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14580 results in History of Medicine

Page 102 of 729

  • 11 - The Ultimate Blow: Deafness

  • Noble Jonathan
  • Book:
    That Jealous Demon, My Wretched Health
    Published by:
    Boydell & Brewer
    Published online:
    05 September 2018
    Print publication:
    15 June 2018, pp 321-350

  • Summary

    Silence is argument carried on by other means

    Che Guevara

    Introduction

    The composer as hero is possibly epitomised by those who became deaf. It seems the supreme injustice. Many ask how musicians can compose when they cannot hear the result of their labours. Beethoven showed that they can. He said, when seriously deaf, that of all his activities composition was the easiest, and social interaction the most difficult. Martin Cooper has talked of Beethoven's ‘inner life of almost unparalleled reality and intensity, unsullied by unwelcome noise and thus distraction, whereby the process of cerebral composition may be actually enhanced’. But one wonders. Beneath one of the Cumbrian mountains is a memorial to a young man who, after amputation of a leg, scaled it on crutches. Perhaps deaf composition is like that.

    Fig. 7 outlines the basic anatomy and mechanism of hearing. Sound waves enter the external meatus having been magnified by the outer ear (pinna), which acts like a megaphone in reverse. On reaching the tympanic membrane the sound waves resonate and are transmitted across the middle ear by three small bones (ossicles) known as malleus, incus and stapes. The stirrup-shaped stapes is attached to a second membrane which then transmits sound to a complex organ, the cochlea, which resembles a baby octopus. Within this marvel of creation are tiny hairs which convert sound waves into impulses, which are electrically transmitted to the hearing centres of the brain via the acoustic (or auditory) nerve, and so we behold the miracle of hearing.

    Deafness is either conductive, usually due to wax in the outer ear or disease in the middle ear, or sensorineural, that is, due to disease with the cochlea and/or the acoustic nerve. Th ere are mixed patterns too. Smetana's deafness was due to syphilitic destruction of that nerve and therefore entirely sensorineural. It was typically syphilitic, with fairly sudden onset and progression to total deafness within a few months. Secondly, presbyacusis is the typical and usually inevitable cochlea sensorineural deafness of old age, which aff ected Ralph Vaughan Williams and possibly Ethel Smyth.

  • 10 - Cancer

  • Noble Jonathan
  • Book:
    That Jealous Demon, My Wretched Health
    Published by:
    Boydell & Brewer
    Published online:
    05 September 2018
    Print publication:
    15 June 2018, pp 285-320

  • Summary

    As quick a growth to meet decay

    Robert Herrick, Hesperides, 1648

    Introduction

    So stark a chapter title befits the subject. Even today, with the outlook for many malignancies dramatically improved, the word ‘cancer’ can strike fear into many hearts. Any attempt to over-simplify the subject would be facile, but there are a few basic rules. Cancer implies a malignant growth or tumour, although the word ‘tumour’ actually means a swelling or lump, and many tumours are benign, the majority (but not all) remaining so. For a tumour to be malignant (cancerous) its method of cell division and replication becomes disordered and goes out of control, a cellular Sorcerer's Apprentice. Human tissues are living and shed old cells to replace them with new ones but in an orderly, even pre-ordained, fashion.

    Two definitive features of cancer are, firstly, that it invades neighbouring tissues and structures and, secondly, that it spreads to remote organs by the blood or the lymphatic systems to cause secondary deposits (metastases). The detailed classification of malignant tumours is complex. It is reasonable to simplify it. Malignant tumours arising from lining surfaces are carcinomas, and those from connective tissues such as fat or bone are sarcomas. To subdivide again, lining tissues are the epithelium (e.g. skin, mouth, gullet) and endothelium, including the lining of the gastrointestinal tract from stomach to rectum. Then there are cancers arising from more specialised tissues, particularly the nervous system. A survival rate is the percentage of patients still alive years after treatment for that growth. Achieving these benchmarks often reassures patients enormously. There are sarcomas for which a survival of two years after therapy almost behoves a cure. For other tumours that may be achieved within five.

