of 1847. After Dr. Molin's death,
he had no confidence in any other physician. In early
1849, Chopin's disease progressed rapidly, and his
friends' fears turned to despair. Chopin's condition
was such that he hardly spoke or left his bed. He also
suffered from pains of the wrists, hands, and ankles.
On hearing this, his sister left Warsaw for Paris.
Although
his
the suffering grew more and more terrible,
of will and
power precision of ideas remained
of
intact, perception intentions clear.
his
When cholera broke out in Paris around the
summer of 1849, his friends decided to move him to
the outskirts of Paris. By now, Chopin was being
treated by a Dr. Fraenkel, who satisfied him no
better than all his other previous physicians. Chopin
said of him: "There is no way of finding out from him
whether I should go to some spa or to the south. He
has once again taken back his infusion and given me
another medicine and once again I don't want
it.and when I ask him concerning my regimen, he
says that I do not need to lead a regular life. In short,
he is crazy."5-8
On the night of June 21st, he had two hemor¬
rhages (though not clarified, the implication was that
these were hemoptysis). The following day he had a
hematemesis, edema ofthe ankles and legs, lethargy,
and increased tiredness. At the end of June, he
wrote, "I have no fever, thank God. .Which baffles
and angers all run of the mill doctors."9
.

On July 2nd he wrote: "I have not spat blood since


the day before yesterday, my legs are swollen, I am
Figure 2. A caricature done in 1844 shows a barrel-chested weak and lazy, I can't go upstairs, I suffocate."910
Chopin with thin limbs (courtesy of Madam M. Maurvois). On July 10th, he consulted Dr. Jean Cruveilhier
(1791-1874). Dr. Cruveilhier was one of France's
leave Paris for good, as he retained his apartment most accomplished doctors. He held the Professor¬
and had no farewell party prior to his departure. In ship of Surgeryof at Montpellier from 1823 to 1825,
London, he was confined to bed frequently, but in Professorship Anatomy at Paris from 1825 to 1836,
April felt well enough to visit Edinburgh. It was in
Scotland that he formed a new relationship, with
Chair of Pathological Anatomy at Paris from 1836 to
1850, and wrote several books on TB, surgery,
Jane Stirling (a Scottish heiress). anatomy, and pathology. He was considered the
On his return to London (November 17th, 1848), father of the clinical and pathological science of
he wrote, "I have been ill for the last 18 days. Ever peptic ulcer disease. His most famous publication
since I reached London, I have not left the house at was his Anatomie Pathologique du Corps Humain,
all. I have had such a cold and such headaches, short published in Paris between 1830 and 1842. To this
breath and all the bad symptoms (my head is very day, thisatlas
is considered the most magnificent patho¬
painful apart from the cough and suffocation). The logical saideverof published.
doctors visit me every day."5 Chopin left London for
Paris on November 19th. On the way to Paris, he
Chopin his encounter with his new doctor:
"I have some sort of diarrhea, he [meaning Dr.
wrote to his friend Solange: "Tomorrow I go to Paris, Cruveilhier] also regards me as consumptive and
scarcely dragging myself and weaker than you have ordered a tea spoonful of something with Lichen in
ever seen me. I am swollen up with neuralgia, can it, he ordered me to rest."3
neither breathe nor sleep."5 Early in September, Chopin's physicians held a
212 Special Report
consultation; Drs. Cruveilhier and Louis (another of back to the room. Princess Marcelina began to recite
Chopin's physicians) had invited Dr. Blacke, a fa¬ the litany for the dying, which others repeated after
mous pediatrician, to confer with them. Chopin her.1'3'11
wrote of the pediatrician's presence: "He will help Chopin's tears ran down his cheeks and he asked
me most, for there is in me something of a child."69 for some music. Princess Marcelina (one of many
The only output we know of this consultation is that wealthy lady friends) and Mr. Franchomme began to
it was decided that the patient was too ill to travel out play the Sonata in G minor, but after the first few
of Paris. measures, the music had to defer to a coughing fit.
By mid September, Mr. Norwid (a close friend) This dying agony went on for 4 days, during which
came to visit Chopin in Chaillot and described his Chopin remained conscious most of the time.
visit: "I found him dressed but reclining on his bed On the evening of October 15th, 1849, Chopin felt
with swollen legs, then in voice broken by his worse; in the night he could not speak because of
coughing and choking, he began to reproach he me for sudden hoarseness, and he lost consciousness at
times. The following day, he made some last instruc¬
not having come to him for such a long time; had
fits of coughing. .he said farewell to me and he tions regarding his manuscripts and personal papers.
pressing my hand, threw his hair back from his He told his sister Ludwika that he wished his heart to
forehead and said: T am going. .' and began to be taken to Warsaw and expressed a wish that
cough. Upon hearing this, I kissed him on the arm Mozart's Requiem should be sung at his funeral
.

and knowing that he was pleased when sharply mass.


