Documente Academic
Documente Profesional
Documente Cultură
RAMR 2014;3:289-309
ISSN 1852 - 236X
Frédéric Chopin (Fyderyk Franciszek Szopen) menor y la Balada N° 1 en sol menor, ambas pie-
nació el 1 de marzo de 1810, en un pequeño pueblo zas sumamente innovadoras para su época. Llegó
llamado Zelazowa Wola, en Polonia. Su madre era a París en el otoño de 1831. Luego de un debut
polaca y su padre francés, pero había vivido en sensacional en el Salle Pleyel el 26 de febrero de
Polonia desde hacía mucho tiempo y trabajaba 1832, con Franz Liszt, Felix Mendelssohn y Luigi
como bibliotecario1. Chopin era el segundo hijo Cherubini entre la audiencia, Chopin se convirtió
de cuatro, y tenía tres hermanas2. en una celebridad parisina. Pudo vivir cómoda-
Dado que era el único niño de la familia, Chopin mente dando clases y conoció a muchos artistas del
recibió una gran cantidad de atención. Lo descri- momento, formando una amistad particularmente
bían como un alumno inteligente y trabajador. cercana con Eugene Delacroix (quien pintaría su
El joven Frédéric comenzó a estudiar piano con retrato en 1838) y más adelante con Liszt. Durante
Wojciech Zywny cuando tenía 6 años, y armonía esos años en París, Chopin compuso sus primeros
y contrapunto con Józef Elsner, el fundador y Nocturnos, los 12 Estudios op 25, dedicados a la
primer director del Conservatorio de Varsovia. condesa d´Agoult (amante de Liszt); el Scherzo N°
A la edad de nueve años, Chopin dio su primera 2, la Sonata N° 2 y completó la Balada N° 1 una de
actuación musical, un concierto de caridad que sus obras más famosas.
fue un gran éxito3. En 1836, Chopin mantenía una asidua corres-
Comenzó a ser conocido fuera de Polonia cuan- pondencia con una muchacha polaca de 17 años
do sus Variaciones, Op. 2, para piano y orquesta llamada Maria Wodzinska, una amiga de la infan-
sobre “La ci darem la mano” de Mozart (escritas cia, mucho más joven que él. Durante este período
cuando tenía 17 años), fueron publicadas, en 1830. Chopin tuvo dos brotes de influenza. Había tenido
No hay datos precisos de que tuviera sinto- hemoptisis y hematemesis durante los mismos y
matología respiratoria en su niñez; sin embargo, estuvo confinado a su cama durante varias sema-
siempre fue pálido y delicado, y se sabe que fue nas. Dada la pobre salud de Chopin, tanto el padre
visto por Laennec. En 1826 se le detectó una ade- como el tío de María pensaron que no sería un ma-
nopatía cervical con cefalea y síntomas respirato- rido adecuado para ella. De esta manera, Chopin
rios. Emilia (la hermana menor) había sido siem- experimentó el dolor de un amor imposible. En esa
pre una niña frágil con tos recurrente y disnea4. época sus síntomas comenzaron a empeorar. Para
Murió a los 14 años a causa de una hemorragia 1835 (a los 25 años), Chopin estaba francamente
gastrointestinal, cuando Frédéric tenía 21 años. enfermo con disnea, astenia, tos, expectoración y
Aproximadamente a esa edad se presentaron los hemoptisis frecuente. A los 28 años media 1,70m y
primeros síntomas en Frédéric: hemoptisis, fiebre, pesaba alrededor de 45kg9. Su rostro fino y pálido
bronquitis y laringitis5. era completamente lampiño10.
En mayo de 1829, Niccolò Paganini llegó a Var- Sin embargo, para esa época se había convertido
sovia a dar conciertos. Chopin lo escuchó y quedó en uno de los compositores y pianistas favoritos
profundamente deslumbrado por su virtuosismo6. de París. Tenía una gran cantidad de estudiantes
Entre 1830-31, Chopin pasó un corto período en prominentes ansiosos por pagar grandes sumas
Viena, y de allí se mudó a París7. Durante este de dinero por sus lecciones de piano. A la edad de
período también compuso el Scherzo N°1 en si 27 años, conoció a Amandine-Aurore-Lucile Du-
290 Revista Americana de Medicina Respiratoria Vol 14 Nº 3 - Septiembre 2014
pin, Baronesa de Dudevant, mejor conocida por dominales y diarrea. No siendo esto suficiente, el
su pseudónimo George Sand. Era una escritora piano de Chopin quedó varado en la aduana y él se
romántica francesa, conocida por sus numerosas vio obligado a alquilar un instrumento que no le
aventuras amorosas con personajes del ambiente complacía. Sin embargo, a pesar de su mala salud
artístico tales como Prosper Mérimée, Alfred de y todas las dificultades, Chopin logró finalmente
Musset y Alexandre Manceau entre otros. Pero que le enviaran un piano desde su hogar y, en el
la Sand también era una escritora talentosa que transcurso de 5 semanas, compuso varias piezas
abogaba por una reforma política real y por el re- para piano con increíble fluidez, entre ellas los 24
conocimiento de los derechos de la mujer. Chopin preludios, Op. 28. Los 24 preludios son composicio-
la conoció en una fiesta organizada por la amante nes de piano extremadamente hermosas, cuya ori-
de Liszt. “Que mujer repulsiva es Sand” le dijo a ginalidad e innovación cambiaron la forma de los
un amigo “¿Es realmente una mujer? Me siento preludios como género para siempre y que abrieron
inclinado a dudarlo”. No tan inesperadamente un nuevos caminos para la música para piano. Desde
encuentro nada sencillo a primera vista: Chopin, lo técnico y musical son genialmente originales y
el pianista absolutamente respetable y tan alejado abren nuevas posibilidades de expresión y nuevos
como fuera posible de la controversia y George lenguajes que nunca antes habían sido utilizados.
Sand, muy probablemente, la persona más contro- Representan los rasgos más característicos de la
vertida de Paris. Pero al poco tiempo, la invitó a música de Chopin: gran lirismo, virtuosismo, una
uno de sus recitales, y encontraron una conexión abrumadora erudición musical y tal vez, ansiedad,
apasionada. Luego de ese encuentro, comenzaron miedo y la consciencia creciente de estar luchando
una relación. Para el verano de 1838, esa relación con una enfermedad mortal.
era pública11. El inicio de la relación con George Sand había
Fueron juntos a Mallorca con los hijos de Sand, sido apasionado y delirante. Pero la experiencia de
Maurice y Solange. En ese momento, Chopin ya Valldemossa cambió ese arrebato amoroso. En unos
padecía de disnea a pequeños esfuerzos y se ago- pocos meses Chopin pasó de ser el pianista brillan-
taba fácilmente; a menudo tenía que ser llevado te e irresistible a convertirse en un enfermo acosa-
a cuestas luego de tocar el piano por un periodo do por el sufrimiento físico y la angustia moral. La
largo. Sufría de hemoptisis recurrente, debilidad, imagen de Chopin va cambiando lentamente en las
sudores nocturnos y pesadillas. Dado que los na- 485 cartas en que George Sand lo menciona y va
tivos de la isla pensaban que todas las enfermeda- desde el inflamado entusiasmo hasta la adoración
des pulmonares eran incurables e infecciosas, el maternal de la que habla en la “Histoire de ma
propietario (convencido de que Chopin sufría de vie”13. En marzo de 1839 escribe a su gran amigo
tuberculosis) echó a Chopin y Sand de la casa que François Rollina: “Me voici de retour en France
alquilaban y les sugirió que quemaran sus muebles après le plus malheureux essai de voyage qui se
e incluso que pagaran la desinfección de la casa. puisse imaginer. Après mille peines et de grandes
La enfermedad de Chopin y el hecho de que no dépenses, nous étions parvenus à nous établir à
estaban casados molestaron a la gente de la isla, Mayorque, pays magnifique, mais inhospitalier
y los cuatro se vieron obligados a quedarse en un par excellence”14. Las esperanzas de curación para
ex monasterio Cartusiano, donde Chopin y Sand su amado Chopin se habían desvanecido en la fría
dormían en habitaciones adyacentes12. Vivieron allí cartuja de Valldemossa.
