Mai's experience as a physician and psychiatrist serves as a basis for his analysis. Working from the symptoms described in the medical evidence, Beethoven's letters and those of his friends, and the reports of his physicians, Mai compares how Beethoven's health complaints would have been understood and treated within the medical, political, and social climate of both his time and ours. He discusses Beethoven's terminal illness and the resulting autopsy report to consider the roles of alcohol, lead poisoning (based on the toxic levels in his hair), and syphilis in causing his death.