The sound that failed

Alcohol and the death of Ludwig van Beethoven: comparison of general biographies to the medical literature

Beethoven's autopsy findings of cirrhosis may have been due to alcoholism. This condition may have been underemphasized historically, given its stigma and the incongruence with the often heroic portrayal of Beethoven. We therefore aimed to compare how medical experts and biographers writing for a non-medical audience describe his final illness in the context of alcoholism. English-language biographies were identified using a survey of biographies of Beethoven and supplemented by the authors. English-language medical publications were identified by searching for "Beethoven" in the PubMed® MEDLINE database. We included studies that mentioned Beethoven's final illness and death. We recorded statements regarding alcohol consumption, alcoholism, or alcohol use disorder, and the role of alcohol in Beethoven's death. The most commonly cited final illness was liver disease. Alcohol use was more frequently mentioned in biographies, but alcoholism less so. Alcohol use was invoked as a possible cause of final illness more frequently by medical publications.

Aetiology of Ludwig van Beethoven's hearing impairment: hypotheses over the past 100 years - A systematic review

OBJECTIVES

Even 250 years after Beethoven's birth, the irrevocable cause of his hearing impairment remains unclear despite multiple publications by different professional groups. This study aimed to analyse the development of the most likely aetiologies during the last 100 years by a systematic review of the relevant medical literature.

METHODS

A systematic review of medical literature in PubMed®, PubMed Central®, and Web of Science® for the period 1920-2020 was conducted. Medical publications between 1920 and 1935 were additionally searched manually by review of reference lists. Studies were eligible when a statement regarding the most likely aetiology of the hearing loss of Beethoven was the aimed objective of the publication.

RESULTS

48 publications were included. The following aetiologies were supposed: otosclerosis (n = 10), syphilis (n = 9), Paget's disease (n = 6), neural deafness (n = 5), immunopathy with inflammatory bowel disease, neural deafness with otosclerosis, sarcoidosis or lead intoxication (n = 2), and systemic lupus erythematosus, trauma, labyrinthitis or inner ear disease (n = 1). There is an ongoing effort with a mean publication frequency in this topic of 0.48/year. From 1920 to 1970, otolaryngologists were the group with the highest interest in this field (67%), whereas since 1971 most authors have belonged to non-otolaryngologic subspecialities (81%).

CONCLUSION

Over the past 100 years, otosclerosis and syphilis were predominantly supposed to be the underlying causes. The hypothesis of syphilis-although rejected for a long time-has had a remarkable revival during the past 20 years. Regarding the outcome following therapeutic intervention by cochlear implantation, the differential diagnosis of neural deafness would be relevant today.

A Modern Case Sheds Light on a Classical Enigma: Beethoven's Deafness

Two hundred and fifty years have passed since the birth of Ludwig van Beethoven, and the enigma about his hearing loss and overall health status seems to be not completely solved. However, the admission to the hospital of a 64-year-old woman in 2018 with symptoms extremely similar to those experienced by the great composer may add further evidence to a theory previously underestimated. The health issues of the modern patient were found to be due to chronic lead intoxication. The lead was released during daily cooking using a ceramic-coated frying pan with worn surface that poisoned her breakfast most probably for years. Abdominal pain, asthenia, and hearing loss affecting the high frequencies with a many impact on speech intelligibility tormented the patient, as they had Beethoven. An extensive review of the music and medical literature was performed, as well as re-examination of manuscripts, correspondence, and autopsy reports of the famous composer; and great similarities have been found. The soundness of the most-cited classical theories about Beethoven's hearing loss will be discussed. After close scrutiny of the theories, our analysis points toward a progressive sensorineural hearing loss due to lead intoxication as the most probable cause of not only Beethoven's hypoacusis but his overall health status as well. Laryngoscope, 131:179-185, 2021.

A bite into the history of the autopsy : From ancient roots to modern decay

The autopsy has had a checkered history, much of which has been surrounded by controversy. The roots of human dissection are found in the ancient world where rumors flourished that the prosectors of the day were engaged in vivisection as well as dissection. Bound up with the prevailing religious and political systems of the day, the autopsy has alternately been prohibited and encouraged, used to explore the nature of disease, and conceal questionable political policy. This review explores the history of the autopsy from its ancient roots in Egypt, Mesopotamia, Alexandria, and the Far East through the dark ages to medieval times and beyond into the renaissance. The development of the autopsy in Europe during the 17th to 19th centuries is discussed before briefly considering the decline of this diagnostic tool in the 20th century.

Contagious rhythm: infectious diseases of 20th century musicians

Infectious diseases have led to illness and death for many famous musicians, from the classical period to the rock 'n' roll era. By the 20th century, as public health improved and orchestral composers began living more settled lives, infections among American and European musicians became less prominent. By mid-century, however, seminal jazz musicians famously pursued lifestyles characterized by drug and alcohol abuse. Among the consequences of this risky lifestyle were tuberculosis, syphilis, and chronic viral hepatitis. More contemporary rock musicians have experienced an epidemic of hepatitis C infection and HIV/AIDS related to intravenous drug use and promiscuity. Musical innovation is thus often accompanied by diseases of neglect and overindulgence, particularly infectious illnesses, although risky behavior and associated infectious illnesses tend to decrease as the style matures.

Biological basis for syphilis

Syphilis is a chronic sexually transmitted disease caused by Treponema pallidum subsp. pallidum. Clinical manifestations separate the disease into stages; late stages of disease are now uncommon compared to the preantibiotic era. T. pallidum has an unusually small genome and lacks genes that encode many metabolic functions and classical virulence factors. The organism is extremely sensitive to environmental conditions and has not been continuously cultivated in vitro. Nonetheless, T. pallidum is highly infectious and survives for decades in the untreated host. Early syphilis lesions result from the host's immune response to the treponemes. Bacterial clearance and resolution of early lesions results from a delayed hypersensitivity response, although some organisms escape to cause persistent infection. One factor contributing to T. pallidum's chronicity is the paucity of integral outer membrane proteins, rendering intact organisms virtually invisible to the immune system. Antigenic variation of TprK, a putative surface-exposed protein, is likely to contribute to immune evasion. T. pallidum remains exquisitely sensitive to penicillin, but macrolide resistance has recently been identified in a number of geographic regions. The development of a syphilis vaccine, thus far elusive, would have a significant positive impact on global health.