    Treatment can readily be classified. Surgery may involve just a local excision, or removal of part or all of an organ and lastly of the total structure, plus a more extensive dissection, removing surrounding tissues. Modern scanning techniques (e.g. CT, MRI and PET) now enable doctors to accurately define the edges of a growth and plan treatment accordingly. Surgery is often supplemented or even supplanted by radiation (radiotherapy) and/or by anti-cancer drugs (chemotherapy). These are sometimes given in conjunction with one another.

  • Epilogue and Coda

  • Noble Jonathan
  • Book:
    That Jealous Demon, My Wretched Health
    Published by:
    Boydell & Brewer
    Published online:
    05 September 2018
    Print publication:
    15 June 2018, pp 351-362

  • Summary

    And to make an end is to make a beginning. The end is where we start from.

    T. S. Eliot, Four Quartets, 1944

    After a rollercoaster ride through so much wonderful music, punctuated by personal tragedy and illness and then abbreviated by death, let us define what themes and conclusions may be drawn. Unease persists with some accounts of composers’ deaths. Although uncertainty will continue regarding the exact cause of Mozart's death, that he was not poisoned is beyond all reasonable doubt, and his final illness, from either kidney or heart failure, took two and a half weeks. There have been cases, more than a hundred years ago, where analysis of contemporaneous accounts allows confident clinical conclusions, as with Beethoven or Brahms. Clearly Schubert did not die of syphilis, although he almost certainly died with it.

    A recurrent theme has been the dogmatic claims made by doctors and musicologists alike. Elgar's ‘last five words’ may reflect more about Ernest Newman than about Elgar. Before we leave Newman, surely his overwhelming character assassination of Beethoven is appalling, defacing the memory of a titanic figure. This tendency to advance the potentially salacious, especially VD or alcohol, can render an awful disservice to the reputations of great people who deserve better, something which had concerned Beethoven himself. Newman's judgement is continued in subsequent quotation by others – and to what end? Opinions from pompous medical pin-stripes should be discarded, along with an apparent urge to publish increasingly abstruse medical opinion. Merging of the scholarly with the ludicrous was seen with various published diagnoses in the cases of Mozart and Beethoven, for both of whom over a hundred diagnoses have previously been advanced. Hopefully, future research will be presented in a manner reasoned upon a balance of probabilities. Moreover, it is a mantra of good clinical practice to never make two or more diagnoses where one would do.

    We should dispose of Mozart's Tourette's syndrome and Gershwin's ‘overwrought hysteria’. A recent Proms concert programme asserted that Schumann died of syphilis, with a suggestion that his hand problem had been self-inflicted; both are questionable. The biographer's responsibility is to do justice to all the evidence.

That Jealous Demon, My Wretched Health
  • Disease, Death and Composers
  • Noble Jonathan
  • Published by:
    Boydell & Brewer
    Published online:
    05 September 2018
    Print publication:
    15 June 2018
  • Despite much triumph in adversity, illness fuelling composition is a misconception.

  • Introduction

  • Noble Jonathan
  • Book:
    That Jealous Demon, My Wretched Health
    Published by:
    Boydell & Brewer
    Published online:
    05 September 2018
    Print publication:
    15 June 2018, pp 1-6

  • Summary

    Music is the companion of joy, the medicine of sorrow Inscription on The Music Lesson (1662–63)

