Yup. I've treated lots of these folks. Mainly in heavy drinkers. He also had evidence of a shrunken pancreas, suggesting pancreatitis.
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.
but at the end of the article they insist he died of lead poisoning.
In 2010, Dr. Andrew C. Todd, of the Mount Sinai School of Medicine in New York City tested two pieces of Beethoven's skull for lead, and determined that the concentration of lead was no greater than would be expected for a normal man of 56 at that time.
The leading cause of death still remains lead poisoning however. M. H. Stevens and his team have concluded that high levels of lead deep in the bone sampled from Beethoven's skull suggest repeated exposure over a long period of time rather than limited exposure prior to the time of death. Among other evidence, the finding of shrunken cochlear nerves at his autopsy is consistent with axonal degeneration due to heavy metals such as lead. Chronic low-level lead exposure causes a slowly progressive hearing loss with sensory and autonomic findings, rather than the classic wrist drop due to motor neuropathy from sub-acute poisoning. Beethoven's physicians thought that he had alcohol dependence
So where did he get lead? Yes, it was used as a medicine, but one overlooked reason for lead is that it was used as a sweetener in cheap wine.
Wikipedia article here on how this was done.
They were made by boiling down grape juice or must (freshly squeezed grapes) in large kettles until it had been reduced to two-thirds the original volume, carenum; half the original volume, defrutum; and one-third, sapa. The main culinary use of defrutum was to help preserve and sweeten wine, but it was also added to fruit and meat dishes as a sweetening and souring agent and even given to food animals such as suckling pig and duck to improve the taste of their flesh
this article discusses lead in Roman times. It was recognized as a poison, since those working with lead tended to get sick.
Lead acetate, also known as sugar of lead, is a salt that (ironically) has a sweet flavor—a fairly unusual quality in poisons, which are more likely to taste bitter, signaling to the taster that they are unsafe for consumption. The ancient Romans used the compound—which they called sapa—to sweeten wine, and the aristocratic segments of the population could toss back as much as two liters a day (about three bottles’ worth, although wine was usually diluted with water). There is debate as to whether the wine alone could have produced the traditional physiological effects of lead poisoning, such as organ failure, infertility and dementia—the little things that help facilitate the fall of an empire.
The irony of lead pipes is not that they could cause lead poisoning, but that hard water deposited calcium on top of the lead. This means all those stories of lead poison from their pipes might be exaggerated: The lead was covered... except when they cleaned them out..
but wine was sweetened by boiling it down... in lead vessels. And some used lead pots.
deposits of calcium carbonate in pipes and aqueducts protected against corrosion and insulated against the introduction of lead. With no taps to shut off, water flowed continuously and so would not have been in prolonged contact with the metal. Most water brought to Rome by its aqueducts was used, in any event, to supply its public baths.
Like modern folks who have gotten acute lead poisoning from drinking acidic wine in pewter or ceramics with high lead content, the lead could cause problem. The article gets into discussing lead vs copper vessels, and then calculates the dosage... or not. Long technical discussion there.
Science magazine discussion of lead poisoning and Rome. Yes, there was lead, but not enough to cause problems.
so what about the skeletal evidence?
The researchers compared the lead isotopes in their sediment samples with those found in preserved Roman piping to create a historical record of lead pollution flowing from the Roman capital. Tap water from ancient Rome likely contained up to 100 times more lead than local spring water, the team reports online today in the Proceedings of the National Academy of Sciences. While the lead contamination was measureable, the team says the levels were unlikely high enough to be harmful, ruling out tap water as a major culprit in Rome's demise.
As far as I know, the first and only study to actually measure levels of lead in skeletons from Rome is the one that involved my samples from the two cemeteries of Casal Bertone and Castellaccio Europarco (1st-3rd c AD)....
What you can see is that there are fairly low levels of lead in the pre-Roman periods in Britain (Neolithic, Bronze Age, Iron Age) and the levels are lower in the post-fall of the Roman Empire (after 5th c AD).
... no one in the pre-Roman period is getting poisoned. The Imperial period is pretty special - we've got a person with lead levels over 20 mg/kg, which is 20 times higher than modern recommendations! In fact, this level is two times higher than the level the WHO considers "very severe lead poisoning."the problem? Sample bias. It is not known if the sample was evidence of lead poisoning in the entire population.
water supply contamination continues to be a problem: in 2004, high lead levels were found in some neighborhoods of WashingtonDC.
find your state here if you want to know if there is a problem.
we still see kids with lead poisoning from old paint: The peeling paint chips are sweet and eaten by toddlers who place everything in their mouths. Since these paints now are forbidden, such cases are much less common, except in older buildings.
of course, nowadays one doubts anyone is using lead acetate to sweeten anything.
But back in 2008, there were a couple dozen acute cases in Germany from smoking marijuana: Some dealers added lead powder to their stash to make it seem heavier than it actually was to make a bigger profit.
Lead acetate has to make meth:
Acute lead poisoning is another potential risk for methamphetamine abusers. A common method of illegal methamphetamine production uses lead acetate as a reagent. Production errors may therefore result in methamphetamine contaminated with lead. There have been documented cases of acute lead poisoning in intravenous methamphetamine abusers.
But lead as a sweetener is not something used nowadays, because there are a lot of other cheap artificial sweeteners that can be used instead.
we get reports of fake sweeteners all the time here, but it is usually cyclamate, which is not very toxic.
However, the real worry is if old fashioned anti freeze is used.
Luckily for folks, the Austrian wine scandal using this chemical was detected by the Germans quickly.
Not all such contamination has been found easily, nowever.
here have been quite a few deaths from Chinese medicines that used Antifreeze to sweeten them.
NYTimes 2007 article about that scandal
Agatha Christie, call your office.