ONE of the most painful of human spectacles is an intellect dominated by a physical ailment, a mind capable of the wise and useful exercise, of its powers enthralled or checked in its peripheral expression by some imperfection in the machinery in the midst of which it has its temporary abiding-place.

The mental effects of bodily disease, in which the organs of special sense are concerned, have been nowhere more carefully noted than in the cases of those whose aptitude for some particular line of intellectual process has raised them above the average of their fellows, and the biographies of celebrated men seldom fail to record some instance of those ills to which flesh is heir and to make deductions therefrom as to its influence upon the life-work of the individual.

There is no more pathetic picture than that of Beethoven in his later years, at an age when he should have been in the perfection of his physical manhood, deaf to overwhelming applause or striking in tumultuous discord the piano which to him was dumb.

References to this deafness, which was to Beethoven such a calamity, have been carefully studied and recorded by his various biographers, and occur nowhere more graphically than in those remarkable letters which give, without the need even of reading between the lines, so clear an exposition of the man as he was, as he aspired, and as he suffered. There has been as yet however no attempt to collate this evidence with a view to making a precise diagnosis of his case or with reference to the possible influence which the infirmity may have had upon his disposition, his habit of thought or possibly even upon the character of his compositions.

"It is hard to arrive," says Grove, "at any certain conclusion on the nature and progress of Beethoven's deafness owing to the vagueness of the information; difficulty of hearing appears to have shown itself about 1798 in singing and buzzing in his ears, loss of power to distinguish words though he could hear the tones of voice, and great dislike to sudden loud noise; it was even then a subject of the greatest pain to his sensitive nature; like Byron with his club-foot he lived in morbid dread of his infirmity being observed, a temper which often kept him silent, and when a few years later he found himself unable to hear the pipe of a peasant playing at a short distance in the open air, it threw him into the deepest melancholy, and he wrote the well-known letter to his brother in 1802, which goes by the name of his Will." The above passage is really an epitomization of Beethoven's case, and, in connection with the collateral evidence and viewed in the light of our present knowledge of aural disease, plainly sets forth the progress as well as the character of his disorder, the exciting cause of which must ever remain a question, though the inference from the course of his disease, from the report of the post-mortem examination and from the evidence afforded by Dr. Bartolini, is at least permissible, that Beethoven's deafness originated, in part at least, in a constitutional disorder which may have been one of his inheritances from his father. Be that as it may, it is shown that he first became definitely aware of his infirmity when he was twenty-eight years of age, that his attention was first drawn to it and his appreciation of it subsequently heightened by the concomitant symptom of subjective noises in the ears, rushing and roaring sounds which he designates as "sausen" and "brausen"; this symptom, common to many forms of aural disease, occurs in such cases as that of Beethoven's only after the changes in the ear have already become well established, it marks a definite stage in the progress of the malady and is explainable as follows: the normal circulation of blood through the blood-vessels is productive of sound, precisely as is the flow of water or other fluid through pipes; these sounds vary in pitch and in intensity in proportion to the size of the blood vessels and the rapidity of flow of the circulating fluid; in the smaller blood-vessels such as are found in the immediate vicinity of the perceptive portion of the human ear the flow of the blood is continuous and not rhythmic in response to the impulse from the heart as is the case in the larger arteries; the sound resulting from the circulation in the smaller blood vessels of the ear is a high pitched singing ranging from a tone of about 15000 v.s. to one of 45000 v.s. while the sounds produced by the larger vessels are very much lower in pitch; these sounds are present in normal conditions, but are not noticed because the adjustment of the sound-transmitting portion of the human ear, the drum head, the chain of small bones and the adjacent parts is such that sounds of this class, within certain limits of intensity, may be transmitted directly outward and pass unnoticed; in the event, however, of structural changes which interfere with the mobility of this sound-transmitting apparatus, the circulation sounds are retained within the ear and become appreciable. This does not occur however in chronic progressive cases such as was Beethoven's until the disease, insidious in its onset, is already well advanced, so that while the first mention of the impairment of hearing and of the subjective noises is made in 1798, it is more than probable that the disease had been at that time several years in progress.

Taking these facts in connection with the other symptoms already mentioned, difficulty of distinguishing words and the dread of sudden loud noises, a definite clinical picture is presented which taken in its entirety permits the diagnosis of a chronic progressive thickening of the mucous membrane lining the cavity of the middle ear and of the passages leading therefrom to the throat.

For a better understanding of the case it is necessary to recall briefly the structure of that portion of the ear affected, namely, the drum membrane placed at the bottom of the outer canal of the ear to receive the sound waves transmitted through that passage and in turn to transmit them through the three small bones which form a chain of communication with the internal or perceptive portion of the ear; the drum membrane forming the boundary between the outer passages and the middle ear, the latter cavity communicating by means of the Eustachian tube with the upper part of the throat and being lined throughout with mucous membrane continuous with that in the latter cavity; in the middle ear this mucous membrane, very delicate and rich in blood vessels, not only lines the middle ear cavity but forms the inner coat of the drum-membrane and also covers the small bones, their articulations and attachments, one of these latter being a muscle, the tensor tympani, which by its contraction renders all the sound-transmitting apparatus more tense. It is easily appreciable that a gradual thickening of this mucous membrane would result in a progressive impairment of the sound-transmitting apparatus, with a corresponding decrease in its power of transmitting sound waves not only from without inward but from within outward. This interference would be first noticed in the transmission of such short sound waves of slight impulse as occur in instruments of high pitch or such as make up the qualitative overtones of the human voice and it was therefore at a comparatively early period in his disease that Beethoven failed to hear the distant sound of the flute, and of the shepherd singing, and to distinguish the difference in the more delicate modulations of the voices of his friends.

