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(Soundbite of Beethoven's Symphony No. 9)

SCOTT SIMON, host:

Later this month, the Baltimore Symphony Orchestra will try to resolve one of music's most enduring mysteries. Why did one of the great composers of all time go deaf? And what was the cause of his death? Ludwig van Beethoven was just 56 years old when he died. In addition to his hearing loss, he'd been in poor health for most of his life. Let's try and set up this investigation. You know, in the criminal justice system the people are represented by two separate yet equally important groups - the music director and conductor of the Baltimore Symphony Orchestra, Marin Alsop, who's here on our studios. Thanks for being with us.

Ms. MARIN ALSOP (Conductor): Great to be here. Thanks.

SIMON: And Dr. Charles Limb, from the department of - I can never pronounce this, Doctor, and I bet you can.

Dr. CHARLES LIMB (Johns Hopkins University Hospital): Otolaryngology.

SIMON: Otolaryngology - thank you very much - at Johns Hopkins University Hospital in Baltimore. You are leading researcher on deafness. And they're both here in the studio to give us a preview of "CSI Beethoven." Thanks very much, both of you, for being with us.

Dr. LIMB: Thank you for having us.

SIMON: The program opens with Beethoven's funeral in Vienna, 1827.

Ms. ALSOP: Right. So the idea here is that it's not enough anymore for me to just play the symphonies. I want to know, you know, Beethoven, and what was going on. So we're going to open at - a little bit like the film "Amadeus," you know, from the end and work our way back.

SIMON: What were the various theories that have, at the time, that have developed over the years as to why Beethoven was deaf, Dr. Limb?

Dr. LIMB: As to why he went deaf, a lot of theories have been proposed. Otosclerosis, which is an arthritis condition of the hearing bones, the ossicles, has been commonly stated to be one of the possible theories. Autoimmune sensory neural hearing loss has been another theory. The question of whether or not he had syphilis and that led to his hearing loss, much like the composer Smetana, is another theory. And I think there is enough evidence to discount those theories. We have autopsy reports. And we know that in that autopsy report he had evidence of inflammation of the lining of the brain and evidence of atrophy of the hearing nerves. And in those situations we do see an association with different forms of meningitis.

Ms. ALSOP: And we have - the lock of Beethoven's hair is actually even going to be present during our "CSI Beethoven."

SIMON: While you're performing?

Ms. ALSOP: Exactly. And we're going to review that and do some analyses and intersperse that with - we have the full orchestra there as well.

SIMON: Are you going to conduct with, you know, wearing white rubber examination gloves?

Ms. ALSOP: That's my hidden desire, as you know, Scott.

(Soundbite of laughter)

SIMON: And Dr. Limb, do you get to take the baton for a while?

Ms. ALSOP: Oh, I bet that's your hidden desire too, isn't it?

Dr. LIMB: If I get the chance, I'll grab it.

SIMON: Now, what was - at the time of his death, what was believed to be the cause of his death?

Dr. LIMB: I think it's pretty clear that when he died, he actually died from liver failure, or complications of liver failure. He had a massively swollen belly that was full of fluid. As part of his treatment he had fluid drawn off in a procedure known as parasitosis. And as part of that sterilization procedure, if you will, saponified lead salts were placed on his abdomen. And we think that that lead led to massive rises in his systemic lead concentration levels because his liver was not able to metabolize it, and he probably died from hepatic failure.

Ms. ALSOP: It's so interesting because even last year there was a new paper published about this concept that perhaps the cure actually was the cause of his death ultimately.

SIMON: In addition to the scientific interest, do you hear anything in Beethoven's music of what we might fairly project to be his suffering? His anguish?

Ms. ALSOP: Oh, without a doubt. I mean, Beethoven really plumbed the emotional extremes in his music. And he was able to push the envelope of classical music to limits really I think never before considered. When you hear a piece like the last movement of one of his later string quartets, which is called the Grosso Fugue, I mean it's so avant-garde and so traumatized and it's filled with strife and conflict.

(Soundbite of Grosso Fugue)

Ms. ALSOP: And yet you can hear another movement from one of these quartets, which he calls Cavatina, which is so intimate and so tender - you know, I mean they're just amazing extremes. And I think the interesting question from my perspective is whether his deafness actually resulted in a more extreme form of creativity. Since he couldn't really judge, you know, in the normal, everyday way by hearing what his compositions sounded like, maybe that compelled him to take more chances. Dr. Limb and I were just talking about that on the way over.

