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Hair, Lead, Deafness: The Heart of the Matter

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ISHLT Links Editor-in-Chief
Professor, Pulmonary and Critical Care Medicine
Medical Director, UTMB Texas Transplant Center
Director, Lung Transplantation
University of Texas Medical Branch
Galveston, Texas, USA

For the month of December, let's give Mark Twain a break or rather let's take a break from Twain. But before I steer clear from him take note of his comments on the great artworks from the old masters. Despite his disdain for the arts, he did recognize the old creation of Da Vinci. "The colors are dimmed with age; ... nearly all expression is gone from them; the hair is a dead blur upon the wall, and there is no life in the eyes ... I am satisfied that the Last Supper was a very miracle of art once. But it was 300 years ago." He added, "... I am glad the old masters are all dead, and I only wish they had died sooner." One of his quotes on classical music is ... "I have never heard enough classical music to be able to enjoy it; and the simple truth is, I detest it. Not mildly, but with all my heart."

Now to the heart of the matter, last year in December and because of the carols of December, a brief treatise on music from Dvorak, the pride of Prague, representing Romanticism, Nationalism, and Exoticism (ISHLT Links 2011, Volume 3, Issue 7) was provided. And as stated last year, where there's music, there's Beethoven. Although regarded as a classicist, Beethoven more than any other composer epitomized the Early Romantic period of classical music. The blending of his intense passion, individualism and fearless self-expression is the central theme of the romantic spirit.

One cannot get very far thinking about Beethoven without thinking about his shaggy, ungainly and unkempt hair. Did Beethoven always have a bad hair day? Recently, eight strands of his hair have been identified to contain lead in concentrations 100 times higher than normal. So at least he had bad hair. Despite intermittent bouts of abdominal discomfort, irritability, depression and progressive deafness, he could not have had distal extensor palsies for he earned the reputation as a virtuoso pianist in Vienna, a city mad for pianists in the late 18th century. Maybe it was the lead that compelled him to create music expressing every kind of emotion, from passionate to tender, yet technically, it was never anything other than faultless.

Beethoven, a Rhinelander from Bonn, Germany, was born on December 17, 1770 into a lifetime of physical, emotional and spiritual struggle. He had a depressed mother and an abusive alcoholic father who futilely tried to beat him into becoming a child prodigy to rival Mozart. There is only one Mozart. His family struggles, poor health, progressive hearing loss, broken heart, destruction of his brother's remaining family and public ridicule all became catalysts to force him to look inward and reinvent himself many times, compelling him to constantly expand his style and ideas. For us, he created the bridge across the Classical and Romantic periods of music. He lived through the turmoil of the French Revolution and Napoleonic Wars. Thus his masterpieces of music sprang up not just for the church or the aristocracy, but for people everywhere. Although he based much of his music on Classical forms, he filled his compositions with a new sense of freedom and personal expression heralding the more emotional and poetic Romantic period. He influenced essentially every composer who came after him.

Ludwig should have thanked his father for his career, however he rejected him. With his unhappy childhood from abuse, Beethoven replaced his father with an "elevated" surrogate. He increasingly believed himself to be the illegitimate son of the King of Prussia, Frederick Wilhelm II or the great warrior-musician-king Frederick the Great. But it was Christian Gottlob Neefe who was Ludwig's music instructor, friend, mentor and surrogate responsible for Beethoven's explosive development. During his development, the organ and the music of Bach profoundly influenced Beethoven which can be noted in the march-like and straightforward arrangement Ludwig composed when he was merely 11, Nine variations in C minor on a March by Dressler, WoO63 (and it is no coincidence that the performer in this video is 11 years old as well). He composed many other works, and by 1785, he was clearly a budding virtuoso.

In 1792, Beethoven moved to Vienna, earned the reputation as an outstanding pianist and became the darling of the Austro-Hungarian Aristocracy. A self-taught pianist, he actually received more training as an organist than a piano player. Because of this, he developed an extraordinary and unconventional approach to the new "pianoforte." Just prior to his move from Bonn to Vienna, Ludwig had a grand breakthrough with intense composition. Among his sets of piano variations, ballet music, concert arias, chamber works for piano and winds and full-blown cantatas for vocal soloists, chorus, and orchestra, the extraordinary Funeral Cantata on the Death of Emperor Joseph II was written. By 1789 he had come of age. In Vienna, the Viennese found Beethoven to be a revelation and a disaster to the existing pianos of the time. Ludwig held his hands high and smashed every piano he touched looking for more volume, more resonance and more expressive power. He did outplay every pianist in Vienna at competitions. He conceived his fabulous piano sonatas in Vienna including one of the most popular and familiar melodies Beethoven ever wrote, Piano Sonata No. 8 in C Minor, Op. 13 commonly known as Sonata Pathétique (Mvt 1 Grave - Allegro di molto e con brio, Mvt 2 Adagio cantabile, and Mvt 3 Rondo: Allegro) and of course there is Piano Sonata No. 14 in C-sharp Minor, Op 27, No 2 (Moonlight Sonata).

