8 November 2013 Last updated at 17:23

Did hard-living or medical neglect kill Dylan Thomas?

Dylan Thomas's death in New York 60 years ago, and the mysterious circumstances that still surround it, has proved to be as fascinating a subject as his life and works.

Speculation still remains around the circumstances of his death, at the age of 39, on 9 November 1953.

Did his hard drinking, fast-living ways inevitably catch up with him, or were individuals near Thomas during his final days - including friends and healthcare professionals - partly to blame for his early demise?

Jeff Towns is one of the world's leading Dylan Thomas experts. He says: "Sixty years do not diminish the tragedy of November 9th 1953. It was such a sad and premature death for a poet and writer who still had so much to offer - indeed he was about to begin work in a new field - as a librettist for an opera with Stravinsky."

Following his death, Igor Stravinsky composed a work in Thomas' memory, In Memoriam Dylan Thomas (1954).

Dylan Thomas had arrived in New York in October 1953 for what would be his last tour. During his visit he was to take part in rehearsals and performances of Under Milk Wood at the Poetry Centre in Manhattan.

On his arrival he was met by Elizabeth Reitell and checked in to the Chelsea Hotel. Reitell was an assistant of his American tour agent John Brinnin, and was to oversee the production of Under Milk Wood. She was also Thomas's lover.

Thomas's health was already in a poor condition when he arrived in America. He had a history of chest problems, needed an inhaler to aid his breathing and suffered from gastritis.

The days following his arrival in New York included a tiring four rehearsals and two performances of the play in the space of five days. David N Thomas, the author of Fatal Neglect: Who Killed Dylan Thomas? (2008), infers in his book that Thomas struggled through the schedule, and that the ambitious Reitell "worked him to death".

"Dangerously debilitated"

Thomas turned 39 on 27 October but was so unwell that he returned early from a birthday party thrown in his honour.

The next few days passed relatively quietly with Thomas giving speeches at a symposium and, on 29 October, a poetry reading at the City College of New York.

His next engagements were not until the following week, giving the poet time to enjoy himself - at times to excess - and his health seems to have deteriorated further as November began.

As David N Thomas states, the poet had "become dangerously debilitated and vulnerable to infection".

On 3 November Thomas spent a large part of the day drinking and sleeping in his hotel room. He went out with Reitell to keep two appointments but returned mid-evening. He left again in the early hours to drink in a bar, and on his return to the hotel boasted to Reitell: "I've had 18 straight whiskies… I think that's the record." This infamous line was almost certainly an exaggeration.

Thomas slept off the alcohol but the next day complained of breathing difficulties. He went out with Reitell to the White Horse Tavern but after two beers he returned to the hotel, still complaining of illness. A doctor, Milton Feltenstein, was called.

Dr Feltenstein administered ACTH, a steroid, but Thomas was still in pain from his gastritis and gout. The doctor returned and gave the poet more of the same medication.

Thomas slept again but it was a fitful sleep and he complained of visions. Feltenstein was summoned for a third time and gave Thomas a sedative.

According to hospital records, the sedative was half a grain of morphine sulphate; an abnormally high dose, and dangerous given his breathing complications. It was also unusual to administer such a drug to alleviate gastritis and gout.

Feltenstein again left the hotel, but soon afterwards Thomas fell unconscious. An ambulance arrived and took him to St Vincent's Hospital. The medical notes state he arrived in a coma at 1.58am.

Thomas never regained consciousness. He died on Monday 9 November 1953 at the hospital.

Shortly after his death rumours of the possible cause started to fly, with many incorrectly assuming it was largely alcohol related.

At the time of his admission to the hospital, Thomas's medical notes stated that there was an impression of 'alcoholic encephalopathy', or damage to the brain by alcohol. News of this was released at the time, and no doubt helped to embed the myth that the poet ultimately died because of his drinking.

However, the post mortem tells a different story. The primary cause of Thomas's death was pneumonia, with pressure on the brain and a fatty liver given as contributing factors.

Self-neglect

It is impossible to deny that Thomas liked a drink; whether or not he was an alcoholic is debatable.

It is also probable that his smoking, drinking, general unhealthy lifestyle and his own self-neglect added to his ill health and arguably, his early demise.

Jeff Towns says: "I believe that these myths are now almost impossible to debunk, but most of his biographers and many of his friends testify that he was neither the womaniser nor alcoholic imbiber that the legends would have us believe.

"I do not want to sanitise nor bowdlerise his life but it is time that we get these traits into a new and more accurate perspective."

Duty of care

Dr Feltenstein can be considered neglectful in the care of his patient. His failure to diagnose any sort of chest infection or to recognise the severity of Thomas's breathing difficulties make the injections of morphine - which only served to depress the poet's breathing further - seem all the crueller.

Paul Ferris is the author of Dylan Thomas: The Biography. In it he suggests that the true cause of death "was almost certainly the half-grain of morphine, which caused the breathing difficulties, deprived the brain of oxygen and set in train the fatal process. This was Feltenstein's fault, and he and the hospital kept quiet about it."

David N Thomas also criticises the actions of both Reitell and Thomas's tour manager Brinnin, and their failure in their duty of care to their client.

In addition to working the poet hard for the productions of Under Milk Wood, David N Thomas criticises Reitell's delay in calling for an ambulance as Thomas slipped into unconsciousness at the hotel.

He also calls into question the actions of Brinnin, who was a largely absent figure during Thomas's final trip to New York. Brinnin had been shocked by the poet's appearance at the final rehearsal for Under Milk Wood, but chose not to cancel any of Thomas's appointments despite the obvious ill health he was suffering.

In Fatal Neglect, David N Thomas surmises: "John Brinnin was well-known for many things. Yet somehow, he managed never to be known as the man who helped send a famous poet to an early and avoidable death, and made a lot of money from doing so."

Following his death, Dylan Thomas's body was returned to Wales.

His funeral took place on 24 November 1953 in Laugharne. He is buried in the graveyard of St Martin's Church, his grave marked by a simple white cross.

Jeff Towns adds: "At the time of Dylan's death his close life-long friend, the poet of Gower, Vernon Watkins wrote a ground-breaking obituary for The Times - unsigned as always, but now recognised as a masterpiece - a moving tribute from one fine poet to another. Vernon would later write that 'the only true tragedy of Dylan Thomas's death was that he died'. I could not agree more."

Every year, the Dylan Thomas Society of Great Britain lays a wreath at Poet's Corner in Westminster Abbey on the anniversary of his death.

The life and works of Dylan Thomas will be celebrated in 2014, the centenary of the poet's birth.