1827年3月27日，兩位醫生 Dr. Johann Wagner 和 Dr. Karl von Rokitansky 在宿舍裡做了屍體解剖。以下為英文版摘錄:
"The cadaver, and especially the limbs, were very wasted and covered with black petechiae; the abdomen was very much swollen and tense with water...
The thoracic cavity and its contents were normal... The abdominal cavity contained four mass (8 liters) of turbid grayish brown fluid. The liver appeared shrunken to half its size, leathery in consistency and grayish-blue in color; its tuberculated superficial surface and its cut surface was full of knotted masses of the size of a bean; all the vessels were very contracted; thickened and devoid of blood.
The bile was a darkish-brown fluid in containing a gritty sediment, the spleen was twice its normal size, blackish in color, and tough; similarly the pancreas was large and firm, and its duct the width of a grey quill. The stomach and intestines were distended with gas.
Both kidneys were contained in a cellular membrane, one inch in thickness, dripping a turbid brownish fluid, its structure was loose, and pale red in colors; each calyx contained a chalky deposit wart-like in shape, and similar to a pea cut across.
The facial nerves were of considerable thickness. The auditory nerves on the other hand seemed shrunken and without pith; accompanying arteries were of the caliber of a crow-quill, and cartilaginous consistency. The left auditory nerve, much the thinner arose by three very thin, grayish roots; the right by one root, stronger and pale white; the superficial substance, surrounding the fourth ventricle was much denser in consistency and more vascular than the nerves which arose from it. The brain was softer and more watery than the normal, and the convolutions appeared to be twice as deep and more numerous than usual. The vault of the skull was markedly and uniformly dense and about half an inch thick.
不請自來。
我是一個貝多芬的小粉絲，本職是西醫。對於貝多芬的耳聾和死亡做過一些調查。我們雖然有很多手稿提到了貝多芬生前各種各樣的身體問題，也有他死後的解剖結果，但由於當時醫療條件不允許更深入的調查，所以他的具體死因並不清楚。現在咱們先看看所知，然後試著去得出合理的解釋。
貝多芬生於1770年。小時候應該得過天花，因為我們透過留下的繪像和模子可以看出他臉上有著深深的疤痕。1787年得過呼吸道感染。1792年，他22歲那年，他第一次抱怨腹痛和拉稀。而在此後的三十年裡，他將患有長期的腹痛和拉稀，但是根據記載並沒有拉血的現象。在信裡面他只是說腸胃不好。腹痛有時會也很嚴重，影響他的正常運作。根據這些信件，他的腸胃病和關節炎是連在一起，差不多同時發作的。發作起來可以持續一個半月。
1821年出過黃疸病。1823年得了眼疾，並且會時不時發作。1825年會時常流鼻血還有吐血。
26歲開始耳聾，48歲完全失聰。晚年還有精神紊亂的現象。
1826年九月他去見他的兄弟。在那裡的時候就已經很不舒服了: 厭食，飢渴，拉稀，體重減少，雙腳浮腫，腹部腫脹。同年12月1日最後一次生病，病了四個月。發燒，發寒，飢渴，腹痛，呼吸不暢。12月9日開始嘔吐，腳腫，次日開始面部發黃，肝部有硬塊。從那以後，他開始少尿，腹部水腫，死前腹部積水取了四次，每次都只得到短暫的緩解。
1827年3月27日，兩位醫生 Dr. Johann Wagner 和 Dr. Karl von Rokitansky 在宿舍裡做了屍體解剖。以下為英文版摘錄:
"The cadaver, and especially the limbs, were very wasted and covered with black petechiae; the abdomen was very much swollen and tense with water...
The thoracic cavity and its contents were normal... The abdominal cavity contained four mass (8 liters) of turbid grayish brown fluid. The liver appeared shrunken to half its size, leathery in consistency and grayish-blue in color; its tuberculated superficial surface and its cut surface was full of knotted masses of the size of a bean; all the vessels were very contracted; thickened and devoid of blood.
The bile was a darkish-brown fluid in containing a gritty sediment, the spleen was twice its normal size, blackish in color, and tough; similarly the pancreas was large and firm, and its duct the width of a grey quill. The stomach and intestines were distended with gas.
Both kidneys were contained in a cellular membrane, one inch in thickness, dripping a turbid brownish fluid, its structure was loose, and pale red in colors; each calyx contained a chalky deposit wart-like in shape, and similar to a pea cut across.
The facial nerves were of considerable thickness. The auditory nerves on the other hand seemed shrunken and without pith; accompanying arteries were of the caliber of a crow-quill, and cartilaginous consistency. The left auditory nerve, much the thinner arose by three very thin, grayish roots; the right by one root, stronger and pale white; the superficial substance, surrounding the fourth ventricle was much denser in consistency and more vascular than the nerves which arose from it. The brain was softer and more watery than the normal, and the convolutions appeared to be twice as deep and more numerous than usual. The vault of the skull was markedly and uniformly dense and about half an inch thick.
