Early in 1908, Sibelius had to spend a spell in hospital. His smoking and drinking had now become life-threatening. Although he cancelled concerts in Rome, Warsaw and Berlin, he maintained an engagement in London but there too his Third Symphony failed to attract the critics. In May 1908, Sibelius's health deteriorated further. He travelled with his wife to Berlin to have a tumour removed from his throat. After the operation, he vowed to give up smoking and drinking once and for all. The impact of this brush with death has been said to have inspired works that he composed in the following years, including "Luonnotar" and the Fourth Symphony.