por 58 días. Sand llamaba al monasterio (enclava- La relación con George Sand duró aproxi-
do en un valle entre las montañas) un acantilado madamente 8 años. Durante gran parte de este
en la tapa del mundo y lo encontraba magnífico. tiempo, Chopin vivió una época feliz y confiada.
Chopin, era menos entusiasta: “mis cabellos están Este periodo también se vio marcado por una gran
desordenados, no tengo mis guantes blancos, y imaginación musical en sus composiciones7. Las
parezco tan pálido como siempre. El techo de mi opiniones acerca de la influencia de Sand en su
habitación, que tiene la forma de un gran ataúd, vida, sin embargo, se encuentran irreconciliable-
está saltado y polvoriento”. Durante su estadía mente divididas: algunos de sus amigos la veían
en Mallorca, Sand comentó tener dificultades como puramente maligna, mientras otros la veían
para encontrar la comida adecuada para Chopin, como su más grande musa y protectora. A pesar de
ya que la comida grasa le producía molestias ab- la naturaleza turbulenta del tiempo que pasaron
La enfermedad de Chopin 291
contrado”22. Aún más tarde, su hermana Ludwika Recientemente, se ha propuesto la fibrosis quística
recordaba que Curveilhier le había dicho que “la como el diagnóstico más probable.
autopsia no reveló la causa de muerte, sin embargo Adam K. Kubba y Madeleine Young en 199827
él no podría haber sobrevivido… patología diver- discutieron ampliamente algunos de los diagnós-
sa… corazón agrandado… no mostraba consunción ticos diferenciales sugeridos durante años, argu-
pulmonar… cambios pulmonares de muchos años mentando como poco probables la estenosis mitral,
de duración... una enfermedad con la que nunca la insuficiencia tricuspídea, la hipogammaglobuli-
antes me había encontrado”. Las inconsistencias nemia, la misma tuberculosis y planteando como
entre el diagnóstico documentado en el certificado sus diagnósticos más probables la fibrosis quística
de defunción y la correspondencia son difíciles de (FQ) o el déficit de alfa-1-antitrypsina (DAT).
reconciliar, a menos que uno crea que Curveilhier, Estas dos condiciones a su juicio explicarían su
un anatomopatólogo muy capaz y con sobrada ex- enfermedad crónica y su muerte temprana. Tam-
periencia en tuberculosis, hubiera reconsiderado bién podrían explicar la muerte de su hermana a
sus impresiones iniciales. Estas incongruencias la edad de 14 años.
en el diagnóstico, también contribuyeron a per- Similar línea argumental había sido sostenida
petuar la controversia que rodea a la enfermedad en 1994 por Kuzemko4 que sostuvo que la histo-
de Chopin18. ria natural de la tuberculosis pulmonar, fibrosis
Durante el pasado cuarto de siglo, ha habido quística o estenosis mitral, es inconsistente con
varias revisiones, mayormente en la literatura las enfermedades sufridas por Emilia y Frédé-
médica, que tratan el tema de la enfermedad de ric. Este autor sostiene también el diagnóstico
Chopin. La mayoría de los artículos postulan que del déficit de alfa-1-antitripsina, ofreciendo la
Chopin no murió de tuberculosis pulmonar, como explicación de que en partes de Europa, una de
se creía. La teoría de la tuberculosis se debatía cada 10 personas posee el gen de la deficiencia,
incluso cuando él vivía, sin embargo, dado que y aproximadamente una de cada 100 posee el ge-
no había otra alternativa razonable, se aceptó notipo PiZZ, el cual los predispone a desarrollar
durante mucho tiempo que ésta fue la causa del compromiso tanto pulmonar como hepático. Al-
crónico sufrimiento de Chopin. De hecho (quizás rededor del 4% de los europeos son heterocigotas
por el romanticismo asociado a la tuberculosis en para la variante Z (PiMZ). La información del
la era preantibiótica y que tan bien se encuadraba fenotipo para Polonia no se encuentra disponible.
con la figura romántica y sensible de Chopin), se Los adultos heterocigota tipo MZ tiene tres veces
ha convertido casi en una leyenda, perpetuada sin más riesgo que la población normal para desa-
saberlo por sus muchos biógrafos y también por su rrollar enfermedades respiratorias. En familias
público y aún algunos médicos25. con un hermano mayor afectado (potencialmente
Puede argumentarse contra la tuberculosis que Frédéric) las probabilidades de que subsecuentes
sería muy poco probable que un individuo con tu- niños afectados desarrollen cirrosis juvenil au-
berculosis no tratada pudiera sobrevivir más de 20 mentan considerablemente y podrían explicar la
años con su enfermedad. Aunque posible, Chopin enfermedad de Emilia.
no gozaba de una constitución robusta, y sus pre- Más recientemente Majka y col. (de la Karol
ferencias de comida peculiares y estilo de vida se- Marcinkowski University of Medical Sciences y el
dentario probablemente no ayudaban a preservar Institute of Human Genetics de Polonia) afirman
sus fuerzas, por lo cual se podría teorizar que su que los argumentos genéticos para los problemas
enfermedad adolescente no fue tuberculosis ante de salud de Chopin son convincentes y consistentes
la larga duración posterior de sus padecimientos. con el conocimiento moderno26. Sus principales
Otra inconsistencia son las serias y permanentes argumentos contra la deficiencia de alfa 1-antitrip-
quejas digestivas que aparecen en biografías de sina son: (1) la historia de diarrea crónica causada
Chopin y que no se explican por la tuberculosis. por insuficiencia pancreática, y (2) la falta de ic-
Se han sugerido muchas enfermedades para ex- tericia y ascitis, si las muertes de Chopin y Emila
plicar la enfermedad de Chopin, entre las cuales se hubieran sido causadas por sangrado de várices
incluye la estenosis mitral, la fibrosis quística, el esofágicas en el curso de hipertensión portal por
enfisema pulmonar, el síndrome de Churg-Strauss cirrosis. Sin embargo, ninguna de éstas excluye
y la aspergilosis broncopulmonar alérgica4, 26, 27. completamente la posibilidad de este diagnóstico.
