Puccini was a heavy smoker of cigarettes and cigars. In February 1924, while composing his last opera Turandot in Viareggio, he began to suffer from sore throat, and in March it developed with cough and hoarseness. The previous summer, while touring the Europe with his son Antonio (Tonio), Puccini accidentally swallowed a goose’s bone in Ingolstadt, that was promptly removed from his hypopharynx. So, initially his problem was thought to be related with that accident.
But the sore throat persisted, and Puccini, suggested by his doctor Prof. Vivi of Milan, decided to consult several physicians that prescribed some useless remedies: mouthwashes, milk and honey, raw eggs. He was erroneously diagnosed with a rheumatic larynx disease by a doctor in Viareggio who told him “Nothing, nothing Maestro…Don’t worry: it’s a rheumatic form…Do some garglings, some painting…Here it is the prescription”. Prof. Domenico Tanturri from Naples suggested to undergo a thermal therapy, that Puccini effectively did in the last week of May at Grand Hotel des Thermes in Salsomaggiore, a health resort near Parma, where he met the italian royal family (the King suggested him to make garglings with water and salt). He wrote to a friend: “Salsomaggiore should be good for uterus, but I have sore throat”. On June 1 he wrote to his friend Sybil Seligman from there: “my throat is just the same — the cure hasn’t made any difference. They say I shall be better later — we’ll see”.
His sore throat eventually developed with earache, deglutition pain, weight loss and lumps in the neck that hindered the closure of his shirt collar.
Puccini, suggested by Prof. Bianchini, decided to consult Prof. Torrigiani and Prof. Toti. Camillo Arturo Torrigiani, an otolaryngologist in Florence, visited him on October 10 and diagnosed an advanced extrinsic cancer of the supraglottis, with the dimension of a walnut.
At that time, laryngeal cancers were classified as intrinsic or extrinsic. Intrinsic laryngeal cancers developed in the interior of the larynx, mostly benign, and with slow growth, spreading very gradually and only invading the glands in an advanced stage. Extrinsic cancers originated around the orifice of the larynx, or on its pharyngeal surface, and they were often malignant, with rapid invasion of the lymphatics at early stages. Extrinsic cancers were considered seldom operable, and complete laryngectomy unhelpful, leaving the patients to their destiny.
Torrigiani suggested Puccini to go to Berlin to Prof. Moss. Puccini contacted the italian embassy in Berlin: the ambassador’s counsellor Antonio Chiaramonte Bordonaro explained that Prof. Moss was no more in activity, having become blind.
On October 22 Puccini wrote to his librettist Giuseppe Adami: “What shall I tell you? I am going through a most terrible time. That trouble in my throat torments me more morally than physically. I am going to Brussels to consult a famous specialist. I am leaving soon. Will they operate on me? Shall I be cured? Shall I be condemned? I cannot go on like this any longer. And Turandot is there. Back from Brussels, I will get to work”.
On October 26, Puccini visited Celle, the small village of his ancestors, in province of Lucca, and he was welcomed with great honours.
On October 28, Puccini went back to Florence, to consult with Prof. Addeo Toti, from 1894 director of the otolaryngologist section of the hospital of S. Maria Nuova. Toti confirmed the laryngeal cancer diagnosis, and suggested Puccini to undergo a radium treatment at the Istituto Fototerapico in Florence, under the supervision of its director, Prof. Celso Pellizzari.
Puccini, suggested by Prof. Vivi, consulted another specialist, Prof. Giuseppe Gradenigo from the University of Naples.
On the same day he wrote to Carlo Clausetti, manager of Casa Ricordi: “My illness is papilloma, not serious, but you must get rid of it and soon; it is located under the epiglottis. I telegraphed to Prof. Gradenigo, I shall undergo surgery…with radium or X-rays, we’ll see the response from Gradenigo. About the location of radium application, Florence or Paris. Nice boredom! But at least now I know what it is my illness that worries and torments me since months”.
Puccini, while conscious of the seriousness of the illness, was not entirely made aware of his desperate condition. His mood was fluctuating from desperation to hope. Only Antonio was told the truth.
On October 29, Antonio consulted Prof. Toti to be updated on his father condition, and Toti told him: “do you know that your father has a riding cancer?”.
On November 2, Torrigiani examined Puccini again in his ambulatory, with Gradenigo and Toti. They performed a laryngeal biopsy and confirmed the clinical diagnosis of extrinsic cancer of the larynx.
Gradenigo then advised Puccini to consult his colleague, Prof. Louis Ledoux of Brussels, that used a combination of radium and surgery to treat laryngeal carcinomas. He told him “Not at all Florence! Go to Brussels. There radium does wonders. I will give you a letter for Prof. Ledoux. A little tumor, all will be gone”.
