Death of Ludwig Van Beethoven - Autopsy and Post-mortem Findings

Autopsy and Post-mortem Findings

An autopsy was performed on 27 March 1827 by Dr. Johann Wagner. While it is unclear who ordered the autopsy, a specific request by Beethoven in his Heiligenstadt Testament may have played a role in the decision. The autopsy revealed a severely cirrhotic and shrunken liver, of which ascites is a common consequence. Scholars disagree over whether Beethoven's liver damage was the result of heavy alcohol consumption, hepatic infection, or both. Hepatitis B and C are causes of cirrhosis, but they spread from contact with contaminated body fluids and were almost unknown in Beethoven's day. Hepatitis A on the other hand can be contracted from food and water that were not handled properly and was very common in the 19th century, although it does not cause liver cirrhosis or permanent organ damage.

Heavy metal contamination is thought to be a contributing factor in Beethoven's death as these were commonly used in the medicine of the time. It has also been theorized that he consumed large amounts of lead from illegally-fortified wine. This was a very common practice to sweeten cheap wines, and despite being outlawed in most European countries during the 18th century, the prohibition was difficult to enforce and production of lead-fortified wine (which originated in Roman times) continued unabated. There is no indication the composer had syphilis beyond a mercury treatment prescribed to him around 1815, but these were used for various other ailments as well.

The autopsy indicated damage to his aural nerves as well as hardening of their accompanying arteries, although the latter appears to be consistent with natural aging and not inflammatory damage from syphilis. Beethoven's brain was described as possessing "exaggerated folds", an excess of fluid in the skull, and some thickening of the membranes inside the left ventricle. Scholars believe he may have had a degree of cerebral atrophy, although he showed no sign of cognitive impairment to the end. The skull was described as "possessing unusual thickness".

Beethoven's kidneys had calcareous growths in them, indicating that he was likely developing renal papillary necrosis, a common result of analgesic abuse (it is known that he used large amounts of drugs obtained from his brother Johann, a pharmacist). Diabetes is also a cause of RPN, and scholars have not ruled out the possibility that the composer had diabetes mellitus. His spleen was swollen to twice the normal size and he had portal hypertension, all consistent with end-stage liver failure. He also appears to have had severe pancreatitis, as the doctors described his pancreas as "shrunken and fibrous", with the exit duct being very thin and narrowed. Large amounts of reddish fluid had accumulated in Beethoven's abdomen, likely from spontaneous bacterial infections mixed with some blood. This was possibly a result of draining fluid from his abdomen in his last days, a practice that very often caused infection and death of the patient in a time before antibiotics and bacterial pathology were known.

In the days immediately preceding and following his death, a number of people, including Anton Schindler and Ferdinand Hiller, cut locks of hair from Beethoven's head. Most of Hiller's lock is now in the Center for Beethoven Studies at San Jose State University. One of Beethoven's friends incorrectly thought that "strangers had cut all of his hair off"; in fact, the apparent lack of hair was due to a cloth cap that covered the hair while the body was lying in state.

On 28 March 1827, castings for a death mask were taken. The body was clothed and placed in an oaken coffin, with the head given a wreath of white roses. Its hands held a wax cross and a lily.