296 Revista Americana de Medicina Respiratoria Vol 14 Nº 3 - Septiembre 2014
Por el contrario, los autores sostienen que expectoración crónicas, anomalías persistentes
el principal argumento que se adujo contra la en la radiografía de tórax (bronquiectasias, ate-
fibrosis quística (la muerte temprana en la era lectasias), obstrucción de la vía aérea, poliposis
pre-antibiótica), hoy no es sostenible. Es verdad nasal, anomalías de los senos paranasales, ano-
que cuando la FQ fue reconocida como una enti- malías gastrointestinales y pancreáticas, retraso
dad clínica en 1938, se pensaba que era invaria- pondoestatural, hipoproteinemia y edema, déficit
blemente fatal durante la infancia. Durante los de vitaminas liposolubles, síndromes de pérdida
últimos 30 años, en cambio, la media de vida de de sal y anomalías urogenitales en varones, pro-
pacientes con FQ ha aumentado, principalmente ductoras de azoospermia obstructiva) o: a) fibrosis
gracias a la mejora en las técnicas de diagnóstico quística en al menos un hermano, o b) un test
y a un mejor tratamiento en centros de cuidado de cribado neonatal positivo. 2. Un test de sudor
multidisciplinarios. positivo en dos ocasiones o más, por iontoforesis
Los pacientes con FQ heredan dos copias defi- con pilocarpina, o en su defecto: a) identificación
cientes de un gen en el brazo largo del cromosoma de dos mutaciones en el gen CFTR, o b) demos-
7. Este gen codifica una proteína llamada el regu- tración de un transporte de iones anormal en el
lador de la conducción de transmembrana de la epitelio nasal.
fibrosis quística (CFTR). Esta proteína de 1480 Es reconocido actualmente que con la mejora
aminoácidos, normalmente regula el transporte de de los métodos diagnósticos, y en concreto del es-
cloro y otros electrolitos. Han sido descritas hasta tudio genético y del potencial de membrana nasal,
ahora más de 1000 mutaciones del gen CFTR que se van delimitando nuevos grupos diagnósticos,
se asocian al fenotipo FQ. La más común de estas que no coinciden con la fibrosis quística típica de
mutaciones, es la delta F508. diagnóstico pediátrico31, 32.
Los genotipos específicos del CFTR no tienen De acuerdo a la los datos provistos por la Cys-
una buena correlación con la severidad de la tic Fibrosis Foundation Patient Registry de los
enfermedad. Por ejemplo, pacientes homocigotas Estados Unidos, el porcentaje de pacientes con
para la mutación z.F508 casi siempre tendrán diagnóstico de FQ en la adultez se duplicó entre
insuficiencia pancreática y valores anormales de 1994 y 1997, pasando de 5.8% a 11.5%33. Los estu-
cloro en sudor, pero sus enfermedades pulmona- dios de cohorte mostraron que aquellos pacientes
res varían de leve a severa, incluso dentro de una diagnosticados tardíamente difieren significativa-
misma familia28. Los elementos genéticos respon- mente del grupo de pacientes diagnosticados más
sables de la regulación de la expresión del CFTR temprano. Los pacientes diagnosticados después
dentro de un genotipo definido, continúan estando de los 16 años muestran un mayor porcentaje
mayormente indefinidos. de mutaciones leves33, lo cual se ve reflejado en
Aunque parecería que las mutaciones que pro- un fenotipo con buena suficiencia pancreática y
ducen un CTFR parcialmente funcional deberían cambios pulmonares menos avanzados. Majka y
llevar a un fenotipo atenuado, el efecto de un col remarcan que en comparación con otras po-
CFTR anormal varía. Resulta evidente que las blaciones caucásicas con FQ la población polaca
mutaciones de CFTR por sí solas no pueden ex- se caracteriza por una heterogeneidad genética
plicar en su totalidad la enfermedad y que otros muy marcada26.
factores genéticos y no genéticos contribuyen al Esta sugerencia de FQ por varios autores (entre
amplio rango de severidades clínicas que se ven ellos expertos polacos) llevó a que se solicitara al
en la enfermedad fibroquística29. gobierno de Polonia que se analizara genética-
Esto implica que un sujeto como Chopin, podría mente el corazón de Chopin para buscar el gen
haber tenido una forma atenuada o frustra de FQ. CFTR y determinar con certeza si había sufrido
Los criterios diagnósticos de la fibrosis quística tuberculosis o FQ.
se basan actualmente en los criterios establecidos En 2008, el Ministro polaco de Cultura y el
por el panel de Consenso de la Fundación para el Director del prestigioso Instituto Fryderyk Chopin
estudio de la fibrosis quística30 e incluyen: 1. Uno en Varsovia, recibieron un pedido detallado para
o más de los rasgos fenotípicos característicos (en- un análisis de ADN del corazón de Chopin. Este
fermedad crónica sinopulmonar con colonización pedido fue realizado por un experto polaco en fibro-
persistente por patógenos típicos de la FQ, tos y sis quística, el profesor Wojciech Cichy. Cichy era
La enfermedad de Chopin 297
en aquel entonces un Profesor de pediatría y Jefe del ADN permitan obtener información de estos
de Gastroenterología pediátrica y enfermedades cabellos. Esto sería especialmente importante si
metabólicas en la Universidad Médica de Poznan, el gobierno polaco se mantiene reacio a exponer
con más de 40 años de experiencia trabajando su corazón.
con pacientes con fibrosis quística, e internacio- Durante toda su vida, Chopin sólo hizo 30 ac-
nalmente reconocido en su campo. Su pedido fue tuaciones públicas. De sus casi 170 composiciones,
rechazado34. prácticamente todas son exclusivamente para
El Ministro y el Director concluyeron que “ni piano. Chopin interpretó su propio trabajo ocasio-
era el momento de dar una aprobación, ni se nalmente en salas de concierto, pero la mayoría de
encontraba justificado”. El Ministro agregó que las veces en su propio salón, sólo para amigos. El
“la visión predominante es que la investigación marco íntimo de sus actuaciones era esencial para
propuesta servirá principalmente para satisfacer la música de Chopin. Él amaba las melodías tristes,
la curiosidad de los autores del proyecto” pero particularmente las cantables. Chopin era alabado
sin ofrecer “conocimiento nuevo que pueda tener por su habilidad de infundir las formas tradicio-
impacto significativo en la valoración de la figura nales como la sonata y el preludio con intimidad
y el trabajo de Chopin”. e intensidad emocional inusuales. Más adelante,
Es cierto que no existe una manera sencilla de a medida que su enfermedad progresaba, Chopin
averiguar el diagnóstico final de Chopin. Incluso tuvo que dejar de hacer actuaciones públicas de
análisis de ADN del tejido de Chopin podrían llevar cualquier tipo.
a asunciones engañosas, a menos que se encontra- El virtuosismo interpretativo de Chopin es una
ran dos mutaciones CFTR. parte de su legado casi tan grande como sus com-
La hipótesis de la fibrosis quística cobra fuerza posiciones. “Escuchen tocar a Chopin!” escribió el
ante el descubrimiento de formas adultas de la periódico musical Le Ménestral en 1848, “es como
enfermedad29, 35. Muchos de los dilemas de esta el suspiro de una flor, el susurro de las nubes, o
investigación se explicarían con esta teoría. Puede el murmullo de las estrellas”. Las actuaciones de
que tanto él como su hermana Emilia hubieran he- Chopin eran únicas; su virtuosismo e inspiración
redado una enfermedad en común, y sin embargo asombraban a quienes lo oían tocar, especialmente
tuvieran distintas mutaciones del gen CFTR lo otros músicos. Como pianista, el estilo de Chopin
cual podría explicar que hayan experimentado un era inigualable, con una armonía particular entre
curso clínico tan distinto y que Chopin sobreviviera su físico frágil y su estilo para tocar, generalmente
hasta la edad de 39 años así también la subsecuen- fluido, dulce y no forzado. Las manos de Chopin,
te muerte de su hermana mayor, Ludwika, quien pequeñas, elásticas y delgadas y con articulaciones
murió a la edad de 47 años de una enfermedad muy laxas eran capaces de alcanzar intervalos de
respiratoria jamás explicada. décimas con facilidad35. Al decir de Stephen Heller
Los confusos resultados post mortem del Dr. “es maravilloso ver las pequeñas manos de Chopin
Cruveilhier no resultarían tan enigmáticos si el abrirse y cubrir un tercio del teclado. Es como
diagnóstico de tuberculosis fuera reemplazado por abrir la boca de una serpiente y tragar un conejo
el de FQ. Cruveilhier no hubiera podido interpretar de una vez”.
