On ,Russia was still using old style dates in the 19th century, and information sources used in the article sometimes report dates as old style rather than new style. Dates in the article are taken verbatim from the source and therefore are in the same style as the source from which they come. nine days after the premiere of his Sixth Symphony, the Pathétique, Pyotr Ilyich Tchaikovsky died in Saint Petersburg, at the age of 53. The official cause of death was reported to be cholera, most probably contracted through drinking contaminated water several days earlier. This explanation was accepted by many biographers of the composer. However, even at the time of Tchaikovsky's death, there were many questions about this diagnosis.

The timeline between when Tchaikovsky drank unboiled water, how he obtained this at a reputable restaurant during a cholera epidemic with strict health regulations, and the emergence of symptoms was brought into question. While cholera infected all levels of Russian society, it was considered a disease of the lower classes. The resulting stigma from such a manner of death for Tchaikovsky was considerable, to the point where its possibility was inconceivable for many people. The accuracy of the medical reports from the two physicians who had treated Tchaikovsky was questioned. The handling of Tchaikovsky's corpse was also scrutinized as it was reportedly not in accordance with official regulations for victims of cholera. This was remarked upon by, among others, Nikolai Rimsky-Korsakov in his autobiography, though some editions censored this section.

Theories that Tchaikovsky's death was a suicide soon began to surface. Postulations ranged from reckless action on the composer's part to orders from Tsar Alexander III of Russia, with the reporters ranging from Tchaikovsky's family members to composer Alexander Glazunov. Since 1979, one variation of the theory has gained some ‌a sentence of suicide imposed in a "court of honor" by Tchaikovsky's fellow alumni of the Imperial School of Jurisprudence, as a censure of the composer's homosexuality. Nonetheless, the cause of Tchaikovsky's death remains highly contested, and the actual truth of it may never come to light.

Final days

Biographer Alexander Poznansky writes that on (Wednesday) Tchaikovsky had gone to a theatre to see Alexander Ostrovsky's play The Ardent Heart. Afterwards, he went with his brother Modest, his nephew Vladimir Davydov, the composer Alexander Glazunov, and other friends to a restaurant named Leiner's, located in Kotomin House at Nevsky Prospekt, Saint Petersburg. During the meal, Tchaikovsky ordered a glass of water. Due to an outbreak of cholera in the city at the time, health regulations required restaurants to boil before serving it. The waiter told Tchaikovsky that no boiled water was currently available, so he instead requested cold unboiled water, which was brought. The others in his party warned him not to drink it, but the composer said he was not afraid of contracting cholera and drank it anyway.Poznansky, Tchaikovsky: The Quest for the Inner Man, 579.

The next morning, at Modest's apartment, Pyotr was not in the sitting room drinking tea as usual, but in bed complaining of diarrhea and an upset stomach. Modest asked about calling a doctor. Tchaikovsky refused, instead taking cod liver oil to no avail. Three days later, he developed signs of cholera. His condition worsened, but he still refused to see a doctor. A doctor was finally sent for but was not home, so another one was called. The diagnosis of cholera was finally made by Dr. Lev Bertenson. In the meantime, Tchaikovsky would seem to improve but then would regress and get much worse. His kidneys began to fail. A priest was called from St. Isaac's Cathedral to administer last rites, but the composer was too far gone to recognise what was going on around him. He died at 3 a.m. on 6 November 1893.Poznansky, Tchaikovsky: The Quest for the Inner Man, 579–589.

After the death

Tchaikovsky biographer David Brown argues that, even before the doctors' accounts on the composer's death had appeared, what happened at his brother Modest's flat had been totally inconsistent with standard procedures for a death from cholera. Regulations stipulated the corpse was to be removed from the scene of death immediately in a closed coffin.Brown, David, Tchaikovsky: The Final Years, 1885–1893 (New York: W.W. Norton & Company, 1991), 481. Instead, Tchaikovsky's body was displayed in Modest's flat, and the flat freely opened to visitors wishing to pay their last respects. Among the guests, composer Nikolai Rimsky-Korsakov was seemingly bewildered by what he saw:Brown, Tchaikovsky: The Final Years, 481. "How strange that, although death had resulted from cholera, still admission to the Mass for the dead was free to all! I remember how [Alexander] Verzhbilovich [a cellist and professor at the Saint Petersburg Conservatory], totally drunk[...] kept kissing the deceased man's head and face."Rimsky-Korsakov, My Musical Life, 340. This passage was edited out of some later versions of Rimsky-Korsakov's book.

Rimsky-Korsakov's own comments, however, would seem to conflict with his actions as later told by Sergei Diaghilev. Diaghilev, who would become known as the founder and impresario of the Ballets Russes, was at that time a university student in St.Petersburg and had met and occasionally conversed with the composer,Diaghilev, Sergei, Memoirs (unpublished). As quoted in Buckle, Richard, Diaghilev (New York: Athenum, 1979), 17–18. to whom he was distantly related by marriage.Diaghilev's step-mother's sister, the soprano Aleksandra Panayeva-Kartsova, married Georgy Kartsov, the son of Tchaikovsky's first cousin Aleksandra Petrovna Kartsova née Tchaikovskaya. On hearing of Tchaikovsky's death, Diaghilev recalls,

Poznansky counters Brown's views by saying that, despite Rimsky-Korsakov's comment, there was nothing odd about what went on. He writes that, despite lingering prejudice, the prevailing medical opinion was that cholera was less contagious than previously supposed. Though public gatherings for cholera victims had previously been discouraged, the Central Medical Council in the spring of 1893 specifically allowed public services and rituals in connection with the funerals of cholera victims.Poznansky, 592. Also, the medical opinion printed by the Petersburg Gazette stated that Tchaikovsky had died from a subsequent blood infection, not from the disease itself, cholera having reportedly been arrested on Friday, ‌three days before the composer's death.Petersburgaia gazeta, 26 October [6 November] 1893. As quoted in Poznansky, 592. According to Poznansky, with the added precaution of constant disinfectant to the lips and nostrils of the body, even the drunken cellist kissing the face of the deceased had little cause for worry.

