When Beethoven entered his thirtieth year, he began to suffer from an annoying roaring and buzzing in both ears. Soon his hearing began to fail and, for all he often would enjoy untroubled intervals lasting for months at a time, his disability finally ended in complete deafness. All the resources of the physician's art were useless. At about the same time Beethoven noticed that his digestion began to suffer. ...

At no time accustomed to taking medical advice seriously, he began to develop a liking for spirituous beverages, in order to stimulate his decreasing appetite and to aid his stomachic weakness by excessive use of strong punch and iced drinks. ... He contracted a severe inflammation of the intestines which, though it yielded to treatment, later on often gave rise to intestinal pains and aching colics and which, in part, must have favored the eventual development of his mortal illness. --Andreas Wawruch, physician attending Beethoven's final illness, 1827

My hearing has become weaker during the last three years. Frank wished to restore me to health by means of strengthening medicines, and to cure my deafness by means of oil of almonds, but, prosit! nothing came of these remedies; my hearing became worse and worse. ... Then an Asinus of a doctor advised cold baths, a more skillful one, the usual tepid Danube baths. These worked wonders; but my deafness remained or became worse. This winter I was truly miserable; I had terrible attacks of Kolik, and I fell quite back into my former state. --Beethoven to Franz Wegeler, 1801

For the last six years I have been afflicted with an incurable complaint, made worse by incompetent doctors. From year to year my hopes of being cured have gradually been shattered ... I must live like an outcast; if I appear in company, I am overcome by a burning anxiety, a fear that I am running the risk of letting people notice my condition. ... How humiliated I have felt if somebody standing beside me heard the sound of a flute in the distance and I heard nothing. ... I have such a sensitive body that any sudden change can plunge me from the best spirits into the worst of humors. ... When I am dead, request on my behalf Professor Schmidt, if he is still living, to describe my disease, and attach this written document to his record, so that after my death at any rate the world and I may be reconciled. ... --Beethoven to brothers Karl and Johann, 1802 (Heiligenstadt Testament)

Medical science is divided as to whether Beethoven's deafness was due to direct damage to the auditory nerve (sensori-neural deafness) or to thickening and fixation of the bones which conduct sound through the middle ear (otosclerosis). ... Otosclerosis is the commonest cause of deafness in a man of twenty-eight years, but the high-frequency hearing loss described by Beethoven is not typical of the condition and makes the diagnosis doubtful. ... Johann Wagner in his autopsy report identified the auditory nerves; he clearly thought they were implicated in the pathological process. The appearance of the auditory arteries seems more typical of atherosclerosis (hardening of the arteries) than of endarteritis obliterans, which would have been seen in a chronic inflammatory condition such as syphilis. --John O'Shea, Was Mozart Poisoned? Medical Investigations into the Lives of the Great Composers, 1991

According to Huttenbrenner, who was in the room, there was a sudden flash of lightning which garishly illuminated the death-chamber--snow lay outside--and a violent thunderclap. At this startling, aweful peal of thunder, the dying man suddenly raised his head and stretched out his right arm majestically, 'like a general giving orders to an army.' This was but for an instant; the arm sank down; he fell back. Beethoven was dead. --A. W. Thayer, Life of Beethoven, 1866

The story of Beethoven apparently 'shaking his fist at the heavens' in one final act of defiance before oblivion has been dismissed as a romantic fiction by most Beethoven biographers. Surprisingly, it is an accurate clinical observation: people who die of hepatic failure often react in an exaggerated way to sudden stimuli such as bright light. This is due to the accumulation of toxic waste products normally excreted by the liver. Beethoven's gesture may be seen as having been due to the cerebral irritation which accompanies hepatic failure, not as a conscious act.

The cause of Beethoven's death--liver failure due to cirrhosis--was confirmed by the autopsy performed by Johann Wagner and Karl von Rokitansky. ... The essential feature was macronodular cirrhosis of long standing with concomitant portal hypertension. Macronodular cirrhosis is less common than micronodular cirrhosis in alcoholic liver disease but certainly occurs frequently. ... Chronic active hepatitis due to viral or auto-immune disease is a possibility, but it is not necessary to invoke this as an explanation in a patient known to have been drinking heavily over a thirty-year period. --O'Shea, 1991

Beethoven's was a long-term hepatitis, as the history from 1821 shows, which had flared up after the exposure during the journey from Gneixendorf. Such a chronic active hepatitis associated with colitis, rheumatism, repeated catarrhs, abscesses, cryopathy (attacks precipitated by chilling), the ophthalmia, and the skin disorder are extremely suggestive of connective tissue immunopathy [auto-immune disease]: such a diagnosis explains all his numerous illnesses. Arterial disease is constant in immunopathy; the atrophy of the auditory nerves could be due to arterial disease. --Edward Larkin, Beethoven's Medical History, 1970

Beethoven once had a terrible Typhus [fever with clouding of the mind]. From this time on dated the ruin of his nervous system and probably the ruin of his hearing, so calamitous in his case. --Aloys Weissenbach, surgeon and Beethoven's friend, 1820

Beethoven may well have had the specific form of immunopathic disease known as Systemic Lupus Erythematosus, which typically commences in early adult life with a fever accompanied by mental confusion. Typical symptoms are destructive rash ('lupus') and redness ('erythema') of the butterfly area of the face. Any of the immunopathic disorders may occur, notably colitis. The excellent life-mask of 1812 shows an elongated atrophic scar particularly suggestive of Lupus. The portraits clearly show flushing of the cheekbones and nose. Beethoven's high color was frequently commented on and may have aroused suspicions of heavy drinking. --Larkin, 1970