On the same day Arturo Toscanini, after the rehearsal of Arrigo Boito‘s Nerone in Bologna, was informed by Giovacchino Forzano (who had been notified about Puccini’s condition with a letter from his wife Teresa), while in his dressing room, that they should go to Viareggio to see Puccini the next day, before his travel to Bruxelles. Toscanini had a temper tantrum “To Puccini? Do I go to Puccini?”. Forzano explained him the reason and Toscanini was moved. “Yes, yes…tomorrow morning immediately…with your car, Forzano…but we should tell him why we come to him, we won’t be able to tell him the truth?”. “Maestro” replied Forzano “we will tell him that we came for the rehearsals of Turandot”. In that period Puccini and Toscanini were not in very good relationships, but once Toscanini learnt about his old friend’s condition, all the clouds disappeared.
On November 3, Forzano took his car and went to Viareggio with Toscanini at Puccini’s Villa in via Buonarroti, officially to discuss about Turandot, in order not to worry Puccini. Following Forzano’s account of the visit, Puccini was very happy to see Toscanini. He said “Arturo! Once back from Brussels I will soon finish the Turandot!”. He ignored the gravity of his illness and joked with Toscanini about the change of the voice that his condition has caused him. “Do you hear Arturo what a tenor voice?” and he was making vocalisms. Puccini showed a radio to Toscanini and Forzano and said: “Yesterday, there was a tenor, Arturo, singing from London, a stuff to revolver shoot him…let’s hear if there is something better today”. He turned the radio on and it was broadcasting Chopin‘s funeral march. Forzano recalls “I don’t know how we could withhold our torment”.
On the same day, Puccini wrote to Riccardo Schnabl: “Dear Riccardo, I leave for Brussels for radium therapy. I consulted with Torrigiani, Toti, Gradenigo came from Naples. They sent me to Brussels! I am seriously ill! You could figure my soul. I go with Tonio; Elvira is too in pieces to sustain the long travel. What miseries! And Turandot? Mah! Having not completed this opera aggrieves me. Will I recover? Will I be able to finish it on time? The opera poster is published yet”.
On November 4 Puccini left for Brussels with his son Antonio and the next day they were at the Radium Institute in Avenue de la Couronne, occupying adjoining rooms. His stepdaughter Fosca and his wife Elvira didn’t follow him, because of the bad health condition of his wife (she was suffering for bronchitis and went to Milan to be able to communicate faster with Puccini). Puccini took with him 36 pages of musical sketches for the finale of Turandot, hoping to make some progress with the opera.
Dr. Ledoux visited Puccini for an hour and a half, examined a piece of tissue taken from the lump in the larynx and then confirmed the diagnosis. He told Puccini’s son: “do you know you have conducted here a corpse and not a man? If only three months ago your father had been here, something probably useful could have been done…today an extirpation surgery is ruled out because your father would die under surgery”.
Puccini’s cancer was of invasive type (adenocarcinoma), too advanced and of vestibular form, with extralaryngeal type and metastasis nodes.
Sybil Seligman, although suffering for an acute sciatica, came to Brussels and wrote a very strong letter to Fosca, Puccini’s stepdaughter, urging her to come to her stepfather. Three days later Fosca came.
On November 7, Puccini started the therapy with Dr. Ledoux. He was treated with a collar containing radium some hours a day. Puccini wrote to Magrini: “I am crucified like Jesus! I have a collar around my throat that is like torture. External radium for now, and then they will put crystal needles into my neck and make a hole, again in my neck, so that I can breathe. Don’t tell that to Elvira, nor to anyone. This hole, with a rubber or silver tube in it, I don’t know yet, terrifies me. They assure me that I won’t suffer nothing, and I must do that to leave quiet the part that must be cured…so I will have to breathe from the tube. My God what an horror! I, after eight days, will resume breathing from the mouth. What an ordeal! God assist me. It’s a long treatment, six weeks, and it is terrible. They assure me that I will recover. I am a bit skeptical and my soul is prepared for all. Since the day of departure, my illness has worsened. I spit vivid and dark blood from the mouth at morning. But the doctor says it is nothing and I must be quiet because the treatment has started. We will see…”. Antonio washed Puccini’s handkerchiefs.
After each collar treatment, Puccini was free of movement; on November 8 he went with his son Antonio to the theatre Le Monnaie to see his Madama Butterfly, where he was recognised and acclaimed by the public. The italian ambassador Orsini-Baroni and the apostolic nuncio Clemente Micara went to see him in the clinic. The belgian royal family asked about his condition every morning.
On November 12, Antonio wrote to Clausetti: “The therapy has started this morning, with external applications of radium; it is a bit torture for dad, because he has the throat enclosed in a wax collar…but patience. Within 8 or 10 days internal application will start, that it seems won’t be painful. Dad’s moral is so so, certain moments very worried and a bit mopish. It grieves poor man. Let’s hope, let’s hope, the doctors do have hope!”. After this letter, Clausetti immediately took the train and came to Brussels.
After some treatment Puccini started to feel better, the bleeding stopped and he was allowed to smoke a few cigarettes.
On November 19, Puccini wrote to Angiolino Magrini: “same story. Bed, collar, inhalations, non appetite, three pillars in bed. On monday the bad starts. Let’s hope they will save me”.