    by Johannes Vermeer, H.M. The Queen's Collection

    In late 1907 the Austrian painter Gustav Klimt stood at Vienna's railway station, woefully declaring, ‘It's over’ as the train taking Gustav Mahler on his journey ultimately to the USA pulled away. Mahler had just suffered the triple hammer blow of his anti-Semitic ousting from the Vienna Opera, the death of his beloved little daughter, ‘Putzi’, and the news of his potentially fatal heart condition. But it was not over. For his remaining nearly three and a half years, before the train brought him back to die in Vienna, further great music was to come, and in some ways it would be different music. From this vignette, the strong influence of both mental and physical health upon the process of composition is seen. It may be asked how Mahler died and of what disease. We can wonder how he managed at all, as other personal and professional problems overshadowed his remaining life. More questions arise from Mahler's story, as they do from medical accounts of many other great composers. These will be posed, and hopefully answered, within this book. There is, after all, a keen general interest in the influence of ill health upon famous men. The outcome from the meeting of the Big Three at Yalta, so crucial for the world today, might have been very different if Roosevelt had not been close to death. By the same token, this book will consider how prevailing sickness affected both the quality and quantity of composition; was it because of, or in spite of, that illness? The nature of the music and how different Western music would be now if a particular composer had lived longer will be considered. For the person interested in classical composers and their sometimes dreadful deaths, and in the relationship between declining health and creative output, here is an overview.

    At the outset it was vital to learn what had already been written on this topic. Not all musical authors have sought medical advice, just as doctors have sometimes neglected musical expertise.

  • 7 - Nerves Beyond the Edge: Other Afflictions of the Nervous System

  • Noble Jonathan
  • Book:
    That Jealous Demon, My Wretched Health
    Published by:
    Boydell & Brewer
    Published online:
    05 September 2018
    Print publication:
    15 June 2018, pp 187-218

  • Summary

    It is in the brain, and the brain only, that the great sins of the world take place

    Oscar Wilde, The Picture of Dorian Gray, 1891

    Introduction: The Nervous System

    In our epoch of rapidly evolving medical science we can look forward to a time quite soon when cancer and heart disease might often be little more than interruptions to our lifestyles and not threats to life itself. So much more of the human system has become accessible, reparable and controllable. A major exception is the nervous system, with its difficulties of surgical access but, above all else, an inability to repair itself or to be repaired, which makes diseases such as motor neurone disease, multiple sclerosis and the aftermath of head injury or stroke still so devastating. There are now some encouraging signs of progress born of genetic engineering and microchip technology.

    The nervous system is enormously complex. There are many millions of nerve cells (neurones), some highly specialised, in our brains, and they are all interconnected. Of prime importance is the central nervous system, which consists of the brain, the repository of our higher functions (e.g. sight, hearing, speech, emotion, memory, intellect and voluntary movement), and the spinal cord. The latter is the main electrical pathway to and from the brain. The knowledge that our foot is too hot is carried in the sensory nerves to the brain via the spinal cord, and the impulse to quickly move it away from the heat source returns down the spinal cord, passing messages to motor nerves via the peripheral nervous system. When these systems are disturbed, diseased or destroyed, then human life can become truly awful.

    We have already encountered neurological disease in earlier chapters. George Gershwin died rapidly from a malignant brain tumour (Chapter 3). Maurice Ravel's brain prematurely atrophied as he developed pre-senile dementia (Chapter 3). A whole chapter is devoted to the dreadful effects of syphilis (Chapter 4), with some of which it was the brain itself which functionally disintegrated, as was the case with Donizetti, or with Smetana, whose auditory nerves were also affected, hence his deafness. It was Delius's optic nerves which were affected, along with the spinal cord.

  • Appendix: Accidental and/or Violent Deaths

  • Noble Jonathan
  • Book:
    That Jealous Demon, My Wretched Health
    Published by:
    Boydell & Brewer
    Published online:
    05 September 2018
    Print publication:
    15 June 2018, pp 363-365

  • Summary

    These studies have revealed little connection between accidental or violent death and musical composition, although there are several caveats to that, and the ultimately fatal accident suffered by Jean-Baptiste Lully is often claimed to have altered or fostered the progress of orchestral conducting. Nevertheless, some surprising statistics emerge. This book covers seventy composers, albeit twenty-six of them briefly. However, an additional nine died violently or accidentally. If we add to them non-fatal injuries suffered by Mendelssohn, Puccini, Prokofiev and Ravel from traffic accidents, as well as Nielsen, then fourteen of a total group of seventy-nine suffered violent or accidental episodes (18%). These are surprisingly high figures, without an obvious explanation. Three died as a result of warfare, two are alleged to have ultimately developed sepsis secondary to boils, and two succumbed to freak accidents.