los resultados de una enfermedad que no se conocía El estilo y los dones de Chopin se volvieron cada
ni se sospechaba. vez más influyentes: Schumann y Liszt eran gran-
Actualmente, hay al menos dos lugares que des admiradores del compositor. Liszt transcribió
han preservado especímenes del pelo de Chopin, 6 de las canciones de Chopin para piano y dedicó
el Museo Fryderyk Chopin, en Varsovia, y la Bi- un movimiento de sus “Harmonies Poutiques ŭ et
bliotheque Polonaise, en París. Se dice que existen Religieuses” a Chopin. A pesar de que Liszt negó
otros especímenes en Alemania, Mallorca y los que haya sido inspirado por la muerte de Chopin,
Estados Unidos. Estos especimenes, que van de la sección media recuerda la famosa Polonaise, op.
cabello marrón a rubio ceniza, parecen ser mues- 53. de Chopin. La ópera tuvo una gran influencia
tras cortadas del cabello de Chopin después de su en las composiciones de Chopin, muchas de sus
muerte, por lo cual seguramente no poseen folí- piezas a menudo tenían un cromatismo intenso y
culos intactos. Sin embargo, se puede esperar que personalizado, y una curva melódica similar a las
en el futuro, las mejoras en el método de análisis óperas de sus contemporáneos, principalmente
298 Revista Americana de Medicina Respiratoria Vol 14 Nº 3 - Septiembre 2014
13. Janer Manlla G. 150 años de la publicación de “Un hiver of Frédéric Chopin’s suffering and death. J Appl Genet
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14. Sand G. Lettres d’une vie. París, Gallimard. 2004. pp 326 Chest. 1998; 113: 210-216.
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18. Hedley A. Selected Correspondence Of Fryderyk Chopin. Consensus Panel. J Pediatr 1998; 132: 589-595.
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org/details/selectedcorrespo002644mbp Navarro P. Fibrosis quística en la edad adulta: nuevas
19. Leigh F. Fryderyc-Francois Chopin (1810-1849): Music and formas clínicas. Med Clin 2003; 120: 584-588.
malady. J Med Biogr 2013. 32. Zielinski J, Tsui LC. Cystic fibrosis: genotypic and pheno-
20. Davila J. Étude de la maladie de Chopin À traverse sa typic variations. Annu Rev Genet 1995; 29: 777-807.
correspondance. Université Paul-Sabatier-Toulouse III, 33. Widerman E, Millner L, Sexauer W, Fiel S. Health status
Faculty de Medicine, 95-Tou 3-1084: 79-82; Bibliotèque and sociodemographic characteristics of adults reciving
Polonaise, Paris. a cystic fibrosis diagnosis after age 18 years. CHEST
21. Opienski H. 1988. Frédéric Chopin: Chopin’s letters. Repr. 2000;118: 427-433.
New York: Dover Publications. 34. Mckie R. Row over plan to DNA test Chopin’s heart. The
22. Lagerberg S. Chopin’s Heart: The Quest to Identify the Observer, 2008. En: http://www.guardian.co.uk/music/2008/
Mysterious Illness of the World’s Most Beloved Composer. jul/27/classilcalmusicandopera.genetics
CreateSpace Independent Publishing Platform, 2011. 35. Comite de Neumonología. Guía de diagnóstico y tratamiento
23. Karasowski M. Life and letters of Chopin. London: William de pacientes con Fibrosis Quística: actualización. Resumen
Reevers Publisher, 1879. ejecutivo. Arch argent. Pediatr 2014; 112: 291-292.
24. Zamoyski A. Chopin. Prince of the Romantics. London: 36. Huneker J. Chopin: The Man and His Music. Dover Pub-
HarperPress, 2010 lications, 1966.
25. Carter ER. Chopin’s malady. Chest 1998; 114: 655-656. 37. Steen M. Chopin: The Great Composers. Icon Books Ltd.
é
26. Majka L, Gozdzik J, Witt M. Cystic fibrosis-a probable cause (London) 2003
1
Fundación Sanatorio Güemes - Hospital Británico - Buenos Aires - Argentina
Frédéric Chopin (Fyderyk Franciszek Szopen), first director of the Warsaw Conservatory. At age
was born on March 1, 1810, in a small town, named nine, Chopin gave his first musical performance, a
Zelazowa Wola, Poland. Chopin’s mother was Pol- charity concert, which was a great success3.
ish and his father was French, but had lived in His name became known outside of Poland when
Poland for a long time working as a bookkeeper1. his Variations, Op. 2, for piano and orchestra on
Chopin was the second child of four, having three Mozart’s “La ci darem la mano” –written when
sisters2. he was 17– were published in 1830.
Being the only boy in the family, Chopin received There is no precise data that he had respiratory
a great deal of attention. He was described as be- symptoms in his childhood; nonetheless, he was
ing an intelligent and industrious student. Young always pale and delicate, and it is known that he
Frédéric started to study piano with Wojciech was treated by Laennec. In 1826 he had a cervical
Zywny when he was 6 year-old and harmony and adenopathy with headache and respiratory
�����������������
symp-
counterpoint with Jozef Elsner the founder and toms. Emilia, the youngest sister, was a frail child
300 Revista Americana de Medicina Respiratoria Vol 14 Nº 3 - Septiembre 2014
too who had recurrent coughing, breathlessness French Romantic writer, noted for her numerous
and ‘asthma’4. She died at age 14 of a gastrointes- love affairs with such prominent figures as Prosper
tinal bleeding, when Frédéric was 21 years old. Mérimée, Alfred de Musset, Alexandre Manceau,
Around that age, Frédéric had the first symptoms: and others. But she also was a talented writer who
hemoptysis, fever, bronchitis and laryngitis 5. campaigned for real political reform and for the
defense of the rights of women. She and Chopin
In May 1829, Niccolò Paganini arrived in War- met at a party given by Franz Liszt’s mistress,
saw to perform. Chopin heard him and was deeply the Countess d’Agoult. “What a repulsive woman
dazzled by his virtuosity6. From 1830-31, Chopin Sand is!” Chopin said to a friend. “Is she really a
spent a brief time in Vienna and from there he woman? I’m inclined to doubt it.” Not curiously
moved to Paris7. In this period he composed the B an uneasy encounter: Chopin, quintessentially
minor Scherzo and the G minor Ballade, both of respectable and shrinking from controversy and
them highly innovative for their time. He then ar- George Sand, arguably the most controversial
rived in Paris in the fall of 1831. After a sensational person in Paris. But soon later, he invited her to
debut at the Salle Pleyel on Feb. 26, 1832, with a recital of his work, and they found a passionate
Franz Liszt, Felix Mendelssohn and Luigi Cheru- connection. By the summer of 1838, their affair
bini among those in the audience, Chopin, became was public11.
