by Suchet, John
Finally Holz suggested a certain Dr Andreas Wawruch, Director of the Medical Clinic in Vienna and Professor of Pathology at Vienna General Hospital. Holz told Beethoven Wawruch was regarded as one of the ablest physicians in Vienna, and was also a keen music-lover, an admirer of Beethoven’s compositions, and a competent cellist.
Beethoven did not demur; Wawruch agreed to attend, and so on 5 December he came to the Schwarzspanierhaus to care for a man he had never examined before, who was clearly terminally ill, and who was the most renowned and revered musician in Europe. It is to his eternal credit that Wawruch, knowing there was only one possible outcome, cared for his patient with kindness and diligence to the end, and left us a remarkable account of the final illness and its treatment.
On first meeting Beethoven, Wawruch wrote in a conversation book, ‘One who greatly reveres your name will do everything possible to give you speedy relief. Prof. Wawruch.’ Examination, given Beethoven’s deafness, was not easy, and so Wawruch dictated questions for Karl to write down.5
Wawruch wrote up a report of the first few days that he treated Beethoven, and it makes difficult reading:
I found Beethoven afflicted with serious symptoms of inflammation of the lungs. His face was damp, he spat blood, his breathing so irregular that it threatened suffocation, and a stitch in the side so painful that it made lying on the back a torment. A strong counter-treatment for inflammation soon brought the desired relief. His constitution triumphed, and by a fortunate outcome he was freed from apparent mortal danger. On the fifth day he was able, in a sitting position, to tell me, amid profound emotion, of the discomforts which he had suffered. On the seventh day he felt considerably better, so that he was able to get out of bed, walk about, read and write.
Wawruch visited Beethoven every day from 5 to 14 December, one day coming twice, but on the eighth day there was a dramatic deterioration. Wawruch wrote it up fully, and it merits quoting. Buried in his text is the suggestion of a furious row between Beethoven and Karl. Conversation book entries point to Beethoven accusing Karl of vacillating over his decision to join the military, and Karl arguing vociferously to the contrary. If these exchanges are what caused the crisis, it is evidence of the deterioration in Beethoven’s condition, and his inability any longer to cope with emotional crisis.
On the eighth day I was considerably alarmed. I visited him in the morning and found him in great distress and jaundiced all over his body. A dreadful attack of vomiting and diarrhoea had threatened his life in the preceding night. A violent rage, a great grief caused by sustained ingratitude and undeserved humiliation, was the cause of this mighty explosion. Trembling and shivering, he was bent double because of the pains which raged in his liver and intestines, and his feet, which had been moderately bloated, were now massively swollen. From this time on dropsy developed, the passing of urine became more difficult, the liver showed plain indication of hard nodules, and there was an increase in jaundice. Gentle persuasion from his friends calmed the mental tempest, and the forgiving man forgot all the humiliation which had been put upon him. But the disease moved onward with gigantic strides. Already in the third week he threatened to suffocate in the night. The enormous accumulation of fluid in his abdomen demanded speedy relief, and I found myself compelled to advise tapping in order to guard against the danger of his stomach bursting.
Things were critical. Beethoven’s abdomen had swollen so much that Wawruch actually feared it would explode, and the only possible solution was to puncture it and drain it manually, a risky and painful procedure.
In the meantime, as Wawruch suggests, Beethoven’s spirits were being kept up by friends, in particular by a thirteen-year-old boy named Gerhard von Breuning, son of his old friend Stephan. Beethoven instantly took to the boy, nicknaming him ‘Hosenknopf’ (‘Trouser Button’).6 Gerhard frequently brought Beethoven soup made by his mother, and visited the composer every day either before, or after, school.
Wawruch took a second opinion, consulting Dr Staudenheim, who had failed to visit as promised earlier, but who now examined Beethoven and concurred with the decision to drain the abdomen.
Only then was Beethoven told. Wawruch reported that ‘after a few moments of serious thought, he gave his consent’.
To perform the risky procedure Wawruch brought in Dr Johann Seibert, chief surgeon at Vienna General Hospital.
