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Beethoven's Medical History
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When Beethoven entered his thirtieth year, he began to
suffer from an
annoying roaring and buzzing in both ears. Soon his hearing
began to
fail and, for all he often would enjoy untroubled intervals
lasting
for months at a time, his disability finally ended in complete
deafness. All the resources of the physician's art were useless.
At about the same time Beethoven noticed that his digestion began
to
suffer. ...
At no time accustomed to taking medical advice seriously,
he began to
develop a liking for spirituous beverages, in order to stimulate
his
decreasing appetite and to aid his stomachic weakness by
excessive use
of strong punch and iced drinks. ... He contracted a severe
inflammation of the intestines which, though it yielded to
treatment,
later on often gave rise to intestinal pains and aching colics
and
which, in part, must have favored the eventual development of his
mortal illness.
--Andreas Wawruch, physician attending Beethoven's final
illness, 1827
My hearing has become weaker during the last three years.
Frank
wished to restore me to health by means of strengthening
medicines,
and to cure my deafness by means of oil of almonds, but, prosit!
nothing came of these remedies; my hearing became worse and
worse.
... Then an Asinus of a doctor advised cold baths, a more
skillful one,
the usual tepid Danube baths. These worked wonders; but my
deafness
remained or became worse. This winter I was truly miserable; I
had
terrible attacks of Kolik, and I fell quite back into my former
state.
--Beethoven to Franz Wegeler, 1801
For the last six years I have been afflicted with an
incurable
complaint, made worse by incompetent doctors. From year to year
my
hopes of being cured have gradually been shattered ... I must
live
like an outcast; if I appear in company, I am overcome by a
burning
anxiety, a fear that I am running the risk of letting people
notice my
condition. ... How humiliated I have felt if somebody standing
beside me heard the sound of a flute in the distance and I heard
nothing. ... I have such a sensitive body that any sudden
change can
plunge me from the best spirits into the worst of humors. ...
When I am dead, request on my behalf Professor Schmidt, if
he is still
living, to describe my disease, and attach this written document
to
his record, so that after my death at any rate the world and I
may be
reconciled. ...
--Beethoven to brothers Karl and Johann, 1802 (Heiligenstadt
Testament)
Medical science is divided as to whether Beethoven's
deafness was due
to direct damage to the auditory nerve (sensori-neural deafness)
or to
thickening and fixation of the bones which conduct sound through
the
middle ear (otosclerosis). ... Otosclerosis is the commonest
cause
of deafness in a man of twenty-eight years, but the
high-frequency
hearing loss described by Beethoven is not typical of the
condition and
makes the diagnosis doubtful. ...
Johann Wagner in his autopsy report identified the auditory
nerves; he
clearly thought they were implicated in the pathological process.
The
appearance of the auditory arteries seems more typical of
atherosclerosis (hardening of the arteries) than of endarteritis
obliterans, which would have been seen in a chronic inflammatory
condition such as syphilis.
--John O'Shea, Was Mozart Poisoned? Medical Investigations
into the
Lives of the Great Composers, 1991
According to Huttenbrenner, who was in the room, there was
a sudden
flash of lightning which garishly illuminated the
death-chamber--snow
lay outside--and a violent thunderclap. At this startling,
aweful peal
of thunder, the dying man suddenly raised his head and stretched
out
his right arm majestically, 'like a general giving orders to an
army.'
This was but for an instant; the arm sank down; he fell back.
Beethoven was dead.
--A. W. Thayer, Life of Beethoven, 1866
The story of Beethoven apparently 'shaking his fist at the
heavens' in
one final act of defiance before oblivion has been dismissed as a
romantic fiction by most Beethoven biographers. Surprisingly, it
is
an accurate clinical observation: people who die of hepatic
failure
often react in an exaggerated way to sudden stimuli such as
bright
light. This is due to the accumulation of toxic waste products
normally excreted by the liver. Beethoven's gesture may be seen
as
having been due to the cerebral irritation which accompanies
hepatic
failure, not as a conscious act.
The cause of Beethoven's death--liver failure due to
cirrhosis--was
confirmed by the autopsy performed by Johann Wagner and Karl von
Rokitansky. ... The essential feature was macronodular
cirrhosis of
long standing with concomitant portal hypertension. Macronodular
cirrhosis is less common than micronodular cirrhosis in alcoholic
liver disease but certainly occurs frequently. ... Chronic
active
hepatitis due to viral or auto-immune disease is a possibility,
but it
is not necessary to invoke this as an explanation in a patient
known
to have been drinking heavily over a thirty-year period.
--O'Shea, 1991
Beethoven's was a long-term hepatitis, as the history from
1821 shows,
which had flared up after the exposure during the journey from
Gneixendorf. Such a chronic active hepatitis associated with
colitis,
rheumatism, repeated catarrhs, abscesses, cryopathy (attacks
precipitated by chilling), the ophthalmia, and the skin disorder
are
extremely suggestive of connective tissue immunopathy
[auto-immune
disease]: such a diagnosis explains all his numerous illnesses.
Arterial disease is constant in immunopathy; the atrophy of the
auditory nerves could be due to arterial disease.
--Edward Larkin, Beethoven's Medical History, 1970
Beethoven once had a terrible Typhus [fever with clouding
of the
mind]. From this time on dated the ruin of his nervous system
and
probably the ruin of his hearing, so calamitous in his case.
--Aloys Weissenbach, surgeon and Beethoven's friend, 1820
Beethoven may well have had the specific form of
immunopathic disease
known as Systemic Lupus Erythematosus, which typically commences
in
early adult life with a fever accompanied by mental confusion.
Typical symptoms are destructive rash ('lupus') and redness
('erythema') of the butterfly area of the face. Any of the
immunopathic disorders may occur, notably colitis. The excellent
life-mask of 1812 shows an elongated atrophic scar particularly
suggestive of Lupus. The portraits clearly show flushing of the
cheekbones and nose. Beethoven's high color was frequently
commented
on and may have aroused suspicions of heavy drinking.
--Larkin, 1970
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