Biographer Lewis Porter speculated that the cause of Coltrane's illness was hepatitis, although he also attributed the disease to Coltrane's heroin use at a previous period in his life.[79] Frederick J. Spencer wrote that Coltrane's death could be attributed to his needle use "or the bottle, or both."[80] He stated that "[t]he needles he used to inject the drugs may have had everything to do with" Coltrane's liver disease: "If any needle was contaminated with the appropriate hepatitis virus, it may have caused a chronic infection leading to cirrhosis or cancer."[80] He noted that despite Coltrane's "spiritual awakening" in 1957, "[b]y then, he may have had chronic hepatitis and cirrhosis... Unless he developed a primary focus elsewhere in later life and that spread to his liver, the seeds of John Coltrane's cancer were sown in his days of addiction."[81]
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