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Communications to the Editor |

Brahms’ Illness Brahms’ Illness FREE TO VIEW

Tsung O. Cheng, MD, FCCP
Author and Funding Information

Affiliations: The George Washington University Medical Center Washington, DC,  Philadelphia VA Medical Center Philadelphia, PA

Correspondence to: Tsung O. Cheng, MD, FCCP, Division of Cardiology, George Washington University, 2150 Pennsylvania Ave, NW, Washington, DC 20037-3201



Chest. 2001;119(3):985-986. doi:10.1378/chest.119.3.985
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To the Editor:

I read with interest the recent article by Margolis in CHEST (July 2000),1in which he hypothesized that the famous composer Johannes Brahms (1833–1897) might have suffered from obstructive sleep apnea as a consequence of his progressive weight gain during the later years of his life. Margolis’ conjecture is certainly worth entertaining. Although Brahms’ biography is well documented, not much was written about his medical history, because most of his life he enjoyed good health.2Because of that, there is little left to speculate in regard to diagnosis, in comparison to Mozart,3Beethoven,45 or Chopin.67

Brahms’ final illness, which lasted more than a year, was characterized by jaundice.2 Although Brahms probably died of pancreatic cancer as Margolis concluded, he could also have had hepatic carcinoma.2 Because of Brahms’ extensive lifelong alcohol consumption,12 he could have had cirrhosis of the liver as a precursor to the liver cancer. As quoted by Franken and Absolon,2 “He looked terribly miserable. The thin white beard, the withered face, the yellow eyes, the flabby thin body, his clothes hanging like on a hanger.” Brahms’ doctor was quoted to have said, “After a careful repeated examination and after observation for three weeks, I found considerable swelling of the liver with complete obstruction of the biliary ducts.”2 Therefore, there is no question that Brahms could have had either primary or metastatic cancer of the liver.

According to Franken and Absolon,2 Brahms’ symptoms and clinical course make a primary liver cancer less likely. The jaundice present from the start is not typical for a primary cancer of the liver. On the other hand, an early obstruction of the common bile duct is usual in cancer of the head of the pancreas. Then, according to Franken and Absolon,2 Brahms did not die in a hepatic coma, which with liver metastases is fairly common.

It is interesting to note that Brahms had a close friend, Theodor Billroth (1829–1894), the famous abdominal surgeon.2 Brahms never excused Billroth for “…cutting out an autographed phrase from his A-minor string quartet (an innovative work dedicated to Billroth). Billroth attached it to Brahms’ photograph, framed and hung it in his office.”2 Why Billroth did not operate on Brahms or was not consulted for Brahms’ jaundice is a mystery to me. Whether Brahms’ presumed obstructive sleep apnea had anything to do with his terminal illness, we will never know, but I doubt it.

Margolis, ML (2000) Brahms’ lullaby revisited: did the composer have obstructive sleep apnea?Chest118,210-213. [CrossRef] [PubMed]
 
Franken, FH, Absolon, KB Diseases of famous composers.1996,255-265 Kabel Publishers. Rockville, MD:
 
Cheng, TO Mozart’s subdural hematoma.Neurology1994;44,2417-2418
 
Cheng, TO A Beethoven reprise [letter]. Cortlandt Forum. 1997;;10(7) ,.:14
 
Cheng, TO Cardiac arrhythmia set to music [letter]. Postgrad Med. 1998;;103(4) ,.:25
 
Cheng, TO Chopin’s illness [letter]. Chest. 1998;;114 ,.:654. [PubMed]
 
Cheng, TO Chopin’s illness revisited [letter]. Chest. 1998;;114 ,.:1796
 

Brahms’ Illness

To the Editor:

I thank Dr. Cheng for his comments. In my opinion, Professor Neumayr makes a convincing case for carcinoma of the pancreas, rather than carcinoma of the liver, in his detailed analysis.1 There is no record of an autopsy, and we will likely never be sure.

I believe I can explain the “mystery” as to why Dr. Billroth was never consulted: the man died on February 6, 1894, > 2 years before the great composer first developed weight loss and jaundice!

References
Neumayr A. Music and medicine. Vol 2. Hummel, Weber, Mendelssohn, Schumann, Brahms, Bruckner: notes on their lives, works, and medical histories. Bloomington, IL: Medi-Ed Press, 1995; 375–468.
 

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References

Margolis, ML (2000) Brahms’ lullaby revisited: did the composer have obstructive sleep apnea?Chest118,210-213. [CrossRef] [PubMed]
 
Franken, FH, Absolon, KB Diseases of famous composers.1996,255-265 Kabel Publishers. Rockville, MD:
 
Cheng, TO Mozart’s subdural hematoma.Neurology1994;44,2417-2418
 
Cheng, TO A Beethoven reprise [letter]. Cortlandt Forum. 1997;;10(7) ,.:14
 
Cheng, TO Cardiac arrhythmia set to music [letter]. Postgrad Med. 1998;;103(4) ,.:25
 
Cheng, TO Chopin’s illness [letter]. Chest. 1998;;114 ,.:654. [PubMed]
 
Cheng, TO Chopin’s illness revisited [letter]. Chest. 1998;;114 ,.:1796
 
Neumayr A. Music and medicine. Vol 2. Hummel, Weber, Mendelssohn, Schumann, Brahms, Bruckner: notes on their lives, works, and medical histories. Bloomington, IL: Medi-Ed Press, 1995; 375–468.
 
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