contradicted, I said, Tou have been going in this way During the night he was troubled with convulsions
every year, and yet, thank God, we still see you alive.' (the nature and etiology of which are not clear) and
To this Chopin finishing the sentence that was severe pain. At eleven o'clock he withdrew his hand
interrupted by the coughing said, T am saying I am from Dr. Cruveilhier's and would not let him take his
going to leave this apartment and move to the place pulse, saying, "It is not worth the trouble Doctor
Vendome.'"13 Late in September, Chopin moved to .soon I'll rid you of me."11 Then he fell asleep until
his last apartment at 12 Place Vendome. midnight; when he awakenedstill.andThechoked with
coughing, his face was dark and doctor bent
over him with a candle and asked him whether he
The Last Days He replied, "no more" in a barely
was in pain.
The accounts of Chopin's last days, even if we perceptible voice.11
A convulsive sleep came over him and lasted until
confine ourselves to those given by eye witnesses, are
a mesh of contradictions that is not wholly possible to October 17th. At 2 am, a cold sweat ran profusely
disentangle. from his brow, and after a brief loss of consciousness,
In the first days of October 1849, Chopin's condi¬ he asked who was near him and kissed the hand of
tion was such that when unsupported, he could not Gutmann after receiving his answer. Chopin died at
sit upright and was very breathless. He lived in this two o'clock in the morning on October 17th, 1849.
apartment for no more than three weeks. Liszt said Dr. Cruveilhier confirmed the death. The cause of
later that new actually arrived on the day
furniture death was given in his death certificate as "tubercu¬
he died.3 losis of the lungs and larynx." Mr. Gavard reported
Chopin wrote a few days before his death: "As this that "Chopin's face, which was blackened in the last
earth will suffocate me, I implore you to have my days, returned to its normal color soon after death."11
Later that day, a man from the art gallery named Mr.
body open so that I may not be buried alive." When
Chopin's death approached, he took on severe Clesinge came and took casts of the dead man's face
cramps. On the night of October 12th, it seemed that and hands. Chopin's closest friends reported that the
his death was imminent. Dr. Cruveilhier sent for physical condition of Chopin was not the outcome of
a newly contracted disease but only an acuter phase
Father Alexander (Abbe Alexander Jelowicki, a Pol¬
ish priest), who came at once. The following day, St. of that old disease from which he had suffered for
Edward's day, the priest came back and was sur¬ over 12 years and which he probably inherited from
prised to be invited by Chopin to have breakfast with his father,1 who died of a chest and heart complaint.
him; the patient's condition seemed to have im¬ His funeral was reported in Paris's Daily News on
proved.
Accounts of this encounter were later recalled by
November 2nd, 1849: "The doors of the Church of
Madeleine were opened at eleven o'clock on Tues¬
Father Alexander. The priest handed him a crucifix day 30th ofand at noon, the vast area was filled by an
and knelt beside him; Chopin made his confession, assembly nearly four thousand people, all was ofwhom
asked for the sacrament, and then called his friends received special invitation." Chopin's body bur-
CHEST/ 113/1 /JANUARY, 1£ 213
ied in the cemetery of Pere Lachaise; his heart was moptysis, cyanosis), which seem to have started in
sent back to Poland and placed in the church of the patient's teens; (2) Systemic complaints (poor
Sainte Croix at Warsaw. exercise tolerance, tiredness, emaciation, failure to
Post Mortem
gain weight, pallor, pigmentation, peripheral edema,
muscle wasting, and icterus); (3) GI symptoms (di¬
This analysis was carried out by Dr. Cruveilhier, arrhea, fatty food intolerance, hematemesis); and (4)
but this document was never found. Speculation no finger clubbing (Fig 3). The most prominent
feature of Chopin's illness was the respiratory com¬
suggests that it might have been destroyed in the of his condition (adjunct to that is a possible
great fires of Paris in 1871 or during the two world ponent
wars.
GI etiology).
conditions:
This could be caused by the following
Jane Stirling, response letter from Liszt,
in a to a
Emphysema. (Dilation of air spaces distal to the
quoted Dr. Cruveilhier as saying that "the autopsy terminal bronchioles with destruction of their walls.)
did nothing to disclose the cause of death, but it
The two common causes of this disease are smoking,
appeared
heart. It
that the lungs were affected less than the
is a disease that I have never encountered
which is not applicable in Chopin's case because he
before." Ludwika Chopin later reported Dr. Cru¬ developed his condition early in life and as far as we
know did not smoke, and a1-antitrypsin (cqAT)
veilhier as saying that "the autopsy did nothing to
disclose the cause of death. .nevertheless he could deficiency: this is a genetic metabolic deficiency
caused by the lack of the protease inhibitor c^AT.
not have survived. .diverse pathology. .enlarged
.

