МЕДИЦИНА І МИСТЕЦТВО

УДК 616.348-002-036.12-08:615.838 ISSN 1727-5725 (Print) DOI: http://doi.org/10.30978/MG-2020-2-85 ISSN 2521-649X (Online)

V. I. Berezutskyi 1, M. S. Berezutska 2 1 SI «Dnipropetrovsk Medical Academy of Ministry of Health of Ukraine», Dnipro 2 M. Glinka Dnipropetrovsk Academy of Music, Dnipro

Treatment of chronic enterocolitis in the first half of the XIX century: Beethoven’s mineral water intake

The great German composer of the First Viennese School Ludwig van Beethoven suffered from hearing impair- ment and diseases of the digestive system for most of his life. His health status strongly influenced both his life and creativity. The use of mineral waters in the first half of the 19th century was an important part of the thera- peutic arsenal of physicians; it was actively used in the Beethoven’s treatment. Balneotherapy is one of the least- studied aspects of the composer’s medical history. The purpose of the research was to study the use of mineral water in the treatment of Ludwig van Beethoven. Beethoven’s letters and works of his most authoritative biog- raphers were analyzed with a view to revealing information about the use of mineral waters in his treatment. Scopus, WebOfScience, MedLine and PubMed databases, electronic archives were searched without time restric- tion for information on the use of mineral waters in European spa resorts in the first half of the 19th century. Since 1796, Beethoven suffered chronic enterocolitis and progressive hearing impairment, since 1820 — portal cirrhosis of the liver. Mineral water intake was an important part of Beethoven’s treatment from 1799 until his death in 1827. The medicine of its time was mainly empirical, the diagnosis was based only on the data of a survey and examination of the patient, methods of physical research have not yet received wide application. Beethoven’s treatment meets the advanced achievements of balneology at the end of the 18th century. The composer annu- ally took mineral water at spa resorts (Baden, Teplice, Carlsbad, Franzenbrunn) during the season (up to 6 months) and continued to receive bottled mineral water in Vienna. Spa therapy (and, in particular, mineral water intake) became part of Ludwig van Beethoven’s life. Key words: the history of Ludwig van Beethoven’s disease, the history of gastroenterology and clinical medicine, the history of balneotherapy, the history of European resorts.

he history of life, creativity and illness of Lud- of the patient, which tell about medicine first half Twig van Beethoven is reflected in 1700 his let- of the 19th century; the history of hearing aids was ters, 140 «conversation notebooks» (another 260 supplemented on the basis of these documents [10, notebooks have not survived to our day). Dozens p. 262 — 273]. The analysis of these documents can of biographical studies and hundreds of scientific help to make an idea of the practical application of articles are written on the basis of this invaluable balneotherapy methods at that time. This aspect of material. Today, these documents are still of great Beethoven’s disease has not yet been thoroughly an- interest to research in various fields of science, in- alyzed. Beethoven’s biographers provide additional cluding the history of medicine. Beethoven suffered information about his illness as well as his stay at from progressive deafness and diseases of the diges- the spa resorts in Europe (Baden near Vienna, Tö- tive system from 1796 until his death in 1827 and, plitz, Carlsbad, Franzensbrunn). Treatises on balne- therefore, he almost constantly treated with lead- ology of 18th—19th centuries contain information ing Viennese doctors. Water cure was an impor- about chemical composition and methods of appli- tant part of the therapeutic arsenal of physicians cation of mineral waters at mentioned spa resorts. in the 18th—19th centuries and the treatment of Information from biographical studies and treatises Beethoven was no exception. Beethoven’s letters on balneology of the 18th—19th centuries allows us and his «conversation notebooks» are the diaries to supplement the information from Beethoven’s letters and perform a kind of reconstruction of the © В. І. Березуцький, М. С. Березуцька, 2020 balneotherapy of the composer.

