Yet it is better and more advisable not to lose confidence in the physician, for after all he has done a great deal.—It is a very well-known fact that dropsy is very slow of cure.—Shall I come when the doctor is here?
A few days later (January 8, says Schindler, who was present) the second operation took place. There were no complications, the tapping was accomplished without difficulty and Dr. Seibert reported that the water was clearer and the outflow greater than the first time. Ten measures were drawn off. On January 11 there was a consultation of physicians to which, besides either Dr. Braunhofer or Staudenheimer, Dr. Malfatti had been called. It had become an ardent wish of Beethoven’s that Malfatti undertake his case, but Malfatti had refused, pleading professional ethics, but no doubt actuated by reasons of a more personal character. Many years before, probably as early as 1813, he had been not only Beethoven’s physician but also his friend; indeed, he was an uncle of the Therese Malfatti to whom the composer once made an offer of marriage. He made, what it is easy to imagine to have been, the experience of all the medical men who undertook the care of the great man. Beethoven was ever a disobedient and impatient patient. He became dissatisfied with Dr. Malfatti’s treatment and commented upon it and him in such a manner as to cause a serious and lasting estrangement. Ten years at least had elapsed between this incident and the time when Beethoven’s longing went out towards his one-time professional friend. Schindler’s story of the disappointments which he suffered when first he tried to persuade Dr. Malfatti to take the case in hand was printed in the “Frankfurter Konversationsblatt” of July 14, 1842. It was a long time afterward, and we can not withhold a suspicion that it is rather highly colored, but since the coming of Malfatti was a matter of large moment to Beethoven and the treatment which he recommended (strictly speaking, he can not be said to have prescribed it, for Dr. Wawruch remained in charge of the case to the end) has a large bearing upon Beethoven’s physical condition and its causes, it may be told here. Schindler writes, in his communication to the Frankfort newspaper:
Never shall I forget the harsh words of that man which he commissioned me to bear to the friend and teacher who lay mortally ill, when after the second operation (January 8) I repeatedly carried to him the urgent requests of Beethoven that he come to his help or he should die. Dr. Wawruch did not know his constitution, was ruining him with too much medicine. He had already been compelled to empty 75 bottles, without counting various powders, he had no confidence in this physician, etc. To all of these representations Malfatti answered me coldly and drily: “Say to Beethoven that he, as a master of harmony, must know that I must also live in harmony with my colleagues.” Beethoven wept bitter tears when I brought him this reply, which, hard as it was, I had to do, so that he might no longer look for help to that quarter.... Though Malfatti finally took pity on poor Beethoven and abolished Wawruch’s medicine bottles at once and prescribed an entirely different course of treatment, despite the pleadings of the patient he refused to remain his ordinarius and visit him often. On the contrary, he came only at long intervals and contented himself with occasional reports from me as to the sick man’s condition. He was not willing even to send one of his assistants to Beethoven and consequently Dr. Wawruch remained his daily visitor in spite of Beethoven’s protests.
Reconciliation with Dr. Malfatti
On January 19, after a second visit to Dr. Malfatti, Schindler wrote to Beethoven saying that the Doctor would come to him and begging him to seek a reconciliation, inasmuch as Malfatti still cherished resentment because of the treatment which he had received a decade before at Beethoven’s hands. Malfatti came, a reconciliation was effected, and under the inspiration of the changed treatment which Malfatti introduced Beethoven’s spirits rose buoyantly, his physical condition responded and the despair which had begun to fill the sufferer gave way to a confident hope of recovery. The treatment was simple, but the improvement which it brought about was not lasting. Malfatti put away the drugs and decoctions and prescribed frozen punch, and rubbing the patient’s abdomen with ice-cold water. Dr. Wawruch in his history of the case confirms Schindler’s statement of the beneficial results which were at first attained. He says:
Then Dr. Malfatti, who thenceforth supported me with his advice, and who, as a friend of Beethoven of long years’ standing understood his predominant inclination for spirituous liquors, hit upon the notion of administering frozen punch. I must confess that the treatment produced excellent effects for a few days at least. Beethoven felt himself so refreshed by the ice with its alcoholic contents that already in the first night he slept quietly throughout the night and began to perspire profusely. He grew cheerful and was full of witty conceits and even dreamed of being able to complete the oratorio “Saul and David”[168] which he had begun. But this joy, as was to have been foreseen, did not last long. He began to abuse the prescription and applied himself right bravely to the frozen punch. The spirits soon caused a violent pressure of the blood upon the brain, he grew soporous, breathed stertorously like an intoxicated person, began to wander in his speech, and a few times inflammatory pains in the throat were paired with hoarseness and even aphony. He became more unruly and when, because of the cooling of the bowels, colic and diarrhœa resulted, it was high time to deprive him of this precious refreshment.
Wawruch’s remark here about Beethoven’s predilection for spirituous liquors formed the basis for Schindler’s charge, which has already been discussed, that the physician had slandered Beethoven and had tried to create the impression that he had contracted dropsy by inordinate use of alcoholic drinks. The account of the beneficial effect of Malfatti’s coming, no less than the treatment which he prescribed, is reasonable enough. Beethoven no doubt, in the warm glow of a recovered friendship, gave the physician a full measure of confidence and hailed in him much more than the ordinary professional leech. It is also safe to assume that Malfatti knew from the beginning that a cure was impossible and strove at once for temporary relief, which in Beethoven’s case was the surest of means for cheering him up and reanimating hope within him. By administering frozen punch he stimulated the jaded organs more successfully than Wawruch had succeeded in doing; at the same time he warned against excess in its use and forbade the patient taking it in a liquid form. But this was only at the beginning; when he saw the inevitable end approaching he waived all injunctions as to quantity. Schindler says:
The quantity of frozen punch permitted in the first weeks was not more than one glass a day. Not until after the fourth operation (February 27th), when it was seen that the case was hopeless, were all restrictions removed. The noble patient, feeling the marked effects of a doubled and even trebled allowance meanwhile, thought himself already half saved and wanted to work on his tenth symphony, which he was allowed to do to a small extent. From these days, so extraordinary in the sight of the friends who surrounded him, the last lines are dated which he wrote to me on March 17—nine days before his death—the very last page which the immortal master wrote with his own hands:
“Miracles! Miracles! Miracles! The highly learned gentlemen are both defeated! Only through Malfatti’s science shall I be saved. It is necessary that you come to me for a moment this forenoon.”
The reiteration of the word “miracles” is indicated by the usual musical sign of repetition 𝄎. There is no date in Beethoven’s handwriting, but Schindler has endorsed it: “Beethoven’s last lines to Schindler on March 17, 1827.” The endorsement is of a later date and marks another obvious error of memory. It is not possible that Beethoven wrote the letter after he had himself abandoned all hope of recovery, as he had before the date affixed by Schindler. Most obviously the pathetic document is an outburst of jubilation on feeling the exhilaration consequent on Malfatti’s prescription, as mentioned in Dr. Wawruch’s report. Schindler says that the “learned gentlemen” referred to were Wawruch and Seibert. Wawruch says that Beethoven abandoned hope after the fourth tapping; Johann van Beethoven records that the physicians declared him lost on March 16. Schindler in his biography describes a letter written in February as the last letter actually written by the composer.