    Jean-Baptiste Lully (1632–1687) famously was conducting his own Te Deum to give thanks for the Sun King's recovery from surgery. As he beat time, he drove his conducting staff's pointed end into his foot, which subsequently became infected. Gangrene followed; he refused an amputation and died two months after the original episode. The theory that, forewarned by this tragedy, conductors thereafter used a scroll, violin bow or ultimately a baton to conduct is exaggerated. By Lully's time the conducting staff was starting to decrease in popularity, although it was Weber, Berlioz, and Wagner, more than a century later, who brought the art of conducting to a picture recognisable today.

    Charles Valentin Alkan (1813–1888) almost by tradition died because, whilst he was seeking his Talmud from a high shelf, the bookcase fell upon him. Alternatively, matters may have been more prosaic as the concierge at his flat found him prostrate on the kitchen floor under the hat stand. It has been sensibly argued that he collapsed on arriving home, grabbing the hat stand as he did so. Having been put to bed, he died there later the same day, most probably from a stroke or heart attack. Otherwise, he may have fainted and collapsed whilst preparing food in the kitchen. McCallum has added mystery to Alkan's story, suggesting he was schizophrenic.

  • Foreword

  • Noble Jonathan
  • Book:
    That Jealous Demon, My Wretched Health
    Published by:
    Boydell & Brewer
    Published online:
    05 September 2018
    Print publication:
    15 June 2018, pp xii-xii

  • Summary

    In my early days at Radio 3 I well remember a veteran producer throwing back a script I'd written for a concert broadcast. ‘There's no colour’, he proclaimed. ‘Bring the composer to life’. It's advice I have never forgotten. Talking about sonata form or key structure is no use to anyone who hasn't studied music theory. But talk about lovers, travels, debts, and above all, health, and a long dead composer can come to life again.

    Beethoven's deafness, Schubert's syphilis, and Elgar's acute hypochondria have become part of the shorthand of their lives – even if, as Jonathan Noble reveals, the relevance of each condition to the composer's existence has been rather exaggerated. Until the last century few composers enjoyed serious academic study during their lifetimes; biographies tended to be either self-serving hagiography, the brutally destructive work of an enemy, or a heavily embellished account based on scant information. Few writers would have consulted medical records; loose, generalised descriptions of health conditions quickly became accepted facts. Peter Shaffer's play ‘Amadeus’ is a masterpiece, but did Mozart really suffer so acutely from Tourette's syndrome? If Sibelius actually was a chronic alcoholic would he have lived to celebrate his 90th birthday?

    The number of surgeons and doctors found in amateur orchestras, string quartets and choral societies is raw proof of a close connection between medicine and music. The author, a renowned orthopaedic surgeon, has treated his subject matter as he would a patient coming for a consultation, considering all the information available to him. His treatment of seventy composers provides a series of fascinating and revealing stories. This opportunity to consider their health as a matter of fact, rather than ‘colour’ burnished by time will surely help us appreciate their lives more, and understand their music better.

  • 2 - A Triumphant Old Age

  • Noble Jonathan
  • Book:
    That Jealous Demon, My Wretched Health
    Published by:
    Boydell & Brewer
    Published online:
    05 September 2018
    Print publication:
    15 June 2018, pp 43-66

  • Summary

    Old age is the most unexpected of all things that happen to a man Leon Trotsky, Diary in Exile,1935

    We have seen both the pathos and the tragedy of young deaths, and yet there was an extraordinary body of work from that group and the eternal question as to what might have been had they lived longer. So what happened with those who survived beyond their seventh decade? Was it all autumnal contentment? But perhaps the key question is whether some may have just laid down their pens because they ran out of ideas and, if they did, were there underlying medical reasons for that or did they just reasonably retire? In relating health to composition, old age, not least today with its anxieties about senile degeneration, is an important condition to consider. It has become a clinical entity and takes people in diverse ways.