Alexander III volunteered to pay the costs of the composer's funeral himself and instructed the Directorate of the Imperial Theatres to organise the event. According to Poznansky, this action showed the exceptional regard with which the Tsar regarded the composer. Only twice before had a Russian monarch shown such favor toward a fallen artistic or scholarly figure. Nicholas I had written a letter to the dying Alexander Pushkin following the poet's fatal duel. Nicholas also came personally to pay his final respects to historian Nikolay Karamzin on the eve of his burial.Poznansky, 594 Moreover, Alexander III gave special permission for Tchaikovsky's memorial service to be held at Kazan Cathedral.Volkov, Solomon, St. Petersburg: A Cultural History (New York: The Free Press, 1995), 128.

Tchaikovsky's funeral took place on 9 November 1893 in St.Petersburg. Kazan Cathedral holds 6,000 people, but 60,000 people applied for tickets to attend the service. Finally, 8,000 people were crammed in.Brown, Tchaikovsky: The Final Years, 486. The composer was interred in Tikhvin Cemetery at the Alexander Nevsky Monastery, near the graves of fellow-composers Alexander Borodin, Mikhail Glinka and Modest Mussorgsky; eventually Rimsky-Korsakov and Mily Balakirev would be buried nearby, as well.Brown, Tchaikovsky: The Final Years, 487.

Cholera in Russia

Biographer Anthony Holden writes that cholera had arrived in Europe less than a century before Tchaikovsky's death. An initial pandemic had hit the continent in 1818. Three others had followed and a fifth, which had begun in 1881, was raging.See cholera: History: Origin and spread. The disease had been imported by pilgrims from Bombay to Arabia, and from there crossed the Russian border."Asiatic Cholera", Encyclopedia of Brogkauz & Efron (St. Petersburg, 1903), vol. 37a, 507–151. As quoted in Holden, 359.

The first reported cases in Russia from this pandemic occurred in Vladivostok in 1888. By 1892, Russia was by far the worst hit of the 21 countries affected. In 1893, no fewer than 70 regions and provinces were combatting epidemics.

Holden adds that, according to contemporary Russian medical records, the specific epidemic which claimed Tchaikovsky's life began on 14 May 1892 and ended on 11 February 1896. During this time, 504,924 people contracted cholera. From that number, 226,940 (44.9 percent) died from it.

A social stigma Even with these numbers, the attribution of Tchaikovsky's death to cholera appeared to degrade his reputation among the upper classes and struck many as inconceivable. While cholera infected all levels of society, it was largely considered a disease of the poor.Poznansky, Tchaikovsky: The Quest for the Inner Man, 596–597.

The cholera outbreak that had begun in the summer of 1893 in St.Petersburg had been confined primarily to the city's slums, where the poor "lived in crowded, insanitary conditions without observing elementary medical conditions." The disease did not affect more affluent and educated families because they observed the medical protocols forbidding the use or drinking of unboiled water.Orlova, Alexandra, "Tchaikovsky: The Last Chapter", 128. As quoted in Holden, Anthony, Tchaikovsky: A Biography (New York: Random House, 1995), 387. Moreover, this epidemic had begun waning with the arrival of the cold autumn weather. On 13 October, 200 cases of cholera were reported. By 6 November, the day of Tchaikovsky's death, this number had been reduced to 68 cases, accompanied by "a sharp decline in mortality".Orlova, 128, footnote 12. As quoted in Holden, 387. Though these figures were taken from Novosti i Birzhevaya Gazeta, Poznansky challenges them as inaccurate.Poznansky, Tchaikovsky's Suicide: Myth and Reality, 217, note 81. As quoted in Holden, 474, footnote 36.

Also, Tchaikovsky's friend Herman Laroche reported that the composer was scrupulous in his personal hygiene.Holden, 360. In the hope of avoiding doctors, Laroche writes, "he relied above all on hygiene, of which he seemed (to my layman's view) to be a true master".As quoted in Holden, 360. The media noted this as they questioned the composer's death. "How could Tchaikovsky, having just arrived in Petersburg and living in excellent hygienic conditions, have contracted the infection?" asked a reporter for the Petersburg Gazette.Peterburgskaia gazeta, 7 November 1893, as quoted in Poznansky, Tchaikovsky: The Quest for the Inner Man, 597. A writer for Russian Life noted, "[E]veryone is astounded by the uncommon occurrence of the lightning-fast infection with Asiatic cholera of a man so very temperate, modest, and austere in his daily habits."Russkaia zhizn, 9 November 1893. As quoted in Poznansky, Tchaikovsky: The Quest for the Inner Man, 597.

Doctors not prepared