SIMON: Do you hear something in the music?

Dr. LIMB: I think it's impossible to extract or separate one's illness and well being from the music that an artist is creating. I mean, they really both have to do with the essential music condition - one's music and one's health. And so I think that one invariably will influence the other. In particular in the case of somebody like Beethoven, you have somebody who's prize possession is his hearing, and he realized early in his life that he was losing it. If you superimpose the timeline of his hearing loss with the timeline of his compositions, I think it's difficult to ignore that there's a relationship that, as he was losing his hearing, his compositions were getting more and more adventurous, if you will, more and more beautiful.

(Soundbite of music)

SIMON: You hear that too?

Ms. ALSOP: I do. And I think that he perhaps was hearing on a level that normal people can't hear. You know, it's almost an imagined, kind of heightened hearing because it's all in his head. Dr. Limb has even put together some examples of what his symphonies might have sounded liked to Beethoven as he begins to lose his hearing.

(Soundbite of Beethoven's Symphony No. 5)

Dr. LIMB: What I did in these sound clips was take period recordings from period instruments and then alter them using a projected audiogram that profiles Beethoven's hearing loss in a chronologically appropriate manner.

(Soundbite of Beethoven's Symphony No. 5)

SIMON: So what we're able to hear is his own symphony as he might have heard it.

Dr. LIMB: Perhaps. And I think that it's important to acknowledge that by the Ninth Symphony's premier, by all accounts he was completely, profoundly deaf and really did not hear any sound. And so any simulations of that are probably better than what he actually heard at the time.

(Soundbite of Beethoven's Symphony No. 9)

SIMON: Beethoven, I've read over the years, was - if I can put this kindly - famously anti-social. Can this be traced to the constant mental tension of not being able to hear, not being able to carry on a conversation?

Dr. LIMB: I think in part it can a great deal. Hearing loss is a very socially isolating condition to be in. Particularly for a musician, I think, it's extremely difficult to adapt to. Now, if you add on top of that the fact that he was a chronically ill man; he had a lot of symptoms that extended well beyond his hearing. He had chronic abdominal pain, chronic diarrhea. He was an unhealthy...

Ms. ALSOP: Miserable.

Dr. LIMB: ...gentleman, essentially.

Ms. ALSOP: Miserable state.

Dr. LIMB: Yeah.

Ms. ALSOP: And also I think - I'm really surprised that he managed to - and this is the thing that inspires me that most about Beethoven. He manages to hold on to the beauty of life through all of this.

Dr. LIMB: I think that's all the more remarkable, given that he likely had what would be today diagnosed as a clinical depression, and to overcome that, really, without medication - really through art speaks volumes.

SIMON: It did, but this raises a question. Is the art there because he wasn't treated?

Dr. LIMB: Obviously from a doctor/patient perspective, you'd always want your patient to be better and to be well and to be able to hear if that's what they wanted.

SIMON: He could have been treated today?

Dr. LIMB: He could have been medically treated. I don't know that it's possible that we would have diagnosed the cause of his hearing loss very accurately, because still today sometimes we can't figure why somebody is losing their hearing, but we can restore it with a cochlear implant. And today if Beethoven walked into my clinic, he'd wind up with a cochlear implant. From history's perspective, I for one am glad that Beethoven lived exactly the way he lived with his hearing loss and his illnesses, because in the end I believe that they were fundamentally related to what he produced.

Ms. ALSOP: I think so too. But I do think that Beethoven somehow managed - and perhaps it's because it was a very sustained and slow decline on every level, so perhaps he was able to somehow cope with things. He loved to take walks in nature. You listen to the Sixth Symphony, the Pastoral, and you realize that he's able to live in this life and outside of this of this life simultaneously.

(Soundbite of Beethoven's Symphony No. 6)

Ms. ALSOP: For me it's the fact that at the end of this - and in every single piece he writes - there's the ray of hope and the joy of life. And that's what I try to relate to, that we as human beings can somehow transcend this world of suffering that in many ways we've created for ourselves.

SIMON: Well, thank you both very much. February 27th, 28th is "CSI Beethoven," the Baltimore Symphony Orchestra. Conductor Marin Alsop, thank you very much.

Ms. ALSOP: Thank you.

SIMON: And Dr. Charles Limb, you'll be a witness for the - prosecution, defense, whatever - of Johns Hopkins University Hospital.

Dr. LIMB: Thank you very much.

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