    Life levels all men; death reveals the eminent

    George Bernard Shaw, Man and Superman, 1903

    On Haydn's seventy-sixth birthday in 1808, Antonio Salieri conducted The Creation. In the audience was a former pupil, who tearfully came forward to embrace the equally lachrymose Haydn. That pupil was Beethoven. By 1808 Haydn was the doyen of composers, to whom Mozart, Beethoven and Schubert had variously paid their obsequies. His long career as Kapellmeister to the Princes Esterházy at Eszterháza, rather than his probably loveless marriage, was the bedrock of his security. His wife, Anna Maria, was barren, to his eternal sadness, as well as being unsympathetic to music, especially Haydn's, whose manuscripts she used to roll pastry upon. He may have fathered a child with his mistress, an Italian singer, Luigia Polzelli. The Swedish composer Johan Fredrik Berwald suggested that his unhappy marriage was why he composed so much. Haydn was not only a stable personality, but he was agreeable, pragmatic and with his wits about him.

    Like other allegedly triumphant old ages, Haydn's was less easy than popular supposition might have us believe. From 1803 until his death in 1809, Haydn composed almost nothing, and Neumayr believes he was ill for his last ten years.

  • 8 - Broken Hearts

  • Noble Jonathan
  • Book:
    That Jealous Demon, My Wretched Health
    Published by:
    Boydell & Brewer
    Published online:
    05 September 2018
    Print publication:
    15 June 2018, pp 219-256

  • Summary

    But his flaw'd heart

    Alack, too weak the conflict to support!

    William Shakespeare, King Lear, Act V scene iii, 1606

    Introduction

    The very phrase ‘broken hearts’ is a flexible expression for many sources of inner anguish, bereavement or disappointment, and it can also mean what it says. The heart is a mechanical pump, and pumps break. The ancients held that the heart was the seat of the soul, so a broken spirit became a broken heart. This distinction will be vital when we try to comprehend the last years of Gustav Mahler, but first let us consider the workings of this complex organ (see Fig. 3).

    The heart is made up of specialised muscle (myocardium). It is divided into two upper, low-pressure and thin-walled chambers (atria) and two lower, thick-walled and high-pressure chambers (ventricles). Huge veins bring stale blood back to the right side of the heart, which then pumps the blood through the lungs, where it is revitalised with oxygen, returning afresh to the left side. The oxygenated blood is then pumped, in systole, through the aorta, whose branches bring oxygen to all other parts of the body. If your blood pressure is 130/70 then the systolic pressure is 130 and the diastolic 70, which is a healthy reading.

    The heart is lined internally by a membrane (endocardium) and surrounded by a membranous sack (pericardium). During our embryonic development, parts of the endocardium specialise to form one-way valves between the chambers. For example, the aortic valve controls the exit from the left ventricle. Like any other big muscle the myocardium itself needs a good blood supply, and that is supplied by the coronary arteries. The heart is an electrically activated pump; accordingly a band of electrical conducting nerve tissue traverses the central septum within the heart. If it activates seventy systolic beats a minute, the pulse rate is seventy.

    So what can go wrong with these excellent arrangements? Th e answer is a lot, of which the following is a very simplifi ed summary.

  • 4 - Syphilis

  • Noble Jonathan
  • Book:
    That Jealous Demon, My Wretched Health
    Published by:
    Boydell & Brewer
    Published online:
    05 September 2018
    Print publication:
    15 June 2018, pp 97-124

  • Summary

    Beware the dreaded spirochaete

    Anon.

    Introduction

    The aphorism ‘Beware the dreaded spirochaete’ was wise. A spirochaete (Treponema pallidum) causes syphilis, an infection which may manifest itself in many forms. Sir Jonathan Hutchinson, the leading nineteenth- century specialist, described syphilis as ‘the great imitator’, hence the caution in judging case histories preceding the standard blood test. That test (the WR) was an antibody test introduced by Wassermann in 1905, immortalising his name. There can be both false positives and negatives. There are more recent blood tests (e.g. VDRL), which are beyond the scope of this book.