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
.

emphysema, bronchiectasis, chronic bronchitis, and


recurrent bronchopulmonary infections), liver cir¬
Differential Diagnoses rhosis, neonatal hepatitis, failure to thrive, and pan¬
Summary of Chopin s symptoms. (1) Recurrent creatic insufficiency. The common deficiency is as¬
respiratory complaints (coughing, breathlessness, he¬ sociated with the ZZ phenotype,13 but only 70 to

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.

in the pre-antibiotic era. It is worthy of note, however,


that CF is a disease of variable severity, and therefore Long-term complications of chronic lung disease
it is possible that Chopin had a milder form of this Pulmonary
1. hypertrophic osteoarthropathy: this
disease.
3. Hypogammaglobulinemia (congenital and ac¬
is clubbing of the fingers, painful swelling of distal
joints, and soft tissue swelling. may
It be caused by
quired), the primary form of which is an X-linked bronchial cancer, emphysema, or bronchiectasis.
autosomal recessive disease, characterized by selective This condition may explain Chopin's pains in his
deficiency of B lymphocytes, resulting in immunoglob¬
ulin deficiency. The patient tends to be susceptible to
hands, ankles, and feet, but it is worth noting that
recurrent bacterial infections, which may explain
finger clubbing was not evident in the casts made of
Chopin's hands.
Chopin's recurrent chest infections, but not his GI 2. Infertility: despite Chopin's several sexual en¬
symptoms. Furthermore, one would expect patients counters and a relationship with George Sand lasting
with this disease to develop other infections involving 11 years, Chopin never fathered a child.
CHEST/113/1 /JANUARY, 1998 215
3. Poor exercise tolerance, failure to gain weight. deficiency because these two conditions could ex¬
All of the above signs and symptoms were present
in Chopin's illness, but it is fair to note that such
plain his chronic ill health and early death. They may
also explain his sister's death at the age of 14. The
complaints are also commonly associated with argument for the latter disease is a little more
chronic states of ill health of different etiologies and persuasive than the former. Ultimately, readers will
are not necessarily specific to respiratory disorders. have to make up their own minds about the real
causes of Chopin's illnesses and early death, but we
Other explanations of Chopin s symptoms
hope that this review will shed more light on the
Mitral stenosis. This is almost always the conse¬ matter.
quence of rheumatic fever (which Chopin could have The name of Chopin conjures up an image of a
had during childhood, though we have no evidence sentimental artist, one of the giants of the musical
to that effect). This disease may result in poor Romantic Period. His music became a symbol of his
exercise tolerance, recurrent chest infections, personal tragedy and sometimes a protestation
breathlessness, orthopnea, palpitations, weight loss, against the restraints that his chronic ill health
and cachexia. We cannot conclude that Chopin had inflicted upon him.
mitral stenosis from the evidence we have; it is
unlikely thatItthis disease occurs as early a patient's
teen years. is also difficult to believe that one
would survive 22 years of pulmonary hemorrhage References
secondary to mitral stenosis. It is also difficult to 1 Niecks F. Frederick Chopin: as a man and a musician. 2nd ed.
account for Chopin's GI complaints if he only had London: Novello, Ewer, & Co., 1890; (vol 2) 277-328
2 Liszt F (translated by John Broadhouse). Life of Chopin.
mitral stenosis. London: William Reevers Publisher, 1877; 28-66
Tricuspid valve incompetence. This often presents 3 Murdoch W. Chopin: his life. New York: McMillan, 1934
with distended pulsatile tender liver, portal hyper¬ 4 Marek G. Chopin. New York: Harper and Row, 1979
tension (which Chopin could have had and which 5 Karasowski M. Life and letters of Chopin. London: William
would account for his hematemesis) secondary to Reevers Publisher, 1879
esophageal varices, gastric varices, or portal hyper¬
tensive gastropathy and with fatigue, peripheral
6 Bone A. Sir James Hedderick. Glasgow: John Smith Publish¬
ers, 1848
7 Wierzynski C (translated by Nortbert Guterman). The life
edema, abdominal pain, and jaundice. and death of Chopin. New York: Simon and Schuster, 1949
We do not believe that Chopin had tricuspid valve 8 O'Shea J. Music and medicine. London: JM Dent, 1993;
incompetence because the natural history of this 140-55
disease is not compatible with his case presentation, 9 Heldey A. Selected correspondence of Chopin. London:
and the lack of jaundice or ascites adds more doubt Heinemann, 1962; 73-74
to this diagnosis. 10 Kuzemko JA. Chopin illnesses. J Roy Soc Med 1994; 87:
Churg-Strauss syndrome, chronic lung abscess 769-72
11 Zamoyski A. Chopin: a biography. London: Granada, 1979
formation, pulmonary hemosiderosis, and pulmonary 12 Shin MS, Ho JK. Bronchiectasis in patients with alpha 1-
arteriovenous malformation are all rare but possible
antitrypsin deficiency: a rare occurrence? Chest 1993; 104:
diagnoses. 1384-86
13 Fagerhol MK, Cox DW. The pi polymorphism: genetic
Conclusions biochemical and clinical aspects of alpha 1 antitrypsin. Adv
Hum Genetics 1981; 11:1-62
We believe that Chopin's diagnosis could be nar¬ 14 Morse JO. Alpha 1 antitrypsin deficiency. N Engl J Med 1978;
rowed down to either a mild form of CF or axAT 299:1045-48, 1099-1105

216 Special Report

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