Beethoven’s Triad: Diarrhoea, Deafness and Cirrhosis
- 1. SA Pathology at Flinders Medical Centre, Bedford Park, South Australia, Australia
CITATION
Allen PW (2022) Beethoven’s Triad: Diarrhoea, Deafness and Cirrhosis. Ann Otolaryngol Rhinol 9(5): 1299.
INTRODUCTION
Beethoven suffered from chronic relapsing diarrhoea from his early twenties and in his early thirties, from progressive deafness, which his late eighteenth-century doctors believed was related to his diarrhoea. He died from cirrhosis of the liver aged 57 in 1820. The multiple diagnoses suggested since he died have included lead poisoning, alcoholic cirrhosis, viral hepatitis, inflammatory eye disease, rheumatism, inflammatory bowel disease, Paget’s disease of bone, Cogan’s syndrome, systemic lupus erythematosus, otosclerosis, chronic pancreatitis, tuberculosis, sarcoidosis, Whipple’s disease, renal papillary necrosis and syphilis. Beethoven described his various illnesses in his letters, which have been translated into English by Emily Anderson (Figure 1)
Figure 1: Photograph of the dust cover of volume 1 of Emily Anderson’s English translation of Beethoven’s collected letters.
[1]. Details of his contemporaries’ observations are recorded in Thayer’s monumental Life of Beethoven [2].
No one had postulated that a single disease could explain the triad of diarrhoea, deafness and cirrhosis until 2005, when Karmody and Bachor suggested that Beethoven suffered from chronic inflammatory bowel disease and its sequelae [3]. It is now known that ulcerative colitis may be complicated by sensorineural deafness and sclerosing cholangitis which progresses to cirrhosis, liver failure and death. These apparently diverse diseases are now believed to share an autoimmune pathogenesis. This explanation neatly joins together Beethoven’s triad of diarrhoea, deafness and cirrhosis. Despite what seems to me to be a strong case [4], Karmody and Bachor’s hypothesis has received virtually no other support. This short communication is intended to draw attention to Karmody and Bachor’s paper and to elicit the views of 21st Century otorhinolaryngologists.
REFERENCES
1. Anderson E. The letters of Beethoven collected, translated and edited with an introduction, appendices, notes and indices in three volumes. Macmillan, 1961.
2. Thayer A. Life of Beethoven revised by Elliot Forbes, Ian Curties, Ed. Folio Society, 2001.