Was Beethoven Lead-Poisoned?

Introduction During the past several years, numerous reports have appeared in the popular media claiming that Beethoven suffered from lead disease. That claim was based on the analysis of hairs from Beethoven's head, hairs that several of his admirers had collected as mementos of the great man shortly after his death. In at least one instance is the provenance of such hairs is well established and documented.1 The initial repon stated that Beethoven's hair contained high levels of lead, but scant quantitative information was provided at that time or subsequendy; nor have the results of these hair analyses appeared in the professional literature to date.2 The colossal publicity that Beethoven's purported lead-poisoning received in the press and other media seems out of proportion to the sparse evidence on which these reports were based, evidence which, until recently, has received little scrutiny.3 Last year Dr. Christian Reiter reported the results of a different type of analysis of Beethoven's hair and his study has renewed speculation, not only regarding Beethoven's lead disease, but also regarding the cause of his death.4 Dr. Reiter did not determine the lead content of Beethoven's hair, as had been attempted earlier but measured the distribution of lead (Pb) along an individual hair. He interpreted this longitudinal Pb concentration profile as a temporal record of lead exposure during the last three months of Beethoven's life. Dr. Reiter relates the dates of five peaks of the Pb profile to the dates of five medical interventions that might have exposed Beethoven to lead and concludes that Dr. Andreas Wawruch, his physician, had inadvertently lead-poisoned him and was responsible for his death. Before reviewing Dr. Reiters experiment and analysis, some general comments regarding the use of hair as an indicator of lead exposure are in order. Ever since the dangers of ingesting lead became widely recognized, physicians and public health authorities have searched for reliable diagnostic indicaron (biomarkers) of the severity of a person's lead exposure. Today the most widely used indicator is the level of lead in blood (blood-Pb), although others are also used, including the levels of metabolites induced by lead exposure and the level of lead stored in bone (bone-Pb), which can be measured non-invasiveh/.5 At first sight, the lead content of hair (hair-Pb) might represent a more convenient, less intrusive, and cheaper alternative to these methods, and consequently many investigatore have studied and tested die effectiveness of hair-Pb as a biomarker.6 Most recently, a panel of experts, convened by the U.S. Center for Disease Control examined the reliability of this approach and concluded that hair-Pb is an ineffective biomarker.7 Among the reasons given were the great variability among hair specimens from the same head, the inconsistency of assays performed by different laboratories, and the impossibility of distinguishing between endogenous and externally adherent lead.8 Hair-Pb was consequently not recommended as an indicator and there exist no established protocols that relate hair-Pb levels to blood-Pb levels or to other indicators, or indeed, the symptoms of lead disease. Dr. Reiter's Experiment and Data Analysis In this section I will briefly describe the novel experimental method used by Dr. Reiter to obtain the Pb profile of an individual hair, before examining critically the assumptions underlying his data analysis and conclusion. Dr. Reiter obtained several hairs from Dr. Alfredo Guevara, Nogales, Arizona, who owns a portion of a well-authenticated lock of Beethoven's hair. A narrow laser beam at right angles to a 4 cm. long hair was used to vaporize the hair along its length, and the lead concentration in the resultant vapor was determined by means of a mass spectrometer. The data allowed Dr. Reiter to obtain the Pb concentration profile of the hair along its length. …