On Wednesday, 20 December, with Wawruch, nephew Karl and brother Johann in attendance, the procedure was performed. Dr Seibert pierced Beethoven’s side with the tube, and immediately fluid gushed out. Relief was instantaneous, even bringing humour from the patient: ‘Professor, you remind me of Moses striking the rock with his staff.’
There were clearly smiling faces all round at the obvious relief Beethoven experienced. Wawruch quickly scribbled a series of questions and advice in a conversation book: ‘Do you feel better? ... Was it painful? ... If you feel unwell you must tell me ... [In English:] God save you ... Lukewarm almond milk ... Are you beginning to feel pain now? ... Keep lying quietly on your side ... We shall soon measure off the fluid ... Five and a half measures were removed ... I hope you will be able to sleep more peacefully tonight ... You behaved like a brave knight.’
Shortly after the procedure the wound in Beethoven’s side became infected, but it does not seem to have caused him much of a problem, and in any case his mood was considerably lightened by the arrival from a London admirer of a forty-volume edition of the works of Handel, whom he immediately declared to be ‘the greatest, ablest composer that ever lived. I can still learn from him.’
With Beethoven bedridden, Karl went about his business of joining the army. He underwent a medical examination, and in the days following Christmas kitted himself out with uniforms, an overcoat and sabre.
On 2 January 1827, Karl bade farewell to his uncle, and embarked on the two-day journey to join his regiment in Iglau.7 There is no record of what was said between them, no conversation book entry. He never saw his uncle again.
The following day Beethoven wrote to his lawyer declaring that Karl, ‘my beloved nephew’, should be the sole heir to all his property, including ‘seven bank shares and whatever cash may be available’.
THE RELIEF FROM the draining of fluid was temporary. Beethoven’s abdomen began to fill again. Wawruch believed a second procedure was necessary, but Seibert was reluctant, possibly because of the infected wound and an unwillingness to create a second puncture.
Beethoven, in a predictable pattern, was losing confidence in Wawruch. According to young Gerhard, when Wawruch’s name was mentioned, Beethoven turned his face to the wall and exclaimed, ‘The man’s an ass.’ But all around him urged him not to give up on the physician. Schindler wrote in a conversation book, ‘He understands his profession, everybody knows that, and he is right in considering your well-being paramount.’
Gerhard, meanwhile, was taking an early interest in the career he was to follow, writing in a conversation book, ‘How are you? ... Has your belly become smaller? ... You are supposed to perspire more ... How was your enema?’ It is likely the dying composer was more willing to discuss his condition with Trouser Button than with a doctor in whom he was losing faith.
On Monday, 8 January, Dr Seibert repeated the procedure. There were no complications; the surgeon managed to draw off more fluid than before, and was pleased to find that it was clearer than the first time.
Three days later a meeting of doctors took place, with an interesting and somewhat unexpected addition to their number. As well as Wawruch, Staudenheim and Braunhofer, who had also now agreed to attend, there was present a name from Beethoven’s past, Dr Johann Malfatti, uncle of Beethoven’s one-time inamorata Therese Malfatti, and summarily dismissed by him ten years previously.
Schindler claims credit for the reconciliation, even saying he had to use all his powers of persuasion on Dr Malfatti, whose initial reaction was to say that as Beethoven was a master of harmony, ‘so must I also live in harmony with my colleagues’.
But he was persuaded, and it seems the doctors were perfectly happy to involve him, all the more so since Beethoven too seemed pleased to see him and patch things up.
He was even more pleased with Dr Malfatti’s recommendation. In effect Malfatti made it clear to the other doctors that the one thing that would bring Beethoven relief was alcohol. He was dying, and there was nothing any of them could do to stop that. So why not at least allow him to alleviate the pain by drinking alcohol? Furthermore, since Beethoven was suffering attacks that caused his skin to burn and brought him out in running sweat, why not make the drinks ice cold?
He prescribed an end to the medicines Beethoven was taking – ‘75 bottles plus powder,’ wrote Schindler later with, no doubt, more than a touch of exaggeration – no intake for Beethoven other than frozen alcoholic fruit punch, accompanied by rubbing of the abdomen with blocks of iced water. He assured his colleagues he had thus completely cured another patient with a similar illness.