one of the celebrities of the French capital. He was They went to Majorca with Sand’s children,
able to make a comfortable living as a teacher and Maurice and Solange. At that time, Chopin was al-
met many artists of the moment, forming particu- ready chronically breathless and easily exhausted;
larly close friendships with Eugene Delacroix, who he often had to be carried off after playing the
would paint a splendid portrait of him in 1838, and piano for any length of time. He suffered haem-
later with Liszt. During those years in Paris, Cho- optysis, weakness, night sweats and nightmares.
pin composed his first Nocturnes, the 12 Études, As the inhabitants on the island regarded all
Op. 25, dedicated to Liszt’s mistress, the Comtesse pulmonary diseases as incurable and infectious,
Marie d’Agoult, the Scherzo Number 2, the Sonata the landlord (convinced that he suffered from
Number 2 and the Ballade Number 18. tuberculosis) demanded that Chopin and George
In 1836 he kept a regular correspondence Sand should leave the house including the sugges-
with a seventeen-year-old Polish girl named tion that their furniture be burned and the house
Maria Wodzinska. Maria Wodzinska was actu- disinfected at their expense. Chopin’s disease and
ally a childhood friend, much younger than him. their unmarried status incensed the locals, and the
During this time Chopin had two bouts with in- four of them were obliged to stay in an abandoned
fluenza. He had hemoptysis and hematemesis. He chilly Carthusian ex-monastery, where Chopin and
was confined to his bed for several weeks. Because Sand lived in adjacent rooms12. They lived there
of Chopin’s poor health, Maria’s father and uncle for 58 days. Sand called the monastery set in a
felt that Chopin would not be a suitable husband valley between the mountains a ‘cliff-top vantage
for Maria. Thus, Chopin experienced the pain of an point’,and found it magnificent. Chopin, was less
impossible love. Around that time, his symptoms enthusiastic: ‘My hair is dishevelled, I am without
started to get worse. By 1835, (at age 25) Chopin my white gloves, and look pale as always. My cell,
was frankly ill with dyspnoea, asthenia, cough, which is shaped like a big coffin, has an enormous
sputum and frequent hemoptysis. He grew to dusty vaulted ceiling’ During their stay in Majorca,
about 170 cm and was reported to be about 45 kg Sand reported difficulties in finding the right food
when 28 years of age9. His refined and pale face for Chopin, because fatty food gave him abdominal
was completely hairless10. discomfort and severe diarrhoea. To make things
However, at that time he had become one of worse, Chopin’s piano got stuck in customs and he
Paris’ favorite composers and performing pianists. was forced to rent an instrument which he called
He had a long queue of prominent students eager a ‘wretched replacement’. But in spite of his bad
to pay large amounts of money for his piano les- health and all the difficulties, Chopin had a piano
sons. At age twenty-seven, Chopin met Amandine- sent from home and, over five weeks, composed
Aurore-Lucile Dupin, Baroness Dudevant, better several piano pieces with astonishing fluency, like
known by her pseudonym George Sand. She was a the 24 Preludes, Op. 28.Chopin’s 24 Preludes are
La enfermedad de Chopin 301
extremely beautiful piano compositions, whose B minor Sonata, the Op. 55 Nocturnes and the
originality and innovative approach have changed Op. 56 Mazurkas– are characterized by remark-
the shape of preludes as a genre forever and opened able refinement and complexity, along with a new
new paths for music. From both technical and melodic, harmonic and formal language.
musical standpoint they are ingeniously original The relationship between Frédéric Chopin and
and open new possibilities of expression and new George Sand, has been a subject of controversy,
languages which had never been used before. They speculation, and romanticization since the two
seem to represent the most characteristic features first met15.
of Chopin’s music, plenty of lyricism, virtuosity, Theirs was perhaps the first popular celebrity
overwhelming musical erudition and perhaps, romance, the truth about which may never be
anxiety, fear and the increasing conscience of being known. Ruth Jordan, an expert on the subject,
struggling with a mortal illness. writes, ‘Over the years legend and truth have be-
The beginning of the relationship with George come so intricately woven into the history of George
Sand had been passionate and delirious. But the Sand’s liaison with Chopin’16. Like in any popular
experience in Valldemossa changed that loving romantic story, fantasy, reality, interpretations
outburst. In a few months Chopin went from the create a net that impedes to see the truth, a truth
brilliant and irresistible pianist to a sick man that perhaps, like in any other emotional human
besieged by physical suffering and moral distress. relationship, does not exist as univocal. Liszt’s
Chopin’s image changed slowly through the 485 biography of Chopin is perhaps the best example
letters in which George Sand mentions him, and of this. His ‘Vie de Chopin’ is probably novelistic
it goes from an inflamed enthusiasm to the ma- romanticism at its best. Liszt exposes his extrava-
ternal adoration she mentions in the “Histoire de gant reconstruction of their relationship when he
ma vie”13. In March 1839, she writes to her great claims that Sand and Chopin’s legendary trip to
friend François Rollina: «Me voici de retour en Majorca was pleasant, enjoyable, and even good for
France après le plus malheureux essai de voyage Chopin’s health17. The ‘disastrous stay in Majorca’
qui se puisse imaginer. Après mille peines et de was anything but the “felicity” described by Liszt.
grandes dépenses, nous étions parvenus à nous It rained most of the time; Chopin was miserable
établir à Mayorque, pays magnifique, mais inhos- and ill and Majorca gave them instead dreary
pitalier par excellence»14. The hope of a cure for her weather, scarceness of adequate food, archaic
beloved Chopin had faded in the cold charterhouse lodgings, and unfriendly locals. Actually it caused
of Valldemossa. Chopin’s health to drastically worsen.
The relationship with George Sand lasted about Sand’s biographers often see Chopin as a mill-
eight years, during which time, Chopin experi- stone around the neck of an extraordinary and
enced a great deal of happiness and fulfilment. diversely-talented woman. Chopin’s biographers
This was a time also marked by a heightened are more likely to depict Sand as responsible,
musical imagination in his compositions7. The in some way at least, for the early death of the
opinions abut the influence of Sand in his life are composer by abandoning him in his last years.
irreconcilably divided, some of their friends saw However, there is no doubt that George Sand felt
her as evil and some of them as his greatest muse a genuine love and cared very much about Chopin.
and kindest protector. In spite of the stormy na- In a letter to her friend Carlotta Mailiani in Paris.
ture of their time together, it seems that there is George Sand wrote “This Chopin is an angel; his
no doubt that some of his greatest works emerged kindness, tenderness and patience sometimes worry
as a result of the emotional contentment he felt me, for I get the idea that his whole being is too
in the early days of their liaison. During the years delicate, too exquisite and too perfect to exist long
they spent together, in spite of emotional ups and in our coarse and heavy earthly life. At Majorca,
downs and recurrent illness, he produced a re- when sick unto death, he composed music full of
markable body of compositions that included the the scent of Paradise; but I am so used to seeing
Ballades in A-flat, Op. 47, and F minor, Op. 52, the him away in the skies that it does not seem to
Mazurkas of Opp. 50, 56, 59, 63 and 67, the A-flat signify whether he is alive or dead. He does not
major Polonaise, Op. 53, the Nocturnes, and the really know on what planet he is living and has no
Sonata in B minor. The best of these works —the precise notion of life as we others conceive it and
302 Revista Americana de Medicina Respiratoria Vol 14 Nº 3 - Septiembre 2014
.
