I am told that a good doctor should listen carefully to the stories patients tell him. These stories of health and disease, of confronting pain and overcoming illness, and at times, of suffering and eventual demise are the usual narratives of life. Some patients, though, usually those who have earned a great deal of fame or notoriety, present narratives of life in which death is not the end of the story, but rather a turning point in a mystery. Such is the medical story of Ludwig Van Beethoven.

After the death of his mother, when he was 17, Beethoven began drinking alcohol to relieve the pain of his loss. Later, when he was thirty, he increased his wine consumption to stimulate his appetite and ease his abdominal pain. His physicians thought that he had an alcohol dependency problem but he was not accustomed to taking medical advice seriously. Housekeeping records confirm the purchase of large quantities of wine. Ludwig preferred wine from the heights around Buda, the capital of medieval Hungary, which lies on the wooded hills west of the Danube river (which separates Buda from Pest, the two parts of the current Hungarian capital, Budapest). His personal secretary, Anton Shindler, stated that Beethoven “was no judge of wine and could not tell the adulterated [wine] from the pure.” It is therefore, the theory goes, that Ludwig could not have known that his wine was tainted with lead, an additive that was illegally added at the time to improve the flavor of inexpensive wines.

Beethoven’s deafness was progressive. At age 30, in a letter to a friend, Pastor Amenda, he wrote: “know that my noblest faculty, my hearing, has greatly deteriorated.” By age 47, he could no longer hear his own music.

His music did not suffer from his deafness, but it was, experts say, affected by it. In an article in the British Medical Journal, Edoardo Saccenti, Age K Smilde, and Wim HM Saris, researchers from Netherlands, charted the relations between the composer’s deafness and his compositions. Analyzing Beethoven’s early, middle and late string quartets and correlating them with the three different periods in which they were written, coinciding with Beethoven’s onset of deafness, worsening of hearing impairment and the supposed total deafness, they found that possible relation between the progression of Beethoven’s deafness and the use of high notes in his music exists. The more deaf he became, the less he made use of notes above high G6.

At age 57, after a life afflicted by bad digestion and abdominal pain, irritability and depression, Beethoven finally died.

As I have mentioned before, Beethoven’s death, was not the end of Beethoven’s medical story. Here is what transpired: On Beethoven’s deathbed, on March 27, 1827, the great composer was visited by Dr. Ferdinand V. Hiller (a teenager at the time, who admired Beethoven and later became a composer himself). After the composer’s death, Ferdinand cut off a lock of hair from Beethoven’s corpse.

The lock of hair has changed several hands: From Hiller’s son to an unknown Jew. From a Danish doctor who received it in exchange for providing medical treatment for Jews trying to escape from the Nazis to a group of members of the American Beethoven’s Society and Dr. Alfredo Guevera, a urologist, like myself, who practices in Nogales, Arizona (it was bought by the group in 1994 at a Sotheby’s auction for 3600); Then, of the 582 strands of hair, 422 went to Ira F. Brilliant from the Center for Beethoven Studies and 160 were kept by Dr. Guevera who later on gave a few strands away to allow for scientific exploration. The rest, The Guevera Lock of Hair, was placed on permanent exhibit at the Beethoven’s center at the San Jose State University.

In a seemingly unrelated episode that occurred in the days following Beethoven’s death, Dr. Johann Wagner, Beethoven’s doctor, performed an autopsy on the body. He found shrunken liver and ascites (both may be consistent with excessive consumption of alcohol). He closely observed Beethoven’s cochlear nerves that “lacked pith” and his acoustic nerves that were “wrinkled.” In the process, fragments from the back of the skull were separated from the body. As in Beethoven’s hair story, the bone fragment must have changed several hands, for it re-surfaced many year later, when a California businessman, Paul Kaufman, who inherited the bone from his great-great uncle, an Austrian doctor, submitted it for DNA analysis that In two separate, elegant studies performed by the U.S. Department of Energy’s Argonne National Laboratory in 2000 and in 2005 (what better use for the taxpayers’ dollars), Beethoven’s bone and his hair showed markedly elevated lead levels consistent with chronic lead poisoning.

Was Beethoven’s deafness a result of lead poisoning? While some researchers are convinced by the high levels of lead in Beethoven’s hair, and in his parietal bone, others are not so sure. In a study of Andean children and adults with chronic lead intoxication, there was no hint of any harmful effect of lead on the cochlea and on hearing.

So while the story of Beethoven’s deafness continues to evolve (autoimmune disease, syphilis, alcohol from Buda and lead poisoning – my head is spinning) I must stop now, for I feel a sudden, irresistable urge to listen to Symphony No. 9, a composition written by a brilliant musician who lived in a world of silence.

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.