The doctors, no doubt assisted by Beethoven’s willingness, concurred. As with the first abdominal procedure, the effect was instantaneous. Even Wawruch was stunned. ‘I must confess that the treatment produced excellent results for a few days at least,’ he wrote.
Beethoven felt himself so refreshed by the ice with alcoholic contents, that already in the first night he slept quietly throughout the night and began to perspire freely. He grew cheerful and was full of witty comments, and even dreamed of being able to complete the oratorio ‘Saul and David’8 which he had begun.
But, again as with the abdominal draining, the relief was temporary, only this time it was largely Beethoven’s fault. He liked drinking the punch so much that he drank more and more of it. In fact he repeatedly drank himself into a stupor. This did wonders for his mental state, successfully taking his mind off his dreadful illness, but had the opposite effect on his body.
On 2 January 1827, Karl bade farewell to his uncle. He never saw him again
Wawruch reported that the spirits soon caused a violent pressure of blood on the brain. Beethoven became comatose; his breathing was noisy and laboured as it would be if he was drunk; he began to slur his speech and talk nonsense, and occasionally, Wawruch noted, inflammatory pains in the throat were accompanied by hoarseness and even an inability to speak. His behaviour became more uncontrollable, and when the effect of the ice-cold drink caused havoc with his bowels, bringing on colic and diarrhoea, it was time ‘to deprive him of this precious refreshment’.
Malfatti had another idea, and it was possibly the most bizarre of all the remedies inflicted on the dying composer. He was made to take a ‘sweat bath’. Jugs filled with hot water were placed in a bath and covered thickly with birch leaves. Beethoven – removed from his bed with enormous difficulty – was made to sit on the heated bed of leaves, and his body covered with a sheet up to the neck. The aim, said Malfatti, was to soften the skin and allow perspiration to flow freely.
The effect was disastrous. Beethoven’s body absorbed the moisture ‘like a block of salt’, wrote Gerhard later, causing swelling all round. It became clear a third procedure to drain fluid from the abdomen would be required, even though the wound in Beethoven’s side had not healed from the last puncture.
Dr Seibert carried out a third draining on 2 February, and the bath treatment was abandoned.
THERE WAS NOW a steady stream of visitors – friends and musical colleagues – anxious to see the great composer before it was too late. His old friend and drinking partner, Nikolaus Zmeskall, bedridden with gout, sent him greetings in a note. Beethoven himself, as if acknowledging time was short, dictated a number of letters.
Pleading financial hardship, as well as ill-health, he wrote to Sir George Smart in London asking the Philharmonic Society of London to make good their offer of payment for a future concert. They responded with a gift of £100, knowing full well the promised concert would never happen.
On a lighter note, he wrote to the publisher Schott of Mainz asking them to send him ‘some very good old Rhine wine’, which was unobtainable in Vienna.
Schuppanzigh and Linke, who had performed the Late Quartets, came to see him. Moritz Lichnowsky, brother of his great patron, came. Gleichenstein brought his wife, sister of Therese Malfatti, who was disappointed that Beethoven did not recognise her, and their son.
Diabelli, for whom Beethoven had written the great set of piano variations, brought him a print he had published of Haydn’s birthplace in Rohrau. Beethoven showed it to Trouser Button Gerhard, and said, ‘Look, I got this today. See what a little house it is, and in it such a great man was born.’
Baron Pasqualati, in whose building on the Mölkerbastei Beethoven had lodged longer than anywhere else, sent provisions, including champagne, wine – and stewed apples, pears and peaches, which the composer particularly liked.
Three men called to see him, and when they sent word in to ask which of them Beethoven would care to see first, the answer came straight back ‘Let Schubert come first.’9 Earlier, Beethoven had said of the Viennese composer, who was to die so young, just twenty months after Beethoven, ‘That man has the divine spark.
AS SOON AS the third procedure was carried out on Beethoven’s abdomen, the swelling began again. There was no hesitation this time. On 27 February Dr Seibert inserted the tube into Beethoven’s side for a fourth time. It seems that now everybody had given up hope, the medical team included.