СУЧАСНА ГАСТРОЕНТЕРОЛОГІЯ | № 2 (112) • 2020 85 МЕДИЦИНА І МИСТЕЦТВО

The objective of the study was reconstruction [3, p. 29]. Frank Johann Peter (1742 — 1821) was of the use of mineral waters in the treatment of Beethoven’s physician from 1800 to 1809. He was Ludwig van Beethoven, based on the analysis of Professor of Clinical Medicine at the University of Beethoven’s letters and data on the development Vienna and director of the general hospital in Vien- of balneology of that period of time, as well as the na. His medical works on health care and preventa- condition of the spa resorts visited by the composer. tive medicine were very advanced for that time. Af- To achieve the goal of study, a search was made ter Professor Frank’s treatments failed, Beethoven for sources in scientometric databases and elec- turned to Dr. Gerhard von Vering (1755 — 1823), tronic archives. Keyword combinations were used: who was director of the Health Institute of the Beethoven’s illness, balneotherapy in Europe in hospitals of Vienna from 1797 to 1809 and medical the XVIII—XIX centuries, spa resorts in Europe advisor to Emperor Joseph. Dr. Vering again «or- in the first half of the XIX century. A search for dered the tepid baths of the Danube» and «succeeded information on the use of mineral spring waters in in almost entirely checking the violent diarrhea» [3, Beethoven’s letters was also conducted. The works p. 29]. Beethoven in 1799 — 1800 was taking bathes of the composer’s most respected biographers, as of the Danube in Vienna’s Bathing establishment, well as the hydrotherapy treatises of the 18th and which was called «the Kaiserbad on the Danube» 19th centuries, were used to supplement and ana- [35, p. 213]. lyze the information received from the letters. Part of the summer and autumn in 1799 Beethoven Biographers found that in the summer of 1896 spent in the village Mödling (14 km from Vienna) [3, Beethoven suffered a serious disease (presum- p. 25]. «Physikalisch-medicinische Darstellung der ably — typhus), after which he had digestive disor- bekannten Heilquellen der vorzüglichsten Länder ders and a progressive hearing disorder [33, p. 201]. Europa’s» 1829 (Physico-medical representation of Beethoven’s medical history has been studied by the well-known healing springs of the most exalted scientists very well. The famous Canadian physician countries of Europe) reports that mineral sulfur wa- François Martin Mai in his work «Diagnosis ge- ter from the source is used in the treatment of rheu- nius» 2007 has analyzed Beethoven’s medical biog- matism, gout, liver and gall bladder diseases, portal raphy the most completely [20, p. 273]. Dr. Mai an- hypertension. Water is used both for baths and for alyzed the symptoms of Beethoven’s disease (based oral administration [23, p. 147]. The healing proper- on his letters) and systematized earlier studies of the ties of the source were known for several centuries, composer’s medical biography. Beethoven’s medi- but it was landscaped and officially opened only in cal biographers reached a conclusion: Beethoven 1815. Biographers do not report whether Beethoven suffered from the chronic enterocolitis from 1897 used the source in 1799, but it is precisely known until his death [20, p. 127]. Beethoven’s physicians that in subsequent visits (1818 — 1821) Beethoven used terminology, quite understandable nowadays: took thermal baths there and drank mineral water «intestinal inflammation» or «the inflammation of from the source [24, p. 369]. the bowels» [20, p. 127; 4, p. 372]. The first mention In the letters of Beethoven, as in the works of his of balneotherapy appears in Beethoven’s letters in biographers, there is no mention that Beethoven 1800. He reports in his letter June 29, 1800: «…bad in 1799 — 1800 drank mineral water. However, an health, has been a stumbling-block in my path. The analysis of the history of the development of Eu- chief cause of this infirmity proceeds from the state ropean balneology shows that by this time the in- of my digestive organs, which, as you know, were ternal use of natural mineral waters was almost as formerly bad enough, but have latterly become much widespread as the external (in the form of baths). worse, and being constantly afflicted with diarrhea, Dr. Aidall in his famous book «The German na- has brought on extreme weakness. Frank [Director of ture-cure, and how to practice it» 1897 (the chap- Vienna general hospital] strove to restore the tone of ter «Inner application of water») reports: «Water my digestion by tonics, and my hearing by oil of al- drinking is often useful in the natural treatment of monds; but alas! These did me no good whatever; my sickness» [2, p. 61]. Sigismund Sutro in his «Lec- hearing became worse, and my digestion continued in tures on the German mineral waters, and on their its former plight» [3, p. 29]. He further reports that rational employment for the cure of certain chronic «the autumn of last year [1799] some judicious doctor diseases» 1851 writes: «In most spas, bathing and recommended me the tepid baths of the Danube which drinking of the respective springs take place. Some, did wonders for me; my digestion improved». How- however, are merely employed internally, others only ever, the improvement was temporary: «I did indeed externally» [32, p. 17]. Augustus Bozzi Granville pass a miserable winter; I suffered from most dread- in his two-volume monograph «The spas of Ger- ful spasms, and sank back into my former condition» many» 1838 wrote: «The word «Spa» employed to

86 № 2 (112) • 2020 | СУЧАСНА ГАСТРОЕНТЕРОЛОГІЯ МЕДИЦИНА І МИСТЕЦТВО signify a mineral source, at which people assemble, contain a mixture of sulphur, vitriol, a martial earth to drink as well as to bathe in the waters» [13, p. 13]. (or salt) the basis of sea salt; sometimes in evaporat- By the end of the 19th century, the culture of water ing them, the vitriolic acid unites with the basis of cures had reached full bloom. Balneotherapy at the sea salt, and forms a Glauber salt». «The waters [in- European spa resorts was carried out not only on ner application] and bath have been used with suc- the basis of a huge experience of practical applica- cess in many disorders» [22, p. 172]. In 1801 Baden tion of natural mineral waters, but also on the basis was a favorite resort of the Viennese. The baths, in of achievements of chemistry and clinical medicine which sulphate of lime is one of the chemicals, were [31]. The history of European balneology shows known to the Romans under the name of’ «Panno- that the scientific study of the therapeutic effect nian Baths» (the reign of the Roman emperor Marc of Austrian mineral waters began much earlier. Aurel 161 — 180 A. C.). Famous English physicians Caspar Schober, an Austrian physician of the early and adept of balneotherapy professor Charles Hut- 16th century, in 1530 wrote «Tractatus de balneis ton in his treatise «Cursory observations on the Germaniae» — a treatise concerning the most fa- mineral water of Baden» 1838 described the miner- mous German and Austrian spas (including Baden al springs of Baden: «It is supplied by twelve springs, near Vienna, where Beethoven annually took baths differing only in temperature. The principal of these and drank mineral water during 1801 — 1825). Cas- springs, called the Ursprung, is situated on a consider- par Schober in 1530 reports the benefits of com- able elevation, near the collegiate church of St. Peter. bined application of mineral water (internal and The temperature of the Ursprung is 153,5 degrees of external) [12]. Fahrenheit (67,5