Some people tell me that I should write what I know, others tell me I should write the stories they know. The other day, in a social gathering, Ms. Peterson, a music teacher, told me the she read my article about Beethoven, his music, and his deafness. She said that it was lead poisoning that caused Beethoven deafness. “You should write about it,” she said.

Not everyone agrees that Beethoven’s deafness was caused by lead poisoning. When CS Karmody and ES Bachor from Tuft University School of Medicine reviewed a large number of documents written by Beethoven’s contemporaries, they looked for a diagnosis that could explain not only Beethoven’s deafness but his other medical problems as well.

Karmody and Bachor noticed that as a teenager, Beethoven had abdominal symptoms suggestive of inflammatory bowel disease, an autoimmune disease in which the cells of the immune system attack the patient’s own body.

• In inflammatory bowel disease, the main victim of the autoimmune response is the intestine, but other organs are not always spared. Unprovoked, repeated attacks of the immune system on the bile ducts inside and outside the liver can cause severe inflammation and blocking of the delicate tubes draining the liver. Eventually, cirrhosis and failure of the liver ensues. The same autoimmune response can also cause sensory-neural hearing loss.

• Inflammatory bowel disease, the distinguished authors conclude, was the one common thread for Beethoven’s intestinal symptoms, his liver disease, his deafness, and his final demise. Was Beethoven’s deafness caused by an autoimmune disease?

Possibly, but unlikely, for the deafness associated with autoimmune disease progresses rapidly and is usually accompanied by vertigo. Beethoven’s deafness progressed over many years, and there is no indication that he ever had vertigo.

• A prescription for a mercurial compound written by one of Beethoven’s physicians, Dr. Bertolini, is often used in support for another theory regarding Beethoven’s deafness.

The ointment, known at the time as Volatile Salbe, was prescribed for the treatment of syphilis which was a common disease in Beethoven’s time, affecting about 15 percent of the earth’s population. Rumor has it that during a visit Beethoven paid to a prostitute, the composer contracted the thin, elongated, spiral bacteria we now call Treponema pallidum.

• Deafness did not ensue immediately, for the disease follows a predicted, protracted course and progresses by stages: About three weeks after the alleged, unfortunate sexual encounter, Beethoven could have developed a painless, firm skin ulcer on his genitalia. Weeks later, a diffuse rash might have appeared on his trunk and on the palms of his hands and feet. The rash would be followed by a peaceful period of several years in which the composer had no symptoms at all.

The disease could have then resurged with vengeance, affecting Beethoven’s nervous system and leading, in its most severe form, called general paresis of the insane, to mental deterioration, personality changes and asocial behavior, depression and at times euphoria, unexplained self-love, megalomania, and delusion of grandeur.

It is in this last stage of syphilis, the theory goes, that Beethoven became deaf.

• Did Beethoven contract syphilis? Was syphilis the cause of his deafness? The evidence against the syphilis theory is strong: None of Beethoven’s physicians, all renowned and well versed in their contemporary medicine, ever mentioned syphilis. His deafness occurred at too young of an age to be caused by advanced syphilis, and although his behavior was strange at times, he did not have delusions of grandeur.

• It is not only the weakness of evidence that makes me question the syphilis theory, but rather my romantic idealism of Beethoven. I refuse to believe rumors of prostitutes, Treponemas, general paresis and insanity. I embrace a romantic Beethoven: lonely, depressed, longing, writing a sonata under the moonlight, dedicating a composition for a mysterious loved one, Fur Elise.

• I have yet to tell you the story Ms. Peterson knows about Beethoven’s deafness. It involves wine, a lot of it, lead poisoning, a lock of hair, and a bone taken from the great composer’s skull.

• Curious? I shall return with the story, in two short weeks.

Editor’s note: Dr. Shahar Madjar is a urologist working in several locations in the Upper Peninsula. Contact him at smadjar@yahoo.com or at DrMadjar.com.