所以看得出來，貝多芬的病症不止一個系統。多年來也有不同的專科醫生試著做出診斷。我所見到的就包含腸胃科，耳鼻喉科，腎科，傳染病科，免疫系統科，精神科。得到的答案可以按照專科來分配:
肝硬化，並在死前造成肝腎綜合症。同時腹部積水和酸鹼失調造成呼吸困難。最後造成昏迷。肝腎衰竭應該是直接的致死原因。
長期的胰炎，也許胰不足最終導致了急性糖尿病。
Paget"s disease 佩吉特氏病，解釋他的頭骨骨質增生。
鉛中毒， 頭髮樣本檢測出來。不是短時間內突發性中毒，而是長時間低量中毒，造成的耳神經退化。應該來自於貝多芬愛喝的葡萄酒。釀酒過程中有鉛汙染，造成長時間服食性中毒。
因為貝多芬還有面板病，腸胃炎，關節炎，眼疾，在近三十年內不少人認為他患有綜合症，自身免疫病如紅斑狼瘡，肉狀瘤病，也有人認為是得了感染了 Tropheryma whippelli 而得的惠普爾氏病，造成吸收不良和各種眼疾。
在我看來，他的病症最終在於肝硬化。按照留下來的資料看，貝多芬當然喝酒，但並不算是酒鬼。他愛喝的是度量較低的英國葡萄酒，而且不常喝醉，所以也許他的酗酒傷脾，但就此造成肝硬化也是頗受質疑的。
我覺得很有可能的是他有遺傳的原發性鐵過剩 (Hemochromatosis). 鐵吸收不良讓鐵存留肝內。有這種病的人一定要保護肝臟，不能喝酒，更遑論鉛中毒。幾個原因加在一起造成了肝硬化和肝腎併發症。
腸胃和面板關節併發症很容易讓人懷疑某種自身免疫症，只不過自身免疫腸胃病會造成便血，但貝多芬的記載裡缺乏便血的描寫。
還有一種是 Primary biliary cirrhosis, 原發性膽汁性肝硬化，但這種病多見於女子，而且一般來說存活不到五十歲。
總而言之，貝多芬的死亡的確是個謎。但一個說法流傳甚廣卻缺乏根據，就是梅毒。我們現在來聊聊，為什麼梅毒的機率很小。
頭髮和骨頭沒有查出汞中毒的跡象。而汞，是治療梅毒的主要藥品。但是貝多芬應該是嘗試過汞治療的，因為當時醫生們差不多用汞去治療任何病症，包括貝多芬的耳聾。但顯然這個方子無效，所以沒有長期服用。
還有，梅毒發病分做三期。前期症狀只是長無痛的痔瘡，會自動消亡。二期會在掌上起疹子。而如若未能及時治療，久而久之會破壞神經系統，在多年後造成失聰，痴呆， 瘋迷。尼采晚年的症狀就符合梅毒晚期。失聰屬於梅毒晚期，但貝多芬經過了三十年才完全變聾，而且沒有類似的痴呆症狀，反而在病逝前六個月還在作曲。完全不符合梅毒症狀。再說了，梅毒雖然能夠造成眼疾和面板病，但不能解釋最為致命的肝硬化，所以這種說法已在我找到的近二十年的醫學文章裡看不到了。
從他的私人生活上來看，做為當時的知名人物，他的緋聞很少了。只讀到說一個大提琴手傳言看到貝多芬和一名妓女坐在一起，還有傳聞說他的朋友會把他灌醉了帶到紅燈區。貝多芬是個人，我不想說他肯定自律檢點從未放縱自己。但我們也知道他的唯一的歌劇描繪了他心中的女神形象，忠貞，堅韌，愛好公義，充滿智慧，不懼死亡。而且，當貝多芬瞭解到他一個朋友染指人妻的時候，毅然與那個朋友絕交。再有，他曾經為了唐璜而吐槽莫扎特 - 居然以這樣道德敗壞死不悔改的人物做主角 (雖然他還是愛唐璜的音樂愛到痴迷)。所以貝多芬會不會私德敗壞而感染梅毒也頗受爭議。
還有傳言說母體梅毒感染。好像也沒什麼根據。貝多芬的母親是早早結婚生子，早早喪夫喪子，再嫁給貝多芬之父的。又為他生了好幾個孩子，但大多早夭，存活下來年紀最長的就是貝多芬。丈夫是酒鬼，對她不好，但從留下來的記錄看，她忍氣吞聲不苟言笑。貝多芬稱她是自己最好的朋友，值得敬重的人。貝多芬後面的一個弟弟活得還挺久。若說梅毒感染，這又怎麼解釋?
貝多芬的母親四十歲左右死於肺結核，沒有梅毒的跡象。
我其實就想說他應該不是死於梅毒。