It was in Vienna when Beethoven personally identified himself with Napoleon. Napoleon was a Florentine among Corsicans and a Corsican among the French. He was an outsider who achieved his accomplishments as a result of his own power and vision. Beethoven was a Rhinelander among the Viennese, hearing impaired among the hearing healthy and an angry man. By 1803, Paris was the capital of the "new Europe." Beethoven planned to move to Paris, where he thought he might be more at home than in Vienna. When Beethoven completed Symphony No 3, he almost named it "Major Bonaparte." However, he renamed it "Eroica." This title change was the result of Napoleon's declaration of himself as emperor, whereupon Beethoven was enraged that Napoleon was becoming a tyrant. Beethoven never moved to Paris, after Napoleon's attack on Austria in 1805. Beethoven, in keeping with his personality, came to regard Napoleon as an authoritative figure; he had a violent hatred towards authority. This third symphony is where Beethoven found his compositional voice of expressive temper with his deepest fears and hopes:

Symphony No. 3 in E flat major, Op. 55 "Eroica":

I. Allegro con brio
II. Marcia Funebre, Adagio assai
III. Scherzo, Allegro vivace
IV. Finale, Allegro molto

It is during this "Heroic" compositional period from 1803-1812 where Beethoven produced brilliant original masterworks including the 4th, 5th, 6th, 7th, and 8th Symphonies along with many concertis, concertos, string quartets, overtures, sonatas, songs, arias and the opera Fidelio. Here are links to Beethoven's 5th, including the ever popular 1st movement:

Symphony No. 5 in C Minor, Op. 67:

I. Allegro con brio
II. Andante con moto
III. Allegro
IV. Allegro

It was 200 years ago today minus one year in this month that Beethoven's 7th Symphony premiered to great acclaim and became so popular that it was inserted into other of his symphonies and later performed as a self-standing composition. Ludwig had become a hero of the Austrian nation, because he had co-written an arrangement celebrating Wellington's Victory over a Napoleonic army at the Battle of Vittoria in Spain, in 1813. The defeat of Napoleon at the Battle of Leipzig instigated patriotic fervor into the Austrians and as such two concerts in December 1813 were given in Vienna for the benefit of Austrian and Bavarian soldiers. This was where Beethoven took the opportunity to premiere his 7th Symphony alongside Wellington's Victory (Mvt I. Battle and Mvt II. Symphony of Triumph). Napoleon's reign of terror had ended.

Beethoven changed the expressive language of Western music, as musicologist Donald Grout wrote, "Beethoven was one of the great disruptive forces in the history of music. After him, nothing could ever be the same; he had opened the gateway to a new world." As his deafness progressed, Beethoven was able to find new forms of experience free from the external environment, free from the rigidities of the material world and free to combine and recombine reality and dreams into a variety of undreamed-of forms and structures.

In his final years of life, in spite of his stone cold deafness, Beethoven wrote his greatest, most profound, and most forward-looking works. The therapeutic benefit of writing music that would help lift him out of his funk was preferable to writing music that mirrored and, perhaps, intensified his unhappiness. His Symphony No. 9 became the single most influential piece of music composed in the 19th century just a few years before his death from cirrhosis. This piece gave precedence to the expressive needs and desires of the artist. His music was his refuge from his troubled life and ultimately his cure.

Symphony No. 9 in D minor, Op. 125:

I. Allegro ma non troppo, un poco maestoso
II. Molto vivace
III. Adagio molto e cantabile
IV. "Choral" (Finale)

Beethoven sacrificed life for music. His temper, his intensity and his passion, to get to the heart of the matter, are all palpable in all his music. Here lies the rub. The March by Dressler has as much to do with Dressler's Syndrome (other than perhaps the derivation of the name Dressler) as lead exposure leads to cirrhosis. On the other hand, the rhythmic sounds of mitral stenosis with an opening snap are undeniably detected in the first four notes of Beethoven's 5th as the triple rhythm of heart disease, the third heart sound, is in Beethoven's 9th, unless of course you are as auditorily challenged as Beethoven was.

Additional Beethoven music links:

Disclosure Statement: The author has no conflicts of interest to disclose.