Figure 1. Chopin in 1829, by Ambrozy Mieroszewski. “Catalogue
of paintings removed from Poland by the German occupation
authorities during the years 1939-1945. Polish paintings”. Figure 2. Frédéric Chopin Louis-Auguste Bisson, very old and
poor copy, completely restored and remastered by Amano1 -
Ernst Burger: Frédéric Chopin. München 1990, S. 323.
live it”18. After the separation, she went to neither
his funeral nor his commemoration and destroyed A doctor in Ipswich charged a guinea a time for
their correspondence. But in one of the letters that pumping a litre of his patented gas mixtures into
survived, written in 1845 and enclosing a lock of the patient’s rectum, ‘whence they were sure to
his hair, she said “Aime-moi mon cher Ange, mon reach the lungs’). Finally, he and George Sand
cher Bonheur, je t’aime”. were compelled to return first to Barcelona, and
On the other side, there is proof of the great then to Marseille (in 1839) where they stayed for
love that bounded Chopin to Sand. When Frédéric a few months to recover. By September 1842, they
Chopin died in 1849, their relatives found amongst were back in Paris.
his belongings, a little envelope in the back of his Chopin’s health visibly declined from the
diary. The letters “G F” (for George and Frédéric) year 1840, he lost weight and was increasingly
were stitched into it, and it contained a lock of pale. A bit later, Chopin already had to be car-
George Sand’s hair. Most prevalent opinion is that ried upstairs. Chopin tried to control his violent
he adored Sand; she was his nurse, companion and bouts of coughing using belladonna and a mixture
substitute mother, as well as his muse and lover. of sugar and opium. He suffered mainly in the
During their stay in Majorca, his health wors- mornings and often with purulent sputum suggest-
ened every single day and he bitterly complained ing he had developed bronchiectasis19. His health
about the incompetence of the local physicians: got progressively worse and he lost interest in
“The first said I was going to die; the second said composition 7. In April of 1848, Chopin made
I had breathed my last; and the third said I was an extended tour to the British Isles, where
already dead.” The local doctors were useless. he struggled under an exhausting schedule. In
He had to stop them bleeding him (bleeding was great suffering, he spent most of his time at
the commonest treatment for TB. Blistering was home only to come out to perform a concert. He
thought to work and cod-liver oil, an ancient rem- made his last public appearance on November
edy, was introduced at the Brompton Hospital. 16, 1848 in London 2.
La enfermedad de Chopin 303
people. It was delayed for almost 2 weeks, appar- tant and unclear observations hurriedly jotted
ently because the Madeleine did not permit the down during that cursory task have formed the
female singers required in the choir for the Req- basis for the tuberculosis story for nearly two
uiem. The church finally granted Chopin’s final hundred years18.
wish provided the female singers remained behind During the past quarter of a century, there
a black velvet curtain. His body was buried at Père have been several comprehensive reviews,
Lachaise cemetery, but his heart was interred at a largely in the medical literature, addressing
church in Warsaw, near the place of his birth. “He the topic of Chopin’s illness. Most of these
was dying all his life,” said Hector Berlioz shortly articles postulate that Chopin did not die from
after Chopin’s death. In Abad Jelowicki’s letter, he pulmonary tuberculosis, as has been commonly
said “Chopin’s frail, weak body was visibly unfitted believed. The tuberculosis theory was debated
for the strength and force of his genius. It was a even while he lived yet, in the absence of any
wonder how in such a weak state, he could live at reasonable alternative explanation, it has long
all, and occasionally act with the greatest energy. been presumed to be the cause of Chopin’s
His body almost diaphanous; his eyes were almost chronic suffering and eventual death. In fact,
shadowed by a cloud from which, from time to time, it has become a legend, perpetuated rather un-
the lightning of his glance flashed. Gentle, kind, knowingly by his many biographers as well as
bubbling with humor, and every way charming, his adoring public, that even some physicians
he seemed no longer to belong to earth, while, un- have supported25.
fortunately, he had not yet thought of heaven”22, 24. There is the telling argument that it would be
But what was the “angel of death” for this most unlikely for an individual with untreated
brilliant and ultra sensitive musician? tuberculosis to survive more than twenty years
Cruveilhier, who treated Chopin during the with this disease. It’s no doubt possible, but
last 4 months of his life, and who confirmed his usually much more likely to last this long in
death, performed the autopsy and removed his those stronger individuals who enjoy better
heart, which was sent to Poland. The results of overall health. From all reports, Chopin did
the autopsy are lost. not enjoy a robust physical constitution and
Chopin’s now-lost death certificate, once com- his often-peculiar food preferences and sed-
pleted by Dr. Cruveilhier, reportedly attributed entary lifestyle probably did little to preserve
the cause of death to “tuberculosis of the lungs his strength. It could be theorized that his
and larynx”. However, in written correspond- adolescent illness was not tuberculosis. Other
ence with Stirling (his friend) and Ludwika (his inconsistencies turn our attention away from
sister) some months later, Cruveilhier expressed tuberculosis. The digestive complaints that pop
his doubts. In a letter Stirling wrote to Liszt, up occasionally in Chopin’s biographies are not
she quoted Cruveilhier as saying, “The autopsy well explained by tuberculosis.
did nothing to disclose the cause of death, but it Many conditions have been suggested to
appeared that the lungs were affected less than explain Frédéric Chopin’s illness and include
the heart. It is a disease I have never encountered pulmonary tuberculosis, mitral stenosis, cystic
before”22. Still later, Ludwika remembered Cru- fibrosis, pulmonary emphysema (alfa 1-antit-
veilhier telling her that “the autopsy did nothing rypsin deficiency), Churg-Strauss syndrome
to disclose the cause of death… nevertheless he and allergic bronchopulmonary aspergillosis4, 26,
could not have survived… diverse pathology… 27
. Recently, a genetic disease (cystic fibrosis or
enlarged heart… did not disclose pulmonary alfa 1-antitrypsin deficiency) has been proposed
consumption… lung changes of many years du- as the most likely diagnosis.
ration… a disease not previously encountered”. Adam K. Kubba and Madeleine Young en 199827
The inconsistencies between the diagnosis docu- discussed some of the differential diagnosis sug-
mented in the death certificate and the subse- gested over the years, and arguing as unlikely
quently reported correspondence are difficult to mitral stenosis, tricuspid regurgitation, hipogam-
reconcile, unless one believes Cruveilhier, a most maglobulinemia and tuberculosis itself, and posing
capable pathologic anatomist, came to reconsider as their most likely diagnosis cystic fibrosis or
his initial impressions. Yet Dr. Cruveilhier’s hesi- alpha-1-antitrypsin deficiency.
