[nukkad] Beethoven's Deafness

[Goyal Nitin <>]

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Born in Bonn in 1770, the eldest son of a singer in the Kapelle of the
Archbishop-Elector of Cologne and grandson of the Archbishop's
Kapellmeister, Beethoven moved in 1792 to Vienna, where he had some lessons
from Haydn and others, quickly establishing himself as a remarkable
keyboard-player and original composer. By 1815 increasing deafness made
public performance impossible and accentuated existing eccentricities of
character, patiently tolerated by a series of rich patrons and his royal
pupil the Archduke Rudolph. Beethoven did much to enlarge the possibilities
of music and widen the horizons of later generations of composers. To his
contemporaries he was sometimes a controversial figure, making heavy demands
on listeners both by the length and by the complexity of his writing, as he
explored new fields of music. 

------------------------------

Deafness 

Beethoven's career as a virtuoso pianist was brought to an end when he began
to experience his first symptoms of deafness. In a letter written to his
friend Karl Ameda on 1 July 1801, he admitted he was experiencing signs of
deafness. 

How often I wish you were here, for your Beethoven is having
a miserable life, at odds with nature and its Creator, abusing
the latter for leaving his creatures vulnerable to the slightest 
accident ... My greatest faculty, my hearing, is greatly 
deteriorated. 

Apparently Beethoven had been aware of the problem for about three years,
avoiding company lest his weakness be discovered, and retreating into
himself. Friends ascribed his reserve to preoccupation and absentmindedness.
In a letter to Wegeler, he w rote: 

How can I, a musician, say to people "I am deaf!" I shall, if 
I can, defy this fate, even though there will be times when I 
shall be the unhappiest of God's creatures ... I live only in 
music ... frequently working on three or four pieces simultaneously.  

Many men would have been driven to suicide; Beethoven may indeed have
contemplated it. Yet his stubborn nature strengthened him and he came to
terms with his deafness in a dynamic, constructive way. In a letter to
Wegeler, written five months after the despairing one quoted above, it
becomes clear that Beethoven, as always, stubborn, unyielding and struggling
against destiny, saw his deafness as a challenge to be fought and overcome: 

Free me of only half this affliction and I shall be a complete,
mature man. You must think of me as being as happy as it is 
possible to be on this earth - not unhappy. No! I cannot endure
it. I will seize Fate by the throat. It will not wholly conquer 
me! Oh, how beautiful it is to live - and live a thousand times over!  

With the end of his career as a virtuoso pianist inevitable, he plunged into
composing. It offered a much more precarious living than that of a
performer, especially when his compositions had already shown themselves to
be in advance of popular taste . In 1802 his doctor sent him to
Heiligenstadt, a village outside Vienna, in the hope that its rural peace
would rest in his hearing. The new surroundings reawakened in Beethoven a
love of nature and the countryside, and hope and optimism returned. Chief
amongst the sunny works of this period was the charming, exuberant Symphony
no. 2. However, when it became obvious that there was no improvement in his
hearing, despair returned. By the autumn the young man felt so low both
physically and mentally that he feared he would not surive the winter. He
therefore wrote his will and left instructions that it was to be opened only
after his death. This 'Heiligenstadt Testament' is a long moving document
that reveals more about his state !
of mind than does the music he was writing at the time. Only his last works
can reflect in sound what he then put down in words. 

O ye men who accuse me of being malevolent, stubborn and 
misanthropical, how ye wrong me! Ye know not the secret 
cause. Ever since childhood my heart and mind were disposed 
toward feelings of gentleness and goodwill, and I was eager 
to accomplish great deeds; but consider this: for six years 
I have been hopelessly ill, aggravated and cheated by quacks in 
the hope of improvement but finally compelled to face a lasting 
malady ... I was forced to isolate myself. I was misunderstood 
and rudely repulsed because I was as yet unable to say to people, 
"Speak louder, shout, for I am deaf" ... With joy I hasten to meet 
death. Despite my hard fate ... I shall wish that it had come later; 
but I am content, for he shall free me of constant suffering. Come 
then, Death, and I shall face thee with courage. Heiglnstadt (sic)
6 October, 1802. 
 
The last page of the 'Heiligenstadt Testament'  

Just how bad was Beethoven's plight? At first the malady was intermittent or
so faint that it worried him only occasionally. but by 1801 he reported that
a whistle and a buzz was constant. Low speech tones became an unintelligible
hum, shouting became an intolerable din. Apparently the illness completely
swamped delicate sounds and distorted strong ones. He may have had short
periods of remission, but for the last ten years of his life he was totally
deaf. 

------------------------------ 

His Medical History 

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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