    Few diseases have been implicated more often with past composers, reflecting partly the overall incidence and ubiquity of the condition, but also the enthusiasm and sometimes carelessness with which it has been over-diagnosed retrospectively. The lists below show composers who were definitely syphilitic and those alleged by some to have possibly been so.

    Known Syphilitics

  • Schubert

  • Donizetti

  • Smetana

  • Delius

  • Wolf

  • Chabrier

    • Some Alleged Syphilitics

  • Vivaldi

  • Mozart

  • Beethoven

  • Schumann

  • Tchaikovsky

  • Duparc

  • Ravel

  • Sibelius

  • Gershwin

  • Britten

    • Syphilis is so important in musicology that a short digression into the history of this disease and its clinical pathology follows.

    A Short History of Syphilis

    A night in the arms of Venus leads to a lifetime on Mercury

    Anon.

    Traditionally, syphilis first appeared when the French army invaded Naples in 1494. This may explain its soubriquet, the French pox; it is known in France as the Italian pox. The age-old question is whether Columbus's expedition took the disease to the Americas or whether his crew brought it to Europe. Waivers described a physician in Barcelona, Dr Ruiz Diaz de Isla, who had seen Vincente Pinzon, the captain of Columbus's second ship, the Nina, avowing that he had syphilis, curiously a disease supposedly unrecognised previously in Europe. So how did he recognise it?

    Rothschild gives a definitive account of the history of syphilis. From a medical, archaeological and anthropological viewpoint, syphilis is easier than many other diseases to study retrospectively because it frequently affects the skeleton. Much is known about this disease from the Oslo study of patients with untreated syphilis over several decades. In 1999, the World Health Organization estimated there to be 12 million cases of syphilis worldwide.

  • 3 - Iatrogenic Afflictions

  • Noble Jonathan
  • Book:
    That Jealous Demon, My Wretched Health
    Published by:
    Boydell & Brewer
    Published online:
    05 September 2018
    Print publication:
    15 June 2018, pp 67-96

  • Summary

    First do not harm the patient

    Hippocrates, c.400BC

    The term ‘iatrogenic’, used of illness and/or death, simply means that they were hastened or caused by medical treatment. Sadly, the biographies of many composers are replete with the iatrogenic.

    Potion or Poison? Good Music and Bad Medicine

    The stark fact is that, until the era of aseptic surgery with anaesthesia, doctors did not really have much at their disposal with which to treat patients. These two advances came in the mid-nineteenth century, followed in the twentieth by intravenous fluids and antibiotics, as well as insulin, steroids and drugs to treat failure or irregularity of the heart rate and raised blood pressure. Then came chemotherapy and radiotherapy to treat cancer. Before the 1840s there were generally half a dozen or so treatments which became somewhat rigid blandishments for most and diverse conditions. Because those therapies applied initially usually failed, others would relentlessly follow. The sick composer was in many cases saved from worse medical remedies only by the felicitous intervention of nature, or by his professing scepticism regarding further medical torture with alternative practitioners. Of these ‘treatments’, the application of leeches and especially bleeding are probably the most notorious although, in fairness, there are today very occasional uses for both leeches and blood-letting. They are specific and beyond the scope of this book. Blood-letting achieved little apart from making patients anaemic, placing a great strain on the heart, which was sometimes the root of the problem originally. This was despite Harvey having explained the circulation in the seventeenth century.

    Poultices, often dirty, were applied to open wounds and sores, introducing further infection. Bed rest and mountain air were benign and, for the tuberculous patient (TB sufferer), removal from smog-bound, overcrowded and insanitary conurbations could be genuinely beneficial. One encounters with many case histories practitioners wedded to one particular treatment. Little wonder that Beethoven famously referred to ‘bumbling doctors and medical asses’, for many of them did literally continue regardless. In so doing, perversely, they generally encountered less opposition than did Semmelweis or Lister introducing asepsis, and Simpson pioneering anaesthesia.

Page 102 of 729