Antonio was called by Dr. Ledoux that told him his father must undergo a surgery. Antonio shivered, Puccini agreed and at evening he wrote to Adami: “For now it is a bit bad the cure. External applications. But on monday God knows what they will do me to reach the interior, under the epiglottis. They assure that I will not suffer, and they also tell that I will recover. Now I start to hope. Days ago I had lost any hope of recovering. And what hours and what days! I am ready for all”.
On November 22, Antonio wrote to Magrini a telegram: “Monday surgery stop Possible complications stop Only way to save him from an atrocious end stop If possibile come here stop I hug you”.
On November 23 Puccini went to the cinema with Antonio, Fosca and Clausetti to watch an american movie.
On November 24 Puccini had the surgery. He was diabetic and at risk of postoperative infections. Dr. Ledoux inserted seven radioactive needles into the larynx. The operation lasted 3 hours and 40 minutes and was performed using local anesthesia with novocaine; general anesthesia was avoided, because of Puccini’s condition. A tracheotomy was carried out, and a nasogastric tube was inserted. Dr. Ledoux planned to leave in the radioactive needles for seven days. Puccini found the strength to rise from the stretcher and put himself to bed without assistance. He wrote: “I feel like I have bayonets in throat!”. Antonio wet his father’s lips with champagne. Antonio gave him a paper and a pencil and Puccini wrote: “Will I be saved?”. They all agreed that the worst was over and he would be saved.
Puccini’s friend Magrini wrote to his wife: “Now I know that the surgery was terrible, 10 centimetres gash in the throat, as you do with the lambs. They then rummaged inside to isolate the tumor, that is big as a walnut, and surrounded it with seven radiating platinum needles. And all this martyrdom for three hours and forty minutes, having administered him strong injections of morphine”.
On November 26 Clausetti wrote to Adami that they were optimistic about the recovery of Puccini and Dr. Ledoux publicly declared to the management of La Monnaie “Puccini s’en sortirà” (Puccini will recover).
On November 28 at 4pm, Fosca was writing a letter to Sybil Seligman, informing her that “Everything is going well and the doctors are more than satisfied; our adored dad is safe! Safe – do you understand? Certainly he has suffered a good deal, but from now on this terrible part of the cure is over, and he will only have to submit the boredom of convalescence”.
But the letter was never finished. At 6 pm Fosca went out of the room to find Sibyl’s address; in the meanwhile Puccini, sitting on the armchair, had a heart attack, and bleeding from the wound. Cardiac frequency raised from 60 to 105. Dr. Ledoux said “C’est le coeur qui ne resist pas” (it’s the heart that does not resist), made two injections, removed the radium needles from Puccini’s neck and, while driving to home, was so distressed by the tragic events occurred in the clinic that he killed a female pedestrian. During the night Puccini wrote “I am worse than yesterday, the hell in the throat – I feel vanishing – fresh water”.
Puccini spent a restless night. His breath came in gasps, he tossed incessantly, and he lost his patience when Antonio refused to go to bed. His hands were constantly moving.
The next morning at 7-8 am, Monsignor Micara was in the anteroom, called by Antonio that asked his father if he could admit him and ambassador Orsini-Baroni in the room. Puccini hailed yes, but only Micara entered and pronounced the last benediction, and the death agony began.
He wrote on a paper his last words for the wife: “Elvira poor woman over”. Puccini raised his hand as though to salute Antonio and Fosca and shortly after his head fell on its side. Puccini passed away. It was a sad rainy day, on November 29 at 11:30 am. Puccini was almost 66 years old. A national state of mourning was declared in Italy and the performance at La Scala canceled.
On December 1 there was a funeral ceremony in Brussels, which was followed on December 3 by a Mass at Milan Cathedral; on that occasion Toscanini conducted the orchestra and the La Scala choir and played the Requiem Mass from Puccini’s Edgar. Puccini was buried in the Toscanini’s family chapel, in the monumental cemetery of Milan, and then translated to his home at Torre del Lago on November 29 1926.
On April 25 1926, Turandot had its premiere at Teatro alla Scala in Milan. Toscanini stopped the performance where Puccini left his composition unfinished with the E♭ played by the Piccolo (after Liu’s funeral procession) and murmured to the public: “Here the opera ends, left unfinished for the death of the Maestro”. Then a deafening silence followed. From the public it was heard “Viva Puccini!”. The public stood up. Antonio and Fosca went on the stage and hugged Toscanini.
From the following replicas, Turandot was performed with the finale composed by Franco Alfano, which based his reconstruction on Puccini’s sketches and Toscanini’s advice, since the conductor had the occasion of discussing Turandot several times with Puccini and listened to it played at the piano by the composer.
 Adami G., Giacomo Puccini. Il romanzo della vita.
 Barigazzi G., La Scala racconta.
 Carter M., Puccini, a critical biography.
 Forzano G., Musicisti della mia vita – Italian television broadcast, RAI (1963).
 Gara E., Carteggi Pucciniani.
 La morte di Giacomo Puccini a Bruxelles, Corriere della Sera, November 30 1924.
 Phillips-Matz M. J., Puccini: A Biography.
 Seligman V., Puccini Among Friends.
 Specht R., Giacomo Puccini the man his life his work.