The distress induced by exposure to loud noises is also accounted for by the fact that the comparative rigidity of the sound transmitting apparatus deprived the deeper sensitive portion of the ear of the protection normally afforded it by the elastic structure capable of taking up and dispersing the excessive impulse and by the further fact that the contraction of the tensor tympani muscle, which contraction is an almost invariable accompaniment of certain chronic diseases of the middle ear, served to still further impair the mobility of the drum-head and ossicles.

Later and numerous references to his deafness scattered throughout his letters and recorded by his friends and associates all point, with one exception, to the steady, pitiless progress of a disease, at that time unamenable to treatment, which finally totally deprived him of the sense most important to the musician; the one exception in question is that recorded by Charles Neate as heard from Beethoven's own lips in 1815, and is to the effect that in a fit of anger Beethoven threw himself upon the floor, and on arising found himself practically deaf in his right ear. There was no explanation of this occurrence offered, but, taken in connection with the report of the autopsy, it is apparent that the sudden loss of hearing in the right ear was the result either of a form of apoplexy of the labyrinth such as occurs in connection with the more advanced stages of chronic catarrh of the middle ear, or was due to a peculiar affection of that portion of the internal ear devoted to sound perception and consequent upon constitutional disease.

Setting aside this incident, it may be noted that, while himself aware of the gradual increase of his deafness, it was not until eight years later, in 1806, that it became especially appreciable to others, after which time its increase was so rapid that it could no longer be kept secret; the degree of the disability varying with his general condition, but its progress being always downward, in 1815 it had so increased that he abandoned his proposed visit to England, and before his death the hearing had become so much affected that his playing ceased to charm, he would play so loudly at times as to break the strings or drown soft passages of the right hand by striking the keys accidentally with the left, while the hearing for his own voice even had become so imperfect that he spoke with unnatural loudness and deficient modulation.

The influence of this almost life-long malady upon his disposition cannot be estimated without taking into consideration the nervous strain which the impairment of so important a sense would induce in a person of Beethoven's temperament; to the mental effects of apprehension of future evil and the disappointments due to the futility of his efforts at obtaining relief must be added the purely physical consequences of the natural attempt at compensation which results in what may be denominated the fatigue of deafness. Normally we possess double the amount of hearing ordinarily required for the uses of life, and it is possible therefore to lose one half of the fullest amount of hearing without being appreciably affected by the loss. Ordinarily, therefore, our hearing-power is exercised without conscious exertion, but when this sense becomes impaired to a certain degree, an effort at hearing is necessary because of the loss of the sound of the more delicate qualitative overtones, such for instance as those which make the difference between the parts of speech most nearly resembling each other; to help out this deficiency the sight is called upon to watch the motion of the lips, and still later by a conscious effort those parts of a sentence which have been lost to hearing and have failed of detection by sight are mentally filled in from the context, three distinct brain processes being thus required to afford the information which came before unconsciously of effort.

That such a nervous strain was part of the infliction which Beethoven suffered, is shown by his increasing disinclination for social intercourse and a tendency to lead as he says a life of isolation from all men. "You cannot believe," writes his friend Stephan von Breuning, "what an indescribable impression the loss of hearing has made upon Beethoven; imagine the effect on his excitable temperament of feeling that he is unhappy, then comes reserve, mistrust often of his best friends, and general irresolution. Intercourse with him is a real exertion, as one can never throw off restraint."

Undoubtedly his deafness, with the consequent isolation from his fellows, had the effect of increasing the morbid peculiarities which were his inheritance, and of all his portraits extant there is none which so distinctly shows the face of the deaf man as that painted by his friend Maler, Vienna, 1812.

"Beethoven's deafness," says Goethe, "has not hurt so much his musical as his social nature."

Indeed it may be questioned if his musical nature were affected at all other than favorably by his infirmity. His art was greater than the man, or rather the man in his art was greater than himself; his deafness, even by shutting him within, seems to have increased his individuality, for, from the time of its absolute establishment onward his compositions grew in musical and intellectual value, and each generation finds in them something new to study and to appreciate. He wrote not for his time alone but for all time, and from what we can learn of his life and of the influence of his infirmity upon his character, we are glad to believe that through all the clouds which overcast his career Beethoven's transcendent genius shone supreme, superior to circumstance, and that the world is left none the poorer, possibly the richer, because of the misfortunes which, while they developed the peculiarities and intensified the faults of the individual, served but to enclose and protect the intellect too great to be bounded or controlled by the limitations of a saddened life.