His primary physician in the years before his death was Dr. Andreas Wawruch, an internist at the Vienna General Hospital who took over Beethoven’s care in December 1826, when the composer’s final illness began in earnest. Wawruch’s account of Beethoven’s last months, written after the composer’s death, describes in clinical detail the progression of the illness: the ascites that required repeated drainage, the jaundice, the progressive weakness, the four surgical punctures of the abdomen that temporarily relieved the fluid accumulation. Wawruch attributed Beethoven’s condition to liver disease and to the effects of his alcohol consumption, a conclusion that aligns with the 2023 genomic study’s findings.
The autopsy, conducted on March 27, 1827—the day after Beethoven’s death—was performed by Dr. Johann Wagner, who was then a prosector at the Vienna General Hospital. Wagner’s report described abnormalities in multiple organ systems, with the most severe changes in the liver, which he described as shrunken and hardened—the characteristic appearance of advanced cirrhosis. The auditory nerves, which Wagner also examined, showed unusual features that have since been interpreted as consistent with several different diagnoses.
The autopsy report is the primary clinical document that anchors the modern understanding of Beethoven’s final illness. It does not, on its own, resolve every question about what caused the liver disease or what caused the hearing loss—those are causal questions that an autopsy description of tissue appearance can inform but cannot definitively answer. But it provides a contemporaneous record of the biological state of Beethoven’s body at the time of his death, and it has been the basis for most subsequent medical historical analysis.