306 Revista Americana de Medicina Respiratoria Vol 14 Nº 3 - Septiembre 2014
These two conditions could explain his chronic This protein, 1,480 amino acids long, spans the
ill health and early death. They may also explain cell membrane of epithelial cells and normally
his sister’s death at the age of 14. regulates the transport of chloride and other
A similar line of argument had been held by electrolytes. More than 1,000 mutations of the
Kuzemko, in 19944 who claimed that the natural CFTR gene associated with the CF phenotype have
history of post primary pulmonary tuberculosis, been described to date. The most common of these
cystic fibrosis or mitral stenosis is highly in- mutations, delta F508.
consistent with the illnesses suffered by Emilia Specific CFTR genotypes do not correlate well
and Frédéric. This author also proposes an with disease severity. For example, patients homo-
alfa-1-antitrypsina deficit diagnosis, offering zygous for the z.F508 mutation will almost always
the explanation that in parts of Europe, one in have pancreatic insufficiency and abnormal sweat
10 individuals are carriers of the deficiency gene chloride values, but their pulmonary disease varies
and about one in 1000 has a genotype PiZZ which from mild to severe, even in the same family28. The
predisposes them to the development of both genetic elements responsible for the regulation
lung and liver disease. About 4% of Europeans of CFTR expression within a defined genotype
are heterozygotes for the Z variant (PiMZ). The remain largely undefined.
phenotype data for Poland are not available. The Although it seems that mutations producing a
heterozygote adults type MZ have three times partly functional CFTR should lead to an attenu-
the risk of normal population for developing ated phenotype, the effect of an abnormal CFTR
respiratory disease. In families with an affected varies. It is thus apparent that CFTR mutations
older sibling (potentially Frédéric) the chances alone cannot fully explain the variable local dis-
of developing juvenile cirrhosis in subsequent af- ease within persons and that other genetic and
fected children (Emilia) is increased considerably nongenetic factors contribute to the broad range of
and might explain Emilia’s disease. clinical severities seen in fibrocystic lung disease29.
More recently, Majka and col. (of the Karol This would indicate that a subject such as Cho-
Marcinkowski University of Medical Sciences and pin could have had an attenuated form of CF. The
the Institute of Human Genetics in Poland) said diagnostic criteria for cystic fibrosis are based upon
that the arguments for genetic background of those established by the panel in the “Consenso de
Frédéric Chopin’s health problems are convincing la Fundación para el estudio de la fibrosis quística“
and consistent with modern knowledge26. Their and they include30:
main counter-arguments against alfa 1-antitrypsin 1. One or more of the phenotype characteristics
deficiency are: (1) the history of chronic diarrhoea (chronic sinopulmonary disease with persistent colo-
caused by pancreatic insufficiency, and (2) lack nisation of typical microorganisms in CF) Chronic
of jaundice and ascites, if Chopin’s and Emila’s cough and sputum, persistent chest-x-ray abnormali-
deaths were caused by variceal bleeding in a course ties (bronchiectasis and/or atelectasis), chronich air-
of portal hypertension. However, none of these ex- ways obstruction, nasal polyposis, sinusal abnormali-
cludes completely the possibility of this diagnosis. ties, gastrointestinbal abnormalities, child growth
Nonetheless, the authors claim that the main arrest, hypoproteinemia and oedema, deficit of lipo-
argument against cystic fibrosis (the early death soluble vitamins, salt loss syndrome and obstructive
in the pre-antibiotic age), is not sustainable to- azoospermiain males or: a) cystic fibrosis in at least
day. It is true that when CF was recognized as a one brother, or b) positive neonatal screening test.
distinct clinical entity in 1938, it was thought to 2. Plus a positive sweat test at least in 2 measure-
be invariably fatal during infancy. Over the last ments or a) identification of two different mutations
30 years, the average life span of CF patients has of the CFTR gen, or b) demonstration of defective
increased, mainly owing to more sensitive diagnos- electrolyte transport in the nasal ephitelium.
tic techniques and better supportive treatment in With the improvement of diagnostic methods,
multidisciplinary CF care centers. and more specifically, the genetic studies and the
CF patients inherit two defective copies of potential study of the nasal membrane, two new
a gene on the long arm of chromosome 7. This diagnostic groups are starting to be outlined, which
gene codes for a protein called the cystic fibrosis do not coincide with the typical CF of the pediatric
transmembrane conductance regulator (CFTR). diagnosis31, 32.
La enfermedad de Chopin 307
According to the U.S. Cystic Fibrosis Foundation can and do exist 29, 35. Many of the dilemmas of
Patient Registry data, the percentage of patients this investigation could be explains by this
with the CF diagnosis made in adulthood doubled theory. He and his sister might have inherited
between the years 1994 and 1997 from 5.8% to a common disease, yet each with distinctly
11.5%33. Cohort studies showed that those diag- separate genetic mutations of their CFTR gene.
nosed late differ significantly from the group of That they each experienced such a different
patients diagnosed early. Patients diagnosed after clinical course could therefore be explained.
the age of 16 years display a higher percentage of Chopin’s survival to the age of thirty-nine
mild mutations33. This is reflected in their phe- could be explained by this hypothesis, as can
notype: they are commonly pancreatic sufficient the subsequent, somewhat premature, death of
(GAN et al. 1995) with less advanced pulmonary his older sister, Ludwika, who died at the age
changes. Majka and col underline that In compari- of forty-seven from an unexplained respiratory
son to other Caucasian CF population, the Polish ailment.
CF population is characterized by profound genetic The puzzling postmortem findings related by
heterogeneity26. Dr. Cruveilhier do not now seem so enigmatic
This suggestion led to a request to the Pol- if cystic fibrosis replaces tuberculosis as the
ish government for genetic testing of Chopin’s diagnosis. It’s doubtful whether Cruveilhier
heart for the CFTR gene to determine if he had would ever have witnessed the postmortem
tuberculosis or cystic fibrosis. pathology present with cystic fibrosis and, if so,
In 2008, the Polish Minister of Culture, he certainly would have been sorely perplexed
Bogdan Zdorojewski, and the director of the to understand it.
highly esteemed Fryderyk Chopin Institute in Currently, there are at least two locations
Warsaw, Grzegorz Michalski, received a detailed that have preserved specimens of Chopin’s
request for a DNA analysis of Chopin’s heart. hair: the Fryderyk Chopin Museum in War-
This scientific inquiry had been proposed by a saw and the Blibliothèque Polonaise in Paris.
leading Polish cystic fibrosis expert, Professor Other specimens are claimed to exist in Ger-
Wojciech Cichy. Cichy was then a sixty-six-year- many, Majorca and the United States. These
old Professor of Pediatric and Chair of Pediatric specimens, ranging from chestnut brown to a
Gastroenterology and Metabolic Diseases at the pale dusty-blond, appear to be samples snipped
Medical University in Poznan. With more than from Chopin’s locks after his demise and thus
forty years of experience in working with cystic devoid of any intact follicles. However, it can
fibrosis patients, Cichy is an internationally be hoped that with future improvements in
recognized researcher in the field. The request DNA analytical methods, these faded filaments
was denied 34. might someday provide a more easily obtainable
Minister Zdrojewski and Director Michalski source of information. This might be especially
concluded, “This was neither the time to give important if the world remains squeamish
approval, nor was it justified”. Michalski fur- about exposing his heart.
ther stated, “the dominant view is the proposed During his entire lifetime, Chopin gave only
research is going to serve first and foremost to 30 public performances. Of his nearly 170 com-
satisfy the curiosity of the project’s authors” positions, almost all of them are exclusively for
while offering no “new knowledge that would the piano. Chopin performed his own works in
have a meaningful impact on the assessment of concert halls but most often in his own salon
the figure and work of Chopin.” for friends. The intimate setting of these per-
There is no easy way of finding out F. Chopin’s formances is essential for Chopin’s music. He
final diagnosis. Even genetic analysis of DNA loved sad melodies, particularly the singing-
from Chopin’s tissue could lead us into deceptive like. Chopin was lauded for his ability to in-
assumptions, unless two CFTR mutations were fuse traditional forms like the sonata and the
found. prelude with intimacy and emotional intensity.
