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Two different strands of hair taken from Beethoven’s head after his death were examined for heavy metals using scanning electron microscopy (SEM) and laser ablation-ICP-MS (inductively coupled plasma–mass spectroscopy). The results revealed the presence of small lead particles on the surface of Beethoven’s hairs and fluctuating lead levels in hair medulla along the length of the hair due to alternating lead exposure, with an average lead exposure of 100 times the normal value. The time-line attached to the peaks of these fluctuating values correlate with the pneumonia treatment and the paracenteses performed, including the subsequent treatment of the procedure wounds. While the administration of lead-containing drugs and treatments had been proven to resolve the pneumonia, it had simultaneously caused massive liver failure, accelerated by pre-existing cirrhosis. The question as to whether Beethoven’s death was a case of malpractice can only be answered from a forensic point of view ex ante, since the state of the medical knowledge of the time has to be taken into account.