Gerhard wrote that as the fluid flowed from Beethoven’s body, it was allowed to run onto the floor and halfway across the room. In the conversation books there is mention of saturated bedclothes, and a suggestion by one of the doctors that an oilcloth be procured and spread on top of the mattress.
Beethoven, finally, accepted that the end was near, and went into a deep depression. Dr Wawruch wrote later, ‘No words of mine could brace him up, and when I promised him that he would certainly get better when the warm weather of spring arrived, he simply answered with a smile, “My day’s work is finished. If there were a physician who could help me, ‘his name shall be called Wonderful!’”’ The allusion to Handel’s Messiah was not lost on Wawruch.
There was a steady stream of visitors anxious to see the great composer
On 23 March Johann Nepomuk Hummel, once Beethoven’s rival in improvisation contests, arrived from Weimar with his wife and a musical colleague, Ferdinand Hiller. They found Beethoven, as Hiller wrote later, lying ‘weak and miserable, sighing deeply at intervals. Not a word fell from his lips. Sweat stood upon his forehead.’
Hummel’s wife took out her fine white linen handkerchief and wiped Beethoven’s face several times. Hiller wrote, ‘Never shall I forget the grateful glance with which his broken eye looked upon her.’
Beethoven had one final onerous task, to append a codicil and signature to his Will, leaving his entire estate to Karl, which for some reason had not been done earlier. It was a difficult and laborious task. He tried several times to write his name correctly, but each time misspelling his surname – once he left out an ‘h’, the next time an ‘e’.
Finally, in despair, and declaring he would not repeat it again, he wrote, ‘luwig van Beethoven’.
When it was over, he turned to the small group gathered, and said, ‘Plaudite, amici, comedia finita est.’ (‘Applaud, my friends, the comedy is over.’)
Beethoven received the last rites. The following day, 24 March, the wine shipment from Schott arrived. He said, ‘Pity, pity, too late.’
They were his final words.
While he could still swallow, a taste of the wine was put on his lips, but in the evening of the 24th he sank into a coma.
Gerhard von Breuning later wrote a graphic and deeply moving account of Beethoven’s final forty-eight hours:
His delirium intensified with every sign of the death agony. This was at five in the afternoon, March 24th, 1827 ... On the next day and the day after that the powerful man lay there unconscious, breathing heavily with a clearly audible rattle in the throat. His p
owerful frame and undamaged lungs fought like giants against approaching death. It was a fearful sight. Although we knew that the poor man was suffering no more, it was appalling to see this noble being so irrevocably disappearing and beyond all further communication. On 25th March it was not expected that he would survive the night, but on the 26th we found him still alive – breathing, if that was possible, even more laboriously than before. March 26th, 1827, was the sad day of Beethoven’s death.
In the late afternoon of 26 March, a storm blew up over Vienna. Gerhard described it as very violent, with driving snow and hail – unusual for late March.
There was a small group by Beethoven’s bedside, but there is confusion over who exactly was there. One of those present, composer and pianist Anselm Hüttenbrenner, said later that Beethoven’s sister-in-law, Karl’s mother Johanna, was present. This is extremely unlikely, since she herself complained later that she had received no news of Beethoven’s final illness until it was all over. Most likely the sole female present was the housekeeper Sali.
Beethoven’s brother Johann was certainly there, and it was probable that Stephan von Breuning and Schindler were also present, though they left some time in the afternoon to choose a burial site. The portrait painter Joseph Teltscher was making a drawing of Beethoven, though he left the room when Stephan remonstrated with him. Gerhard, Trouser Button, left at a quarter past five to attend a lesson.
At around a quarter to six, there was an enormous clap of thunder, which startled everyone present. Beethoven opened his eyes, lifted his right hand, and looked up for several seconds with fist clenched, as if he wanted to say, ‘Inimical powers, I defy you! Away with you! God is with me! Courage, soldiers! Forward! Trust in me! Victory is assured!’ We owe this legendary, but exaggerated, account of Beethoven’s last moments to Hüttenbrenner. If there is truth in it, the clenching of the fist was probably a muscle spasm brought on by the disease that almost certainly killed Beethoven, cirrhosis of the liver. But the legends had begun, within moments of his death.