The cystic fibrosis hypothesis remains alive But Chopin’s own virtuoso piano perfor-
and still possible when one learns of the more mances are nearly as great a part of his legacy
recent discovery that adult forms of the disease as his compositions. “Listen to Chopin play!”
308 Revista Americana de Medicina Respiratoria Vol 14 Nº 3 - Septiembre 2014
wrote the music periodical Le Ménestral in The Polonaise in Ab major, Op. 53, posthumous-
1848, “It is like the sighing of a flower, the ly nicknamed Heroique, is a work for piano written
whisper of the clouds, or the murmur of the by Chopin in 1842 and dedicated to Auguste Léo.
stars”. Chopin’s performances were unique; his This is one of his most admired works and has long
virtuosity and inspiration astounded all who been a favorite of the classical piano repertoire. It
heard him play, especially his fellow musicians. requires exceptional piano skills and great virtuos-
As a pianist Chopin’s style was unique with a ity to be interpreted at a high degree of proficiency.
peculiar harmony between his frail physique The Heroique nickname seems to have originated
and his playing style, generally fluent, sweet with Chopin’s companion, George Sand, who
and unforced. Chopin’s elastic hand, small, suggested that the piece be a symbol of the 1848
thin, with lightly articulated fingers, was ca- Revolution because of its heroic character36.
pable of stretching tenths with ease 36. Stephen Chopin’s cello sonata, Op. 65, was his last major
Heller said that “it was a wonderful sight to see work He worked on it through 1845 and well into
Chopin’s small hands expand and cover a third 1846, sketching and drafting as he had not done
of the keyboard. It was like the opening mouth before, and Extant sketches show that Chopin did
of a serpent about to swallow a rabbit whole.” indeed discard an incredible amount of material
Chopin’s style and gifts became increasingly and redrafted most of his ideas before deciding on
influential: Schumann and Liszt, were great the final form of the work. The piece was printed in
admirers of the composer. Liszt transcribed Paris in 1847. Chopin and Franchomme premiered
six of Chopin’s songs for piano and dedicated the sonata in Paris to great acclaim, in what was to
a movement of his “Harmonies Poétiques et be the last performance of Chopin’s career.
Religieuses” to Chopin. Despite Liszt denied Work on the G minor Sonata took up the au-
it had been inspired by Chopin’s death, the tumn days of 1846 at Nohant. It was work filled
mid-section recalls powerfully the famous oc- with doubts and hesitation, difficult decisions
tave trio section of Chopin’s Polonaise, op. 53. and arduous labours. Those labours are attested
Opera had a major influence on Chopin’s com- by almost two hundred pages of sketches for this
positions, many of his pieces often rely on an work, not counting the thirty-page manuscript.
intense and personalized chromaticism, as well It was not until the summer of 1847 that Cho-
as a melodic curve familiar to the operas of Cho- pin considered work on the G minor Sonata to
pin’s times, mainly those by Rossini, Gaetano be completed. In June, he sold the work to the
Donizetti, and especially Bellini. Chopin used Leipzig publisher Breitkopf. As a result, in July,
the piano to re-create the gracefulness of the he was able to inform his nearest and dearest in
singing voice, and talked and wrote constantly Warsaw that ‘as regards my music, I shall now
about singers. be printing my Sonata with cello… he final deci-
Although Chopin’s musical style changed sions concerning the shape and expression of the
remarkably little over his years, his later works G minor Sonata –an unquestionable masterwork,
displayed less of the showy brilliance of his a pinnacle of the last (post-Romantic) phase in
youth and came to possess a more contempla- the Chopin oeuvre– matured in the atmosphere
tive character. This melancholic tinge, although of his split with George Sand and the incidents
certainly apparent in his earliest works, would connected with the marriage of her daughter.
become increasingly common in those written Chopin’s post-romanticism brought a foretaste
later in his life. Ten years prior to his death, of the style that would come to prominence dur-
he would write to a friend to say “It would be ing the second half of the century, in the music
good if I could still have a few years of big, of Brahms and Tchaikovsky, Dvorák ŭ and Franck,
completed work”. Fortunately, he did and was Grieg and Mahler. In Chopin, it manifested itself
able to crank out such gems as the lovely Bar- as a new style. His previous style –the quintes-
carolle, the Berceuse, the Sonata for Cello and sential Chopin– could be found in the ballades,
Piano, his major Sonata, Op. 58, the brilliant scherzos and nocturnes, in the two great sonatas
Polonaise, Op. 53, the meandering Polonaise- (the B flat minor and the B minor), in the War-
Fantasie, an interestingly introspective scher- saw concertos and the Parisian mazurkas and
zo, the Ballade N° 4 and many others 37. polonaises.
La enfermedad de Chopin 309
How much did Chopin’s illness influence the 16. Jordan R. George Sand: A Biographical Portrait .New York:
Taplinger Publishing Company, 1976.
transition of this style? Would his music have
17. Liszt, Franz. Life of Chopin. New York: Oliver Ditson
been different had his disease not treated him so Company, 4’ ed.
cruelly? We will never know. He was undoubtedly 18. Hedley A. Selected Correspondence Of Fryderyk Chopin.
an example of the ability that an unbreakable London: Heinemann Publishers, 1962. En: https://archive.
passion has to overcome such a devastating illness org/details/selectedcorrespo002644mbp
19. Leigh F. Fryderyc-Francois Chopin (1810-1849): Music and
like the one Chopin suffered through in his short malady. J Med Biogr 2013.
life. Neither the genetic mutations (if there were 20. Davila J. Étude de la maladie de Chopin À traverse sa
any), the extreme weakness, the hemoptysis nor correspondance. Université Paul-Sabatier-Toulouse III,
the dyspnoea prevented him from creating some Faculty de Medicine, 95-Tou 3-1084:79-82; Bibliotèque
Polonaise, Paris.
of the most exquisite compositions in the history 21. Opienski H. 1988. Frédéric Chopin: Chopin’s letters. Repr.
of music. His illness is still a mystery, but his art New York: Dover Publications.
is and will always be one of the most refined and 22. Lagerberg S. Chopin’s Heart: The Quest to Identify the
magnificent expressions of human talent. Mysterious Illness of the World’s Most Beloved Composer.
CreateSpace Independent Publishing Platform, 2011.
Acknowledgements: The authors thank Master 23. Karasowski M. Life and letters of Chopin. London: William
Edgardo Cianciaroso (Instituto Universitario Nacional de Reevers Publisher, 1879.
Arte, Buenos Aires) and Dr. Hernan Rowensztein (Hospital 24. Zamoyski A. Chopin. Prince of the Romantics. London:
Garrahan, Buenos Aires) for his valuable comments and HarperPress, 2010.
suggestions in the writing of this manuscript. 25. Carter ER. Chopin’s malady. Chest 1998;114:655-656.
26. Majka L, Gozdziké J, Witt M. Cystic fibrosis-a probable cause
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